家庭为基础的阻塞性睡眠呼吸暂停诊断和治疗的结果。

Outcomes of home-based diagnosis and treatment of obstructive sleep apnea.

机构信息

Division of Respiratory Critical Care and Sleep Medicine, Department of Medicine, The University of Saskatchewan, Saskatoon, SK, Canada.

出版信息

Chest. 2010 Aug;138(2):257-63. doi: 10.1378/chest.09-0577. Epub 2010 Feb 19.

DOI:10.1378/chest.09-0577

PMID:20173052

Abstract

BACKGROUND: Home diagnosis and therapy for obstructive sleep apnea (OSA) may improve access to testing and continuous positive airway pressure (CPAP) treatment. We compared subjective sleepiness, sleep quality, quality of life, BP, and CPAP adherence after 4 weeks of CPAP therapy in subjects in whom OSA was diagnosed and treated at home and in those evaluated in the sleep laboratory. METHODS: A randomized trial was performed consisting of home-based level 3 testing followed by 1 week of auto-CPAP and fixed-pressure CPAP based on the 95% pressure derived from the auto-CPAP device, and in-laboratory polysomnography (PSG) (using mostly split-night protocol) with CPAP titration; 102 subjects were randomized (age, 47.4 +/- 11.4 years; 63 men; BMI, 32.3 +/- 6.3 kg/m(2); Epworth Sleepiness Scale [ESS]: 12.5 +/- 4.3). The outcome measures were daytime sleepiness (ESS), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Calgary Sleep Apnea Quality of Life Index [SAQLI], 36-Item Short-Form Health Survey [SF-36], BP, and CPAP adherence after 4 weeks. RESULTS: After 4 weeks of CPAP therapy, there were no significant differences in ESS (PSG 6.4 +/- 3.8 vs home monitoring [HM] 6.5 +/- 3.8, P = .71), PSQI (PSG 5.4 +/- 3.1 vs HM 6.2 +/- 3.4, P = .30), SAQLI (PSG 4.5 +/- 1.1 vs HM 4.6 +/- 1.1, P = .85), SF-36 vitality (PSG 62.2 +/- 23.3 vs HM 64.1 +/- 18.4, P = .79), SF-36 HM (PSG 84.0 +/- 10.4 vs HM 81.3 +/- 14.9, P = .39), and BP (PSG 129/84 +/- 11/0 vs HM 125/81 +/- 13/9, P = .121). There was no difference in CPAP adherence (PSG 5.6 +/- 1.7 h/night vs HM 5.4 +/- 1.0 h/night, P = .49). CONCLUSIONS: Compared with the home-based protocol, diagnosis and treatment of OSA in the sleep laboratory does not lead to superior 4-week outcomes in sleepiness scores, sleep quality, quality of life, BP, and CPAP adherence. TRIAL REGISTRATION: clinicaltrials.gov; Identifier: NCT00139022.

摘要

背景：家庭诊断和治疗阻塞性睡眠呼吸暂停（OSA）可以改善检测和持续气道正压通气（CPAP）治疗的机会。我们比较了在家庭中诊断和治疗的 OSA 患者与在睡眠实验室中评估的患者，在接受 CPAP 治疗 4 周后主观嗜睡、睡眠质量、生活质量、血压和 CPAP 依从性的变化。

方法：进行了一项随机试验，包括基于水平 3 的家庭测试，随后进行 1 周的自动 CPAP 和基于自动 CPAP 设备得出的 95%压力的固定压力 CPAP，以及在睡眠实验室中进行多导睡眠图（PSG）（主要使用分夜方案）和 CPAP 滴定；102 名患者被随机分配（年龄 47.4 ± 11.4 岁；63 名男性；BMI 32.3 ± 6.3 kg/m2；嗜睡量表 [ESS]：12.5 ± 4.3）。结局指标为白天嗜睡（ESS）、睡眠质量（匹兹堡睡眠质量指数 [PSQI]）、生活质量（卡尔加里睡眠呼吸暂停质量指数 [SAQLI]，36 项简明健康调查 [SF-36]，BP 和 CPAP 依从性在 4 周后。

结果：在 CPAP 治疗 4 周后，ESS（PSG 6.4 ± 3.8 vs 家庭监测 [HM] 6.5 ± 3.8，P =.71）、PSQI（PSG 5.4 ± 3.1 vs HM 6.2 ± 3.4，P =.30）、SAQLI（PSG 4.5 ± 1.1 vs HM 4.6 ± 1.1，P =.85）、SF-36 活力（PSG 62.2 ± 23.3 vs HM 64.1 ± 18.4，P =.79）、SF-36 HM（PSG 84.0 ± 10.4 vs HM 81.3 ± 14.9，P =.39）和 BP（PSG 129/84 ± 11/0 vs HM 125/81 ± 13/9，P =.121）差异均无统计学意义。CPAP 依从性（PSG 5.6 ± 1.7 小时/夜 vs HM 5.4 ± 1.0 小时/夜，P =.49）也无差异。

结论：与家庭方案相比，在睡眠实验室中诊断和治疗 OSA 并不会在 4 周时的嗜睡评分、睡眠质量、生活质量、BP 和 CPAP 依从性方面带来更好的结果。

试验注册：clinicaltrials.gov；标识符：NCT00139022。