过渡性气道内正压通气治疗睡眠呼吸暂停综合征

Transitive Treatment with nCPAP in Obstructive Sleep Apnea Syndrome

目的 观察睡眠呼吸暂停综合征 (OSAS)患者应用经鼻气道正压通气(nCPAP)治疗的依从性。方法 2 5例OSAS患者和 8例肥胖性低通气综合征(OHS)患者 ,在多导睡眠监测仪 (PSG)监测下使用nCPAP治疗 ,对治疗开始不能耐受或治疗失败者 ,改用经鼻双水平正压通气 (nBiPAP)。经 1周或 1个月治疗后 ,逐渐过渡到nCPAP。结果 ⑴OHS组有较高的BMI、PaCO2 ,较低的FEV1 、FEV1 /FVC、PaO2 与OSAS组比有明显差异性 ,P <0 .0 1 ,但两组AHI差异不明显。⑵ 33例患者均用nCPAP治疗 ,2 4例成功 ,9例 ( 2例OSAS和 7例OHS)失败改用nBiPAP治疗。两种方法治疗前后各指标比较有显著性差异 ( P <0 .0 1 ,P<0 .0 1 ) ,组间无差异。 9例治疗失败改用nBiPAP治疗后再过渡到nCPAP治疗的各项指标比较无显著性差异 ( P >0 .0 5 ,P >0 .0 5 )。结论 nCPAP是治疗OSAS的一种有效方法 ,如果睡眠呼吸障碍并存在低通气或严重的高碳酸血症时 ,nBiPAP治疗可能是一种有效并易耐受的过渡方法 。

Objective To observe the compliance of treatment with nasal continuous positive airway pressure(nCPAP) in obstructive sleep apnea syndrom(OSAS). Methods 25 cases of OSAS and 8 cases of obesity hypoventilation syndrome(OHS) were diagnosed by a full night polysomnography(PSG), The patients were treated by nCPAP under the full night PSG.If nCPAP was not tolerated or failed to correct breathing abnormalities at beginning, after using Bi Level positive airway pressure (BiPAP) for a week a month, the patients were switched to nCPAP again. Results ①OHS patients had higher body mass index(BMI),PaCO 2 and lower PaO 2, FEV 1 and FEV 1/FVC, compared with OSAS patients had differences significantly (P<0.01). Apnea hypopnea index (AHI) had no difference in two groups. ② The treatments were successful in 23 cases of OSAS and one case of OHS with nCPAP. 9 patients(2 OSAS+7 OHS) were unsuccessful, in whom BiPAP S/T was an effective treatment modality. There were significantly differences between before and after two therapies, respectively (P<0.01,P<0.01). But there was no difference between nCPAP and BiPAP. Conclusion nCPAP therapy is an effective therapeutic option in patients with OSAS. If patients were OSAS,following hypoventilation or seriously hypercapnia in whom, BiPAP may be a better treatment modality.The both therapies may increase the acceptance and the compliance of treatment in OSAS.