在开始家庭使用自动气道正压通气（APAP）治疗之前，实施睡眠技师监督和个性化 APAP 接口适配会议可提高阻塞性睡眠呼吸暂停患者的治疗依从性。

Implementing a sleep technician-supervised and personalized APAP interface fitting session prior to initiation of home APAP therapy improves adherence in patients with obstructive sleep apnea.

机构信息

Department of Internal Medicine, Ascension Genesys Hospital, Grand Blanc, Michigan.

Windsor University, School of Medicine, Cayon, Saint Kitts and Nevis, West Indies.

出版信息

J Clin Sleep Med. 2021 Oct 1;17(10):2057-2065. doi: 10.5664/jcsm.9368.

DOI:10.5664/jcsm.9368

PMID:33983111

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8494097/

Abstract

STUDY OBJECTIVES

Home automatic positive airway pressure (APAP) therapy is becoming a mainstay treatment of obstructive sleep apnea. It is typically prescribed without any prior supervised titration. Initial experience of APAP treatment dictates subsequent use. Discomfort related to the APAP interface contributes to poor APAP adherence.

METHODS

After obtaining institutional review board approval, 156 adult patients newly diagnosed with obstructive sleep apnea were prospectively randomized into 2 groups (group A and group B). Group A received a 30-minute personalized interface/mask fitting session supervised by a certified sleep technician, during which APAP therapy was simulated and patients were educated on proper use. Patients sampled different interfaces to address any issues with comfort. Group B received usual care where patients obtained an interface through durable medical equipment suppliers. Primary endpoints included percent APAP usage (number of days APAP was used for ≥ 4 hours divided by 30 days) and APAP usage (number of days APAP was used for any duration) during the initial 30 days of home APAP therapy. Interface-associated air leak served as the secondary endpoint.

RESULTS

Mean percent APAP usage was higher in group A compared to group B (78.4% vs 67.8%; = .04). On average, group A utilized the APAP machine on more days compared to group B (27 vs 24 days; = .01). APAP interface associated air leak was lower in group A compared to group B (14.9 vs 21.1 l/min; = .03).

CONCLUSIONS

Our findings demonstrate that implementing a personalized interface fitting session supervised by a sleep technician improves APAP adherence.

CITATION

Syed Z, Mehta I, Hella JR, Barber K, Khorfan F. Implementing a sleep technician-supervised and personalized APAP interface fitting session prior to initiation of home APAP therapy improves adherence in patients with obstructive sleep apnea. . 2021;17(10):2057-2065.

摘要

研究目的

家庭自动正压通气（APAP）治疗正成为阻塞性睡眠呼吸暂停的主要治疗方法。通常在未经任何监督滴定的情况下开具处方。APAP 治疗的初始经验决定了后续的使用。与 APAP 接口相关的不适会导致 APAP 顺应性差。

方法

在获得机构审查委员会批准后，156 名新诊断为阻塞性睡眠呼吸暂停的成年患者前瞻性随机分为 2 组（A 组和 B 组）。A 组接受由认证睡眠技术人员监督的 30 分钟个性化接口/面罩适配会议，在此期间模拟 APAP 治疗并对患者进行正确使用的教育。患者尝试不同的接口以解决舒适度问题。B 组接受常规护理，患者从耐用医疗设备供应商处获得接口。主要终点包括初始 30 天家庭 APAP 治疗期间的 APAP 使用百分比（APAP 使用≥4 小时的天数除以 30 天）和 APAP 使用（APAP 使用的任何天数）。接口相关空气泄漏作为次要终点。

结果

与 B 组相比，A 组的 APAP 使用百分比更高（78.4%比 67.8%；P =.04）。平均而言，A 组比 B 组使用 APAP 机器的天数更多（27 天比 24 天；P =.01）。与 B 组相比，A 组的 APAP 接口相关空气泄漏较低（14.9 比 21.1 l/min；P =.03）。