持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者勃起功能障碍疗效的meta分析

目的:评价持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)患者勃起功能障碍(ED)的影响。方法:计算机检索Cochrane Library、PubMed、中国学术期刊全文数据库、中国生物医学文献数据库、万方资源数据库和中国重要会议论文全文数据库并手工检索相关期刊,全面收集CPAP对OSAS合并性功能障碍的临床研究,按照纳入、排除标准选择实验研究并评价质量,而后提取有效数据进行meta分析。结果:最终纳入4篇文献,1篇中文,3篇英文,包括77例患者。meta分析结果显示各研究间无统计学异质性(P=0.80;I2=0%),故采用固定效应模型进行meta分析。结果显示经CPAP治疗后,IIEF-5增高[WMD=4.19,95%(3.01,5.36),P<0.001]。结论:现有临床研究证据显示,对于OSAS合并ED患者,CPAP治疗能明显减轻ED。但因研究质量及研究样本存在明显局限性,期待更多高质量、大规模的临床随机对照研究加以验证。     

全程护理对阻塞性睡眠呼吸暂停综合征患者正压通气治疗依从性的影响

目的探讨全程护理模式对阻塞性睡眠呼吸暂停综合征患者正压通气治疗依从性的影响。方法将88例愿意接受正压通气治疗的阻塞性睡眠呼吸暂停综合征患者随机分为治疗组和对照组各44例。对照组采用传统护理模式,治疗组实施院内、院外全程护理模式。比较两组患者6个月后呼吸机使用情况、嗜睡评分和多导睡眠图各项参数。结果护理干预6个月后,治疗组患者持续气道正压通气治疗依从性显著高于对照组,嗜睡评分显著低于对照组,呼吸暂停低通气指数、最低血氧饱和度、0.90的氧减时间比等参数较对照组有显著改善(P0.05,P0.01)。结论采用全程护理模式,可提高阻塞性睡眠呼吸暂停综合征患者正压通气治疗依从性,改善其相关症状。     

脑卒中伴阻塞性睡眠呼吸暂停患者持续气道正压通气依从性调查

目的 了解社区脑卒中伴阻塞性睡眠呼吸暂停患者持续气道正压通气依从性现状,并分析其影响因素。方法 选取接受持续气道正压通气治疗的141例社区脑卒中并伴阻塞性睡眠呼吸暂停患者为调查对象,调查患者一般资料、脑卒中损伤程度、阻塞性睡眠呼吸暂停严重程度、睡眠情况及健康信念,6个月后评价其持续气道正压通气治疗依从性。结果 患者持续气道正压通气治疗依从率为29.8%。回归分析结果显示,家庭收入高、脑卒中损伤程度严重、健康信念总分高是患者持续气道正压通气治疗依从的保护因素(均P<0.05)。结论 社区脑卒中伴阻塞性睡眠呼吸暂停患者持续气道正压通气治疗依从性较低,其影响因素较多。应加强健康教育,增强患者的健康信念,提高脑卒中轻度损伤患者对疾病的重视程度,从而提升患者治疗依从性。     

A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome

OBJECTIVE: The study goal was to determine the effectiveness of (1) multilevel temperature-controlled radiofrequency tissue ablation (TCRFTA) or (2) continuous positive airway pressure (CPAP) for the treatment of mild to moderate obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND METHODS: We conducted a randomized, placebo-controlled, 2-site trial, comparing TCRFTA (n = 30) and CPAP (n = 30) with sham-placebo (n = 30) using intention-to-treat analysis. RESULTS: Compared with pretreatment baseline, TCRFTA improved reaction time, OSAS-specific quality of life (QOL), and subjective sleepiness (all P < 0.05). Compared with sham-placebo, TCRFTA improved QOL, airway volume, apnea index, and respiratory arousal index (all P < 0.05). TCRFTA side effects and complications were mild, temporary, and similar to sham-placebo. CPAP improved QOL and sleepiness compared with baseline and QOL when compared with sham-placebo (all P < 0.05). Significant differences were not seen between TCRFTA and CPAP outcomes. CONCLUSION: TCRFTA and CPAP each improve QOL for mild-moderate OSAS patients. TCRFTA improvements may result from changes in airway volume, apnea index, and respiratory arousal index.     

