中重度OSAHS患者白天小睡与夜间睡眠时AutoC-PAP治疗及压力滴定的对照研究

The comparison study of the Auto-CPAP application to treating and titrating severe OSAHS patients in daytime nap and nocturnal sleep

目的 通过白天小睡与夜间睡眠Auto CPAP治疗时的压力滴定在中重度OSAHS患者中应用的对比研究 ,找出其差异性或规律性 ,同时为中重度OSAHS患者白天Auto CPAP治疗及压力滴定的可行性提供一客观依据。方法 选择 2 0 0 2 - 0 2～ 2 0 0 2 - 0 8北京协和医院呼吸内科门诊中睡眠时打鼾及白天嗜睡、睡眠时憋醒等不适主诉的患者行睡眠监测检查及Epworth嗜睡程度评价并筛选出AHI>2 0的OSAHS患者为研究对象。每位入选患者均于压力治疗滴定检查当日分别行午间及夜晚 2次Auto CPAP治疗滴定检查 ,白天小睡治疗滴定时间为1h至 2h 30min。测定项目包括 :睡眠呼吸紊乱指数 (AHI)、呼吸暂停指数 (AI)、低通气指数 (HI)、最长呼吸暂停和低通气持续时间 (LAHT)、最低甲床血氧饱和度 (LSaO2 )、治疗所需最高压力 (HP)、平均压力 (MP)、90 %压力(90 %P)和 95 %压力 (95 %P)。结果 Auto CPAP诊断治疗系统对于中重度睡眠呼吸暂停低通气患者的午间小睡与夜间治疗的效果显著且效果一致。中重度睡眠呼吸暂停低通气患者白天小睡时所需的治疗压力与夜间治疗时所需要的治疗压力差异无显著性 (P >0 0 5 )。结论 白天小睡Auto CPAP治疗及压力滴定能代替夜晚治疗时的压力滴定检查。

Objective To find out the difference or the regularity by the comparison study on the Auto-CPAP application to treating severe OSAHS patients in daytime nap and nocturnal sleep.It also supplies an evidence for reducing the expense in treating and testing severe OSAHS patients.Methods The patients who complained of snoring or dyspnea during sleeping and excessive daytime somnolence were selected as the subjects.They were monitored by PSG or Auto-CPAP ventilator system.Meanwhile their somnolent level were estimated by Epwoth.After that the patients with more than 20 AHI were selected as the advanced subjects.They were treated respectively in daytime nap and in the nocturnal sleep.And the daytime treating time lasted more than one hour and less than two hours and thirty minutes.Monitoring items included AHI,AI,HI,the longest duration of apnea or hyponea(LAHT),the lowest SaO\-2,the highest CPAP pressure(HP),median pressure(MP),90% pressure(90%P) and 95% pressure(95%P).Results The therapeutical effect is distinguished and is the same with the severe OSAHS in both daytime nap and nocturnal sleep.And also they need the same CPAP pressure level basically.Conclusion The CPAP pressure level titrated in daytime nap treatment period can be used in the nocturnal sleep therapy for severe OSAHS patients.