不同监测方法下压力滴定对阻塞性睡眠呼吸暂停低通气综合征患者经鼻持续正压通气治疗依从性的影响

Effects of Pressure Titration by Two Different Configurations on the Treatment Compliance of OSAHS Patients Undergoing Nasal CPAP

目的探讨整夜多导睡眠图(PSG)监测下进行自动压力滴定和整夜脉氧饱和度仪监测下进行自动压力滴定对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者使用经鼻持续正压通气(nCPAP)治疗依从性的影响。方法选择2010年1月—2012年6月在我院睡眠监测室明确诊断的中重度OSAHS〔睡眠呼吸暂停低通气指数(AHI)>20次/h〕并愿意接受自动压力滴定治疗的患者66例,采用随机单盲法分为两组,A组31例选择在监测室PSG监测下进行自动压力滴定,B组35例选择在监测室或家中整夜脉氧饱和度仪进行自动压力滴定。监测两组压力滴定结果 (AHI、最低脉氧饱和度、滴定压力、面罩漏气量)及nCPAP治疗依从性(规律用机率、平均每天用机小时数、每月用机天数)。结果两组AHI、最低脉氧饱和度、滴定压力、面罩漏气量、规律用机率、平均每天用机小时数及每月用机天数比较,差异均无统计学意义(P>0.05)。结论采用两种不同监测方法进行自动压力滴定,并不影响压力滴定的结果及患者nCPAP治疗的依从性,而整夜脉氧饱和度仪监测下进行自动压力滴定相比传统压力滴定方法成本低,更易于被患者接受,值得临床推广。

Objective To investigate the effects of two pressure titration methods by monitoring of overnight polysom- nography （PSG） and overnight pulse oximetry on the treatment compliance of OSAHS patients undergoing nCPAP. Methods 66 moderate to severe OSAHS patients （AHI 〉 20/hour） who were willing to take pressure titration nCPAP treatment were divided into two groups with randomly single - blinded method. The 31 cases in group A was given pressure titration by PSG monitoring, while the 35 cases in group B was given pressure titration by overnight pulse oximetry monitoring. The results of pressure titration of the two groups （ AHI, minimum pulse oximetry, pressure and mask air leakage） and treatment compliance of nCPAP （ regular usage rate of machine, average usage hour per day and average usage days per month ） were compared between the two groups. Results AHI, minimum pulse oximetry, pressure, mask air leakage, regular machine usage rate, average machine usage hour per day and average machine usage days per month showed no statistically significant difference between the two groups （P 〉 0.05 ） . Conclusion Although the monitoring methods of pressure titration are different, the outcome of titration and pa- tients＇ compliance to the therapy are not affected. Since the overnight pulse oximetry is more cost - efficient and easier to be man- aged than PSG, it should replace the PSG in clinical application.