Bradshaw David A, Ruff Gregory A, Murphy David P
Pulmonary Division, Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134-1005, USA.
Chest. 2006 Nov;130(5):1369-76. doi: 10.1378/chest.130.5.1369.
Compliance with continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) is highly variable. Recent studies suggest that the initial experience with CPAP may determine long-term success. We hypothesized that administration of a hypnotic medication to new CPAP users would facilitate acclimation and increase usage.
Seventy-two male OSA patients referred for CPAP treatment were randomized to also receive an oral hypnotic agent (zolpidem), placebo pill, or neither (standard care) for the first 14 days of CPAP treatment. CPAP usage (effective mask pressure [hours per day]) was recorded by an internal data chip. Patient symptoms were assessed with the Epworth sleepiness scale (ESS) and functional outcomes of sleep questionnaire (FOSQ). Treatment groups were matched for age, body mass index, and baseline ESS and FOSQ scores. Despite randomization, the standard care group had a higher apnea/hypopnea index than either the zolpidem or placebo pill groups (54.75 +/- 28.02 vs 32.61 +/- 25.12 vs 38.09 +/- 25.65, p = 0.012) [mean +/- SD]. Compared to placebo pill and standard care groups, the zolpidem group did not show greater CPAP usage in terms of total days used (zolpidem, 20.58 +/- 7.40 days; placebo pill, 17.83 +/- 9.33 days; standard care, 22.92 +/- 6.95 days; p = 0.198) or average time used per night (4.43 +/- 1.16 h vs 4.23 +/- 2.14 h vs 4.94 +/- 1.44 h, p = 0.361). All groups showed significant symptom improvements on both the ESS (p < 0.001) and FOSQ (p < 0.05).
Administration of an oral hypnotic agent did not improve initial CPAP compliance in men with OSA.
阻塞性睡眠呼吸暂停（OSA）患者对持续气道正压通气（CPAP）治疗的依从性差异很大。最近的研究表明，CPAP的初始体验可能决定长期治疗效果。我们假设，给新使用CPAP的患者服用催眠药物将有助于适应并增加使用量。
72名因CPAP治疗前来就诊的男性OSA患者在CPAP治疗的前14天被随机分组，分别接受口服催眠药（唑吡坦）、安慰剂或不接受任何药物（标准治疗）。CPAP使用情况（有效面罩压力[每天小时数]）由内部数据芯片记录。使用Epworth嗜睡量表（ESS）和睡眠功能结果问卷（FOSQ）评估患者症状。治疗组在年龄、体重指数以及基线ESS和FOSQ评分方面进行了匹配。尽管进行了随机分组，但标准治疗组的呼吸暂停/低通气指数高于唑吡坦组或安慰剂组（分别为54.75±28.02、32.61±25.12和38.09±25.65，p = 0.012）[均值±标准差]。与安慰剂组和标准治疗组相比，唑吡坦组在总使用天数（唑吡坦组为20.58±7.40天；安慰剂组为17.83±9.33天；标准治疗组为22.92±6.95天；p = 0.198）或每晚平均使用时间（分别为4.43±1.16小时、4.23±2.14小时和4.94±1.44小时，p = 0.361）方面并未显示出更高的CPAP使用量。所有组在ESS（p < 0.001）和FOSQ（p < 0.05）上的症状均有显著改善。
口服催眠药并未改善男性OSA患者对CPAP的初始依从性。
