Galetke Wolfgang, Randerath Winfried J, Stieglitz Sven, Laumanns Cordula, Anduleit Norbert, Richter Kerstin, Schäfer Thorsten
Bethanien Hospital Solingen, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute for Pneumology at the University Witten/Herdecke, D-42699 Solingen, Germany.
Sleep Med. 2009 Mar;10(3):337-43. doi: 10.1016/j.sleep.2008.03.007. Epub 2008 Jul 22.
Continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome (OSAS) requires pressure titration usually performed during attended in-hospital polysomnography. This manual titration procedure is not well standardized. The aim of the study was to ascertain whether a new automatic titration device is as effective as standard manual titration in determining constant CPAP pressure.
We included 38 patients with a newly diagnosed OSAS. Participants were randomly assigned to attended in-laboratory manual titration and automatic titration in two consecutive nights. Fixed CPAP pressure was set at the optimal pressure determined during the second night. The follow-up period was 6 weeks. Main outcomes were apnea/hypopnea index (AHI) and Epworth sleepiness scale (ESS).
AHI (manual: baseline 40.5+/-21.5/h vs. treatment 6.4+/-3.3/h (p<0.001); automatic: 53.3+/-28.1/h vs. 7.8+/-3.3/h (p<0.001)) and ESS (manual: 11.3+/-4.7 vs. 8.8+/-5.1 (ns); automatic: 11.5+/-5.6 vs. 7.0+/-3.8 (p<0.05)) showed a similar improvement in both groups. Pressure recommendation by the device and the technician, although not statistically different (8.7+/-2.9 vs. 9.0+/-3.3 mbar), corresponded only in 50% of the patients.
Automatic titration effectively predicts constant CPAP pressure for long-term treatment when performed during an attended polysomnography. Careful evaluation of raw data and polysomnography recording is mandatory before choosing a fixed CPAP pressure after automatic titration.
阻塞性睡眠呼吸暂停综合征（OSAS）的持续气道正压通气（CPAP）治疗需要进行压力滴定，通常在有医护人员在场的住院多导睡眠监测期间进行。这种手动滴定程序的标准化程度不高。本研究的目的是确定一种新的自动滴定设备在确定持续气道正压通气（CPAP）恒定压力方面是否与标准手动滴定一样有效。
我们纳入了38例新诊断为阻塞性睡眠呼吸暂停综合征（OSAS）的患者。参与者被随机分配在连续两个晚上分别进行有医护人员在场的实验室手动滴定和自动滴定。固定的持续气道正压通气（CPAP）压力设定为第二个晚上确定的最佳压力。随访期为6周。主要结局指标是呼吸暂停/低通气指数（AHI）和爱泼华嗜睡量表（ESS）。
呼吸暂停/低通气指数（手动滴定：基线40.5±21.5次/小时 vs. 治疗后6.4±3.3次/小时（p<0.001）；自动滴定：53.3±28.1次/小时 vs. 7.8±3.3次/小时（p<0.001））和爱泼华嗜睡量表（手动滴定：11.3±4.7 vs. 8.8±5.1（无统计学差异）；自动滴定：11.5±5.6 vs. 7.0±3.8（p<0.05））在两组中均显示出相似的改善。设备和技术人员推荐的压力虽然无统计学差异（8.7±2.9 vs. 9.0±3.3毫巴），但仅在50%的患者中一致。
在有医护人员在场的多导睡眠监测期间进行自动滴定可有效预测用于长期治疗的持续气道正压通气（CPAP）恒定压力。在自动滴定后选择固定的持续气道正压通气（CPAP）压力之前，必须仔细评估原始数据和多导睡眠监测记录。
