摘要目的:探讨公务员人群阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）筛查、干预的新模式及其影响因素。方法:入选2017年9—12月在广东省一公务员单位门诊部进行年度体检的在职公务员1 241例，对其先进行柏林问卷筛查OSA高危患者，然后采用3型便携式睡眠监测（home sleep testing，HST）仪对高危人群进行OSA诊断。对诊断为OSA的患者进行免费的持续气道正压通气（continuous positive airway pressure，CPAP）干预、随访。分析该职业人群中高危OSA患者睡眠监测接受度，OSA患病率，CPAP初始治疗应答率和依从性趋势及影响因素。结果:共1 036例公务员职业人群完成了柏林问卷筛查，其中22.0%（228/1 036）柏林问卷阳性，被认为OSA高危患者。对228例OSA高危患者进行免费的HST筛查，32.5%（74/228）拒绝行睡眠监测。154例接受睡眠监测，103例最终被诊断为OSA，其中轻度41例（40.2%），中度35例（33.3%），重度27例（26.5%）。在公务员职业人群中估计的OSA患病率为9.9%（103/1 036）。为所有的OSA患者提供免费的自动调节的持续气道正压通气（auto-CPAP）治疗，仅有55.3%（57/103）接受初始CPAP治疗。多因素Logistic回归分析表明，接受治疗与OSA的严重程度呈正相关（ OR=5.65，95% CI：1.007~31.693）；与简明健康状况调查表（36-Item Short Form of the Medical Outcomes Survey，SF-36）中一般健康状况评分呈负相关（ OR=0.968，95% CI：0.938~0.998）。自我决定的行为干预和不需要治疗的自我观念是不接受治疗的原因。第一周初始CPAP治疗随访，70.2%（40/57）患者依从性≥4 h/晚［平均为5.0（4.0，6.0） h/晚］；17例（29.8%）<4 h/晚［平均为0（0，2.0） h/晚］。单因素分析显示，入睡困难，焦虑、抑郁障碍，存在戴机的不良反应者（鼻罩不适感以及憋气感）依从性更差。长期依从性逐渐下降，至2年随访期，仅有22.0%的患者依从性良好。 结论:即使给予免费的睡眠筛查及疾病干预模式，睡眠筛查、CPAP治疗接受度仍低，CPAP治疗短期及长期依从性差。ESS评分、是否患有高血压以及对疾病的认知影响对睡眠监测的接受度。精神心理因素以及存在戴机的不良反应影响CPAP治疗依从性。

abstractsObjective:To explore the new mode of screening and intervention for obstructive sleep apnea (OSA) in civil servants and its influencing factors.Methods:From September to December 2017, 1 241 civil servants who underwent annual physical examination in the outpatient department of a civil servant unit in Guangdong province were enrolled. They were screened for high-risk patients with OSA by Berlin questionnaire, and then those high-risk patients would receive type 3 home sleep testing (HST). Patients diagnosed with OSA were given free continuous positive airway pressure (CPAP) intervention and follow-up. The HST acceptance of high-risk OSA patients, OSA prevalence, CPAP initial treatment response rate and adherence trend and influencing factors were analyzed among the civil servants.Results:A total of 1036 civil servants completed the Berlin Questionnaire screening, of which 22.0% (228/1 036) were positive for the Berlin Questionnaire and were considered to be at high risk for OSA. A total of 228 high-risk OSA patients underwent free HST screening, and 32.5% (74/228) refused sleep monitoring. 154 people received sleep monitoring, 103 people were eventually diagnosed with OSA, of which 41 were mild (40.2%), 35 were moderate (33.3%), and 27 were severe (26.5%). The estimated prevalence of OSA among civil servants was 9.9% (103/1 036). All OSA patients were provided with free auto-CPAP treatment, and only 55.3% (57/103) received initial CPAP treatment. Multivariate logistic regression analysis showed that the CPAP treatment response rate was positively correlated with the severity of OSA ( OR=5.65, 95% CI: 1.007―31.693); it was negatively correlated with the general health status score of the 36-Item Short Form of the Medical Outcomes Survey (SF-36, OR=0.968, 95% CI: 0.938―0.998).Self-determined behavioral interventions and self-perceptions that treatment not needed were the reasons for not receiving treatment.In the first week of initial CPAP treatment follow-up, 70.2% (40/57) patients had good adherence ≥4 h/night, and the median adherence was 5.0(4.0, 6.0) h/night. The adherence of 17 cases (29.8%) was less than 4 h/night, and the median adherence was 0 (0, 2.0) h/night. Univariate analysis showed that those with difficulty falling asleep, anxiety, depression, and adverse reactions to CPAP (nasal mask discomfort and suffocation) had worse adherence. The long-term adherence to CPAP treatment gradually declined, and by the 2-year follow-up period, only 22.0% of patients had good adherence. Conclusions:Even with free sleep screening and disease intervention mode, the acceptance of sleep monitoring and CPAP treatment is still low, and the short-term and long-term adherence to CPAP is poor. Epworth sleepiness Score, hypertension, and disease cognition affected the acceptance of sleep monitoring. Psycho psychological factors and adverse reactions to CPAP affect patient compliance.