多导睡眠监测评估两种模式正压通气呼吸机对重度阻塞性睡眠呼吸暂停综合征的疗效

目的探讨自动调节持续气道正压通气呼吸机(Auto-CPAP)与双水平正压通气呼吸机(Bi-PAP)在治疗重度阻塞性睡眠呼吸暂停综合征(OSAHS)患者时的疗效。方法 120例重度(AHI>40)OSAHS患者根据AHI是否大于60,并且夜间平均血氧饱和度(MSaO2)是否低于80%分为A组和B组,先后接受Auto-CPAP和Bi-PAP治疗,观察治疗前和治疗时PSG参数变化。结果 A组患者应用Auto-CPAP较Bi-PAP治疗效果无明显差异,B组患者应用Bi-PAP较Auto-CPAP治疗效果明显改善。治疗效果主要表现在睡眠效率(SE),觉醒次数(WASO),Ⅰ期+Ⅱ期,Ⅲ期+IV期及REM期睡眠各占总睡眠时间(TST)的比例,而呼吸暂停低通气指数(AHI),夜间平均血氧饱和度(MSaO2),夜间最低血氧饱和度(LSaO2)无明显差异。结论对于重度OSAHS患者,AHI≤60,MSaO2≥80%的患者建议选择Auto-CPAP进行治疗,AHI大于60,MSaO2低于80%建议选择Bi-PAP进行治疗。

Therapeutic selection of auto-continuous positive airway pressure and Bi-level positive airway pressure on the obstructive sleep apnea-hypopnea syndrome

Objective To explore the application of auto-positive airway pressure （ Auto-CPAP ） and bi-level positive airway pressure （ Bi-PAP） on the patients with severe obstructive sleep apnea-hypopnea syndrome （ OS-AHS）. Methods 120 OSAHS patients were divided into two groups,namely 60 with AHI≤60 and M SaO2≥80% in A group and 60 with AHI〉 60 and M SaO2〈 80% in B group. All patients received Auto-CPAP one day and Bi-PAP therapy the next day. The changes of PSG parameters were observed. Results The therapy effects of Auto-CPAP and Bi-PAP in A group has no significance. The therapy effects of Bi-PAP were much better than Auto-CPAP in B group. The effects of treatment were manifested as sleep efficiency （ SE） ,number of WASO （ wake after sleep onset） ,time of NREM I ＋ II over total sleep time,time of III ＋ IV and REM over total sleep time. The apnea-hypopnea index （ AHI） ,night time mean SaO2（ M SaO2） and nighttime the lowest SaO2 （ L SaO2） have no significance. Con-clusion For severe OSAHS patients,when AHI≤60 and M SaO2≥80% ,Auto-CPAP should be used,and when AHI 〉60 and M SaO2 〈80% ,Bi-PAP should be selected for therapy.