Predictors of Initial CPAP Prescription and Subsequent Course with CPAP in Patients with Central Sleep Apneas at a Single Center.
Predictors of Initial CPAP Prescription and Subsequent Course with CPAP in Patients with Central Sleep Apneas at a Single Center.
复制标题
单一中心中枢性睡眠呼吸暂停患者初始 CPAP 处方和后续 CPAP 疗程的预测因素。
DOI：
10.1007/s00408-023-00657-z
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发表时间：
2023
期刊：
影响因子：
5
通讯作者：
Sundar,KrishnaM
中科院分区：
文献类型：
--
作者：
Locke,BrianW;Sellman,Jeffrey;McFarland,Jonathan;Uribe,Francisco;Workman,Kimberly;Sundar,KrishnaM
目的指南建议考虑进行持续气道正压通气（CPAP）治疗中枢性睡眠呼吸暂停（CSA）的初步试验。然而，实践模式差别很大。本研究探讨了预测的CPAP在中枢性呼吸暂停患者的初始试验，以及这些因素是否预测足够的治疗反应，在患者接受初始CPAP trial.MethodsCharts的睡眠研究后，在2016-2018年在一个单一的中心接受CSA诊断代码的患者进行了审查。从电子健康记录中提取患者因素、初始治疗处方和随后的治疗变化。回归模型用于估计与初始CPAP处方相关的因素和CPAP反应充分的可能性（无后续治疗变化和无治疗中断）。结果429/588例（73%）中枢性呼吸暂停患者接受了CPAP的初始试验。年龄较小、通过家庭睡眠测试诊断、中枢性呼吸暂停的非阿片类病因以及诊断时中枢性呼吸暂停的比例较低与初始CPAP试验的可能性较高独立相关。较低比例的中枢性呼吸暂停与较高的充分反应概率相关，而当前吸烟和阿片类药物相关的中枢性呼吸暂停预测CPAP试验不成功。一项新的发现是，年龄较大的预测一个较低的可能性，最初的CPAP处方，但没有预测一个令人不满的反应CPAP.ConclusionClinicians可能不正确地权衡某些临床和睡眠研究的特点，当决定是否要试验CPAP与中枢性呼吸暂停的患者。
PurposeGuidelines recommend considering an initial trial of continuous positive airway pressure (CPAP) to treat central sleep apnea (CSA). However, practice patterns vary widely. This study investigated predictors for an initial trial of CPAP in patients with central apneas and whether those factors predict adequate treatment response in patients receiving an initial CPAP trial.MethodsCharts of patients receiving a diagnostic code for CSA following a sleep study during 2016–2018 at a single center were reviewed. Patient factors, initial treatment prescriptions, and subsequent changes to therapy were extracted from electronic health records. Regression models were used to estimate factors associated with an initial CPAP prescription and the likelihood of an adequate CPAP response (no subsequent therapy change and no discontinuation of therapy) among patients prescribed CPAP.Results429/588 (73%) patients with central apneas received an initial trial of CPAP. Younger age, diagnosis by home sleep testing, non-opiate etiology of central apneas, and a lower proportion of central apneas at diagnosis were independently associated with a higher likelihood of an initial CPAP trial. A lower proportion of central apneas was associated with a higher probability of adequate response, while current smoking and opiate-related central apneas predicted an unsuccessful CPAP trial. A new finding was that older age predicted a lower likelihood of an initial CPAP prescription but did not predict an unsatisfactory response to CPAP.ConclusionClinicians may incorrectly weigh certain clinical and sleep study characteristics when deciding whether to trial CPAP for patients with central apneas.