CHEST:远程医疗增加了医护的工作量,并没有获得比传统管理更好的治疗依从性和疗效

2021-09-18 裴果,欧琼 MedSci原创

基于OSA的表型使用量身定制的管理策略,才能确保远程医疗管理达到更好的治疗依从性和治疗获益。

Impact of a multimodal telemonitoring intervention on CPAP adherence in symptomatic low-cardiovascular risk sleep apnea: a randomized controlled trial,DOI:https://doi.org/10.1016/j.chest.2020.05.613

近期,呼吸领域权威杂志《CHEST》发表了题为:多模式远程监护干预对症状性低血管风险睡眠呼吸暂停患者CPAP依从性的影响:一项随机对照试验。

治疗阻塞性睡眠呼吸暂停(OSA)的主要挑战之一是获得足够的持续气道正压通气(CPAP)依从性。远程监护可以在治疗过程中提供个性化管理并早期识别治疗过程中的问题。那么多模式远程监护干预对心血管风险较低的症状性OSA患者的治疗依从性、生活质量和功能状态有何影响呢?

该研究是一项前瞻性、多中心、随机对照试验,纳入了206名年龄18-78岁,多导睡眠监测(PSG)显示呼吸暂停低通气指数(AHI)>30的重度OSA患者,这些OSA患者在基线时没有已知的心血管疾病,以及心血管风险低于5%。纳入研究的OSA患者被随机分配到多模式远程监护组(TM)或常规护理组(UC)。远程监护在治疗过程中出现副作用,漏气或持续残留事件的情况下及时调整CPAP治疗。该研究的主要评估结果是CPAP依从性(小时/夜)。

次要评估结果包括日间症状,如疲劳和嗜睡,以及通过自我报告问卷测量的生活质量。在206例纳入研究的OSA患者中,102例接受了常规护理,104例接受了远程监护。研究发现,经过6个月的治疗,在心血管风险较低的重度OSA患者中,两组患者的CPAP依从性是相似的,多模式远程监护并不会增加CPAP依从性。两组在改善日间症状以及生活质量的效果方面并没有显著差异。跟常规护理相比,远程监护显著增加了医生和家庭护理提供者的随访工作量。

这项针对低心血管风险症状性OSA患者的随机对照试验研究表明,远程监护管理对这一人群的影响可能微乎其微。未来需要将远程监护与其他患者管理方式相结合,同时进行强有力的成本效益评估来提高患者依从性。基于OSA的表型使用量身定制的管理策略,才能确保远程医疗管理达到更好的治疗依从性和治疗获益。

关于解读作者

广东省人民医院 广东省医学科学院 睡眠呼吸障碍诊疗中心主任医师、博士生导师

主要研究方向:1. 阻塞性睡眠呼吸暂停早期机体损伤机制及干预 2. OSA临床及队列研究 睡眠医学相关经历及贡献:1.AASM早期睡眠医学Mini-Fellow,较早将美国睡眠中心标准与国内实际结合,探索并实行了睡眠呼吸慢病诊疗管理模式。2.中国医学科学院全生命期队列广东睡眠健康队列项目负责人3..较早在国内开展职业人群OSA的筛查和干预 主要学术任职: 广东省预防医学会睡眠障碍及相关疾病防治专业委员会主任委员 中国睡眠研究会睡眠呼吸障碍专业委员会副主任委员 中国老年医学会睡眠医学分会副会长 中国医师协会睡眠专业医师分会常委 中国医学装备协会呼吸病学装备专业委员会常委 中国医药质量管理协会临床研究质量与评价委员会常委 粤港澳大湾区睡眠医学专业医师联盟副主任 广东省医师协会、医学会睡眠副主委

