Is the 2013 American Thoracic Society CPAP-tracking system algorithm useful for managing non-adherence in long-term CPAP-treated patients?

Respiratory Research

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[1] 0000 0001 0507 738X, grid.413745.0, Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France;0000 0001 0507 738X, grid.413745.0, Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France;0000 0000 9961 060X, grid.157868.5, Department of Medical Information, Montpellier University Hospital, Montpellier, France;0000 0001 0507 738X, grid.413745.0, Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France;0000 0001 2097 0141, grid.121334.6, PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France;0000 0001 0507 738X, grid.413745.0, Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France;Pulmonary Disorders and Respiratory Sleep Disorders Unit, Polyclinic Saint-Privat, Boujan sur Libron, France;Apard groupe Adène, Montpellier, France;IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France;0000 0000 9961 060X, grid.157868.5, Department of Medical Information, Montpellier University Hospital, Montpellier, France;IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France;Apard groupe Adène, Montpellier, France;grid.31151.37, Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France;grid.450307.5, Grenoble Alps University, Inserm U1042, HP2 (Hypoxia PhysioPathology) Laboratory, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France;

关键词: CPAP;    Leaks;    Apnea-hypopnea index;    Telemedicine;   

DOI  :  10.1186/s12931-019-1150-7

来源: publisher

【 摘 要 】

BackgroundWhereas telemedicine usage is growing, the only clinical algorithm for Continuous Positive Airway Pressure (CPAP) adherence management is that stipulated by the 2013 American Thoracic Society (ATS). The capacity of the latter to predict non-adherence in long-term CPAP-treated patients has not been validated.MethodsPatients from the prospective real-life InterfaceVent study (NCT03013283, study conducted in an adult cohort undergoing at least 3 months of CPAP) and eligible for ATS algorithm usage were analysed. The residual device Apnea–Hypopnea-Index (AHIflow) and High Large Leak (HLL) thresholds proposed in the ATS algorithm were evaluated for predicting adherence (i.e. AHIflow > 10/h, HLLs 95th > 24 L/min for ResMed® devices and ResMed® nasal mask, HLLs 95th > 36 l/min for ResMed® devices and ResMed® oronasal masks, HLLs > 1 h for Philips® devices and HHLs > 60 l/min for Fisher & Paykel® devices). Adherence was defined according to the 2013 ATS algorithm (i.e. CPAP use > 4 h/j for at least 70% of days).Results650/1484 patients eligible for ATS algorithm usage were analysed (15.38% non-adherent, 74% male with a median (IQ25–75) age of 68 (61–77) years, a body mass index of 30.8 (27.7–34.5) kg/m2, an initial AHI of 39 (31–55) events/h, and CPAP-treatment-duration of 5.1 (2.2–7.8) years). Logistic regression analysis demonstrated no significant relationship between the ATS proposed AHIflow or HLL thresholds and non-adherence. Complementary ROC curve analysis failed to determine satisfactory AHIflow and HLL thresholds.ConclusionWhen managing non-adherence in long-term CPAP-treated patients, our data do not validate absolute AHIflow or HLL thresholds in general.Trial registrationThe INTERFACE-VENT study is registered on ClinicalTrials.gov (Identifier: study (NCT03013283).

【 授权许可】

CC BY