基于电子健康记录的阻塞性睡眠呼吸暂停经正压通气追踪系统管理后的结局。

Electronic health record-derived outcomes in obstructive sleep apnea managed with positive airway pressure tracking systems.

机构信息

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.

Pulmonary, Critical Care, and Sleep Medicine, Owensboro Health Medical Group, Owensboro, Kentucky.

出版信息

J Clin Sleep Med. 2022 Mar 1;18(3):885-894. doi: 10.5664/jcsm.9750.

DOI:10.5664/jcsm.9750

PMID:34725036

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8883092/

Abstract

STUDY OBJECTIVES

To assess the effectiveness of continuous positive airway pressure (CPAP) management guided by CPAP machine downloads in newly diagnosed patients with obstructive sleep apnea (OSA) using electronic health record-derived health care utilization, biometric variables, and laboratory data.

METHODS

Electronic health record data of patients seen at the University of Utah Sleep Program from 2012-2015 were reviewed to identify patients with new diagnosis of OSA in whom CPAP adherence and residual apnea-hypopnea index as measured by a positive airway pressure adherence tracking device data for ≥ 1 year were available. Biometric data, laboratory data, and system-wide charges were compared in the 1 year before and after CPAP therapy. Subgroups were divided by whether patients met tracking criteria, mean nightly usage, and OSA severity.

RESULTS

976 consecutive, newly diagnosed participants with OSA (median age 55 years, 56.6% male) met inclusion criteria. There was a mean decrease of systolic blood pressure (BP) of 1.2 mm Hg and diastolic BP of 1.0 mm Hg within a year of initiation of CPAP therapy. BP improvements in the subgroup meeting CPAP tracking targets were 1.36 mmHg (systolic) and 1.37 mmHg (diastolic). No significant change was noted in body mass index, glycated hemoglobin, or serum creatinine values within a year of starting CPAP therapy, and health care utilization increased (mean acute care visits 0.22 per year to 0.53 per year; mean charges of $3,997 per year to $8,986 per year).

CONCLUSIONS

An improvement in BP was noted within a year of CPAP therapy in newly diagnosed patients with OSA, with no difference in the magnitude of improvement between those meeting tracking system adherence targets.

CITATION

Locke BW, Neill SE, Howe HE, Crotty MC, Kim J, Sundar KM. Electronic health record-derived outcomes in obstructive sleep apnea managed with positive airway pressure tracking systems. . 2022;18(3):885-894.

摘要

研究目的

使用电子病历衍生的医疗保健利用情况、生物计量学变量和实验室数据，评估经 CPAP 机下载指导的持续气道正压通气（CPAP）管理对新诊断为阻塞性睡眠呼吸暂停（OSA）患者的效果。

方法

回顾 2012 年至 2015 年期间在犹他大学睡眠项目就诊的患者的电子病历数据，以确定新诊断为 OSA 的患者，这些患者在使用 CPAP 治疗至少 1 年后，CPAP 依从性和残留的呼吸暂停低通气指数（由气道正压依从性跟踪设备数据测量）可用。比较 CPAP 治疗前 1 年和治疗后 1 年的生物计量学数据、实验室数据和系统范围的费用。亚组根据患者是否符合跟踪标准、平均夜间使用情况和 OSA 严重程度进行划分。

结果

976 名连续的新诊断 OSA 患者（中位年龄 55 岁，56.6%为男性）符合纳入标准。CPAP 治疗开始后 1 年内，收缩压（BP）平均降低 1.2mmHg，舒张压平均降低 1.0mmHg。符合 CPAP 跟踪目标的亚组的 BP 改善分别为 1.36mmHg（收缩压）和 1.37mmHg（舒张压）。CPAP 治疗开始后 1 年内，体重指数、糖化血红蛋白或血清肌酐值无显著变化，医疗保健利用率增加（平均急性护理就诊次数从每年 0.22 次增加到每年 0.53 次；平均费用从每年 3997 美元增加到每年 8986 美元）。