Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany.
Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
BMC Pulm Med. 2018 Dec 5;18(1):186. doi: 10.1186/s12890-018-0748-8.
There is a lack of robust data about factors predicting continuation (or termination) of positive airway pressure therapy (PAP) for sleep apnea. This analysis of big data from a German homecare provider describes patients treated with PAP, analyzes the therapy termination rate over the first year, and investigates predictive factors for therapy termination.
Data from a German homecare service provider were analyzed retrospectively. Patients who had started their first PAP therapy between September 2009 and April 2014 were eligible. Patient demographics, therapy start date, and the date of and reason for therapy termination were obtained. At 1 year, patients were classified as having compliance-related therapy termination or remaining on therapy. These groups were compared, and significant predictors of therapy termination determined.
Of 98,329 patients included in the analysis, 11,702 (12%) terminated PAP therapy within the first year (after mean 171 ± 91 days). There was a U-shaped relationship between therapy termination and age; therapy termination was higher in the youngest (< 30 years, 15.5%) and oldest (≥ 80 years, 19.8%) patients, and lower in those aged 50-59 years (9.9%). Therapy termination was significantly more likely in females versus males (hazard ratio 1.48, 95% confidence interval 1.42-1.54), in those with public versus private insurance (1.75, 1.64-1.86) and in patients whose first device was automatically adjusting or fixed-level continuous positive airway pressure versus bilevel or adaptive servo-ventilation (1.28, 1.2-1.38).
This analysis of the largest dataset investigating PAP therapy termination identified a number of predictive factors. These can help health care providers chose the most appropriate PAP modality, identify specific patient phenotypes at higher risk of stopping PAP and target interventions to support ongoing therapy to these groups, as well as allow them to develop a risk stratification tool.
目前缺乏关于预测睡眠呼吸暂停患者持续（或终止）使用气道正压通气治疗（PAP）的因素的可靠数据。这项来自德国家庭护理服务提供商的大数据分析描述了接受 PAP 治疗的患者，分析了第一年的治疗终止率，并研究了治疗终止的预测因素。
对德国家庭护理服务提供商的数据进行回顾性分析。符合条件的患者为 2009 年 9 月至 2014 年 4 月期间开始首次 PAP 治疗的患者。获得了患者人口统计学、治疗开始日期以及治疗开始日期和终止日期和原因。在 1 年时，将患者分为与依从性相关的治疗终止或继续治疗的患者。对这两组进行了比较，并确定了治疗终止的显著预测因素。
在纳入分析的 98329 名患者中，11702 名（12%）在第一年（平均 171±91 天后）内终止了 PAP 治疗。治疗终止与年龄呈 U 型关系；年龄最小（<30 岁，15.5%）和最大（≥80 岁，19.8%）的患者，以及 50-59 岁的患者（9.9%）的治疗终止率更高。与男性相比，女性终止治疗的可能性显著更高（风险比 1.48，95%置信区间 1.42-1.54），与私人保险相比，公共保险的可能性更高（1.75，1.64-1.86），与首次使用自动调节或固定水平持续气道正压通气的设备相比，使用双水平或适应性伺服通气的设备的可能性更高（1.28，1.2-1.38）。
这项针对最大数据集的 PAP 治疗终止分析确定了一些预测因素。这些因素可以帮助医疗保健提供者选择最合适的 PAP 方式，确定停止 PAP 治疗风险较高的特定患者表型，并针对这些人群进行干预以支持持续治疗，同时还可以帮助他们开发风险分层工具。
