睡眠呼吸中止症患者居家使用陽壓呼吸器之影響因素探討

Factors affecting the willingness to continually adopt CPAP after trial at home for patients with obstructive sleep apnea.

吳郁婷(Yu-ting Wu)

指導教授 ： 陳永福

中臺科技大學/管理學院/健康產業管理研究所/碩士(2012年)

https://doi.org/10.6822/CTUST.2012.00040

摘要

阻塞型睡眠呼吸中止症是現今常見的睡眠呼吸障礙疾病，配帶連續陽壓呼吸器(CPAP)是目前治療的黃金標準。臨床上多數民眾仍缺乏此疾病認知及病識感，故採用保守療法居多。目前多數文獻研究不是僅以客觀檢查數據分析，就是以主觀的問卷訪談方式進行分析研究。本研究除了考量客觀檢查數據分析之外，亦考量患者主觀問卷訪談內容，探討患者接受CPAP治療的影響因子。
本研究於2011年7月至2012年5月期間，於中部某睡眠醫學中心收集35名中度以上(AHI≧15/h)之睡眠呼吸中止症病患資料進行統計分析研究，並經醫囑使用CPAP前完成整夜多頻道睡眠檢查及CPAP參數調整兩次檢查，經過7天居家CPAP試機後，依是否願意使用CPAP繼續接受治療分為願意使用及不願意使用兩群組。資料採用SPSS統計分析軟體進行描述性統計及Pearson χ2 test、Student’s t-test、羅吉斯迴歸等推論性統計分析。
第一次CPAP參數檢查之分析結果顯示，使用CPAP調整後，二組病患之呼吸中止與淺呼吸指數(AHI)均有明顯的改善(願意使用者：從 49.74/h降至6.95/h；不願意使用者：從38.56/h降至6.55/h)，此與先前之研究結果吻合。然而，影響居家試用CPAP檢查之睡眠呼吸中止症患者，持續使用CPAP治療的最大因素是深睡期百分比，其次是血氧飽和濃度。因此，如果在居家試用CPAP時，病患感受深度睡眠或總睡眠時間有明顯增加，而且血氧飽和濃度有提升時，患者會有較高意願繼續使用CPAP療；此時疾病嚴重度(AHI)並非最主要影響因素。經由患者於居家試機前後之主觀問卷內容分析及客觀量化接受CPAP治療前後之檢查數據分析結果顯示，進行CPAP titration當晚的重要性及居家試機期間使用經驗上配戴的舒適感、正確性及有效的壓力調整是治療初期影響病患後續接受CPAP治療意願的重要因素；另外，病患之經濟壓力及CPAP之價格亦是重要因素。

關鍵字

居家試機 ； 連續性陽壓呼吸器 ； 多層次睡眠檢查 ； 睡眠呼吸中止症

並列摘要

Obstructive sleep apnea syndrome (OSAS) is a popular sleep disorder generally found in chest and ENT clinics. Continues positive airway pressure (CPAP) is deemed as the gold standard for treating patients with OSAS. Clinically, the majority of people still lack the awareness and sense of this disease, thereby adopting conservative treatments. At present, most of the previous studies adopted data obtained from either objective polysomnography (PSG) examination or subjective questionnaire survey for analyses. In this study, data obtained from both objective PSG examination and subjective questionnaires were taken into account to study the factors affecting patients’ acceptance of CPAP therapy.
Data of 35 patients diagnosed with moderate or severe OSAS (AHI≧15/h) acquired from July, 2011 to May, 2012 at the Sleeping Center of a Medical University Hospital situated in central Taiwan were used for this study. All the recruited patients had undergone 2 consecutive sleep studies with an initial PSG study followed by an additional CPAP titration study. In addition, all patients were asked to experience CPAP treatments at home for 7 days after the PSG studies. The patients were classified into two groups based on whether they agreed to continue adopting CPAP for further OSA treatment afterward. SPSS software package was used to conduct descriptive analysis, as well as inferential analysis, including Pearson χ2 test, t-test and logistic regression analysis, to compare the variables between the two groups.
The results showed that the severity indicated by apnea and hypopnea index (AHI) was significantly improved for both groups after CPAP titration (Patients willing to adopt CPAP: AHI decreased from 49.74/h to 6.95/h; Patients unwilling to adopt CPAP: AHI decreased from 38.56/h to 6.55/h), which is consistent to previous studies. However, it was found that the most important factors affecting the CPAP adoption were the percentage of deep sleep, followed by oxygen saturation. Therefore, if the patients perceive more time of deep-sleeping stage and more total sleeping time with higher oxygen saturation, they will have higher willingness to adopt CPAP treatment. In contrast, the severity is not the main factor affecting the adoption of CPAP treatment. After analyses of questionnaire surveys, it was also observed that patients'' economic status and CPAP price are also important factors. In conclusion, the experiences of CPAP titration and home trial, such as wearing comfort and suitable CPAP pressure, as well as patient economic status and CPAP price are important factors affecting the patient’s willingness to continue adopting the CPAP for further treatment.

並列關鍵字

Polysomnography (PSG) ； Obstructive Sleep Apnea (OSA) ； Home Trial. ； Continuous Positive Airway Pressure (CPAP)

參考文獻

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