CAUSES OF CPAP NONADHERENCE

CPAP 不依从的原因

• 批准号: 6349177
• 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: 2000
• 资助国家: 美国
• 起止时间: 2000-09-01 至 2001-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6349177
• 关键词: behavioral /social science research tag; clinical research; health behavior; health care cost /financing; human subject; personal log /diary; polysomnography; respiratory airway pressure; respiratory disease /disorder 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客观数据， 患者对持续气道正压通气（CPAP）的依从性 阻塞性睡眠呼吸暂停综合征（OSA）的患者。 鼻CPAP是OSA的主要非手术治疗方法。但最近的 有证据表明，只有大约一半的接受CPAP的患者 实际上遵循这个处方，对于大约45%的 不依从CPAP的患者，不依从的模式是 在CPAP使用的最初几天内， 有限的，我们认为，发展的方法，以改善CPAP 在很大程度上取决于首先建立可靠的预测CPAP非 坚持。考虑到患者早期不依从CPAP，我们 假设在家庭治疗的第一个晚上后， 随后的夜晚将取决于：1）患者的预治疗 感知的自我效能（即，对OSA风险的感知脆弱性， 对CPAP降低OSA风险能力的预期，以及对CPAP的认知 掌握CPAP治疗要求的能力）; 2）立即治疗 减少疾病的功效（即，CPAP治疗降低 疾病严重程度的要素，如呼吸暂停）;以及3）立即治疗- 递送功效（即，治疗压力的输送和存在 副作用）。此外，我们的概念的这三个组成部分， 模型，我们还将研究人口统计学的预测价值， 特征以及客观和主观疾病严重程度。样品 200名OSA患者的RDI大于或等于15）， 招募的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的客观测量和自我感知， 功效每日日记和活动记录仪将在治疗前完成， 在治疗期间获得主观和客观睡眠的家庭测量结果 质量.在治疗的前七天， 呼吸暂停事件、气流限制和面罩泄漏将在 使用AutoSet/TM临床系统（瑞思迈公司）在家中进行。该系统将 也可以在接下来的14天内使用，但仅用于监测CPAP的使用， 确定CPAP依从性的模式。副作用的存在将是 记录在治疗期间完成的日记中。的结果 我们从这项研究中得出的最有力的预测方程是 用于检测最有可能成为非依从性的患者， CPAP治疗和针对性干预的最具成本效益的方法， 增加OSA患者CPAP的使用。