背景:在检查阻塞性睡眠呼吸暂停(OSA)患者气道正压通气(PAP)依从性与健康结局的相关性的观察性研究中,健康依从性效应(HAE)作为潜在的偏倚来源受到越来越多的关注。
目的:坚持PAP与设备处方前的健康行为和医疗资源使用有关吗?
方法:来自IRSRPaysdelaLoire睡眠队列的数据与健康管理数据相关联,以确定健康行为(HB)的代理,包括对心血管(CV)药物的依从性(药物占有比例,[MPR]),癌症筛查测试,流感疫苗接种,酒精和吸烟消费,以及OSA患者PAP发作前两年与嗜睡相关的道路交通事故。进行多变量回归分析以评估HB与随后的PAP依从性的关联。根据随后的PAP依从性评估医疗保健资源的使用。
结果:我们纳入了2012年至2018年开始PAP治疗的2,836例患者(其中65%为PAP粘附者,平均每日使用≥4小时/晚)。依附于CV活性药物(MPR≥80%)和非吸烟者与PAP依从性的可能性更高(优势比,OR[95%置信区间]:分别为1.43[1.15;1.77]和1.37[1.10;1.71])。没有嗜睡相关道路交通事故史的患者更有可能继续PAP(OR:1.39[1.04;1.87])。PAP患者在PAP开始前2年使用的医疗保健资源较少,非患者(平均门诊咨询次数:19.0vs17.2,P=.003;住院天数:5.7vs5.0,P=.04;急诊室就诊次数:30.7vs24.0%P=.0002)。
结论:坚持使用PAP治疗OSA的患者比未坚持使用PAP治疗的患者更多寻求健康,并且在设备启动前的医疗保健使用者更少。直到更好地理解与PAP依从性相关的HAE,在非随机队列中解释PAP依从性与CV健康结果和医疗保健资源使用的关联时,需要谨慎。
BACKGROUND: The healthy adherer effect has gained increasing attention as potential source of bias in observational studies examining the association of positive airway pressure (PAP) adherence with health outcomes in OSA.
OBJECTIVE: Is adherence to PAP associated with healthy behaviors and health care resource use prior to device prescription?
METHODS: Data from the IRSR Pays de la Loire Sleep Cohort were linked to health administrative data to identify proxies of heathy behaviors, including adherence to cardiovascular (CV) drugs (medical possession ratio), cancer screening tests, influenza vaccination, alcohol and smoking consumption, and drowsiness-related road accidents during the 2 years preceding PAP onset in patients with OSA. Multivariable regression analyses were conducted to evaluate the association of heathy behaviors with subsequent PAP adherence. Health care resource use was evaluated according to subsequent PAP adherence.
RESULTS: We included 2,836 patients who had started PAP therapy between 2012 and 2018 (65% of whom were PAP adherent with mean daily use ≥ 4 h/night). Being adherent to CV active drugs (medical possession ratio ≥ 80%) and a person who does not smoke were associated with a higher likelihood of PAP adherence (OR, 1.43; 95% CI, 1.15-1.77 and OR, 1.37; 95% CI, 1.10-1.71, respectively). Patients with no history of drowsiness-related road accidents were more likely to continue PAP (OR, 1.39; 95% CI, 1.04-1.87). Patients who were PAP adherent used less health care resources 2 years before PAP initiation than patients who were nonadherent (mean number of outpatient consultations: 19.0 vs 17.2, P = .003; hospitalization days: 5.7 vs 5.0; P = .04; ED visits: 30.7% vs 24.0%, P = .0002, respectively).
CONCLUSIONS: Patients who adhere to PAP therapy for OSA were more health-seeking and used less health care resources prior to device initiation than patients who were nonadherent. Until the healthy adherer effect associated with PAP adherence is better understood, caution is warranted when interpreting the association of PAP adherence with CV health outcomes and health care resource use in nonrandomized cohorts.