Prediction of continuous positive airway pressure in obstructive sleep apnea

Continuous positive airway pressure (CPAP) prediction formulas can potentially simplify the treatment of obstructive sleep apnea (OSA). However, they can be difficult to derive and validate. We tested a statistical method to derive and validate a CPAP prediction formula using the same sample population. Seventy-six OSA patients underwent polysomnography and CPAP titration. Anthropometric measures, sleep parameters, and the Epworth sleepiness scale (ESS) were evaluated as predictors. All subsets regression was used to determine the optimum number of variables in the model. The Bayes information criterion was used to find the best-fit model. The model was then evaluated by a tenfold cross-validation procedure. Subjects were obese (BMI 31.3 ± 5.4) and had significant daytime somnolence (ESS 11.9 ± 5). Mean respiratory disturbance index (RDI) was 53.5 ± 31.3. The ESS was not predictive of titrated CPAP. The best-fit model included three variables (CPAP_pred = 30.8 + RDI × 0.03 − nadir saturation × 0.05 − mean saturation × 0.2). This model explained 67% of the variance. Our data and the literature suggest that a combination of two to three factors is predictive of titrated CPAP: RDI, oxyhemoglobin saturation, and obesity. Except for RDI, the specific factors vary in each population. A CPAP prediction formula that explains a high proportion of the titrated CPAP variance can be easily derived from parameters measured during the diagnostic work-up of OSA patients using a unique statistical model that allows derivation and validation of the formula in the same test population.     

经鼻持续气道正压通气对阻塞性睡眠呼吸暂停综合征的综合疗效

经鼻持续气道正压通气（CPAP）是目前治疗阻塞性呼吸暂停综合征（OSAS）最有效的内科治疗方法,通过向气道内增加一定程度的正压,保持上气道通畅,消除患者夜间缺氧,改善患者夜间打鼾,白天嗜睡等临床症状,恢复睡眠结构,并治疗与此相关的各系统疾病,提高患者长期的生活质量。     

持续正压通气治疗阻塞性睡眠呼吸暂停低通气综合征伴高血压的护理

目的研究持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴高血压的作用及护理。方法45例OSAHS伴高血压患者使用CPAP,每晚治疗8h。定时测量血压,并辅以积极的护理措施,观察患者治疗前后的血压变化。结果治疗后血压有所下降(P<0.05),下降时间为3～14d,平均(5±2.5)d。结论CPAP治疗OSAHS伴高血压是一种有效方法,护理有其特殊性和重要性。     

持续气道正压通气治疗对OSAHS患者血液流变学的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者经鼻持续气道正压通气(ncpap)治疗对其血液流变学指标的影响。方法随机选择我科确诊为中度或重度OSAHS的患者30例,其中男20例,女10例,年龄45~68岁,平均年龄(58±3)岁,治疗前14d内未服用过非甾体类消炎药及阿斯匹林,潘生丁等抗凝剂,并排除其它呼吸系疾病、紫绀性先心病、肾脏疾病及原发性红细胞增多症,分别于治疗前及治疗30d后检测血细胞比容、全血比粘度(高切度、中切度、低切度),红细胞聚集指数。结果治疗后血细胞比容、全血比粘度(高切度、中切度、低切度)、红细胞聚集指数较治疗前显著降低(P<0.01)。结论OSAHS存在显著血栓栓塞高危因素,ncpap对其有明显防治作用。     

持续气道正压通气对阻塞性睡眠呼吸暂停患者睡眠结构的影响

目的探讨患者白天嗜睡等症状的原因,评估经鼻持续气道内正压通气(nCRAP)治疗对阻塞性睡眠呼吸暂停患者睡眠结构的影响。方法选择2001-2004年广东省佛山市第一人民医院呼吸科34例OSAS病人在睡眠多导生理记录仪监测下,进行nCPAP治疗,观察治疗前后呼吸紊乱指数、血氧饱和度和睡眠结构的变化。结果治疗后呼吸紊乱指数下降,最低血氧饱和度上升,睡眠结构明显改善。结论nCRAP能有效地改善OSAS病人的睡眠结构和呼吸紊乱。     

