全科医师对阻塞性睡眠呼吸暂停的认知现状及线上培训的影响

摘要/Abstract

摘要：

目的：了解全科医师对阻塞性睡眠呼吸暂停（obstructive sleep apnea， OSA）的认知现状及相关影响因素，评估线上培训对全科医师认知水平和自信度的提升效果。方法：通过问卷调查评估培训前后全科医师对OSA知识的掌握情况和态度、认知，并分析潜在的影响因素。结果：120名全科医师培训前OSA相关知识平均得分为（59.7±18.8）分，及格率为70.8％；培训后平均得分提高至（75.0±9.6）分，及格率达97.5％（均P<0.05）。经过培训，全科医师对OSA相关知识的整体掌握水平有了显著提高（P<0.05）。培训对于医师在识别高危风险OSA患者方面表现显著（P<0.05）。关于未来培训需求，全科医师主要希望加强在OSA评分量表使用、无创气道正压通气治疗知识和OSA相关性慢性病表现方面的培训。结论：线上培训对全科医师的OSA知识水平和态度认知具有显著影响，提高了其对OSA的认知水平和诊疗自信度。全科医师应积极通过继续教育培训提升OSA诊疗能力，从而能够早期识别OSA患者，提高OSA的诊断和治疗率。

关键词:阻塞性睡眠呼吸暂停,全科医师,问卷调查,认知水平,继续教育培训

Abstract:

ObjectiveTo investigate general practitioner (GP) current understanding level of obstructive sleep apnea (OSA) and related influencing factors and evaluate the effect of online training on improving their knowledge and confidence levels of identifying and treatment of OSA.MethodsQuestionnaire surveys were used to evaluate GPs’ knowledge and understanding level of OSA before and after the training, and to analyze potential influencing factors.ResultsBefore the training, the average score of questionnaires of 120 GP was (59.7±18.8) points, and the passing rate was 70.8%. After the training, the average score of questionnaires was increased to (75.0±9.6) points, and the passing rate reached 97.5%. The training significantly improved the GPs’ overall knowledge of OSA (P<0.05). The survey revealed that the training significantly enhanced GPs’ ability to identify high-risk OSA patients (P<0.05). Regarding future training needs, GP mainly expressed a desire to strengthen training in the use of OSA scoring scales, knowledge of non-invasive positive airway pressure (PAP) ventilation therapy, and the management of chronic diseases associated with OSA.ConclusionsOnline training significantly improved GPs’ knowledge and understanding level of OSA, enhanced their confidence in diagnosis and treatment of OSA. GP should actively participate in continuing education and training related to OSA.

Key words:Obstructive sleep apnea,General practitioners,Questionnaire survey,Cognitive level,Continuing education training

中图分类号:

R563.5

蒋婕, 李小丽, 苏晓荣, 童建菁. 全科医师对阻塞性睡眠呼吸暂停的认知现状及线上培训的影响[J]. 内科理论与实践, 2024, 19(04): 243-248.

JIANG Jie, LI Xiaoli, SU Xiaorong, TONG Jianjing. General practitioners’ current understanding level of obstructive sleep apnea and effect of online training[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(04): 243-248.

图/表5

图1

表1

全科医师OSA知识测试及格影响因素

变量	OR	95%CI	P
性别（ref=男）
女	0.933	0.421~2.070	0.865
年龄（ref=25~34岁）
35~44岁	0.898	0.366~2.202	0.814
45~54岁	3.900	0.905~16.798	0.068
学历（ref=本科）
硕士及以上	1.000	0.448~2.233	1.000
职称（ref=中级）
高级	0.570	0.151~2.160	0.408
是否诊断过OSA（ref=否）
是	0.261	0.057~1.204	0.085
是否参加过OSA培训（ref=是）
否	0.268	0.075~0.965	0.044

表1

问卷条目	培训前	培训后	正确率提高百分点	χ²	P
OSA的流行病学	16(13.3)	50（41.7）	28.4	24.159	<0.001
OSA的发病机制	60(50.0)	94（78.3）	28.3	20.948	<0.001
OSA的临床表现	24(20.0)	40（33.3）	13.3	5.455	0.020
OSA的诊断	1(0.8)	4（3.3）	2.5	1.838	0.175
OSA的治疗	1(0.8)	7（5.8）	5.0	4.655	0.031

