Inpatient CPAP adherence may predict post-discharge adherence in hospitalized patients screened high risk for OSA,Sleep and Breathing

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Inpatient CPAP adherence may predict post-discharge adherence in hospitalized patients screened high risk for OSA
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-06-18 , DOI: 10.1007/s11325-022-02659-2
Sunil Sharma ₁ , Robert Stansbury ₁ , Varun Badami ₁ , Edward Rojas ₁ , Stuart F Quan _{2,

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Affiliation

Rationale

Despite increased recognition of sleep disordered breathing in hospitalized patients, studies are lacking on the impact of inpatient adherence with positive airway pressure (PAP) therapy on post-discharge adherence.

Objectives

To assess the predictive value of inpatient adherence to PAP therapy on post-discharge compliance and adherence.

Methods

We reviewed data on individuals as part of a registry of a hospital-based sleep medicine program between August 2019 and December 2020. Consecutive patients identified as high risk for sleep disordered breathing based on our 2-tier screening process and initiated on Auto-PAP (APAP) therapy were included. Their adherence and post-discharge course were recorded. Primary objectives were polysomnography (PSG) compliance, sleep medicine clinic follow-up compliance, and 30-day adherence to PAP therapy if indicated by PSG.

Results

In total, 900 individuals were screened during the study period. Of these, 281 were offered inpatient PAP therapy. Patients on bilevel PAP therapy (88 patients) were excluded due to lack of objective compliance recording. Final analysis was performed on 193 patients. Of the 193 patients placed on inpatient APAP, 140 (73%) were adherent to the therapy with average usage of 367 min per day versus 140 min per day in the non-adherent (p < 0.001). There was no significant difference in oxygen desaturation index between the adherent and non-adherent groups (32.4 ± 21.9 events per hour and 34.5 ± 21.9 events per hour consistent; p = 0.5). No demographic and anthropometric characteristics or comorbid conditions were noted. Those who were adherent to PAP therapy in-hospital 47/140 (34%) underwent ambulatory PSG post-discharge compared to 7/53 (13%) of those non-adherent in-hospital (p = 0.002). The adherent group also had significantly higher likelihood for post-discharge clinic follow-up (p = 0.01) and adherence to outpatient PAP therapy (p = 0.01).

Conclusions

Hospitalized patients identified as high risk for sleep disordered breathing have high adherence to PAP therapy during hospitalization and inpatient adherence predicts outpatient follow-up (both PSG testing and sleep clinic) and home PAP adherence.

中文翻译：

住院患者 CPAP 治疗依从性可预测 OSA 高风险住院患者出院后的依从性

基本原理

尽管人们对住院患者睡眠呼吸障碍的认识有所提高，但仍缺乏关于住院患者坚持气道正压 (PAP) 治疗对出院后依从性影响的研究。

目标

评估住院患者对 PAP 治疗的依从性对出院后依从性和依从性的预测价值。

方法

作为 2019 年 8 月至 2020 年 12 月期间医院睡眠医学计划登记的一部分，我们审查了个人数据。根据我们的两级筛查流程，连续患者被确定为睡眠呼吸障碍高风险患者，并启动了 Auto-PAP（ APAP）治疗也包括在内。记录他们的依从性和出院后的情况。主要目标是多导睡眠图 (PSG) 依从性、睡眠医学诊所随访依从性以及 30 天坚持 PAP 治疗（如果 PSG 指示）。

结果

研究期间总共对 900 人进行了筛查。其中，281 人接受了住院 PAP 治疗。由于缺乏客观的依从性记录，接受双水平 PAP 治疗的患者（88 名患者）被排除在外。对 193 名患者进行了最终分析。在接受住院 APAP 治疗的 193 名患者中，140 名 (73%) 坚持治疗，平均每天使用 367 分钟，而未坚持治疗的患者平均每天使用 140 分钟 (p < 0.001 ) 。粘附组和非粘附组之间的氧饱和度指数没有显着差异（每小时 32.4 ± 21.9 次事件和每小时 34.5 ± 21.9 次事件一致；p = 0.5）。没有注意到人口统计学和人体测量特征或合并症。坚持住院 PAP 治疗的患者中有 47/140 (34%) 出院后接受了门诊 PSG，而未坚持住院治疗的患者中有 7/53 (13%) 接受了门诊 PSG (p = 0.002 ) 。坚持组出院后临床随访 ( p = 0.01) 和坚持门诊 PAP 治疗 ( p = 0.01) 的可能性也显着更高。