Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville Suite 7-088, C-54 UF Health Clinical Center, 655 west 8th Street, Jacksonville, FL, 32209, USA.
Sleep Breath. 2021 Jun;25(2):1181-1186. doi: 10.1007/s11325-020-02193-z. Epub 2020 Sep 23.
The aim of this study was to investigate potential patient or polysomnogram (PSG) characteristics that can help determine who might benefit from bilevel positive airway pressure (BPAP) in the treatment of uncomplicated OSA.
This was a single center, retrospective, observational study in which 19 patients who met our inclusion criteria for BPAP were matched to 40 patients in the control group. Data on patient baseline characteristics as well as PSG results were analyzed.
Baseline patient and PSG characteristics were similar with the exception of shorter sleep time in the BPAP group, 290 min compared with 351 min (p = 0.005). Analysis of oxygen saturations revealed that the percent of total sleep time (TST) spent below 90% (SpO < 90%) was statistically higher in BPAP group (mean 21.4% ± 23.6%) compared with CPAP (mean 9.1% ± 11.1%, p = 0.045). For every 5% increase in TST at SpO < 90%, there is a 28% increase in the odds of BPAP prescription (OR = 1.276, 95%CI 1.029, 1.582, p = 0.027), and for every 10% increase, there is an increase of 63% (OR 1.627, 95%CI 1.058-2.502). The Hosmer-Lemeshow goodness-of-fit test revealed a good fit (p = 0.23). The AUC was 0.7.
There is an association between duration of hypoxemia on the PSG and the likelihood of requiring BPAP for the treatment of uncomplicated OSA. More research is needed to understand the best patient-centered therapy when initiating PAP in the management of OSA.
本研究旨在探究潜在的患者或多导睡眠图（PSG）特征，以帮助确定哪些患者可能从双水平气道正压通气（BPAP）治疗单纯性阻塞性睡眠呼吸暂停（OSA）中获益。
这是一项单中心、回顾性、观察性研究，其中符合 BPAP 纳入标准的 19 名患者与对照组的 40 名患者相匹配。分析了患者基线特征和 PSG 结果。
除了 BPAP 组的睡眠时间更短（290 分钟 vs. 351 分钟，p=0.005）外，基线患者和 PSG 特征相似。对氧饱和度的分析表明，BPAP 组总睡眠时间（TST）低于 90%的时间百分比（SpO < 90%）明显更高（平均 21.4%±23.6%），而 CPAP 组（平均 9.1%±11.1%，p=0.045）。每增加 5%的 TST 在 SpO < 90%，BPAP 处方的几率增加 28%（OR=1.276，95%CI 1.029，1.582，p=0.027），每增加 10%，几率增加 63%（OR 1.627，95%CI 1.058-2.502）。Hosmer-Lemeshow 拟合优度检验显示拟合良好（p=0.23）。AUC 为 0.7。
PSG 上的低氧血症持续时间与需要 BPAP 治疗单纯性 OSA 的可能性之间存在关联。需要进一步研究以了解在 OSA 管理中启动 PAP 时以患者为中心的最佳治疗方法。
