McArdle Nigel, Rea Clare, King Stuart, Maddison Kathleen, Ramanan Dinesh, Ketheeswaran Sahisha, Erikli Lisa, Baker Vanessa, Armitstead Jeff, Richards Glenn, Singh Bhajan, Hillman David, Eastwood Peter
Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.
West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.
Sleep. 2017 Oct 1;40(10). doi: 10.1093/sleep/zsx136.
New noninvasive ventilation (NIV) modes can automatically adjust pressure support settings to deliver effective ventilation in response to varying ventilation demands. It is recommended that fixed expiratory positive airway pressure (FixedEPAP) is determined by attended laboratory polysomnographic (PSG) titration. This study investigated whether automatically determined EPAP (AutoEPAP) was noninferior to FixedEPAP for the control of obstructive sleep apnea (OSA) during intelligent volume-assured pressure support (iVAPS) treatment of chronic hypoventilation.
In this randomized, double-blind, crossover study, patients with chronic hypoventilation and OSA used iVAPS with AutoEPAP or FixedEPAP over two separate nights of attended PSG. PSG recordings were scored by an independent scorer using American Academy of Sleep Medicine 2012 criteria.
Twenty-five adults (14 male) with chronic hypoventilation secondary to obesity hypoventilation syndrome (n = 11), chronic obstructive pulmonary disease (n = 9), or neuromuscular disease (n = 5), all of whom were on established home NIV therapy, were included (age 57 ± 7 years, NIV for ≥3 months, apnea-hypopnea index [AHI] >5/hour). AutoEPAP was noninferior to FixedEPAP for the primary outcome measure (median [interquartile range] AHI 2.70 [1.70-6.05]/hour vs. 2.40 [0.25-5.95]/hour; p = .86). There were no significant between-mode differences in PSG sleep breathing and sleep quality, or self-reported sleep quality, device comfort, and patient preference. Mean EPAP with the Auto and Fixed modes was 10.8 ± 2.0 and 11.8 ± 3.9 cmH2O, respectively (p = .15).
In patients with chronic hypoventilation using iVAPS, the AutoEPAP algorithm was noninferior to FixedEPAP over a single night's therapy.
新的无创通气（NIV）模式可自动调整压力支持设置，以根据变化的通气需求提供有效的通气。建议通过有医护人员在场的实验室多导睡眠图（PSG）滴定来确定固定呼气末正压通气（FixedEPAP）。本研究调查了在慢性通气不足的智能容量保证压力支持（iVAPS）治疗期间，自动确定的呼气末正压通气（AutoEPAP）在控制阻塞性睡眠呼吸暂停（OSA）方面是否不劣于FixedEPAP。
在这项随机、双盲、交叉研究中，患有慢性通气不足和OSA的患者在有医护人员在场的PSG监测下，分两个独立的夜晚使用带有AutoEPAP或FixedEPAP的iVAPS。PSG记录由一名独立评分员根据美国睡眠医学学会2012年标准进行评分。
纳入了25名成年人（14名男性），他们因肥胖低通气综合征（n = 11）、慢性阻塞性肺疾病（n = 9）或神经肌肉疾病（n = 5）继发慢性通气不足，所有患者均接受既定的家庭NIV治疗（年龄57±7岁，NIV治疗≥3个月，呼吸暂停低通气指数[AHI]>5次/小时）。对于主要结局指标，AutoEPAP不劣于FixedEPAP（中位数[四分位间距]AHI为2.70[1.70 - 6.05]/小时 vs. 2.40[0.25 - 5.95]/小时；p = 0.86）。在PSG睡眠呼吸、睡眠质量或自我报告的睡眠质量、设备舒适度和患者偏好方面，两种模式之间没有显著差异。Auto模式和Fixed模式的平均呼气末正压分别为10.8±2.0和11.8±3.9 cmH2O（p = 0.15）。
在使用iVAPS的慢性通气不足患者中，经过一晚的治疗，AutoEPAP算法不劣于FixedEPAP。
