Obstrüktif uyku apne hastalarında eğitimsel ve destekleyici yöntemlerin pozitif hava yolu basıncı tedavisi uyumuna etkisi
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ ve AMAÇ: Obstrüktif uyku apne (OSA) tanılı hastalarda pozitif hava yolu basıncı (PAP) tedavisi ile üst hava yolu kollapsının önlenmesine ve uyku apne semptomlarının ve yaşam kalitesinin iyileşmesine karşın uzun dönemde PAP tedavisine uyum oranları %29 ile %83 arasında değişmektedir. Bu çalışmanın birincil amacı, OSA tanısı ile PAP tedavisi başlanacak hastalarda eğitimsel ve destekleyici yöntemlerin PAP uyumuna etkisini araştırmak, ikincil amacı ise cinsiyetin, yanı sıra komorbid insomnia ve OSA'nın uzun dönem PAP uyumu üzerine etkisini değerlendirmektir. YÖNTEM: Bu prospektif çalışmada Ege Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı Uyku Laboratuvarına yatırılarak OSA tanısı alan ve PAP tedavisi başlanan hastalar 12 ay süreyle izlendi. Hastalar kontrol, eğitim ve destek grubu olmak üzere üç gruba randomize edilerek uzun dönem PAP uyumları değerlendirildi. Kontrol grubuna rutin izlem prosedürleri uygulandı. Eğitim grubuna OSA; PAP tedavisinin faydaları, yan etkileri ve uyku sorunları hakkında eğitim verildi. Destek grubuna herhangi bir sorunla karşılaştıklarında telefonla, kısa mesajla veya WhatsApp uygulamasıyla istedikleri zaman ulaşabilecekleri doktorun iletişim bilgileri verildi. Tüm gruplar, tedavinin 1., 6. ve 12. aylarında rutin olarak değerlendirildi. Tedavi öncesi, 6. ay ve 12. ay vizitlerinde uykululuğu değerlendirmek için Epworth Uykululuk Ölçeği (ESS), uyku kalitesini değerlendirmek için Pittsburgh Uyku Kalitesi İndeksi (PUKİ), anksiyete ve depresyonu ölçmek için Hastane Anksiyete ve Depresyon (HAD) Ölçeği ve insomniayı değerlendirmek için Uykusuzluk Şiddeti İndeksi (ISI) anketleri yapıldı. BULGULAR: OSA tanısıyla PAP tedavisine başlanan 312 hasta çalışmaya dahil edildi. Başlangıçta her grupta 104 hasta bulunmakta iken 12. ay sonunda kontrol grubunda 50 hasta, eğitim grubunda 56 hasta ve destek grubunda 60 hasta çalışmayı tamamladı (166 hasta; %69.3'ü erkek, ortalama yaş 55.9±11.3, beden kitle indeksi 31.6±4.9 kg/m2, AHİ 45.4± 24.9/sa). Tüm gruplar birlikte değerlendirildiğinde; bir yılın sonunda hastaların PAP cihazını ortalama 6 gece ve gecede 5.3 saat kullandığı ve PAP uyumunun %75.3 olduğu görüldü. Uzun süreli PAP uyumu kontrol, eğitim ve destek gruplarında benzer bulundu (sırasıyla %80, %78.6 ve %68.3, p>0.05). PAP uyumu kadınlarda %76.5, erkeklerde %74.8 idi ve cinsiyetin PAP uyuma anlamlı etkisi saptanmadı (p>0.05). Komorbid insomnia olan ve olmayan hastalar karşılaştırıldığında; PAP uyumunda ve cihaz kullanım süresinde anlamlı fark saptanmadı (sırasıyla %78.4 ve %73.9, p>0.05). PAP tedavisi ile kontrol, eğitim ve destek gruplarında semptomlarda ve ESS, ISI, PUKİ ve HAD ölçeğinde 6. ay ve 12. ay vizitlerinde anlamlı azalma olurken (p<0.001), farklı tedavi gruplarındaki hastalar arasında anlamlı fark gözlenmedi (p> 0.05). SONUÇ: Bu çalışmada, OSA hastalarını rutin olarak izlemenin PAP tedavisine uyumunu, semptomları, gündüz uykululuğu, yaşam kalitesini ve duygu durum bozukluklarını iyileştirdiği sonucuna varıldı. Bununla birlikte, OSA hastalarında eğitici ve destekleyici müdahaleler ile PAP tedavisine uyumunda rutin kontrole kıyasla ek bir fayda sağlanmadığı gözlendi.
