使用环路增益测量来确定复杂睡眠呼吸暂停患者持续气道正压通气疗效的临床应用。一项初步研究。
Clinical Use of Loop Gain Measures to Determine Continuous Positive Airway Pressure Efficacy in Patients with Complex Sleep Apnea. A Pilot Study.
作者信息
Stanchina Michael, Robinson Kristen, Corrao William, Donat Walter, Sands Scott, Malhotra Atul
机构信息
1 Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School at Brown University, Providence, Rhode Island.
2 Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
出版信息
Ann Am Thorac Soc. 2015 Sep;12(9):1351-7. doi: 10.1513/AnnalsATS.201410-469BC.
RATIONALE
Measures of unstable ventilatory control (loop gain) can be obtained directly from the periodic breathing duty ratio on polysomnography in patients with Cheyne-Stokes respiration/central sleep apnea and can predict the efficacy of continuous positive airway pressure (CPAP) therapy.
OBJECTIVES
In this pilot study, we aimed to determine if this measure could also be applied to patients with complex sleep apnea (predominant obstructive sleep apnea, with worsening or emergent central apneas on CPAP). We hypothesized that loop gain was higher in patients whose central events persisted 1 month later despite CPAP treatment versus those whose events resolved over time.
METHODS
We calculated the duty ratio of the periodic central apneas remaining on the CPAP titration (or second half of the split night) while patients were on optimal CPAP with the airway open (obstructive apnea index < 1/h). Loop gain was calculated by the formula: LG = 2π/[(2πDR - sin(2πDR)]. Patients were followed on CPAP for 1 month. Post-treatment apnea-hypopnea index and compliance data were recorded from smart cards.
MEASUREMENTS AND MAIN RESULTS
Thirty-two patients with complex sleep apnea were identified, and 17 patients had full data sets. Eight patients continued to have a total of more than five events per hour (11.8 ± 0.5/h) (nonresponders). The remaining nine patients had an apnea-hypopnea index less than 5/h (2.2 ± 0.4/h) (responders). Loop gain was higher in the nonresponders versus responders (2.0 ± 0.1 vs. 1.7 ± 0.2, P = 0.026). Loop gain and the residual apnea-hypopnea index 1 month after CPAP were associated (r = 0.48, P = 0.02). CPAP compliance was similar between groups.
CONCLUSIONS
In this pilot study, loop gain was higher for patients with complex sleep apnea in whom central apneas persisted after 1 month of CPAP therapy (nonresponders). Loop gain measurement may enable an a priori determination of those who need alternative modes of positive airway pressure.
原理
对于存在潮式呼吸/中枢性睡眠呼吸暂停的患者，不稳定通气控制（环路增益）的测量值可直接从多导睡眠图上的周期性呼吸占比获得，并且能够预测持续气道正压通气（CPAP）治疗的效果。
目的
在这项初步研究中，我们旨在确定该测量方法是否也适用于复杂睡眠呼吸暂停患者（以阻塞性睡眠呼吸暂停为主，在CPAP治疗时中枢性呼吸暂停加重或出现）。我们假设，与中枢性事件随时间缓解的患者相比，尽管接受了CPAP治疗但1个月后中枢性事件仍持续存在的患者环路增益更高。
方法
在患者使用气道开放的最佳CPAP（阻塞性呼吸暂停指数<1次/小时）时，我们计算了CPAP滴定（或分夜试验后半段）时剩余的周期性中枢性呼吸暂停的占比。环路增益通过以下公式计算：LG = 2π/[(2πDR - sin(2πDR)]。患者接受CPAP治疗1个月。从智能卡记录治疗后的呼吸暂停低通气指数和依从性数据。
测量与主要结果
识别出32例复杂睡眠呼吸暂停患者，17例患者有完整数据集。8例患者每小时总事件数持续超过5次（11.8±0.5次/小时）（无反应者）。其余9例患者呼吸暂停低通气指数小于5次/小时（2.2±0.4次/小时）（有反应者）。无反应者的环路增益高于有反应者（2.0±0.1对1.7±0.2，P = 0.026）。CPAP治疗1个月后的环路增益与残余呼吸暂停低通气指数相关（r = 0.48，P = 0.02）。两组间CPAP依从性相似。
结论
在这项初步研究中，对于复杂睡眠呼吸暂停患者，若在CPAP治疗1个月后中枢性呼吸暂停仍持续存在（无反应者），其环路增益更高。测量环路增益可能有助于预先确定那些需要替代气道正压通气模式的患者。
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