Page 90 - 2022-27-中国全科医学

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Prevalence of Acceptance of Noninvasive Positive-pressure Ventilation and Associated Factors in Hainan Adult
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Population with Obstructive Sleep Apnea-hypopnea Syndrome DU Li ，XIONG Xiaohua ，DUAN Fangfang ，REN
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Xue ，YANG Chunju ，GUAN Yiting ，WANG Peipei 1*
1.Sleep Medicine Department，Sanya Central Hospital（Hainan Third People's Hospital），Sanya 572000，China
2.Clinical Epidemiology Research Center，Beijing Jishuitan Hospital，Beijing 100035，China
3.Sanya Rehabilitation and Recuperation Center，People's Liberation Army Joint Logistic Support Force，Sanya 572000，China
*
Corresponding author：WANG Peipei，Associate chief physician；E-mail：peipeiwang@pku.edu.cn
【Abstract】 Background Noninvasive positive-pressure ventilation（NPPV） is the first choice for the treatment
of obstructive sleep apnea-hypopnea syndrome（OSAHS），a common sleep-related breathing disorder. But low patient
adherence to NPPV limits its clinical application and promotion. Objective To explore the situation of acceptance of NPPV
and associated factors in adult OSAHS patients. Methods OSAHS patients（age ≥ 18）with clinical indications for NPPV
were selected from Sleep Medicine Department，Sanya Central Hospital（Hainan Third People's Hospital），from December
2019 to December 2021. Demographic and clinical data were compared in groups defined by the acceptance of NPPV titration
（acceptors and rejecters of NPPV titration）and treatment（acceptors and rejecters of NPPV）. Results In all，402 OSAHS
patients were included. Three hundred and twenty-seven rejected NPPV，245（74.5%）of them directly rejected the treatment
at the time of diagnosis without NPPV titration，and the most common reason was perceived unnecessity of NPPV treatment due
to insufficient understanding of OSAHS and its related risks，and 82（25.1%） rejected the treatment after NPPV titration，and
the most common reason was perceived inconvenience of long-term NPPV. Only 75（75/402，18.7%）patients accepted NPPV.
No differences were found between acceptors and rejecters of titration in demographic data，clinical characteristics（P>0.05）.
Multivariable Logistic regression analysis revealed none of above-mentioned factors were related to titration acceptance（P>0.05）.
Univariable analysis showed that compared with NPPV rejecters，NPPV acceptors had higher prevalence of middle-aged（45-59
years old） individuals（49.3 % vs 33.3%），lower prevalence of older individuals（age ≥ 60）（12.0% vs 32.1%），higher
prevalence of nighttime awakening due to shortness of breath（38.7% vs 26.3%），and severe condition（64.0% vs 47.4%），
lower mean nocturnal SpO 2 and nadir SpO 2 ，and longer mean duration with SpO 2 below 90%（T90，P<0.05）. Multivariable
Logistic regression analysis revealed that age and T90 were independently associated with NPPV acceptance（P<0.05）. After
controlling for other factors，age〔OR=0.39，95%CI（0.16，0.93），P<0.05〕and T90〔OR=1.14，95%CI（1.01，1.29），
P<0.05〕were still the independently associated with NPPV acceptance. Conclusion The prevalence of NPPV acceptance was
low in OSAHS patients，which was mainly associated with age and T90. In view of this，to improve the adherence to NPPV，
relevant health education and cognitive and behavioral interventions for the patients，especially the older individuals（age ≥ 60），
should be strengthened. Meanwhile，close attention should be paid to whole course management of NPPV in these patients.
【Key words】 Sleep apnea，obstructive；Noninvasive ventilation；Positive-pressure ventilations；Adherence；
Acceptance；Positive airway pressure；Adult

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一
本文价值：
种临床常见的慢性疾病。OSAHS 患者睡眠时上气道反
无创正压通气（NPPV）是阻塞性睡眠呼吸暂停
复塌陷、阻塞引起低通气和呼吸暂停等呼吸事件，导致
低通气综合征（OSAHS）的一线治疗方法，但治疗依
患者睡眠结构被破坏、间歇性低氧血症、交感神经紧张
从性差限制了其临床获益。本研究发现仅 18.7% 的
性增加，可引起夜间憋醒、心悸，并导致患者出现日间
OSAHS 患者接受 NPPV 治疗，对疾病、NPPV 认知不
嗜睡、记忆力注意力下降等症状，长期可致患者多系统
足及老年人（年龄≥ 60 岁）是拒绝接受 NPPV 治疗
器官功能受损，心脑血管、代谢性疾病发病率增加，严 的重要原因。这一结果提示加强对患者尤其老年人对
重者可导致患者猝死 ［1］ 。
OSAHS 及 NPPV 治疗的认知、提高其接受度，应成
无创正压通气（NPPV）是指通过正压无创呼吸机
为睡眠医学科的工作重点之一。
涡轮增压的方式，给患者持续输送适宜的气道正压从而
保持患者上呼吸道开放的疗法，是治疗 OSAHS 患者的 后的发生 ［3-5］ 。但若想完全发挥 NPPV 治疗的优势，
首选方式 ［2］ 。长期 NPPV 治疗可有效减少患者呼吸事 其前提就是患者需要持续、规范地接受 NPPV 治疗，但
件的发生，改善患者日间症状（如日间嗜睡）、生活质 如何提高 OSAHS 患者的治疗依从性仍是一大难点 ［6］ 。
量和神经认知功能，降低患者发生交通事故的风险。并 NPPV 治疗依从性包括接受性和顺应性两点，接受性指
且 NPPV 可改善心血管合并症患者的症状，减少不良预 OSAHS 患者是否愿意接受 NPPV 治疗；顺应性指患者