Morgenthaler Timothy I, Kuzniar Tomasz J, Wolfe Lisa F, Willes Leslee, McLain William C, Goldberg Rochelle
Mayo Clinic Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
NorthShore University HealthSystem, Evanston, IL.
Sleep. 2014 May 1;37(5):927-34. doi: 10.5665/sleep.3662.
Prior studies show that adaptive servoventilation (ASV) is initially more effective than continuous positive airway pressure (CPAP) for patients with complex sleep apnea syndrome (CompSAS), but choosing therapies has been controversial because residual central breathing events may resolve over time in many patients receiving chronic CPAP therapy. We conducted a multicenter, randomized, prospective trial comparing clinical and polysomnographic outcomes over prolonged treatment of patients with CompSAS, with CPAP versus ASV.
Qualifying participants meeting criteria for CompSAS were randomized to optimized CPAP or ASV treatment. Clinical and polysomnographic data were obtained at baseline and after 90 days of therapy.
We randomized 66 participants (33 to each treatment). At baseline, the diagnostic apnea-hypopnea index (AHI) was 37.7 ± 27.8 (central apnea index [CAI] = 3.2 ± 5.8) and best CPAP AHI was 37.0 ± 24.9 (CAI 29.7 ± 25.0). After second-night treatment titration, the AHI was 4.7 ± 8.1 (CAI = 1.1 ± 3.7) on ASV and 14.1 ± 20.7 (CAI = 8.8 ± 16.3) on CPAP (P ≤ 0.0003). At 90 days, the ASV versus CPAP AHI was 4.4 ± 9.6 versus 9.9 ± 11.1 (P = 0.0024) and CAI was 0.7 ± 3.4 versus 4.8 ± 6.4 (P < 0.0001), respectively. In the intention-to-treat analysis, success (AHI < 10) at 90 days of therapy was achieved in 89.7% versus 64.5% of participants treated with ASV and CPAP, respectively (P = 0.0214). Compliance and changes in Epworth Sleepiness Scale and Sleep Apnea Quality of Life Index were not significantly different between treatment groups.
Adaptive servoventilation (ASV) was more reliably effective than CPAP in relieving complex sleep apnea syndrome. While two thirds of participants experienced success with CPAP, approximately 90% experienced success with ASV. Because both methods produced similar symptomatic changes, it is unclear if this polysomnographic effectiveness may translate into other desired outcomes.
Clinicaltrials.Gov NCT00915499.
先前的研究表明，对于复杂性睡眠呼吸暂停综合征（CompSAS）患者，适应性伺服通气（ASV）最初比持续气道正压通气（CPAP）更有效，但由于在许多接受长期CPAP治疗的患者中，残留的中枢性呼吸事件可能会随着时间的推移而缓解，因此治疗方法的选择一直存在争议。我们进行了一项多中心、随机、前瞻性试验，比较了CompSAS患者接受CPAP与ASV长期治疗后的临床和多导睡眠图结果。
符合CompSAS标准的合格参与者被随机分配至优化CPAP或ASV治疗。在基线和治疗90天后获取临床和多导睡眠图数据。
我们将66名参与者随机分组（每组33名）。基线时，诊断性呼吸暂停低通气指数（AHI）为37.7±27.8（中枢性呼吸暂停指数[CAI]=3.2±5.8），最佳CPAP AHI为37.0±24.9（CAI 29.7±25.0）。经过第二晚治疗滴定后，ASV治疗时AHI为4.7±8.1（CAI=1.1±3.7），CPAP治疗时AHI为14.1±20.7（CAI=8.8±16.3）（P≤0.0003）。在90天时，ASV与CPAP的AHI分别为4.4±9.6和9.9±11.1（P=0.0024），CAI分别为0.7±3.4和4.8±6.4（P<0.0001）。在意向性分析中，治疗90天时成功（AHI<10）的参与者比例在接受ASV和CPAP治疗的患者中分别为89.7%和64.5%（P=0.0214）。治疗组之间的依从性以及Epworth嗜睡量表和睡眠呼吸暂停生活质量指数的变化无显著差异。
适应性伺服通气（ASV）在缓解复杂性睡眠呼吸暂停综合征方面比CPAP更可靠有效。虽然三分之二的参与者使用CPAP取得了成功，但使用ASV的参与者中约90%取得了成功。由于两种方法产生的症状变化相似，尚不清楚这种多导睡眠图的有效性是否能转化为其他期望的结果。
Clinicaltrials.Gov NCT00915499
