夜间吸氧对高原 OSA 患者的影响：一项随机、交叉试验。
Effect of One Night of Nocturnal Oxygen Supplementation on Highland Patients With OSA: A Randomized, Crossover Trial.
机构信息
Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurology, Diqing Tibetan Autonomous Prefectural People's Hospital, Shangri-La, China.
出版信息
Chest. 2021 Aug;160(2):690-700. doi: 10.1016/j.chest.2021.02.046. Epub 2021 Mar 2.
BACKGROUND
The treatment of OSA in highland residents is not established.
RESEARCH QUESTIONS
Does nocturnal oxygen supplementation (NOS) improve sleep-related breathing disturbances, nocturnal oxygenation, and cognitive performance in patients with OSA living at 3,200 m?
STUDY DESIGN AND METHODS
Forty patients with OSA permanently living in Shangri-La, China at 3,200 m (median age [interquartile range], 47.0 [44.0-53.0] years; oxygen desaturation index, 38.4/h [34.2/h-52.3/h]), were randomly assigned to receive nasal NOS and sham oxygen (ambient air), for one night each, at 2 L/min, in a crossover design, separated by a washout period of 2 weeks. During treatment nights polysomnography was performed, and further outcomes were evaluated the next morning. The primary outcome was the difference in apnea-hypopnea index (AHI) between nights with NOS and nights with sham oxygen.
RESULTS
During nights with sham oxygen, the median (interquartile range) total AHI was 43.4/h (31.1/h-67.5/h), the obstructive AHI was 41.9/h (28.5/h-66.8/h), and the central AHI was 0.6/h (0.1/h-1.3/h); blood oxygenation as determined by pulse oximetry (Spo) was 87.0% (84.5%-89.0%). In intention-to-treat analysis, NOS decreased the total AHI by a median of 17.9/h (95% CI, 8.0/h-27.1/h; P < .001), through a reduction in obstructive AHI by 16.0/h (95% CI, 6.8/h-26.0/h; P < .001) and central AHI by 0.4/h (95% CI, 0.1/h-0.9/h; P < .001). NOS also increased Spo by 7.0% (95% CI, 6.0%-8.0%; P < .001). Heart rate during sleep and pulse rate in the morning after NOS were significantly reduced, but subjective sleep quality and cognitive performance showed no changes.
INTERPRETATION
In highland residents with OSA, NOS significantly improved sleep-related breathing disturbances and nocturnal oxygenation. NOS also reduced heart rate during sleep and morning pulse rate. If these beneficial effects are confirmed in longer term studies, NOS may be a treatment option for highland patients with OSA who cannot be treated by CPAP.
TRIAL REGISTRY
Chinese Clinical Trial Registry; No.: ChiCTR1800017715; URL: http://www.chictr.org.cn/showproj.aspx?proj=29768.
背景
高海拔地区居民阻塞性睡眠呼吸暂停（OSA）的治疗方法尚未确定。
研究问题
夜间补充氧气（NOS）是否能改善长期居住在海拔 3200 米的高原居民的 OSA 患者的睡眠相关呼吸紊乱、夜间氧合和认知功能？
研究设计和方法
40 名长期居住在中国香格里拉（海拔 3200 米）的 OSA 患者（中位数年龄[四分位距]，47.0 [44.0-53.0]岁；氧减指数，38.4/h [34.2/h-52.3/h]），采用交叉设计随机分配接受鼻 NOS 和假氧（环境空气）治疗，每种治疗持续一夜，流速为 2 L/min，洗脱期为 2 周。在治疗夜间进行多导睡眠图检查，并在次日早晨评估进一步的结果。主要结局是 NOS 治疗夜与假氧治疗夜之间的呼吸暂停低通气指数（AHI）差异。
结果
在接受假氧治疗的夜间，总 AHI 的中位数（四分位距）为 43.4/h（31.1/h-67.5/h），阻塞性 AHI 为 41.9/h（28.5/h-66.8/h），中枢性 AHI 为 0.6/h（0.1/h-1.3/h）；脉搏血氧饱和度（Spo）测定的血氧饱和度为 87.0%（84.5%-89.0%）。在意向治疗分析中，NOS 使总 AHI 中位数降低了 17.9/h（95%置信区间，8.0/h-27.1/h；P<0.001），通过降低阻塞性 AHI 16.0/h（95%置信区间，6.8/h-26.0/h；P<0.001）和中枢性 AHI 0.4/h（95%置信区间，0.1/h-0.9/h；P<0.001）。NOS 还使 Spo 增加了 7.0%（95%置信区间，6.0%-8.0%；P<0.001）。NOS 治疗后夜间的心率和早晨的脉搏率显著降低，但主观睡眠质量和认知功能没有变化。
解释
在高原 OSA 居民中，NOS 显著改善了睡眠相关呼吸紊乱和夜间氧合。NOS 还降低了睡眠期间的心率和早晨的脉搏率。如果这些有益的效果在更长期的研究中得到证实，NOS 可能成为高原 OSA 患者的一种治疗选择，这些患者不能通过 CPAP 治疗。
试验注册
中国临床试验注册中心；编号：ChiCTR1800017715；网址：http://www.chictr.org.cn/showproj.aspx?proj=29768。
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