Wu Hao, Fang Fang, Wu Chan, Zhan Xiaojun, Wei Yongxiang
Sleep Medicine Center, Dept. of Otolaryngology-Head & Neck Surgery Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Sleep Medicine Center, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Sleep Breath. 2021 Jun;25(2):887-895. doi: 10.1007/s11325-020-02197-9. Epub 2020 Oct 4.
To determine the predictive factors of initial and long-term adherence to positive airway pressure (PAP) therapy and factors leading to an unfavorable shift of PAP compliance.
This follow-up study was comprised of newly diagnosed patients with obstructive sleep apnea (OSA) amenable to PAP therapy from January 2017 to April 2019. Information on basic demographics, comorbidities, and sleep-related symptoms were collected. PAP adherence data were collected at the end of the first week and the third month.
Of 166 patients enrolled, data from 142 (86%) were in the final analysis. Overall PAP usage was worse at 3 months declining from the first week. After adjusting for age and gender, multinomial logistic regression analysis showed that a small number of sleep-related symptoms (OR, 0.69; 95% CI, 0.52-0.91) and low arousal threshold (ArTH) (OR, 4.44; 95% CI, 1.52-12.98) were associated with higher odds of noncompliance. Low ArTH (OR, 2.87; 95% CI, 1.09-7.57) and lower body mass index (BMI) (OR, 0.88; 95% CI, 0.78-0.99) increased the risk of compliance-to-noncompliance shift. Sixty-two patients with polysomnography were analyzed separately. After adjustment for age and gender, poor sleep efficiency (OR, 0.80; 95% CI, 0.68-0.94) was associated with higher odds of consistent noncompliance. Low ArTH (OR, 15.36; 95% CI, 1.44-164.24) increased the risk of compliance-to-noncompliance shift in this subgroup.
Lower BMI and low ArTH were associated with an unfavorable shift of PAP compliance over time in patients with OSA, which was different from the predictors of consistent PAP noncompliance of patients with OSA.
确定持续气道正压通气（PAP）治疗初始及长期依从性的预测因素，以及导致PAP依从性出现不利转变的因素。
这项随访研究纳入了2017年1月至2019年4月新诊断的适合PAP治疗的阻塞性睡眠呼吸暂停（OSA）患者。收集了基本人口统计学、合并症及睡眠相关症状的信息。在第一周结束时和第三个月末收集PAP依从性数据。
166名入组患者中，142名（86%）的数据纳入最终分析。总体PAP使用情况在3个月时比第一周更差。在调整年龄和性别后，多项逻辑回归分析显示，少量睡眠相关症状（比值比[OR]，0.69；95%置信区间[CI]，0.52 - 0.91）和低唤醒阈值（ArTH）（OR，4.44；95% CI，1.52 - 12.98）与不依从的较高几率相关。低ArTH（OR，2.87；95% CI，1.09 - 7.57）和较低的体重指数（BMI）（OR，0.88；95% CI，0.78 - 0.99）增加了依从性向不依从转变的风险。对62名进行了多导睡眠图检查的患者进行了单独分析。在调整年龄和性别后，睡眠效率差（OR，0.80；95% CI，0.68 - 0.94）与持续不依从的较高几率相关。在该亚组中，低ArTH（OR，15.36；95% CI，1.44 - 164.24）增加了依从性向不依从转变的风险。
较低的BMI和低ArTH与OSA患者PAP依从性随时间出现的不利转变相关，这与OSA患者持续PAP不依从的预测因素不同。
