Bironneau Vanessa, Ingrand Pierre, Pontier Sandrine, Iamandi Carmen, Portel Laurent, Martin Francis, Mallart Anne, Lerousseau Lionel, Alfandary Didier, Levrat Virginie, Portier Florence, Tamisier Renaud, Goutorbe Frédéric, Rabec Claudio, Codron François, Auregan Guy, Mercy Magalie, Attali Valérie, Soyez Frank, Launois Claire, Recart Didier, Vecchierini Marie-Françoise, Gagnadoux Frédéric, Meurice Jean-Claude
INSERM CIC 1402, IS-ALIVE Research Group, University of Poitiers, Poitiers, France.
Pneumologie, CHU de Poitiers, Poitiers, France.
Respirology. 2023 Nov;28(11):1069-1077. doi: 10.1111/resp.14569. Epub 2023 Aug 16.
Continuous positive airway pressure (CPAP) in the treatment of severe obstructive sleep apnoea (OSA) can be used in fixed CPAP or auto-adjusted (APAP) mode. The aim of this prospective randomized controlled clinical study was to evaluate the 3 month-efficacy of CPAP used either in fixed CPAP or APAP mode.
Eight hundred one patients with severe OSA were included in twenty-two French centres. After 7 days during which all patients were treated with APAP to determine the effective pressure level and its variability, 353 and 351 patients were respectively randomized in the fixed CPAP group and APAP group. After 3 months of treatment, 308 patients in each group were analysed.
There was no difference between the two groups in terms of efficacy whatever the level of efficient pressure and pressure variability (p = 0.41). Exactly, 219 of 308 patients (71.1%) in the fixed CPAP group and 212 of 308 (68.8%) in the APAP group (p = 0.49) demonstrated residual apnoea hypopnoea index (AHI) <10/h and Epworth Score <11. Tolerance and adherence were also identical with a similar effect on quality of life and blood pressure evaluation.
The two CPAP modes, fixed CPAP and APAP, were equally effective and tolerated in severe OSA patients.
持续气道正压通气（CPAP）治疗重度阻塞性睡眠呼吸暂停（OSA）可采用固定CPAP模式或自动调压（APAP）模式。这项前瞻性随机对照临床研究的目的是评估固定CPAP模式或APAP模式下CPAP治疗3个月的疗效。
801例重度OSA患者纳入法国22个中心。在7天内，所有患者均接受APAP治疗以确定有效压力水平及其变异性，之后353例和351例患者分别随机分配至固定CPAP组和APAP组。治疗3个月后，对每组308例患者进行分析。
无论有效压力水平和压力变异性如何，两组在疗效方面均无差异（p = 0.41）。确切地说，固定CPAP组308例患者中有219例（71.1%），APAP组308例中有212例（68.8%）（p = 0.49）的残余呼吸暂停低通气指数（AHI）<10/h且爱泼沃斯嗜睡量表评分<11。耐受性和依从性也相同，对生活质量和血压评估有相似影响。
固定CPAP和APAP这两种CPAP模式在重度OSA患者中疗效相同且耐受性良好。
