正念可能是与 OSAHS 患者 CPAP 依从性相关的一个新因素。

Mindfulness may be a novel factor associated with CPAP adherence in OSAHS patients.

机构信息

Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, China.

Department of Geriatrics, The Second Xiangya Hospital of Central South University, Middle Ren-Min Road No. 139, Changsha, Hunan, 410011, People's Republic of China.

出版信息

Sleep Breath. 2020 Mar;24(1):183-190. doi: 10.1007/s11325-019-01858-8. Epub 2019 May 8.

DOI:10.1007/s11325-019-01858-8

PMID:31069649

Abstract

BACKGROUND

Poor adherence to continuous positive airway pressure (CPAP) remains the greatest obstacle to effective treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). The purpose of the present study was to identify if mindfulness is associated with CPAP adherence of OSAHS patients.

METHODS

Newly diagnosed patients with OSAHS completed questionnaires including the Epworth Sleepiness Scale (ESS), the Mindful Attention Awareness Scale (MAAS), and the Hospital Anxiety and Depression Scale (HADS) and had experienced an overnight CPAP titration. Participants returned to the sleep center for a scheduled research visit after 30-day CPAP treatment at home. Demographics, disease severity, and device-related variables were collected. Multiple linear regression analysis was performed to build a multivariate predictive model for the outcome variable, mean daily CPAP use over 30 days.

RESULTS

Mean CPAP use was 4.7 ± 2.4 h/night for the study sample of 100 patients and 67% were classified as CPAP adherent. MAAS scale was 45.2 ± 18.8, whereas only 13% of patients expressed anxiety or depression. MAAS scales were significantly higher in the CPAP adherent group compared to the non-adherent group (49.5 ± 14.5 vs 40.8 ± 14.2, p < 0.001) with mean hours of daily CPAP use over 30 days for the adherent group (5.7 ± 1.4 h/night) compared to the non-adherence group (3.0 ± 1.7 h/night). There were differences between the two groups in HADS depression, AHI, lowest SaO, optimal CPAP pressure, residual AHI, mean days over 30 days, and mean daily CPAP use in the first week. Univariate analyses identified an unadjusted association between mean daily CPAP use over 30 days and HADS depression, MAAS, AHI, lowest SaO, optimal pressure, and mean daily CPAP use in the first week. Multiple linear regression analysis demonstrated only MAAS and AHI were associated (p < 0.05) with mean daily CPAP use. MAAS and AHI uniquely explained 10.1% (p < 0.001) and 8.7% (p < 0.001) of mean daily CPAP use respectively.

CONCLUSIONS

This study found a significant independent association of dispositional mindfulness with CPAP adherence. As a novel factor, mindfulness may play an important role in CPAP adherence.

摘要

背景

持续气道正压通气（CPAP）治疗依从性差仍然是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）有效治疗的最大障碍。本研究旨在确定正念是否与 OSAHS 患者的 CPAP 依从性相关。

方法

新诊断的 OSAHS 患者完成了包括 Epworth 嗜睡量表（ESS）、正念注意觉察量表（MAAS）和医院焦虑抑郁量表（HADS）在内的问卷，并进行了一夜 CPAP 滴定。在接受 30 天家庭 CPAP 治疗后，参与者返回睡眠中心进行预定的研究访问。收集人口统计学、疾病严重程度和设备相关变量。进行多元线性回归分析，建立以 30 天内平均每日 CPAP 使用量为因变量的多变量预测模型。

结果

研究样本中 100 例患者的平均 CPAP 使用量为 4.7±2.4 小时/夜，67%的患者被归类为 CPAP 依从者。MAAS 量表为 45.2±18.8，而只有 13%的患者表示焦虑或抑郁。CPAP 依从组的 MAAS 量表显著高于非依从组（49.5±14.5 比 40.8±14.2，p<0.001），CPAP 依从组 30 天内的平均每日 CPAP 使用量（5.7±1.4 小时/夜）高于非依从组（3.0±1.7 小时/夜）。在 HADS 抑郁、AHI、最低 SaO、最佳 CPAP 压力、残余 AHI、30 天内平均天数和第一周平均每日 CPAP 使用方面，两组存在差异。单变量分析确定了 30 天内平均每日 CPAP 使用量与 HADS 抑郁、MAAS、AHI、最低 SaO、最佳压力和第一周平均每日 CPAP 使用量之间存在未调整的关联。多元线性回归分析表明，只有 MAAS 和 AHI 与平均每日 CPAP 使用量相关（p<0.05）。MAAS 和 AHI 分别独立解释了 10.1%（p<0.001）和 8.7%（p<0.001）的平均每日 CPAP 使用量。