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

doi:10.12114/j.issn.1007-9572.2022.0265

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (33): 4179-4184.DOI: 10.12114/j.issn.1007-9572.2022.0265

Special Issue: 精神卫生最新文章合集；睡眠问题专题研究

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

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.

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

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

通讯作者: 韩芳
作者简介:
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

Abstract

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

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（r_PCS=-0.27，P<0.05；r_MCS=-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

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.
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.

Figures/Tables 4

References 29

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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

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

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

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

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

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

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

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