Wang Tsai-Yu, Huang Yu-Chen, Lin Ting-Yu, Ni Yung-Lun, Lo Yu-Lun
Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan.
School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Front Neurol. 2022 Jun 13;13:882465. doi: 10.3389/fneur.2022.882465. eCollection 2022.
The titration pressure of continuous positive airway pressure (CPAP) is important in patients with obstructive sleep apnea (OSA). This study aimed to understand the difference between drug-induced sleep endoscopy (DISE)-guided CPAP titration and conventional sleep center (CSC) CPAP titration in patients with OSA.
In this randomized, controlled, and single-blind crossover trial, we compared the effects of 1-month CPAP treatment in patients with OSA with either DISE-guided CPAP titration or CSC CPAP titration. Twenty-four patients with OSA were recruited for the study. All patients underwent polysomnography, DISE-guided CPAP titration, and accommodation. Initially, patients were randomly assigned to receive either DISE-guided CPAP titration or CSC CPAP treatment for the first month. They were then switched to other treatments in the second month. The Epworth sleepiness scale (ESS) score was recorded at baseline, 1 and 2 months.
The upper limit of the pressure of DISE-guided titration and CSC CPAP titration was not significantly different (13.9 ± 0.7 vs. 13.5 ± 0.5 cm HO; = 0.92). The residual apnea-hypopnea index and compliance were also not significantly different between the groups. ESS score significantly improved from baseline to 1 month after CPAP treatment in both groups. Both epiglottis (anterior-posterior collapse) and tongue base collapse were significantly associated with 95% CPAP pressure ( = 0.031 and 0.038, respectively). After multivariate regression analyses, the epiglottis (anterior-posterior collapse) was an independent factor for 95% CPAP pressure. The incidence rate of bradycardia was 58.3%, which is a safety concern for DISE. Despite the high incidence of bradycardia, all patients with bradycardia recovered with proper management.
Both modalities were comparable in terms of establishing the pressure settings required to treat patients. Further large-scale studies are required to confirm these results.
https://clinicaltrials.gov/, NCT03523013.
持续气道正压通气（CPAP）的滴定压力对阻塞性睡眠呼吸暂停（OSA）患者很重要。本研究旨在了解药物诱导睡眠内镜检查（DISE）引导下的CPAP滴定与传统睡眠中心（CSC）CPAP滴定在OSA患者中的差异。
在这项随机、对照、单盲交叉试验中，我们比较了1个月CPAP治疗对采用DISE引导CPAP滴定或CSC CPAP滴定的OSA患者的影响。招募了24例OSA患者进行研究。所有患者均接受多导睡眠图检查、DISE引导CPAP滴定和适应期。最初，患者被随机分配在第一个月接受DISE引导CPAP滴定或CSC CPAP治疗。然后在第二个月改为接受另一种治疗。在基线、1个月和2个月时记录爱泼华嗜睡量表（ESS）评分。
DISE引导滴定和CSC CPAP滴定的压力上限无显著差异（13.9±0.7 vs. 13.5±0.5 cm H₂O；P = 0.92）。两组之间的残余呼吸暂停低通气指数和依从性也无显著差异。两组患者在CPAP治疗后1个月时ESS评分均较基线显著改善。会厌（前后塌陷）和舌根塌陷均与95% CPAP压力显著相关（分别为P = 0.031和0.038）。经过多变量回归分析，会厌（前后塌陷）是95% CPAP压力的独立因素。心动过缓的发生率为58.3%，这是DISE的一个安全问题。尽管心动过缓发生率高，但所有心动过缓患者经适当处理后均康复。
在确定治疗患者所需的压力设置方面，两种方法具有可比性。需要进一步的大规模研究来证实这些结果。
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