Annunziata Anna, Calabrese Cecilia, Simioli Francesca, Coppola Antonietta, Pierucci Paola, Mariniello Domenica Francesca, Fiorentino Giuseppe
Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi-Cotugno Hospital, 80131 Naples, Italy.
Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
J Clin Med. 2023 Sep 9;12(18):5866. doi: 10.3390/jcm12185866.
Non-invasive ventilation (NIV) is associated with improvement of both morbility and mortality in patients affected by neuromuscular diseases with chronic respiratory failure. Several studies have also shown that long-term NIV positively impacts the patient's quality of life and perception of disease status. Its effectiveness is likely related to the adherence to NIV. Several factors, patient- and not patient-related, may compromise adherence to NIV, such as physical, behavioral, familiar, and social issues. Few data are currently available on the role of psychological factors in influencing NIV adherence.
In this pilot study, we evaluated the adherence to NIV in a group of 15 adult patients with neuromuscular diseases (Duchenne muscular dystrophy, myotonic dystrophy, and amyotrophic lateral sclerosis) in relation to their grade of depression assessed by the Beck Depression Inventory (BDI) questionnaire. Other data were collected, such as clinical features (age and sex), use of anxiolytic drugs, the presence of a family or professional caregiver, the quality of patient-physician relationship, the beginning of psychological support after BDI screening, and the family acceptance of NIV. NIV adherence was definied as the use of NIV for at least 4 h per night on 70% of nights in a month.
The overall rate of NIV adherence was 60%. Based on the BDI questionnaire, patients who were non-adherent to NIV had a higher rate of depression, mainly observed in the oldest patients. The acceptance of NIV by the family and positive physician-patient interaction seem to favor NIV adherence.
Depression can interfere with NIV adherence in patients with neuromuscolar diseases.
无创通气（NIV）与改善患有慢性呼吸衰竭的神经肌肉疾病患者的发病率和死亡率相关。多项研究还表明，长期无创通气对患者的生活质量和疾病状态认知有积极影响。其有效性可能与无创通气的依从性有关。一些因素，包括与患者相关和不相关的因素，可能会影响无创通气的依从性，如身体、行为、家庭和社会问题。目前关于心理因素对无创通气依从性影响的数据很少。
在这项前瞻性研究中，我们评估了15例成年神经肌肉疾病（杜氏肌营养不良症、强直性肌营养不良症和肌萎缩侧索硬化症）患者对无创通气的依从性，并通过贝克抑郁量表（BDI）问卷评估他们的抑郁程度。还收集了其他数据，如临床特征（年龄和性别）、抗焦虑药物的使用情况、是否有家庭或专业护理人员、医患关系质量、BDI筛查后心理支持的开始情况以及家庭对无创通气的接受程度。无创通气依从性定义为一个月内70%的夜晚每晚使用无创通气至少4小时。
无创通气的总体依从率为60%。根据BDI问卷，不依从无创通气的患者抑郁率较高，主要出现在年龄较大的患者中。家庭对无创通气的接受程度和积极的医患互动似乎有利于无创通气的依从性。
抑郁症会干扰神经肌肉疾病患者对无创通气的依从性。
