Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha 410011.
Department of Emergency, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Apr 28;47(4):479-487. doi: 10.11817/j.issn.1672-7347.2022.210590.
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease that seriously affects health. Continuous positive airway pressure (CPAP) therapy is the preferred treatment for moderate-to-severe OSAHS patients. However, poor adherence to CPAP is a major obstacle in the treatment of OSAHS. Information-motivation-behavioral (IMB) skills, as a kind of mature technology to change the behavior, has been used in various health areas to improve treatment adherence. This study aims to explore the effects of the IMB skills intervention on CPAP adherence in OSAHS patients.
Patients who were primary diagnosed with moderate-to-severe OSAHS were randomly divided into the IMB group (=62) and the control group (=58). The patients in the IMB group received CPAP therapy and the IMB skills intervention for 4 weeks. The patients in the control group received CPAP therapy and a usual health care provided by a registered nurse. We collected the baseline data of the general information, including age, sex, body mass index (BMI), the Epworth Sleepiness Scale (ESS) score, the Hospital Anxiety and Depression Scale (HADS) score, and indicators about disease severity [apnea-hypopnea index (AHI), percentage of time with arterial oxygen saturation SaO<90% (T90), average SaO, lowest SaO, arousal index]. After CPAP titration, we collected CPAP therapy-relevant parameters (optimal pressure, maximum leakage, average leakage, 95% leakage, and residual AHI), score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. After 4 weeks treatment, we collected the ESS score, HADS score, CPAP therapy-relevant parameters, effective CPAP therapy time per night, CPAP therapy days within 4 weeks, CPAP adherence rate, score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. Visual analog scale (VAS) of 0-5 was used to evaluate the satisfaction and acceptance of IMB intervention measures in the IMB group.
There were no significant differences in the baseline level of demographic parameters, ESS score, HADS score, disease severity, and CPAP therapy related parameters between the IMB group and the control group (all >0.05). There were no significant differences in score of willingness to continue CPAP therapy, as well as score of satisfaction and acceptance of CPAP therapy after CPAP titration between the IMB group and the control group (both >0.05). After 4 weeks treatment, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group were significantly decreased, while the score of satisfaction and acceptance of CPAP therapy and willingness to continue CPAP therapy of the IMB group were significantly increased (all <0.05); while the above indexes in the control group were not different before and after 4 weeks treatment (all <0.05). Compared with the control group, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group after 4 weeks treatment were significantly lower (all <0.05); the effective CPAP therapy time, CPAP therapy days within 4 weeks, score of satisfaction and acceptance of CPAP therapy, score of willingness to continue CPAP therapy of the IMB group were significantly higher (all <0.05). The rate of CPAP therapy adherence in 4 weeks of the IMB group was significantly higher than that of the control group (90.3% vs 62.1%, <0.05). The VAS of overall satisfaction with IMB skills intervention measures was 4.46±0.35.
IMB skills intervention measures can effectively improve the adherence of CPAP therapy in OSAHS patients, and is suitable for clinical promotion.
阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种常见疾病，严重影响健康。持续气道正压通气（CPAP）治疗是中重度 OSAHS 患者的首选治疗方法。然而，CPAP 治疗的依从性差是 OSAHS 治疗的主要障碍。信息-动机-行为（IMB）技能作为一种改变行为的成熟技术，已被应用于各种健康领域，以提高治疗依从性。本研究旨在探讨 IMB 技能干预对 OSAHS 患者 CPAP 依从性的影响。
将首次被诊断为中重度 OSAHS 的患者随机分为 IMB 组（n=62）和对照组（n=58）。IMB 组患者接受 CPAP 治疗和 4 周的 IMB 技能干预。对照组患者接受 CPAP 治疗和由注册护士提供的常规健康护理。我们收集了一般信息的基线数据，包括年龄、性别、体重指数（BMI）、嗜睡量表（ESS）评分、医院焦虑和抑郁量表（HADS）评分以及疾病严重程度指标[呼吸暂停-低通气指数（AHI）、动脉血氧饱和度 SaO<90%（T90）的时间百分比、平均 SaO、最低 SaO、觉醒指数]。CPAP 滴定后，我们收集了 CPAP 治疗相关参数（最佳压力、最大漏气、平均漏气、95%漏气和残余 AHI）、CPAP 治疗满意度和接受度评分、继续 CPAP 治疗的意愿评分。治疗 4 周后，我们收集了 ESS 评分、HADS 评分、CPAP 治疗相关参数、每晚有效 CPAP 治疗时间、4 周内 CPAP 治疗天数、CPAP 治疗依从率、CPAP 治疗满意度和接受度评分以及继续 CPAP 治疗的意愿评分。0-5 分的视觉模拟量表（VAS）用于评估 IMB 组对 IMB 干预措施的满意度和接受度。
IMB 组和对照组在人口统计学参数、ESS 评分、HADS 评分、疾病严重程度和 CPAP 治疗相关参数的基线水平上无显著差异（均>0.05）。CPAP 滴定后，IMB 组和对照组的继续 CPAP 治疗意愿评分以及 CPAP 治疗满意度和接受度评分均无显著差异（均>0.05）。治疗 4 周后，IMB 组的 ESS 评分、HADS 评分、最大漏气、平均漏气和 95%漏气均显著降低，而 IMB 组的 CPAP 治疗满意度和接受度评分以及继续 CPAP 治疗的意愿评分显著增加（均<0.05）；而对照组在 4 周治疗前后上述指标均无差异（均<0.05）。与对照组相比，治疗 4 周后，IMB 组的 ESS 评分、HADS 评分、最大漏气、平均漏气和 95%漏气均显著降低（均<0.05）；IMB 组的有效 CPAP 治疗时间、4 周内 CPAP 治疗天数、CPAP 治疗满意度和接受度评分、继续 CPAP 治疗的意愿评分均显著升高（均<0.05）。IMB 组 4 周 CPAP 治疗依从率明显高于对照组（90.3% vs 62.1%，<0.05）。对 IMB 技能干预措施的总体满意度的 VAS 评分为 4.46±0.35。
IMB 技能干预措施可有效提高 OSAHS 患者 CPAP 治疗的依从性，适合临床推广。
