Cumplimiento del tratamiento con presión positiva continua nasal (CPAP) en el síndrome de las apneas-hipopneas durante el sueño
Compliance with nasal continuous positive airway pressure for apnea-hypopnea during sleep
Serveis de Pneumologia. Hospital Clínic i Provincial. Barcelona
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"apellidos" => "Barbé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.G.N." "apellidos" => "Agustí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Granados" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serveis de Pneumologia. Hospital Universitario Son Dureta, Palma de Mallorca. Barcelona" "etiqueta" => "*" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Serveis de Pneumologia. Agència d’Evaluació de Tecnologia Mèdica (Servei Català de la Salut). Barcelona" "etiqueta" => "**" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Compliance with nasal continuous positive airway pressure for apnea-hypopnea during sleep" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1994-06-28" "fechaAceptado" => "1994-09-27" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546484" "palabras" => array:3 [ 0 => "Cumplimiento" 1 => "Síndrome de apnea del sueño" 2 => "Presión continua basal en la vía aérea superior" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec546483" "palabras" => array:2 [ 0 => "Compliance" 1 => "Syndrome apnea-hypopnea sleep" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Desde su introducción en 1981 por Sullivan, la presión continua nasal en la vía aérea superior (CPAP) durante la noche es el tratamiento estándar para el síndrome de la apnea-hipopnea durante el sueño (SAHS). Sin embargo, este tratamiento se efectúa a expensas de un coste económico elevado, algunos pacientes no la toleran y su eficacia está en relación al grado de cumplimiento del tratamiento. El propósito del presente estudio ha sido analizar el grado de cumplimiento del tratamiento con CPAP durante los primeros 3 meses en un grupo de 142 pacientes consecutivos afectados de un SAHS de moderada-severa intensidad (índice de apneahipopnea: 48,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20) que precisaban CPAP para su tratamiento. El diagnóstico y la medición del nivel de presión de CPAP (9,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,5<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O) necesarios se efectuó mediante polisomnografía. De estos, 18 pacientes (13%) no volvieron a control. En los 124 restantes (54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11 años), el cumplimiento del tratamiento se valoró a través de un diario del sueño que el sujeto cumplimentaba y en donde anotaba las horas de utilización nocturna de la CPAP, y se cotejaban los datos obtenidos con los del contador horario que llevaba incorporado el generador de CPAP. A todos los sujetos se les interrogaba acerca del grado de somnolencia previo al tratamiento, mediante un cuestionario estandarizado. Aunque la mayoría de los pacientes, según su diario del sueño, manifestaban una utilización regular de la CPAP, sólo aproximadamente un 60% de los casos la utilizaban un promedio diario superior a 4,5 horas. Los “cumplidores” no podían diferenciarse de los “no cumplidores” ni por el grado de somnolencia inicial ni por el índice de apnea/hipopnea hora ni por el nivel de presión de CPAP requerida.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conclusiones</span><p id="spar1005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">a)</span> la opinión del enfermo en cuanto al grado de cumplimiento del tratamiento con CPAP no siempre refleja su grado real de utilización; <span class="elsevierStyleItalic">b)</span> durante los primeros</p></span>" "secciones" => array:2 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusiones" ] ] ] "en" => array:2 [ "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ever since Sullivan introduced nighttime nasal continuous pressure on the upper airway (CPAP) in 1981 it has been the standard treatment for sleep-hypopnea syndrome (SAHS). However, CPAP is carried out at great expense and is not tolerated by all patients. Moreover, its efficacy is dependent on the degree of compliance. In this study we set out to analyze the degree of compliance with CPAP over the first 3 months of treatment in a group of 142 consecutive patients with moderate to severe SAHS (apnea-hypopnea index: 48.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20). Diagnosis and measurement of the level of CPAP needed (9.