Watanabe Naomitsu, Levri John M, Peng Victor T, Scharf Steven M, Diaz-Abad Montserrat
University of Maryland School of Medicine, Medicine - Baltimore - Maryland - United States.
University of Maryland Medical Center Midtown Campus, Medicine - Baltimore - Maryland - United States.
Sleep Sci. 2022 Apr-Jun;15(Spec 2):328-332. doi: 10.5935/1984-0063.20210015.
Obstructive sleep apnea (OSA) is a common disease, often treated using continuous positive airway pressure (CPAP) therapy. In many cases, patients fail a CPAP titration study due to inadequate control of the apnea-hypopnea index (AHI, events/hour) or due to treatment-emergent central sleep apnea (TE-CSA). We report our experience using a mode of non-invasive ventilation for alternative treatment of these patients.
We reviewed records of adults who had OSA with AHI≥15 diagnosed on polysomnography (PSG) with failed CPAP titration and in whom titrations with average volume-assured pressure support (AVAPS) with auto-titrating expiratory positive airway pressure were performed.
Forty-five patients, age 57.9±13.1 y, 26 males, body mass index (BMI) 40.2±8.7kg/m. Reasons for CPAP titration failure included: TE-CSA (25, 55.6%) and inadequate control of AHI at maximum CPAP of 20cm H2O (20, 44.4%). Changes noted from baseline PSG to AVAPS titration: AHI: 65.3±29.3 decreased to 22.3±16.1 (p<0.001). Median time SpO2 ≤88%: 63.7 to 6.9min (p<0.001). In 16 patients the AHI was reduced to <15 and in 16 additional patients the AHI was reduced to <30. Improvement in AHI was not related to gender, age, or opioid use, but was correlated with BMI: ∆AHI=12.2 - (1.4 * BMI); p=0.05. AVAPS resulted in improved sleep architecture: median N3 sleep increased: 1.4% to 19.6% total sleep time (TST) (p<0.001), and median R sleep increased: 6.4% to 13.6% TST (p<0.01).
For patients with OSA for whom CPAP titration failed, titration with AVAPS may be an effective treatment.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，通常采用持续气道正压通气（CPAP）治疗。在许多情况下，患者因呼吸暂停低通气指数（AHI，事件/小时）控制不佳或因治疗引发的中枢性睡眠呼吸暂停（TE-CSA）而CPAP滴定研究失败。我们报告了使用一种无创通气模式对这些患者进行替代治疗的经验。
我们回顾了经多导睡眠图（PSG）诊断为AHI≥15的阻塞性睡眠呼吸暂停成年患者的记录，这些患者CPAP滴定失败，并接受了平均容量保证压力支持（AVAPS）和自动滴定呼气末正压通气的滴定。
45例患者，年龄57.9±13.1岁，男性26例，体重指数（BMI）40.2±8.7kg/m²。CPAP滴定失败的原因包括：TE-CSA（25例，55.6%）和在最大CPAP为20cm H₂O时AHI控制不佳（20例，44.4%）。从基线PSG到AVAPS滴定的变化：AHI：65.3±29.3降至22.3±16.1（p<0.001）。SpO₂≤88%的中位时间：63.7分钟至6.9分钟（p<0.001）。16例患者的AHI降至<15，另有16例患者的AHI降至<30。AHI的改善与性别、年龄或阿片类药物使用无关，但与BMI相关：∆AHI=12.2 -（1.4×BMI）；p=0.05。AVAPS改善了睡眠结构：N3睡眠中位时间增加：占总睡眠时间（TST）的1.4%至19.6%（p<0.001），R睡眠中位时间增加：占TST的6.4%至13.6%（p<0.01）。
对于CPAP滴定失败的阻塞性睡眠呼吸暂停患者，AVAPS滴定可能是一种有效的治疗方法。
