Kakkar Rahul K, Berry Richard B
Malcom Randall Veterans Affairs Medical Center 111A, 1601 S Archer Rd, Gainesville, FL 32608, USA.
Chest. 2007 Sep;132(3):1057-72. doi: 10.1378/chest.06-2432.
Positive airway pressure (PAP) is the treatment of choice for patients with moderate-to-severe obstructive sleep apnea (OSA). Randomized controlled trials have demonstrated that PAP can effectively reduce the apnea-hypopnea index and improve subjective and objective sleepiness. Some studies have also demonstrated benefits in sleep quality and quality of life for both the patient and bed partner. Observational studies have shown a reduction in the risk of cardiovascular events in OSA patients treated with PAP compared to untreated patients. Since continuous PAP (CPAP) treatment of OSA was described, additional modes of pressure delivery have been developed (bilevel PAP, autoadjusting PAP, flexible PAP). While none of the variants of PAP improves adherence in unselected patients compared to CPAP, individual patients may respond to a change in pressure mode. Attended PAP titration remains the standard of practice for selecting a treatment pressure. However, use of autotitrating PAP devices in the unattended setting can provide an effective titration alternative with careful patient selection and review of titration results. More choices of mask interface are now available to improve comfort and intervene for mask or mouth leaks. However, despite the increase in PAP treatment options, lack of acceptance and inadequate adherence to PAP therapy remain the major causes of treatment failure. Some studies suggest that heated humidification can improve PAP adherence, especially in patients with nasal congestion or dryness. A systematic approach to PAP treatment including education, objective adherence monitoring, early intervention for side effects, and telephone and clinic support is essential to optimize adherence.
气道正压通气（PAP）是中重度阻塞性睡眠呼吸暂停（OSA）患者的首选治疗方法。随机对照试验表明，PAP可有效降低呼吸暂停低通气指数，改善主观和客观嗜睡情况。一些研究还表明，PAP对患者及其同床伴侣的睡眠质量和生活质量均有益处。观察性研究显示，与未接受治疗的患者相比，接受PAP治疗的OSA患者发生心血管事件的风险降低。自从描述了持续气道正压通气（CPAP）治疗OSA以来，已开发出其他压力输送模式（双水平气道正压通气、自动调压气道正压通气、柔性气道正压通气）。虽然与CPAP相比，PAP的任何变体都不能提高未选择患者的依从性，但个别患者可能对压力模式的改变有反应。有医护人员在场的PAP滴定仍然是选择治疗压力的标准做法。然而，在无人值守的情况下使用自动调压PAP设备，经过仔细的患者选择和滴定结果审查，可以提供一种有效的滴定替代方法。现在有更多面罩接口可供选择，以提高舒适度并解决面罩或口部漏气问题。然而，尽管PAP治疗选择有所增加，但对PAP治疗缺乏接受度和依从性不足仍然是治疗失败的主要原因。一些研究表明，加热湿化可以提高PAP的依从性，尤其是在有鼻充血或鼻干燥的患者中。一种系统的PAP治疗方法，包括教育、客观的依从性监测、对副作用的早期干预以及电话和门诊支持，对于优化依从性至关重要。
