Dielesen Julia, Ledwaba-Chapman Lesedi J, Kasetti Pragna, Husain Noori Fatima, Skinner Timothy C, Pengo Martino F, Whiteman Teresa, Asimakopoulou Koula, Merritt Simon, Jones David, Dickel Peter, Pulakal Siddiq, Ward Neil R, Pepperell Justin, Steier Joerg, Sathyapala S Amanda
National Heart and Lung Institute, Imperial College London, London, UK.
King's College London, London, UK.
Thorax. 2025 Apr 15;80(5):300-308. doi: 10.1136/thorax-2024-221763.
High rates of non-adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnoea hamper good clinical outcomes. Current recommendations assumes two behaviours (adherence and non-adherence) and days 7-90 follow-up post-CPAP initiation mitigates against non-adherence.
To investigate associations between early CPAP-usage behaviours and (1) CPAP adherence at month 3 of treatment and (2) sleep centres' treatment pathways (the procedures patients undergo that may affect barriers or facilitators of CPAP adherence).
We conducted growth mixture modelling (GMM) on retrospective data from 1000 patients at 5 UK sleep centres. Night 1 to month 3 telemonitored CPAP-usage data were downloaded from 200 patients per centre who started CPAP in 2019 (100) or 2020 (100). Adherence was defined using accepted criteria (mean CPAP-usage ≥4 hours/night for ≥70% of nights).
GMM identified six distinct CPAP-usage behaviour patterns over month 1. In four (54% of patients), CPAP-usage increased or decreased, in two (remaining 46%), CPAP-usage/non-usage was consistent. 62% of the cohort were non-adherent by month 3, despite pathways following current recommendations. 98% of patients who were non-adherent by month 3 were already non-adherent by month 1. Regression analysis with a separate dataset demonstrated that early CPAP-usage behaviour explained 86% of the variance in CPAP non-adherence at month 3.
These data, supported by previous work, indicate that recommended day 30-90 follow-up is too late to prevent CPAP non-adherence. Determining CPAP-usage behavioural pattern in week 2 identifies risk of CPAP non-adherence at month 3 and permits the possibility of tailored interventions.
阻塞性睡眠呼吸暂停患者对持续气道正压通气（CPAP）治疗的不依从率很高，这妨碍了良好的临床疗效。目前的建议假定存在两种行为（依从和不依从），并且在CPAP治疗开始后的第7至90天进行随访可减少不依从情况。
研究早期CPAP使用行为与（1）治疗第3个月时的CPAP依从性以及（2）睡眠中心的治疗路径（患者接受的可能影响CPAP依从性障碍或促进因素的程序）之间的关联。
我们对英国5个睡眠中心1000例患者的回顾性数据进行了生长混合模型（GMM）分析。从每个中心200例于2019年（100例）或2020年（100例）开始使用CPAP的患者中下载第1晚至第3个月的远程监测CPAP使用数据。依从性采用公认标准定义（平均CPAP使用时间≥4小时/晚，且≥70%的夜晚使用）。
GMM在第1个月内确定了六种不同的CPAP使用行为模式。其中四种模式（占患者的54%）中，CPAP使用量增加或减少，另外两种模式（其余46%）中，CPAP使用/不使用情况保持一致。尽管治疗路径遵循当前建议，但到第3个月时，62%的队列患者不依从。到第3个月不依从的患者中，98%在第1个月时就已不依从。对一个单独数据集进行的回归分析表明，早期CPAP使用行为可解释第3个月时CPAP不依从差异的86%。
这些数据，加上之前的研究结果，表明推荐的第30至90天随访对于预防CPAP不依从来说为时已晚。在第2周确定CPAP使用行为模式可识别第3个月时CPAP不依从的风险，并使针对性干预成为可能。
