Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Aufderhoeher Str. 169-175, 42699, Solingen, Germany.
Löwenstein Medical Technology GmbH + Co. KG, Karlsruhe, Germany.
Sleep Breath. 2020 Sep;24(3):825-833. doi: 10.1007/s11325-019-01901-8. Epub 2019 Aug 6.
Previous studies revealed substantially varying therapy efficacy of automatic continuous positive airway pressure (APAP) devices in the treatment of obstructive sleep apnea (OSA). We evaluated the efficacy of a new APAP device using the forced oscillation technique (FOT) to evaluate upper airway obstruction during apneas and flow contour analyses during hypopneas.
Forty-six initially diagnosed OSA patients were included and the pressure range was set from 5 to 20 hPa. Therapy efficacy was assessed based on the reduction of apnea-hypopnea index (AHI), improvement of objective sleep quality parameters, and the appropriateness of the device's pressure regulation.
AHI and arousal index significantly decreased during APAP therapy (median [interquartile range]: AHI 36 [23-55] vs. 2 [1-6]/h, arousal index 30 [22-45] vs. 15 [10-19]/h, both p < 0.001). The amount of slow wave sleep (SWS) and rapid-eye-movement (REM) sleep significantly increased (SWS 20 [14-29] vs. 29 [19-34]%, REM 16 [11-21] vs. 24 [14-30]%, both p < 0.01). Most residual respiratory events during therapy were of central etiology and attributable to five patients, who presented with treatment-emergent central sleep apnea. The device's pressure regulation abolished most obstructive respiratory events (n = 6.7 residual obstructive events per patient). Of central respiratory events, 534/646 (83%) did not lead to pressure increases.
This pilot study provides a proof of concept that the APAP device combining FOT and evaluation of flow contour allows for the suppression of obstructive events without relevant false reactions.
先前的研究表明，自动持续气道正压通气（APAP）设备在治疗阻塞性睡眠呼吸暂停（OSA）方面的疗效差异很大。我们使用强迫振荡技术（FOT）评估了一种新的 APAP 设备的疗效，该技术用于评估呼吸暂停期间的上气道阻塞和低通气期间的流量轮廓分析。
纳入了 46 例初诊 OSA 患者，压力范围设定为 5 至 20 hPa。根据呼吸暂停低通气指数（AHI）的降低、客观睡眠质量参数的改善以及设备压力调节的适宜性来评估治疗效果。
APAP 治疗期间，AHI 和觉醒指数显著降低（中位数[四分位距]：AHI 从 36[23-55]降至 2[1-6]/h，觉醒指数从 30[22-45]降至 15[10-19]/h，均 p<0.001）。慢波睡眠（SWS）和快速眼动（REM）睡眠的量显著增加（SWS 从 20[14-29]增至 29[19-34]%，REM 从 16[11-21]增至 24[14-30]%，均 p<0.01）。治疗期间大多数残余呼吸事件为中枢性病因，与 5 名出现治疗后中枢性睡眠呼吸暂停的患者有关。设备的压力调节消除了大多数阻塞性呼吸事件（每位患者剩余阻塞性事件 6.7 次）。在中枢性呼吸事件中，534/646（83%）未导致压力增加。
这项初步研究提供了一个概念验证，即结合 FOT 和流量轮廓评估的 APAP 设备可以在不产生相关假反应的情况下抑制阻塞性事件。
