依从指数：睡眠深度和夜间通气不足可预测严重阻塞性睡眠呼吸暂停患者长期使用气道正压治疗的依从性。

Adherence Index: sleep depth and nocturnal hypoventilation predict long-term adherence with positive airway pressure therapy in severe obstructive sleep apnea.

机构信息

Sleep Disorders Center, Misericordia Health Center, University of Manitoba, Winnipeg, Canada.

YRT Limited, Winnipeg, Manitoba, Canada.

出版信息

J Clin Sleep Med. 2022 Aug 1;18(8):1933-1944. doi: 10.5664/jcsm.10028.

DOI:10.5664/jcsm.10028

PMID:35499136

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9340588/

Abstract

STUDY OBJECTIVES

Treatment of obstructive sleep apnea with positive airway pressure (PAP) devices is limited by poor long-term adherence. Early identification of individual patients' probability of long-term PAP adherence would help in their management. We determined whether conventional polysomnogram (PSG) scoring and measures of sleep depth based on the odds ratio product would predict adherence with PAP therapy 12 months after it was started.

METHODS

Patients with obstructive sleep apnea referred to an academic sleep center had split-night PSG, arterial blood gases, and a sleep questionnaire. Multiple linear regression analysis of conventional PSG scoring and the odds ratio product both during diagnostic PSG and PAP titration provided an "Adherence Index," which was correlated with PAP use 12 months later.

RESULTS

Patients with obstructive sleep apnea (n = 236, apnea-hypopnea index 72.2 ± 34.1 events/h) were prescribed PAP therapy (82% received continuous PAP, 18% received bilevel PAP). Each patient's adherence with PAP therapy 12 months later was categorized as "never used," "quit using," "poor adherence," and "good adherence." PSG measures that were most strongly correlated with PAP adherence were apnea-hypopnea index and odds ratio product during nonrapid eye movement sleep; the additional contribution of nocturnal hypoxemia to this correlation was confined to those with chronic hypoventilation treated with bilevel PAP. The Adherence Index derived from these measures, during both diagnostic PSG and PAP titration, was strongly correlated with PAP adherence 12 months later.

CONCLUSIONS

Long-term adherence with PAP therapy can be predicted from diagnostic PSG in patients with severe obstructive sleep apnea, which may facilitate a precision-based approach to PAP management.

CITATION

Younes MK, Beaudin AE, Raneri JK, Gerardy BJ, Hanly PJ. Adherence Index: sleep depth and nocturnal hypoventilation predict long-term adherence with positive airway pressure therapy in severe obstructive sleep apnea. 2022:18(8):1933-1944.

摘要

研究目的

正压通气（PAP）设备治疗阻塞性睡眠呼吸暂停的效果受到长期依从性差的限制。早期识别个别患者长期使用 PAP 的可能性有助于其管理。我们确定常规多导睡眠图（PSG）评分和基于比值比乘积的睡眠深度测量是否可以预测开始 PAP 治疗 12 个月后的依从性。

方法

被转诊到学术睡眠中心的阻塞性睡眠呼吸暂停患者进行了分段式 PSG、动脉血气分析和睡眠问卷。在诊断性 PSG 和 PAP 滴定期间，对常规 PSG 评分和比值比乘积的多元线性回归分析提供了一个“依从性指数”，该指数与 12 个月后 PAP 的使用相关。

结果

236 例阻塞性睡眠呼吸暂停患者（呼吸暂停低通气指数 72.2±34.1 次/小时）接受了 PAP 治疗（82%接受持续 PAP，18%接受双水平 PAP）。每个患者 12 个月后对 PAP 治疗的依从性分为“从未使用”、“停止使用”、“依从性差”和“依从性好”。与 PAP 依从性相关性最强的 PSG 测量值是非快速眼动睡眠期间的呼吸暂停低通气指数和比值比乘积；夜间低氧血症对这种相关性的额外贡献仅限于接受双水平 PAP 治疗的慢性通气不足患者。这些测量值在诊断性 PSG 和 PAP 滴定期间得出的依从性指数与 12 个月后 PAP 的依从性密切相关。