持续气道正压治疗对阻塞性睡眠呼吸暂停患者夜间多尿症状的影响

目的研究持续气道正压（CPAP）治疗对阻塞性睡眠呼吸暂停综合征（OSAS）患者夜间多尿症状的影响。方法15例多导睡眠图（PSG）确诊的OSAS患者,记录CPAP治疗前后的夜尿次数、夜尿量、夜尿渗透压和夜尿钠排泄量,测定其中8例患者治疗前后夜间（23时、02时、05时）心钠素（ANP）水平。结果(1)CPAP治疗后OSAS患者夜尿次数明显减少（P<0.01）。(2)夜尿量由(0.078±0.017)L/h降至(0.052±0.011)L/h（P<0.01）。(3)CPAP治疗后OSAS患者夜尿渗透压由(381±96)mmol/L明显增高至(570±169)mmol/L（P<0.05）。(4)CPAP治疗后OSAS患者夜尿钠的排泄量由(1.16±0.35)mmol/h降至(0.63±0.13)mmol/h（P<0.01）。(5)8例患者CPAP治疗前后的夜间ANP平均水平分别为(146±14)ng/L和(106±10)ng/L,两者相比差异有显著性(P<0.01)。(6)8例测定ANP患者在CPAP治疗后ANP降低值与该患者夜尿量降低值、夜尿渗透压增高值、夜尿钠排泄量减少值均有显著的正相关,相关系数分别为0.82、0.84、0.81(P均<0.01)。结论CPAP治疗可明显减少OSAS患者夜尿次数和夜尿量,减少夜尿钠排泄量,增加夜尿渗透压,这些改变可能与ANP水平降低有关。     

CPAP治疗重度OSAHS的疗效观察

目的 观察持续气道正压通气(CPAP)治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效、影响因素.方法 36例确诊为重度OSAHS的患者经CPAP治疗后,观察其治疗前后的呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(SaO2)及临床症状的变化.结果 治疗后AHI明显下降,夜间最低SaO2及临床症状明显改善.结论 CPAP是治疗重度OSAHS的有效方法.患者的依从性对重度OSAHS的治疗有决定性的意义.     

Screening for obstructive sleep apnea before coronary angiography

IntroductionThe prevalence of obstructive sleep apnea (OSA) in patients with suspected coronary heart disease (CHD) is yet to be clarified. This study aimed to investigate the prevalence of OSA before coronary angiography (CAG).MethodsWe retrospectively evaluated patients with suspected CHD admitted to the Department of Geriatric Cardiology of our hospital between July 2019 and July 2021. OSA was screened using the level III home sleep apnea test before CAG. The prevalence of OSA was then compared between the CHD and non‐CHD groups. CHD severity was determined using the Gensini score of CAG results, and OSA severity was graded using the apnea‐hypopnea index (AHI).ResultsAmong the 327 patients, 211 had CHD. In total, 264 patients were diagnosed with OSA (80.7%) (184 patients, CHD group [87.2%]; 80 patients, non‐CHD group [69.0%]). The CHD group had a significantly higher prevalence of OSA (P < 0.01) and higher AHI (CHD group 18.76 ± 14.94, non‐CHD group 11.56 ± 10.67, P < 0.01). The Gensini score was positively correlated with OSA severity in patients with CHD, and AHI ≥ 20 was a risk factor for CHD (odds ratio: 1.961, 95% confidence interval: 1.065–3.608, P < 0.05).ConclusionOSA screening before CAG revealed a higher prevalence in CHD patients than in non‐CHD patients. The degree of coronary artery obstruction is positively correlated with AHI, and AHI ≥ 20 is a risk factor for CHD. Therefore, attention should be paid to OSA screening and management before CAG in patients with suspected CHD.     