原始出处:Tamisier R, Treptow E, Joyeux-Faure M, Levy P, Sapene M, Benmerad M, Bailly S, Grillet Y, Stach B, Muir JF, Pegliasco H, Pépin JL; OPTISAS trial Investigators. Impact of a Multimodal Telemonitoring Intervention on CPAP Adherence in Symptomatic OSA and Low Cardiovascular Risk: A Randomized Controlled Trial. Chest. 2020 Nov;158(5):2136-2145. doi: 10.1016/j.chest.2020.05.613. Epub 2020 Jul 5. PMID: 32640196.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2051690, encodeId=6185205169022, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Dec 02 00:54:54 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929669, encodeId=092d192966926, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Tue Aug 02 05:54:54 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951699, encodeId=9ae7195169996, content=<a href='/topic/show?id=dcfc6458314' target=_blank style='color:#2F92EE;'>#治疗依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64583, encryptionId=dcfc6458314, topicName=治疗依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Tue Jan 25 19:54:54 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040817, encodeId=dc7a204081e6b, content=<a href='/topic/show?id=c7364e91730' target=_blank style='color:#2F92EE;'>#工作量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47917, encryptionId=c7364e91730, topicName=工作量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Sat Feb 26 06:54:54 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319356, encodeId=b7d21319356be, content=<a href='/topic/show?id=60172686668' target=_blank style='color:#2F92EE;'>#依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26866, encryptionId=60172686668, topicName=依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9df476, createdName=fyxzlh, createdTime=Mon Sep 20 07:54:54 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
    2021-12-02 xiangyuzhou971
  2. [GetPortalCommentsPageByObjectIdResponse(id=2051690, encodeId=6185205169022, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Dec 02 00:54:54 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929669, encodeId=092d192966926, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Tue Aug 02 05:54:54 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951699, encodeId=9ae7195169996, content=<a href='/topic/show?id=dcfc6458314' target=_blank style='color:#2F92EE;'>#治疗依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64583, encryptionId=dcfc6458314, topicName=治疗依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Tue Jan 25 19:54:54 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040817, encodeId=dc7a204081e6b, content=<a href='/topic/show?id=c7364e91730' target=_blank style='color:#2F92EE;'>#工作量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47917, encryptionId=c7364e91730, topicName=工作量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Sat Feb 26 06:54:54 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319356, encodeId=b7d21319356be, content=<a href='/topic/show?id=60172686668' target=_blank style='color:#2F92EE;'>#依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26866, encryptionId=60172686668, topicName=依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9df476, createdName=fyxzlh, createdTime=Mon Sep 20 07:54:54 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
    2022-08-02 Smile2680
  3. [GetPortalCommentsPageByObjectIdResponse(id=2051690, encodeId=6185205169022, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Dec 02 00:54:54 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929669, encodeId=092d192966926, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Tue Aug 02 05:54:54 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951699, encodeId=9ae7195169996, content=<a href='/topic/show?id=dcfc6458314' target=_blank style='color:#2F92EE;'>#治疗依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64583, encryptionId=dcfc6458314, topicName=治疗依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Tue Jan 25 19:54:54 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040817, encodeId=dc7a204081e6b, content=<a href='/topic/show?id=c7364e91730' target=_blank style='color:#2F92EE;'>#工作量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47917, encryptionId=c7364e91730, topicName=工作量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Sat Feb 26 06:54:54 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319356, encodeId=b7d21319356be, content=<a href='/topic/show?id=60172686668' target=_blank style='color:#2F92EE;'>#依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26866, encryptionId=60172686668, topicName=依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9df476, createdName=fyxzlh, createdTime=Mon Sep 20 07:54:54 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2051690, encodeId=6185205169022, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Dec 02 00:54:54 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929669, encodeId=092d192966926, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Tue Aug 02 05:54:54 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951699, encodeId=9ae7195169996, content=<a href='/topic/show?id=dcfc6458314' target=_blank style='color:#2F92EE;'>#治疗依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64583, encryptionId=dcfc6458314, topicName=治疗依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Tue Jan 25 19:54:54 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040817, encodeId=dc7a204081e6b, content=<a href='/topic/show?id=c7364e91730' target=_blank style='color:#2F92EE;'>#工作量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47917, encryptionId=c7364e91730, topicName=工作量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Sat Feb 26 06:54:54 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319356, encodeId=b7d21319356be, content=<a href='/topic/show?id=60172686668' target=_blank style='color:#2F92EE;'>#依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26866, encryptionId=60172686668, topicName=依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9df476, createdName=fyxzlh, createdTime=Mon Sep 20 07:54:54 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2051690, encodeId=6185205169022, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Dec 02 00:54:54 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929669, encodeId=092d192966926, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Tue Aug 02 05:54:54 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951699, encodeId=9ae7195169996, content=<a href='/topic/show?id=dcfc6458314' target=_blank style='color:#2F92EE;'>#治疗依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64583, encryptionId=dcfc6458314, topicName=治疗依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Tue Jan 25 19:54:54 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040817, encodeId=dc7a204081e6b, content=<a href='/topic/show?id=c7364e91730' target=_blank style='color:#2F92EE;'>#工作量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47917, encryptionId=c7364e91730, topicName=工作量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Sat Feb 26 06:54:54 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319356, encodeId=b7d21319356be, content=<a href='/topic/show?id=60172686668' target=_blank style='color:#2F92EE;'>#依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26866, encryptionId=60172686668, topicName=依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9df476, createdName=fyxzlh, createdTime=Mon Sep 20 07:54:54 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
    2021-09-20 fyxzlh

相关资讯

专家解读:美国心脏协会呼吁心血管疾病患者该查“睡眠杀手”

6月21日,美国心脏协会(AHA)发布了一份关于阻塞性睡眠呼吸暂停和心血管病的科学声明。

Sleep and Breathing:未合并心血管疾病的轻度阻塞性睡眠呼吸暂停患者心脏影像学改变,OSA相关心血管疾病的一级预防不可忽视

近期,广东省人民医院呼吸科睡眠障碍中心主任医师欧琼专家团队在Sleep and Breathing发表,题为“Cardiac imageology changes in patients

Chest:先天性心脏病儿童阻塞性睡眠呼吸暂停与神经认知障碍

与未患OSA的儿童相比,患有OSA的CHD儿童神经认知功能受损。OSA可能是CHD儿童神经认知障碍的可逆原因。还需要进一步的研究来评估OSA治疗对CHD儿童神经认知功能损害的影响。

Diabetes Care:阻塞性睡眠呼吸暂停是2型糖尿病患者心血管和微血管疾病的危险因素

与不伴有OSA的患者相比,伴有OSA的2型糖尿病患者发生CVD、AF、PN、DFD、CKD和全因死亡增加。伴有OSA的2型糖尿病患者属于高危人群,应针对OSA进行筛查以预防心血管和微血管并发症。

Thorax:儿童期OSA是成年期血压的危险因素

儿童期OSA是影响成年期不良BP结局的独立危险因素。

Chest:OSA与2型糖尿病以及CPAP的治疗效果

由此可见,尽管OSA严重程度可独立预测了糖尿病,但在调整各种基线代谢危险因素和随后的体重变化后,长期接受CPAP治疗与降低T2D风险相关。