The Compliance and Effectiveness of Continuous Positive Airway Pressure on the Patient of Obstructive Sleep Apnea

• Main Authors: Hang Liang-wen, 杭良文
• Other Authors: Lan Shou-Jen
• Format: Others
• Language: en_US
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/84898705331408173574

博士 === 亞洲大學 === 健康產業管理學系健康管理組 === 101 === Part I Better Sleep Quality Improves the CPAP Compliance in Patients with OSA Objectives: An extensive use of continuous positive airway pressure (CPAP) has been shown to have greater clinical benefit for most patients with obstructive Sleep apnea (OSA). Patient compliance remains a major limiting factor to the effectiveness of CPAP. This study sought to determine the potential and quantifiable factors affecting OSA patients to undertake CPAP treatment by comparing the polysomnographic parameters recorded during diagnosis and titration between persistent users and non-users of CPAP. Methods: Patients with moderate-to-severe OSA attended diagnostic polysomnography (PSG) and CPAP titration at the sleep center of China Medical University Hospital were included for this study. A total of 312 patients were divided to persistent users and non-users of CPAP according to treatment with and without in-home CPAP following titration and a 7-day trial use. Patient characteristics and their polysomnographic parameters were analyzed for comparing sleep efficacy and quality between persistent users and non-users. Results: Total sleep time, sleep efficiency, and minimum SaO2 were statistically significant different between persistent users and non-users during CPAP titration. The overall sleep quality was also improved among persistent users. Conclusions: CPAP adherence was associated with longer Total sleep time (TST), better sleep efficiency, lower minimum SaO2, and improved sleep quality during CPAP titration. Appropriate CPAP devices, experienced sleep technicians, and comfortable environment were key elements potentially influencing patients' decision-making of CPAP adoption. Part 2: Do Personality in OSA patients reduce motivation to purchase CPAP machine. Objectives: Use of continuous positive airway pressure (CPAP) has been shown to be clinically beneficial for most patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Patient compliance remains a major limiting factor to the effectiveness of CPAP. This study sought to determine the factors that may contribute to the decision of purchasing mechanical ventilation including personality. Methods: Patients with moderate-to-severe OSAHS who attended diagnostic polysomnography (PSG) and CPAP titration were included in this study. After personality types were determined using a questionnaire, 101 OSAHS patients with Type-D personality were selected and matched at a ratio of 1:1 to OSAHS patients with Non type-D personality. The factors that might affect the decision of purchasing CPAP were analyzed using a conditional logistic regression model . Results: Characteristic differences were only observed in income and sleep habit with or without a partner between the patients with Type-D and non Type-D personalities. Type-D personality was not significantly associated with the motivation of purchasing a CPAP machine, and EES was the only predicting variable in this study. Conclusions: CPAP adherence was associated with Type-D personality. More studies using population-based and longitudinal designs with randomly selected OSAS patients are needed to correct the potential bias of participant inclusion and to assess the long term impacts of Type-D personality on health status among OSAS patients. Part 3 In view of these relevant evidence supporting the association of OSAHS with NAFLD, this study aimed to determine the incidence of NAFLD among OSASH patients, to evaluate whether CPAP treatment contributes to those with these two disorders in a prospective and population-based study in Taiwan, followed-up over a period of 10 years, and to investigate the incidences and effects of comorbidities. To determine whether OSAHS is a risk factor for the development of NAFLD and to compare the relative risks between OSAHS patients with and without CPAP treatment, we measured the hazards ratios (HRs) of NAFLD by using the stratified Cox proportional hazards model adjusting for age, gender, and comorbidities. All data management and calculation of HRs was performed using the SAS System (version 9.3; SAS Institute, Cary, NC). Cumulative incidence was analyzed via the Statistical Package for the Social Sciences (version 10.0; SPSS Inc, Chicago, IL).Our observations from the cohort data suggested that the mechanisms thereby OSAHS increasing the incidence of NALFD are likely associated with the both settings, insulin resistance and intermittent hypoxia (nocturnal hypoxemia). This study also suggests that treatment of OSAHS with CPAP may delay the development or reduce the incidences of NALFD. More evidence is also needed on how to manage comorbidities in OSAHS. Comorbidities not only adds challenges to treatment, but also increases the complexity of patient care, as well as adding to the economic burden of disease. Further interventional studies are required to demonstrate whether CPAP treatment results in diminished severity of NASLD and/or other comorbidities.