Troitino Anthony, Labedi Nawman, Kufel Thomas, El-Solh Ali A
The Veterans Affairs Western New York Healthcare System, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Medical Research, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA.
Sleep Breath. 2014 May;18(2):367-73. doi: 10.1007/s11325-013-0894-4. Epub 2013 Sep 24.
This study aims to compare treatment response and adherence rate to positive airway pressure (PAP) in patients with opioid-related central sleep apnea (O-CSA) and idiopathic central sleep apnea (I-CSA).
We performed a retrospective chart over a 5-year period performed at a VA sleep center. Continuous PAP (CPAP) was prescribed initially for all participants. For those nonresponders (apnea hypopnea index (AHI) of >10/h), bi-level PAP (BiPAP) or adaptive servoventilation (ASV) was instituted upon provider's discretion. Adherence to therapy was checked with the built-in meter.
Thirty-four patients with O-CSA and 61 with I-CSA were included in the analysis. The two groups were comparable with respect to age, body mass index (BMI), Epworth Sleepiness Scale, and burden of comorbidities. The mean daily equivalent dose of morphine in the O-CSA was 168 mg (range 30-1,217 mg). In the O-CSA group, 24% of PAP-naïve patients responded to CPAP compared to 38% in the I-CSA group. BiPAP and ASV were comparable in eliminating central events in both O-CSA (66 versus 60 %) and I-CSA (93 versus 90%), respectively. Eight patients (24%) with O-CSA and six patients (10%) with I-CSA were considered nonresponders. The adherence rate was 48 and 24% in the I-CSA group compared to 23 and 18% in the O-CSA group at 3 and 12 months following initiation of effective treatment (p = 0.04 and p = 0.6).
The presence of O-CSA does not preclude an adequate response to CPAP. Adherence rate to PAP was poor in both the O-CSA and I-CSA groups. Further studies are needed to define optimal adherence rate and long-term benefits of PAP in CSA.
本研究旨在比较阿片类药物相关中枢性睡眠呼吸暂停（O-CSA）患者和特发性中枢性睡眠呼吸暂停（I-CSA）患者对气道正压通气（PAP）的治疗反应和依从率。
我们对一家退伍军人事务部睡眠中心5年内的病历进行了回顾性分析。最初为所有参与者开具持续气道正压通气（CPAP）治疗。对于那些无反应者（呼吸暂停低通气指数（AHI）>10次/小时），根据医生的判断采用双水平气道正压通气（BiPAP）或适应性伺服通气（ASV）治疗。通过内置仪器检查治疗依从性。
分析纳入了34例O-CSA患者和61例I-CSA患者。两组在年龄、体重指数（BMI）、爱泼华嗜睡量表及合并症负担方面具有可比性。O-CSA组吗啡的平均每日等效剂量为168毫克（范围30 - 1217毫克）。在O-CSA组中，初次使用PAP的患者有24%对CPAP有反应，而I-CSA组为38%。BiPAP和ASV在消除O-CSA组（分别为66%对60%）和I-CSA组（分别为93%对90%）的中枢性事件方面效果相当。8例（24%）O-CSA患者和6例（10%）I-CSA患者被视为无反应者。在开始有效治疗后的3个月和12个月时，I-CSA组的依从率分别为48%和24%，而O-CSA组分别为23%和18%（p = 0.04和p = 0.6）。
O-CSA的存在并不排除对CPAP有充分反应。O-CSA组和I-CSA组对PAP的依从率均较低。需要进一步研究来确定PAP在中枢性睡眠呼吸暂停中的最佳依从率和长期益处。
