Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):373-380. doi: 10.1093/milmed/usae133.
Obstructive sleep apnea (OSA) is prevalent among U.S. military personnel, but adherence to positive airway pressure (PAP) treatment is suboptimal. This study sought to identify factors that predict the adherence to PAP therapy of active duty military patients newly diagnosed with OSA.
The study was a retrospective cross-sectional analysis of 239 active duty military patients (94% men, mean age 40.0 ± 7.8 years), who were admitted into PAP therapy and participated in a single 90-minute behavioral intervention session. The session included a self-assessment of sleep trouble, sleep distress, impact of sleep on functioning, emotional difficulty from sleep, stress appraisal, and beliefs about OSA and PAP. PAP usage data of the patients were analyzed at 30-, 60-, and 180 days post-intervention using descriptive statistics and multivariable linear regression analysis.
Positive airway pressure adherence of at least 4 hours nightly usage decreased slightly over the course of the study; mean number of days used over a 30-day timeframe at the 30-, 60-, and 180-day mark were 15.6, 14.9, and 14.1 days, respectively. On nights used, PAP usage remained consistent at 4.8 to 5.0 hours over the 30-, 60-, and 180-day mark. Age, apnea-hypopnea index, readiness, self-efficacy or confidence in treatment implementation, and worries about sleep were statistically significant predictors of adherence. Furthermore, worries about sleep negatively affected PAP usage hours on nights used, regardless of meeting adherence criterion, in the early phase of treatment and in the long run at the 180-day mark.
Readiness for therapy, self-efficacy, confidence in putting into action the treatment plan, and worries about sleep are modifiable variables that may be targeted in programs to boost PAP adherence and usage among the military population. Future studies should explore the predictive aspects of each of these variables and identify interventions to improve them.
阻塞性睡眠呼吸暂停（OSA）在美国军人中较为普遍，但对正压通气（PAP）治疗的依从性并不理想。本研究旨在确定预测新诊断为 OSA 的现役军人患者对 PAP 治疗依从性的因素。
这是一项回顾性的横断面分析研究，共纳入 239 名现役军人患者（94%为男性，平均年龄 40.0±7.8 岁），他们接受 PAP 治疗，并参加了一次 90 分钟的行为干预课程。该课程包括对睡眠问题、睡眠困扰、睡眠对功能的影响、睡眠引起的情绪困难、压力评估以及对 OSA 和 PAP 的信念进行自我评估。使用描述性统计和多变量线性回归分析，在干预后 30、60 和 180 天分析患者的 PAP 使用数据。
至少每晚使用 4 小时的正压通气依从性在研究过程中略有下降；在 30 天、60 天和 180 天的时间框架内，平均使用天数分别为 15.6、14.9 和 14.1 天。在使用的夜晚，PAP 使用量在 30 天、60 天和 180 天的标记处保持在 4.8 到 5.0 小时之间。年龄、呼吸暂停低通气指数、准备情况、实施治疗的自我效能或信心以及对睡眠的担忧是依从性的统计学显著预测因素。此外，无论是否达到依从性标准，在治疗的早期阶段和在 180 天的标记处的长期阶段，对睡眠的担忧都会对使用 PAP 的夜间使用时间产生负面影响。
治疗准备情况、自我效能、实施治疗计划的信心以及对睡眠的担忧是可改变的变量，可以作为提高军队人群 PAP 依从性和使用率的方案的目标。未来的研究应该探讨这些变量的预测方面，并确定改善这些变量的干预措施。
