Obstrüktif uyku apne sendromu'nda pozitif hava yolu basıncı tedavisine uyumun solunum fonksiyonlarıyla ilişkisi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: OUAS (Obstrüktif uyku apne sendromu); uyku sırasında tekrarlayan tam (apne) veya parsiyel (hipopne) üst solunum yolu obstrüksiyonu epizodları ve sıklıkla kan oksijen saturasyonunda düşmenin eşlik ettiği bir sendromdur. Polisomnografi (PSG) günümüzde OUAS tanısında kullanılan altın standart yöntemidir. Uyku apne sendromunun tedavi edilmesi, uyku ve yaşam kalitesinde düzelme sağlamanın yanında, hastalığa bağlı oluşan ciddi komplikasyonların birçoğunun önlenmesini de sağlar. Bu hastalıkta temel tedavi modalitesi pozitif havayolu basıncı (Positive Airway Pressure-PAP) uygulamasıdır. Ancak tedavide cihaz uyumu konusunda sorunlar yaşanmaktadır. Biz de çalışmamızda hastaların PAP tedavisine uyumunun solunum fonksiyon testleri (SFT) ile ilişkisini araştırmayı amaçladık. Gereç-Yöntem: 2016-2018 tarihleri arasında Göğüs Hastalıkları Anabilim dalı Uyku Laboratuarında OUAS tanısı koyulmuş ve PAP titrasyonu için yatırılmış, titrasyonu başarı ile yapılmış, PAP raporu düzenlenmiş PAP cihazını temin etmiş ve kullanmaya başlamış, çalışmaya katılmaya kabul eden hastalar çalışmaya dahil edildi. Hasta uyumunu etkileyen demografik özellikler, cihaz ve maske ile ilişkili şikayetler ve depresyon, anksiyete ölçekleri ile beraber hastalarımızın SFT parametreleri değerlendirildi. Bulgular: Çalışmaya alınan 98 bireyin %63'ü (n=62) erkekti ve bireylerin yaş ortalaması 52±9,6 (29-72) idi. Hastaların %67'si kullanılan cihaza uyum göstermekteydi. OUAS derecesine göre cihaza uyum gösteren ve göstermeyen bireylerin oranları arasında anlamlı düzeyde bir farklılık vardı (p<0,05). Ağır OUAS tanılı hastalar daha uyumlu idi. Cihaza uyumlu hastaların beck depresyon (BDÖ) ve beck anksiyete ölçek (BAÖ) puanları, uyumlu olmayan hastalarda ölçülen değerlerinden anlamlı düzeyde daha düşüktü (sırasıyla p<0,001 p=0,044 ). Her bir solunum fonksiyon test değeri açısından gruplar arasında anlamlı düzeyde fark saptanmadı (p>0,05). Cihaza uyum gösteren bireylerde nazal maske kullanma oranı, CPAP'ı tolere etmede zorlanmama, uykuya dalmada güçlük çekmeme, karında şişlik, maske nedeniyle yüzde yara görülmemesi, hava kaçağı görülmemesi, cihazdan fayda görme, gündüz uykululuk halinde azalma, uygun tedavi uygulandığını düşünme oranları, cihaza uyum göstermeyenlerden anlamlı düzeyde daha yüksekti (p<0,05). Cihaza uyum gösterenlerde klostrofobi, basınçtan rahatsız olma, cihaza uyum göstermeyenlerden anlamlı düzeyde daha düşüktü (p<0,05 ). Bireylerin cihaza uyum sağlama durumunu etkilediği saptanan değişkenler alınarak oluşturulan ileriye doğru Wald çoklu lojistik regresyon modeli sonucunda BDÖ puanındaki artışın bireylerin cihaza uyum sağlamama Odds oranını 1,08 kat arttırdığı; hava kaçağı şikâyeti olan bireylerin şikayeti olmayan bireylere göre cihaza uyum sağlamama Odds oranının 6,82 kat; basınç rahatsızlığı şikâyeti olanların şikâyeti olmayan bireylere göre cihaza uyum sağlamama Odds oranının 5,21 kat; gündüz uykululuğunda azalma görülmeyen bireylerin görülenlere göre cihaza uyum sağlamama Odds oranının 5,87 kat daha fazla olduğu saptandı. Sonuç: SFT parametreleri ile PAP tedavisine uyum arasında ilişki saptanmamakla beraber, cihaz uyumuna etkisi olan anlamlı faktörler saptandı. OUAS tanılı hastalarda PAP tedavisine başlamadan önce, uyum açısından riskli gruplar tanımlanmalı, erken dönemde eğitim desteği sağlanmalıdır. Hastaların yakın takip edilmesi ve tedaviye bağlı şikayetlerinin çözümünün hastaların PAP tedavisine uyumunu arttıracağını düşünmekteyiz.
