气道内正压通气对睡眠呼吸暂停综合征患者睡眠质量的作用

Continuous positive airway pressure in the improvement of sleep quality in patients with obstructive sleep apnea syndrome

目的观察auto-CPAP治疗阻塞性睡眠呼吸暂停综合征(OSAS)的疗效及耐受性,探讨CPAP治疗压力滴定的方法。方法31例确诊为OSAS患者,夜间睡眠使用auto-CPAP治疗同时做多导睡眠图(PSG)监测,分析监测参数与最佳治疗压力相关性。取睡眠分期为Ⅱ期以上,压力平稳,血氧饱和度90%以上的CPAP治疗压力值进行平均,所得的值即为CPAP治疗压力值。结果auto-CPAP治疗后,患者总觉醒时间减少、睡眠效率提高(P<0.05),Ⅰ期睡眠时间占睡眠时间百分比下降(P<0.05),Ⅱ期睡眠时间占睡眠时间百分比升高(P>0.05),Ⅲ、Ⅳ期及快动眼睡眠时间占睡眠时间百分比升高(P<0.05)。最低血氧饱和度上升,呼吸紊乱指数、SaO2<90%时间、血氧下降≥4%次数减少(P<0.05),15例OSAS合并高血压患者经治疗后,醒后收缩压由(144±15)mmHg下降为(134±8)mmHg(P<0.05),醒后舒张压由(94±13)mmHg下降为(83±6)mmHg(P<0.05)。结论auto-CPAP治疗OSAS效果肯定,耐受性好,可逆转高血压,取代人工滴定CPAP压力。

Aim To observe the therapeutic effect and tolerance of auto-CPAP in tr eatment of OSAS and explore the method of pressure titration.Methods 31 patients with OSAS were treated by auto-CPAP while sleeping and monitored by the polyso mmography (PSG). The relationship between optimal pressure and parameters of PSG was analyzed. The pressures recorded if sleep stage≥Ⅱaccording to the sleep s tages with steady pressure and SaO2 >90%were averagedfor the therapeutic pressu re.Results After auto-CPAP therapy, the arousal decreased obviously,time of sta geⅠwas shorter(P< 0.05).While the time of stageⅡchange longer(P >0.05),the tim e of stage Ⅲand Ⅳand rapid eye movement stage all changed longer(P< 0.05),slee p efficiency improved(P< 0.05),Apnea hypoventilation index(AHI) decreased and lo west SaO2 increased(P< 0.05),the time SaO2≤90%,and the frequency of SaO2 desa tura ≥4%both decreased(P< 0.05) and in 15 patients OSAS with hypertension afte r Auto-CPAP therapy,systolic blood pressure decreased from (144±15)mmHg to (13 4±8) mmHg, diastolic blood pressure decreased from (94±13) mmHg to(83±6) mmHg (P< 0.05). Conclusion Auto-CPAP is an effective treatment for patients with OSA S, with good tolerance, can be reverse hypertension, and can be replaced Artific ial titration of CPAP pressur.