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首页> 外文期刊>Patient Preference and Adherence >Positive airway pressure adherence and subthreshold adherence in posttraumatic stress disorder patients with comorbid sleep apnea
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Positive airway pressure adherence and subthreshold adherence in posttraumatic stress disorder patients with comorbid sleep apnea

机译：创伤后应激障碍合并睡眠呼吸暂停患者的气道正压依从性和亚阈值依从性

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Study objectives: Patients with comorbid posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) manifest low adherence to continuous positive airway pressure (CPAP) due to fixed, pressure-induced expiratory pressure intolerance (EPI), a subjective symptom and objective sign aggravated by anxiety sensitivity and somatosensory amplification. As advanced PAP therapy modes (ie, auto-bilevel PAP [ABPAP] or adaptive servo-ventilation [ASV]) may address these side effects, we hypothesized such treatment would be associated with decreased expiratory intolerance and increased adherence in posttraumatic stress patients with co-occurring OSA. Methods: We reviewed charts of 147 consecutive adult patients with moderately severe posttraumatic stress symptoms and objectively diagnosed OSA. All patients failed or rejected CPAP and were manually titrated on auto-adjusting, dual-pressure ABPAP or ASV modes in the sleep laboratory, a technique to eliminate flow limitation breathing events while resolving EPI. Patients were then prescribed either mode of therapy. Follow-up encounters assessed patient use, and objective data downloads (ODDs) measured adherence. Results: Of 147 charts reviewed, 130 patients were deemed current PAP users, and 102 provided ODDs: 64 used ASV and 38 used ABPAP. ODDs yielded three groups: 59 adherent per insurance conventions, 19 subthreshold compliant partial users, and 24 noncompliant. Compliance based on available downloads was 58%, notably higher than recently reported rates in PTSD patients with OSA. Among the 19 partial users, 17 patients were minutes of PAP use or small percentages of nights removed from meeting insurance compliance criteria for PAP devices. Conclusion: Research is warranted on advanced PAP modes in managing CPAP failure in PTSD patients with comorbid OSA. Subthreshold adherence constructs may inform clinical care in a patient-centric model distinct from insurance conventions. Speculatively, clinical application of this transitional zone (“subthreshold” number of hours) may increase PAP use and eventual adherence.
机译：研究目标：合并性创伤后应激障碍（PTSD）和阻塞性睡眠呼吸暂停（OSA）患者由于固定的，压力诱发的呼气压力不耐（EPI），主观症状和客观体征而表现出对持续持续气道正压（CPAP）的依从性较低焦虑敏感性和体感放大加剧。由于先进的PAP治疗模式（例如，自动双水平PAP [ABPAP]或自适应伺服通气[ASV]）可能会解决这些副作用，因此我们推测，这种治疗与伴有Co -发生OSA。方法：我们回顾了147例连续中度严重创伤后应激症状和客观诊断OSA的成年患者的图表。所有患者均未成功或拒绝CPAP，并在睡眠实验室中以自动调节，双压ABPAP或ASV模式进行手动滴定，该技术可在解决EPI时消除流量受限呼吸事件。然后为患者开出两种治疗方式。随访过程评估了患者的使用情况，客观数据下载（ODD）评估了依从性。结果：在147张图表中，有130位患者被认为是当前的PAP使用者，其中102位提供了ODD：64位使用了ASV，38位使用了ABPAP。 ODD分为三类：每个保险公约中的59位依从者，19位低于阈值的部分用户和24位不遵从。基于可用下载量的依从性为58％，明显高于最近报道的PTSD OSA患者的比率。在这19名部分用户中，有17名患者使用了PAP的分钟数或从符合PAP设备的保险合规性标准中去除的夜间比例很小。结论：有必要对先进的PAP模式进行治疗，以治疗合并症OSA的PTSD患者CPAP失败。阈下依从性构建可以以不同于保险惯例的以患者为中心的模型为临床护理提供信息。从推测上讲，此过渡区的临床应用（“阈值以下”小时数）可能会增加PAP的使用和最终的依从性。

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