Purpose: OSAS (Obstructive sleep apnoea syndrome) is a syndrome characterized by recurrent episodes of complete (apnoea) or partial (hypopnoea) upper respiratory airway obstruction and often accompanied by a decrease in blood oxygen saturation. Polysomnography (PSG) is the gold standard method utilized in the diagnosis of OSAS. Successful management of sleep apnoea not only improves sleep quality and quality of life but also helps to prevent most of the serious complications associated with the syndrome, in which positive airway pressure (PAP) treatment is the main modality of management. However, issues regarding compliance and adherence to the device are often experienced by patients and clinicians alike. In this study, we aim to investigate the association between patients' compliance with PAP treatment and the results of their pulmonary function tests (PFT). Materials and Methods: : Patients included in this study were diagnosed with OSAS in the Sleep Study Lab at the Department of Pulmonology in Duzce University, who was then admitted to the Pulmonology ward for PAP titration, successfully titrated, issued with a PAP device report and provided with a device, all of whom had given their consent to the study. Their demographic features and complaints regarding the device and its mask which affected their adherence to the treatment, and their depression and anxiety scale scores were evaluated along with their PFT parameters. Conclusion: 63% of 98 individuals (n=62) were males and their average age was 52 ± 9,6 (29-72). 67% of patients were found to be compliant with devices they were provided with. A statistically significant difference (p<0,05) was observed in different grades of OSAS in terms of patient compliance. Patients with severe OSAS were found to be more compliant. Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS) scores of device-compliant patients were observed to be lower than the non-compliant, which was also statistically significant (p<0,001 and p=0,044, respectfully). There were no significant differences in terms of separate PFT parameters (p>0,05). Rates of nasal cannula use, tolerance of CPAP, ability to fall asleep quickly, no abdominal discomfort or facial lacerations due to the mask, no leakage of oxygen, benefit from the device, reduction in daytime sleepiness and the thought that adequate and appropriate treatment had been administered in patients who complied with the device were significantly higher than those who were not compliant (p<0,05). Claustrophobia, discomfort concerning pressure were also significantly lower in complying patients than non-complying patients (p<0,05). A forward Wald multiple logistic regression model was established using variables which were found to affect the patients' compliance rates, which showed that an increase BDS scale score increased the non-compliance odds ratio by 1,08, the complaint of air leakage by 6,82, pressure discomfort by 5,21, and absence of improvement in daytime sleepiness by 5,87. Result: Whereas an association between PFT parameters and compliance to PAP treatment wasn't established, statistically significant factors that affected device compliance were detected. In patients with OSAS, high-risk groups in terms of compliance should be identified before starting PAP treatment, and educational support should be provided. Our view is that close followups of patients and solution of their complaints regarding treatment could improve their compliance with PAP treatment.
Purpose: OSAS (Obstructive sleep apnoea syndrome) is a syndrome characterized by recurrent episodes of complete (apnoea) or partial (hypopnoea) upper respiratory airway obstruction and often accompanied by a decrease in blood oxygen saturation. Polysomnography (PSG) is the gold standard method utilized in the diagnosis of OSAS. Successful management of sleep apnoea not only improves sleep quality and quality of life but also helps to prevent most of the serious complications associated with the syndrome, in which positive airway pressure (PAP) treatment is the main modality of management. However, issues regarding compliance and adherence to the device are often experienced by patients and clinicians alike. In this study, we aim to investigate the association between patients' compliance with PAP treatment and the results of their pulmonary function tests (PFT). Materials and Methods: : Patients included in this study were diagnosed with OSAS in the Sleep Study Lab at the Department of Pulmonology in Duzce University, who was then admitted to the Pulmonology ward for PAP titration, successfully titrated, issued with a PAP device report and provided with a device, all of whom had given their consent to the study. Their demographic features and complaints regarding the device and its mask which affected their adherence to the treatment, and their depression and anxiety scale scores were evaluated along with their PFT parameters. Conclusion: 63% of 98 individuals (n=62) were males and their average age was 52 ± 9,6 (29-72). 67% of patients were found to be compliant with devices they were provided with. A statistically significant difference (p<0,05) was observed in different grades of OSAS in terms of patient compliance. Patients with severe OSAS were found to be more compliant. Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS) scores of device-compliant patients were observed to be lower than the non-compliant, which was also statistically significant (p<0,001 and p=0,044, respectfully). There were no significant differences in terms of separate PFT parameters (p>0,05). Rates of nasal cannula use, tolerance of CPAP, ability to fall asleep quickly, no abdominal discomfort or facial lacerations due to the mask, no leakage of oxygen, benefit from the device, reduction in daytime sleepiness and the thought that adequate and appropriate treatment had been administered in patients who complied with the device were significantly higher than those who were not compliant (p<0,05). Claustrophobia, discomfort concerning pressure were also significantly lower in complying patients than non-complying patients (p<0,05). A forward Wald multiple logistic regression model was established using variables which were found to affect the patients' compliance rates, which showed that an increase BDS scale score increased the non-compliance odds ratio by 1,08, the complaint of air leakage by 6,82, pressure discomfort by 5,21, and absence of improvement in daytime sleepiness by 5,87. Result: Whereas an association between PFT parameters and compliance to PAP treatment wasn't established, statistically significant factors that affected device compliance were detected. In patients with OSAS, high-risk groups in terms of compliance should be identified before starting PAP treatment, and educational support should be provided. Our view is that close followups of patients and solution of their complaints regarding treatment could improve their compliance with PAP treatment.
Açıklama
YÖK Tez No: 632416
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases
