Bailes Sally, Rizzo Dorrie, Fichten Catherine, Baltzan Marc, Grad Roland, Creti Laura, Amsel Rhonda, Libman Eva
Jewish General Hospital, Psychiatry Department, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada.
McGill University, Faculty of Medicine, Department of Psychiatry, Montreal, Canada.
Psychol Health Med. 2023 Jul-Dec;28(7):1924-1937. doi: 10.1080/13548506.2023.2176525. Epub 2023 Feb 28.
In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment.
在我们之前的研究中，我们为老年家庭医学患者提供了阻塞性睡眠呼吸暂停（OSA）检测，发现接受检测的患者中有80%后来被诊断出患有此前未被怀疑的OSA。在本研究中，我们对这些患者进行了3年的常规治疗随访。目标是：（1）观察更广泛的OSA检测是否会增加病例识别率和治疗接受度；（2）确定与诊断和治疗效果相关的症状和健康特征。从家庭医学诊所招募的101名女性和75名男性（年龄>45岁）完成了问卷调查、多导睡眠图检查，并同意进行病历审查（时间1）。患有OSA的参与者接受了睡眠医学专家的治疗和随访。3年后对所有人进行了重新评估（时间2）。在时间1时，93%的参与者被诊断为OSA。其中，53人开始治疗（46人采用持续气道正压通气（PAP）治疗）；在时间2时，24名PAP使用者符合依从性标准。与未依从的参与者相比，PAP依从的参与者在时间1时OSA更严重，报告的症状也更严重。在时间2时，与无变化的未依从参与者相比，PAP依从的参与者在失眠和日间症状方面有所改善。依从和不依从的参与者在时间1时健康指标无差异，在三年随访中也无变化。治疗的益处包括共病失眠和日间功能的改善；然而，对老年家庭医学患者进行更广泛的OSA检测，诊断率很高，但治疗采用率和依从性很低。因此，一种具有成本效益的策略将识别并支持那些可能采用并坚持治疗的患者。
