Barnes Maree, Houston Danielle, Worsnop Christopher J, Neill Alister M, Mykytyn Ivanka J, Kay Amanda, Trinder John, Saunders Nicholas A, Douglas McEvoy R, Pierce Robert J
Department of Respiratory Medicine, Austin and Repatriation Medical Center, Victoria, Australia.
Am J Respir Crit Care Med. 2002 Mar 15;165(6):773-80. doi: 10.1164/ajrccm.165.6.2003166.
A common clinical dilemma faced by sleep physicians is in deciding the level of severity at which patients with obstructive sleep apnea (OSA) should be treated. There is particular uncertainty about the need for, and the effectiveness of, treatment in mild cases. To help define the role of nasal continuous positive airway pressure (CPAP) treatment in mild OSA we undertook a randomized controlled cross-over trial of CPAP in patients with an apnea- hypopnea index (AHI) of 5 - 30 (mean, 12.9 +/- 6.3 SD). Twenty-four-hour blood pressure and neurobehavioral function were measured at baseline, after 8 wk of treatment with CPAP, and after 8 wk of treatment with an oral placebo tablet. Twenty-eight of 42 patients enrolled in the study completed both treatment arms. Baseline characteristics were not different between those who completed the study and those who did not complete the study. Patients used CPAP for a mean (SD) of 3.53 (2.13) h per night and the mean AHI on the night of CPAP implementation was 4.24 (2.9). Nasal CPAP improved self-reported symptoms of OSA, including snoring, restless sleep, daytime sleepiness, and irritability (in-house questionnaire), more than did placebo, but did not improve objective (Multiple Sleep Latency Test) or subjective (Epworth Sleepiness Scale) measures of daytime sleepiness. We found no benefit of CPAP over placebo in any tests of neurobehavioral function, generic SF-36 (36-item Short Form Medical Outcomes Survey) or sleep-specific (Functional Outcomes of Sleep Questionnaire) quality of life questionnaires, mood score (Profile of Moods States and Beck Depression Index), or 24-h blood pressure. However, the placebo tablet resulted in a significant improvement in a wide range of functional variables compared with baseline. This placebo effect may account for some of the treatment responses to CPAP observed previously in patients with mild OSA.
睡眠医生面临的一个常见临床难题是，确定阻塞性睡眠呼吸暂停（OSA）患者应接受治疗的严重程度级别。对于轻度病例治疗的必要性和有效性，尤其存在不确定性。为了帮助明确鼻持续气道正压通气（CPAP）治疗在轻度OSA中的作用，我们对呼吸暂停低通气指数（AHI）为5 - 30（平均12.9 +/- 6.3标准差）的患者进行了一项CPAP随机对照交叉试验。在基线时、CPAP治疗8周后以及口服安慰剂片治疗8周后，测量24小时血压和神经行为功能。该研究纳入的42名患者中有28名完成了两个治疗组。完成研究的患者与未完成研究的患者的基线特征没有差异。患者每晚使用CPAP的平均（标准差）时间为3.53（2.13）小时，实施CPAP当晚的平均AHI为4.24（2.9）。与安慰剂相比，鼻CPAP更能改善OSA的自我报告症状，包括打鼾、睡眠不安、日间嗜睡和易怒（内部问卷），但没有改善日间嗜睡的客观（多次睡眠潜伏期测试）或主观（爱泼华嗜睡量表）指标。在神经行为功能、通用的SF - 36（36项简短健康调查）或睡眠特异性（睡眠问卷功能结果）生活质量问卷、情绪评分（情绪状态剖面图和贝克抑郁量表）或24小时血压的任何测试中，我们都未发现CPAP比安慰剂更有优势。然而，与基线相比，安慰剂片在广泛的功能变量方面有显著改善。这种安慰剂效应可能解释了先前在轻度OSA患者中观察到的对CPAP的一些治疗反应。
