Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea

IF 2.4 Q2 RESPIRATORY SYSTEM
Yukio Fujita , Motoo Yamauchi , Shigeo Muro
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Abstract

Obstructive sleep apnea (OSA) causes excessive daytime sleepiness, impaired daytime functioning, and an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is a highly effective therapy for moderate to severe OSA. Although CPAP adherence is commonly assessed using a 4-hthreshold, determining the optimal usage time based on clinical outcomes is crucial. While subjective sleepiness often improves with ≥4 h of CPAP usage, an extended duration (≥6 h) may be necessary to impact objective sleepiness. CPAP demonstrated a modest yet clinically meaningful dose-dependent effect on lowering blood pressure. For patients seeking antihypertensive benefits from CPAP therapy, the goal should extend beyond 4 h of use to maximize the therapeutic impact. Recognizing individual variations in sleep duration and responses to CPAP therapy is essential. The adoption of 'individualized goals for CPAP use,' outlining target times for specific outcomes, should also consider an individual's total sleep duration, including periods without CPAP. The impact of CPAP on clinical outcomes may vary, even with the same duration of CPAP use, depending on the period without CPAP use, particularly during the first or second half of sleep. Patients who remove or initiate CPAP midway or have a low CPAP usage frequency may require different forms of guidance. Tailoring patient education to address CPAP usage patterns may be necessary to enhanced satisfaction, self-efficacy, and adherence to therapy. Management of CPAP treatment should be personalized to meet individual needs and adapted based on specific response patterns for achieving treatment efficacy.

阻塞性睡眠呼吸暂停患者持续气道正压疗法的评估与管理
阻塞性睡眠呼吸暂停(OSA)会导致白天过度嗜睡、日间功能受损,并增加罹患心血管疾病的风险。持续气道正压(CPAP)是治疗中度至重度 OSA 的高效疗法。虽然 CPAP 的依从性通常以 4 小时为阈值进行评估,但根据临床结果确定最佳使用时间至关重要。使用 CPAP ≥4 小时后,主观嗜睡通常会有所改善,但可能需要延长使用时间(≥6 小时)才能对客观嗜睡产生影响。CPAP 在降低血压方面具有适度但有临床意义的剂量依赖性效果。对于希望从 CPAP 治疗中获得降压益处的患者,其目标应超过 4 小时的使用时间,以最大限度地发挥治疗效果。认识到睡眠时间和对 CPAP 治疗反应的个体差异至关重要。在采用 "使用 CPAP 的个性化目标"(概述特定结果的目标时间)时,还应考虑个人的总睡眠时间,包括不使用 CPAP 的时间。即使使用 CPAP 的时间相同,CPAP 对临床疗效的影响也可能不同,这取决于未使用 CPAP 的时间,尤其是在睡眠的前半部分或后半部分。中途停用或启用 CPAP 或使用 CPAP 频率较低的患者可能需要不同形式的指导。针对使用 CPAP 的模式对患者进行量身定制的教育可能是提高满意度、自我效能和坚持治疗所必需的。对 CPAP 治疗的管理应个性化,以满足个人需求,并根据特定的反应模式进行调整,以达到治疗效果。
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来源期刊
Respiratory investigation
Respiratory investigation RESPIRATORY SYSTEM-
CiteScore
4.90
自引率
6.50%
发文量
114
审稿时长
64 days
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