Yu Wen-Yi, Xu Li-Wen, Sun Shu-Tong, Zheng Yi-Xi, Jing Tian-Yu, Xu Gang, Tang Tie-Yu, Chu Cheng
Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.
Front Neurol. 2025 Jun 20;16:1604935. doi: 10.3389/fneur.2025.1604935. eCollection 2025.
Positive Airway Pressure (PAP) treatment is the recommended initial approach for moderately severe obstructive sleep apnea patients. Its efficacy is contingent upon patient compliance, yet compliance studies in combined stroke and obstructive sleep apnea (OSA) patients have demonstrated lower rates of compliance, and most of the influencing factors are unregulated. This study aimed to explore short-term respiratory therapy compliance status among stroke patients with obstructive sleep apnea and identify modifiable influencing factors to improve compliance and create personalized plans.
This study was conducted among 254 stroke patients with OSA. Data were collected using standardized questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Self-Efficacy Measure for Sleep Apnea (SEMSA). Polysomnography (PSG) was used to assess objective sleep parameters. Logistic regression analysis was performed to identify predictors of PAP adherence.
The overall compliance rate of stroke patients with OSA was 27.2%, and self-efficacy in patients with stroke combined with OSA (perceived risk (OR = 2.23, 95% CI = 1.74 ~ 2.83), expected effect of treatment (OR = 1.23, 95% CI = 1.23 ~ 1.4), self-assessment (OR = 1.17, 95% CI = 1.06 ~ 1.30), total score on the Health Beliefs Scale (OR = 1.20, 95% CI = 1.13 ~ 1.26)), objective sleep condition (total sleep duration (OR = 1.00, 95% CI = 1.00 ~ 1.01), sleep efficiency (OR = 1.00, 95% CI = 1.00 ~ 1.04)) (OR = 1.01, 95% CI = 1.00 ~ 1.02), N1 phase duration (OR = 1.01, 95% CI = 1.00 ~ 1.01)), OSA severity (AHI (OR = 1.04, 95% CI = 1.02 ~ 1.06), and longest hypoventilation time (s) (OR = 1.02, 95% CI = 1.00 ~ 1.03), and oxygen desaturation ≥3 index (ODI) (OR = 1.03, 95% CI = 1.01 ~ 1.05) were the risk factors affecting their PAP treatment.
Patients with stroke combined with OSA have poorer compliance to PAP treatment (27.2%) compared with the general population, and this compliance is closely related to self-efficacy, objective sleep, and the severity of OSA. In the future, we can combine with the Health Belief Models to formulate an individualized intervention plan based on patients' self-efficacy.
气道正压通气（PAP）治疗是中重度阻塞性睡眠呼吸暂停患者推荐的初始治疗方法。其疗效取决于患者的依从性，但针对合并中风和阻塞性睡眠呼吸暂停（OSA）患者的依从性研究显示，依从率较低，且大多数影响因素未得到规范。本研究旨在探讨中风合并阻塞性睡眠呼吸暂停患者的短期呼吸治疗依从性状况，并确定可改变的影响因素，以提高依从性并制定个性化方案。
本研究在254例中风合并OSA患者中进行。使用标准化问卷收集数据，包括匹兹堡睡眠质量指数（PSQI）、爱泼华嗜睡量表（ESS）和睡眠呼吸暂停自我效能量表（SEMSA）。采用多导睡眠图（PSG）评估客观睡眠参数。进行逻辑回归分析以确定PAP依从性的预测因素。
中风合并OSA患者的总体依从率为27.2%，中风合并OSA患者的自我效能（感知风险（OR = 2.23，95%CI = 1.74～2.83）、预期治疗效果（OR = 1.23，95%CI = 1.23～1.4）、自我评估（OR = 1.17，95%CI = 1.06～1.30）、健康信念量表总分（OR = 1.20，95%CI = 1.13～1.26））、客观睡眠状况（总睡眠时间（OR = 1.00，95%CI = 1.00～1.01）、睡眠效率（OR = 1.00，95%CI = 1.00～1.04）（OR = 1.01，95%CI = 1.00～1.02）、N1期时长（OR = 1.01，95%CI = 1.00～1.01））、OSA严重程度（呼吸暂停低通气指数（AHI）（OR = 1.04，95%CI = 1.02～1.06）、最长低通气时间（秒）（OR = 1.02，95%CI = 1.00～1.03）、氧饱和度下降≥3指数（ODI）（OR = 1.03，95%CI = 1.01～1.05））是影响其PAP治疗的危险因素。
与一般人群相比，中风合并OSA患者对PAP治疗的依从性较差（27.2%），且这种依从性与自我效能、客观睡眠及OSA严重程度密切相关。未来，我们可结合健康信念模型，根据患者的自我效能制定个性化干预方案。
