L’observance et l’acceptation au traitement par pression positive continue dans le cadre du syndrome d’apnées obstructives du sommeil
Mots-clés :
SAOS, PPC, ObservanceRésumé
Introduction : La pression positive continue (PPC) constitue le traitement de référence du syndrome d’apnées obstructives du sommeil (SAOS). Il s’agit d’une thérapeutique contraignante qui peut poser des problèmes d’observance et d’acceptation à long terme.
Les objectifs : Evaluer l’observance et l’acceptation à long terme de la PPC chez des patients suivis et appareillés pour un SAOS sévère et examiner leurs facteurs prédictifs.
Méthodes : Etude rétrospective ayant intéressé des patients suivis au service de pneumologie pour SAOS sévère. Les facteurs influençants l’observance et l’acceptation à long terme ont été identifiés. La méthode de Kaplan-Meier et le test du Logrank ont été utilisés pour comparer l’évolution de la proportion de patients sous traitement PPC
Résultats : Notre population était composée de 145 patients SAOS sévères. L’âge moyen était de 55,4 ± 10,2 ans. Les principales comorbidités retrouvées étaient l’hypertension artérielle (47%), le diabète (25,5%) et la BPCO (11%). L’index d’apnées hypopnées moyen était de 56 ±19,5/ heure. Quinze patients avaient refusé d’emblée le traitement par PPC. Les 130 patients appareillés étaient suivis sur une durée moyenne de 75 ± 34 mois. Durant la période du suivi, 42 patients avaient abandonné le traitement par PPC. Le délai moyen d’arrêt était de 24, 2 ±18,8 mois et 21% des patients ont abandonné leur traitement pendant les 6 premiers mois. La BPCO était identifiée comme le seul facteur prédictif de mauvaise observance (OR = 0,118 ; p = 0,02). La probabilité de poursuite du traitement par PPC à 5 ans a été de 69,4% et de 64,1 % à 10 ans. Les patients non observant avaient une probabilité plus élevée d’arrêter l’utilisation de la PPC par rapport aux patients observants (p < 0,0001).
Conclusion : le traitement du SAOS par PPC est généralement bien accepté au long terme. Les abandons de traitement ont été plus fréquents chez les patients non observant justifiant un suivi régulier et rapproché les premiers mois du traitement.
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Young T, Peppard PE, Gottlieb DJ. Epidemiology of Obstructive Sleep Apnea. Am J Respir Crit Care Med 2002; 165:1217-39.
Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoeahypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet 2005;365:1046-53.
Terán-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The Association between Sleep Apnea and the Risk of Traffic Accidents. N Engl J Med 1999; 340:847-51.
D'Ambrosio C, Bowman T, Mohsenin V. Quality of life in patients with obstructive sleep apnea: Effect of nasal continuous positive airway pressure a prospective study. Chest 1999; 115:123-9.
Bazzano LA, Khan Z, Reynolds K, He J. Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea. Hypertension 2007; 50:417-23.
McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999;159:1108-14.
Engleman HM, Wild MR. Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 2003;7:81-99.
Abdelghani A, Slama S, Hayouni A, Harrabi I, Mezghanni S, Garrouche A, et al. Évaluation de l'observance et de l'acceptation du traitement du syndrome d'apnées obstructives du sommeil par pression positive continue. Étude prospective de 72 patients appareillés entre 2004 et 2007. Rev Pneumol Clin 2009;65:147-52.
Berkani K, Dimet J. Acceptation et observance à long terme du traitement par pression positive continue. Rev Mal Respir 2015;32:249-55. 10. Organization WH. Obesity: Preventing and Managing the Global Epidemic. World Health Organization; 2000.
Synthèse des recommandations de bonne pratique clinique : prise en charge du syndrome d'apnées-hypopnées de l'adulte obstructives du sommeil (SAHOS). Médecine Sommeil 2010;7:161-5.
Synthèse des recommandations de bonne pratique clinique : prise en charge du syndrome d'apnées-hypopnées de l'adulte obstructives du sommeil (SAHOS). Médecine Sommeil 2010;7:161-5.
Clinical Guideline for the Evaluation, Management and Longterm Care of Obstructive Sleep Apnea in Adults. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 2009; 5:263-76.
Meurice J-C. Observance de la ventilation en PPC dans le SAS. Rev Mal Respir 2006;23, Supplement 2:34-7.
Lacassagne L, Didier A, Doussau S, Murris-Espin M, Birot P, Charlet JP, et al. Results of 248 patients with sleep apnea syndrome treated by continuous positive pressure ventilation between 1990 and 1995. A study of compliance and outcome of the apneahypopnea index. Rev Mal Respir 2000;17:467-74.
Rauscher H, Popp W, Wanke T, Zwick H. Acceptance of CPAP therapy for sleep apnea. Chest J 1991;100:1019-23.
