Kuźniar Tomasz J, Kasibowska-Kuźniar Kamilla, Freedom Thomas
Sleep Center, NorthShore University Health System, Evanston, IL, USA.
Pneumonol Alergol Pol. 2012;80(3):214-9.
Patients with complex sleep apnoea (CompSAS) have obstructive sleep apnoea and experience persistent central apnoeas when exposed to positive airway pressure. Elevated loop gain is one of the postulated mechanisms of CompSAS. We speculated that bilevel positive airway pressure - spontaneous (BPAP-S), by producing relative hyperventilation, may more readily produce CompSAS activity than continuous positive airway pressure (CPAP). If found to do so, a trial of BPAP-S might be a simple way of identifying patients with elevated loop gain who are at risk for CompSAS.
Thirty-nine patients with complex sleep apnoea were included in the study. Segments of NREM sleep on CPAP and BPAP-S matched for body position and expiratory airway pressure (comparison pressure) were retrospectively analysed. Correlations between clinical and demographic variables and polysomnographic response to CPAP and BPAP-S were sought.
There was no difference in any of the polysomnographic indices on CPAP and BPAP-S. In 19 patients the use of CPAP was associated with lower AHI at the comparison pressure; in 20 patients the opposite was true. No clinical variables correlated to the differential response to CPAP vs. BPAP-S.
BPAP-S was not more effective than CPAP in stimulating complex sleep apnoea activity.
复杂睡眠呼吸暂停（CompSAS）患者存在阻塞性睡眠呼吸暂停，在接受气道正压通气时会出现持续性中枢性呼吸暂停。环路增益升高是CompSAS的一种假定机制。我们推测，双水平气道正压通气-自发模式（BPAP-S）通过产生相对过度通气，可能比持续气道正压通气（CPAP）更容易引发CompSAS活动。如果确实如此，BPAP-S试验可能是一种识别环路增益升高且有CompSAS风险患者的简单方法。
本研究纳入了39例复杂睡眠呼吸暂停患者。回顾性分析了在CPAP和BPAP-S模式下，非快速眼动睡眠期与体位和呼气气道压力（对照压力）相匹配的片段。寻找临床和人口统计学变量与多导睡眠图对CPAP和BPAP-S反应之间的相关性。
CPAP和BPAP-S模式下的任何多导睡眠图指标均无差异。在19例患者中，在对照压力下使用CPAP与较低的呼吸暂停低通气指数相关；在20例患者中情况则相反。没有临床变量与对CPAP和BPAP-S的差异反应相关。
在刺激复杂睡眠呼吸暂停活动方面，BPAP-S并不比CPAP更有效。
