正压通气治疗使用者的呼吸道感染风险：一项回顾性队列研究。

Respiratory infection risk in positive airway pressure therapy users: a retrospective cohort study.

机构信息

Department of Neurology, Division of Sleep Medicine, University of Michigan, Ann Arbor, Michigan.

Department of Neurology, Division of Neuroimmunology, University of Michigan, Ann Arbor, Michigan.

出版信息

J Clin Sleep Med. 2023 Oct 1;19(10):1769-1773. doi: 10.5664/jcsm.10670.

DOI:10.5664/jcsm.10670

PMID:37264674

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10546000/

Abstract

STUDY OBJECTIVES

Concerns regarding the risk of positive airway pressure (PAP)-associated respiratory infection (RI) have shaped consumer views toward PAP device use and maintenance. However, data regarding temporal associations between PAP use and risk for RIs are limited. The purpose of the present study was to examine longitudinal associations between PAP use and risk of clinically significant RIs in a cohort of patients with obstructive sleep apnea.

METHODS

The frequency of clinically reported respiratory RIs pre- and post-PAP use were compared in a sample of 482 adult patients with obstructive sleep apnea who underwent PAP titration at a large academic sleep center between 2011 and 2014. RIs were identified by clinical record review beginning two years before and ending two years after the participants' PAP titration. Presence of longitudinal standard PAP data download reports identified PAP users from nonusers. PAP adherence was defined as at least 4 hours of use per day, five days per week for at least 70% of days. Poisson regression models, adjusted for age, sex, body mass index, and the number of pre-PAP use RIs were utilized to examine associations between PAP use and subsequent RIs.

RESULTS

Poisson regression models adjusted for age, sex, body mass index, and the number of pre-PAP use RIs did not show associations between PAP therapy use and rate of post-PAP use RIs (rate ratio = 1.27, 95% confidence interval: 0.86-1.86). A sensitivity analysis that included only PAP users with difference in PAP adherence showed similar results (rate ratio = 0.65, 95% confidence interval: 0.32-1.30).

CONCLUSIONS

Among adults with obstructive sleep apnea, we did not find evidence for association between PAP use/adherence and increased RI frequency. These data offer new information that could assuage patients with obstructive sleep apnea who are considering PAP deferral based on RI concerns.

CITATION

Gavidia R, Shieu MM, Dunietz GL, Braley TJ. Respiratory infection risk in positive airway pressure therapy users: a retrospective cohort study. . 2023;19(10):1769-1773.

摘要

研究目的

对正压通气（PAP）相关呼吸道感染（RI）风险的担忧影响了消费者对 PAP 设备使用和维护的看法。然而，关于 PAP 使用与 RI 风险之间时间关联的数据有限。本研究的目的是在 2011 年至 2014 年间在一家大型学术睡眠中心进行 PAP 滴定的阻塞性睡眠呼吸暂停患者队列中，研究 PAP 使用与临床显著 RI 风险之间的纵向关联。

方法

在 482 名接受过 PAP 滴定的阻塞性睡眠呼吸暂停成年患者样本中，比较了 PAP 使用前后临床报告的呼吸道 RI 频率。通过临床记录回顾，从参与者接受 PAP 滴定前两年开始，到两年后结束，确定 RI。存在纵向标准 PAP 数据下载报告可从非使用者中识别出 PAP 用户。PAP 依从性定义为每天至少使用 4 小时，每周至少使用 5 天，至少使用 70%的天数。使用泊松回归模型，调整年龄、性别、体重指数和 PAP 使用前 RI 的数量，以检查 PAP 使用与随后 RI 之间的关联。

结果

调整年龄、性别、体重指数和 PAP 使用前 RI 数量的泊松回归模型未显示 PAP 治疗与 PAP 使用后 RI 发生率之间的关联（发生率比=1.27，95%置信区间：0.86-1.86）。仅包括 PAP 依从性差异的 PAP 用户的敏感性分析得出了类似的结果（发生率比=0.65，95%置信区间：0.32-1.30）。