从持续气道正压通气转换为双水平气道正压通气对阻塞性睡眠呼吸暂停患者睡眠质量的影响：前瞻性POP IN VAuto研究

Effect of switching from continuous to bilevel positive airway pressure on sleep quality in patients with obstructive sleep apnea: the prospective POP IN VAuto study.

作者信息

Palot Alain, Nguyên Xuân-Lan, Launois Sandrine, Prigent Arnaud, Graml Andrea, Aversenq Elodie, Koltes Christian, Recart Didier, Lavergne Florent

机构信息

Hôpital Saint Joseph, Marseille, France.

Centre du sommeil CEREVES, Paris, France.

出版信息

J Thorac Dis. 2023 Feb 28;15(2):918-927. doi: 10.21037/jtd-22-825. Epub 2023 Jan 14.

DOI:10.21037/jtd-22-825

PMID:36910096

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9992565/

Abstract

BACKGROUND

Issues with tolerability and side effects can decrease continuous positive airway pressure (CPAP) device usage and the benefits of therapy. Different positive airway pressure (PAP) therapy modes providing expiratory pressure relief or using a different pressure during inspiration expiration (bilevel PAP) may alleviate some of these issues. This multicenter, prospective study evaluated the effects of switching from CPAP to bilevel PAP (VAuto mode) on respiratory parameters, device usage, side effects and patient-reported outcomes in patients with obstructive sleep apnea (OSA).

METHODS

Eligible OSA patients had started CPAP ≥3 months previously, had good compliance (mean 6.1±2.0 h/night) and well-controlled OSA [residual apnea-hypopnea index (AHI) 4.9±3.1/h] but had pressure tolerance issues or persistent side effects/discomfort. All were switched from CPAP to bilevel PAP (AirCurve 10 VAuto; ResMed). Effectiveness (residual AHI), sleep quality, daytime sleepiness, fatigue, therapy-related side effects, and patient satisfaction/preference were assessed after 3 months and 1 year.

RESULTS

Forty patients were analyzed (68% male, age 64±11 years, body mass index 30.7±5.8 kg/m). At 3 months and 1 year after switching to bilevel PAP, median [interquartile range] residual AHI was 4/h [2-5.3] and 3.7/h [1.8-5], respectively, and device usage was 7.0 [4.9-7.5] and 6.4 [4.4-7.3] h/night, respectively. Device switch was associated with significant reductions from baseline in expiratory PAP {from 12 [11-13] to 8 [7-9] cmHO at 3 months (P<0.001) and 9 [8-12] cmHO at 1 year (P=0.005)}, 95 percentile pressure {from 14 [12-14] to 10 [9-11] and 10 [8-11] cmH2O; P<0.001 and P=0.001, respectively} and leak {from 1 [0-6] to 0 [0-1] and 0 [0-2] L/min; P=0.049 and P=0.033, respectively}. The Pittsburgh Sleep Quality Index score decreased significantly from baseline to 3 and 6 months [7.2±4.0 to 5.0±3.2 (P=0.005) and 4.5±2.7 (P<0.001), respectively]. CPAP-related mouth dryness, choking sensation and aerophagia were significantly improved one year after switching to bilevel PAP. Bilevel PAP was preferred over CPAP by 90% of patients.

CONCLUSIONS

Switching to bilevel PAP had several benefits in patients struggling with CPAP, facilitating therapy acceptance and ongoing device usage.

摘要

背景

耐受性和副作用问题会降低持续气道正压通气（CPAP）设备的使用情况以及治疗效果。不同的气道正压通气（PAP）治疗模式，即提供呼气压力释放或在吸气/呼气期间使用不同压力（双水平气道正压通气），可能会缓解其中一些问题。这项多中心前瞻性研究评估了阻塞性睡眠呼吸暂停（OSA）患者从CPAP转换为双水平气道正压通气（VAuto模式）对呼吸参数、设备使用情况、副作用以及患者报告结局的影响。

方法

符合条件的OSA患者此前已使用CPAP≥3个月，依从性良好（平均6.1±2.0小时/晚）且阻塞性睡眠呼吸暂停得到良好控制[残余呼吸暂停低通气指数（AHI）为4.9±3.1次/小时]，但存在压力耐受性问题或持续的副作用/不适。所有患者均从CPAP转换为双水平气道正压通气（AirCurve 10 VAuto；瑞思迈公司）。在3个月和1年后评估有效性（残余AHI）、睡眠质量、日间嗜睡、疲劳、与治疗相关的副作用以及患者满意度/偏好。

结果

对40例患者进行了分析（68%为男性，年龄64±11岁，体重指数30.7±5.8kg/m²）。转换为双水平气道正压通气后3个月和1年时，残余AHI的中位数[四分位间距]分别为4次/小时[2 - 5.3]和3.7次/小时[1.8 - 5]，设备使用时间分别为7.0[4.9 - 7.5]和6.4[4.4 - 7.3]小时/晚。设备转换与呼气末气道正压从基线显著降低相关{3个月时从12[11 - 13]降至8[7 - 9]cmH₂O（P<0.001），1年时降至9[8 - 12]cmH₂O（P = 0.005）}，第95百分位数压力{分别从14[12 - 14]降至10[9 - 11]和10[8 - 11]cmH₂O；P<0.001和P = 0.001}以及漏气{分别从1[0 - 6]降至0[0 - 1]和0[0 - 2]L/分钟；P = 0.049和P = 0.033}。匹兹堡睡眠质量指数评分从基线到3个月和6个月时显著降低[7.2±4.0降至5.0±3.2（P = 0.005）和4.5±2.7（P<0.001）]。转换为双水平气道正压通气1年后，与CPAP相关的口干、哽咽感和气吞症显著改善。90%的患者更喜欢双水平气道正压通气而非CPAP。