Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients.
Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients.
复制标题
DOI：
10.5664/jcsm.6188
复制
发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Harneet K. Walia;S. Griffith;Nicolas R. Thompson;D. Moul;N. Foldvary-Schaefer;R. Mehra
中科院分区：
文献类型：
--
作者：
Harneet K. Walia;S. Griffith;Nicolas R. Thompson;D. Moul;N. Foldvary-Schaefer;R. Mehra
研究目的我们假设睡眠呼吸障碍(SDB)和高血压(HTN)患者的气道正压(PAP)可以改善患者报告的预后(PRO)。方法采用问卷调查法对SDB和HTN患者入院时和入院后1年内的嗜睡[Epworth嗜睡评分(ESS)]、抑郁[患者健康问卷9(PHQ-9)]和疲劳[疲劳严重程度评分(FSS)]进行了回顾性调查。根据基线年龄、性别、种族、体重指数、顽固性高血压(RHTN)状态、心脏病和糖尿病病史以及重复测量之间的相关性，使用多变量线性混合效应模型估计PRO变化。用PAP交互作用项检验年龄和种族(均值变化，95%可信区间)。结果共检查HTN和SDB患者894例。130例(15%)有基础RHTN(年龄58±12岁，男性52.9%，BMI 36.2±9.1 kg/m2)。在多变量模型中，嗜睡ESS(-2.09，95%CI：-2.37，-1.82)、PHQ-9(-1.91，95%CI：-2.25，-1.56)和FSS评分(-4.06，95%CI：-4.89，-3.22)显著改善。通过PAP效应交互作用观察到显著的种族差异(P<；所有职业者为0.0001)；高加索人比非高加索人有更大的进步。PAP与年龄的交互作用对ESS(p=0.04)和phq-9(p=0.0003)有显著意义，表明在年轻患者中改善更大。结论：在这组以临床为基础的高血压队列中，观察到SDB患者广泛的PRO结构域对PAP反应的持续改善；高加索人和年轻患者受益更大。
STUDY OBJECTIVES We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN). METHODS Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation. PRO changes were estimated using multivariable linear mixed-effect models adjusted for baseline age, sex, race, body mass index, resistant hypertension (RHTN) status, cardiac and diabetes history, and correlation between repeated measurements. Age and race by PAP interaction terms (mean change, 95% CI) were examined. RESULTS 894 patients with HTN and SDB were examined. 130 (15%) had baseline RHTN (age 58 ± 12 y, 52.9 % male, BMI 36.2 ± 9.1 kg/m2). In multivariable models, a significant improvement in sleepiness ESS (-2.09, 95% CI: -2.37, -1.82), PHQ-9 (-1.91, 95% CI: -2.25, -1.56), and FSS scores (-4.06 95% CI: -4.89, -3.22) was observed. A significant race by PAP effect interaction was observed (p < 0.0001 for all PROs); Caucasians had greater improvements than non-Caucasians. The interaction term of effect of PAP and age was significant for ESS (p = 0.04) and PHQ-9 (p = 0.0003), indicating greater improvement in younger patients. CONCLUSIONS Consistent improvement of broad PRO domains in response to PAP in SDB was observed in this clinic-based hypertensive cohort; Caucasians and younger patients derived greater benefit.