老年阻塞性睡眠呼吸暂停低通气综合征患者持续气道正压通气治疗的依从性

Analysis of compliance to continuous positive airway pressure in patients aged over 65 years with obstructive sleep apnea hypopnea syndrome

目的评价65岁以上老年阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者接受持续气道正压通气（CPAP）治疗的依从性是否与年龄〈65岁患者有所不同；并探讨影响OSAHS患者接受CPAP治疗依从性的因素。方法将147位经过多导睡眠仪（PSG）诊断的OSAHS患者分为两组，其中年龄≥65岁组为46例，年龄〈65岁组101例，147例OSAHS患者的临床资料及PSG检查结果均被前瞻性的输入数据库，随访所有患者CPAP治疗压力水平及呼吸机使用时间。结果与年龄〈65岁OSAHS组比较，年龄≥65岁OSAHS组中合并慢性阻塞性肺疾病（COPD）较高（16％对4％，P=0．02），心血管疾患患病率较高（23％对10％，P=0．04），长期饮酒者所占比例较高（61％对38％，P=0．007）。打鼾者比例较低（31％对54％，P=0．03）；睡眠时间较短（378min对423min，P=0．001），入睡后的醒觉时间延长（162min对115min，P=0，004），睡眠效率减低（69％对77％，P〈0．001），1期睡眠时间延长（29％对20％，P=0．001），3～4期睡眠（6%对9％，P=0．016）与快速眼动相（REM）睡眠时间（12％对15％，P=0．001）缩短。在3个月、6个月、1年、2年、3年期间接受CPAP治疗的患者在≥65岁组中为91％、89％、84％、82％、82％，而在〈65岁组中为92％、86％、81％、72％、67％。CPAP的平均使用时间在年龄≥65岁组为（5．1±1．5）h／d，在年龄〈65岁组中为（3．9±1．2）h／d。多元回归分析结果表明．相对较高的CPAP治疗压力是较好CPAP治疗依从性的唯一因素。结论与年龄〈65岁患者比较，年龄≥65岁OSAHS患者接受CPAP治疗的依从性并未见降低；相对较高的CPAP治疗压力与较好的治疗依从性有关。

Objective To explore whether the patients aged over 65 years with obstructive sleep apnea hypopnea syndrome （OSAHS） are able to tolerate continuous positive airway pressure （CPAP） while compared with patients aged less than 65 years. And to investigate the factors that affect compliance to CPAP in OSAHS patients. Methods A total of 147 OSAHS patients diagnosed with overnight polysomnography （PSG） were divided into two groups： ≥65 years old group （n=46）, 〈65 years old group （n= 101）. Clinical data and PSG parameters were included in a computerized database. The pressure level of CPAP, the duration of respirator use were followed up. Results Compared with 〈65 years old group, there were higher prevalences of COPD （16% vs. 4%, P= 0.02）, cardiovascular disease （23% vs. 10%, P=0.04）, apnea （43% vs. 26%, P=0.03）, regular alcohol consumption （61% vs. 38%, P=0. 007） and lower incidence of snoring （31% vs. 54%, P= 0.03）, shorter total sleeping time （378 min vs. 423 rain, P=0. 001）, longer wake after sleep onset periods （162 min vs. 115 min, P=0. 004）, lower sleep efficiency （69% vs. 77%, P〈0. 001）, higher percentage of stage 1 sleep （29% vs. 20%, P=0. 001）, lower percentage of stage 3-4 sleep （6% vs. 9%, P=0.016） and rapid eye movement （REM） sleep （12% vs. 15%, P=0. 001） in ≥65 years old group. The percentages of acceptance to CPAP at 3 months, 6 months, 1 year, 2 years and 3 years were 91%, 89%, 84%, 82% and 82% respectively in ≥65 years old group, and were 92%, 86%, 81%, 72% and 67% in 〈65 years old group. Average use time ofCPAPwere （5.1±1.5） h/night in ≥65 years old group, and were （3.9±1.2） h/night in〈65 years old group （P=0.022）. By analysis of multivariate logistic regression, a high pressure CPAP was associated with higher objective CPAP compliance in OSAHS patients. Conclusions Compliance to CPAP in older OSAHS patients is not decreased when compared to younger adults. A high CPAP pressure is the only significant independent predictor of better CPAP compliance.