基于路径分析的方法探讨抑郁症状对阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性的影响

doi:10.12114/j.issn.1007-9572.2022.0265

中国全科医学 ›› 2022, Vol. 25 ›› Issue (33): 4179-4184.DOI: 10.12114/j.issn.1007-9572.2022.0265

所属专题：精神卫生最新文章合集；睡眠问题专题研究

基于路径分析的方法探讨抑郁症状对阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性的影响

衣荟洁¹^,², 李建祥², 张驰¹, 许力月¹, 董霄松¹, 韩芳¹^,^*()

1.100044　北京市，北京大学人民医院呼吸睡眠医学中心
2.100044　北京市，北京大学护理学院

收稿日期:2022-06-07 修回日期:2022-06-28 出版日期:2022-11-20 发布日期:2022-09-08
通讯作者: 韩芳
衣荟洁，李建祥，张驰，等.基于路径分析的方法探讨抑郁症状对阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性的影响[J].中国全科医学，2022，25（33）：4179-4184. [www.chinagp.net]
作者贡献：衣荟洁负责文章的构思与设计，研究的实施与可行性分析，撰写论文；李建祥负责数据收集；张驰负责数据的整理与统计学处理；衣荟洁、张驰负责对结果进行分析与解释；许力月负责论文的修订；董霄松、韩芳负责文章的质量控制及审校；韩芳对文章整体负责，监督管理。
基金资助:
国防科技创新特区163计划

Effect of Depressive Symptoms on the Adherence to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients Using a Path Analysis-based Approach

YI Huijie¹^,², LI Jianxiang², ZHANG Chi¹, XU Liyue¹, DONG Xiaosong¹, HAN Fang¹^,^*()

1.Respiratory and Sleep Medicine Center, Peking University People's Hospital, Beijing 100044, China
2.School of Nursing, Peking University, Beijing 100044, China

Received:2022-06-07 Revised:2022-06-28 Published:2022-11-20 Online:2022-09-08
Contact: HAN Fang
About author:
YI H J, LI J X, ZHANG C, et al. Effect of depressive symptoms on the adherence to continuous positive airway pressure in obstructive sleep apnea patients using a path analysis-based approach [J]. Chinese General Practice, 2022, 25 (33) : 4179-4184.

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摘要/Abstract

摘要： 背景持续气道正压通气（CPAP）治疗效果与阻塞性睡眠呼吸暂停（OSA）患者的使用依从性密切相关，心理社会特征是CPAP治疗依从性的重要影响因素之一，抑郁症状对CPAP治疗依从性的影响尚需进一步探讨。目的探讨OSA患者抑郁症状与CPAP治疗依从性及其中间变量间的作用通路。方法选取2019年5月至2021年7月在北京大学人民医院呼吸睡眠医学中心确诊并接受CPAP治疗的OSA患者177例，评估患者基本信息、疾病严重程度及CPAP治疗依从性。以流调中心抑郁水平评定量表-10（CES-D-10）评估患者抑郁症状，以失眠严重程度指数量表（ISI）评估失眠情况，以睡眠功能结局问卷-10（FOSQ-10）评估日间功能，以生存质量简表-12（SF-12）评估生存质量，运用路径分析的方法确定各变量之间的关系。结果 OSA患者抑郁症状的检出率较高（19.7%，35/177），OSA患者的抑郁症状与失眠呈正相关（r=0.65，P<0.05），与日间功能（r=-0.51，P<0.05）及生存质量（rPCS=-0.27，P<0.05；rMCS=-0.72，P<0.05）呈负相关。抑郁症状与患者CPAP治疗依从性无直线相关关系（r=0.09，P>0.05），但其能通过降低日间功能增加OSA患者对CPAP的治疗依从性（β=0.078，P<0.01）。结论抑郁症状与OSA患者的失眠、生存质量下降及日间功能降低相关，并可通过降低OSA患者日间功能增加其对CPAP的治疗依从性。

关键词: 睡眠呼吸暂停，阻塞性, 抑郁, 正压呼吸, 治疗依从性, 路径分析

Abstract:

Background

The treatment adherence is closely related to the effect of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) , which is also strongly influenced by patients' psychosocial characteristics. However, the influence of depression symptoms on the adherence to CPAP needs to be further explored.

Objective

To evaluate the relationship of depression symptoms with adherence to CPAP, and the pathwaybetween the associated factors in OSA patients.

Methods

A total of 177 patients who were diagnosed with OSA and treated with CPAP in the Respiratory and Sleep Medicine Center, Peking University People's Hospital from May 2019 to July 2021 were selected. The general information, disease severity and adherence to CPAP were evaluated. The prevalence of depression symptoms was measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) . The severity of insomnia was assessed by the Insomnia Severity Index (ISI) . The influence of daytime sleepiness on activities of daily living was measured by the 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) . The 12-item Short Form Health Survey (SF-12) was used to evaluate the quality of life. The relationships among variables were determined by path analysis.

