Good long-term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

被引：12

作者：

Campos-Rodriguez, Francisco ^{[1
,2
,3
]}

Navarro-Soriano, Cristina ^{[4
]}

Reyes-Nunez, Nuria ^{[1
]}

Torres, Gerard ^{[5
]}

Caballero-Eraso, Candela ^{[6
]}

Lloberes, Patricia ^{[7
]}

Diaz-Cambriles, Trinidad ^{[8
]}

Somoza, Maria ^{[9
]}

Masa, Juan F. ^{[3
,10
]}

Gonzalez, Monica ^{[11
]}

Manas, Eva ^{[12
]}

de la Pena, Monica ^{[13
]}

Barbe, Ferran ^{[3
,14
]}

Garcia-Rio, Francisco ^{[3
,15
]}

Montserrat, Josep Maria ^{[16
]}

Muriel, Alfonso ^{[3
,17
,18
,19
]}

Garcia-Ortega, Alberto ^{[4
]}

Selma, Maria J. ^{[4
]}

Martinez-Garcia, Miguel-Angel ^{[4
]}

机构：

[1] Hosp Univ Valme, Resp Dept, Seville, Spain

[2] Univ Seville, Inst Biomed Sevilla IBIS, Seville, Spain

[3] CIBER Enfermedades Resp, CIBERes, Madrid, Spain

[4] Hosp Univ & Politecn La Fe, Resp Dept, Valencia, Spain

[5] Hosp Univ Santa Maria, Internal Med Serv, Lleida, Spain

[6] Hosp Univ Virgen del Rocio, Resp Dept, Seville, Spain

[7] Hosp Univ Vall Hebron, Resp Dept, Barcelona, Spain

[8] Hosp Univ 12 Octubre, Resp Dept, Madrid, Spain

[9] Consorcio Sanitario Terrassa, Resp Dept, Barcelona, Spain

[10] Hosp Univ San Pedro de Alcantara, Resp Dept, Caceres, Spain

[11] Hosp Univ Marques Valdecilla, Resp Dept, Santander, Spain

[12] Hosp Univ Ramon y Cajal, Resp Dept, Madrid, Spain

[13] Hosp Univ Son Espases, Resp Dept, Palma De Mallorca, Spain

[14] IRB Lleida, Inst Recerca Biomed, Lleida, Spain

[15] Hosp Univ La Paz, Resp Dept, IdiPAZ, Madrid, Spain

[16] Hosp Clin IDIBAPS, Resp Dept, Barcelona, Spain

[17] Hosp Ramon & Cajal, Unidad Bioestadist Clin, Madrid, Spain

[18] IRYCIS, Madrid, Spain

[19] Univ Alcala, Dept Enfermeria, Madrid, Spain

来源：

JOURNAL OF SLEEP RESEARCH | 2019年 / 28卷 / 05期

关键词：

adherence; continuous positive airway pressure; obstructive sleep apnea; resistant hypertension; BLOOD-PRESSURE; CARDIOVASCULAR EVENTS; CPAP THERAPY; PREDICTORS; DISEASE; PROGNOSIS;

D O I：

10.1111/jsr.12805

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Although adequate adherence is paramount in achieving the beneficial effects of continuous positive airway pressure therapy in patients with obstructive sleep apnea, long-term adherence and the variables involved in continuous positive airway pressure compliance in patients with resistant hypertension and obstructive sleep apnea are yet unknown. We conducted a prospective, multicentre, observational study in 177 patients recruited from hypertensive units with resistant hypertension confirmed by means of 24-hr blood pressure monitoring (blood pressure >= 130 and/or >= 80 mmHg, despite taking at least three antihypertensive drugs or 3 drugs) and obstructive sleep apnea (apnea-hypopnea index >= 5 in a respiratory polygraph) who were prescribed continuous positive airway pressure treatment. Good adherence was defined as an average cumulative continuous positive airway pressure use of >= 4 hr per night at the end of the follow-up. A multivariate Cox regression analysis was performed to identify independent predictors of continuous positive airway pressure adherence. Patients were followed for a median of 57.6 (42-72) months after initiating continuous positive airway pressure therapy. At the end of the follow-up, the median continuous positive airway pressure use was 5.7 (inter-quartile range 3.9-6.6) hr per night, and 132 patients (74.5%) showed good continuous positive airway pressure adherence. The only baseline variable associated with poor adherence was the presence of previous stroke (hazard ratio 4.00, 95% confidence interval 1.92-8.31). Adequate adherence at 1 month also predicted good adherence at the end of the follow-up (hazard ratio 14.4, 95% confidence interval 4.94-56). Both variables also predicted adherence at a threshold of 6 hr per night. Our results show that good continuous positive airway pressure adherence is an achievable and feasible goal in patients with resistant hypertension and obstructive sleep apnea. Previous stroke and short-term adherence predicted long-term adherence.

引用

页数：8

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