单中心中枢性睡眠呼吸暂停患者初始CPAP处方和后续CPAP疗程的预测因素

IF 4.6 2区 医学 Q1 RESPIRATORY SYSTEM
Lung Pub Date : 2023-12-01 Epub Date: 2023-11-21 DOI:10.1007/s00408-023-00657-z
Brian W Locke, Jeffrey Sellman, Jonathan McFarland, Francisco Uribe, Kimberly Workman, Krishna M Sundar
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引用次数: 0

摘要

目的:指南建议考虑初始试验持续气道正压通气(CPAP)治疗中央性睡眠呼吸暂停(CSA)。然而,实践模式差异很大。本研究调查了中心性呼吸暂停患者CPAP初始试验的预测因素,以及这些因素是否能预测接受CPAP初始试验的患者有足够的治疗反应。方法:回顾2016-2018年单中心睡眠研究后接受CSA诊断代码的患者图表。从电子健康记录中提取患者因素、初始治疗处方和随后的治疗变化。回归模型用于评估与初始CPAP处方相关的因素,以及在服用CPAP的患者中获得充分CPAP反应的可能性(没有随后的治疗改变和没有停止治疗)。结果:429/588(73%)中心性呼吸暂停患者接受了CPAP的初始试验。年龄较小、通过家庭睡眠测试诊断、非阿片类药物导致中枢性呼吸暂停以及诊断时中枢性呼吸暂停比例较低与初始CPAP试验的可能性较高独立相关。中枢性呼吸暂停比例较低与适当反应的可能性较高相关,而当前吸烟和阿片类药物相关的中枢性呼吸暂停预测CPAP试验不成功。一项新的发现是,年龄越大预示着初始CPAP处方的可能性越低,但并不预示着对CPAP的反应不满意。结论:临床医生在决定是否对中枢性呼吸暂停患者进行CPAP试验时,可能不正确地权衡某些临床和睡眠研究特征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Predictors of Initial CPAP Prescription and Subsequent Course with CPAP in Patients with Central Sleep Apneas at a Single Center.

Predictors of Initial CPAP Prescription and Subsequent Course with CPAP in Patients with Central Sleep Apneas at a Single Center.

Purpose: Guidelines recommend considering an initial trial of continuous positive airway pressure (CPAP) to treat central sleep apnea (CSA). However, practice patterns vary widely. This study investigated predictors for an initial trial of CPAP in patients with central apneas and whether those factors predict adequate treatment response in patients receiving an initial CPAP trial.

Methods: Charts of patients receiving a diagnostic code for CSA following a sleep study during 2016-2018 at a single center were reviewed. Patient factors, initial treatment prescriptions, and subsequent changes to therapy were extracted from electronic health records. Regression models were used to estimate factors associated with an initial CPAP prescription and the likelihood of an adequate CPAP response (no subsequent therapy change and no discontinuation of therapy) among patients prescribed CPAP.

Results: 429/588 (73%) patients with central apneas received an initial trial of CPAP. Younger age, diagnosis by home sleep testing, non-opiate etiology of central apneas, and a lower proportion of central apneas at diagnosis were independently associated with a higher likelihood of an initial CPAP trial. A lower proportion of central apneas was associated with a higher probability of adequate response, while current smoking and opiate-related central apneas predicted an unsuccessful CPAP trial. A new finding was that older age predicted a lower likelihood of an initial CPAP prescription but did not predict an unsatisfactory response to CPAP.

Conclusion: Clinicians may incorrectly weigh certain clinical and sleep study characteristics when deciding whether to trial CPAP for patients with central apneas.

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来源期刊
Lung
Lung 医学-呼吸系统
CiteScore
9.10
自引率
10.00%
发文量
95
审稿时长
6-12 weeks
期刊介绍: Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.
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