Cihaz Konforundan Sosyal Desteğe: Obstrüktif Uyku Apnesi Hastalarında PAP Tedavisine Uyumun Çok Yönlü Belirleyicileri

Öz

Obstrüktif uyku apnesi tanısı alan ve pozitif havayolu basıncı tedavisi başlanan hastalarda cihaz kullanımına uyumu etkileyen demografik, klinik, çevresel ve psikososyal faktörlerin değerlendirilmesi amaçlanmıştır. Ocak 2020–Aralık 2024 tarihleri arasında uyku kliniğine başvuran, polisomnografi ile orta-ağır Obstrüktif uyku apnesi (OUA), tanısı konulan ve Pozitif havayolu basıncı (PAP) tedavisi başlanan hastalar retrospektif olarak incelendi. Toplam 337 hasta telefon ile arandı, 212’sine ulaşıldı ve 117’si onay vererek çalışmaya dahil edildi. Hastaların demografik özellikleri, komorbiditeleri, cihaz türü ve kullanım alışkanlıkları kaydedildi. Cihaz uyumu, en az 3 ay düzenli kullanım ve halen aktif kullanım olarak tanımlandı. Anketlerde bireysel, çevresel ve psikososyal faktörler beşli Likert ölçeği ile sorgulandı. Katılımcıların %68’i erkek olup, uyum oranı %67 olarak bulundu. Uyumlu grupta erkek cinsiyet (p=0.034) ve otomatik pozitif hava yolu basıncı (APAP) kullanımı (p<0.01) daha yüksek iken, uyumsuz grupta koroner arter hastalığı, astım ve hipotiroidi daha sık izlendi. Uyumlu hastalarda cihaz günlük ≥4 saat düzenli kullanılmış olup cihaz memnuniyeti, yaşam kalitesi ve hekim ile iletişim daha yüksek bulundu (tümünde p<0.001). Uyumsuz grupta ise cihazla ilişkili şikayetler (basınç intoleransı, hortum rahatsızlığı, uykuya dalma güçlüğü vb.) daha sık rapor edildi. Çevresel faktörlerden oda sıcaklığından rahatsızlık ve kötü hava kalitesi uyumsuzlukla ilişkili bulundu. Semptomatik iyileşme özellikle uyumlu grupta belirgin olup, gündüz aşırı uykululuk, uyku kalitesi ve horlamadan rahatsızlık en anlamlı düzelme sağlanan şikayetlerdi. Sonuç olarak, OUA hastalarında PAP tedavisine uyumu belirleyen çok sayıda faktör bulunduğu gösterilmiştir. Bulgularımız, cihazla ilişkili rahatsızlıkların giderilmesi, erken dönemde yakın değerlendirme ve hekimle düzenli iletişimin tedaviye devamlılık açısından kritik olduğunu ortaya koymuştur.

Anahtar Kelimeler

• Psikososyal faktörler
• sürekli pozitif havayolu basıncı
• tedavi uyumu
• tıkayıcı uyku apnesi
• yaşam kalitesi

From Device Comfort to Social Support: Multidimensional Determinants of PAP Adherence in Patients with Obstructive Sleep Apnea

Öz

This study aimed to evaluate demographic, clinical, environmental, and psychosocial determinants of adherence to positive airway pressure therapy in patients with obstructive sleep apnea. Patients admitted to the sleep clinic between January 2020 and December 2024, diagnosed with moderate-to-severe Obstructive sleep apnea (OSA) by polysomnography, and started on PAP therapy were retrospectively analyzed. A total of 337 patients were contacted, 212 were reached, and 117 consented to participate. Demographics, comorbidities, device type, and usage habits were recorded. Adherence was defined as regular Positive airway pressure (PAP) use for at least three months. Individual, environmental, and psychosocial factors were assessed using a five-point Likert scale. Among participants, 68% were male, and the overall adherence rate was 67%. Male sex (p=0.034) and automatic positive airway pressure (APAP) use (p<0.001) were more common in the adherent group, whereas coronary artery disease, asthma, and hypothyroidism were more frequent in the non-adherent group. Adherent patients used the device ≥4 h/night and reported greater satisfaction and beter physician communication (all p<0.001). Device-related complaints, including pressure intolerance, hose discomfort, and difficulty initiating sleep, were significantly more frequent in the non-adherent group. Environmental factors, such as uncomfortable room temperature and poor air quality, were also linked to non-adherence. Symptom improvement was more evident in the adherent group, particularly in daytime sleepiness, sleep quality, and snoring. In conclusion, adherence to PAP therapy in OSA is influenced by demographic, clinical, and psychosocial factors. Addressing device-related dissues, ensuring early follow-up, and strengthening physician–patient communication are essential to improve adherence and maintain clinical benefit.

Anahtar Kelimeler

• Psychosocial factors
• continuous positive airway pressure
• medication adherence
• obstructive sleep apnea
• quality of life

Kaynakça

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