Nakanishi Nobuto, Suzuki Yasuhiro, Ishihara Manabu, Ueno Yoshitoyo, Tane Natsuki, Tsunano Yumiko, Itagaki Taiga, Oto Jun
Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN.
Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, JPN.
Cureus. 2020 Jul 20;12(7):e9303. doi: 10.7759/cureus.9303.
Introduction Sleep-disordered breathing (SDB) is common after stroke. Although the standard treatment of SDB is continuous positive airway pressure (CPAP) ventilation, the patient's intolerance and discomfort result in low adherence rates. Alternatively, high-flow nasal cannula (HFNC) may be useful as it reduces upper airway collapse with low level of positive pressure and well tolerability. The aim of this study was to investigate whether HFNC therapy reduces SDB and improves sleep quality with higher compliance rate. Methods We included acute stroke patients with SDB for the assessment of apnea-hypopnea index (AHI) >5/h using WatchPAT 200 (Itamar Medical Ltd, Caesarea, Israel). Patients who met inclusion criteria received HFNC therapy (40 L/min) with monitoring by WatchPAT. AHI, oxygen desaturation index (ODI), sleep efficiency, and rapid eye movement (REM) sleep were compared in patients with and without HFNC therapy. We also evaluated the patient's comfort of HFNC therapy (discomfort or not). Results Among 17 patients assessed for AHI, 12 received HFNC therapy. HFNC therapy was not adhered in two patients due to intolerance. Eight patients remained for final analysis. There were no differences in SDB and sleep quality with and without HFNC therapy as follows: HFNC therapy vs control; AHI 24.9 ± 20.1 vs 21.3 ± 15.0/h (p = 0.63), ODI 16.2 ± 16.5 vs 12.9 ± 12.3/h (p = 0.54), sleep efficiency 80.4 ± 12.9 vs 87.1 ± 6.2 (p = 0.28), percentage of REM sleep 19.4% ± 9.6% vs 27.6% ± 8.9% (p = 0.07). Two patients (17%) complained of discomfort among eight patients. Conclusion HFNC therapy did not improve SDB and sleep quality. Nonadherence and discomfort were observed in HFNC therapy. We need a large trial to confirm this result.
睡眠呼吸障碍（SDB）在中风后很常见。虽然SDB的标准治疗方法是持续气道正压通气（CPAP），但患者的不耐受和不适导致依从率较低。另外，高流量鼻导管（HFNC）可能有用，因为它能以低水平的正压减少上气道塌陷且耐受性良好。本研究的目的是调查HFNC治疗是否能降低SDB并提高睡眠质量，同时具有更高的依从率。
我们纳入了患有SDB的急性中风患者，使用WatchPAT 200（以色列凯撒利亚的Itamar Medical Ltd公司）评估呼吸暂停低通气指数（AHI）>5次/小时。符合纳入标准的患者接受HFNC治疗（40升/分钟），并通过WatchPAT进行监测。比较接受和未接受HFNC治疗的患者的AHI、氧饱和度下降指数（ODI）、睡眠效率和快速眼动（REM）睡眠情况。我们还评估了患者对HFNC治疗的舒适度（是否不适）。
在17名接受AHI评估的患者中，12名接受了HFNC治疗。两名患者因不耐受而未坚持HFNC治疗。8名患者留作最终分析。接受和未接受HFNC治疗的患者在SDB和睡眠质量方面没有差异，具体如下：HFNC治疗组与对照组；AHI分别为24.9±20.1次/小时和21.3±15.0次/小时（p=0.63），ODI分别为16.2±16.5次/小时和12.9±12.3次/小时（p=0.54），睡眠效率分别为80.4±12.9和87.1±6.2（p=0.28），REM睡眠百分比分别为19.4%±9.6%和27.6%±8.9%（p=0.07）。8名患者中有两名（17%）抱怨不适。
HFNC治疗并未改善SDB和睡眠质量。在HFNC治疗中观察到不依从和不适情况。我们需要进行大规模试验来证实这一结果。
