Randerath W J
Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen.
Pneumologie. 2007 Apr;61(4):228-32. doi: 10.1055/s-2007-959176.
Although continuous airway pressure therapy (CPAP) represents the standard treatment for obstructive sleep apnea syndrome (OSAS) auto-adjusting CPAP (APAP) devices were developed which adapt the treatment pressure to the actual requirement of the patients. The aim of automatic CPAP therapy is to improve the patients' acceptance of positive pressure treatment. The devices react to respiratory flow, flattening of the inspiratory flow contour, snoring, generator speed or the upper airway impedance. In recent years several studies showed that auto CPAP effectively treats respiratory disturbances, improves sleep profile and the self-assessment of the patients equally as good as the gold standard constant CPAP. Moreover, APAP reduces the treatment pressure substantially. Although an improvement of the patient's compliance has not consistently been proven, most patients prefer APAP versus constant CPAP. APAP devices use different algorithms depending on the primary purpose of the application. Therefore, a clear distinction between automatic titration and treatment is of major relevance. While titration devices aim at the finding of one single pressure which is fixed to a constant CPAP device, automatic treatment means the chronic use of APAP at home for optimal adaptation of the treatment pressure to the actual requirements of the patient. A high constant CPAP level, huge pressure variability, insufficient compliance with constant CPAP may be indications for APAP treatment. The main reason for automatic titration is the standardisation of the initiation process.
尽管持续气道正压通气治疗（CPAP）是阻塞性睡眠呼吸暂停综合征（OSAS）的标准治疗方法，但自动调压CPAP（APAP）设备已被研发出来，它能根据患者的实际需求调整治疗压力。自动CPAP治疗的目的是提高患者对正压治疗的接受度。这些设备会对呼吸气流、吸气气流轮廓变平、打鼾、发生器速度或上气道阻抗做出反应。近年来的多项研究表明，自动CPAP在有效治疗呼吸紊乱、改善睡眠状况以及患者自我评估方面与金标准固定CPAP一样出色。此外，APAP能大幅降低治疗压力。尽管患者依从性的改善尚未得到一致证实，但大多数患者更喜欢APAP而非固定CPAP。APAP设备根据应用的主要目的使用不同的算法。因此，明确区分自动滴定和治疗至关重要。滴定设备旨在找到一个固定到恒定CPAP设备上的单一压力，而自动治疗意味着在家中长期使用APAP，以使治疗压力能最佳地适应患者的实际需求。高恒定CPAP水平、巨大的压力变异性、对恒定CPAP的依从性不足可能是APAP治疗的指征。自动滴定的主要原因是启动过程的标准化。