Katsantonis GP, Branham GH, Chambers G, Schweitzer PK, Walsh JK. Management of obstructive sleep apnea: Comparison of various treatment modalities. The Laryngoscope 1988;98:304-9.
Waldhorn RE, Herrick TW, Nguyen MC, O'Donnell AE, Sodero J, Potolicchio SJ. LOng-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. Chest 1990;97:33-8.
Chollet S, Ordronneau J, Chailleux E, Nogues B, Canfrere I, Hervouet A. Facteurs prédictifs de l'observance de la pression positive continue nocturne chez les patients porteurs d'un syndrome d'apnées du sommeil. Rev Mal Respir 1993;10:519-25.
Meslier N, Lebrun T, Grillier-Lanoir V, Rolland N, Henderick C, Sailly JC, et al. A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: benefits, tolerance, compliance and quality of life. Eur Respir J 1998;12:185-92.
Krieger J. Long-term compliance with nasal continuous positive airway pressure (CPAP) in obstructive sleep apnea patients and non apneic snorers. Sleep 1992;15:S42-6.
Pépin JL, Chouri-Pontarollo N, Tamisier R, Lévy P. Long term compliance with nasal CPAP. Rev Mal Respir 2005;22:922-4.
Bizieux-Thaminy A, Gagnadoux F, Binquet C, Meslier N, Person C, Racineux JL. Long term use of nCPAP therapy in sleep apnoea patients. Rev Mal Respir 2005;22:951-7.
Queiroz DLC, Yui MS, Braga AA, Coelho ML, Küpper DS, Sander HH, et al. Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service. Braz J Otorhinolaryngol 2014;80:126-30.
Hussain SF, Irfan M, Waheed Z, Alam N, Mansoor S, Islam M. Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients-a cross sectional study. BMC Pulm Med 2014;14:188.
Johnson MK, Carter R, Nicol A, Paton R, Banham SW. Long-term continuous positive airway pressure (CPAP) outcomes from a sleep service using limited sleep studies and daycase CPAP titration in the management of obstructive sleep apnoea/hypopnoea syndrome. Chron Respir Dis 2004;1:83-8.
Willemin M-C, Fry S, Peres S, Wallaert B, Mallart A. Éducation thérapeutique de patients apnéiques inobservants sous pression positive continue. Rev Pneumol Clin 2013;69:70-5.
Kohler M, Smith D, Tippett V, Stradling JR. Predictors of longterm compliance with continuous positive airway pressure.Thorax 2010;65:829-32.
Pelletier-Fleury N, Rakotonanahary D, Fleury B. The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox's proportional hazard analysis. Sleep Med 2001;2:225-32.
Campos-Rodriguez F, Martinez-Garcia MA, Reyes-Nunez N, Caballero-Martinez I, Almeida-Gonzalez CV, Catalan-Serra P, et al. Long-term continuous positive airway pressure compliance in females with obstructive sleep apnoea.Eur Respir J 2013;42:1255- 62.
Weaver TE, Grunstein RR. Adherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment. Proc Am Thorac Soc 2008;5:173-8.
Sin DD. Long-term Compliance Rates to Continuous Positive Airway Pressure in Obstructive Sleep Apnea : A Population- Based Study. CHEST J 2002;121:430.
Berkani K, Dimet J, Breton P, Bizieux-Thaminy A, Berruchon J. Prise en charge du syndrome d'apnées du sommeil dans un hôpital général. Étude rétrospective de 1718patients appareillés du 1er janvier 1994 au 1er janvier 2010. Rev Mal Respir 2012;29:871-7.
Woehrle H, Graml A, Weinreich G. Age and gender dependent adherence with continuous positive airway pressure therapy. Sleep Med 2011;12:1034-6.
Salepci B, Caglayan B, Kiral N, Parmaksiz ET, Comert SS, Sarac G, et al. CPAP Adherence of Patients With Obstructive Sleep Apnea. Respir Care 2013;58:1467-73.
Ye L, Pien GW, Ratcliffe SJ, Weaver TE. Gender Differences in Obstructive Sleep Apnea and Treatment Response to Continuous Positive Airway Pressure. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 2009;5:512-8.
Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P, et al. Early CPAP use identifies subsequent adherence to CPAP therapy. SLEEP-N Y THEN Westchest- 2007;30:320.
Russo-Magno P, O'Brien A, Panciera T, Rnp, Rrt, Rounds S. Compliance with CPAP Therapy in Older Men with Obstructive Sleep Apnea. J Am Geriatr Soc 2001;49:1205-11.
Stepnowsky CJ Jr, Bardwell WA, Moore PJ, Ancoli-Israel S, Dimsdale JE. Psychologic correlates of compliance with continuous positive airway pressure. Sleep 2002;25:758-62.
Wells RD, Freedland KE, Carney RM, Duntley SP, Stepanski EJ. Adherence, Reports of Benefits, and Depression Among Patients Treated With Continuous Positive Airway Pressure: Psychosom Med 2007;69:449-54.
