Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway.
Western Norway University of Applied Sciences, Bergen, Norway.
Respiration. 2022;101(12):1099-1109. doi: 10.1159/000527066. Epub 2022 Nov 9.
Long-term noninvasive ventilation (NIV) can increase or maintain health-related quality of life (HRQoL) for patients with chronic hypercapnic respiratory failure (CHRF). Evidence from studies systematically assessing how NIV-specific factors influence HRQoL is limited.
The objective of this study was to describe HRQoL measured by the Severe Respiratory Insufficiency Questionnaire (SRI) in patients with CHRF treated with long-term NIV and to analyze the associations between HRQoL and hypoxemia, hypercapnia, and respiratory events such as apneas, hypopneas (AHI), and patient ventilator asynchrony (PVA) occurring during long-term NIV.
We included sixty-seven stable patients with established long-term NIV due to neuromuscular disease or thoracic cage disorders in a prospective cross-sectional study at Oslo University Hospital. Patients answered the SRI and underwent daytime arterial blood gases, nocturnal pulse oximetry, sleep polygraphy, and nocturnal transcutaneous CO2.
The mean global SRI for 62 patients was 64.8 ± 14.5, with the highest score in SRI Social Relationships (79.5 ± 15.6). There were no differences in HRQoL between the different patient groups. Compliant patients had a significantly higher score in SRI Attendant and Sleep. Residual nocturnal hypoxemia affected both the subscale SRI "Respiratory Complaints" and SRI "Attendant Symptoms and Sleep." Persisting daytime hypercapnia, nocturnal hypoventilation, and high AHI affected the subscale SRI "Anxiety" negatively, while frequent PVA was associated with a lower score in SRI "Physical Function."
In a group of patients with long-term NIV, undesired respiratory events during NIV are associated with lower HRQoL in several of the SRI subscales. We suggest designing interventional studies to confirm the possible relationship between HRQoL and respiratory events during long-term NIV.
长期无创通气（NIV）可提高或维持慢性高碳酸血症性呼吸衰竭（CHRF）患者的健康相关生活质量（HRQoL）。从系统评估 NIV 特异性因素如何影响 HRQoL 的研究中获得的证据有限。
本研究旨在描述接受长期 NIV 治疗的 CHRF 患者使用严重呼吸不足问卷（SRI）测量的 HRQoL，并分析 HRQoL 与低氧血症、高碳酸血症以及在长期 NIV 期间发生的呼吸事件（如呼吸暂停、低通气（AHI）和患者呼吸机不同步（PVA））之间的相关性。
我们在奥斯陆大学医院进行了一项前瞻性的横断面研究，纳入了 67 例因神经肌肉疾病或胸壁疾病而接受长期 NIV 治疗的稳定患者。患者回答 SRI 并接受日间动脉血气、夜间脉搏血氧饱和度、睡眠多导睡眠图和夜间经皮二氧化碳监测。
62 例患者的平均 SRI 总分为 64.8±14.5，其中 SRI 社会关系的得分最高（79.5±15.6）。不同患者组之间的 HRQoL 没有差异。依从性好的患者在 SRI 照顾者和睡眠方面的得分明显更高。夜间残留低氧血症影响 SRI“呼吸投诉”和 SRI“照顾者症状和睡眠”两个亚量表。持续的日间高碳酸血症、夜间通气不足和高 AHI 负性影响 SRI“焦虑”亚量表，而频繁的 PVA 与 SRI“身体功能”得分较低相关。
在一组接受长期 NIV 的患者中，NIV 期间出现的不良呼吸事件与 SRI 几个亚量表的 HRQoL 降低相关。我们建议设计干预研究以确认长期 NIV 期间 HRQoL 与呼吸事件之间的可能关系。
