Gulati Atul, Oscroft Nicholas, Chadwick Rebecca, Ali Masood, Smith Ian
Colchester Hospital University Foundation Trust, Turner Road, Colchester CO45LE, UK.
The Respiratory Support and Sleep Centre, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
Respir Med. 2015 Jun;109(6):778-83. doi: 10.1016/j.rmed.2015.01.020. Epub 2015 Feb 19.
Pressure intolerance is a reason for poor acceptance and subsequent compliance in some patients starting treatment with continuous positive airway pressure (CPAP). In unselected populations initiating CPAP; different types of pressure generating device have not been found to improve compliance. We hypothesized that using Bi-level PAP for patients who reported pressure related discomfort as a cause for poor compliance with CPAP might increase their hours of treatment use. Patients using CPAP <4 h/night with symptoms to suggest pressure intolerance were randomized to receive either a Bi-level PAP device or a new CPAP for 4 weeks. Following a washout period of 2 weeks, they were crossed over to the other device for 4 weeks. Twenty eight volunteers completed the protocol. Compared to the baseline (mean 1.49 h per night), improvement in compliance was noticed when changed to a new CPAP (2.23 h, p = 0.006) or Bi-level PAP (2.73 h, p < 0.001). The trend suggesting superior compliance with a Bi-level PAP device compared to new CPAP was not significant (p = 0.059) and there were no differences in subjective or objective measures of sleepiness. The results of this study suggest that routine intervention with Bi-level PAP in this group of sub-optimally compliant individuals was not very effective in improving PAP usage. There is however a subgroup of patients who complains of difficulty with exhalation; where favorable trends towards improved compliance were observed on Bi-level PAP.
压力不耐受是一些开始接受持续气道正压通气（CPAP）治疗的患者接受度差及后续依从性差的一个原因。在未经过筛选就开始使用CPAP的人群中，尚未发现不同类型的压力产生装置能提高依从性。我们推测，对于那些报告称与压力相关的不适是导致CPAP依从性差的原因的患者，使用双水平气道正压通气（Bi-level PAP）可能会增加他们的治疗使用时长。每晚使用CPAP时间<4小时且有症状提示压力不耐受的患者被随机分为两组，分别接受双水平气道正压通气装置或新的CPAP，为期4周。经过2周的洗脱期后，他们交叉使用另一组装置，为期4周。28名志愿者完成了该方案。与基线水平（平均每晚1.49小时）相比，更换为新的CPAP（2.23小时，p = 0.006）或双水平气道正压通气（2.73小时，p < 0.001）时，依从性有所改善。与新的CPAP相比，双水平气道正压通气装置依从性更高的趋势并不显著（p = 0.059），且在嗜睡的主观或客观测量方面没有差异。这项研究的结果表明，在这组依从性欠佳的个体中，常规使用双水平气道正压通气进行干预对改善气道正压通气的使用效果不太显著。然而，有一小部分患者抱怨呼气困难，在这些患者中观察到使用双水平气道正压通气时依从性有改善的有利趋势。
