Uyku ile ilişkili solunum bozukluğu olan hastalarda pozitif hava yolu basıncı tedavisine uyumu bozan etkenler

Amaç: Pozitif hava yolu basıncı (PAP) tedavisi, düzenli kullanılma koşuluyla uyku ile ilişkili solunum bozukluğunun (USB) en etkili tedavi yöntemidir. PAP tedavisine uyum, USB bulunan hastaların etkin tedavisi ve tedavi izlemi için önemlidir. Bu çalışmada PAP tedavisine uyumu iyi olmayan USB olan hastalarda uyumu bozan etkenleri araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya, uyku bozuklukları merkezinde 2006-2007 yılları arasında yapılan polisomnografi (PSG) ile USB tanısı konan ve PAP tedavisi önerilen 125 hasta dahil edildi. Hastalara ortalama 12 ay sonra telefonla uyku özelliklerine ait anket uygulandı. Bulgular: Yüz yirmi beş hastanın 24’ü kadındı (%17,5) ve yaş ortalaması 52,3 (SS: 10) idi. Obstrüktif Uyku Apne Sendromu 108 (%86,4), Santral Uyku Apne Sendromu 6 (%4,8), Uyku ile İlişkili Hipoventilasyon-Hipoksemi Sendromu 11 (%8,8) hastada bulundu. O sırada PAP tedavisi kullanımı ortalama 10,2 ay takip sonrası; 85 (%67,4) hastada ortalama haftada 6,8 gün ve gecede 6,5 saat olarak saptandı. PAP tedavisi kullanmadığını bildiren 41 hastada tedavi kullanım süresi ortancası iki ay olarak bulundu. PAP kullanmamanın ana nedenleri sıklık sırasıyla maske sorunu 9 (%21,9), basıncı tolere edememe 8 (%19,5), boğulma hissi 7 (%17,0) ve maske ile uyumakta güçlük 5 (%12,1) olarak bildirildi. Uyumun kötü olması, uyumu iyi olan hastalara gore, uyku latansının uzun (>30 dakika: %24,6 ve %10,3), uyku bölünmesinin sık (%49,1 ve %29,4) ve dinlendirici olmayan uykunun az sıklıkta olması (%63,2 ve %92,6) ile ilişkiliydi. Sonuç: Özellikle ilk iki ay içinde ortaya çıkan uyku kalitesini bozan problemler PAP kullanımını engellemektedir. Yeni teknolojik gelişmelere rağmen halen PAP uyumunu etkileyen en önemli problemler maskenin yarattığı sıkıntılardır. PAP tedavisi öncesi uyku kalitesinin değerlendirilmesi, tedavisi ve hastanın maske problemleri açısından ilk iki ay boyunca yakından takibi uyumu artıracaktır.

Factors effecting the compliance of positive airway pressure therapy in patients with sleep related breathing disorders

Aim: Positive airway pressure (PAP) treatment is the most efficient treatment of sleep related breathing disorders (SRBD) when used regularly. Data on the compliance of PAP therapy is important in the management and follow-up of patients with sleep SRBD. The purpose of this study was to investigate the reasons of noncompliance for PAP therapy in patients with SRBD. Material and Methods: The study enrolled 125 patients, who received diagnosis of SRBD in polysomnography between 2006 and 2007 in the sleep disorders clinic. Patients were contacted about 12 months later and answered a telephone administered questionnaire, with information on characteristics of sleep. Results: Of the 125 patients, 24 were female (17,5%) and the mean age (SD) was 52,3 (10) years. Diagnoses were obstructive sleep apnea syndrome in 108 (86,4%), central sleep apnea syndrome in 6 (4,8%), sleep related hypoventilation-hypoxemic syndrome in 11 (8,8%). Current use of therapy was reported in 85 (67,4%) patients after a median use of 10,2 months, for a median use of 6,8 days, and 6,5 hours in a night. Among the 41 noncompliant patients, median duration of treatment use was 2 months. Main reasons were mask problems in 9 (21,9%), pressure intolerance in 8 (19,5%), choking sensation in 7 (17,0%), and difficulty in sleeping with a mask in 5 (12,1%). Noncompliance was related with longer latency to sleep (>30 minutes: 24,6% vs 10,3%), frequent sleep interruption (49,1% vs 29,4%) and lower frequency of unrested sleep (63,2% vs 92,6%). Conculation: Problems related to sleep quality could hinder the use of PAP, mostly within two months. Despite technological improvements, mask problems are still the main reason of noncompliance for PAP. Assessment and treatment of sleep quality of the patients before PAP prescription and close followup especially for mask problems within two months will improve the compliance.

