Second Department of Internal Medicine (Department of Respiratory Medicine), Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Sleep Breath. 2013 May;17(2):845-52. doi: 10.1007/s11325-012-0775-2. Epub 2012 Oct 19.
Individuals have different breathing patterns at rest, during wakefulness, and during sleep, and patients with sleep apnea are no different. The hypothesis for this study was that breathing irregularity during wakefulness associates with CPAP acceptance in obstructive sleep apnea (OSA).
From a 2007-2010-database of patients with a diagnostic polysomnography (PSG) and prescribed CPAP (n = 380), retrospectively, 66 patients who quit CPAP treatment at 6 months were identified. Among them, 27 OSA patients quit despite having no side effects for discontinuing CPAP (Group A) and were compared to a matched group (age, body mass index, and apnea-hypopnea index) with good 6-month CPAP adherence (Group B; n = 21). Five minutes of respiratory signal during wakefulness at the initial PSG were extracted from respiratory inductance plethysmography recordings, and measured in a blinded fashion. The coefficients of variation (CV) for the breath-to-breath inspiration time (T i), expiration time (T e), T i + T e (T tot), and relative tidal volume, as well as an independent information theory-based metric of signal pattern variability (mutual information) were compared between groups.
The CV for tidal volume was significantly greater (p = 0.001), and mutual information was significantly lower (p = 0.041) in Group A as compared to Group B.
Differences in two independent measures of breathing irregularity correlated with CPAP rejection in OSA patients without nasal symptoms or comorbidity. Prospective studies of adherence should examine traits of breathing stability.
个体在静息、觉醒和睡眠时的呼吸模式存在差异，睡眠呼吸暂停患者也不例外。本研究的假设是，觉醒时呼吸不规则与阻塞性睡眠呼吸暂停（OSA）患者接受 CPAP 治疗的情况相关。
从 2007 年至 2010 年的诊断性多导睡眠图（PSG）和处方 CPAP 患者数据库中（n=380），回顾性地确定了 66 例在 6 个月时停止 CPAP 治疗的患者。其中，27 例 OSA 患者尽管停止 CPAP 治疗后没有副作用（A 组），但仍停止了 CPAP 治疗，与依从性良好的 6 个月 CPAP 治疗（B 组；n=21）的匹配组进行了比较。从初始 PSG 的呼吸感应体积描记记录中提取了觉醒时 5 分钟的呼吸信号，并进行了盲法测量。比较了两组间呼吸时间（T i）、呼气时间（T e）、T i+T e（T tot）和相对潮气量的呼吸间变异性系数（CV），以及基于独立信息理论的信号模式变异性度量（互信息）。
与 B 组相比，A 组的潮气量 CV 显著更大（p=0.001），互信息显著更低（p=0.041）。
两种独立的呼吸不规则性测量指标的差异与 OSA 患者在没有鼻部症状或合并症的情况下拒绝 CPAP 治疗相关。对依从性的前瞻性研究应检查呼吸稳定性的特征。
