Universiti Kebangsaan Malaysia Medical Centre, Department of Medicine, Respiratory Unit, Malaysia.
Med J Malaysia. 2021 Sep;76(5):611-616.
Continuous Positive Airway Pressure (CPAP) is required for obstructive sleep apnoea (OSA). Thisstudy compares the efficacy between Fixed Pressure CPAP (Fixed CPAP) and Auto-adjusting Pressure (APAP) based on Apnoea Hypopnoea Index (AHI), Epworth Sleepiness Score (ESS) among patients with symptomatic OSA and to ascertain their CPAP preference.
This is a prospective, randomised, crossover, single-blinded study conducted from February 2018 to February 2019 among adult subjects attending respiratory clinic Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
Forty-six subjects were recruited with 27 males (58.7%). The mean age was 54 (+11) year old. The baseline median Body Mass Index (BMI) was 34.2 kg/m (Interquartile Range IQR: 30.8 kg/m -41.7 kg/m2); baseline median AHI 28.8 /hour (IQR 21.2/hour-54.0/hour); andbaseline median ESS 15 (IQR 13-16). After intervention, the median AHI was 5.0 / hour (IQR 4.2/hour-6.0/hour) at fixed CPAP arm; APAP arm was 5.5/ hour (IQR 4.2/hour-6.3/hour); p<0.01. The median ESS at fixed CPAP arm was 2 (IQR 0-3); APAP arm was 2 (IQR 1-3); p < 0.01. Those who preferred APAP were 22 subjects (47.8%) and had median optimal CPAP pressure 13.0 cmH2O (IQR 12.0 cmH2O -13.5 cmH2O); 24 subjects (52.2%) who preferred Fixed CPAP had median optimal CPAP pressure 8.0 cmH2O (IQR 6.3 cmH2O -8.7 cmH2O); p<0.01. Median baseline BMI was 37.6 kg/m (IQR 30.8 kg/m -43.0 kg/m) for those who preferred APAP and 32.3 kg/m (IQR 30.8 kg/m - 38.4 kg/m) for subjects preferred Fixed CPAP; p=0.03.
Fixed CPAP maybe considered as first line therapy for symptomatic moderate and severe OSA with titrated optimal CPAP pressure less than 8 cmH2O and BMI less than 32.3 kg/m; based on subjects' preference. Baseline AHI and average daily CPAP usage was not statisticallysignificant in affecting patient preference between fixed and auto adjusting CPAP. This is the first study of its kind conducted in Malaysia.
持续气道正压通气（CPAP）是阻塞性睡眠呼吸暂停（OSA）的必需治疗方法。本研究比较了固定压力 CPAP（固定 CPAP）和自动调整压力（APAP）在基于呼吸暂停低通气指数（AHI）、嗜睡评分（ESS）的有症状 OSA 患者中的疗效，并确定了他们对 CPAP 的偏好。
这是一项前瞻性、随机、交叉、单盲研究，于 2018 年 2 月至 2019 年 2 月在马来西亚国立大学医学中心（UKMMC）呼吸科就诊的成年患者中进行。
共招募了 46 名受试者，其中 27 名男性（58.7%）。平均年龄为 54（+11）岁。基线中位数体重指数（BMI）为 34.2kg/m（四分位距 IQR：30.8kg/m-41.7kg/m2）；基线中位数 AHI 为 28.8/小时（IQR 21.2 小时-54.0 小时）；和基线中位数 ESS 为 15（IQR 13-16）。干预后，固定 CPAP 臂的中位 AHI 为 5.0/小时（IQR 4.2 小时-6.0 小时）；APAP 臂为 5.5/小时（IQR 4.2 小时-6.3 小时）；p<0.01。固定 CPAP 臂的中位 ESS 为 2（IQR 0-3）；APAP 臂为 2（IQR 1-3）；p<0.01。22 名（47.8%）更喜欢 APAP 的受试者的中位最佳 CPAP 压力为 13.0cmH2O（IQR 12.0cmH2O-13.5cmH2O）；24 名（52.2%）更喜欢固定 CPAP 的受试者的中位最佳 CPAP 压力为 8.0cmH2O（IQR 6.3cmH2O-8.7cmH2O）；p<0.01。那些更喜欢 APAP 的受试者的基线 BMI 中位数为 37.6kg/m（IQR 30.8kg/m-43.0kg/m），而那些更喜欢固定 CPAP 的受试者的基线 BMI 中位数为 32.3kg/m（IQR 30.8kg/m-38.4kg/m）；p=0.03。
对于经滴定后 CPAP 压力低于 8cmH2O 和 BMI 低于 32.3kg/m 的有症状中重度 OSA 患者，可考虑将固定 CPAP 作为一线治疗方法；基于患者的偏好。基线 AHI 和平均每日 CPAP 使用量在固定和自动调整 CPAP 之间对患者偏好没有统计学意义。这是在马来西亚进行的此类研究中的第一项。