Long-term effects of nasal continuous positive airway pressure on vasodilatory endothelial function in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is associated with a dysfunction of vascular endothelial cells. The aim of this study was to investigate long-term improvement of endothelial dysfunction in OSAS with nasal continuous positive airway pressure (nCPAP) treatment. We investigated endothelium-dependent and endothelium-independent vasodilatory function in patients with OSAS using the hand vein compliance technique. Dose–response curves to endothelium-dependent vasodilator bradykinin were obtained in 16 subjects with OSAS before and after 6 months of nCPAP therapy and in 12 control subjects without OSAS. Maximum dilation (Emax) to bradykinin, being impaired in all OSAS patients, was completely restored with nCPAP. Mean Emax to bradykinin rose from 54.9±18.5 to 108.2±28.7% with 164.4±90.0 nights of nCPAP therapy (p<0.0001; Emax healthy controls, 94.8±9.5%). At treatment follow-up, endothelium-dependent vasodilatory capacity was not significantly different in nCPAP-treated OSAS patients vs healthy controls. Mean vasodilation with endothelium independently acting nitroglycerin was not altered initially and did not change with nCPAP therapy indicating that nCPAP restored endothelial cell function and not unspecific, endothelium-independent factors. These results suggest that regular nocturnal nCPAP treatment leads to a sustained restoration of OSAS-induced impaired endothelium-dependent nitric oxide-mediated vasodilation, suggesting an improvement of systemic endothelial dysfunction in patients studied.     

气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者脉压的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者脉压的变化及经鼻持续气道正压通气（nCPAP）的影响。方法选择85例经多导睡眠图仪（PSG）诊断的OSAHS患者,同时随机选取15例中重度OSAHS患者进行nCPAP治疗,在PSG监测前后及期间每2小时测量其血压,计算出脉压、脉压变化幅度、平均收缩压及平均舒张压,并计算体重指数。结果41％OSAHS患者同时合并有高血压;OSAHS合并高血压组患者的呼吸紊乱指数、脉压及体重指数明显高于单纯OSAHS患者,其最低血氧饱和度以及平均血氧饱和度均低于单纯OSAHS患者;重度OSAHS患者的脉压、体重指数、平均收缩压及平均舒张压均明显大于轻、中度OSAHS患者,而轻、中OSAHS患者之间差异无显著性意义。nCPAP可提高OSAHS患者最低血氧饱和度,同时降低其呼吸紊乱指数、平均收缩压、平均舒张压及脉压。相关分析结果表明,呼吸紊乱指数与脉压（r=0．395,P〈0．01）、平均收缩压（r=0．403,P〈0．01）、平均舒张压（r=0．313,P〈0．01）呈正相关,与最低氧饱和度（r=-0．424,P〈0．01）呈负相关,与体重指数、平均氧饱和度无相关。结论脉压是OSAHS的严重程度及是否并发高血压心血管事件的预测因子;nCPAP能下调OSAHS患者脉压及血压,是缓解OSAHS病情进展的有效治疗措施。     

Effects of continuous positive airway pressure treatment in obstructive sleep apnea patients with atrial fibrillation: A meta-analysis

Background:Obstructive sleep apnea (OSA) is correlated with atrial fibrillation (AF). Over the past decade, there has been an increasing interest in the relationship between OSA with continuous positive airway pressure (CPAP) and progression or recurrence of AF.Methods:This investigation was an analysis of studies searched in the Cochrane Library, PubMed, EMBASE, EBSCO, OVID, and Web of Science databases from inception to July 2020 to evaluate the recurrence or progression of AF in CPAP users, CPAP nonusers, and patients without OSA.Results:Nine studies with 14,812 patients were recruited. CPAP therapy reduced the risk of AF recurrence or progression by 63% in a random-effects model (24.8% vs 40.5%, risk ratio [RR] = 0.70, 95% confidence interval [CI] = 0.57–0.85, P = .035). Compared with non-OSA patients, AF recurrence or progression was much higher in CPAP nonusers (40.6% vs 21.1%, RR = 1.70, 95% CI = 1.19–2.43, P = .000). However, AF recurrence or progression in the CPAP group was similar to that in the non-OSA group (24.0% vs 21.1%, RR = 1.13, 95% CI = 0.87–1.47, P = .001). Begg correlation test and Egger regression test revealed no publication bias in this analysis.Conclusions:OSA is a salient factor in the progression or recurrence of AF. CPAP therapy for OSA may contribute to reduction of AF in patients for whom radiofrequency ablation or direct current cardioversion is not performed.Trial Registration:The protocol for this meta-analysis was registered on PROSPERO with a registration No. CRD42019135229.     

