Inoue Akiko, Chiba Shintaro, Matsuura Kentaro, Osafune Hiroshi, Capasso Robson, Wada Kota
Department of Otorhinolaryngology, Toho University Graduate School of Medicine, Japan; Department of Otorhinolaryngology, Toho University Omori Medical Center, Japan; Ota Memorial Sleep Center, Ota General Hospital, Japan.
Ota Memorial Sleep Center, Ota General Hospital, Japan.
Auris Nasus Larynx. 2019 Aug;46(4):548-558. doi: 10.1016/j.anl.2018.11.006. Epub 2018 Dec 8.
Continuous positive airway pressure (CPAP) is the mainstay therapy for patients with obstructive sleep apnea (OSA) however compliance with CPAP is variable. Nasal ailments, such as nasal congestion are frequently mentioned as a cause for CPAP non-compliance, and potentially could be addressed prior to CPAP initiation, however, no specific criteria or recommendations for the evaluation and management of these patients exist. The aim of this retrospective study is to evaluate the effects of nasal anatomic features and disease on adherence to CPAP therapy for patients with OSA and determine the indications for pre-CPAP nasal treatment by using data obtained at clinical examination.
In total, 711 adult patients with initial diagnosis of OSA and an apnea-hypopnea index of ≥20 who were amenable to CPAP were included. We analyzed nasal parameters, past history of nasal disease, subjective symptoms, and disease severity in addition to whether CPAP therapy had been initiated, rate of CPAP therapy use (initial and 1year), treatment continuation rate at 2 months and 1year, and nasal treatments for all patients.
CPAP therapy was initiated in 543 of 711 patients. Nasal resistance was significantly higher in patients who discontinued therapy soon after CPAP initiation. Nasal disease and nasal parameters were not found to be predictors of treatment adherence at 1year. Allergic rhinitis, moderate to severe nasal congestion at bedtime, slight or extensive sinus opacification, and a high nasal septum deviation score were found to be independent predictors of nasal treatment, while strong awareness of nasal congestion, a past history of sinusitis, and a total nasal resistance (supine position) of ≥0.35Pa/cm/s were independent predictors of surgical treatment.
Long-term CPAP therapy adherence in patients with OSA can be predicted from initial CPAP adherence. Nasal disease and nasal parameters are important factors for early CPAP therapy discontinuation and should be adequately treated before therapy initiation to ensure long-term adherence. Indications for pre-CPAP nasal treatment and nasal surgery for patients with OSA can be predicted from the data obtained at the first examination, and these patients should be treated differently from those without OSA.
持续气道正压通气（CPAP）是阻塞性睡眠呼吸暂停（OSA）患者的主要治疗方法，然而CPAP的依从性存在差异。鼻病，如鼻充血，常被提及是CPAP不依从的原因，并且在开始CPAP治疗之前可能可以解决，然而，对于这些患者的评估和管理不存在具体标准或建议。这项回顾性研究的目的是通过使用临床检查获得的数据，评估鼻解剖特征和疾病对OSA患者CPAP治疗依从性的影响，并确定CPAP治疗前鼻腔治疗的指征。
总共纳入了711例初步诊断为OSA且呼吸暂停低通气指数≥20且适合CPAP治疗的成年患者。我们分析了鼻参数、既往鼻病病史、主观症状和疾病严重程度，此外还分析了是否开始CPAP治疗、CPAP治疗使用率（初始和1年）、2个月和1年时的治疗持续率以及所有患者的鼻腔治疗情况。
711例患者中有543例开始了CPAP治疗。在CPAP治疗开始后不久停止治疗的患者中，鼻阻力明显更高。未发现鼻病和鼻参数是1年治疗依从性的预测因素。变应性鼻炎、睡前中度至重度鼻充血、轻度或广泛的鼻窦混浊以及高鼻中隔偏曲评分被发现是鼻腔治疗的独立预测因素，而对鼻充血的强烈意识、鼻窦炎既往史以及总鼻阻力（仰卧位）≥0.35Pa/cm/s是手术治疗的独立预测因素。
OSA患者长期CPAP治疗依从性可从初始CPAP依从性预测。鼻病和鼻参数是早期停止CPAP治疗的重要因素，应在治疗开始前进行充分治疗以确保长期依从性。OSA患者CPAP治疗前鼻腔治疗和鼻腔手术的指征可根据首次检查获得的数据预测，并且这些患者应与无OSA的患者区别对待。
