睡眠低氧指标能否预测气道正压治疗的长期依从性？

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠相关呼吸障碍，其特征是反复发生上气道塌陷。持续气道正压（CPAP）是金标准治疗，但依从率较低。夜间低氧可能改变睡眠结构和OSA症状，从而可能影响PAP治疗依从性。本研究旨在评估夜间低氧指标能否预测长期PAP依从性。方法：我们开展了一项真实世界回顾性研究，纳入207例OSA患者。收集了症状、合并症、家庭睡眠呼吸暂停检测（HSAT）指标、处方治疗以及通过设备内置软件获得的客观依从性数据等临床资料。夜间呼吸衰竭（NRF）定义为血氧饱和度低于90%的总睡眠时间（TST90）≥30%。结果：在该队列中，119例患者符合NRF标准。与无NRF的患者相比，这些患者BMI更高、OSA更严重，且COPD患病率更高。随访时，NRF患者表现出显著更好的治疗依从性，并更常报告多种日间和夜间症状改善。时间-事件分析和校正多变量回归显示，TST90≥30%的患者获得良好长期PAP依从性的概率更高。结论：这些发现提示，长时间夜间低氧血症可能识别出更有可能维持长期PAP治疗的患者亚组。

英文摘要

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by recurrent upper airway collapse. Continuous positive airway pressure (CPAP) is the gold standard treatment but is burdened by low adherence rates. Nighttime hypoxia may alter sleep structure and OSA symptoms, potentially affecting PAP treatment adherence. This study aims to evaluate whether nocturnal hypoxia measures could predict long-term PAP adherence. We conducted a real-life, retrospective study including 207 OSA patients. Clinical data were collected on symptoms, comorbidities, home sleep apnea test (HSAT) metrics, prescribed therapy and objective adherence data via in-built device software. Nocturnal respiratory failure (NRF) was defined as a total sleep time with SpO2 < 90% (TST90) ≥ 30%. Among the cohort, 119 patients met the criteria for NRF. These patients exhibited higher BMI, more severe OSA and a higher prevalence of COPD compared to those without NRF. At follow-up, patients with NRF demonstrated significantly better treatment adherence and more frequently reported improvement in several daytime and nighttime symptoms. Time-to-event analysis and adjusted multivariable regressions showed a higher probability of good long-term PAP adherence in patients with TST90 ≥ 30%. These findings suggest that prolonged nocturnal hypoxemia may identify a subgroup of patients more likely to maintain long-term PAP treatment.