Heiser C, Strassen U, Knopf A, Leuchten Y, Hofauer B
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
HNO. 2019 Sep;67(9):663-669. doi: 10.1007/s00106-019-0697-4.
Many patients suffer from positional obstructive sleep apnea (POSA; 56%). In these cases, positional therapy may be an option. A sleep position trainer (SPT) is a small vibrating device that trains the patient to avoid sleeping in the supine position. This study aimed to compare the efficacy and tolerance of gradual and intensive training onset in POSA patients MATERIALS AND METHODS: Patients with mild to moderate POSA and incompliance with continuous positive airway pressure (CPAP) therapy were included in this prospective double-blind trail. Patients were randomized according to how training was initiated and the SPT was set to either a gradual or an intensive training program. Polygraphy was used to check respiratory parameters after 1 month, and subjective parameters and compliance were assessed prior to and after this time period using a questionnaire.
A total of 38 patients were included (20 intensive; 18 gradual; 49 ± 13 years) of whom 31 completed the study protocol. After 1 month the apnea-hypopnea index (AHI) in both groups was significantly reduced, but there was no difference in AHI between the two training modalities (AHI intensive: 16.7 ± 6.3/h to 4.2 ± 3.2/h; AHI gradual: 18.9 ± 11.2/h to 8.4 ± 7.9/h). The same effect was observed for subjective sleepiness.
The objective severity of OSA and the associated subjective daytime sleepiness was reduced in both groups. There was no difference in terms of clinical outcome or compliance between the gradual or intensive SPT therapy in POSA patients during the observation period. Both training modalities are highly successful and well tolerated.
许多患者患有体位性阻塞性睡眠呼吸暂停(POSA,56%)。在这些情况下,体位治疗可能是一种选择。睡眠体位训练器(SPT)是一种小型振动装置,可训练患者避免仰卧睡眠。本研究旨在比较POSA患者中逐渐开始训练和强化开始训练的疗效及耐受性。
本前瞻性双盲试验纳入了轻度至中度POSA且不依从持续气道正压通气(CPAP)治疗的患者。根据训练开始方式将患者随机分组,SPT设置为逐渐训练或强化训练方案。1个月后使用多导睡眠图检查呼吸参数,并在此时间段前后使用问卷评估主观参数和依从性。
共纳入38例患者(20例强化组;18例逐渐组;年龄49±13岁),其中31例完成了研究方案。1个月后,两组的呼吸暂停低通气指数(AHI)均显著降低,但两种训练方式的AHI无差异(强化组AHI:从16.7±6.3次/小时降至4.2±3.2次/小时;逐渐组AHI:从18.9±11.2次/小时降至8.4±7.9次/小时)。主观嗜睡情况也观察到了相同效果。
两组患者的OSA客观严重程度及相关的主观日间嗜睡情况均有所减轻。在观察期内,POSA患者中逐渐或强化SPT治疗在临床结果或依从性方面无差异。两种训练方式均非常成功且耐受性良好。