Épidémiologie du syndrome d’apnées-hypopnées obstructives du sommeil de l’adulte et de ses complications

[Effects of continuous positive airway pressure on depression, anxiety and quality of life in obstructive sleep apnea hypopnea syndrome patients]

INTRODUCTION

The obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP).

METHODS

We conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP.

RESULTS

The prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P<0.001), anxiety (P=0.002) and QOL (P<0.001).

CONCLUSIONS

These results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.

[Effects of an educational program in non-adherent apneic patients treated with continuous positive airway pressure]

INTRODUCTION

Obstructive Sleep Apnea (OSA) is a chronic, frequent pathology impacting patients' quality of life. Continuous positive airways pressure (CPAP) is the most effective treatment, but is often considered binding and thus poorly observed. The aim of this study was to assess the impact of an educational program in non-adherent patients with OSA, to identify the factors of inobservance and to determine risk groups.

PATIENTS AND METHODS

We enrolled 21 patients presenting OSA in this monocentric, forward-looking study. Nineteen patients completed the study. The inclusion criterion was a daily observance less than 4 hours a night. Educational program was realized by a specialized, trained team, with the authorization of the Regional Agency of Health.

RESULTS

Our population consisted of 15 male and six female, all of them obese, with a medium age of 57.7 ± 12.9 years, treated for 10,7 ± 15 months. All of our patients had few symptoms. After the educational program, two groups were individualized according to their observance. Fifty-two percent of patients became compliant to CPAP treatment. Demographic data and medical histories did not differ between these two groups: nine patients remained inobservant (medium daily treatment duration of 57 ± 49 minutes); ten patients became observant (medium daily treatment duration raising from 104 ± 70 minutes to 322 ± 65 minutes, P=0.0002). Among these ten patients, seven were considered as having accepted their disease at initial educational diagnosis.

CONCLUSION

The educational program improved adherence to CPAP treatment in 52% of our patients. All included patients had few symptoms. This could raise the issue of a poorer perception of treatment efficacy in less symptomatic patients. Disease acceptance also appeared linked to CPAP treatment compliance.

[Trends in prevalence of continuous positive airway pressure treatment for adults from 2006 to 2010]

INTRODUCTION

The aim of this study was to evaluate the evolution from 2006 to 2010 of the prevalence of continuous positive airway pressure treatment for the beneficiaries of two regional health care insurance funds (17 and 43).

METHODS

One million forty-eight thousand four hundred and thirty beneficiary-years were analyzed from 2006 to 2010. The prevalence of continuous positive airway pressure treatment was tested with regard to the effect of the year of delivery. A logit regression was used to adjust for potentially confounding differences in age and gender, which were included as covariates. The prevalence of alternative treatments and of controls of reimbursement benefits implemented by the funds are evaluated too during the same period.

RESULTS

Continuous positive airway pressure treatment annual prevalence was 6.34/1000. A significant annual increase of prevalence from 2006 to 2008 was followed by a slowing of the rate of growth starting from 2008. In the same time for fund 43, obesity surgery rose from 41.85/100,000 to 55.44/100,000 and mandibular osteotomy surgery rose from 0.97/100,000 to 4.78/100,000. For fund 17 mandibular advancement devices rose from 10.72/100,000 to 21,08/100,000. The two funds started a reinforced inspections of reimbursement benefits for continuous positive airway pressure treatment in 2008.

CONCLUSIONS

The dynamics of continuous positive airway pressure treatment have to be considered in the context of policies introduced and trends in the application of alternative treatments in each fund.