Dados do Trabalho

Título

LONG-TERM ADHERENCE TO POSITIVE PRESSURE THERAPY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND OBESITY

Introdução

Obstructive Sleep Apnea (OSA) is a disorder frequently associated with obesity, which is a risk factor for its development, around of 50% to 60% of patients with obesity have OSA. Treatment of OSA involves positive airway pressure (PAP) therapy. However, adequate adherence to PAP therapy (use >4 hours per night on 70% of nights) can be requested and telemonitoring can be a tool to improve adherence.

Objetivo

To analyze long-term adherence to PAP therapy in obese patients with OSA using telemonitoring as a tool.

Métodos

Cross-sectional study of analyzing patient records from a sleep physiotherapy clinic, between March 2020 to November 2022. The study was approved by the ethics committee, used a non-probabilistic for convenience sample, and included individuals over 18 years old, both sexes, who had used PAP therapy for more than a year. Incomplete data records and patients with neurological or neurodegenerative disorders were excluded. Data obtained through the outpatient telemonitoring protocol were considered, on the seventh day of using the device (D7), on the fifteenth day (D15), thirtieth day (D30), ninetieth day (D90) and after one year of use. All patients use basic CPAP with an integrated humidifier, fixed pressure and a nasal mask. Data were analyzed in Microsoft Excel and the Pearson correlation test was used to assess the association between adherence predictors and usage time after one year (p < 0.05). The results were presented as mean, standard deviation and percentage.

Resultados

One hundred and fifty-four records were analyzed, after the exclusion criteria, 38 remained. The sample was composed of 55% women, a mean age of 53.95 ± 10.65 years, BMI of 36.58 ± 5.55 kg/m², initial AHI of 45.14 ± 24.18, ODI of 40.49 ± 17.44, and TSpO2<90% of 144.69 ± 126.13 minutes. The average pressure used was 8.89 ± 1.37 cmH2O, 59.5% of patients maintained the pressure titrated in the initial adaptation after one year of use, 21.5% the pressure was increased, 19.0% there was a reduction in pressure. Four hundred and two telemonitoring consultations were recorded in one year, estimating an average of 10.6 consultations/year per patient. Adherence therapy rates were 89.87% at D7, 92.88% at D30, 90.42% at D90, and 82.70% after one year and the residual AHI was 7.02 ± 12.28 at D7, 5.26 ± 8.45 at D30, 5.33 ± 10.14 at D90 and 2.51 ± 2.67 after one year of usage. Correlations were observed between polysomnography data and device usage time: T<90% versus % of days with >4h usage (r=0.43; p=0.007); T<90% versus % average usage time (r=0.386; p=0.01); average SpO2 versus % of days with >4h usage (r=-0.339; p=0.037); and average SpO2 versus % average usage time (r=-0.437; p=0.008).

Conclusões

Obese patients with OSA demonstrated good adherence to PAP over one year, despite a trend of decreasing adherence over time. It was not necessary to use high pressures to maintain a controlled residual AHI (< 5) after one year of use in this population. Better adherence was noted in those with higher time of SpO2<90%, suggesting that more severe cases tend to use the device more.

Palavras -chave

obesity; obstructive sleep apnea; positive pressure; treatment adherence.