WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand.
J Sleep Res. 2011 Mar;20(1 Pt 2):233-40. doi: 10.1111/j.1365-2869.2010.00846.x.
Auto-adjusting positive airway pressure (APAP) devices are being increasingly used to treat obstructive sleep apnoea (OSA). Anecdotal encounters of obese patients requiring high therapeutic pressure whose OSA was inadequately controlled by APAP led to this study aiming to compare the effectiveness of continuous positive airway pressure (CPAP) and APAP (S8 Autoset II(®) , ResMed, NSW, Australia) in a randomised, single-blinded crossover trial. Twelve morbidly obese patients with severe OSA [mean±SD apnoea-hypopnoea index (AHI) 75.8±32.7, body mass index 49.9±5.2 kg m(-2) , mean pressure 16.4 cmH(2)O] were consecutively recruited, and received CPAP or APAP in random order for six nights at home, separated by a four-night washout. Polysomnographic (PSG) indices of OSA were recorded at baseline and following each treatment arm. Both therapies substantially reduced the AHI (APAP 9.8±9.5 and CPAP 7.3±6.6 events h(-1) ; P=0.35), but residual PSG measures of disease (AHI >5) were common. APAP delivered a significantly lower 95th percentile pressure averaged over the home-use arm than CPAP (14.2±2.7 and 16.1±1.8 cmH(2)O, respectively, P=0.02). The machine-scored AHI significantly overestimated the level of residual disease compared with the laboratory-scored AHI (using Chicago criteria); however, when the machine-scored AHI was ≤5 and ≤10 this was always confirmed by the PSG data. In morbidly obese OSA patients without significant co-morbid disease requiring high therapeutic pressure, our data provide support for the use of either APAP or manually titrated CPAP. We recommend objective assessment by sleep study if the S8 Autoset II indicates a high level of residual disease.
自动调节气道正压（APAP）设备正越来越多地被用于治疗阻塞性睡眠呼吸暂停（OSA）。有一些轶事报道称，肥胖患者需要较高的治疗压力，而这些患者的 OSA 用 APAP 无法得到充分控制，这导致了本研究旨在比较持续气道正压通气（CPAP）和 APAP（S8 Autoset II®，ResMed，新南威尔士州，澳大利亚）在一项随机、单盲交叉试验中的疗效。我们连续招募了 12 名患有严重 OSA 的病态肥胖患者[平均±标准差呼吸暂停低通气指数（AHI）75.8±32.7，体重指数 49.9±5.2kg/m2，平均压力 16.4cmH2O]，并在家中以随机顺序分别接受 APAP 或 CPAP 治疗 6 晚，中间间隔 4 晚洗脱期。在基线和每个治疗臂结束时记录 OSA 的多导睡眠图（PSG）指数。两种治疗方法均显著降低 AHI（APAP 9.8±9.5 和 CPAP 7.3±6.6 事件/h；P=0.35），但疾病的残留 PSG 指标（AHI>5）仍然常见。APAP 在家庭使用期间的 95 百分位压力平均值明显低于 CPAP（分别为 14.2±2.7 和 16.1±1.8cmH2O，P=0.02）。与实验室评分 AHI 相比，机器评分 AHI 显著高估了残留疾病的程度（使用芝加哥标准）；然而，当机器评分 AHI≤5 和≤10 时，这始终被 PSG 数据所证实。在没有明显合并症且需要高治疗压力的病态肥胖 OSA 患者中，我们的数据支持使用 APAP 或手动滴定 CPAP。如果 S8 Autoset II 表明存在大量残留疾病，我们建议进行睡眠研究的客观评估。
