Department of Pneumology, HELIOS Clinic Ambrock, Hagen, Germany.
Sleep Breath. 2013 Mar;17(1):111-5. doi: 10.1007/s11325-012-0657-7.
Auto-CPAP devices (APAP) are controlled, e.g.,by the respiratory flow and pressure to adjust the treatment pressure to the variable obstruction in sleep apnea syndromes.By obstruction of the upper airway during inspiration,a pressure difference between the lower airways and the mask can be measured. In case of an opening of the pharynx at the end of the obstruction, the pressure decreases immediately. This brief negative pressure, the so-called obstructive pressure peak (OPP) can be used to identify obstruction or open airways with the algorithm of an APAP device. Useless pressure increases, e.g., after central apneas without obstruction may be avoided. We therefore investigated the association of the OPP signal with respiratory events during APAP therapy.
In this pilot study, 13 patients with obstructive sleep apnea syndrome were evaluated. Attended automatic CPAP titration (SOMNO balance, Fa Weinmann Hamburg/Germany)was performed. The OPP signal was recorded synchronous lyin parallel with the polysomnographic data. If the OPP signal was within a time range of ± 5 s of the resumption of normal breathing, it was assigned to the event.
A total of 480 sleep-related breathing disorders events were studied. The most common were the mixed apneas associated with more than 90% of all cases with an OPP signal, followed by obstructive sleep apneas (66.7%)and central apneas (38%). The difference in OPP frequency distribution between central apneas and obstructive apneas was significant with p<0.001.
The analysis of the pressure characteristics of APAP treatment with the registration of OPP allows a further differentiation in obstructed and not obstructed upper airways.
自动持续气道正压通气（APAP）设备通过呼吸流量和压力控制来调整治疗压力，以适应睡眠呼吸暂停综合征中的可变阻塞。在吸气过程中，上气道受阻时，可以测量下气道和面罩之间的压力差。在阻塞结束时咽腔开放的情况下，压力会立即下降。这种短暂的负压，即所谓的阻塞压力峰值（OPP），可用于通过 APAP 设备的算法识别阻塞或开放气道。可以避免例如阻塞后中枢性呼吸暂停引起的无用压力增加。因此，我们研究了 OPP 信号与 APAP 治疗期间呼吸事件的关联。
在这项初步研究中，对 13 例阻塞性睡眠呼吸暂停综合征患者进行了评估。进行了有监护的自动 CPAP 滴定（SOMNO balance，Fa Weinmann Hamburg/Germany）。OPP 信号与多导睡眠图数据同步记录。如果 OPP 信号在正常呼吸恢复的 ± 5 秒时间范围内，则将其分配给事件。
共研究了 480 例与睡眠相关的呼吸障碍事件。最常见的是与超过 90%的病例都存在 OPP 信号相关的混合性呼吸暂停，其次是阻塞性睡眠呼吸暂停（66.7%）和中枢性呼吸暂停（38%）。中枢性呼吸暂停和阻塞性呼吸暂停之间的 OPP 频率分布差异具有统计学意义（p<0.001）。
通过 OPP 的注册分析 APAP 治疗的压力特征，可以进一步区分阻塞性和非阻塞性上气道。
