Schoebel Christoph, Woehrle Holger, Ficker Joachim H, Graml Andrea, Zeman Florian, Fietze Ingo, Young Peter, Arzt Michael
Department of Sleep and Telemedicine, University Duisburg-Essen, Essen, Germany.
Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany.
Ann Am Thorac Soc. 2025 Jan;22(1):130-137. doi: 10.1513/AnnalsATS.202310-913OC.
Adherence to positive airway pressure (PAP) therapy is a common and challenging issue. Although some studies have looked at the impact of initial mask selection, there is a lack of data regarding the impact of a change in mask on adherence to PAP therapy. This study investigated the impact of a mask change or renewal on midterm PAP adherence. German homecare provider data were retrospectively analyzed. Patients aged ≥18 years who started PAP therapy in 2014-2019, had data on the type of device and interface (mask) used, and had mask change/renewal within ≤1 year after starting PAP were eligible. Mask change was defined as switching to a different mask type, whereas mask renewal referred to supply of a replacement mask of the same type. The primary endpoint was change in PAP use after mask change/renewal, overall and in patient subgroups based on previous PAP use (<4 and ≥4 h/night). A total of 12,551 patients were included (71% male; age, 62 ± 12 yr), and previous PAP use was <4 h/night ( = 3,510) or ≥4 h/night ( = 9,041). After mask change/renewal, there was no change in device use overall or in patients with previous use ≥4 h/night. However, in those with PAP use <4 h/night, mask change/renewal was associated with increased device use (+55 min [+57 min for change, +39 min for renewal), and it increased the proportion of days with PAP use ≥4 h/night by 19% (+20% for change, +12% for renewal). In this patient subgroup, early mask change/renewal (within 90 d), higher levels of previous device use, and older age were significant predictors of improving device usage to ≥4 h/night after mask change/renewal. For patients with low PAP adherence on their existing mask system, early intervention to change or renew the mask was associated with clinically relevant improvements in device use.
坚持使用持续气道正压通气（PAP）治疗是一个常见且具有挑战性的问题。尽管一些研究探讨了初始面罩选择的影响，但关于面罩更换对PAP治疗依从性的影响的数据却很缺乏。本研究调查了面罩更换或更新对中期PAP治疗依从性的影响。对德国家庭护理机构的数据进行了回顾性分析。纳入了2014 - 2019年开始PAP治疗、有使用设备和接口（面罩）类型数据且在开始PAP治疗后≤1年内进行面罩更换/更新的≥18岁患者。面罩更换定义为更换为不同类型的面罩，而面罩更新指供应相同类型的替换面罩。主要终点是面罩更换/更新后PAP使用情况的变化，总体情况以及根据之前PAP使用情况（<4小时/晚和≥4小时/晚）划分的患者亚组情况。共纳入12,551例患者（71%为男性；年龄62±12岁），之前PAP使用情况为<4小时/晚（n = 3,510）或≥4小时/晚（n = 9,041）。面罩更换/更新后，总体设备使用情况以及之前使用≥4小时/晚的患者没有变化。然而，在PAP使用<4小时/晚的患者中，面罩更换/更新与设备使用增加相关（增加55分钟[更换增加57分钟，更新增加39分钟]），并且使PAP使用≥4小时/晚的天数比例增加了19%（更换增加20%，更新增加12%）。在这个患者亚组中，早期面罩更换/更新（90天内）、之前较高的设备使用水平和年龄较大是面罩更换/更新后设备使用改善至≥4小时/晚的显著预测因素。对于现有面罩系统PAP依从性低的患者，早期干预更换或更新面罩与设备使用方面具有临床意义的改善相关。
