气道正压治疗OSAS不同压力滴定方法的比较.docVIP

气道正压治疗OSAS不同压力滴定方法的比较 李燕1 刘欣欣2 王莞尔2 王扬2 高和2 【摘要】目的 比较整夜值守多导睡眠监测下人工压力滴定（PSG-CPAP）、多导睡眠监测下自动气道正压压力滴定（PSG-APAP）和自动气道正压压力滴定(APAP)方法的有效性和安全性。方法 采用单盲、自身对照方法，对20例单纯中重度阻塞性睡眠呼吸暂停(OSAS)患者，随机实施三种不同压力滴定治疗，并对其滴定治疗压力、残存睡眠呼吸事件、睡眠结构等相关参数进行分析。结果 PSG-APAP、APAP滴定90%时间压力较PSG-CPAP滴定最佳压力平均高3.05 cmH2O和2.55 cmH2O，P＜0.01；但PSG-APAP与APAP滴定结果间无统计学差异，P＞0.05。PSG-APAP、APAP滴定平均压力与PSG-CPAP滴定最佳压力间无明显统计学差异，P＞0.05。PSG-APAP、APAP与PSG-CPAP压力滴定相比，残存AHI无统计学差异，P＞0.05；与基线PSG相比,PSG-CPAP与PSG-APAP压力滴定治疗后ODI均明显减少，P＜0.01，但PSG-CPAP与PSG-APAP无统计学差异，P＞0.05，两种滴定方法在改善ODI上具有同等的效果。与基线PSG结果相比，PSG-CPAP和PSG-APAP压力滴定治疗后睡眠效率（SE）无统计学差异，P＞0.05； ArI明显减少,P＜0.01；N1和N2期睡眠百分比减少，P＜0.01和P＜0.05；N3期和R期睡眠百分比增加，P＜0.05和P＜0.01。两种滴定方法均能改善睡眠结构且疗效相当，P＞0.05。滴定研究期间病人的主要不适包括睡眠干扰，眼或口干，头痛，对呼吸机有恐惧感，憋气，腹胀等。结论 对单纯中重度OSAS，在严格控制入选标准及压力滴定前教育的基础上，PSG-APAP、APAP压力滴定及治疗安全有效，其滴定出的平均压力可为CPAP确定最佳治疗压力。 【关键词】阻塞性睡眠呼吸暂停综合征；气道正压通气；压力滴定 Comparisons of various pressure titration method to OSAS LI Yan1, LIU Xinxin, WANG Waner, WANG Yang, GAO He. 1hebei north college，Zhangjiakou 075000, China. Corresponding author: GAO He, airforce general hospital, PLA. Beijing 100142, bjgaohe@ 【Abstract】Objective To evaluate the efficacies and security in simple moderate-severe obstructive sleep apnea syndrome(OSAS) by PSG-APAP and APAP titration.Methods In our sleep center twenty patients with simple moderate-severe OSAS were recruited and underwented a random，blind and self comparison study among PSG-CPAP,PSG-APAP and APAP titration for the parameters of sleep respiration,sleep structure of the patients.Results Compared with the PSG-CPAP optimal pressure, the 90th centile pressure of the time of PSG-APAP and APAP titration were higher 3.05 cmH2O and 2.55 cmH2O respectively,P＜0.01,but there were no statistical significance between APAP and PSG-APAP titrations,P＞0.05. The mean pressures among the three titrations were no statistical significance,P＞0.05.All of the three titrations were efficacies. Compaired with basic PSG ,the AHI and ODI among the three groups