经鼻持续正压通气治疗夜间心绞痛合并阻塞性睡眠呼吸暂停低通气综合征

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）和夜间心绞痛的关系以及经鼻持续正压通气治疗能否改善合并有OSAHS患者夜间心绞痛发作。方法 采用多导睡眠监测系统对46例夜间心绞痛患者进行整夜监测，对合并OSAHS的患者应用经鼻持续正压通气治疗，将患者治疗前后多导睡眠监测参数进行对照研究。结果 夜间心绞痛合并OSAHS的患者经持续正压通气治疗多导睡眠参数明显改善，治疗前后对比差异有显著性，心绞痛症状明显改善。结论 OSAHS和夜间心绞痛有相关性，OSAHS是夜间心绞痛发作的诱因。经鼻持续正压通气治疗可改善合并有0SAHS患者夜间心绞痛发作。     

Association between sleep apnea severity and blood coagulability: treatment effects of nasal continuous positive airway pressure

A prothrombotic state may contribute to the elevated cardiovascular risk in patients with obstructive sleep apnea (OSA). We investigated the relationship between apnea severity and hemostasis factors and effect of continuous positive airway pressure (CPAP) treatment on hemostatic activity. We performed full overnight polysomnography in 44 OSA patients (mean age 47±10 years), yielding apnea–hypopnea index (AHI) and mean nighttime oxyhemoglobin saturation (SpO₂) as indices of apnea severity. For treatment, subjects were double-blind randomized to 2 weeks of either therapeutic CPAP (n=18), 3 l/min supplemental nocturnal oxygen (n=16) or placebo–CPAP (<1 cm H₂O) (n=10). Levels of von Willebrand factor antigen (VWF:Ag), soluble tissue factor (sTF), D-dimer, and plasminogen activator inhibitor (PAI)-1 antigen were measured in plasma pre- and posttreatment. Before treatment, PAI-1 was significantly correlated with AHI (r=0.47, p=0.001) and mean nighttime SpO₂ (r=−0.32, p=0.035), but these OSA measures were not significantly related with VWF:Ag, sTF, and D-dimer. AHI was a significant predictor of PAI-1 (R ²=0.219, standardized β=0.47, p=0.001), independent of mean nighttime SpO2, body mass index (BMI), and age. A weak time-by-treatment interaction for PAI-1 was observed (p=0.041), even after adjusting for age, BMI, pre-treatment AHI, and mean SpO₂ (p=0.046). Post hoc analyses suggested that only CPAP treatment was associated with a decrease in PAI-1 (p=0.039); there were no changes in VWF:Ag, sTF, and D-dimer associated with treatment with placebo–CPAP or with nocturnal oxygen. Apnea severity may be associated with impairment in the fibrinolytic capacity. To the extent that our sample size was limited, the observation that CPAP treatment led to a decrease in PAI-1 in OSA must be regarded as tentative.     

