正压通气治疗中手动及自动压力滴定模式比较

Comparison of different continuous positive airway pressure titration methods for obstructive sleep apnea hypopnea syndrome

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者上气道持续正压通气（CPAP）治疗自动压力滴定与手动压力滴定所得结果之间是否存在差异及其影响因素,为两种压力滴定模式的合理使用提供理论依据.方法 本实验纳入符合要求的OSAHS患者共61例,所有的患者均于1周内顺序接受手动压力滴定及自动压力滴定,收集所有患者的临床资料、多道睡眠监测结果以及两种压力滴定得到的治疗压力进行分析.结果 61例患者的睡眠呼吸暂停低通气指数（AHI）14.9 ～110.4次/h,平均（（x）±s,下同）为（63.1 ±17.7）次/h;手动压力滴定得到的治疗压力为（8.4±2.1）cmH2O（1 cmH2O =0.098 kPa）,显著低于自动压力滴定得到的治疗压力（11.5 ±2.7）cmH2O（t=-9.797,P＜0.001）.以两个治疗压力差（△P）3 cmH2O作为界值将患者分为两组,发现△P＞3 cmH2O的27例患者的自动压力滴定的治疗压力值（13.3±2.3）cmH2O显著高于△P≤3 cmH2O的34例患者压力值（10.0±2.0） cmH2O,t=-6.159,P＜0.001,差异有统计学意义;两组之间的手动压力滴定值分别为（8.6±2.4）cmH2O和（8.3±2.0） cmH2O,差异无统计学意义（P值均＞0.05）;两组间年龄、体质量指数、颈围、腹围、AHI以及最低动脉血氧饱和度间差异均无统计学意义（P＞0.05）.结论 自动压力滴定得到的治疗压力高于手动压力滴定所得到的治疗压力.对于自动压力滴定治疗压力较高的患者,可建议接受进一步的手动滴定压力检查以降低其潜在的治疗压力,提高CPAP治疗的舒适性及依从性.

Objective To explore whether there were differences between the results of automatic titration and the results of manual titration for positive airway pressure treatment in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and its influencing factors,the results might provide a theoretical basis for the rational use of two pressure titration methods.Methods Sixty one patients with OSAHS were included in this study.All patients underwent a manual titration and an automatic titration within one week.The clinical informations,polysomnography data,and the results of both two titration of all patients were obtained for analysis.Results The overall apnea/hypopnea index was （63.1 ±17.7）/h,with a range of 14.9/h to l10.4/h.The treatment pressure of manual titration was （8.4±2.1）cmH2O,which was significantly lower than the treatment pressure of automatic titration,（11.5 ± 2.7） cmH2O （t =-9.797,P〈0.001）.After using a △P of 3 cmH2O for the cutoff value （△p was defined as the difference of automatic titration and manual titration）,it was found that the pressure of automatic titration was significantly higher in patients with a △P 〉 3 cmH2O than in patients with a △P≤3 cmH2O,which was （13.3±2.3）cmH2O vs （10.0±2.0）cmH2O （t =-6.159,P〈0.001）.However,there were no differences for the pressure of manual titration between these two groups,which was （8.6±2.4） cmH2O vs （8.3 ±2.0） cmH2O （P 〉 0.05）.There was no significant difference in age,body mass index,neck circumference,abdomen circumference,apnea hypopnea index,and arterial oxygen saturation between these two groups.Conclusions The treatment pressure of automatic titration is usually higher than that of manual titration.For patients with a high treatment pressure which is derived from automatic titration,a suggestion about manual titration could be given to decrease the potential treatment pressure of continuous positive airway pressure,which may be helpful in improving the comfortableness and the compliance of this treatment.