Hooper Robert G
Center for Sleep Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Pragmat Obs Res. 2020 Jul 13;11:67-76. doi: 10.2147/POR.S258632. eCollection 2020.
There are many options available to patients who are placed on constant positive airway pressure (CPAP) for obstructive sleep apnea. Despite the success of CPAP in correcting apnea, a significant number of patients have difficulty with the therapy. A large number of those patients who have difficulty stop therapy and are often labeled as "CPAP Failure". Non-sleep specialists may view CPAP therapy as a singular course of treatment, but there are many ways CPAP may be ordered for a patient. Each patient experiences a unique set of options that constitute a unique order set.
In order to demonstrate the magnitude of the possible options, estimates of the number of unique order sets were calculated. The author chose individual order options and the number of selections possible within each option. The calculated sets included a "Generous, Limited and Minimal" number of selections for each option. Calculations were done separately for standard CPAP and for auto-adjusting CPAP. Additional calculations were performed using the number of commercially available masks in the United States.
The maximum number of unique order sets was seen using a standard CPAP combined with commercially available masks: 49,152 unique order sets. The fewest number of unique order sets were seen with the auto-adjusting CPAP and the "Minimal" selections: 288 unique order sets.
There are a large number of unique CPAP orders that a patient may experience. CPAP treatment is not a singular or simple therapy. When evaluating obstructive sleep apnea patients with histories of CPAP failure or prior difficulty with CPAP, paying close attention to the patient's treatment experiences may help explain a significant number of those patients' CPAP therapy problems.
对于因阻塞性睡眠呼吸暂停而接受持续气道正压通气（CPAP）治疗的患者而言，有多种选择。尽管CPAP在纠正呼吸暂停方面取得了成功，但仍有相当数量的患者在接受该治疗时遇到困难。许多遇到困难的患者停止了治疗，常被贴上“CPAP治疗失败”的标签。非睡眠专科医生可能将CPAP治疗视为单一的治疗过程，但为患者开具CPAP的方式有很多种。每个患者都会经历一组独特的选择，构成一个独特的医嘱集。
为了说明可能的选择数量，计算了独特医嘱集数量的估计值。作者选择了各个医嘱选项以及每个选项内可能的选择数量。计算的集合包括每个选项的“丰富、有限和最少”选择数量。分别针对标准CPAP和自动调压CPAP进行了计算。还使用美国市场上可买到的面罩数量进行了额外计算。
使用标准CPAP结合市场上可买到的面罩时，独特医嘱集的最大数量为49,152个。自动调压CPAP和“最少”选择的独特医嘱集数量最少，为288个。
患者可能会经历大量独特的CPAP医嘱。CPAP治疗并非单一或简单的治疗方法。在评估有CPAP治疗失败病史或之前使用CPAP有困难的阻塞性睡眠呼吸暂停患者时，密切关注患者的治疗经历可能有助于解释这些患者中相当一部分人的CPAP治疗问题。
