Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects.
Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects.
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DOI：
10.2147/nss.s286403
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发表时间：
2020
影响因子：
3.4
通讯作者：
Heraganahally SS
中科院分区：
文献类型：
--
作者：
Garg H;Er XY;Howarth T;Heraganahally SS
在为期两年的研究期间（2018 年和 2019 年），评估澳大利亚北领地地区和偏远人群中被诊断患有阻塞性睡眠呼吸暂停 (OSA) 的患者中姿势性睡眠呼吸暂停 (POSA) 的患病率及其预测因素。在总共 1463 名接受诊断性多导睡眠监测 (PSG) 的成年患者中，有 946 名患者符合纳入研究的条件，其中对 810 名连续睡眠 > 4 小时且仰卧位和侧卧位睡眠时间≥ 30 分钟的 OSA（呼吸暂停低通气指数 (AHI) ≥ 5）患者进行了评估。如果仰卧位 AHI 与侧位 AHI 之比≥2，则认为患者患有 POSA。使用模型模拟评估了使用持续正压气道治疗 (CPAP) 或体位治疗 (PT) 对疾病严重程度的可能比较影响。共有 495/810 (61%) 患者患有 POSA，大多数是男性（68% vs 60%，p=0.013）和非土著澳大利亚人（93% vs 87%，p=0.004）。与非 POSA 患者相比，POSA 患者更年轻（平均差异 2.23 岁（95% CI 0.27, 4.19）），肥胖程度较低（BMI 平均差异 3.06（95% CI 2.11, 4.01）），OSA 严重程度较轻（p < 0.001），并且报告饮酒比例较高（72% vs 62%，p=0.001）。使用模拟模型，如果 POSA 患者使用 PT，三分之二 (323/495, 65%) 的 OSA 严重程度将得到显着改善，五分之一 (92/495, 19%) 的患者表现出完全缓解。与模拟 CPAP 治疗相比，大多数（444/495，90%）将显示出显着改善，三分之一（162/495，33%）将显示完全解决。 POSA 需要得到常规认可，并将体位治疗纳入实践，特别是在偏远地区和发展中国家，当有有效的方法来监测体位治疗时。
To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and one-third (162/495, 33%) will display complete resolution. POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.