经鼻气道正压治疗睡眠呼吸暂停低通气综合征压力相关因素分析

Study on pressure level of continuous positive airway pressure in the treatment of obstructive sleep apnea hypoxia syndrome

目的分析经鼻持续气道正压(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)最适治疗压力的相关因素,建立预测CPAP治疗压力的指标。方法120例经全夜多导睡眠图(PSG)监测确诊的中、重度OSAHS患者,A组(74例)在PSG监测下调定最适压力水平,分析最适压力值与颈围、体重指数、PSG监测参数的相关性,推导回归方程式,计算预测压力值;B组(46例)在PSG监测下,用预测压力行CPAP治疗。比较两组CPAP治疗疗效。结果最适压力水平与颈围、氧饱和度低于90%时间占睡眠时间百分比(TS90%)、呼吸紊乱指数呈显著正相关(r=0.785、0.658、0.468,P<0.001)。两组CPAP治疗后呼吸紊乱指数、最低氧饱和度、最长暂停时间,TS90%均明显改善(P<0.001),两组疗效差异无显著性(P>0.05)。结论CPAP治疗压力与颈围、TS90%、呼吸紊乱指数相关,颈围、TS90%可用于预测CPAP治疗压力。

Objective To evaluate the efficacy and to predict the optimal pressure level of continuous positive airway pressure （CPAP） in the treatment of obstructive sleep apnea hypoxia sydrome（OSAHS）. Methods 120 patients with OSAHS were studied. Their actual pressure levels of CPAP were determined by the polysom nographic （PSG） system plus CPAP system. The relationships among optimal pressure, parameters of PSG and neck circumference were analyzed. The correlative regression equations were calculated. 74 patients （group A） were treated with optimal actual pressure and 46 patients （group B） with predicted pressure which was derived from the regression equation. Results The results showed that the respiratory disturbance index and sleep hypoxemia were improved significantly after CPAP treatment（P〈0. 001）. There was a close positive linear correlation between neck circumference, TS90% （the percentage of time under SaO2 〈90 % over total sleeping time） and actual pressure, respectively （r=0. 785 and r=0. 658, P〈0.01, respectively）. There was no significant difference between group A and B in assessing their efficacies. Conclusions It suggests that CPAP is an effective treatment for OSAHS, and the parameter of TS90% and neck circumference are simple and valuable in predicting the pressure level of CPAP. （Shanghai Med J ,2005,28 ： 1004 1006）