The effects of continuous positive airway pressure therapy on mean platelet volume in patients with obstructive sleep apnea

Previous studies have reported increased platelet activation and aggregation in patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) treatment has been shown to decrease platelet activation. We aimed to study the effects of nasal CPAP therapy has on MPV values in patients with severe OSA. Thirty-one patients (21 men; mean age 53.8?±?9.2 years) with severe OSA (AHI?>?30 events/hour) constituted the study group. An age, gender and body mass index (BMI) matched control group was composed 25 subjects (14 men; mean age 49.6?±?8.5 years) without OSA (AHI?<?5 events/hour). We measured MPV values in patients with severe OSA and control subjects and we measured MPV values after 6 months of CPAP therapy in severe OS patients. The median (IQR) MPV values were significantly higher in patients with severe OSA than in control group (8.5 [8.3–9.1] vs. 8.3 [7.5–8.8] fL; p?=?0.03). The platelet counts were significantly lower in patients with severe OSA than in control group (217.8?±?45.9 vs. 265.4?±?64.0?×?10⁹/L; p?=?0.002). The six months of CPAP therapy caused significant reductions in median (IQR) MPV values in patients with severe OSA (8.5 [8.3–9.1] to 7.9 [7.4–8.2] fL; p?<?0.001). Six months of CPAP therapy caused significant increase in platelet counts when compared with baseline values (217.8?±?45.9 to 233.7?±?60.6?×?10⁹/L; p?<?0.001). We have found that the MPV values of patients with severe OSA were significantly higher than those of the control subjects and 6 months CPAP therapy caused significant reductions in the MPV values in patients with severe OSA.     

持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者能量代谢的影响

目的研究中重度阻塞性睡眠呼吸暂停低通气综合征（0SAHS）患者经鼻面罩持续气道正压通气（CPAP）治疗前后能量代谢的变化特点。方法选取2004年3月至2006年5月在我院睡眠疾患诊治中心就诊的30例中重度OSAHS患者,分别于CPAP治疗前后测量入睡前及非快速眼动（NREM）Ⅰ～Ⅱ期睡眠时静息能量消耗（REE）。同时随机选取我院健康体检中心和我院健康职工其性别、年龄、体质量指数（BMI）均与之相当的30例作为对照组。结果OSAHS组入睡前REE高于对照组F9别为（1823±88）kcal／d、（1537±130）kcal／d],差异有显著性意义（P〈0．01）。与入睡前相比,NREMⅠ～Ⅱ期睡眠时OSAHS组REE明显增高F9别为（1823±88）kcal／d、（3726±650）kcal／d],而对照组[（1434±135）kcal／d]明显降低,差异均有显著性意义（P均〈0．01）。经鼻面罩CPAP治疗后,OSAHS患者入睡前REE降至（1573±130）kcal／d,与治疗前相比差异无显著性意义（P〉0．05）;睡眠时0SAHS组REE降至（2393±456）kcal／d,与治疗前相比差异有显著性意义（P〈0．01）。结论OSAHS患者存在能量代谢异常,经CPAP治疗后其NREMⅠ～Ⅱ期睡眠时REE明显下降。     

Autotitration positive airway pressure therapy in patients with obstructive sleep apnea who are intolerant of fixed continuous positive airway pressure

Compliance with continuous positive airway pressure (CPAP) therapy is one of the most difficult management problems for patients with obstructive sleep apnea (OSA). We postulated that autotitration positive airway pressure (APAP) may be effective in some patients who have an intolerance of fixed CPAP. The study was done to estimate how often patients who cannot tolerate fixed CPAP can tolerate APAP. We identified 25 patients seen in the Sleep Disorders Center who had been treated with fixed CPAP for OSA and were intolerant of CPAP therapy despite multiple efforts to improve tolerance. We substituted APAP therapy and measured subjective and objective compliance with treatment 1 month later. The primary end point was the number of patients who successfully tolerated the use of APAP at the end of 30 days, measured objectively by the device's compliance monitor. A positive outcome was defined as an average use of APAP that was greater than 3 h per night on more than 70% of possible nights. Of the 25 patients (mean age, 68 years; mean apnea-hypopnea index, 35), 11 were able to tolerate APAP therapy. The mean number of hours of use in these responders was 6.2; the mean percentage of nights of use among responders was 89%. Determinants of successful APAP use were an apnea-hypopnea index (AHI) less than 18, male sex, OSA related to rapid eye movement, and a high body mass index. APAP therapy may be an effective option in patients who do not tolerate fixed-CPAP therapy.