Factors influencing adherence to nasal continuous positive airway pressure in obstructive sleep apnea patients in Japan
Factors influencing adherence to nasal continuous positive airway pressure in obstructive sleep apnea patients in Japan
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DOI：
10.1007/s41105-016-0064-8
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发表时间：
2016-10-01
影响因子：
1.1
通讯作者：
Hashimoto, Shu
中科院分区：
文献类型：
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作者：
Uematsu, Akihito;Akashiba, Tsuneto;Hashimoto, Shu
坚持鼻腔持续正压(n-CPAP)治疗是阻塞性睡眠呼吸暂停(OSA)的重要临床要求；然而，一些患者经常发现即使继续治疗也存在困难。我们认为，与OSA的严重程度等客观结果相比，坚持n-CPAP治疗更多地受到每个患者的主观因素的影响，如对OSA的认识和治疗的不良反应。我们调查了在我们的睡眠中心启动n-CPAP的阻塞性睡眠呼吸暂停患者，并获得了至少12个月的随访数据。总共有937名患者接受了问卷调查，其中包括那些已经停止治疗的患者，其中732人完成了问卷调查。根据自我报告的依从性数据，患者被分为三组(未依从性、依从性好和依从性差)。此外，通过问卷调查提取了与治疗有关的各种问题，并将其制成表格，以回顾检查影响依从性的因素。732例1年前开始n-CPAP的患者中，依从率为78.1%。未坚持治疗组的常见问题是呼吸困难、失眠/睡眠不足，以及治疗效果不佳/症状没有改善。同样，空气压力不适和口罩掉落与依从性差密切相关。与多导睡眠图获得的客观数据相比，依从性可能更显著地受到主观预测因素的影响，包括临床症状和伴随治疗的直观主诉。我们的结果表明，在治疗开始后的早期阶段识别具有这些预测因素的患者并对他们进行持续干预可能是朝着更好的依从性发展的第一步。
Adherence to nasal continuous positive airway pressure (n-CPAP) therapy is a clinically important requirement for obstructive sleep apnea (OSA); however, some patients often find difficulty even in continuing with treatment. We suggest that rather than the objective results such as the severity of OSA, adherence to n-CPAP therapy is more greatly influenced by the subjective factors of each patient, such as awareness of OSA, and adverse effects of treatment. We surveyed patients with OSA who initiated n-CPAP at our sleep center, with at least 12 months of follow-up data. In total, 937 patients, including those who had already discontinued therapy, were surveyed via questionnaires, 732 completed questionnaires. According to self-reported adherence data, patients were split into three groups (no-adherence, good adherence, and poor adherence). Furthermore, various issues with treatment were extracted using questionnaires and tabulated to retrospectively examine factors influencing adherence. The adherence rate was 78.1 % among 732 patients who initiated n-CPAP >= 1 year previously. Commonly reported issues in the non-adherence group were respiratory difficulty, insomnia/lack of sleep, and no effect of treatment felt/no improvement in symptoms. Similarly, air pressure discomfort and mask falling were significantly associated with poor adherence. Compared with objective data obtained using polysomnography, adherence may be more significantly influenced by subjective predictors, including clinical symptoms and intuitive complaints accompanying treatment. Our results suggested that the identification of patients with these predictors during the early phase after treatment initiation and continuous intervention for them may be the first step towards developing better adherence.