自动压力滴定推荐的经鼻持续气道内正压通气压力治疗阻塞性睡眠呼吸暂停低通气综合征长期有效性的研究

Evaluation of automatic titration for the determination of therapeutic nasal continuous positive airway pressure in obstructive sleep apnea bypopnea syndrome

目的评价自动压力滴定推荐的经鼻持续气道内正压通气（nasal continuous positive airway pressure，nCPAP）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的长期有效性和顺应性。方法36例中重度OSAHS患者在睡眠呼吸实验室进行-夜自动压力滴定治疗，记录并对比治疗前后的呼吸暂停低通气指数（apnea hypopnea index，AHI）和最低血氧饱和度（lowest oxygen satuation，LSO2）。其中16例OSAHS患者选用自动压力滴定的95％可信限压力（P95）作为nCPAP家庭治疗值，并在治疗6个月后返实验室再次评估P95的长期治疗效果、依从性和患者的嗜睡症状。结果一夜自动压力滴定后，36例OSAHS的AHI[（63．83±4．79）次／hVS（4．55±0．67）次／h，Pd0．001]显著降低，I．S02[（65．39±1．99）％VS（91．17±0．70）％，P〈0．001]显著升高；16例选用P95长期家庭CPAP治疗者，平均每日治疗时间（6．63±0．25）h，随诊6个月后评估，P95仍有明显疗效[AHI：（75．98±5．77）次／hVS（4．91±1．15）次／h，P〈0．001；LSO2：（62．00±2．52）%VS（94．44±0．70）％，P〈0．001]；Epworth嗜睡量表评分显著降低（16．75±0．87vs4．88±0．36，P=0．001）。结论自动调节气道内正压治疗能有效纠正OSAHS的呼吸紊乱和低氧。自动压力滴定所推荐的P95作为家庭CPAP的长期治疗压在第6个月随访时仍是有效的，能改善嗜睡，并有较高的依从性，可用于nCPAP长期治疗的压力设定。

Objective To evaluate automatic titration for the determination of therapeutic nasal continuous positive airway pressure （nCPAP） in obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Thirty six previously untreated OSAHS patients had undergone one night automatic titration in the laboratory. Apnea hypopnea index（AHI） and lowest oxygen satuation（LSO2） were measured before and after the automatic titration. The 95th percentile airway pressure （P95）of the automatic titration was recommended as the long-term fixed CPAP therapeutic pressure. Only sixteen regular nCPAP treatment subjects whose body weights were stable（BMI≤1. 5 kg/m^2 change from baseline） were recruited to the reassessment study after 6 months of treatment with nCPAP at P95. This evaluation was based on compliance, daily usage, Epworth sleepiness score and respiratory recording under nCPAP. Results After one overnight automatic titration, there was a significant decrease in AHI （63.83 ± 4.79 events/h vs 4.55±0.67 events/h, P 〈0. 001） and increase in LSO2 [（65.39±1.99）%0 vs （91.17±0.70）%0, P 〈 0. 001]. And after 6 months of fixed nCPAP treatment, the reassessment study showed the recommended 95th percentile airway pressure by automatic titration was continued to valid to treat the OSAHS [ n 16 ,AHI：before,75.98±5.77/h,after,4.9±1.15/h, P 〈0. 001. LSO2 ：before, （62.00±2.52）% ,after, （94.44±0.70）M, P 〈0. 001]. The Epworth sleepiness scale was significantly decreased （before, 16. 75 ±0.87,after,4.88±0.36, P =0. 001）. The daily usage was （6.63±0.25） h. Conclusions This study confirms the efficacy of automatic titration and the suitability of P95 determined by automatic titration after 6 months. The P95 can be applied for the long-term fixed single therapeutic pressure in OSAHS.