Coexisting obstructive sleep apnea (OSA) and insomnia, termed COMISA, is clinically prevalent but frequently underdiagnosed. Although non-invasive positive pressure ventilation (NPPV) is the first-line treatment for OSA, patients with COMISA often show poor adherence to NPPV due to difficulty falling asleep and intolerance to the mask or airflow. Eszopiclone improves insomnia and shortens sleep latency, thus potentially enhancing initial NPPV adherence. Telemedicine management overcomes geographical barriers, enables dynamic adjustment of ventilator parameters, and facilitates long-term follow-up.

To investigate the effect of telemedicine management combined with eszopiclone on NPPV adherence in patients with COMISA.

Patients who attended the Sleep Center and Physical Examination Center of Sichuan Provincial Fourth People's Hospital from January to October 2024 were enrolled. After completing questionnaire assessments and polysomnography, those who met the diagnostic criteria for COMISA and agreed to receive NPPV were randomly assigned to either an experimental group or a control group. The experimental group received telemedicine-supported NPPV pressure titration and treatment, plus oral eszopiclone for 4 weeks before bedtime. The control group received in-hospital manual NPPV pressure titration and routine outpatient card-reading follow-up. Both groups were followed for 3 months. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Scale of Sleep (SRSS), and Epworth Sleepiness Scale (ESS) were recorded at baseline and at 3 months. NPPV adherence parameters (nightly use hours, percentage of days of use relative to total days, percentage of days with ≥4 hours of use, 95th percentile pressure, residual AHI, and air leak) were automatically collected via the ventilator cloud platform at 1 week, 1 month, and 3 months. Repeated-measures analysis of variance (ANOVA) was used to compare changes over time between groups, and paired t-tests were used to compare pre- and post-treatment scores within groups.

A total of 83 patients with confirmed COMISA (43 in the experimental group, 40 in the control group) were included. During the 3-month treatment period, the experimental group showed significantly better outcomes than the control group in NPPV use hours, percentage of days of use (both total days and days with ≥4 hours), post-treatment AHI, and air leak (all adjusted P<0.017). Regarding sleep scales, at 3 months the experimental group had significant reductions from baseline in PSQI (P=0.022), SRSS (P<0.001) and ESS (P=0.041), whereas the control group showed a reduction only in PSQI (P=0.001) and SRSS (P=0.036). Between-group comparisons revealed lower PSQI (P<0.001) and ESS (P=0.016) scores in the experimental group than in the control group; no significant between-group difference was observed in SRSS scores (P>0.05). The incidence of eszopiclone-related adverse events in the experimental group was 25.6% (11/43), all events were mild to moderate, with no serious adverse events or signs of respiratory depression. All patients in the experimental group were successfully connected to the telemedicine platform, and a total of 3 280 automatic data uploads were completed.

Telemedicine management combined with eszopiclone effectively improves NPPV adherence, sleep quality in patients with COMISA. This integrated approach offers a novel strategy for the comprehensive management of this population.

阻塞性睡眠呼吸暂停（OSA）合并失眠（COMISA），临床发病率高，但易被漏诊。无创正压通气（NPPV）是OSA的首选治疗，COMISA患者因合并入睡困难、对呼吸机不耐受等，呼吸机治疗依从性普遍较差。右佐匹克隆可改善失眠、缩短入睡潜伏期，可能有助于提高NPPV初始依从性；远程管理技术则可突破地域限制，动态调整呼吸机参数，提升长期随访效果。

探讨远程管理联合右佐匹克隆对COMISA患者NPPV治疗依从性的影响。

研究纳入2024年1—10月于四川省第四医院睡眠中心及体检中心就诊，完成量表及多导睡眠监测后符合COMISA诊断标准的患者。将同意进行NPPV患者随机分为试验组和对照组。试验组接受远程管理支持下的NPPV压力滴定及治疗，并在睡前口服右佐匹克隆4周；对照组接受睡眠中心人工NPPV压力滴定及门诊常规读卡随访。两组患者共随访3个月，分别记录患者基线时及干预后3个月匹兹堡睡眠质量指数（PSQI）评分、睡眠状况自评量表（SRSS）评分、Epworth嗜睡量表（ESS）评分。记录干预后1周、1个月、3个月患者NPPV治疗依从性：呼吸机远程平台自动统计1周、1个月、3个月的每晚呼吸机使用时间、使用天数占总天数比例、使用天数≥4 h比例、95%治疗压力、治疗后AHI、漏气量。采用重复测量方差分析比较两组不同治疗时间点呼吸机参数变化及依从性，采用t检验对治疗前后PSQI评分、SRSS评分、ESS评分进行差异性比较。

研究纳入符合COMISA诊断标准的患者83例，其中试验组43例，对照组40例。治疗3个月期间，试验组在NPPV使用时长、使用天数占总天数比例及≥4 h比例、治疗后AHI及漏气量方面均显著优于对照组（校正后均P<0.017）。睡眠量表方面，试验组3个月后PSQI评分（P=0.022）、SRSS评分（P<0.001）、ESS评分（P=0.041）较基线下降；对照组仅PSQI评分（P=0.001）、SRSS评分（P=0.036）下降。组间比较显示，试验组PSQI评分（P<0.001）和ESS评分（P=0.016）均低于对照组；两组SRSS评分比较，差异无统计学意义（P>0.05）。试验组右佐匹克隆相关不良事件发生率为25.6%（11/43），均为轻/中度，无严重不良事件或呼吸抑制征象。试验组患者均成功接入远程管理平台，累计自动上传呼吸机数据3 280次。

远程管理与右佐匹克隆联合治疗可有效改善COMISA人群的NPPV依从性，并提高患者睡眠质量，为COMISA人群的综合管理提供新思路。