Choi Ji Ho, Shin Sungkyoung, Lee Yeji, Ha Tae Kyoung, Suh Sooyeon
Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170, Jomaru-ro, Bucheon 14584, Republic of Korea.
Department of Psychology, Sungshin Women's University, 2, Bomun-ro 34da-gil, Seongbuk-gu, Seoul 02844, Republic of Korea.
Medicina (Kaunas). 2025 Sep 5;61(9):1610. doi: 10.3390/medicina61091610.
Although numerous studies have explored various predictors of positive airway pressure (PAP) adherence, the potential impact of objective sleep scoring data obtained during PAP titration on adherence has not been thoroughly investigated. The objective of this study was to evaluate the association between objective sleep parameters obtained from PAP titration, including sleep efficiency (SE), wake after sleep onset (WASO), and sleep latency (SL), and short-term PAP adherence in individuals with obstructive sleep apnea (OSA). A total of 227 individuals with a confirmed diagnosis of OSA underwent overnight PAP titration and were subsequently divided into adherence and non-adherence groups. Baseline demographic characteristics, clinical data, diagnostic polysomnography results, and PAP titration data were obtained for all subjects. Paired sample -tests were utilized to assess differences in sleep parameters between diagnostic polysomnography and PAP titration within each group. Binomial logistic regression was used to evaluate the predictive value of changes in SE, WASO, and SL for PAP adherence and to determine optimal cut-off values. A χ analysis was conducted to assess the relationship between categorical improvements in SE and WASO and adherence to PAP therapy. Among the study cohort, 176 (77.5%) participants were classified as adherent, while 51 (22.5%) participants were classified as non-adherent. SE during PAP titration (83.3 ± 12.6%) was significantly higher compared to baseline polysomnography (80.9 ± 12.4%, = 0.020), and WASO was significantly reduced (63.9 ± 58.9 min vs. 77.7 ± 67.2 min, = 0.016). No significant difference was observed in SL between the two groups. Logistic regression analysis indicated that increased SE (odds ratio [OR]: 1.025, = 0.039) and decreased WASO (OR: 0.994, = 0.027) both served as significant predictors of PAP adherence, but the overall predictive ability of these indicators was modest (area under the curve 0.60 for SE; 0.62 for WASO). The optimal thresholds distinguishing adherence were ΔSE ≥ 2.39% and ΔWASO < -1.5 min. Participants who exhibited improvements in SE (χ = 5.296, = 0.021) and WASO (χ = 6.877, = 0.009) demonstrated a significantly higher likelihood of adhering to PAP therapy. The findings demonstrate that objective increases in sleep quality, specifically elevated SE and decreased WASO during initial PAP titration, are significantly associated with short-term PAP adherence among patients with OSA.
尽管众多研究探讨了持续气道正压通气（PAP）依从性的各种预测因素，但在PAP滴定期间获得的客观睡眠评分数据对依从性的潜在影响尚未得到充分研究。本研究的目的是评估从PAP滴定中获得的客观睡眠参数，包括睡眠效率（SE）、睡眠开始后觉醒时间（WASO）和睡眠潜伏期（SL），与阻塞性睡眠呼吸暂停（OSA）患者短期PAP依从性之间的关联。共有227名确诊为OSA的个体接受了整夜PAP滴定，随后被分为依从组和非依从组。获取了所有受试者的基线人口统计学特征、临床数据、诊断性多导睡眠图结果和PAP滴定数据。采用配对样本检验来评估每组中诊断性多导睡眠图和PAP滴定之间睡眠参数的差异。二项逻辑回归用于评估SE、WASO和SL变化对PAP依从性的预测价值，并确定最佳临界值。进行χ分析以评估SE和WASO的分类改善与PAP治疗依从性之间的关系。在研究队列中，176名（77.5%）参与者被归类为依从者，而51名（22.5%）参与者被归类为非依从者。PAP滴定期间的SE（83.3±12.6%）显著高于基线多导睡眠图（80.9±12.4%，P = 0.020），且WASO显著降低（63.9±58.9分钟对77.7±67.2分钟，P = 0.016）。两组之间的SL未观察到显著差异。逻辑回归分析表明，SE升高（优势比[OR]：1.025，P = 0.039）和WASO降低（OR：0.994，P = 0.027）均是PAP依从性的显著预测因素，但这些指标的总体预测能力一般（SE的曲线下面积为0.60；WASO为0.62）。区分依从性的最佳阈值为ΔSE≥2.39%和ΔWASO < -1.
