CAUSES OF CPAP NONADHERENCE

CPAP 不依从的原因

• 批准号: 6110943
• 负责人: TERRI Elizabeth WEAVER
• 金额: $ 21.99万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-09-01 至 1999-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6110943
• 关键词: behavioral /social science research tag; clinical research; health behavior; health care cost /financing; human subject; polysomnography; respiratory airway pressure; respiratory therapy; sleep apnea; therapy compliance

This project is aimed at providing objective data on causes of non- adherence to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) during the first week of treatment. Nasal CPAP is the primary non-surgical treatment for OSA. However, recent evidence indicates that only about half of all patients who accept CPAP actually follow this prescription, and that for the approximately 45% of patients who become non-adherent to CPAP, the pattern of non-adherence is established early in treatment within the first few days of CPAP use are limited and we believe that the development of ways to improve CPAP depends heavily upon first establishing reliable predictors to CPAP non- adherence. Given how early non-adherence to CPAP occurs in patients, we hypothesize that after the first night of home treatment, adherence on subsequent nights will be determined by: 1) patients' pre-treatment perceived self-efficacy (i.e., perceived vulnerability to OSA risks, expectations regarding ability of CPAP to reduce OSA risks, and perception of ability to master demands of CPAP therapy); 2) immediate treatment disease-reduction efficacy (i.e., capability of CPAP treatment to reduce elements of disease severity such as apnea); and 3) immediate treatment- delivery efficacy (i.e., delivery of therapeutic pressure and presence of side effects). In addition, to these three components of our conceptual model, we will also study the predictive value of demographic characteristics and objective and subjective disease severity. A sample size of 200 OSA patients RDI greater than or equal to 15) will be recruited. After their polysomnogram subjects will complete subjective and objective measure of pre-treatment disease severity and perceived self- efficacy. Daily diaries and actigraphs will be completed pre-treatment and during treatment to obtain home measures of subjective objective sleep quality. For the first seven days of treatment, the presence of residual apneic events, airflow limitation, and mask leaks will be monitored in the home using the AutoSet/TM Clinical system (ResMed Corp.). This system will also be used the following 14 days, but only to monitor CPAP use to determine the pattern of CPAP adherence. Presence of side effects will be documented on the diary completed during treatment. The results of the most powerful prediction equation we can derive from this study will be used for the detection of patients most likely to become non-adherent to CPAP therapy and to target the most cost-effective ways to intervene and enhance the use of CPAP by patients with OSA.

该项目的目的是提供非传染性疾病原因的客观数据。 患者对鼻腔持续正压通气(CPAP)的依从性 在治疗的第一周出现阻塞性睡眠呼吸暂停(OSA)。 鼻腔CPAP是阻塞性睡眠呼吸暂停综合征的主要非手术治疗方法。然而，最近 有证据表明，接受CPAP治疗的患者中只有一半左右 实际上遵循这个处方，对于大约45%的人来说 不遵守CPAP的患者，不遵守的模式是 在CPAP使用的头几天内建立的早期治疗是 有限，我们相信改进CPAP的方法的发展 在很大程度上依赖于首先建立可靠的CPAP非预测因子 坚持不懈。考虑到患者早期出现不遵守CPAP的情况，我们 假设在第一晚的家庭治疗后，坚持服用 随后的夜晚将取决于：1)患者的治疗前情况 感知到的自我效能感(即对OSA风险的感知脆弱性， 对CPAP降低OSA风险的能力的期望，以及认知 掌握CPAP治疗要求的能力)；2)立即治疗 减少疾病的疗效(即CPAP治疗的能力 疾病严重程度的因素，如呼吸暂停)；以及3)立即治疗- 传递效力(即传递治疗压力和存在 副作用)。此外，除了我们概念上的这三个组成部分 模型中，我们还将研究人口统计的预测价值 特点及主客观疾病严重程度。一份样品 200名OSA患者的大小(RDI大于或等于15)将 被招募了。在他们的多导睡眠图之后，受试者将完成主观和 治疗前疾病严重程度和自我感觉的客观测量 功效。每日日记和活动记录将在治疗前和 在治疗期间获得主客观睡眠的家庭测量 质量。在治疗的前七天，残留的存在 呼吸暂停事件、气流受限和面罩泄漏将在 使用AutoSet/TM临床系统(ResMed Corp.)。这个系统将会 也可在接下来的14天内使用，但仅用于监测CPAP的使用情况 确定CPAP遵守的模式。副作用的存在将是 在治疗过程中完成的日记中记录的。评选结果 我们从这项研究中得出的最有力的预测方程将是 用于检测最有可能成为不依从者的患者 CPAP疗法和针对性的最具成本效益的干预和 加强阻塞性睡眠呼吸暂停患者对CPAP的使用。