Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, 13000 Bruce B. Downs Blvd. (116-B), FL, 33612, USA; Dept. of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave Tampa, FL, 33613, USA; Dept. of Psychology, University of South Florida, 4202 East Fowler Ave, PCD4118G, Tampa, FL, 33620, USA; Defense and Veterans Brain Injury Center (DVBIC), James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Blvd. (117), FL, 33612, USA.
Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, 13000 Bruce B. Downs Blvd. (116-B), FL, 33612, USA.
Sleep Med. 2020 May;69:159-167. doi: 10.1016/j.sleep.2020.01.016. Epub 2020 Jan 25.
The purpose of this study was to describe incidence and assess predictors of adherence to Positive Airway Pressure (PAP) therapy for Obstructive Sleep Apnea (OSA) in persons with acquired brain injury (ABI).
A 2012-2015 retrospective analysis of consecutive ABI patients admitted for neurorehabilitation, referred for polysomnography (PSG), and prescribed PAP for OSA. Univariable linear regressions were conducted to examine predictors of average hours of nightly PAP use. Univariable logistic regressions were conducted to examine predictors of PAP adherence using the conventional clinical definition of ≥4 h per night ≥70% of the time. Persons with traumatic etiology were separately analyzed.
ABI etiology was 51% traumatic, 36% stroke, and 13% other nontraumatic causes. Nearly two-thirds were nonadherent to PAP. For the overall sample, higher average nightly PAP usage was significantly predicted by positive hypertension diagnosis (β = 0.271, p = 0.019). Likewise, greater adherence based on the conventional cutoff was predicted by poorer motor functioning at hospital admission (OR = 0.98, p = 0.001) and lower oxygen saturation nadir (OR = 0.99, p = 0.003). For those with traumatic injuries, greater adherence was predicted by poorer functional status at hospital admission (OR = 0.98, p = 0.010) and positive hypertension diagnosis (OR = 0.16, p = 0.023).
In this study of hospitalized neurorehabilitation patients with ABI and comorbid OSA, predictors of adherence included lower oxygen saturation, poorer functional status and hypertension diagnosis, perhaps signifying the role of greater severity of illness on treatment adherence. High rates of refusal and nonadherence to frontline PAP therapy for sleep apnea is a concern for persons in recovery form ABI who are at a time of critical neural repair.
本研究旨在描述获得性脑损伤（ABI）患者接受正压通气（PAP）治疗阻塞性睡眠呼吸暂停（OSA）的依从性的发生率，并评估其预测因素。
对 2012 年至 2015 年连续收治的神经康复患者进行回顾性分析，这些患者因 OSA 接受多导睡眠图（PSG）检查并接受 PAP 治疗。采用单变量线性回归分析评估夜间平均 PAP 使用时间的预测因素。采用传统临床定义的每晚≥4 小时且≥70%时间的 PAP 依从性的单变量逻辑回归分析评估 PAP 依从性的预测因素。分别分析创伤性病因患者。
ABI 的病因分别为 51%的创伤性病因、36%的中风和 13%的其他非创伤性病因。近三分之二的患者对 PAP 治疗不依从。对于总体样本，高血压阳性诊断（β=0.271，p=0.019）显著预测了平均夜间 PAP 使用量更高。同样，基于传统切点的更大依从性也可预测入院时运动功能较差（OR=0.98，p=0.001）和氧饱和度最低值较低（OR=0.99，p=0.003）。对于创伤性损伤患者，入院时功能状态较差（OR=0.98，p=0.010）和高血压阳性诊断（OR=0.16，p=0.023）预测了更大的依从性。
在这项对住院神经康复 ABI 合并 OSA 患者的研究中，依从性的预测因素包括较低的氧饱和度、较差的功能状态和高血压诊断，这可能表明疾病严重程度对治疗依从性的影响更大。在接受神经修复治疗的 ABI 患者中，拒绝和不依从一线 PAP 治疗睡眠呼吸暂停的比例较高，这令人担忧。