Results

The prevalence of depressive symptoms in OSA patients was relatively high (19.7%, 35/177) in our study. Depression symptoms were associated with increased insomnia prevalence (r=0.65, P<0.05) , and decreased levels of activities of daily living (r=-0.51, P<0.05) and quality of life (r_PCS=-0.27, P<0.05; r_MCS=-0.72, P<0.05) . In addition, depressive symptoms had no relationship on the adherence to CPAP (r=0.09, P>0.05) , but could increase the adherence to CPAP by decreasing the activities of daily living (β=0.078, P<0.01) .

Conclusion

Depressive symptoms were significantly associated with insomnia, decreased quality of life and activities of daily living in OSA patients, and could increase patients' adherence to CPAP through decreasing the activities of daily living.

Key words: Sleep apnea, obstructive, Depression, Positive-pressure respiration, Patient compliance, Path analysis

衣荟洁,李建祥,张驰,等. 基于路径分析的方法探讨抑郁症状对阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性的影响[J]. 中国全科医学, 2022, 25(33): 4179-4184. DOI: 10.12114/j.issn.1007-9572.2022.0265.
YI Huijie,LI Jianxiang,ZHANG Chi, et al. Effect of Depressive Symptoms on the Adherence to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients Using a Path Analysis-based Approach[J]. Chinese General Practice, 2022, 25(33): 4179-4184. DOI: 10.12114/j.issn.1007-9572.2022.0265.

图/表 4

表1 治疗依从性良好组患者和治疗依从性差组患者的临床资料比较

Table 1 Comparison of clinical data between obstructive sleep apnea patients with good and poor adherence to continuous positive airway pressure

组别	例数	年龄（±s，岁）	男性〔n（%）〕	BMI （±s，kg/m²）	AHI （±s，次/ h）	CESD-10评分（±s，分）	ISI评分（±s，分）	FOSQ-10得分（±s，分）	PCS （±s，分）	MCS （±s，分）
依从性良好组	118	45.1±11.2	113（63.8）	28.3±3.7	40.7±23.7	7.3±5.3	10.5±5.3	15.3±2.7	41.2±7.3	50.5±10.9
依从性差组	59	41.7±9.6	54（30.5）	28.1±3.5	38.1±21.5	6.3±4.9	8.78±4.5	16.2±2.6	43.7±5.9	53.6±8.3
t（χ²）值		-1.95	1.32^a	-0.25	-0.72	-1.13	-2.08	2.01	2.29	1.93
P值		0.05	0.25	0.79	0. 47	0.25	0.03	0.04	0.02	0.05

表2 OSA患者抑郁症状与生存质量的身体健康、心理健康、失眠严重程度以及日间功能的相关性分析

Table 2 Correlation analysis of depressive symptoms measured by the CES-D-10 with physical function measured by the physical component summary，mental function measured by the mental component summary，severity of insomnia assessed by the ISI，and activities of daily living measured by the FOSQ-10 in obstructive sleep apnea patients

项目	CES-D-10评分	PCS	MCS	ISI评分	FOSQ-10得分	治疗依从性
PCS	-0.27^a	—	—	—	—	—
MCS	-0.72^a	0.21^a	—	—	—	—
ISI评分	0.65^a	-0.31^a	-0.48^a	—	—	—
FOSQ-10得分	-0.51^a	0.39^a	0.53^a	-0.49^a	—	—
治疗依从性	0.09	-0.16^a	-0.16^a	0.13	-0.16^a	—
AHI	0.07	-0.05	-0.07	0.15^a	-0.15^a	0.11

图1 抑郁症状与OSA患者CPAP治疗依从性的路径分析注：CPAP=持续气道正压通气，CESD-10=流调中心抑郁水平评定量表，ISI=失眠严重程度指数量表，FOSQ-10=睡眠功能性结局问卷-10，PCS=生理健康总得分，MCS=心理健康总得分

Figure 1 Pathway analysis of depressive symptoms and adherence to continuous positive airway pressure in obstructive sleep apnea patients

表3 抑郁症状与OSA患者CPAP治疗依从性之间的路径系数

Table 3 Path coefficients between depressive symptoms and adherence to continuous positive airway pressure in obstructive sleep apnea patients

路径			β	SE	P值
ISI评分	<---	CES-D-10评分	0.654	0.056	<0.01
MCS	<---	CES-D-10评分	-0.715	0.104	<0.01
PCS	<---	ISI评分	-0.312	0.097	<0.01
FOSQ-10得分	<---	MCS	0.345	0.023	<0.01
FOSQ-10得分	<---	CES-D-10评分	-0.195	0.045	0.02
FOSQ-10得分	<---	PCS	0.266	0.024	<0.01
治疗依从性	<---	FOSQ-10得分	-0.158	0.750	0.03

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基于路径分析的方法探讨抑郁症状对阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性的影响

Effect of Depressive Symptoms on the Adherence to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients Using a Path Analysis-based Approach

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