INTRODUCTION AND AIM: Positive airway pressure (PAP) therapy prevents upper airway collapse and improves sleep apnea symptoms, and quality of life in patients with obstructive sleep apnea (OSA). However, the rates of long-term adherence to PAP therapy vary between 29 and 83%. The primary aim of this study was to investigate the effect of educational and supportive interventions on PAP adherence, and the secondary aim was to assess the effect of sex and also comorbid insomnia and OSA on long-term PAP adherence in OSA patients starting PAP treatment. METHOD: In this prospective study, newly diagnosed OSA patients on PAP therapy were followed up for 12 months at Ege University Faculty of Medicine, Department of Chest Diseases, Sleep Laboratory. They were randomly assigned into three groups as usual care, education, and support, and long-term PAP adherence was evaluated. Routine follow-up visits were applied to the usual care group. The education group was informed about OSA, side effects, benefits of PAP therapy and sleep problems. The support group was given the contact information of the doctor, whom they can reach by phone, text message, or WhatsApp application at any time. Follow-up assessments were conducted routinely at 1, 6, and 12 months of starting the treatment in all groups. Epworth Sleepiness Score (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) was evaluated at baseline, 6- and 12-month visits. RESULTS: Three hundred twelve patients starting PAP therapy with the diagnosis of OSA were included in the study. At the beginning, there were 104 patients in each group, whereas 50 patients in the usual care group, 56 patients in the education group and 60 patients in the support group completed the study at the end of the 12 months (166 patients; 69.3% men, mean age 55.9±11.3, body mass index 31.6±4.9 kg/m2, AHI 45.4±24.9/h). When all groups are evaluated together; it was observed that the patients used their PAP device for an average of 6 nights/week and 5.3 hours/night, and the PAP adherence was 75.3% at the end of one year. Long-term PAP adherence was similar in the usual care, education and support groups (80%, 78.6% and 68.3%, respectively, p>0.05). PAP adherence rate was 76.5% in women and 74.8% in men, and there was no significant difference between sex in terms of PAP adherence (p>0.05). In the comparison of patients with and without comorbid insomnia, no significant difference was found in PAP adherence and device usage time (78.4% and 73.9%, respectively, p> 0.05). PAP therapy significantly decreased symptoms and ESS, ISI, PSQI and HADS in all groups at 6- and 12-month visits (p <0.001), but there was no significant difference between the different intervention groups (p>0.05). CONCLUSION: In the present study, we concluded that following up OSA patients routinely improves PAP adherence, symptoms, daytime sleepiness quality of life and mood disturbances. However, educational and supportive interventions show no additional effect on long-term PAP adherence compared to usual care.
INTRODUCTION AND AIM: Positive airway pressure (PAP) therapy prevents upper airway collapse and improves sleep apnea symptoms, and quality of life in patients with obstructive sleep apnea (OSA). However, the rates of long-term adherence to PAP therapy vary between 29 and 83%. The primary aim of this study was to investigate the effect of educational and supportive interventions on PAP adherence, and the secondary aim was to assess the effect of sex and also comorbid insomnia and OSA on long-term PAP adherence in OSA patients starting PAP treatment. METHOD: In this prospective study, newly diagnosed OSA patients on PAP therapy were followed up for 12 months at Ege University Faculty of Medicine, Department of Chest Diseases, Sleep Laboratory. They were randomly assigned into three groups as usual care, education, and support, and long-term PAP adherence was evaluated. Routine follow-up visits were applied to the usual care group. The education group was informed about OSA, side effects, benefits of PAP therapy and sleep problems. The support group was given the contact information of the doctor, whom they can reach by phone, text message, or WhatsApp application at any time. Follow-up assessments were conducted routinely at 1, 6, and 12 months of starting the treatment in all groups. Epworth Sleepiness Score (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) was evaluated at baseline, 6- and 12-month visits. RESULTS: Three hundred twelve patients starting PAP therapy with the diagnosis of OSA were included in the study. At the beginning, there were 104 patients in each group, whereas 50 patients in the usual care group, 56 patients in the education group and 60 patients in the support group completed the study at the end of the 12 months (166 patients; 69.3% men, mean age 55.9±11.3, body mass index 31.6±4.9 kg/m2, AHI 45.4±24.9/h). When all groups are evaluated together; it was observed that the patients used their PAP device for an average of 6 nights/week and 5.3 hours/night, and the PAP adherence was 75.3% at the end of one year. Long-term PAP adherence was similar in the usual care, education and support groups (80%, 78.6% and 68.3%, respectively, p>0.05). PAP adherence rate was 76.5% in women and 74.8% in men, and there was no significant difference between sex in terms of PAP adherence (p>0.05). In the comparison of patients with and without comorbid insomnia, no significant difference was found in PAP adherence and device usage time (78.4% and 73.9%, respectively, p> 0.05). PAP therapy significantly decreased symptoms and ESS, ISI, PSQI and HADS in all groups at 6- and 12-month visits (p <0.001), but there was no significant difference between the different intervention groups (p>0.05). CONCLUSION: In the present study, we concluded that following up OSA patients routinely improves PAP adherence, symptoms, daytime sleepiness quality of life and mood disturbances. However, educational and supportive interventions show no additional effect on long-term PAP adherence compared to usual care.
Açıklama
Anahtar Kelimeler
Obstrüktif Uyku Apne, PAP Uyumu, Destekleyici Yöntem, Eğitimsel Yöntem, Gündüz Uykululuk, Yaşam Kalitesi, Obstructive Sleep Apnea, PAP Adherence, Supportive Intervention, Educational Intervention, Daytime Sleepiness, Quality of Life
