Ficker J H, Clarenbach C F, Neukirchner C, Fuchs F S, Wiest G H, Schahin S Pour, Harsch I A, Hahn E G
Medical Department 1, University of Erlangen-Nuremberg, Erlangen, Germany.
Biomed Tech (Berl). 2003 Mar;48(3):68-72. doi: 10.1515/bmte.2003.48.3.68.
Autoadjusting CPAP devices (APAP) are designed to continuously adjust the positive pressure to the required levels, and thus increase treatment quality and patient compliance. The results of APAP treatment strongly depend on the control mechanism of the respective APAP device. In agreement with other working groups, we have recently shown that the forced oscillation technique (FOT) is capable of detecting incipient upper airway obstruction prior to physiological reactions such as the onset of increasing esophageal pressure swings or microarousals. Therefore we studied efficacy and acceptance of a novel APAP device controlled exclusively by FOT. 100 consecutive patients with OSAS confirmed by polysomnography (mean AHI 47.9 +/- 22.6) and daytime sleepiness (Epworth sleepiness scale, ESS 12.6 +/- 3.9) were randomized to either APAP treatment (n = 50) or conventional CPAP treatment (n = 50). Polysomnographies were performed at the second treatment night and subjective sleepiness (modified ESS) was established in the morning. The respiratory disturbance was largely normalized in both treatment groups in the second treatment night (AHI 4.7 +/- 5.3 vs. 3.7 +/- 3.4; n.s.). Both groups showed largely improved sleep profiles and had markedly reduced ESS-scores (6.6 +/- 3.6 vs. 7.0 +/- 3.4; n.s.). The mean treatment pressure during APAP was significantly lower than during CPAP treatment (6.0 +/- 2.0 vs. 9.0 +/- 1.8 mbar; p < 0.001). There were no significant differences between APAP and CPAP treatment in any parameter of efficacy or acceptance. APAP treatment with this device controlled exclusively by FOT is well accepted by the patients and permits an adequate treatment of OSAS without the need for invidiual CPAP titration.
自动调压持续气道正压通气设备（APAP）旨在持续将正压调整至所需水平，从而提高治疗质量和患者依从性。APAP治疗的效果在很大程度上取决于相应APAP设备的控制机制。与其他工作组一致，我们最近表明，强迫振荡技术（FOT）能够在诸如食管压力摆动增加或微觉醒开始等生理反应之前检测到早期上气道阻塞。因此，我们研究了一种仅由FOT控制的新型APAP设备的疗效和可接受性。100例经多导睡眠图确诊为阻塞性睡眠呼吸暂停低通气综合征（平均呼吸暂停低通气指数47.9±22.6）且有日间嗜睡（爱泼沃斯嗜睡量表，ESS 12.6±3.9）的连续患者被随机分为APAP治疗组（n = 50）或传统持续气道正压通气（CPAP）治疗组（n = 50）。在第二个治疗夜晚进行多导睡眠图检查，并在早晨评估主观嗜睡情况（改良ESS）。在第二个治疗夜晚，两个治疗组的呼吸紊乱在很大程度上均得到了改善（呼吸暂停低通气指数4.7±5.3对3.7±3.4；无统计学差异）。两组的睡眠状况均有很大改善，ESS评分显著降低（6.6±3.6对7.0±3.4；无统计学差异）。APAP治疗期间的平均治疗压力显著低于CPAP治疗期间（6.0±2.0对9.0±1.8毫巴；p < 0.001）。在疗效或可接受性的任何参数方面，APAP和CPAP治疗之间均无显著差异。这种仅由FOT控制的设备进行APAP治疗很受患者欢迎，并且无需进行个性化的CPAP滴定即可对阻塞性睡眠呼吸暂停低通气综合征进行充分治疗。
