Aalaei Shokoufeh, Rezaeitalab Fariborz, Tabesh Hamed, Amini Mahnaz, Afsharisaleh Lahya, Mostafavi Sayyed Mostafa, Asadpour Hadi, Eslami Saeid
Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Med Sci. 2020 May;45(3):170-178. doi: 10.30476/ijms.2019.45785.
Continuous positive airway pressure (CPAP) is the gold standard therapy for treating obstructive sleep apnea (OSA) disorder. However, patients' adherence to its regular use is poor. The present study aimed to determine the adherence rate to CPAP therapy by identifying factors affecting its regular use and its associated problems and discomforts among a sample population in Mashhad (Iran).
The study was conducted from October 2017 to March 2018 in Mashhad (Iran) using both quantitative and qualitative methods. The quantitative study was carried out using a retrospective cross-sectional data collection from five sleep clinics and one CPAP sales office. The patients were classified into an adherent and a non-adherent group to determine the factors affecting CPAP adherence. Quantitative data were analyzed using SPSS software (version 22.0). Additionally, a prospective qualitative study was performed through a series of telephone interviews using the content analysis method. Qualitative data were analyzed using MAXQDA 10 software.
In the quantitative study, the medical records of 159 patients were used, out of which 79 (49.6%) were non-adherent to CPAP therapy. The mean age of all patients was 56.9±9.8 years. The mean body mass index, apnea-hypopnea index, and Epworth sleepiness scale (ESS) scores were 30.9±6.6 kg/m, 37.2±28.1 events/hour, and 10.4±5.5, respectively. At baseline, the adherent group had a significantly higher age (P=0.006), higher oxygen desaturation index (P=0.006), and lower ESS (P=0.023) compared to the non-adherent group. In the qualitative study, a total of 29 telephone interviews were held with patients from the non-adherent group (8 women and 21 men). Analysis of the interviews resulted in three main categories (level of knowledge, discomfort, and costs) and nine sub-categories.
A high percentage of OSA patients had poor adherence to CPAP therapy. Device-related issues could be adequately resolved by providing complementary information during follow-up visits. Moreover, efforts to reduce costs through comprehensive insurance coverage or with government subsidy would improve patients' adherence to CPAP therapy.
持续气道正压通气（CPAP）是治疗阻塞性睡眠呼吸暂停（OSA）疾病的金标准疗法。然而，患者对其常规使用的依从性较差。本研究旨在通过确定影响其常规使用的因素以及在伊朗马什哈德的样本人群中其相关问题和不适，来确定CPAP治疗的依从率。
该研究于2017年10月至2018年3月在伊朗马什哈德采用定量和定性方法进行。定量研究通过从五个睡眠诊所和一个CPAP销售办公室进行回顾性横断面数据收集来开展。将患者分为依从组和不依从组，以确定影响CPAP依从性的因素。定量数据使用SPSS软件（版本22.0）进行分析。此外，通过一系列电话访谈并采用内容分析法进行前瞻性定性研究。定性数据使用MAXQDA 10软件进行分析。
在定量研究中，使用了159例患者的病历，其中79例（49.6%）不依从CPAP治疗。所有患者的平均年龄为56.9±9.8岁。平均体重指数、呼吸暂停低通气指数和爱泼华嗜睡量表（ESS）评分分别为30.9±6.6kg/m、37.2±28.1次/小时和10.4±5.5。在基线时，依从组与不依从组相比，年龄显著更高（P = 0.006）、氧饱和度下降指数更高（P = 0.006）且ESS更低（P = 0.023）。在定性研究中，对不依从组的患者（8名女性和21名男性）共进行了29次电话访谈。访谈分析得出三个主要类别（知识水平、不适和成本）和九个子类别。
高比例的OSA患者对CPAP治疗的依从性较差。通过在随访期间提供补充信息，可以充分解决与设备相关的问题。此外，通过全面的保险覆盖或政府补贴来降低成本的努力将提高患者对CPAP治疗的依从性。
