Couillard A, Pepin J-L, Rabec C, Cuvelier A, Portmann A, Muir J-F
Fédération ANTADIR, 66, boulevard Saint-Michel, 75006 Paris, France.
Laboratoire EFCR, CHU Michallon, coté Chartreuse, boulevard de La Chantourne, 38700 La Tronche, France.
Rev Mal Respir. 2015 Mar;32(3):283-90. doi: 10.1016/j.rmr.2014.02.013. Epub 2014 Jun 24.
Noninvasive ventilation is recommended to correct the nocturnal hypoventilation and relieve the symptoms of patients with the obesity-hypoventilation syndrome (OHS). The benefits of fixed pressure ventilation (S/T technology) are recognized but limited on account of the variability of nocturnal ventilatory requirements. The new technique AVAPS-AE (automatic EPAP) allows adjustment of the pressure according to the volume currently targeted. Its efficacy has not yet been evaluated. Our objectives are to evaluate firstly, whether AVAPS-AE optimizes the benefits of S/T technology on sleep architecture and quality, secondly, whether these benefits are associated with an improvement in gas exchange, symptoms, exercise tolerance, level of physical activity and quality of life of patients with OHS. In this multicenter trial, 60 newly diagnosed patients with OHS will be randomized to the control (S/T) and trial (AVAPS-AE) groups. A standardized titration procedure will be followed for the calibration of the ventilators. Functional evaluations (polysomnography, blood gases, impedance measurements and walking tests), questionnaires (physical activity, quality of life, quality of sleep and daytime somnolence) visual scales (fatigue, headaches) and a recording of activity will be undertaken after two months of ventilation.
建议采用无创通气来纠正肥胖低通气综合征（OHS）患者的夜间通气不足并缓解症状。固定压力通气（S/T技术）的益处已得到认可，但由于夜间通气需求的变异性，其作用有限。新技术AVAPS-AE（自动呼气末正压通气）可根据当前设定的容积来调整压力。其疗效尚未得到评估。我们的目标，一是评估AVAPS-AE是否能优化S/T技术对睡眠结构和质量的益处，二是评估这些益处是否与OHS患者气体交换的改善、症状、运动耐力、身体活动水平及生活质量的提高相关。在这项多中心试验中，60例新诊断的OHS患者将被随机分为对照组（S/T）和试验组（AVAPS-AE）。将遵循标准化的滴定程序来校准呼吸机。通气两个月后，将进行功能评估（多导睡眠图、血气分析、阻抗测量和步行测试）、问卷调查（身体活动、生活质量、睡眠质量和日间嗜睡情况）、视觉量表（疲劳、头痛）以及活动记录。
