Department of Geriatrics, Kliniken-Essen-Mitte, Essen, Germany.
J Physiol Pharmacol. 2009 Nov;60 Suppl 5:51-5.
Sleep disordered breathing (SDB) is a frequent finding in the elderly. SDB is related to morbidity, mortality, quality of life, disability, and cognitive impairment. Treatment of choice for SDB is nasal positive airway pressure breathing (nCPAP). The impact of treatment for SDB on activities of daily living (ADLs) is unclear. We therefore investigated the relationship between SDB and ADLs in a sample of elderly in-hospital patients with severe SDB defined as a oxygen desaturation index of 30 events per hour. All patients eligible were assigned to nCPAP therapy. Patients with refusal of nCPAP were offered nocturnal oxygen supply via nasal prongs. The Barthel-index (BI) at admission and discharge was used to measure ADLs. Two hundred patients with a mean age of 81+/-7 years were included. 22 (11%) patients accepted nCPAP therapy, 42 (21%) patients accepted oxygen therapy and 136 (68%) patients refused both treatment options. The subgroups did not differ significantly in BI at admission and length of stay in hospital. BI increased from 42+/-28 to 49+/-30 in patients with refusal of any treatment, from 39+/-23 to 61+/-20 in patients with oxygen therapy and from 48+/-35 to 72+/-28 in patients with nCPAP therapy. The BI at discharge differed significantly between all three patients groups (p< 0.03). Logistic regression analysis revealed that Barthel Index at admission and treatment with nCPAP or treatment with oxygen were independently associated with a gain in BI of at least 30 points. Age, dementia or length of in-hospital stay showed no association with gain in BI. This is the first study that shows an impact of treatment for severe SDB on ADLs in elderly patients. Furthermore, treatment with nCPAP and oxygen supply nearly had the same impact on ADLs. Since the higher rate of acceptance of oxygen therapy and the important impact of oxygen supply on BI, administration of oxygen seems to be a rational alternative in elderly subjects with severe sleep apnea and refusal of nCPAP.
睡眠呼吸障碍（SDB）在老年人中很常见。SDB 与发病率、死亡率、生活质量、残疾和认知障碍有关。SDB 的治疗选择是鼻正压通气（nCPAP）。SDB 治疗对日常生活活动（ADLs）的影响尚不清楚。因此，我们在一组患有严重 SDB 的住院老年患者中调查了 SDB 与 ADLs 之间的关系，严重 SDB 的定义为每小时 30 次事件的氧减饱和指数。所有符合条件的患者均被分配接受 nCPAP 治疗。拒绝 nCPAP 的患者接受经鼻插管夜间供氧。入院和出院时使用巴氏指数（BI）来测量 ADLs。共纳入 200 例平均年龄 81+/-7 岁的患者。22 例（11%）患者接受 nCPAP 治疗，42 例（21%）患者接受氧疗，136 例（68%）患者拒绝两种治疗方案。亚组在入院时的 BI 和住院时间方面无显著差异。拒绝任何治疗的患者的 BI 从 42+/-28 增加到 49+/-30，接受氧疗的患者从 39+/-23 增加到 61+/-20，接受 nCPAP 治疗的患者从 48+/-35 增加到 72+/-28。所有三组患者的 BI 在出院时差异有统计学意义（p<0.03）。Logistic 回归分析显示，入院时的 Barthel 指数以及 nCPAP 治疗或氧疗与 BI 至少增加 30 分独立相关。年龄、痴呆或住院时间与 BI 增加无关联。这是第一项研究表明治疗严重 SDB 对老年患者的 ADLs 有影响。此外，nCPAP 治疗和供氧对 ADLs 的影响几乎相同。由于接受氧疗的比例较高，以及供氧对 BI 的重要影响，对于拒绝 nCPAP 的严重睡眠呼吸暂停老年患者，供氧似乎是一种合理的替代治疗方法。
