Internal Medicine, Intermountain Healthcare, Sandy, Utah, United States of America.
Intermountain Healthcare, Sandy, Utah, United States of America.
PLoS One. 2020 Aug 13;15(8):e0237359. doi: 10.1371/journal.pone.0237359. eCollection 2020.
Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA.
This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study.
The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12-25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types).
Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.
患有阻塞性睡眠呼吸暂停（OSA）并服用处方类阿片类药物的患者，其发病率和死亡率更高。本研究评估了专注于慢性疼痛管理的初级保健团队是否可以使用经过验证的问卷（STOP-Bang）和动机随访来增加 OSA 的识别和治疗。
本研究为回顾性、双臂、前后对照研究。本研究的参与者包括该初级保健团队治疗的完整慢性疼痛管理亚组。参与者年龄≥18 岁，每日服用阿片类药物治疗慢性疼痛。所有参与者都参加了一次多方面、个性化的教育会议，包括填写 STOP-Bang 问卷。评分≥3 分的参与者被建议与初级保健医生跟进。研究期间，参与者每季度接受一次随访。
本研究的主要结果是，65%的可能患有 OSA 的参与者在干预后至少使用 CPAP 治疗 12 个月（范围为 12-25 个月，平均 18 个月），而对照组中仅 37%的参与者使用 CPAP（12 个月的观察期），两组均为慢性阿片类药物使用者合并 OSA。这是 28%的相对改善（p = 0.0034）。次要结果是，8.9%的非 CPAP 使用者在干预后获得 CPAP；使用 CPAP 的比例从 56.7%提高（p = 0.0064，x2 = 10.08，自由度为 1）。此外，与不太可能患有 OSA（STOP-Bang 评分<3 或睡眠多导图检查结果为阴性（AHI<5））的参与者相比，患有 OSA（STOP-Bang 评分≥3 或睡眠多导图检查结果阳性（AHI>5 且合并症）的参与者更有可能为男性、体重指数更高、患有高血压、心血管疾病和/或糖尿病（所有类型）。
接受处方类阿片类药物治疗的患者接受团队为基础的护理管理，其中包括完成 STOP-Bang 问卷，与 OSA 的识别和治疗增加有关。
