Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review

0 CRITICAL CARE MEDICINE Canadian Journal of Respiratory Therapy Pub Date : 2024-01-12 DOI:10.29390/001c.92080
Daniel Stevens, Michaela Title, Kathleen Spurr, Debra Morrison
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Abstract

Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). A commonly used definition for PAP therapy adherence is based upon the minimum requirements to receive Medicare coverage in the US, defined as PAP usage of four or more hours per night on 70 percent of nights for at least 30 consecutive days. However, little evidence exists to support this definition for PAP therapy adherence. Therefore, the present study sought to determine the efficacy of the present definition of PAP therapy adherence on longitudinal outcomes in patients with OSA, using objectively measured PAP device usage time. An exploratory longitudinal, retrospective, randomized chart review was done to assess clinical outcomes between patients with OSA who were defined as PAP therapy adherent (n=50) and non-adherent (n=50) during an eight-year observation period. No significant differences were shown between groups for mortality, hospitalizations, or development of co-morbidities during the observation period. However, logistic regression showed significantly higher odds of adherence in male patients compared to female patients (OR=8.519; 95%CI=1.301–55.756; p=0.025) and significantly lower odds of adherence in patients with higher normal (OR=0.039; 95%CI=0.005–0.392; p=0.003), mild excessive (OR=0.039; 95%CI=0.003–0.517; p=0.014), and severe excessive (OR=0.088; 95%CI=0.012–0.635; p=0.016) daytime sleepiness compared to patients with lower normal daytime sleepiness. An increasing number of hospitalizations also corresponded with a significant decrease in odds of being adherent (OR=0.741; 95%CI=0.551–0.995; p=0.046). The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful.
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阻塞性睡眠呼吸暂停患者的气道正压疗法坚持率和疗效:探索性纵向回顾随机病历审查
阻塞性睡眠呼吸暂停(OSA)患者需要接受气道正压(PAP)治疗。通常使用的正压通气疗法坚持治疗的定义是基于美国医疗保险的最低要求,即至少连续 30 天有 70% 的夜晚每晚使用正压通气疗法 4 小时或以上。然而,几乎没有证据支持这一关于 PAP 治疗依从性的定义。因此,本研究试图利用客观测量的 PAP 设备使用时间来确定目前的 PAP 治疗依从性定义对 OSA 患者纵向疗效的影响。本研究采用探索性纵向、回顾性、随机病历审查的方法,评估了在八年观察期内被定义为坚持使用气囊导引器治疗(50 人)和不坚持使用气囊导引器治疗(50 人)的 OSA 患者的临床疗效。在观察期内,两组患者的死亡率、住院率或并发症发生率无明显差异。然而,逻辑回归结果显示,男性患者坚持治疗的几率明显高于女性患者(OR=8.519;95%CI=1.301-55.756;P=0.025),而正常值较高的患者坚持治疗的几率明显低于男性患者(OR=0.039;95%CI=0.005-0.392;p=0.003)、轻度过度(OR=0.039;95%CI=0.003-0.517;p=0.014)和重度过度(OR=0.088;95%CI=0.012-0.635;p=0.016)白天嗜睡与白天嗜睡正常程度较低的患者相比,坚持治疗的几率明显较低。住院次数的增加也与坚持治疗几率的显著下降相对应(OR=0.741;95%CI=0.551-0.995;p=0.046)。目前有越来越多的文献呼吁对具有临床意义的 PAP 治疗依从性定义进行更多的考虑和证据支持,本研究为这些文献提供了支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Canadian Journal of Respiratory Therapy
Canadian Journal of Respiratory Therapy Health Professions-Health Professions (miscellaneous)
CiteScore
2.00
自引率
0.00%
发文量
34
期刊介绍: The CJRT is published four times a year and represents the interests of respiratory therapists nationally and internationally. The CJRT has been redesigned to act as an educational dissemination tool. The CJRT encourages submission of original articles, papers, commentaries, case studies, literature reviews and directed reading papers. Submissions can be sent to Rita Hansen.
期刊最新文献
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