比较阻塞性睡眠呼吸暂停综合征初始滴定期间的 CPAP 面罩：一年经验。
Comparing CPAP masks during initial titration for Obstructive Sleep Apnea Syndrome: one-year experience.
机构信息
Hospital IPO - Instituto Paranaense de Otorrinolaringologista, Curitiba, PR, Brazil.
Hospital IPO - Instituto Paranaense de Otorrinolaringologista, Curitiba, PR, Brazil.
出版信息
Braz J Otorhinolaryngol. 2022 Nov-Dec;88 Suppl 5(Suppl 5):S63-S68. doi: 10.1016/j.bjorl.2021.10.007. Epub 2021 Nov 25.
OBJECTIVE
Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. A wide variety of masks are used during CPAP therapy. The aim of the study is to compare polysomnography outcomes during titration for different types of masks (oronasal, nasal and pillow) and assess the impact on PAP titration.
METHODS
We retrospectively analyzed all CPAP titration polysomnography for one year. Anthropometric data and baseline apnea severity were documented.
RESULTS
A total of 497 patients were evaluated. Nasal masks were used in 82.3% (n = 409), pillow in 14.1% (n = 70) and oronasal in 3.6% (n = 18). There was no difference according to body mass index and baseline apnea-hypopnea index among the groups. The oronasal group was older and had higher titrated CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency, more superficial N1 sleep and longer wake time after sleep onset. All other polysomnography outcomes were similar among the groups. The mean CPAP level was 11.6 ± 2.1 cm HO for the oronasal mask, 10.1 ± 2.1 cm HO for the nasal mask and 9.8 ± 2.2 cm HO for the pillow. The residual apnea-hypopnea index was 10.4 ± 7.9 for the oronasal mask, 5.49 ± 5.34 events/h for the nasal mask and 4.98 ± 5.48 events/h for the pillow. The baseline apnea-hypopnea index was correlated with of a higher CPAP pressure for all the groups (p < 0.001 for the nasal group, p = 0.001 for the pillow group and p = 0.049 for the oronasal group). Body mass index and residual AHI were correlated with of a higher CPAP pressure for the nasal and pillow groups only (p < 0.001).
CONCLUSION
The interface can have a significant impact on the effectiveness of PAP titration. Patients with oronasal masks have higher CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency and higher wake time after sleep onset. Oronasal masks should not be recommended as the first choice for apnea patients.
LEVEL OF EVIDENCE
Level 3.
目的
持续气道正压通气（CPAP）是 OSA 的金标准治疗方法。CPAP 治疗期间使用了各种各样的面罩。本研究的目的是比较不同类型的面罩（口鼻、鼻和枕头）在滴定过程中的睡眠监测结果，并评估其对 PAP 滴定的影响。
方法
我们回顾性分析了一年来所有的 CPAP 滴定睡眠监测结果。记录了人体测量数据和基线呼吸暂停严重程度。
结果
共评估了 497 名患者。鼻面罩使用率为 82.3%（n=409），枕头面罩为 14.1%（n=70），口鼻面罩为 3.6%（n=18）。三组间的体重指数和基线呼吸暂停低通气指数无差异。口鼻面罩组年龄较大，CPAP 压力较高，残余呼吸暂停低通气指数较高，睡眠效率较低，N1 睡眠较浅，睡眠起始后清醒时间较长。所有其他睡眠监测结果在各组间相似。口鼻面罩的平均 CPAP 水平为 11.6±2.1cmH2O，鼻面罩为 10.1±2.1cmH2O，枕头面罩为 9.8±2.2cmH2O。残余呼吸暂停低通气指数分别为口鼻面罩 10.4±7.9 次/小时，鼻面罩 5.49±5.34 次/小时，枕头面罩 4.98±5.48 次/小时。基线呼吸暂停低通气指数与所有组的 CPAP 压力升高相关（鼻面罩组 p<0.001，枕头面罩组 p=0.001，口鼻面罩组 p=0.049）。BMI 和残余 AHI 与鼻面罩和枕头面罩组的 CPAP 压力升高相关（p<0.001）。
结论
界面会对面罩通气治疗（PAP）滴定的效果产生重大影响。使用口鼻面罩的患者 CPAP 压力较高、残余呼吸暂停低通气指数较高、睡眠效率较低、睡眠起始后清醒时间较长。对于呼吸暂停患者，不建议将口鼻面罩作为首选。
证据水平
3 级。
Zotero 插件