Berry Richard B, Parish James M, Hartse Kristyna M
Malcom Randall VAMC/University of Florida, Gainesville, USA.
Sleep. 2002 Mar 15;25(2):148-73.
This paper reviews the efficacy of auto-titrating continuous positive airway pressure (APAP) for treatment of obstructive sleep apnea. It is based on a review of 30 articles published in peer review journals conducted by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters for use of APAP devices for treatment of obstructive sleep apnea (OSA). The data indicate that APAP can be used to treat many patients with OSA (auto-adjusting) or to identify an effective optimal fixed level of continuous positive airway pressure (CPAP) for treatment (auto-titration). Patients with significant congestive heart failure, chronic obstructive pulmonary disease (COPD), or significant amounts of central apnea were excluded from many treatment trials and there is insufficient evidence that APAP can be used to treat these patients. Many clinical trials have been performed in patients already on CPAP or with the initial APAP night in a laboratory setting. At this time only a few studies have evaluated initial titration with APAP in CPAP-naïve patients in an unattended setting. Further studies of APAP in this circumstance are needed. No studies have systematically compared the efficacy of one APAP technology with another. Devices using different technology may not give the same results in a given patient. Devices solely dependent on vibration may not work in non-snorers or patient who have undergone upper-airway surgery. High mask or mouth leaks may prevent adequate titration in devices monitoring snoring, flow, or impedance (forced oscillation technique). Review of the raw data to identify periods of high leak was performed in several of the APAP titration studies, to identify a pressure for fixed CPAP treatment or to determine if the titration was adequate. There is conflicting evidence for and against the premise that treatment with APAP increases acceptance and adherence compared to fixed CPAP. In studies demonstrating an increase in adherence with APAP, there was similar improvement in measures of daytime sleepiness as with fixed CPAP treatment. Further studies are needed to determine if APAP can increase acceptance or adherence with positive pressure treatment in patients with OSA.
本文综述了自动调压持续气道正压通气（APAP）治疗阻塞性睡眠呼吸暂停的疗效。它基于美国睡眠医学会任命的一个特别工作组对发表在同行评审期刊上的30篇文章的综述，该工作组旨在制定使用APAP设备治疗阻塞性睡眠呼吸暂停（OSA）的实践参数。数据表明，APAP可用于治疗许多OSA患者（自动调压）或确定用于治疗的有效最佳固定持续气道正压水平（CPAP）（自动滴定）。许多治疗试验排除了患有严重充血性心力衰竭、慢性阻塞性肺疾病（COPD）或大量中枢性呼吸暂停的患者，并且没有足够的证据表明APAP可用于治疗这些患者。许多临床试验是在已经使用CPAP的患者中或在实验室环境中进行APAP首夜治疗时进行的。目前只有少数研究在无人值守的环境中评估了初治患者使用APAP进行初始滴定的情况。在这种情况下需要对APAP进行进一步研究。没有研究系统地比较一种APAP技术与另一种APAP技术的疗效。使用不同技术的设备在给定患者中可能不会产生相同的结果。仅依赖振动的设备在不打鼾者或接受过上气道手术的患者中可能不起作用。高面罩或口腔漏气可能会妨碍对监测打鼾、气流或阻抗（强迫振荡技术）的设备进行充分滴定。在一些APAP滴定研究中对原始数据进行了审查，以确定固定CPAP治疗的压力或确定滴定是否充分。关于与固定CPAP相比，APAP治疗是否能提高接受度和依从性这一前提，存在相互矛盾的证据。在显示APAP依从性增加的研究中，白天嗜睡的测量指标与固定CPAP治疗相似。需要进一步研究以确定APAP是否能提高OSA患者对正压治疗的接受度或依从性。
