Prevalence of Acceptance of Noninvasive Positive-pressure Ventilation and Associated Factors in Hainan Adult Population with Obstructive Sleep Apnea-hypopnea Syndrome

Abstract

Background Noninvasive positive-pressure ventilation (NPPV) is the first choice for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) , a common sleep-related breathing disorder. But low patient adherence to NPPV limits its clinical application and promotion. Objective To explore the situation of acceptance of NPPV and associated factors in adult OSAHS patients. Methods OSAHS patients (age≥18) with clinical indications for NPPV were selected from Sleep Medicine Department, Sanya Central Hospital (Hainan Third People's Hospital) , from December 2019 to December 2021. Demographic and clinical data were compared in groups defined by the acceptance of NPPV titration (acceptors and rejecters of NPPV titration) and treatment (acceptors and rejecters of NPPV) . Results In all, 402 OSAHS patients were included. Three hundred and twenty-seven rejected NPPV, 245 (74.5%) of them directly rejected the treatment at the time of diagnosis without NPPV titration, and the most common reason was perceived unnecessity of NPPV treatment due to insufficient understanding of OSAHS and its related risks, and 82 (25.1%) rejected the treatment after NPPV titration, and the most common reason was perceived inconvenience of long-term NPPV. Only 75 (75/402, 18.7%) patients accepted NPPV. No differences were found between acceptors and rejecters of titration in demographic data, clinical characteristics (P>0.05) . Multivariable Logistic regression analysis revealed none of above-mentioned factors were related to titration acceptance (P>0.05) . Univariable analysis showed that compared with NPPV rejecters, NPPV acceptors had higher prevalence of middle-aged (45-59 years old) individuals (49.3 % vs 33.3%) , lower prevalence of older individuals (age≥60) (12.0% vs 32.1%) , higher prevalence of nighttime awakening due to shortness of breath (38.7% vs 26.3%) , and severe condition (64.0% vs 47.4%) , lower mean nocturnal SpO2 and nadir SpO2, and longer mean duration with SpO2 below 90% (T90, P<0.05) . Multivariable Logistic regression analysis revealed that age and T90 were independently associated with NPPV acceptance (P<0.05) . After controlling for other factors, age〔OR=0.39, 95%CI (0.16, 0.93) , P<0.05〕and T90〔OR=1.14, 95%CI (1.01, 1.29) , P<0.05〕were still the independently associated with NPPV acceptance. Conclusion The prevalence of NPPV acceptance was low in OSAHS patients, which was mainly associated with age and T90. In view of this, to improve the adherence to NPPV, relevant health education and cognitive and behavioral interventions for the patients, especially the older individuals (age≥60) , should be strengthened. Meanwhile, close attention should be paid to whole course management of NPPV in these patients.

Keywords

• sleep apnea, obstructive|noninvasive ventilation|positive-pressure ventilations|adherence|acceptance|positive airway pressure|adult