Stradling John R, Smith Debbie, Crosby Joy
Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.
J Sleep Res. 2007 Dec;16(4):436-8. doi: 10.1111/j.1365-2869.2007.00617.x.
Following treatment with continuous positive airway pressure (CPAP), some patients with obstructive sleep apnoea (OSA) remain sleepy despite effective CPAP and attention to other diagnoses that can provoke sleepiness. It is unclear if this residual sleepiness is an irreversible result of their previous OSA and merits consideration for pharmacological treatment or simply because of the many and varied causes of sleepiness normally found in the community. We have measured levels of sleepiness, using the Epworth Sleepiness Score (ESS), in 572 patients on CPAP and compared them with a control group of 525 subjects from a community survey, which would have included the usual lifestyle reasons for sleepiness as well as any undiagnosed sleep disorders. There was no difference in the percentage of patients with an ESS >10 in the CPAP group compared with the controls (16.1 versus 14.3, P = 0.54). Thus, although there clearly are sleepy patients within the CPAP group, the prevalence is no higher than in the community. We question whether so-called 'post-CPAP sleepiness' should be regarded as any more abnormal and worthy of treatment than a 'normal' population. Post-CPAP sleepiness as a specific disorder may not exist.
在接受持续气道正压通气（CPAP）治疗后，一些阻塞性睡眠呼吸暂停（OSA）患者尽管CPAP治疗有效且已关注其他可能导致嗜睡的诊断，但仍感到困倦。目前尚不清楚这种残余嗜睡是其先前OSA的不可逆结果，值得考虑药物治疗，还是仅仅因为社区中通常存在的多种导致嗜睡的原因。我们使用爱泼华嗜睡量表（ESS）测量了572名接受CPAP治疗患者的嗜睡程度，并将其与来自社区调查的525名对照组受试者进行比较，该对照组包括导致嗜睡的常见生活方式原因以及任何未确诊的睡眠障碍。CPAP组中ESS>10的患者百分比与对照组相比无差异（16.1对14.3，P = 0.54）。因此，尽管CPAP组中显然有嗜睡患者，但其患病率并不高于社区。我们质疑所谓的“CPAP治疗后嗜睡”是否应被视为比“正常”人群更异常且值得治疗的情况。作为一种特定疾病的CPAP治疗后嗜睡可能并不存在。