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O) were based on polysomnography. Eighteen (13%) patients did not return for follow-up evaluation. In the remaining 124 patients (age 54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11 years) compliance with treatment was evaluated by way of a sleep diary in which the patient recorded the hours CPAP was used at night; this record was compared with readings from the CPAP generator's counter. All subjects were asked about their degree of sleepiness before treatment by way of a standard questionnaire. Although most patients reported regular use of CPAP in diaries, only about 60% actually used it for longer than a mean 4.5 hours daily. The most compliant patients could not be differentiated from the least compliant with respect to degree of initial sleepiness, apnea-hypopneaper-hour index or level of CPAP required.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">1) the patient's opinion as to degree of compliance with CPAP treatment does not always reflect the real extent of use; 2) Only 60% of our patients used CPAP long enough in the first 3 months of treatment; and 3) Degree of compliance cannot be predicted based on initial sleepiness, level of CPAP required or severity of SAHS. Consequently, procedures for assuring adequate control of CPAP use must be established.</p></span>" "secciones" => array:2 [ 0 => array:1 [ "identificador" => "abst0015" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Phillipson EA, TD Bradley, editores. Breathing disorders in sleep. Clin Chest Med 1992; 13: 383-550." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Bradley TD, Phillipson EA. Pathogenesis and pathophysiology of the Obstructive Sleep Apnea. En: Thawley, S.E., editor. Sleep Apnea Disorders. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 1 | 8 |
| 2024 October | 41 | 17 | 58 |
| 2024 September | 44 | 19 | 63 |
| 2024 August | 65 | 43 | 108 |
| 2024 July | 48 | 23 | 71 |
| 2024 June | 62 | 30 | 92 |
| 2024 May | 56 | 30 | 86 |
| 2024 April | 45 | 31 | 76 |
| 2024 March | 43 | 30 | 73 |
| 2024 February | 41 | 38 | 79 |
| 2024 January | 0 | 2 | 2 |
| 2023 December | 0 | 4 | 4 |
| 2023 November | 0 | 2 | 2 |
| 2023 October | 1 | 5 | 6 |
| 2023 September | 0 | 1 | 1 |
| 2023 July | 0 | 19 | 19 |
| 2023 June | 19 | 2 | 21 |
| 2023 March | 7 | 4 | 11 |
| 2023 February | 28 | 21 | 49 |
| 2023 January | 29 | 40 | 69 |
| 2022 December | 42 | 25 | 67 |
| 2022 November | 33 | 19 | 52 |
| 2022 October | 30 | 27 | 57 |
| 2022 September | 36 | 22 | 58 |
| 2022 August | 41 | 44 | 85 |
| 2022 July | 31 | 35 | 66 |
| 2022 June | 42 | 23 | 65 |
| 2022 May | 37 | 27 | 64 |
| 2022 April | 37 | 32 | 69 |
| 2022 March | 33 | 40 | 73 |
| 2022 February | 38 | 27 | 65 |
| 2022 January | 30 | 23 | 53 |
| 2021 December | 20 | 36 | 56 |
| 2021 November | 26 | 31 | 57 |
| 2021 October | 20 | 29 | 49 |
| 2021 September | 30 | 41 | 71 |
| 2021 August | 19 | 19 | 38 |
| 2021 July | 29 | 25 | 54 |
| 2021 June | 33 | 39 | 72 |
| 2021 May | 29 | 29 | 58 |
| 2021 April | 37 | 44 | 81 |
| 2021 March | 55 | 25 | 80 |
| 2021 February | 56 | 12 | 68 |
| 2021 January | 25 | 14 | 39 |
| 2020 December | 45 | 16 | 61 |
| 2020 November | 34 | 23 | 57 |
| 2020 October | 24 | 6 | 30 |
| 2020 September | 26 | 8 | 34 |
| 2020 August | 51 | 19 | 70 |
| 2020 July | 45 | 23 | 68 |
| 2020 June | 24 | 13 | 37 |
| 2020 May | 33 | 17 | 50 |
| 2020 April | 44 | 25 | 69 |
| 2020 March | 27 | 18 | 45 |
| 2020 February | 48 | 24 | 72 |
| 2020 January | 53 | 26 | 79 |
| 2019 December | 47 | 33 | 80 |
| 2019 November | 20 | 12 | 32 |
| 2019 October | 28 | 13 | 41 |
| 2019 September | 33 | 41 | 74 |
| 2019 August | 20 | 14 | 34 |
| 2019 July | 30 | 33 | 63 |
| 2019 June | 21 | 24 | 45 |
| 2019 May | 29 | 30 | 59 |
| 2019 April | 35 | 65 | 100 |
| 2019 March | 11 | 34 | 45 |
| 2019 February | 6 | 14 | 20 |
| 2019 January | 8 | 14 | 22 |
| 2018 December | 10 | 24 | 34 |
| 2018 November | 21 | 25 | 46 |
| 2018 October | 28 | 26 | 54 |
| 2018 September | 18 | 13 | 31 |
| 2018 May | 11 | 1 | 12 |
| 2018 April | 16 | 16 | 32 |
| 2018 March | 12 | 22 | 34 |
| 2018 February | 5 | 17 | 22 |
| 2018 January | 6 | 10 | 16 |
| 2017 December | 13 | 15 | 28 |
| 2017 November | 7 | 16 | 23 |
| 2017 October | 11 | 10 | 21 |
| 2017 September | 7 | 8 | 15 |
| 2017 August | 11 | 15 | 26 |
| 2017 July | 4 | 10 | 14 |
| 2017 June | 10 | 11 | 21 |
| 2017 May | 10 | 12 | 22 |
| 2017 April | 6 | 8 | 14 |
| 2017 March | 6 | 21 | 27 |
| 2017 February | 6 | 10 | 16 |
| 2017 January | 6 | 9 | 15 |
| 2016 December | 11 | 9 | 20 |
| 2016 November | 22 | 12 | 34 |
| 2016 October | 16 | 26 | 42 |
| 2016 September | 18 | 12 | 30 |
| 2016 August | 23 | 9 | 32 |
| 2016 July | 30 | 4 | 34 |
| 2016 June | 29 | 8 | 37 |
| 2016 May | 16 | 1 | 17 |
| 2016 April | 20 | 0 | 20 |
| 2016 March | 19 | 1 | 20 |
| 2016 February | 16 | 1 | 17 |
| 2016 January | 23 | 8 | 31 |
| 2015 December | 31 | 21 | 52 |
| 2015 November | 37 | 16 | 53 |
| 2015 October | 9 | 2 | 11 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 June | 1 | 0 | 1 |
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