围手术期持续气道正压通气的依从性及其对阻塞性睡眠呼吸暂停患者术后夜间低氧血症的影响：一项前瞻性队列研究。
Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: a prospective cohort study.
机构信息
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, MCL 2-405, 399 Bathurst St., Toronto, ON, M5T2S8, Canada.
Department of Anesthesia and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
出版信息
BMC Anesthesiol. 2021 May 11;21(1):142. doi: 10.1186/s12871-021-01371-0.
BACKGROUND
Although continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation.
METHODS
This prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation.
RESULTS
One hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO, minimum SpO, and percentage of sleep duration with SpO < 90%. Use of supplemental oxygen therapy was much lower in the CPAP adherent group vs non-adherent group (9.8% vs 46.5%, p < 0.001).
CONCLUSIONS
Among patients with a preoperative CPAP prescription, approximately 50% were consistently adherent. CPAP adherence was associated with improved preoperative ODI and the benefit was maintained on N1. These modest effects may be underestimated by a higher severity of OSA in the CPAP adherent group and a higher rate of oxygen supplementation in the non-adherent group.
TRIAL REGISTRATION
ClinicalTrials.Gov registry ( NCT02796846 ).
背景
尽管持续气道正压通气（CPAP）是阻塞性睡眠呼吸暂停（OSA）患者的一线治疗方法，但围手术期的依从率尚不清楚。本研究的目的是确定有 CPAP 处方的 OSA 患者的围手术期依从率，以及依从性对夜间氧饱和度的影响。
方法
这是一项前瞻性队列研究，纳入了接受择期非心脏手术的有 CPAP 处方的 OSA 成年手术患者。根据使用时间（≥ 4 小时/晚）将患者分为 CPAP 依从组和不依从组。术前和术后第 1 天（N1）和第 2 天（N2）进行夜间血氧饱和度监测。主要结局是依从率，次要结局是夜间氧饱和度。
结果
132 例患者完成了研究。术前 CPAP 依从率为 61%，术后 N1 为 58%，N2 为 59%。49%的患者术前和术后一直 CPAP 依从。使用线性固定效应回归，CPAP 依从性显著改善了氧减指数（ODI）（p=0.0011）。CPAP x N1 的交互项有统计学意义（p=0.0015），表明 CPAP 依从性在 N1 与术前的效果不同。CPAP 依从性对术后平均 SpO、最低 SpO 和 SpO<90%的睡眠时间百分比没有获益。CPAP 依从组的补充氧疗使用率明显低于不依从组（9.8% vs 46.5%，p<0.001）。
结论
在有术前 CPAP 处方的患者中，约 50%的患者一直依从。CPAP 依从性与术前 ODI 改善相关，且在 N1 时仍有获益。CPAP 依从组 OSA 严重程度较高和不依从组补充氧疗率较高，可能低估了这种适度的效果。
试验注册
ClinicalTrials.Gov 注册（NCT02796846）。
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