比较两款自动调节气道正压通气设备干预阻塞性睡眠呼吸暂停低通气综合征治疗压力参数与患者症状的改善

Improvement in therapeutic pressure parameters and symptoms in patients with obstructive sleep apnea hypopnea syndrome after intervention with two types of devices for automatic and continuous regulation of the positive airways pressure

目的:比较两款自动调节气道正压通气设备治疗阻塞性睡眠呼吸暂停低通气综合征的效果,为临床选择Auto-CPAP提供参考。方法:选择2004-04/2005-04在商丘市第五人民医院和商丘市第三人民医院睡眠疾患诊疗中心就诊的阻塞性睡眠呼吸暂停低通气综合征32例住院患者,所有患者均接受2次实验治疗,按随机顺序用两款设备各治疗1次,每次治疗时间为1个晚上(23:00～次日6:00)。2次治疗之间相隔不超过1周。两款Auto-CPAP:Auto SetSpirit(Res MeD,Australia),Puritan Bennett420E(Puritan Bennett,U.S.A)。接受Auto-CPAP治疗的同时,以多参数睡眠记录监测口鼻气流,胸腹呼吸运动、鼾声、动脉血氧饱和度等参数变化。采用随机单盲自身设计,对比研究32例阻塞性睡眠呼吸暂停低通气综合征患者,比较两款Auto-CPAP治疗之间睡眠参数和治疗压力的差异,并进行计数资料行卡方检验,治疗前后计数资料的对比作样本异方差假设t检验。两款机器计数资料的对比以同一患者前后两次治疗的参数作配对t检验。结果:30例患者进入结果分析,2例脱失。①32例患者接受420E治疗后与治疗前相比,84.5%的患者白天困倦症状改善,86.7%的患者经Auto-CPAP治疗后呼吸紊乱指数下降(治疗后呼吸紊乱指数<5次/h),最低动脉血氧饱和度平均达90%。②两种Auto-CPAP治疗之间呼吸紊乱指数、最低动脉血氧饱和度、平均动脉血氧饱和度、平均暂停时间差异无显著性。③spirit治疗在缩短最长暂停时间、降低呼吸事件(低通气和呼吸暂停占睡眠时间百分比)方面的疗效优于420E治疗[最长暂停时间(26.23±9.81),(34.15±15.23)s;时间百分比0.87±0.72,1.47±1.10,P<0.05]。④Spirit的平均治疗压力高于420E[平均差值(102.90±117.60)Pa,P>0.05]。⑤两设备最大压力和95%可信限压力差异无显著性。结论:spirit和420E对中重度阻塞性睡眠呼吸暂停低通气综合征患者均有疗效,但设备之间在改善某些单项睡眠参数方面的效果存在差异,平均治疗压力也存在差异。

AIM： To compare the clinical efficacy of two types device regulating automatic continuous positive airways pressure （Auto-CPAP） in treating obstructive sleep apnea hypopnea syndrome, so as to provide references for clinical selection of Auto-CPAP. METHODS： Thirty-two inpatients with obstructive sleep apnea hypopnea syndrome treated in Fifth People＇s Hospital of Shangqiu and Sleep Disorders Center, Third People＇s Hospital of Shangqiu between April 2004 and April 2005 were selected. All the patients received twice treatments, in which they were given Auto-CPAP： AutoSet Spirit （ResMeD, Australia） and Puritan Bennett 420E （Puritan Bennett, U.S.A） therapy in randomized order, every treatment lasted for one evening （23：00 to 6：00 of the next day） and the interval was less than I week between two treatments. Simultaneity, the sleep parameters such as airflow of mouth and nose, respiratory movement of chest, snore, saturation of arterial blood oxygen （SAO2） and so on were measured. With random single blind design, the sleep parameter and therapeutic preesure during two types Auto-CPAP therapy were compared among the 32 patients with obstructive sleep apnea hypopnea syndrome. The chi-square test was adopted for count data, and t-test was used to compare the count data before and after treatment. The comparison of the count data between the two types device treated the same patient was analyzed with t test. RESULTS： Thirty patients involved in the result analysis, and 2 were lost. （1）After 420E therapy for the 32 patients, 84.5% showed significant improvement in drowsiness in daytime; the apnea-hypopnea index （AHI） of 86.7% was decreased （AHI 〈 5 times per hour after treatment）, and the lowest SAO2 reached 90%. （2）No significant difference was found in AHI, lowest SAO2, mean SAO2 and averge apnea time. （3）Sprit was more efficacious in shortening the longest apnea time and lowering the anapnea events （percentage of hypopnea and apnea time） compared with 420E [longest apnea time： （26.23±9.81）, （34.15±15.23） s; percentage of time： （0.87±0.72）, （1.47±1.10）, P 〈 0.05]. （4） The mean pressure of Spirit was larger than that of 420E [mean difference values： （102.90±1 17.60） Pa, P 〉 0.05]. （5）There was no significant difference in the maximum pressure and 95% confidence interval pressure. CONCLUSION： AutoSet Spirit is equally as effective as Puritan Bennett 420E in treating medium and severe obstructive sleep apnea hypopnea syndrome. But there are some differences in improving certain single sleep parameter between the two types device, and their average therapeutic pressures are also different.