Obstructive sleep apnea, continuous positive airway pressure, and surgery

Patients with obstructive sleep apnea (OSA) who have undergone upper airway surgery could be expected to improve if surgery alleviated some or all of the anatomic obstructions, or continue to desaturate at preoperative levels if the surgery was not corrective. Factors such as morbid obesity, general anesthesia recovery, and operative edema can potentially cause desaturations below preoperative levels. Because of this risk, patients with severe OSA have been considered for protective tracheostomy. The findings of our study suggest that selected patients who would have been past candidates for protective tracheostomy while undergoing surgery for severe OSA can, as an alternative, be considered for immediate postoperative use of nasal continuous positive airway pressure (CPAP). Ten surgical patients with severe OSA who elected surgical treatment were successfully treated with CPAP immediately after extubation and postoperatively to assist with airway patency and hemoglobin saturation. Postoperative followup included monitoring of continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases. Preoperatively, all ten patients had marked decrease in oxygen desaturation levels during sleep, with a mean nadir oxygen saturation (SaO2) to 51.5%. After surgery, all patients in this group maintained SaO2 levels to no lower than 90%, with a mean SaO2 level of 93% while using CPAP on room air (F10(2) 21%) only.     

Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea

BACKGROUND: Obstructive sleep apnoea (OSA) elicits a number of cardiovascular perturbations that could lead acutely or chronically to increased ventricular ectopy in patients with heart failure (HF). We tested the hypothesis that treatment of OSA with continuous positive airway pressure (CPAP) in patients with HF would reduce the frequency of ventricular premature beats (VPBs) during sleep in association with reduced sympathetic nervous system activity. METHODS: Following optimisation of medical treatment, 18 HF patients with OSA and >10 VPBs per hour of sleep were randomised to a control group (n = 8) or a treatment group who received CPAP (n = 10). The frequency of VPBs and urinary norepinephrine (noradrenaline) concentrations during total sleep time were determined at baseline and after 1 month. RESULTS: Control patients did not experience any significant changes in apnoea-hypopnoea index (AHI), mean nocturnal O(2) saturation, or the frequency of VPBs. In contrast, there was a significant reduction in AHI (p<0.001), an increase in minimum O(2) saturation (p = 0.05), a reduction in urinary norepinephrine concentrations (p = 0.009), and a 58% reduction in the frequency of VPBs during total sleep (from mean (SE) 170 (65) to 70 (28) per hour, p = 0.011) after 1 month of CPAP treatment. CONCLUSIONS: In patients with HF, treatment of co-existing OSA by CPAP reduces the frequency of VPBs during sleep. These data suggest that reductions in VPBs and other ventricular arrhythmias through treatment of OSA might improve the prognosis in patients with HF.     

Sildenafil combined with continuous positive airway pressure for treatment of erectile dysfunction in men with obstructive sleep apnea

Objectives To assess efficacy and safety of the combination of sildenafil and continuous positive airway pressure (CPAP), and satisfaction with treatment for erectile dysfunction (ED) in men with obstructive sleep apnea (OSA). Patients and methods Forty men suffering from OSA and concurrent ED were treated with CPAP after a thorough investigation. After a 4-week run-in period, the patients were randomly allocated to treatment for 6 weeks; 20 men to the combination group, receiving additionally 100 mg sildenafil on demand for intercourse, and 20 men to CPAP alone. After a 1-week washout phase, the two groups switched to the other treatment arm for an additional 6 weeks period. End points for efficacy evaluation were the percentage of successful attempts for intercourse based on an event log and the overall satisfaction with sildenafil in the treatment of ED. Results The patients recorded a total of 149 attempts for intercourse during the run-in phase with a success rate of 19.5%. During the 12 weeks of treatment, the success rate of intercourse attempts was 24.8% when only on CPAP and 61.1% when in combination with sildenafil (P < 0.001). Of the studied men, 70% were satisfied with the use of sildenafil while 30% remained unhappy with this additional treatment. Conclusions Sildenafil in combination with CPAP appears clearly superior to CPAP alone. The efficacy of this combination is superior to that of sildenafil alone, as reported in previous studies. Both treatment modalities are safe and well tolerated. However, approximately one-third of the patients remain unsatisfied even from the␣combination treatment. Further treatment options are needed.     

The use of continuous positive airway pressure during an awake craniotomy in a patient with obstructive sleep apnea

We describe the anesthetic management of a morbidly obese patient with obstructive sleep apnea who underwent awake craniotomy. The patient's personal continuous positive airway pressure (CPAP) machine was used to support ventilation intraoperatively. Dexmedetomidine was used as the primary sedative. During cortical mapping, the CPAP was discontinued. The patient was comfortable and able to cooperate with language testing.     

