Compliance with Positive Airway Pressure Treatment for Obstructive Sleep Apnea
1
조회
0
다운로드
11
인용
0
참고문헌
키워드
초록
Objectives. Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients. Methods. We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7 of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors. Results. After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twentyfour patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P= 0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=- 0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other. Conclusion. The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.
Abstract
Objectives. Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients. Methods. We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7 of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors. Results. After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twentyfour patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P= 0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=- 0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other. Conclusion. The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.
참고문헌 (19)
- Loube DI, "Indications for positive airway pressure treatment for adult obstructive sleep apnea patients: a consensus statement", Chest, 115(3), pp.863~866 (1999)
- McArdle N, "Long-term use of CPAP therapy for sleep apnea", hypopnea syndrome, 1999, pp.159(4), 1108~1114
- Engleman HM, "Improving CPAP use by patients with the sleep apnea", hypopnea syndrome, 2003, pp.7(1), 81~99
- Kakkar RK, "Positive airway pressure treatment for obstructive sleep apnea", Chest, 132(3), pp.1057~1072 (2007)
- Aloia MS, "Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy", Chest, 127(6), pp.2085~2093 (2005)
- Chobanian AV, "The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure:the JNC 7 report", JAMA, 289(19), pp.2560~2572 (2003)
- Pepin JL, "Effective compliance during the first 3 months of continuous positive airway pressure: a European prospective study of 121 patients", Am J Respir Crit Care Med, 160(4), pp.1124~1129 (1999)
- Galetke W, "Comparison of automatic and continuous positive airway pressure in a nightby-night analysis: a randomized, crossover study", Respiration, 75(2), pp.163~169 (2008)
- Marshall NS, "Randomised trial of compliance with flexible (C-Flex) and standard continuous positive airway pressure for severe obstructive sleep apnea", Sleep Breath, 12(4), pp.393~396 (2008)
- Sin DD, "Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study", Chest, 121(2), pp.430~435 (2002)
- Gay P, "Positive Airway Pressure Task Force;Standards of Practice Committee, et al. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults", Sleep, 29(3), pp.381~401 (2006)
- Kushida CA, "Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep related breathing disorders", Sleep, 29(3), pp.375~380 (2006)
- Kribbs NB, "Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea", Am Rev Respir Dis, 147(4), pp.887~895 (1993)
- Stepnowsky CJ Jr, "Nasal CPAP treatment for obstructive sleep apnea: developing a new perspective on dosing strategies and compliance", J Psychosom Res, 54(6), pp.599~605 (2003)
- Hukins C, "Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial", Sleep, 27(8), pp.1512~1517 (2004)
- Malhotra A, "Obstructive sleep apnoea", Lancet, 360(9328), pp.237~245 (2002)
- Happel A, "Pressure-relief continuous positive airway pressure vs constant continuous positive airway pressure: a comparison of efficacy and compliance", Chest, 130(4), pp.1018~1024 (2006)
- Ballard RD, "Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure", J Clin Sleep Med, 3(7), pp.706~712 (2007)
- Campos-Rodriguez F, "Long-term effect of continuous positive airway pressure on BP in patients with hypertension and sleep apnea", Chest, 132(6), pp.1847~1852 (2007)