Phillips B A, Schmitt F A, Berry D T, Lamb D G, Amin M, Cook Y R
Department of Medicine and Neurology, University of Kentucky College of Medicine, Lexington.
Chest. 1990 Aug;98(2):325-30. doi: 10.1378/chest.98.2.325.
Nasal CPAP is presently accepted as first-line therapy for obstructive sleep apnea, but a significant minority of patients do not tolerate nasal CPAP. The purpose of this study was to compare the benefits of nasal CPAP, nasal oxygen (O2), and placebo (air) using patients as their own controls. We studied eight men, aged 33 to 72 (mean 57 years), who had mild obstructive sleep apnea. To be eligible for study, patients had to have an apnea plus hypopnea index greater than or equal to 5, plus one or more of the following: blood pressure greater than 150/95 mm Hg, multiple sleep latency test mean score less than or equal to 10 minutes, or significant nocturnal cardiac ectopy. After a baseline study, patients received a month each of nocturnal O2 at 4 LPM and air at 4 LPM, presented in random order. The third month of treatment consisted of nasal CPAP (range 2.5 to 12.5 cm H2O). Patients underwent evaluation at baseline and after each month of treatment. It was concluded that oxygen was more effective in improving oxygenation and hypopneas than is nasal CPAP. However, oxygen did not reduce apneas or improve daytime hypersomnolence as well as nasal CPAP in patients with mild OSA. Oxygen might be considered as an alternate form of treatment for patients who are not hypersomnolent, or as an adjunct to nasal CPAP.
目前，鼻持续气道正压通气（Nasal CPAP）被公认为阻塞性睡眠呼吸暂停的一线治疗方法，但仍有相当一部分患者无法耐受鼻CPAP。本研究的目的是通过让患者自身作为对照，比较鼻CPAP、鼻吸氧（O2）和安慰剂（空气）的疗效。我们研究了8名年龄在33至72岁（平均57岁）之间的轻度阻塞性睡眠呼吸暂停男性患者。符合研究条件的患者，其呼吸暂停低通气指数必须大于或等于5，且伴有以下一项或多项情况：血压大于150/95 mmHg、多次睡眠潜伏期测试平均得分小于或等于10分钟，或显著的夜间心脏异位搏动。在进行基线研究后，患者按随机顺序分别接受为期一个月的夜间4 LPM的O2和4 LPM的空气治疗。第三个月的治疗为鼻CPAP（压力范围为2.5至12.5 cm H2O）。患者在基线及每个月治疗后均接受评估。研究得出结论，在改善氧合和低通气方面，吸氧比鼻CPAP更有效。然而，对于轻度阻塞性睡眠呼吸暂停患者，吸氧在减少呼吸暂停或改善日间嗜睡方面不如鼻CPAP。对于不伴有嗜睡症状的患者，吸氧可被视为一种替代治疗方式，或作为鼻CPAP的辅助治疗手段。
