Stasche Norbert
Westpfalz-Klinikum HNO Klinik, Kaiserslautern, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2006;5:Doc06. Epub 2006 Oct 5.
Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders (SRBD). A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV) must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP), most commonly used for symptomatic obstructive sleep apnoea (OSA) without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP). Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV), which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal PAP device must be carefully selected, taking into account side effects that influence compliance.
气道正压通气（PAP）是大多数睡眠相关呼吸障碍（SRBD）的首选治疗方法。在应用之前，必须仔细考虑各种使用气道正压的PAP设备（持续气道正压通气CPAP、双水平气道正压通气BiPAP、自动调压气道正压通气APAP、适应性伺服通气ASV）。本综述旨在根据睡眠相关呼吸障碍的严重程度和类型提供选择最佳PAP设备的标准。此外，还将讨论治疗应用范围、限制和副作用以及PAP的替代方法。本综述基于对当前文献和临床经验的分析。数据从耳鼻喉科睡眠实验室的角度呈现，旨在帮助耳鼻喉科医生开始治疗并提供支持。将描述不同的滴定方法、当前设备和可能的应用。除了最常用于无并发症的症状性阻塞性睡眠呼吸暂停（OSA）的恒压设备（CPAP）外，还将介绍双水平气道正压通气（BiPAP）模式。这些模式允许两种不同的正压设置，因此特别适合患有心肺疾病或不耐受压力的患者，可显著提高该亚组的依从性。对于治疗第一晚的患者、压力需求高度可变的患者或体位性OSA患者，使用自动调压气道正压通气（APAP）设备（自动气道正压通气）也可以提高依从性。中枢性睡眠呼吸暂停的一种亚型——陈-施呼吸患者受益于适应性伺服通气（ASV），它可以持续分析呼吸模式并相应地调整实际通气压力。这不仅可以减少白天的嗜睡，还可以对心脏病产生积极影响。气道正压通气治疗在消除与阻塞相关的睡眠疾病和症状方面非常有效。然而，由于治疗通常是终身应用的，因此必须仔细选择最佳的PAP设备，同时考虑影响依从性的副作用。
