Sleep & Attention Disorders Institute, Sterling Heights, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Clin EEG Neurosci. 2020 May;51(3):174-179. doi: 10.1177/1550059419892759. Epub 2019 Dec 18.
The objective was to test whether there were better outcomes on switching from autotitrating positive airway pressure (APAP) to continuous positive airway pressure (CPAP) in a clinic sample of patients with obstructive sleep apnea (OSA). Patients prescribed APAP in 2015-2016 and belonging to a subset characterized by side effects, or suboptimal response or adherence, were advised a switch to CPAP following a CPAP titration polysomnography. The main analysis was for improvement (after switch from APAP to CPAP) in (1) sleepiness, wakefulness inability, and fatigue, using change from baseline in the Sleepiness-Wakefulness Inability and Fatigue Test (delta SWIFT), and Epworth Sleepiness Scale (delta ESS), and (2) adherence using percentage of days with ≥4-hour use and whether there was ≥4-hour use on ≥70% days. To determine possible predictors for switching, additional analysis was performed for differences at baseline between patients switching and those staying on APAP. A total of 148 patients were switched from APAP to CPAP and had greater improvement in delta SWIFT (5.2 vs 4.1, = .004), greater improvement in delta ESS (3.6 vs 2.9, = .011), and better adherence (79.4% vs 74.3%, = .006) on CPAP than on APAP. More patients were adherent on CPAP than on APAP (83.1% vs 68.9%, = .006). Patients switching had higher baseline arousal index and stage N1 sleep, and lower nadir oxygen saturation, than 96 patients not switching. Thus, there is a subset of patients with better outcomes after switching to CPAP than on APAP. Patients with baseline lighter sleep (indicated by more arousals and stage N1), or greater desaturation, may be more likely to do better on CPAP than on APAP. CPAP may be the preferable treatment in a significant subset of patients. If APAP is used first anyway, side effects, or suboptimal response or adherence, should lead to consideration of switching to CPAP based on a CPAP titration polysomnography.
目的在于检验在阻塞性睡眠呼吸暂停（OSA）患者的临床样本中，从自动调节气道正压通气（APAP）切换到持续气道正压通气（CPAP）是否会有更好的效果。2015-2016 年接受 APAP 治疗且具有副作用、反应不佳或顺应性不佳特征的患者，在进行 CPAP 滴定多导睡眠图后，建议切换到 CPAP。主要分析指标为（1）使用睡眠觉醒能力及疲劳测试（SWIFT）和 Epworth 嗜睡量表（ESS）中的嗜睡、觉醒困难和疲劳改善情况，以及（2）采用≥4 小时使用天数百分比和≥70%的日子是否有≥4 小时使用来评估顺应性。为了确定切换的可能预测因素，还对切换患者和继续使用 APAP 患者之间的基线差异进行了额外的分析。共有 148 名患者从 APAP 切换到 CPAP，SWIFT 差值改善（5.2 比 4.1， =.004），ESS 差值改善（3.6 比 2.9， =.011），CPAP 顺应性更好（79.4%比 74.3%， =.006）。CPAP 组的患者比 APAP 组更能坚持使用 CPAP（83.1%比 68.9%， =.006）。与未切换的 96 名患者相比，切换组患者的基线觉醒指数和 N1 期睡眠较高，最低氧饱和度较低。因此，有一部分患者切换到 CPAP 后效果更好。基线睡眠较浅（表现为更多觉醒和 N1 期）或更低的患者，可能在 CPAP 治疗上效果更好。CPAP 可能是一部分患者的首选治疗方法。如果无论如何首先使用 APAP，出现副作用、反应不佳或顺应性不佳，应根据 CPAP 滴定多导睡眠图考虑切换到 CPAP。
