适应性伺服通气治疗复杂性睡眠呼吸暂停综合征的长期疗效分析

Long term efficacy of adaptive servo ventilation in the treatment of complex sleep apnea syndrome

目的探讨适应性伺服通气（adaptive servo ventilation，ASV）治疗复杂性睡眠呼吸暂停综合征（complex sleep apnea syndrome，CompSAS）的长期疗效。方法收集2014年6月至2016年6月在民航总医院睡眠中心诊断为CompSAS且愿意接受长期（90d以上）ASV治疗的患者。于治疗前、持续气道正压通气（continuous positive airway pressure，CPAP）滴定、ASV滴定及AsV治疗90d时进行睡眠呼吸监测，观察长期ASV治疗对睡眠结构及睡眠呼吸事件的改变；分析长期ASV治疗依从性及相关不良事件。结果本研究共收集42例CompSAS患者，其中接受长期ASV治疗的患者共有22例。该22例CompSAS患者均为男性，均患有严重OSAHS，平均睡眠呼吸暂停低通气指数（apnea hyponea index，AHI）为（45．76±10．08）次／hi其中平均仰卧位AHI达（55．76±8．25）次／h。左室射血分数大致正常。经过CPAP滴定治疗CompSAS患者AHI、阻塞性睡眠呼吸暂停指数（obstructive apnea index，OAI）、混合性睡眠呼吸暂停指数（mix apnea index，MAD较治疗前显著下降，中枢性睡眠呼吸暂停指数（central apnea index，CAI）较治疗前显著升高；最低血氧饱（lowest oxygen saturation，LSpO2）和度较治疗前显著升高；快动眼（rapid eye movement，REM）睡眠比例较治疗前显著增加。与治疗前及CPAP滴定治疗时相比，AsV滴定及ASV治疗90d时N3期显著增加，N1期4-N2期显著降低；AHI、CAI及MAI均显著降低；LSpO2显著升高。此外，与CPAP滴定时比较，ASV滴定及ASV治疗90d时睡眠效率显著提高；与治疗前比较，REM期在ASV滴定及ASV治疗90d时显著提高。长期治疗过程中，ASV平均使用时间为4．8h／晚。3例患者曾有胸闷表现，调整治疗后胸闷消失。结论对于无严重心肺疾病及脑血管病的CompSAS患者，ASV长期治疗几乎完全能够消除睡眠呼吸事件，提高睡眠质量，患者依从性好且未见严重不良反应。

Objective To evaluate the long term efficacy of adaptive servo ventilation （ASV） in the treatment of complex sleep apnea syndrome （CompSAS）. Methods Adult patients who were diagnosed with CompSAS and were willing to receive long term （90 days or more） ASV treatment in sleep center of General Hospital of Civil Aviation had been prospectively studied. PSG examination were performed before treatment, CPAP titration, ASV titration and 90 days after ASV treatment. Sleep structure and sleep apnea events were analysised. Adverse reaction and compliance of ASV treatment were recorded. Results A total of 42 patients with CompSAS were enrolled, including 22 patients treated with long term ASV.The 22 patients with CompSAS were all male and all suffered from severe OSAHS. The average AHI was （45.76± 10.08） times/h, the average AHI in supine position was （55.76±8.25） times/h. Left ventricular ejection fraction was normal. After CPAP titration AHI, OAI and MAI was significantly decreased, CAI was significantly increased, the LSpO2 significantly increased,and REM were significantly increased. After ASV titration and ASV treatment for 90 days the LSpO2 % was significantly increased, N3 sleep was significantly increased while N1 and N2 sleep was significantly reduced compared with CPAP titration and before treatment. Compared with CPAP titration, sleep efficiency was significantly increased after ASV titration and ASV treatment for 90 days. Compared with before treatment, REM sleep was significantly increased after ASV titration and ASV treatment for 90 days. The average duration of ASV use was 4.8 hours/night. Three patients had chest tightness, and the chest tightness disappeared after adjustment treatment. Conclusions Long term ASV treatment could almost completely eliminate sleep breathing events and improve sleep quality for CompSAS patients without severe cardiopulmonary disease and cerebrovascular disease. ASV treatment also showed good compliance and no severe adverse reactions.