Berry Richard B, Hill Gilbert, Thompson Linda, McLaurin Valorea
Malcom Randall VAMC, Gainesville, FL, USA.
Sleep. 2008 Oct;31(10):1423-31.
To compare a clinical pathway using portable monitoring (PM) for diagnosis and unattended autotitrating positive airway pressure (APAP) for selecting an effective continuous positive airway pressure (CPAP) with another pathway using polysomnography (PSG) for diagnosis and treatment of obstructive sleep apnea (OSA).
Randomized parallel group
Veterans Administration Medical Center
106 patients with daytime sleepiness and a high likelihood of having OSA MEASUREMENTS AND RESULTS: The AHI in the PM-APAP group was 29.2 +/- 2.3/h and in the PSG group was 36.8 +/- 4.8/h (P= NS). Patients with an AHI > or = 5 were offered CPAP treatment. Those accepting treatment (PM-APAP 45, PSG 43) were begun on CPAP using identical devices at similar mean pressures (11.2 +/- 0.4 versus 10.9 +/- 0.5 cm H2O). At a clinic visit 6 weeks after starting CPAP, 40 patients in the PM-APAP group (78.4% of those with OSA and 88.8% started on CPAP) and 39 in the PSG arm (81.2% of those with OSA and 90.6% of those started on CPAP) were using CPAP treatment (P = NS). The mean nightly adherence (PM-APAP: 5.20 +/- 0.28 versus PSG: 5.25 +/- 0.38 h/night), decrease in Epworth Sleepiness Scale score (-6.50 +/- 0.71 versus -6.97 +/- 0.73), improvement in the global Functional Outcome of Sleep Questionnaire score (3.10 +/- 0.05 versus 3.31 +/- 0.52), and CPAP satisfaction did not differ between the groups.
A clinical pathway utilizing PM and APAP titration resulted in CPAP adherence and clinical outcomes similar to one using PSG.
比较一种使用便携式监测（PM）进行诊断以及无人值守自动调压气道正压通气（APAP）来选择有效的持续气道正压通气（CPAP）的临床路径与另一种使用多导睡眠图（PSG）进行阻塞性睡眠呼吸暂停（OSA）诊断和治疗的临床路径。
随机平行组
退伍军人管理局医疗中心
106例白天嗜睡且极有可能患有OSA的患者 测量与结果：PM - APAP组的呼吸暂停低通气指数（AHI）为29.2±2.3次/小时，PSG组为36.8±4.8次/小时（P =无显著性差异）。AHI≥5的患者接受CPAP治疗。接受治疗的患者（PM - APAP组45例，PSG组43例）使用相同设备，以相似的平均压力（11.2±0.4与10.9±0.5厘米水柱）开始CPAP治疗。在开始CPAP治疗6周后的一次门诊就诊时，PM - APAP组有40例患者（占OSA患者的78.4%，开始使用CPAP治疗患者的88.8%），PSG组有39例患者（占OSA患者的81.2%，开始使用CPAP治疗患者的90.6%）正在使用CPAP治疗（P =无显著性差异）。两组的平均夜间依从性（PM - APAP组：5.20±0.28与PSG组：5.25±0.38小时/晚）、Epworth嗜睡量表评分的降低（-6.50±0.71与-6.97±0.73）、睡眠问卷全球功能结局评分的改善（3.10±0.05与3.31±0.52）以及CPAP满意度均无差异。
采用PM和APAP滴定的临床路径所产生的CPAP依从性和临床结果与采用PSG的临床路径相似。
