Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia.
University of New South Wales, Sydney, NSW, Australia.
Spinal Cord. 2019 Jul;57(7):579-585. doi: 10.1038/s41393-019-0256-6. Epub 2019 Feb 13.
Prospective, double-blind, randomised, placebo-controlled, cross-over trial of nasal decongestion in tetraplegia.
Tetraplegia is complicated by severe, predominantly obstructive, sleep apnoea. First-line therapy for obstructive sleep apnoea is nasal continuous positive airway pressure, but this is poorly tolerated. High nasal resistance associated with unopposed parasympathetic activation of the upper airway contributes to poor adherence. This preliminary study tested whether reducing nasal decongestion improved sleep.
Participants' homes in Melbourne and Sydney, Australia.
Two sleep studies were performed in participants' homes separated by 1 week. Participants were given a nasal spray (0.5 mL of 5% phenylephrine or placebo) in random order and posterior nasal resistance measured immediately. Outcomes included sleep apnoea severity, perceived nasal congestion, sleep quality and oxygenation during sleep.
Twelve middle-aged (average (SD) 52 (12) years) overweight (body mass index 25.3 (6.7) kg/m) men (C4-6, AIS A and B) participated. Nasal resistance was reduced following administration of phenylephrine (p = 0.02; mean between treatment group difference -5.20: 95% confidence interval -9.09, -1.32 cmHO/L/s). No differences were observed in the apnoea hypopnoea index (p = 0.15; -6.37: -33.3, 20.6 events/h), total sleep time (p = 0.49; -1.33: -51.8, 49.1 min), REM sleep% (p = 0.50; 2.37: -5.6, 10.3), arousal index (p = 0.76; 1.15: -17.45, 19.75), 4% oxygen desaturation index (p = 0.88; 0.63: -23.5, 24.7 events/h), or the percentage of mouth breathing events (p = 0.4; -8.07: -29.2, 13.0) between treatments. The apnoea hypopnoea index did differ between groups, however, all except one participant had proportionally more hypopnoeas than apnoeas during sleep after decongestion.
These preliminary data found that phenylephrine acutely reduced nasal resistance but did not significantly change sleep-disordered breathing severity.
前瞻性、双盲、随机、安慰剂对照、交叉试验，研究鼻塞在四肢瘫痪中的缓解作用。
四肢瘫痪会导致严重的、主要为阻塞性的睡眠呼吸暂停。阻塞性睡眠呼吸暂停的一线治疗是持续气道正压通气，但患者耐受性差。与上气道副交感神经激活导致的阻力增加相关的高鼻阻力，导致治疗依从性差。这项初步研究测试了减轻鼻塞是否能改善睡眠。
澳大利亚墨尔本和悉尼的参与者家中。
参与者的家中进行了两次睡眠研究，间隔 1 周。参与者随机接受鼻腔喷雾（0.5 毫升 5%苯肾上腺素或安慰剂），并立即测量后鼻阻力。结果包括睡眠呼吸暂停严重程度、感知的鼻塞、睡眠质量和睡眠期间的氧合。
12 名中年（平均（SD）52（12）岁）超重（体重指数 25.3（6.7）kg/m）男性（C4-6、AIS A 和 B）参与了研究。给予苯肾上腺素后，鼻阻力降低（p=0.02；治疗组间差异均值-5.20：95%置信区间-9.09，-1.32cmHO/L/s）。呼吸暂停低通气指数（p=0.15；-6.37：-33.3，20.6 次/h）、总睡眠时间（p=0.49；-1.33：-51.8，49.1min）、REM 睡眠%（p=0.50；2.37：-5.6，10.3）、觉醒指数（p=0.76；1.15：-17.45，19.75）、4%氧减饱和度指数（p=0.88；0.63：-23.5，24.7 次/h）或治疗间口呼吸事件的百分比（p=0.4；-8.07：-29.2，13.0）无差异。然而，两组间呼吸暂停低通气指数不同，所有参与者除 1 名外，在鼻塞缓解后睡眠时的低通气事件比例均高于呼吸暂停事件。
这些初步数据表明，苯肾上腺素可急性减轻鼻阻力，但并未显著改变睡眠呼吸障碍的严重程度。
