在患有阻塞性睡眠呼吸暂停的患者中,六种早期CPAP使用行为模式决定了CPAP坚持的峰值,并允许量身定制的干预
Julia Dielesen1, Lesedi J Ledwaba-Chapman2, Pragna Kasetti1
1National Heart and Lung Institute, Imperial College London, London, UK.
Thorax
|February 27, 2025
概括
在阻塞性睡眠呼吸暂停患者的早期持续正气道压力 (CPAP) 使用模式预测了坚持. 在第二周之前识别不坚持的风险,可以及时,定制的干预措施,以改善治疗结果.
科学领域:
- 睡眠医学 睡眠医学
- 呼吸系统医学 呼吸系统医学
- 行为科学 行为科学
背景情况:
- 不坚持持续正气道压力 (CPAP) 的高比例会对阻塞性睡眠呼吸暂停 (OSA) 的临床结果产生负面影响.
- 目前的治疗指导方针假设一种二进制的坚持/不坚持模式,并建议在第7至90天之间进行随访,这可能不足以解决不坚持.
研究的目的:
- 为了检查早期CPAP使用行为和开始后3个月的坚持之间的关联.
- 调查早期CPAP使用模式与OSA患者的睡眠中心治疗途径之间的关系.
主要方法:
- 增长混合模型 (GMM) 应用于5个英国睡眠中心1000名OSA患者的追溯远程监控CPAP使用数据.
- 对2019年或2020年开始CPAP的患者,分析了从第一夜到第三个月的数据.
- 坚持被定义为平均CPAP使用时间≥4小时/晚上在≥70%的夜晚.
主要成果:
- 在第一个月内确定了六种不同的CPAP使用行为模式,其中46%的患者表现出一致的使用/不使用.
- 到第3个月,62%的队列患者不坚持,至关重要的是,98%的这些患者在第1个月已经不坚持了.
- 早期CPAP使用行为解释了CPAP在第3个月不坚持的差异的86%.
结论:
- 标准30至90天的随访期过晚,无法有效预防OSA患者的CPAP不遵守.
- 在第2周确定患者的CPAP使用行为模式,可以准确预测3个月后的不坚持风险.
- 早期识别可以实施量身定制的干预措施,以改善CPAP的坚持和治疗成功.
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