Kaynakça

1 Sullivan CE, Issa FG, Berthon-Jones M, Eves L: Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-865.

2 Hoffstein V, Zamel N, Phillipson EA: Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis 1984;130:175-178.

3 Van de Graaff WB: Thoracic influence on upper airway patency. J Appl Physiol 1988;65:2124-2131.

4 Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, Fernandez- Palacin A: Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest 2005;128:624-633.

5 American academy of sleep medicine. International classification of sleep disorders: Diagnostic and coding manual, ed 2nd. Westchester, 2005.

6 Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA: Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: A consensus statement. Chest 1999;115:863-866.

7 Reeves-Hoche MK, Meck R, Zwillich CW: Nasal cpap: An objective evaluation of patient compliance. Am J Respir Crit Care Med 1994;149:149-154.

8 Bollig SM: Encouraging cpap adherence: It is everyone’s job. Respir Care 2010;55:1230-1239.

9 Gay P, Weaver T, Loube D, Iber C: Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006;29:381-401.

10 Chervin RD, Theut S, Bassetti C, Aldrich MS: Compliance with nasal cpap can be improved by simple interventions. Sleep 1997;20:284-289.

11 Strollo PJ, Jr., Sanders MH, Atwood CW: Positive pressure therapy. Clin Chest Med 1998;19:55-68.

12 Pepin JL, Krieger J, Rodenstein D, Cornette A, Sforza E, Delguste P, Deschaux C, Grillier V, Levy P: Effective compliance during the first 3 months of continuous positive airway pressure. A european prospective study of 121 patients. Am J Respir Crit Care Med 1999;160:1124-1129.

13 Hoffstein V, Viner S, Mateika S, Conway J: Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 1992;145:841-845.

14 Abisheganaden J, Chan CC, Chee CB, Yap JC, Poh SC, Wang YT, Cheong TH: The obstructive sleep apnoea syndrome-experience of a referral centre. Singapore Med J 1998;39:341-346.

15 Lojander J, Brander PE, Ammala K: Nasopharyngeal symptoms and nasal continuous positive airway pressure therapy in obstructive sleep apnoea syndrome. Acta Otolaryngol 1999;119:497- 502.

16 Sanders MH, Gruendl CA, Rogers RM: Patient compliance with nasal cpap therapy for sleep apnea. Chest 1986;90:330-333.

17 Meyer TJ, Pressman MR, Benditt J, McCool FD, Millman RP, Natarajan R, Hill NS: Air leaking through the mouth during nocturnal nasal ventilation: Effect on sleep quality. Sleep 1997;20:561-569.

18 Sanders MS, F.: New development in positive pressure therapy for sleep apnea; in Pack AI (ed Sleep apnea: Pathogenesis, diagnosis, and treatment. New York, Marcel Dekker, 2002, pp 495–522.

19 Ramos Platon MJ, Espinar Sierra J: Changes in psychopathological symptoms in sleep apnea patients after treatment with nasal continuous positive airway pressure. Int J Neurosci 1992;62:173-195.

20 Brander PE, Soirinsuo M, Lohela P: Nasopharyngeal symptoms in patients with obstructive sleep apnea syndrome. Effect of nasal cpap treatment. Respiration 1999;66:128-135.

21 Nino-Murcia G, McCann CC, Bliwise DL, Guilleminault C, Dement WC: Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med 1989;150:165-169.