Erectile dysfunction in men with obstructive sleep apnea syndrome: a randomized study of the efficacy of sildenafil and continuous positive airway pressure

The aim of this study was to compare the efficacy of sildenafil and continuous positive airway pressure (CPAP) in men with erectile dysfunction (ED) and obstructive sleep apnea syndrome (OSAS). In all, 30 men were randomly treated for 12 weeks either with sildenafil 100 mg before intercourse (15 men) or CPAP during night time sleep (15 men). Under sildenafil, 97/180 (53.9%) of attempted intercourses were successful compared to 33/138 (23.9%) under CPAP. The mean IIEF (erectile function domain score) was 12.9 and 9.3 after sildenafil and CPAP treatment, respectively (P=0.007), compared to 7.9 and 7 at baseline. In all, 53.3% of patients were satisfied with sildenafil and 20% with CPAP for ED treatment (P=0.058). Although sildenafil was superior to CPAP, comorbidities and OSAS per se possibly resulted in a lower effectiveness of sildenafil compared to that in the general population of ED men. While about half of the patients were not satisfied even with the more effective treatment, we conclude that a combination of the two therapeutic tools or a different therapeutic mode should be studied further.     

Severe obstructive sleep apnoea treated with long term nasal continuous positive airway pressure.

Seven patients with the severe obstructive sleep apnoea syndrome were treated with nasal continuous positive airway pressure for from three to 22 months. This treatment reversed all symptoms due to the syndrome in every patient and continued to be used in five patients. One patient stopped treatment after eight months and subsequently remained incapacitated and another underwent tracheostomy at the time of transphenoidal hypophysectomy. Nasal continuous positive airway pressure is a safe, non-invasive treatment, which may be used in the presence of cardiac and respiratory failure. It is able fully to reverse upper airway obstruction and can be used at home on a long term basis.     

Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea

BACKGROUND: It is unclear whether continuous positive airway pressure (CPAP), the treatment of choice for severe obstructive sleep apnoea (OSA), is effective at improving outcomes in mild OSA. METHODS: To help define the role of humidified CPAP in mild OSA, a randomised crossover study was undertaken of patients with an apnoea hypopnoea index (AHI) of 5-30/hour. Subjective sleepiness, objective wakefulness, mood, reaction time, and quality of life were measured at baseline, after 3 weeks treatment with humidified CPAP and 3 weeks sham CPAP (2 week washout). RESULTS: Twenty nine of 31 enrolled patients (age 25-67 years, seven women, mean (SD) body mass index 31.5 (6) kg/m2) completed the protocol. Humidified CPAP improved polysomnographic indices of OSA and Epworth Sleepiness Scale (2.4 points (95% CI 0.6 to 4.2)). Objective wakefulness (modified maintenance of wakefulness test) showed a trend towards improvement (5.2 minutes (95% CI -0.6 to 11)). Mood (Hospital Anxiety and Depression Scale), quality of life (SF 36, Functional Outcomes of Sleep Questionnaire), and reaction times (Psychomotor Vigilance Task) were not improved more than sham CPAP. Compliance with humidified and sham CPAP both averaged 4.9 hours/night. Placebo effects were evident in many outcomes and there was no clear treatment preference. CONCLUSIONS: Humidified CPAP improves subjective sleepiness and possibly objective wakefulness but not reaction times, quality of life, or mood. These results do not support the routine use of CPAP in all patients with mild OSA, but offers some support for the trialling of CPAP in those with severe sleepiness.     

Effect of chronic continuous positive airway pressure (CPAP) therapy on upper airway size in patients with sleep apnoea/hypopnoea syndrome.

BACKGROUND: There is evidence to suggest that chronic continuous positive airway pressure (CPAP) therapy may produce reversible changes in upper airway morphology and function in patients with sleep apnoea/hypopnoea. This study was designed to examine the effect of chronic CPAP therapy on upper airway calibre. METHODS: Twenty four men with the sleep apnoea/hypopnoea syndrome (mean (SE) apnoea/hypopnoea index 37 (5)) underwent lateral cephalometry with measurement of posterior airway space performed before and at least three months after initiation of CPAP therapy. RESULTS: There was no weight change between the two assessments and mean CPAP use was 4.8 (0.4) hours per night. Posterior airway space (PAS) was measured in erect and supine postures. PAS supine increased with CPAP therapy from a mean (SE) of 11.8 (0.8) mm to 13.4 (0.8) mm, but PAS erect did not. Correlation of the change in PAS (dPAS) before and after CPAP therapy showed an increase with increasing CPAP compliance measured as machine run time both for dPAS supine (r = 0.68) and dPAS erect (r = 0.47). CONCLUSIONS: Patients with the sleep apnoea/hypopnoea syndrome regularly using CPAP for more than four hours per night all showed an increase in dPAS supine. The use of chronic CPAP increases PAS supine probably by a reduction in upper airway oedema, and the change in size is dependent on CPAP use.