表2

项目	培训前	培训后	χ²	P
OSA作为一种临床疾病	27(22.5)	45(37.5)	6.429	0.011
临床实践中鉴别诊断OSA	28(23.3)	47(39.2)	7.001	0.008
鉴别患者是否有OSA危险因素	38(31.7)	47(39.2)	0.017	0.895
针对不同的OSA患者给予个性化建议	52(43.3)	55(45.8)	0.152	0.679
远程治疗及随访OSA患者	41(34.2)	48(40.0)	0.875	0.350

表3

项目	培训前	培训后	χ²	P
识别具有高危风险的OSA患者	57(47.5)	85(70.8)	13.521	<0.001
对OSA患者开展相关治疗	49(40.8)	56（46.7)	0.830	0.362
正确处理接受CPAP治疗的 OSA患者	44(36.7)	52（43.3)	1.111	0.292

表4

参考文献16

[1]	Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea[J].Lancet,2014,383(9918):736-747. doi:10.1016/S0140-6736(13)60734-5pmid:23910433
[2]	Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American heart association[J].Circulation,2021,144(3):e56-e67.
[3]	Redline S, Azarbarzin A, Peker Y. Obstructive sleep apnoea heterogeneity and cardiovascular disease[J].Nat Rev Cardiol,2023,20(8):560-573. doi:10.1038/s41569-023-00846-6pmid:36899115
[4]	Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis[J].Lancet Respir Med,2019,7(8):687-698. doi:10.1016/S2213-2600(19)30198-5pmid:31300334
[5]	Lyons MM, Bhatt NY, Pack AI, et al. Global burden of sleep-disordered breathing and its implications[J].Respirology,2020,25(7):690-702. doi:10.1111/resp.13838pmid:32436658
[6]	Shawon MS, Perret JL, Senaratna CV, et al. Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: a systematic review[J].Sleep Med Rev,2017,32:58-68.
[7]	Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association[J].Circulation,2016,133(15):e599.
[8]	Javaheri S, Peker Y, Yaggi HK, et al. Obstructive sleep apnea and stroke: the mechanisms, the randomized trials, and the road ahead[J].Sleep Med Rev,2022,61:101568.
[9]	Lee JJ, Sundar KM. Evaluation and management of adults with obstructive sleep apnea syndrome[J].Lung,2021,199(2):87-101. doi:10.1007/s00408-021-00426-wpmid:33713177
[10]	Alzahrani MM, Alghamdi AA, Alghamdi SA, et al. Knowledge and attitude of dentists towards obstructive sleep apnea[J].Int Dent J,2022,72(3):315-321.
[11]	Al-Khafaji H, Bilgay IB, Tamim H, et al. Knowledge and attitude of primary care physicians towards obstructive sleep apnea in the Middle East and North Africa region[J].Sleep Breath,2021,25(2):579-585.
[12]	Lin L, Zhao T, Ngan P, et al. Obstructive sleep apnea-related knowledge, attitude, experience, and behaviors among orthodontic professionals: a survey[J].Sleep Breath,2023,27(6):2361-2369. doi:10.1007/s11325-023-02852-xpmid:37222934
[13]	Cherrez Ojeda I, Jeffe DB, Guerrero T, et al. Attitudes and knowledge about obstructive sleep apnea among Latin American primary care physicians[J].Sleep Med,2013,14(10):973-977. doi:10.1016/j.sleep.2013.06.005pmid:23973417
[14]	Desteghe L, Hendriks JML, McEvoy RD, et al. The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation[J].Clin Res Cardiol,2018,107(8):617-631. doi:10.1007/s00392-018-1248-9pmid:29651786
[15]	Singh M, Gali B, Levine M, et al. Integrating sleep knowledge into the anesthesiology curriculum[J].Anesth Analg,2021,132(5):1296-1305. doi:10.1213/ANE.0000000000005490pmid:33857971
[16]	Erfanian R, Sohrabpour S, Najafi A, et al. Effect of otolaryngology residency program training on obstructive sleep apnea practice[J].Indian J Otolaryngol Head Neck Surg,2022,74 Suppl3:4579-4586.