自适应伺服通气治疗对中枢性睡眠呼吸暂停患者的医疗利用和死亡率的影响：一项基于人群的研究。

Effects of Adaptive Servoventilation Therapy for Central Sleep Apnea on Health Care Utilization and Mortality: A Population-Based Study.

机构信息

Center for Sleep Medicine, Mayo Clinic, Minnesota.

Department of Psychiatry and Psychology, Mayo Clinic, Minnesota.

出版信息

J Clin Sleep Med. 2019 Jan 15;15(1):119-128. doi: 10.5664/jcsm.7584.

DOI:10.5664/jcsm.7584

PMID:30621843

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6329537/

Abstract

STUDY OBJECTIVES

Adaptive servoventilation (ASV) is the suggested treatment for many forms of central sleep apnea (CSA). We aimed to evaluate the impact of treating CSA with ASV on health care utilization.

METHODS

In this population-based study using the Rochester Epidemiology Project database, we identified patients over a 9-year period who were diagnosed with CSA (n = 1,237), commenced ASV therapy, and had ≥ 1 month of clinical data before and after ASV initiation. The rates of hospitalizations, emergency department visits (EDV), outpatient visits (OPV) and medications prescribed per year (mean ± standard deviation) in the 2 years pre-ASV and post-ASV initiation were compared.

RESULTS

We found 309 patients (68.0 ± 14.6 years, 80.3% male, apnea-hypopnea index 41.6 ± 26.5 events/h, 78% with cardiovascular comorbidities, 34% with heart failure) who met inclusion criteria; 65% used ASV ≥ 4 h/night on ≥ 70% nights in their first month. The overall 2-year mortality rate was 9.4% and CSA secondary to cardiac cause was a significant risk factor for mortality (hazard ratio 1.81, 95% CI 1.09-3.01, = .02). Comparing pre-ASV and post-ASV initiation, there was no change in the rate of hospitalization (0.72 ± 1.63 versus 0.79 ± 1.44, = .46), EDV (1.19 ± 2.18 versus 1.26 ± 2.08, = .54), OPV (31.59 ± 112.42 versus 13.60 ± 17.36, = .22), or number of prescribed medications (6.68 ± 2.0 versus 5.31 ± 5.86, = .06). No differences in these outcomes emerged after accounting for adherence to ASV, CSA subtype and comorbidities via multiple regression analysis (all > .05).

CONCLUSIONS

Our cohort of patients with CSA was quite ill and the use of ASV was not associated with a change in health care utilization.

摘要

研究目的

适应性伺服通气（ASV）是治疗多种中枢性睡眠呼吸暂停（CSA）的首选方法。本研究旨在评估使用 ASV 治疗 CSA 对医疗保健利用的影响。

方法

本研究使用罗切斯特流行病学项目数据库进行了一项基于人群的研究，纳入了在 9 年内被诊断为 CSA（n=1237）并开始接受 ASV 治疗且在 ASV 治疗前后有≥1 个月临床数据的患者。比较了在 ASV 治疗前 2 年和治疗后 2 年内每年的住院率、急诊就诊率（EDV）、门诊就诊率（OPV）和处方药物种类（平均值±标准差）。

结果

共纳入 309 名患者（68.0±14.6 岁，80.3%为男性，呼吸暂停低通气指数 41.6±26.5 次/小时，78%合并心血管合并症，34%合并心力衰竭）；其中 65%的患者在第一个月内至少有 70%的夜晚使用 ASV 治疗≥4 小时/晚。总的 2 年死亡率为 9.4%，CSA 继发于心脏原因是死亡的显著危险因素（风险比 1.81，95%置信区间 1.09-3.01， =.02）。与 ASV 治疗前相比，治疗后住院率（0.72±1.63 与 0.79±1.44， =.46）、EDV（1.19±2.18 与 1.26±2.08， =.54）、OPV（31.59±112.42 与 13.60±17.36， =.22）或处方药物种类（6.68±2.0 与 5.31±5.86， =.06）均无变化。通过多元回归分析（均 >.05）考虑到对 ASV 的依从性、CSA 亚型和合并症后，这些结果也没有差异。