OBJECTIVE MEASUREMENT OF PATTERNS OF NASAL CPAP USE BY PATIENTS WITH OBSTRUCTIVE SLEEP-APNEA
OBJECTIVE MEASUREMENT OF PATTERNS OF NASAL CPAP USE BY PATIENTS WITH OBSTRUCTIVE SLEEP-APNEA
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DOI：
10.1164/ajrccm/147.4.887
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发表时间：
1993-04-01
期刊：
影响因子：
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通讯作者：
DINGES, DF
中科院分区：
文献类型：
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作者：
KRIBBS, NB;PACK, AI;DINGES, DF
睡眠中上呼吸道阻塞（OSAS）的治疗主要是通过患者自我给予持续气道正压通气（CPAP）。为了获得CPAP使用模式的客观证据，从两个城市站点收集了35名OSAS患者的信息，这些患者共接受CPAP治疗3，743天。给患者提供CPAP机器，该机器包含微处理器和监测器，该监测器在每个24小时的每一天中的每一分钟测量面罩处的实际压力，平均每个患者106天。他们不知道CPAP机器内的监视器。将监测输出与患者的诊断状态、治疗前临床和人口统计学特征以及CPAP使用、问题、副作用以及日间疲劳和嗜睡方面的随访自我报告进行比较。在监测的天数中，患者平均尝试使用CPAP的天数为66 +/- 37%。当使用CPAP时，平均使用时间为4.88 +/- 1.97 h。然而，患者报告的CPAP使用持续时间高估了实际使用时间69 ± 110分钟（p < 0.002）。第一个月使用CPAP的频率和持续时间可靠地预测了第三个月的使用（p < 0.0001）。尽管大多数（60%）患者声称每晚使用CPAP，但35例患者中只有16例（46%）符合定期使用的标准，即在70%的监测日至少使用4小时CPAP。相对于不太经常使用者，这16名患者有更多年的教育（p = 0.05），更有可能在专业职业中工作。在治疗前，他们倾向于报告更多的白天嗜睡事件（p = 0.062）和更少的执行任务的能力（p = 0.069），在使用CPAP后的随访中，他们报告了对CPAP的更高满意度（p = 0.025）和白天能量水平的改善（p = 0.046）。最常提到的CPAP问题是“不便”（54%）和“鼻塞”（46%），尽管面罩导致“幽闭恐惧症”的投诉是19名不经常使用CPAP的患者中唯一明显更常见的问题（p < 0.02）。令人惊讶的是，35例患者中只有2例在超过或等于70%的天数内使用CPAP至少7 h，这表明在接受CPAP治疗的OSAS患者中，频繁、长时间、高质量的睡眠相对罕见。我们的结论是，OSAS患者的实际CPAP使用福尔斯达不到每晚提供优质睡眠的治疗目标，并且患者的自我报告对夜间和夜间之间的实际使用的估计相当差。需要努力加强CPAP的使用，特别是在治疗的早期。
Obstruction of the upper airway during sleep (OSAS) is widely treated by having patients self-administer nasal continuous positive airway pressure (CPAP). To obtain objective evidence of the patterns of CPAP use, information was gathered from two urban sites on 35 OSAS patients who were prescribed CPAP for a total of 3,743 days. Patients were given CPAP machines that contained a microprocessor and monitor that measured actual pressure at the mask for every minute of each 24-h day for an average of 106 days per patient. They were not aware of the monitor inside the CPAP machines. Monitor output was compared with patients' diagnostic status, pretreatment clinical and demographic characteristics, and follow-up self-reports of CPAP use, problems, side effects, and aspects of daytime fatigue and sleepiness. Patients attempted to use CPAP an average of 66 +/- 37% of the days monitored. When CPAP was used, the mean duration of use was 4.88 +/- 1.97 h. However, patients' reports of the duration of CPAP use overestimated actual use by 69 +/- 110 min (p < 0.002). Both frequency and duration of CPAP use in the first month reliably predicted use in the third month (p < 0.0001). Although the majority (60%) of patients claimed to use CPAP nightly, only 16 of 35 (46%) met criteria for regular use, defined by at least 4 h of CPAP administered on 70% of the days monitored. Relative to less regular users, these 16 patients had more years of education (p = 0.05), and were more likely to work in professional occupations. At pretreatment they tended to report more episodes of daytime sleepiness (p = 0.062) and less ability to perform tasks (p = 0.069), and at follow-up after CPAP use they reported greater satisfaction with CPAP (p = 0.025) and an improved level of daytime energy (p = 0.046). The most frequently cited problems with CPAP were ''inconvenience'' (54%) and ''stuffy nose'' (46%), although the complaint that the mask caused ''claustrophobia'' was the only problem identified significantly more often by the 19 patients who used CPAP less regularly (p < 0.02). Surprisingly, only 2 of the 35 patients studied used CPAP for at least 7 h on greater-than-or-equal-to 70% of days, suggesting that frequent, long-duration, quality sleep is a relatively rare occurrence in OSAS patients treated with CPAP. We conclude that actual CPAP use by OSAS patients falls short of the therapeutic goal of providing quality sleep all night, every night, and that patients' self-reports are rather poor estimates of actual use within and between nights. Efforts to enhance CPAP use are needed, especially early in treatment.