CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities
CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities
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DOI：
10.1016/j.chest.2018.04.010
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发表时间：
2018-09-01
期刊：
影响因子：
9.6
通讯作者：
Mehra, Reena
中科院分区：
文献类型：
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作者：
May, Anna M.;Gharibeh, Tarek;Mehra, Reena
背景：在以白人男性为主的阻塞性睡眠呼吸暂停综合征临床试验中，CPAP依从性不佳限制了可解释性和概括性。我们在一项临床试验中检验了CPAP依从性的预测因素。方法：睡眠呼吸暂停压力研究-一项针对中到重度OSA患者的随机、双盲、假对照试验-包括具有完整8周依从性数据的参与者(n=138)。结果：总体年龄为51+/-12岁，男性占55%，白人占55%，体重指数为36.7+/-7.7 kg/m(2)，呼吸暂停低通气指数中位数为20(四分位数范围13-37)。在单变量分析中，随机化活动CPAP(81分钟；95%可信区间，30-132)、增加年龄(35分钟/十年；95%可信区间，13-57)、白人(78分钟，95%可信区间，26-129)和每周每小时坚持(41分钟，95%可信区间，32-51)，依从性增加。在多变量分析中，积极的CPAP(48分钟，95%CI，6-91)、年龄增加(27分钟/十年，95%CI，10-44)和较高的1周依从性(36分钟/小时，95%CI，27-46)与依从性的改善显著相关。亚组分析显示，白人患者的依从性与治疗臂有更强的相关性，少数族裔患者的年龄增加。年龄和白人种族的增加与女性的依从性有更强的相关性。结论：在这项性别分布接近均匀和少数民族代表较多的试验中，我们发现CPAP分配、年龄增加和早期依从性除了性别和种族特定的依从性差异外，还与更好的依从性相关。这些结果可以为有针对性的临床试验依从性优化策略提供依据。
BACKGROUND: Suboptimal CPAP adherence in OSA clinical trials involving predominantly white men limits interpretability and generalizability. We examined predictors of CPAP adherence in a clinical trial enriched with minorities.METHODS: The Sleep Apnea Stress Study-a randomized, double-blind, sham-controlled trial of patients with moderate-to-severe OSA-included participants with complete 8-week adherence data (n = 138). Overnight 14-channel polysomnography, anthropometry, socioeconomic status, mood questionnaires, and week 1 CPAP adherence were analyzed via adjusted linear models relative to CPAP adherence (average minutes per night usage).RESULTS: Overall, age was 51 +/- 12 years, 55% of the patients were male, 55% were white, BMI was 36.7 +/- 7.7 kg/m(2), and median apnea-hypopnea index was 20 (interquartile range, 13-37). In univariate analyses adherence increased with randomization to active CPAP (81 min; 95% CI, 30-132), increasing age (35 min/decade; 95% CI, 13-57), white race (78 min, 95% CI, 26-129), and per hour of week 1 adherence (41 min, 95% CI, 32-51). Active CPAP (48 min, 95% CI, 6-91), increasing age (27 min/decade, 95% CI, 10-44), and higher 1-week adherence (36 min/h, 95% CI, 27-46) were significantly associated with improved adherence in multivariable analyses. Subgroup analyses showed stronger associations of adherence with treatment arm in whites and increasing age in minorities. Increasing age and white race were more strongly associated with adherence in women.CONCLUSIONS: In this trial with near-even sex distribution and high ethnic minority representation, we identified CPAP assignment, increasing age, and early adherence to be associated with improved adherence in addition to sex-specific and race-specific adherence differences. These results can inform targeted clinical trial adherence optimization strategies.