Analysis Of Factors Influencing Adherence To Continuous Positive Airway Pressure Therapy In Obstructive Sleep Apnea Syndrome

Objective: To investigate the adherence and its influencing factors on the patients with Obstructive Sleep Apnea Syndrome(OSAS)who using continuous positive airway pressure(CPAP)treatment in the first two weeks.Methods: A questionnaire was designed according to the study objectives,and clinical data were collected from October 2021 to October 2022 from patients diagnosed with OSAS by polysomnography(PSG)at the Affiliated Hospital of Yan’an University and the General Hospital of the People’s Liberation Army in Beijing,who were all treated with CPAP for the first time.All patients purchased their own home ventilators.In order to investigate the potential influences on CPAP therapy adherence in patients with OSAS,patients were divided into groups based on how much time they spent using the machine during the 2-week observation period.Results: A total of 296 cases were collected,mainly middle-aged obese men.During the two-week observation period,the average wearing time was(5.59±1.44)h/night,with good adherence accounting for 69.6% and the average wearing time was(6.39 ±0.84)h/night.The demographic characteristics of patients(age,sex,height,weight,BMI,ethnic group,education level,work status and marital status)are not the influencing factors of adherence.In terms of disease,post-titrated residual AHI was the influencing factor of CPAP treatment adherence,the smaller the residual AHI,the better the adherence;baseline AHI,residual AHI after 2 weeks of treatment,AHI decrease(including post-titrated AHI decrease and AHI decrease after 2 weeks of home treatment),longest duration of apnea,mean time of apnea,lowest blood oxygen saturation at night,and mean oxygen saturation after night were not statistically different between the two groups;In addition,there was no difference in comorbidity between the two groups.There were statistical differences in CPAP treatment pressure(maximum pressure,average pressure and minimum pressure)and treatment mode(single-level automatic pressure and double-level fixed pressure)between the two groups.The higher CPAP treatment pressure,the worse patient adherence.Single-level automatic pressure mode can promote the adherence of CPAP treatment,while double-level fixed pressure mode will limit the adherence of CPAP treatment;In addition,the wearing time of titration night was also found to be statistically different between the two groups.The longer the wearing time of titration night,the better the adherence of patients,but there was no statistical difference in the selection of oral and nasal mask types.The comfort of getting up in the morning with CPAP was also found to be different between the two groups.The higher the comfort of getting up in the morning,the better the adherence of OSAS patients with CPAP.Among the side effects of CPAP treatment,dry nose and mouth is the most common side effect of CPAP treatment(50%),and other common side effects include holding your breath in the chest,uncoordinated breathing,uncomfortable facial compression and intolerance,among which the difference between the two groups is statistically significant.The results of binary Logistic regression analysis showed that there was an independent positive correlation between the patient’s night wearing time and CPAP treatment adherence,and the night wearing time of titration with good adherence was 1.48 times(1.207 ～ 1.815)longer than that with poor adherence.Conclusion:(1)The adherence of CPAP treatment for OSAS patients in this group was 69.6%,and the average wearing time was(6.39±0.84)h.(2)The influencing factors of CPAP treatment adherence of OSAS patients are divided into:(1)promoting factors,such as residual AHI after titration,titration night machine time,single level automatic pressure mode,morning comfort;(2)restriction factor,including maximum pressure for CPAP treatment,average pressure,minimum pressure,double-level fixed pressure mode,breathing disharmony,and facial compression discomfort.(3)The titration night wearing time is an independent influencing factor of CPAP treatment for OSAS patients.