积极的气道压力治疗的坚持和阻塞性睡眠呼吸暂停的结果:一个探索性的纵向追溯随机图表审查
Daniel Stevens1, Michaela Title1, Kathleen Spurr2
1School of Health and Human Performance Dalhousie University.
概括
目前对阻塞性睡眠呼吸暂停 (OSA) 治疗坚持的正气道压力 (PAP) 的定义可能在临床上没有意义. 这项研究发现,使用这个定义,坚持和不坚持的患者之间的健康结果没有显著差异.
科学领域:
- 睡眠医学 睡眠医学
- 呼吸系统医学 呼吸系统医学
- 临床结果研究研究
背景情况:
- 阳性气道压力 (PAP) 治疗是阻塞性睡眠呼吸暂停 (OSA) 的标准治疗方法.
- 目前的坚持定义,通常基于医疗保险覆盖标准 (例如,在70%的夜晚30天内每晚4个小时以上),缺乏对临床疗效的强有力的支持证据.
- 目标 PAP 设备使用数据对于评估合规性定义至关重要.
研究的目的:
- 评估目前基于医疗保险的PAP治疗坚持的Medicare定义对OSA患者纵向临床结果的有效性.
- 确定标准依从性定义是否准确地反映了有意义的临床改进.
主要方法:
- 在8年的时间里,对100名OSA患者 (50名附属患者,50名非附属患者) 的探索性,纵向,回顾性图表审查.
- 客观的PAP设备使用数据被用来根据既定标准来定义遵守.
- 评估了临床结果,包括死亡率,住院和并发性疾病的发展.
主要成果:
- 在坚持和不坚持的群体之间没有观察到死亡率,住院或并发症发展的显著差异.
- 与女性相比,男性患者的坚持率明显更高.
- 增加白天的嗜睡和更多的先前住院病例与显著较低的坚持率有关.
结论:
- 这些发现挑战了目前对PAP治疗坚持的标准定义的临床实用性.
- 需要进一步的研究,以建立一个临床上有意义的定义PAP坚持OSA患者.
- 基于证据的方法来定义PAP的坚持是有必要的,以确保治疗的有效性.
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