Cuvelier A, Muir J F, Czernichow P, Vavasseur E, Portier F, Benhamou D, Samson-Dolfuss D
Respiratory and Intensive Care Department, Rouen University Hospital, France.
Chest. 1999 Jul;116(1):22-9. doi: 10.1378/chest.116.1.22.
We compared the efficacy of the standard nasal cannula and the demand oxygen delivery system (DODS) during sleep in patients with COPD.
Twenty patients with moderate or severe COPD were included in the study.
Four consecutive polysomnographic recordings were performed under the following conditions: DODS powered by compressed air (night 1 [N1]); oxygen delivered with a nasal cannula alone (night 2 [N2]); oxygen delivered through a DODS (night 3 [N3]); and oxygen delivered with nasal cannula alone (night 4 [N4]). Oxygen flow rates with and without DODS were adjusted the day before the first night so that the resulting transcutaneous arterial oxygen saturation (SaO2) was > or = 95%. The following parameters were evaluated each night: apnea-hypopnea index, nocturnal SaO2, total oxygen saving, and several neurophysiologic parameters.
The oxygen saving with the DODS was, on average, 60%. All parameters obtained during N2 and N4 (oxygen alone) were identical. The percentage of total recording time spent at SaO2 > or = 95% was comparable between N2 ([mean +/- SD]; 69+/-32%) and N3 (61+/-31%) (difference is not significant [NS]), as was the time spent at SaO2 between 90% and 95% (N2, 29.8+/-31%; N3, 35.9+/-27%; NS) and < 90% (N2, 0.75+/-2.6%; N3, 2.5+/-8.6%; NS). Although the mean response time was not significantly different between N2 and N3, two patients experienced a substantial increase in response time with an SaO2 < 90% on the DODS. The DODS device did not induce any difference in the percentage of time spent in rapid eye movement (REM) sleep (N2, 12.3+/-8.7%; N3, 16.4+/-7.8%; NS) or non-REM sleep (N2, 87.7+/-8.7%; N3, 83.7+/-7.9%; NS). Non-REM distribution in stage 1-2 sleep and in stage 3-4 sleep was comparable between N2 and N3. Similarly, no difference was observed for the sleep efficiency index (N2, 71+/-15%; N3, 69.6+/-14%; NS). Differences between sleep onset latency times were NS.
In a majority of moderate to severe COPD patients, the use of a DODS device does not induce any significant alteration of nocturnal neurophysiologic and ventilatory profiles. However, the presence of nocturnal desaturation in a few patients justifies the need to systematically perform a ventilatory polygraphic recording when prescribing a DODS device.
我们比较了慢性阻塞性肺疾病（COPD）患者睡眠期间标准鼻导管与按需给氧系统（DODS）的疗效。
20例中度或重度COPD患者纳入本研究。
在以下条件下进行连续4次多导睡眠图记录：压缩空气驱动的DODS（第1晚[N1]）；仅用鼻导管输氧（第2晚[N2]）；通过DODS输氧（第3晚[N3]）；仅用鼻导管输氧（第4晚[N4]）。在第一晚前一天调整有或无DODS时的氧流量，以使经皮动脉血氧饱和度（SaO2）≥95%。每晚评估以下参数：呼吸暂停低通气指数、夜间SaO2、总节氧量以及几个神经生理学参数。
DODS平均节氧量为60%。N2和N4（仅输氧）期间获得的所有参数均相同。SaO2≥95%的总记录时间百分比在N2（[均值±标准差]；69±32%）和N3（61±31%）之间具有可比性（差异无统计学意义[NS]），SaO2在90%至95%之间的时间（N2，29.8±31%；N3，35.9±27%；NS）以及＜90%的时间（N2，0.75±2.6%；N3，2.5±8.6%；NS）也是如此。尽管N2和N3之间的平均反应时间无显著差异，但有两名患者在使用DODS且SaO2＜90%时反应时间大幅增加。DODS设备在快速眼动（REM）睡眠（N2，12.3±8.7%；N3，16.4±7.8%；NS）或非REM睡眠（N2，87.7±8.7%；N3，83.7±7.9%；NS）中所占时间百分比未引起任何差异。N2和N3之间1-2期睡眠和3-4期睡眠中的非REM分布具有可比性。同样，睡眠效率指数也未观察到差异（N2，71±15%；N3，69.6±14%；NS）。睡眠起始潜伏时间之间的差异无统计学意义。
在大多数中度至重度COPD患者中，使用DODS设备不会引起夜间神经生理学和通气状况的任何显著改变。然而，少数患者夜间出现血氧饱和度降低，这证明在开具DODS设备处方时需要系统地进行通气多导睡眠图记录。
