Effect of adherence on daytime sleepiness, fatigue, depression and sleep quality in the obstructive sleep apnea/hypopnea syndrome patients undertaking nasal continuous positive airway pressure therapy
Received 20 November 2016
Accepted for publication 28 February 2017
Published 12 April 2017 Volume 2017:11 Pages 769—779
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Dr Naifeng Liu
Yeying Wang,1,2 Li Ai,1 Jiahong Luo,2 Ran Li,1 Yanlin Chai,1 Xiaojie He,1 Yu Cao,1 Yongxia Li1
1Department of Respiratory Medicine, The Second Affiliated Hospital of Kunming Medical University, 2Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Chenggong New City, Kunming, Yunnan Province, People’s Republic of China
Objectives: The aims of this study were to describe changes in day- and nighttime symptoms and the adherence to nasal continuous positive airway pressure (nCPAP) during the first 3-month nCPAP therapy among newly diagnosed patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and to identify the effect of adherence on the changes in day- and nighttime symptoms during the first 3 months.
Methods: Newly diagnosed OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures of the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Zung’s Self-Rating Depression Scale (SDS) and the Pittsburgh Sleep Quality Index (PSQI) at baseline and the end of 3rd, 6th, 9th and 12th week of therapy were collected. Twelve weeks’ adherence was calculated as the average of each 3-week period. Mixed model was used to explore the effect of adherence to nCPAP therapy on ESS, FSS, SDS and PSQI in each 3-week phase.
Results: Seventy-six patients completed the 12-week follow-up. The mixed-effects models showed that under the control of therapy phase adherence in the range of <4 hours per night, using nCPAP could independently improve daytime sleepiness, in terms of ESS (coefficient, [95% confidence interval] unit; –4.49 [–5.62, –3.36]). Adherence at 4–6 hours per night could independently improve all variables of day- and nighttime symptoms included in this study, namely ESS –6.69 (–7.40, –5.99), FSS –6.02 (–7.14, –4.91), SDS –2.40 (–2.95, –1.85) and PSQI –0.20 (–0.52, –0.12). Further improvement in symptoms could be achieved at ≥6 hours per night using nCPAP, which was ESS –8.35 (–9.26, –7.44), FSS –10.30 (–11.78, –8.83), SDS –4.42 (–5.15, –3.68) and PSQI –0.40 (–0.82, –0.02). The interaction between adherence level and therapy phase was not significant in day- and nighttime symptoms.
Conclusion: The effect of adherence on the above-mentioned symptoms is stable through the first 3 months. Under the control of therapy phase, the nCPAP therapy effectively improves day- and nighttime symptoms with ≥4 hours adherence, and the patients can achieve a further improvement with ≥6 hours adherence.
Keywords: OSAS, nCPAP, Epworth Sleepiness Scale, Fatigue Severity Scale , Zung’s Self-Rating Depression Scale, the Pittsburgh Sleep Quality Index
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