摘要目的 分析阻塞性睡眠呼吸暂停(OSA)患者持续气道正压通气(CPAP)治疗的长期依从性.方法 采用前瞻性研究方法对2009年5月至2013年12月在广东省人民医院睡眠呼吸障碍诊治中心诊断并接受CPAP治疗的OSA患者进行长期随访,探讨其治疗的长期依从性.OSA的诊断、压力滴定和CPAP治疗均采用中心外睡眠诊疗模式,以治疗后第1、3、6、12个月及之后的每年定期1次与专科医师面对面形式完成随访,内容包括患者主观症状、CPAP治疗的依从性、对患者定期教育及不良反应的处理,并分为依从性好与差两组进行统计学分析.结果 随访截至2015年12月,共入选77例患者,73例完成随访,随访时间2～6年,平均(3.93±1.29)年,总体CPAP治疗依从性为54.8％ (40/73),平均用机时间(4.02±1.87)h/晚.长期依从性趋势为治疗初始3个月升高,随后下降,至第2年随访点后又升高.依从性好组治疗的依从性初始3个月呈上升趋势,随后下降,第1年随访点后稳定至第3年,再次下降,至第4年随访点后再次升高.依从性差组自治疗开始即呈下降趋势,到第2年有一小段上升,后呈直线下降.多因素分析显示长期依从性与第1周自动压力滴定时间(P ＜0.001)、气流监测时间(P＜0.01)及压力滴定次数(P＜0.05)相关;与年龄、白天嗜睡、氧减指数、焦虑、抑郁等均无显著相关(均P＞0.05).结论 OSA患者CPAP治疗的长期依从性呈曲线式改变,依从性的升高与定期随访有关.患者初期的诊治配合度可预测长期依从性.

abstractsObjective To explore the continuous positive airway pressure (CPAP) therapy compliance in patients with obstructive sleep apnea (OSA).Methods This prospective study recruited a group of subjects from May 2009 to December 2013 who were diagnosed and had accepted CPAP treatment in Sleep Center of Guangdong General Hospital,and the patients were followed-up regularly for long-term and assessed the CPAP treatment compliance.The patients were diagnosed,had pressure titration and CPAP treatment through out of center sleep test.The subjects were followed-up for 1 st,3rd,6th,12th month,and each year regularly after accepting the CPAP treatment in Sleep Center by face to face follow-up with specialist physicians.Physicians followed-up the patients' subjective symptoms,CPAP adherence,patient education and side effect solutions.The patients were classified into good and poor compliance groups,and statistical analysis was done between the two groups.Results There were 77 cases enrolled until December 2015,only 73 patients completed the study.The patients were followed-up about 2-6 years,the average was (3.93 ± 1.29) years,the compliance accounted for 54.8％ (40/73),and the average compliance was (4.02 ± 1.87) hours/night.The trend of the long-term compliance showed that there was a gradual increase within the first 3 months of CPAP treatment and then the compliance decreased;it then increased gradually after the first two years.The good compliance group showed that the compliance increased gradually in the initial 3 months,and then fell;from the first year to the 3rd year,the compliance was stable;after the 3rd year there was a drop and the compliance tended to increase again after the 4th year.The poor compliance group showed the compliance had a downward trend from the beginning of the first two years,then after a brief rise,the compliance decreased linearly.Multivariate analysis showed that long-term compliance was not associated with age,daytime sleepiness (ESS),oxygen desaturation index (ODI),anxiety,depression (P ＞ 0.05),etc.However,it was associated with the time of the titration treatment (P ＜ 0.001),the time of the flow monitored (P ＜ 0.01) and the number of the pressure titration within one week (P ＜ 0.05).Conclusions Long-term compliance shows a curve change,the increased compliance is related with the regular follow-up.Long-term compliance can be predicted by the degree of cooperation with the initial diagnosis and treatment.