Kempenhaeghe, Sleep Medicine Centre, Heeze, The Netherlands.
Kempenhaeghe, Center for Residential Epilepsy Care, Heeze, The Netherlands.
Sleep Breath. 2021 Sep;25(3):1257-1265. doi: 10.1007/s11325-020-02221-y. Epub 2020 Oct 21.
Obstructive sleep apnea (OSA) is common in people with intellectual disabilities (ID), but in practice continuous positive airway pressure (CPAP) is often deemed unfeasible. We investigated adherence to and effect of CPAP in patients with ID and OSA.
Patients with ID were started on CPAP using an intensive training program. Acceptable adherence was defined as use of ≥ 4 h/night during ≥ 70% of the nights. Treatment effect was measured with a patient global impression scale and customized questionnaires. Reasons for not starting CPAP, factors influencing treatment, and reasons for terminating CPAP were explored.
Of 39 patients with ID, 87% after 8-10 weeks and 70% at 8 months still used CPAP, of whom 74% and 77% showed acceptable adherence. Baseline apnea-hypopnea (AHI) index decreased from 41.2/h to 5.3/h after 8-10 weeks (p < 0.001), and 4.3/h after 8 months (p < 0.001). At 8-10 weeks and after 8 months, there was an improvement in the most restrictive reported complaint (both p < 0.0005), difficulty waking up (p < 0.01; p < 0.0005), handling behavior (p < 0.03; p < 0.02), presence of irritability (p < 0.01), and sleepiness (p < 0.05). The expectation that CPAP would not be tolerated was the main reason for not starting. CPAP use in the first 2 weeks predicted adherence at 8-10 weeks and 8 months (r = 0.51, p < 0.01; r = 0.69, p < 0.01). Of 13 patients who terminated CPAP, the reasons for termination included behavioral problems, comorbid insomnia, anxiety, discomfort, or other side effects.
With adequate guidance, CPAP is both feasible and effective in people with ID and OSA.
阻塞性睡眠呼吸暂停（OSA）在智障人士（ID）中很常见，但实际上持续气道正压通气（CPAP）往往被认为不可行。我们研究了 CPAP 在 ID 和 OSA 患者中的依从性和疗效。
使用强化培训计划为 ID 患者启动 CPAP。可接受的依从性定义为在≥70%的夜间使用≥4 小时/夜。使用患者总体印象量表和定制问卷来测量治疗效果。探讨了未开始 CPAP 的原因、影响治疗的因素以及终止 CPAP 的原因。
39 例 ID 患者中，87%在 8-10 周后和 70%在 8 个月后仍使用 CPAP，其中 74%和 77%显示出可接受的依从性。8-10 周后，基础呼吸暂停低通气指数（AHI）从 41.2/h 降至 5.3/h（p<0.001），8 个月后降至 4.3/h（p<0.001）。8-10 周和 8 个月后，最受限的报告抱怨（均 p<0.0005）、醒来困难（p<0.01；p<0.0005）、行为处理（p<0.03；p<0.02）、易怒（p<0.01）和嗜睡（p<0.05）均有所改善。无法耐受 CPAP 是不开始的主要原因。CPAP 使用在头 2 周预测了 8-10 周和 8 个月的依从性（r=0.51，p<0.01；r=0.69，p<0.01）。13 例终止 CPAP 的患者中，终止的原因包括行为问题、共患失眠、焦虑、不适或其他副作用。
在充分指导下，CPAP 对 ID 和 OSA 患者是可行且有效的。
