伴有失眠和阻塞性睡眠呼吸暂停的患者对上气道刺激疗法的使用减少。
Reduced usage of upper airway stimulation therapy in patients with comorbid insomnia and obstructive sleep apnea.
机构信息
Thomas Jefferson University Sleep Disorders Center, Philadelphia, Pennsylvania.
Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania.
出版信息
J Clin Sleep Med. 2023 Dec 1;19(12):1997-2004. doi: 10.5664/jcsm.10752.
STUDY OBJECTIVES
Upper airway stimulation (UAS) is a hybrid surgical-medical device used to treat moderate-to-severe obstructive sleep apnea (OSA). Comorbid insomnia and OSA (COMISA) is present in ∼50% of these patients. Our aim was to study UAS outcomes and adherence in patients with COMISA.
METHODS
A retrospective review of 379 patients with OSA who underwent UAS implantation at a single institution between 2014 and 2021. Demographics, OSA severity metrics, and insomnia data were collected. Patients were categorized into OSA alone (OSAa) or COMISA. Objective adherence data were collected from device downloads during follow-up. Data were analyzed with using R Studio (R Foundation for Statistical Computing, Vienna, Austria) and Prism (Boston, MA, USA).
RESULTS
Of the 274 patients included, 148 had COMISA (54.0%) and 126 OSAa (46.0%). Average follow-up time was 2.5 years and OSAa had more males than COMISA ( < .001). Patients with COMISA had higher insomnia severity index scores than OSAa preoperatively (16 vs 8.7; = .003). All groups showed significant decreases in objective and self-reported OSA outcomes postoperatively, but there was no difference between COMISA and OSAa. Patient with COMISA had decreased device usage (4.9 vs 5.8 h/night; = .015) and paused therapy more often than patients with OSAa (1.4 vs 0.4 pauses/night; < .001). Multivariate linear regression, when controlling for sex as a covariate, showed insomnia to be an independent predictor of lower UAS hours/night and more pauses/night ( < .01).
CONCLUSIONS
Patients with COMISA use UAS therapy for shorter durations and require more breaks from therapy when compared with those with OSAa. Future research is needed to explore the underlying mechanism and improve UAS treatment adherence in patients with COMISA.
CITATION
Kaffenberger TM, Chandna M, Kaki P, et al. Reduced usage of upper airway stimulation therapy in patients with comorbid insomnia and obstructive sleep apnea. . 2023;19(12):1997-2004.
研究目的
上气道刺激（UAS）是一种混合手术-医学装置，用于治疗中重度阻塞性睡眠呼吸暂停（OSA）。约 50%的这些患者存在合并失眠和 OSA（COMISA）。我们的目的是研究患有 COMISA 的患者的 UAS 治疗结果和依从性。
方法
对 2014 年至 2021 年间在一家机构接受 UAS 植入术的 379 例 OSA 患者进行回顾性分析。收集人口统计学、OSA 严重程度指标和失眠数据。将患者分为单纯 OSA（OSAa）或 COMISA。从随访期间的设备下载中收集客观依从性数据。使用 R Studio（维也纳，奥地利，R 基金会的统计计算）和 Prism（波士顿，MA，美国）进行数据分析。
结果
在 274 例患者中，148 例患有 COMISA（54.0%），126 例 OSAa（46.0%）。平均随访时间为 2.5 年，OSAa 中的男性多于 COMISA（<.001）。术前 COMISA 患者的失眠严重指数评分高于 OSAa（16 对 8.7；=.003）。所有组在术后均表现出客观和自我报告的 OSA 结果显著改善，但 COMISA 和 OSAa 之间无差异。COMISA 患者的设备使用时间（4.9 对 5.8 小时/夜；=.015）和暂停治疗的次数（1.4 对 0.4 次/夜；<.001）均低于 OSAa 患者。在控制性别作为协变量的多变量线性回归中，失眠是 UAS 每夜使用时间和暂停治疗次数减少的独立预测因素（<.01）。
结论
与 OSAa 患者相比，患有 COMISA 的患者使用 UAS 治疗的持续时间更短，并且需要更多的治疗暂停。需要进一步研究以探索潜在机制并提高 COMISA 患者的 UAS 治疗依从性。
引文
Kaffenberger TM, Chandna M, Kaki P, et al. 在上气道刺激治疗中，合并失眠和阻塞性睡眠呼吸暂停的患者使用时间更短，暂停治疗的次数更多。. 2023;19(12):1997-2004.
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