Boyaci H, Gacar K, Baris SA, Basyigit I, Yildiz F. Positive airway pressure device compliance of the patients with obstructive sleep apnea syndrome. Adv Clin Exp Med Off Organ Wroclaw Med Univ 2012;22:809-15.
Barbé F, Mayoralas LR, Duran J, Masa JF, Maimó A, Montserrat JM, et al. Treatment with Continuous Positive Airway Pressure Is Not Effective in Patients with Sleep Apnea but No Daytime SleepinessA Randomized, Controlled Trial. Ann Intern Med 2001;134:1015-23.
Chen Y-F, Hang L-W, Huang C-S, Liang S-J, Chung W-S. Polysomnographic predictors of persistent continuous positive airway pressure adherence in patients with moderate and severe obstructive sleep apnea. Kaohsiung J Med Sci 2015;31:83-9.
Wang Y, Gao W, Sun M, Chen B. Adherence to Continuous Positive Airway Pressure in Patients With OSA in a Chinese Population. Respir Care 2011
Beecroft J. Oral Continuous Positive Airway Pressure for Sleep Apnea: Effectiveness, Patient Preference, and Adherence. CHEST J 2003;124:2200.
Khanna R, Kline LR. A prospective 8 week trial of nasal interfaces vs. a novel oral interface (OracleTM) for treatment of obstructive sleep apnea hypopnea syndrome. Sleep Med 2003;4:333-8.
Chai-Coetzer CL, Luo Y-M, Antic NA, Zhang X-L, Chen B-Y, He QY, et al. Predictors of Long-Term Adherence to Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea and Cardiovascular Disease in the SAVE Study. Sleep 2013.
Anderson FE, Kingshott RN, Taylor DR, Jones DR, Kline LR, Whyte KF. A randomized crossover efficacy trial of oral CPAP (Oracle) compared with nasal CPAP in the management of obstructive sleep apnea. Sleep 2003;26:721-6.
Mortimore IL, Whittle AT, Douglas NJ. Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax 1998;53:290-2.
Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, et al. Type of Mask May Impact on Continuous Positive Airway Pressure Adherence in Apneic Patients. PLoS One 2013;8:e64382.
Ayas NT, Patel SR, Malhotra A, Schulzer M, Malhotra M, Jung D, et al. Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. SLEEP.2004 Mar15; 27(2): 249-53.
Teschler H, Farhat AA, Exner V, Konietzko N, Berthon-Jones M. AutoSet nasal CPAP titration: constancy of pressure, compliance and effectiveness at 8 month follow-up.Eur Respir J1997;10:2073-8.
Hukins C. Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial. Sleep 2004;27:15127.
Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, et al. Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home. Am J Respir Crit Care Med 2003;167:20-3.
Sériès F, Marc I, Cormier Y, La Forge J. Required levels of nasal continuous positive airway pressure during treatment of obstructive sleep apnoea. Eur Respir J 1994;7:1776-81.
Hui DSC. Determinants of Continuous Positive Airway Pressure Compliance in a Group of Chinese Patients With Obstructive Sleep Apnea. Chest 2001;120:170-6.
Hoffstein V, Viner S, Mateika S, Conway J. Treatment of Obstructive Sleep Apnea with Nasal Continuous Positive Airway Pressure: Patient Compliance, Perception of Benefits, and Side Effects. Am Rev Respir Dis 1992;145:841-5.
Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ. Self-reported use of cpap and benefits of cpap therapy : A patient survey. Chest 1996; 109:1470-6.
Lewis KE, Seale L, Bartle IE, Watkins AJ, Ebden P. Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep. 2004; 27:134-8.
Pépin JL, Leger P, Veale D, Langevin B, Robert D, Lévy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome : Study of 193 patients in two french sleep centers. Chest 1995; 107:375-81.
Valentin A, Subramanian S, Quan SF, Berry RB, Parthasarathy S. Air Leak is Associated with Poor Adherence to Autopap Therapy. Sleep 2011.
Rolfe I, Olson LG, Saunders NA. Long-term Acceptance of Continuous Positive Airway Pressure in Obstructive Sleep Apnea. Am Rev Respir Dis 1991;144:1130-3.
Meurice J-C. Erratum à l'article «Comment améliorer l'observance vis-Ã -vis de la PPC dans le Syndrome d'apnées du sommeil: du coaching à la télémédecine ». Rev Mal Respir 2012;29.
Meurice JC, Cornette A, Philip-Joet F, Pepin JL, Escourrou P, Ingrand P, et al. Evaluation of autoCPAP devices in home treatment of sleep apnea/hypopnea syndrome. Sleep Med 2007;8:695-703.
Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. physiologic and clinica implications. Chest 1990;98:317-24.
Gagnadoux F. The place of CPAP in Sleep apnea syndrome treatment: management algorithme. Rev Mal Respir. 2006; 23 Spec N2: 7s30-7s33.
