Noninvasive positive-pressure ventilation (NPPV) is the first choice for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) , a common sleep-related breathing disorder. But low patient adherence to NPPV limits its clinical application and promotion.

To explore the situation of acceptance of NPPV and associated factors in adult OSAHS patients.

OSAHS patients (age≥18) with clinical indications for NPPV were selected from Sleep Medicine Department, Sanya Central Hospital (Hainan Third People's Hospital) , from December 2019 to December 2021. Demographic and clinical data were compared in groups defined by the acceptance of NPPV titration (acceptors and rejecters of NPPV titration) and treatment (acceptors and rejecters of NPPV) .

In all, 402 OSAHS patients were included. Three hundred and twenty-seven rejected NPPV, 245 (74.5%) of them directly rejected the treatment at the time of diagnosis without NPPV titration, and the most common reason was perceived unnecessity of NPPV treatment due to insufficient understanding of OSAHS and its related risks, and 82 (25.1%) rejected the treatment after NPPV titration, and the most common reason was perceived inconvenience of long-term NPPV. Only 75 (75/402, 18.7%) patients accepted NPPV. No differences were found between acceptors and rejecters of titration in demographic data, clinical characteristics (P>0.05) . Multivariable Logistic regression analysis revealed none of above-mentioned factors were related to titration acceptance (P>0.05) . Univariable analysis showed that compared with NPPV rejecters, NPPV acceptors had higher prevalence of middle-aged (45-59 years old) individuals (49.3 % vs 33.3%) , lower prevalence of older individuals (age≥60) (12.0% vs 32.1%) , higher prevalence of nighttime awakening due to shortness of breath (38.7% vs 26.3%) , and severe condition (64.0% vs 47.4%) , lower mean nocturnal SpO₂ and nadir SpO₂, and longer mean duration with SpO₂ below 90% (T90, P<0.05) . Multivariable Logistic regression analysis revealed that age and T90 were independently associated with NPPV acceptance (P<0.05) . After controlling for other factors, age〔OR=0.39, 95%CI (0.16, 0.93) , P<0.05〕and T90〔OR=1.14, 95%CI (1.01, 1.29) , P<0.05〕were still the independently associated with NPPV acceptance.

The prevalence of NPPV acceptance was low in OSAHS patients, which was mainly associated with age and T90. In view of this, to improve the adherence to NPPV, relevant health education and cognitive and behavioral interventions for the patients, especially the older individuals (age≥60) , should be strengthened. Meanwhile, close attention should be paid to whole course management of NPPV in these patients.

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种常见的慢性睡眠呼吸障碍，无创正压通气（NPPV）是该疾病的首选治疗方式，但治疗依从性差影响了该疗法的临床应用与推广。

探究OSAHS患者对NPPV治疗的接受情况及影响因素。

选取2019年12月至2021年12月就诊于三亚中心医院（海南省第三人民医院）睡眠医学科且符合NPPV治疗指征的OSAHS患者（年龄≥18岁）为研究对象。根据NPPV滴定接受与否将患者分为接受滴定组和拒绝滴定组，比较两组患者人口学资料及临床资料；根据NPPV治疗接受与否将患者分为接受治疗组与拒绝治疗组，比较两组人口学资料及临床资料。采用多因素Logistic回归分析探讨患者对NPPV压力滴定接受、NPPV治疗接受的影响因素。

共纳入402例符合条件的OSAHS患者。327例患者拒绝NPPV治疗，其中245例（74.9%）在确诊后未进行压力滴定就直接拒绝NPPV治疗，拒绝最常见的原因是对疾病及其风险认知不足，认为无治疗必要性；82例（25.1%）在进行压力滴定后拒绝NPPV治疗，拒绝最常见的原因是认为长期NPPV治疗不方便。仅75例（75/402，18.7%）接受了NPPV治疗。接受滴定组和拒绝滴定组人口学资料、临床资料比较，差异均无统计学意义（P>0.05）。多因素Logistic回归分析显示，人口学资料、临床资料不影响患者对压力滴定的接受情况（P>0.05）。单因素分析显示，与拒绝治疗组相比，接受治疗组中年人（45~59岁）占比高（49.3% vs 33.3%）、老年人（年龄≥60岁）占比低（12.0% vs 32.1%）、伴夜间憋醒比例高（38.7% vs 26.3%）、重度OSAHS患者占比高（64.0% vs 47.4%）、夜间平均血氧饱和度（SPO₂）及最低SPO₂均更低、SPO₂低于90%的时间（T90）更长（P<0.05）。多因素Logistic回归分析显示，年龄、T90是患者NPPV治疗接受情况的影响因素（P<0.05）。控制其他因素后发现，年龄〔OR=0.39，95%CI（0.16，0.93），P<0.05〕、T90〔OR=1.14，95%CI（1.01，1.29），P<0.05〕仍是患者NPPV治疗接受情况的影响因素。

OSAHS患者的NPPV治疗接受情况不佳，年龄、T90是其影响因素。未来在诊疗过程中应加强对患者，尤其是超过60岁患者的教育及认知行为干预，以提高NPPV接受情况。同时应注重全流程管理，增强NPPV治疗依从性。