基于路径分析的方法探讨抑郁症状对阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性的影响

Effect of Depressive Symptoms on the Adherence to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients Using a Path Analysis-based Approach

背景持续气道正压通气(CPAP)治疗效果与阻塞性睡眠呼吸暂停(OSA)患者的使用依从性密切相关,心理社会特征是CPAP治疗依从性的重要影响因素之一,抑郁症状对CPAP治疗依从性的影响尚需进一步探讨。目的探讨OSA患者抑郁症状与CPAP治疗依从性及其中间变量间的作用通路。方法选取2019年5月至2021年7月在北京大学人民医院呼吸睡眠医学中心确诊并接受CPAP治疗的OSA患者177例,评估患者基本信息、疾病严重程度及CPAP治疗依从性。以流调中心抑郁水平评定量表-10(CES-D-10)评估患者抑郁症状,以失眠严重程度指数量表(ISI)评估失眠情况,以睡眠功能结局问卷-10(FOSQ-10)评估日间功能,以生存质量简表-12(SF-12)评估生存质量,运用路径分析的方法确定各变量之间的关系。结果OSA患者抑郁症状的检出率较高(19.7%,35/177),OSA患者的抑郁症状与失眠呈正相关(r=0.65,P<0.05),与日间功能(r=-0.51,P<0.05)及生存质量(r_(PCS)=-0.27,P<0.05;rMCS=-0.72,P<0.05)呈负相关。抑郁症状与患者CPAP治疗依从性无直线相关关系(r=0.09,P>0.05),但其能通过降低日间功能增加OSA患者对CPAP的治疗依从性(β=0.078,P<0.01)。结论抑郁症状与OSA患者的失眠、生存质量下降及日间功能降低相关,并可通过降低OSA患者日间功能增加其对CPAP的治疗依从性。

Background The treatment adherence is closely related to the effect of continuous positive airway pressure(CPAP)therapy in patients with obstructive sleep apnea(OSA),which is also strongly influenced by patients'psychosocial characteristics.However,the influence of depression symptoms on the adherence to CPAP needs to be further explored.Objective To evaluate the relationship of depression symptoms with adherence to CPAP,and the pathwaybetween the associated factors in OSA patients.Methods A total of 177 patients who were diagnosed with OSA and treated with CPAP in the Respiratory and Sleep Medicine Center,Peking University People's Hospital from May 2019 to July 2021 were selected.The general information,disease severity and adherence to CPAP were evaluated.The prevalence of depression symptoms was measured by the 10-item Center for Epidemiologic Studies Depression Scale(CES-D-10).The severity of insomnia was assessed by the Insomnia Severity Index(ISI).The influence of daytime sleepiness on activities of daily living was measured by the 10-item Functional Outcomes of Sleep Questionnaire(FOSQ-10).The 12-item Short Form Health Survey(SF-12)was used to evaluate the quality of life.The relationships among variables were determined by path analysis.Results The prevalence of depressive symptoms in OSA patients was relatively high(19.7%,35/177)in our study.Depression symptoms were associated with increased insomnia prevalence(r=0.65,P<0.05),and decreased levels of activities of daily living(r=-0.51,P<0.05)and quality of life(r_(PCS)=-0.27,P<0.05;rMCS=-0.72,P<0.05).In addition,depressive symptoms had no relationship on the adherence to CPAP(r=0.09,P>0.05),but could increase the adherence to CPAP by decreasing the activities of daily living(β=0.078,P<0.01).Conclusion Depressive symptoms were significantly associated with insomnia,decreased quality of life and activities of daily living in OSA patients,and could increase patients'adherence to CPAP through decreasing the activities of daily living.