Construction And Primary Confirmation Of Management Procedure For Continuous Positive Airway Pressure Treatment In Patients With Obstructive Sleep Apnea-hypopnea Syndrome

Objective:To introduce the English version of standard procedure of continuous positive airway pressure(CPAP)treatment education and management for patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and construct Chinese version of management procedure for CPAP treatment in OSAHS patients by translation,back translation and expert consultation,then confirm its feasibility and effectiveness.Methods:On the basis of obtaining the approval of the original author,we converted the English version of standard procedure of CPAP treatment education and management into the first draft of Chinese version of management procedure for CPAP treatment in OSAHS patients by translation and back translation.12 experts were invited to conduct 3 rounds of Delphi expert consultation to form the final draft of CPAP treatment management procedure.OSAHS patients who were eligible for CPAP treatment were enrolled into CPAP treatment management procedure to investigate patients’ compliance and apnea hypopnea index(AHI)in one month to determine the effectiveness of CPAP treatment management procedure.The problems encountered by patients,doctors and therapists during the implementation process were observed by observation method to determine the feasibility of CPAP treatment management procedure.Content analysis was used to classify the problems,solutions,part of the management procedure and link.Qualitative interviews were conducted for patients who refused to enter the management procedure or did not complete the management procedure.Content analysis was used to explore the reasons for the patients’ refusal of treatment and the unfinished management procedure.Results:After translation,back translation and Delphi expert consultation of the English version of management procedure,Chinese version of management procedure for CPAP treatment in OSAHS patients was constructed.The management procedure included:(1)sufficient explaining of sleep monitoring report;(2)initial training of CPAP use;(3)trial treatment and equipment purchase;(4)summary of trial treatment.At the sampling process,426 patients were screened by STOP-Bang questionnaire;181 patients were at high risk for OSAHS;69 patients were given portable sleep monitoring;51 patients were diagnosed with OSAHS,and lastly 47 patients required CPAP treatment.Only 6 patients entered the CPAP management procedure;among of them,3 patients completed the management procedure with a good treatment compliance and AHI was obviously improved within 1 month.The problems encountered in the management procedure included:(1)doctor’s focuses during the report interpretating were not prominent;(2)patient’s treatment intention was not firm;(3)the mask was not properly selected by therapist;(4)the connection of cloud platform broke off;(5)it was difficult for patients to master the operation.The other 3 patients gave up the CPAP treatment after CPAP try treatment.41 patients refused to enter the management procedure.Qualitative interviews were conducted for 3 patients who gave up the CPAP treatment after CPAP try treatment and 41 patients who refused to enter the management procedure.The results showed the reasons for the patients’ rejection including:(1)lack of cognition including lack of basic knowledge of OSAHS and lack of knowledge related to CPAP treatment;(2)bad CPAP treatment experience including the cumbersome management and uncomfortable try experience that patients felt;(3)insufficient social support including economic constraints,limited time and lack of family support.Conclusion:The Chinese version of management procedure for CPAP treatment in OSAHS patients was initially constructed which could be used as a reference for CPAP treatment administrators in OSAHS patients.While the requirements for the medical staff were higher,in terms of the CPAP treatment management procedure,it was easy to master for OSAHS patients.A successful try conducted is the key for management procedure.It is necessary to educate the knowledge of OSAHS and CPAP therapy for OSAHS patients who did not conduct a try.