行为技能培训干预课程提升现役伴有阻塞性睡眠呼吸暂停的军人对气道正压通气治疗的依从性。

Behavioral KSA Intervention Class to Boost Positive Airway Pressure Adherence Among Active Duty Military Personnel With Obstructive Sleep Apnea.

机构信息

Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA.

Department of Family, Community, and Preventive Medicine, Drexel University College of Medicine, Philadelphia, PA 19104, USA.

出版信息

Mil Med. 2024 Aug 19;189(Suppl 3):350-356. doi: 10.1093/milmed/usae126.

DOI:10.1093/milmed/usae126

PMID:39160792

Abstract

INTRODUCTION

Obstructive sleep apnea (OSA) is a treatable cause of daytime sleepiness and associated medical problems that can negatively impact soldier readiness and performance. This study examined adherence to positive airway pressure (PAP) by soldiers who were newly diagnosed with OSA and prescribed PAP therapy and participated in a Knowledge, Skills, and Attitudes (KSA) behavioral intervention class.

MATERIALS AND METHODS

The KSA was a one-time, interactive 90-minute class attended by up to 10 patients per class. PAP adherence was examined using Medicare standard at 30-, 60-, 90-, and 180 days post class. The analytic sample comprised 379 active duty patients (93% men; mean age 40.21 ± 8.06) categorized into 3 groups: KSA (n = 235), did not show (DNS; n = 61), and mandatory education class (MEC; n = 83). The MEC group comprised patients from an education class in a previous year.

RESULTS

Baseline scores on the apnea hypopnea index, body mass index, sleepiness, insomnia severity, and age were non-significant among the 3 groups. At 30 days, significantly more patients in KSA (48%) and MEC (51%) were adherent than the DNS group (16%). At 60 days, the adherence rates for the KSA, DNS, and MEC were significantly different at 39%, 22%, and 27%, respectively. At 90- and 180 days, the adherence rates among the KSA, DNS, and MEC groups did not differ significantly at 34%, 17%, and 26% (90 days) and 34%, 27%, and 25% (180 days), respectively. Consistently, more patients in KSA were adherent than those in DNS and MEC, except at 30 days. Additionally, adherence rates for KSA intervention declined more gradually over the 6 month period. The mean PAP usage on nights used was 4.6 hours that computed to a 34% non-use rate based on an optimal 7-hour/night sleep time.

CONCLUSION

KSA could be a behavioral intervention that enhances PAP adherence with a booster session implemented at the 90 days mark.

摘要

简介

阻塞性睡眠呼吸暂停（OSA）是一种可治疗的日间嗜睡病因，并伴有可能影响士兵战备和表现的相关医疗问题。本研究调查了新诊断为 OSA 并接受持续气道正压通气（PAP）治疗和参加知识、技能和态度（KSA）行为干预课程的士兵对 PAP 的依从性。

材料和方法

KSA 是一个一次性的、互动式的 90 分钟课程，每个班级最多有 10 名患者参加。使用医疗保险标准在课程结束后 30、60、90 和 180 天检查 PAP 依从性。分析样本包括 379 名现役患者（93%为男性；平均年龄 40.21±8.06），分为 3 组：KSA（n=235）、未显示（DNS；n=61）和强制教育课程（MEC；n=83）。MEC 组由前一年教育课程中的患者组成。

结果

3 组间的呼吸暂停低通气指数、体重指数、嗜睡、失眠严重程度和年龄的基线评分无显著性差异。在 30 天时，KSA（48%）和 MEC（51%）组的患者明显比 DNS 组（16%）更能坚持治疗。在 60 天时，KSA、DNS 和 MEC 的依从率分别为 39%、22%和 27%，差异有统计学意义。在 90 和 180 天，KSA、DNS 和 MEC 组的依从率分别为 34%、17%和 26%（90 天）和 34%、27%和 25%（180 天），差异无统计学意义。一致的是，KSA 组的患者比 DNS 和 MEC 组的患者更坚持治疗，除了在 30 天的时候。此外，KSA 干预措施的依从率在 6 个月期间下降得更缓慢。根据最佳 7 小时/夜睡眠时间，使用的平均 PAP 时间为每晚 4.6 小时，计算得出不使用率为 34%。