22 Zwillich CW: Sleep apnoea and autonomic function. Thorax 1998;53 Suppl 3:S20-24.

23 Noseda A, Jann E, Hoffmann G, Linkowski P, Kerkhofs M: Compliance with nasal continuous positive airway pressure assessed with a pressure monitor: Pattern of use and influence of sleep habits. Respir Med 2000;94:76-81.

24 Engleman HM, Wild MR: Improving cpap use by patients with the sleep apnoea/hypopnoea syndrome (sahs). Sleep Med Rev 2003;7:81-99.

25 Sin DD, Mayers I, Man GC, Pawluk L: Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: A population-based study. Chest 2002;121:430-435.

26 Kohler M, Smith D, Tippett V, Stradling JR: Predictors of longterm compliance with continuous positive airway pressure. Thorax 2010;65:829-832.

27 Yetkin O, Kunter E, Gunen H: Cpap compliance in patients with obstructive sleep apnea syndrome. Sleep Breath 2008;12:365-367.

28 Peppard PE, Young T, Palta M, Skatrud J: Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384.

29 Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB, Newman AB, Lebowitz MD, Pickering TG: Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep heart health study. JAMA 2000;283:1829-1836.

30 Bardwell WA, Ancoli-Israel S, Berry CC, Dimsdale JE: Neuropsychological effects of one-week continuous positive airway pressure treatment in patients with obstructive sleep apnea: A placebo-controlled study. Psychosom Med 2001;63:579-584.

31 Hack M, Davies RJ, Mullins R, Choi SJ, Ramdassingh-Dow S, Jenkinson C, Stradling JR: Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax 2000;55:224-231.

32 Jenkinson C, Davies RJ, Mullins R, Stradling JR: Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised prospective parallel trial. Lancet 1999;353:2100-2105.

33 Lojander J, Maasilta P, Partinen M, Brander PE, Salmi T, Lehtonen H: Nasal-cpap, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest 1996;110:114-119.

34 McArdle N, Douglas NJ: Effect of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome: A randomized controlled trial. Am J Respir Crit Care Med 2001;164:1459-1463.

35 Barbe F, Mayoralas LR, Duran J, Masa JF, Maimo A, Montserrat JM, Monasterio C, Bosch M, Ladaria A, Rubio M, Rubio R, Medinas M, Hernandez L, Vidal S, Douglas NJ, Agusti AG: Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. A randomized, controlled trial. Ann Intern Med 2001;134:1015-1023.

36 Dimsdale JE, Loredo JS, Profant J: Effect of continuous positive airway pressure on blood pressure : A placebo trial. Hypertension 2000;35:144-147.

37 Engleman HM, Martin SE, Kingshott RN, Mackay TW, Deary IJ, Douglas NJ: Randomised placebo controlled trial of daytime function after continuous positive airway pressure (cpap) therapy for the sleep apnoea/hypopnoea syndrome. Thorax 1998;53:341-345.

38 Henke KG, Grady JJ, Kuna ST: Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apneahypopnea syndrome. A randomized, placebo-controlled trial. Am J Respir Crit Care Med 2001;163:911-917.

39 Loredo JS, Ancoli-Israel S, Dimsdale JE: Effect of continuous positive airway pressure vs placebo continuous positive airway pressure on sleep quality in obstructive sleep apnea. Chest 1999;116:1545-1549.

40 Faccenda JF, Mackay TW, Boon NA, Douglas NJ: Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001;163:344-348.

41 McNicholas WT, Bonsigore MR: Sleep apnoea as an independent risk factor for cardiovascular disease: Current evidence, basic mechanisms and research priorities. Eur Respir J 2007;29:156-178.

42 McNicholas WT: Cardiovascular outcomes of cpap therapy in obstructive sleep apnea syndrome. Am J Physiol Regul Integr Comp Physiol 2007;293:R1666-1670.

Kaynak Göster

Solunum
  • ISSN: 1302-4922
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018

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