患者的治疗性持续气道正压通气（CPAP）需求可预测对氧气和催眠药联合治疗阻塞性睡眠呼吸暂停的反应。
Response to a combination of oxygen and a hypnotic as treatment for obstructive sleep apnoea is predicted by a patient's therapeutic CPAP requirement.
作者信息
Landry Shane A, Joosten Simon A, Sands Scott A, White David P, Malhotra Atul, Wellman Andrew, Hamilton Garun S, Edwards Bradley A
机构信息
Department of Physiology, Monash University, Melbourne, Victoria, Australia.
Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia.
出版信息
Respirology. 2017 Aug;22(6):1219-1224. doi: 10.1111/resp.13044. Epub 2017 Apr 13.
BACKGROUND AND OBJECTIVE
Upper airway collapsibility predicts the response to several non-continuous positive airway pressure (CPAP) interventions for obstructive sleep apnoea (OSA). Measures of upper airway collapsibility cannot be easily performed in a clinical context; however, a patient's therapeutic CPAP requirement may serve as a surrogate measure of collapsibility. The present work aimed to compare the predictive use of CPAP level with detailed physiological measures of collapsibility.
METHODS
Therapeutic CPAP levels and gold-standard pharyngeal collapsibility measures (passive pharyngeal critical closing pressure (P ) and ventilation at CPAP level of 0 cmH O (V )) were retrospectively analysed from a randomized controlled trial (n = 20) comparing the combination of oxygen and eszopiclone (treatment) versus placebo/air control. Responders (9/20) to treatment were defined as those who exhibited a 50% reduction in apnoea/hypopnoea index (AHI) plus an AHI<15 events/h on-therapy.
RESULTS
Responders to treatment had a lower therapeutic CPAP requirement compared with non-responders (6.6 (5.4-8.1) cmH O vs 8.9 (8.4-10.4) cmH O, P = 0.007), consistent with their reduced collapsibility (lower P , P = 0.017, higher V P = 0.025). Therapeutic CPAP level provided the highest predictive accuracy for differentiating responders from non-responders (area under the curve (AUC) = 0.86 ± 0.9, 95% CI: 0.68-1.00, P = 0.007). However, both P (AUC = 0.83 ± 0.11, 95% CI: 0.62-1.00, P = 0.017) and V (AUC = 0.77 ± 0.12, 95% CI: 0.53-1.00, P = 0.44) performed well, and the difference in AUC for these three metrics was not statistically different. A therapeutic CPAP level ≤8 cmH O provided 78% sensitivity and 82% specificity (positive predictive value = 78%, negative predictive value = 82%) for predicting a response to these therapies.
CONCLUSION
Therapeutic CPAP requirement, as a surrogate measure of pharyngeal collapsibility, predicts the response to non-anatomical therapy (oxygen and eszopiclone) for OSA.
背景与目的
上气道可塌陷性可预测阻塞性睡眠呼吸暂停（OSA）患者对多种非持续气道正压通气（CPAP）干预措施的反应。上气道可塌陷性的测量在临床环境中不易进行；然而，患者的治疗性CPAP需求可作为可塌陷性的替代指标。本研究旨在比较CPAP水平的预测价值与可塌陷性的详细生理测量指标。
方法
回顾性分析一项随机对照试验（n = 20）中治疗性CPAP水平及金标准咽部可塌陷性测量指标（被动咽部临界关闭压（P）和CPAP水平为0 cmH₂O时的通气量（V）），该试验比较了氧气与艾司佐匹克隆联合治疗（治疗组）与安慰剂/空气对照组。治疗反应者（9/20）定义为治疗期间呼吸暂停/低通气指数（AHI）降低50%且AHI<15次/小时的患者。
结果
与无反应者相比，治疗反应者的治疗性CPAP需求较低（6.6（5.4 - 8.1）cmH₂O 对8.9（8.4 - 10.4）cmH₂O，P = 0.007），这与其可塌陷性降低一致（较低的P，P = 0.017，较高的V，P = 0.025）。治疗性CPAP水平在区分反应者与无反应者方面具有最高的预测准确性（曲线下面积（AUC）= 0.86 ± 0.09，95%可信区间：0.68 - 1.00，P = 0.007）。然而，P（AUC = 0.83 ± 0.11，95%可信区间：0.62 - 1.00，P = 0.017）和V（AUC = 0.77 ± 0.12，95%可信区间：0.53 - 1.00，P = 0.044）的表现也较好，这三个指标的AUC差异无统计学意义。治疗性CPAP水平≤8 cmH₂O在预测这些治疗反应时的敏感性为78%，特异性为82%（阳性预测值 = 78%，阴性预测值 = 82%）。
结论
治疗性CPAP需求作为咽部可塌陷性的替代指标，可预测OSA患者对非解剖学治疗（氧气和艾司佐匹克隆）的反应。
Zotero 插件