Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ, USA.
Sleep Breath. 2023 Mar;27(1):165-172. doi: 10.1007/s11325-022-02590-6. Epub 2022 Mar 14.
To determine factors that are associated with OSA therapy outcomes with auto-titrating positive airway pressure (APAP).
We sequentially grouped patients from a retrospective cohort based on APAP efficacy (sufficiently vs. insufficiently treated; insufficiently treatment defined as residual AHI of ≥ 5), therapy adherence (adherent vs. non-adherent, non-adherence defined as < 70% usage for ≥ 4 h/night), and therapy outcomes (optimal vs. non-optimal and non-optimal outcomes defined as non-adherent and/or insufficiently treated). We subsequently compared each group.
The insufficiently treated were older (68.4 ± 12.5 vs. 60.4 ± 13.1 years, p < 0.01) and had lower BMI (31.9 ± 6.3 vs. 37.9 ± 9.1 kg/m, p < 0.01). They had higher baseline central apnea indices (CAI), longer leaks, higher peak pressures, and were less compliant. The non-adherent were younger (61.1 ± 12.6 vs. 65.5 ± 13.2 years, p = 0.03) and comprised more females (56.1 vs. 43.9%, p = 0.04). The leak duration per usage hour was higher in the non-compliant (median: 1.5; IQR 7.9 vs. median: 0.3; IQR 1.9 min/h; p < 0.01). The non-optimally treated had lower BMI, longer leaks, and less nightly usage. Multivariate analyses showed that leak duration was the common factor associated with treatment effectiveness and optimal therapy outcomes.
Various demographic and clinical factors were associated with treatment efficacy and adherence. However, leak duration was the common factor related to treatment efficacy and overall optimal therapy outcomes.
确定与自动滴定式正压通气（APAP）治疗阻塞性睡眠呼吸暂停（OSA）结果相关的因素。
我们根据 APAP 的疗效（充分治疗与治疗不足；治疗不足定义为残余 AHI≥5）、治疗依从性（依从与不依从；不依从定义为每晚使用时间<70%且≥4 小时）和治疗结果（最佳与非最佳；非最佳结果定义为不依从和/或治疗不足）将回顾性队列中的患者进行连续分组。然后，我们比较了每个组。
治疗不足的患者年龄更大（68.4±12.5 岁比 60.4±13.1 岁，p<0.01），BMI 更低（31.9±6.3 千克/平方米比 37.9±9.1 千克/平方米，p<0.01）。他们的基线中枢性睡眠呼吸暂停指数（CAI）更高，漏气时间更长，最高压力更高，且依从性更低。不依从的患者更年轻（61.1±12.6 岁比 65.5±13.2 岁，p=0.03），且女性更多（56.1%比 43.9%，p=0.04）。不依从者的每小时使用漏气时间更长（中位数：1.5；IQR 7.9 分钟比中位数：0.3；IQR 1.9 分钟/小时；p<0.01）。非最佳治疗的患者 BMI 更低，漏气时间更长，夜间使用时间更少。多变量分析表明，漏气时间是与治疗效果和最佳治疗结果相关的共同因素。
各种人口统计学和临床因素与治疗效果和依从性相关。然而，漏气时间是与治疗效果和整体最佳治疗结果相关的共同因素。
