便携式鼻呼气阻抗装置治疗阻塞性睡眠呼吸暂停低通气综合征初步观察

Preliminary observation of effectiveness of portable nasal expiratory positive

目的观察一种便携式鼻呼气阻抗装置(expiratory positive airway pressure device,EPAPD)治疗成人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的疗效及不良反应。方法对74例OSAHS患者进行EPAPD治疗,治疗前、治疗1周以及3个月后进行多道睡眠图(PSG)监测及Epworth嗜睡量表(ESS)评分。比较治疗前、后的主客观指标,观察其不良反应。结果患者治疗1周及3个月时,其呼吸暂停低通气指数(AHI)、平均最低血氧饱和度(lowest oxygen saturation,LSaO_2)、ESS较基线期有显著性改善(AHI:F=73.62,P=0.00;LSaO_2:F=12.65,P=0.00;ESS:F=61.49,P=0.00)。基线期不同低通气呼吸暂停程度的OSAHS患者,使用EPAPD装置后AHI改善存在显著性差异(1周:F=15.39,P=0.00;3个月:F=12.60,P=0.00);不同缺氧程度的患者,LSaO_2改善也存在显著性差异(1周:F=3.80,P=0.03;3个月:F=3.27,P=0.04)。基线期不同嗜睡程度的患者,ESS在治疗1周时有显著性改善(F=6.17,P=0.00)。便携式EPAPD的不良反应占44.59%(33/74),主要为口腔及鼻腔干燥、鼻塞及鼻部不适。结论EPAPD对于OSAHS患者有较好的治疗效果,对于症状严重的患者疗效相对更好。使用过程中不良反应轻微,值得临床推广。

OBJECTIVETo explore the curative effect and adverse reactions of a convenient expiratory positive airway pressure device(EPAPD) in treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). METHODS74 subjects with OSAHS were treated by EPAPD. Polysomnography(PSG) and Epworth sleepiness scores(ESS) were performed and evaluated before, within 1 week and after 3 months using the EPAPD. The index of PSG and ESS were compared at different time. The adverse reactions were also observed at the same time.RESULTS Compared to baseline, the AHI, LSaO2, ESS were significantly improved both within 1 week and after 3 months(AHI:F=73.62,P=0.00; LSaO2:F=12.65,P=0.00; ESS:F=61.49,P=0.00). The improvement of AHI between different OSAHS groups(divided by the severity of AHI in baseline) was significantly different(within 1 week:F=15.39,P=0.00; after 3 months:F=12.60,P=0.00). There was also significant difference between different hypoxia groups which were divided by the severity of LSaO2 in baseline(within 1 week:F=3.80,P=0.03; after 3 months:F=3.27,P=0.04). Meanwhile, the ESS was significantly improved in different sleepiness groups(divided by the ESS score in baseline) within 1 week(F=6.17,P=0.00). The device-related adverse events were reported by 44.59%(33/74). There were not serious adverse reaction happened. The major adverse reactions were throat and nose dry, nasal obstruction, and nose discomfort.CONCLUSION The EPAPD is an effective, convenient device in treating OSAHS. Meanwhile, the device related adverse reactions are slight. It may be more efficient for serious OSAHS patients than mild ones.