Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea.
Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea.
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DOI：
10.5664/jcsm.26436
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发表时间：
2006-01
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影响因子：
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通讯作者：
B. Mokhlesi;A. Tulaimat;A. T. Evans;Yue Wang;A. Itani;H. Hassaballa;J. Herdegen;E. Stepanski
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作者：
B. Mokhlesi;A. Tulaimat;A. T. Evans;Yue Wang;A. Itani;H. Hassaballa;J. Herdegen;E. Stepanski
白天高碳酸血症在患有阻塞性睡眠呼吸暂停的病态肥胖患者中很常见，并与严重的并发症有关。我们的目的是量化这些患者坚持气道正压通气对高碳酸血症和缺氧的影响。方法：我们对75例患者进行了回顾性队列研究，采用多变量一般线性模型分析，以确定预测治疗后PaCO 2和PaO 2变化的变量。使用Bootstrap回归方法计算显著预测因子效应的置信区间，并对预测模型进行内部验证。结果预测PaCO 2变化的变量为平均每日正压治疗时间、FEV 1占预测值的百分比和基线PaCO 2（模型R（2）= 0.70）。PaCO 2每小时下降1.84 mm Hg，并在平均每日使用7小时时达到稳定。PaO 2每小时依从性改善约3 mm Hg，治疗4.5小时后达到稳定（模型R2 = 0.48）。每天使用治疗超过4.5小时的患者与粘附较少的患者相比，PaCO 2和PaO 2显著改善（APaCO 2 7.7+/-5 vs 2.4+/-4 mmHg，p <0.001; Δ PaO 2 9.2+/-11 vs 1.8+/-9 mmHg，p <0.001）。对于依从性患者，日间家庭氧疗的需求从30%降至6%（p = .02）。结论：在阻塞性睡眠呼吸暂停高碳酸血症患者中，坚持气道正压通气是PaCO 2和PaO 2改善的重要可变预测因素，其获益在每日治疗5 - 7小时之间达到平台。
BACKGROUND Daytime hypercapnia is common in morbidly obese patients with obstructive sleep apnea and is associated with serious complications. Our objective was to quantify the effect of adherence with positive airway pressure on hypercapnia and hypoxia in these patients. METHODS We performed a retrospective cohort study of 75 patients using a multivariable general linear model analysis to identify variables that predicted changes in PaCO2 and PaO2 after therapy. Bootstrap resampling methods were used to calculate confidence intervals for the effects of significant predictors and to internally validate the predictive models. RESULTS The variables that predicted the change in PaCO2 were average daily hours of positive pressure therapy, FEV1 percentage of predicted, and baseline PaCO2 (model R(2) = 0.70). The PaCO2 dropped 1.84 mm Hg per hour of adherence and plateaued at 7 hours of average daily use. The PaO2 improved by approximately 3 mm Hg per hour of adherence and plateaued after 4.5 hours of therapy (model R2 = 0.48). Patients who used therapy for more than 4.5 hours per day experienced significant improvements in PaCO2 and PaO2 compared with less-adherent patients (APaCO2 7.7+/-5 vs 2.4+/-4 mm Hg, p < .001; delta PaO2 9.2+/-11 vs 1.8+/-9 mm Hg, p < .001). For adherent patients, the need for daytime home oxygen therapy decreased from 30% to 6% (p = .02). CONCLUSION In hypercapnic patients with obstructive sleep apnea, adherence with positive airway pressure is an important modifiable predictor of improvements in PaCO2 and PaO2, and its benefit plateaus between 5 and 7 hours of daily therapy.