Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain.
Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, Sevilla, Spain.
J Sleep Res. 2019 Oct;28(5):e12805. doi: 10.1111/jsr.12805. Epub 2019 Jan 2.
Although adequate adherence is paramount in achieving the beneficial effects of continuous positive airway pressure therapy in patients with obstructive sleep apnea, long-term adherence and the variables involved in continuous positive airway pressure compliance in patients with resistant hypertension and obstructive sleep apnea are yet unknown. We conducted a prospective, multicentre, observational study in 177 patients recruited from hypertensive units with resistant hypertension confirmed by means of 24-hr blood pressure monitoring (blood pressure ≥ 130 and/or ≥ 80 mmHg, despite taking at least three antihypertensive drugs or < 130/80 mmHg with > 3 drugs) and obstructive sleep apnea (apnea-hypopnea index ≥ 5 in a respiratory polygraph) who were prescribed continuous positive airway pressure treatment. Good adherence was defined as an average cumulative continuous positive airway pressure use of ≥ 4 hr per night at the end of the follow-up. A multivariate Cox regression analysis was performed to identify independent predictors of continuous positive airway pressure adherence. Patients were followed for a median of 57.6 (42-72) months after initiating continuous positive airway pressure therapy. At the end of the follow-up, the median continuous positive airway pressure use was 5.7 (inter-quartile range 3.9-6.6) hr per night, and 132 patients (74.5%) showed good continuous positive airway pressure adherence. The only baseline variable associated with poor adherence was the presence of previous stroke (hazard ratio 4.00, 95% confidence interval 1.92-8.31). Adequate adherence at 1 month also predicted good adherence at the end of the follow-up (hazard ratio 14.4, 95% confidence interval 4.94-56). Both variables also predicted adherence at a threshold of 6 hr per night. Our results show that good continuous positive airway pressure adherence is an achievable and feasible goal in patients with resistant hypertension and obstructive sleep apnea. Previous stroke and short-term adherence predicted long-term adherence.
尽管在阻塞性睡眠呼吸暂停患者中实现持续气道正压通气治疗的有益效果至关重要，但长期的依从性以及与难治性高血压和阻塞性睡眠呼吸暂停患者的持续气道正压通气依从性相关的变量尚不清楚。我们对 177 名患者进行了一项前瞻性、多中心、观察性研究，这些患者来自高血压单位，其难治性高血压通过 24 小时血压监测（血压≥130 和/或≥80mmHg，尽管服用了至少三种降压药，或<130/80mmHg 时用了>3 种药物）和阻塞性睡眠呼吸暂停（呼吸多导图上的呼吸暂停-低通气指数≥5）得到了确认，他们被处方了持续气道正压通气治疗。良好的依从性定义为在随访结束时平均累计使用持续气道正压通气治疗≥4 小时/夜。进行了多变量 Cox 回归分析以确定持续气道正压通气依从性的独立预测因素。患者在开始持续气道正压通气治疗后中位随访 57.6（42-72）个月。在随访结束时，中位持续气道正压通气使用时间为每晚 5.7（四分位距 3.9-6.6）小时，132 名患者（74.5%）表现出良好的持续气道正压通气依从性。唯一与依从性差相关的基线变量是既往卒中（风险比 4.00，95%置信区间 1.92-8.31）。1 个月时的充分依从性也预测了随访结束时的良好依从性（风险比 14.4，95%置信区间 4.94-56）。这两个变量也预测了 6 小时/夜的阈值依从性。我们的结果表明，在难治性高血压和阻塞性睡眠呼吸暂停患者中，良好的持续气道正压通气依从性是一个可以实现和可行的目标。既往卒中和短期依从性预测了长期依从性。
