Aalaei Shokoufeh, Amini Mahnaz, Taghipour Ali, Afsharisaleh Lahya, Rezaeitalab Fariborz, Asadpour Hadi, Eslami Saeid
Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 9177948564, Iran.
Sleep Breath. 2021 Sep;25(3):1359-1368. doi: 10.1007/s11325-020-02216-9. Epub 2020 Nov 7.
Despite the serious consequences of sleep apnea, some patients do not follow their physicians' advice to undergo a sleep study. The present study aimed to determine the rate of adherence and influencing factors in conducting a polysomnography test in patients suspected of obstructive sleep apnea.
This qualitative and quantitative analysis was conducted between July 2017 and November 2019 on patients suspected of sleep apnea. The quantitative analysis aimed at determining the rate of adherence through a retrospective cross-sectional study. The qualitative content analysis was conducted on purposefully selected subgroup of patients suspected of obstructive sleep apnea who were referred for polysomnography. The required data were collected through the semi-structured in-depth interviews and then recorded, transcribed, and analyzed using SPSS.22 and MAXQDA10.
Quantitative part: Of 311 patients (mean age: 47.6 ± 13.1 years) referred for polysomnography, 283 patients (91%) were at a high risk of developing obstructive sleep apnea. Among those referred for polysomnography, 31% (n = 95) adhered to recommendations for a sleep study. Qualitative part: Factors affecting adherence to polysomnography were categorized as "barriers" and "triggers." Barriers included inadequate knowledge, psychological factors, cost, and the service system. Triggers included adequate knowledge and tangible experience of consequences of the illness.
The majority of patients at risk of developing obstructive sleep apnea did not follow the recommendation for polysomnography, indicating a need for systematic interventions. Among the identified barriers, knowledge and psychological factors are modifiable ones that can be addressed with the patient. We theorize that raising awareness among patients by providing additional information and eliminating concerns may help to increase the rate of adherence. Insurance coverage or subsidy to reduce the sleep study costs may also be an effective strategy to increase adherence to recommendations for polysomnography.
尽管睡眠呼吸暂停会带来严重后果，但一些患者并未听从医生建议进行睡眠研究。本研究旨在确定疑似阻塞性睡眠呼吸暂停患者进行多导睡眠图测试的依从率及影响因素。
2017年7月至2019年11月对疑似睡眠呼吸暂停的患者进行了定性和定量分析。定量分析旨在通过回顾性横断面研究确定依从率。对有意选择的疑似阻塞性睡眠呼吸暂停并被转诊进行多导睡眠图检查的患者亚组进行定性内容分析。所需数据通过半结构化深度访谈收集，然后使用SPSS.22和MAXQDA10进行记录、转录和分析。
定量部分：在311名被转诊进行多导睡眠图检查的患者（平均年龄：47.6±13.1岁）中，283名患者（91%）有发展为阻塞性睡眠呼吸暂停的高风险。在被转诊进行多导睡眠图检查的患者中，31%（n=95）遵守了睡眠研究的建议。定性部分：影响多导睡眠图检查依从性的因素分为“障碍”和“触发因素”。障碍包括知识不足、心理因素、费用和服务系统。触发因素包括对疾病后果有足够的认识和切实的体验。
大多数有发展为阻塞性睡眠呼吸暂停风险的患者未遵循多导睡眠图检查的建议，这表明需要进行系统干预。在已确定的障碍中，知识和心理因素是可改变的，可以针对患者加以解决。我们推测，通过提供更多信息和消除疑虑来提高患者的认识，可能有助于提高依从率。提供保险覆盖或补贴以降低睡眠研究费用，也可能是提高对多导睡眠图检查建议依从性的有效策略。
