气道正压治疗阻塞性睡眠呼吸暂停综合征不同压力滴定方法的比较：随机、单盲、自身对照临床研究  

Comparison of 3 titration methods of positive airway pressure for obstructive sleep apnea syndrome: a random,single-blind and self-control clinical study

作　　者：李燕[1] 刘欣欣[2] 王莞尔[2] 王扬[2] 高和[2] 

机构地区：[1]河北北方学院,河北张家口075000 [2]空军总医院临床睡眠医学中心,北京100142

出　　处：《解放军医学杂志》2013年第5期373-377,共5页Medical Journal of Chinese People's Liberation Army

基　　金：首都医学发展科研基金(20091028)~~

摘　　要：目的比较单纯中重度阻塞性睡眠呼吸暂停综合征(OSAS)患者整夜值守多导睡眠监测下人工压力滴定(PSG-CPAP)、多导睡眠监测下自动气道正压压力滴定(PSG-APAP)和自动气道正压压力滴定(APAP)的有效性和安全性。方法收集20例单纯中重度OSAS患者,序贯接受3种不同压力滴定治疗。对患者主要的有效性指标(滴定压力、残存呼吸事件、睡眠结构)和安全性指标(面部皮肤压伤情况、压力滴定期间舒适性的主观评价和不良主诉)进行比较。结果在有效性指标中获得的结果显示,PSG-APAP、APAP和PSG-CPAP均有效。PSG-APAP和APAP滴定90%时间压力较PSG-CPAP滴定最佳压力平均高3.05cmH2O和2.55cmH2O(P<0.01),但PSG-APAP与APAP间差异无统计学意义(P>0.05)。PSG-APAP和APAP滴定平均压力与PSG-CPAP滴定最佳压力间无统计学差异(P>0.05)。PSG-CPAP、PSG-APAP和APAP的残存睡眠呼吸暂停低通气指数(AHI)差异无统计学意义(P>0.05);压力滴定治疗后血氧饱和度下降指数(ODI)明显减少(P<0.01),但PSG-CPAP与PSG-APAP间差异无统计学意义(P>0.05),两种滴定方法在改善ODI上具有同等效果。与基线PSG比较,PSG-CPAP和PSG-APAP压力滴定后,患者睡眠效率差异无统计学意义(P>0.05),觉醒指数(ArI)明显下降(P<0.01),N1、N2期睡眠占总睡眠时间的百分比(N1%、N2%)明显降低(P<0.01,P<0.05),N3%和R%增加(P<0.05,P<0.01),PSG-CPAP和PSG-APAP两种滴定方法均能改善睡眠结构,但差异无统计学意义(P>0.05)。在安全性指标中获得的结果显示,研究期间受试者均未出现面部皮肤压伤,未发现任何与压力滴定相关的严重不良事件。滴定研究期间患者的主要不适包括干扰睡眠、眼或口干、头痛、憋气、腹胀等。结论对单纯中重度OSAS,采用PSG-APAP和APAP压力滴定和治疗均安全有效,滴定出的平均压力可为CPAP确定最佳治疗压力。Objective To evaluate the efficacy and safety of polysomnography-manual continuous positive airway pressure titration （PSG-CPAP）, polysomnography-automatic positive airway pressure titration （PSG-APAP）, or automatic positive airway pressure titration （APAP） in patients with moderate or severe simple obstructive sleep apnea syndrome （OSAS）. Methods Twenty patients with moderate or severe OSAS sequentially underwent PSG-CPAP, PSG-APAP and APAP titration 3 days apart, and then 3 primary efficacy indicators （titration pressure, remaining respiratory event and state of sleep）, and safety indicators （compression injury of face skin, the subjective evaluation on degree of comfort or any complaint during titration） were compared. Results The results of efficacy indicators revealed that all PSG-APAP, APAP and PSG-CPAP were effective. Compared with the optimal pressure of PSG-CPAP titration, PSG-APAP and APAP pressures were 3.05 and 2.55cmH20 higher, respectively, in 90% of occasion （P〈0.01）. However, there was no statistically significant difference between APAP and PSG-APAP titration （P〉0.05）. There was no statisticallysignificant difference between the optimal pressure of PSG-CPAP and the mean pressures of PSG-APAP and APAP （P〉0.05）. There was no statistically significant difference between the 3 titration methods on residue apnea/hypopnea index （AHI, P〉0.05）. The oxygen desaturation index （ODI） decreased significantly after titration treatment （P〈0.01）, but no statistically significant difference was found between PSG-CPAP and PSG-APAP titration （P〉0.05）. Both PSG-CPAP and PSG-APAP titrations showed the same effects in improving ODI. Compared with basic PSG, no obvious improvement was found in sleep efficiency （SE） after PSG-CPAP and PSG-APAP titration （P〉0.05）, however, the arousal index （ArI） decreased obviously （P〈0.01）, the percentage of sleep time spent during N1 phase （N1%） and N2 phase （N2%） decreased significantly （P�

关 键 词：睡眠呼吸暂停 阻塞性 持续气道正压通气 多导睡眠描记术 

分 类 号：R563.19[医药卫生—呼吸系统]