Predictors of long-term compliance with continuous positive airway pressure

Predictors of long-term compliance with continuous positive airway pressure
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DOI：
10.1136/thx.2010.135848
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发表时间：
2010-09-01
期刊：
THORAX
影响因子：
10
通讯作者：
Stradling, John R.
Stradling, John R.
中科院分区：
医学1区
文献类型：
--
作者：
Kohler, Malcolm;Smith, Debbie;Stradling, John R.

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背景：关于持续气道正压通气（CPAP）长期依从性的客观评估数据很少。没有单一的因素一直被确定为预测持续CPAP use.Methods坚持和协会与客观CPAP的使用进行了检查，在1994年和2005年之间开始CPAP治疗的3900例患者中的639。Kaplan-Meier生存分析用于估计仍在接受CPAP治疗的患者比例。结果CPAP治疗后的中位随访时间为3.9（1.5-6.9）年，平均使用CPAP时间为6.2（4.5-7.3）h/夜。5年和10年后坚持CPAP治疗的患者百分比分别为81%和70%。多变量分析，包括性别、年龄、颈围、埃普沃思嗜睡评分、氧饱和度下降指数（ODI）和研究参与情况，表明ODI是唯一与CPAP长期依从性独立相关的临床变量（每1起事件的HR =0.97，p15-30/h=0.68，p=0.100，95% CI 0.43 - 1.08; ODI组>30-60/h=0.37，p60/h=0.17，p=0.001，结论大多数睡眠呼吸障碍患者长期使用CPAP治疗，睡眠呼吸障碍的严重程度与CPAP治疗的有效性有关。呼吸紊乱而不是嗜睡决定了CPAP治疗的长期坚持。
Background There are very few data on objectively assessed long-term compliance with continuous positive airway pressure (CPAP). No single factor has been consistently identified as predictive of continued CPAP use.Methods Adherence to and associations with objective CPAP use were examined in 639 of 3900 patients in whom CPAP treatment was started between 1994 and 2005. Kaplan-Meier survival analyses were used to estimate the proportion of patients still on CPAP. Cox regression models were used to explore the effects of covariates on continued use of CPAP.Results The median (IQR) follow-up time after initiating CPAP therapy was 3.9 (1.5-6.9) years and the average use of CPAP was 6.2 (4.5-7.3) h/night. The percentage of patients adherent to CPAP after 5 and 10 years was 81% and 70%, respectively. Multivariate analysis, including gender, age, neck circumference, Epworth Sleepiness Score, oxygen desaturation index (ODI) and research study participation, indicated that ODI was the only clinical variable independently associated with long-term adherence to CPAP (HR per 1 event=0.97, p15-30/h=0.68, p=0.100, 95% CI 0.43 to 1.08; for ODI group >30-60/h=0.37, p60/h=0.17, p=0.001, 95% CI 0.06 to 0.48).Conclusions The majority of patients with sleep-disordered breathing are using CPAP in the long term and the severity of sleep-disordered breathing rather than sleepiness determines long-term adherence to CPAP therapy.