Sandberg O, Franklin K A, Bucht G, Eriksson S, Gustafson Y
Dept of Community Medicine and Rehabilitation, Geriatric Medicine, Respiratory Medicine, Umeå University, Sweden.
Eur Respir J. 2001 Oct;18(4):630-4. doi: 10.1183/09031936.01.00070301.
The authors have investigated whether treatment of sleep apnoea with nasal continuous positive airway pressure (nCPAP) improves depressive symptoms, personal activities of daily living (ADL), cognitive functioning and delirium in patients that have suffered a stroke. Sixty-three patients consecutively admitted to a stroke rehabilitation unit 2-4 weeks after a stroke, with an apnoea/hypopnoea index > or =15, were randomized to either nCPAP treatment (n=33) or a control group (n=30). Four patients dropped out after randomization. Both groups were assessed at baseline and after 7 and 28 nights using the Montgomery-Asberg Depression Rating Scale (MADRS), Barthel-ADL index, and the Mini-Mental State Examination (MMSE) scale. Compared to the control group, depressive symptoms (MADRS total score) improved in patients randomized to nCPAP treatment (p=0.004). No significant treatment effect was found with regard to delirium, MMSE or Barthel-ADL index. Delirium and low cognitive level (MMSE score) explained poor compliance with nCPAP. Depressive symptoms are reduced through nasal continuous positive airway pressure treatment in patients with severe stroke and sleep apnoea. Compliance with nasal continuous positive airway pressure treatment is a problem in stroke patients, especially when delirium and severe cognitive impairment occur.
作者研究了采用经鼻持续气道正压通气（nCPAP）治疗睡眠呼吸暂停是否能改善中风患者的抑郁症状、日常生活活动能力（ADL）、认知功能和谵妄。63例中风后2 - 4周连续入住中风康复单元、呼吸暂停/低通气指数≥15的患者被随机分为nCPAP治疗组（n = 33）和对照组（n = 30）。随机分组后有4例患者退出。两组在基线时以及7个晚上和28个晚上后使用蒙哥马利 - 阿斯伯格抑郁评定量表（MADRS）、巴氏ADL指数和简易精神状态检查表（MMSE）进行评估。与对照组相比，随机接受nCPAP治疗的患者抑郁症状（MADRS总分）有所改善（p = 0.004）。在谵妄、MMSE或巴氏ADL指数方面未发现显著治疗效果。谵妄和低认知水平（MMSE评分）解释了nCPAP依从性差的原因。对于重症中风和睡眠呼吸暂停患者，经鼻持续气道正压通气治疗可减轻抑郁症状。中风患者对经鼻持续气道正压通气治疗的依从性是个问题，尤其是在发生谵妄和严重认知障碍时。
