专用口腔途径和侧卧位对适应口鼻面罩的阻塞性睡眠呼吸暂停（OSA）患者使用口鼻持续气道正压通气（CPAP）治疗效果的影响。

Impact of Exclusive Mouth Route and Lateral Position on the Efficacy of Oronasal CPAP to Treat OSA in Patients With OSA Adapted to Oronasal Mask.

作者信息

Xavier Jeane Lima de Andrade, Fernandes Mariana Delgado, Andrade Rafaela Garcia Santos de, Genta Pedro R, Lorenzi-Filho Geraldo

机构信息

Laboratorio do Sono, Divisão de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

出版信息

Chest. 2025 Feb;167(2):611-618. doi: 10.1016/j.chest.2024.10.023. Epub 2024 Oct 24.

DOI:10.1016/j.chest.2024.10.023

PMID:39454998

Abstract

BACKGROUND

Oronasal masks are used widely for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP.

RESEARCH QUESTION

What is the impact of oral route and lateral position in patients well adapted to oronasal CPAP? Can these patients be switched to nasal CPAP?

STUDY DESIGN AND METHODS

Patients with OSA receiving oronasal CPAP underwent two CPAP polysomnography titrations in random order using an oronasal mask with two independent sealed compartments connected to two separate pneumotachographs. One study was performed with the nasal and oral compartments opened and the other study was performed with only the oral compartment opened. CPAP titration was carried out in the supine and lateral positions. Finally, the patients were offered a nasal mask. A third polysomnography test was performed using nasal CPAP.

RESULTS

Twenty patients with OSA (baseline apnea-hypopnea index [AHI], 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers with optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (median, 2 [interquartile range (IQR), 1-6.0] vs 12.5 [IQR, 1.8-28.3); P = .003), despite a significantly higher CPAP level (median, 10 cm HO [IQR, 9-10 cm HO] vs 11 cm HO [IQR, 10-12 cm HO]; P = .003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue using a nasal mask, which resulted in lower CPAP and better OSA control.

INTERPRETATION

Our results indicate that the effectiveness of oronasal CPAP to abolish OSA is decreased significantly when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. The transition to nasal mask results in higher CPAP effectiveness to treat OSA.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT05272761; URL: www.

CLINICALTRIALS

gov.

摘要

背景

口鼻面罩广泛用于持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停（OSA）。然而，口鼻CPAP与比鼻CPAP更低的有效性和依从性相关。

研究问题

对于已很好适应口鼻CPAP的患者，经口途径和侧卧位有何影响？这些患者能否改用鼻CPAP？

研究设计与方法

接受口鼻CPAP治疗的OSA患者使用带有两个独立密封腔室并连接到两个单独呼吸流速计的口鼻面罩，以随机顺序进行两次CPAP多导睡眠图滴定。一项研究在鼻和口腔腔室打开的情况下进行，另一项研究仅在口腔腔室打开的情况下进行。CPAP滴定在仰卧位和侧卧位进行。最后，为患者提供鼻面罩。使用鼻CPAP进行第三次多导睡眠图测试。

结果

研究了20例已适应口鼻CPAP的OSA患者（基线呼吸暂停低通气指数[AHI]，52±21次/小时）。大多数患者（75%）是使用最佳CPAP的口鼻呼吸者。经口CPAP治疗OSA的效果不如口鼻CPAP，残余AHI更高证明了这一点（中位数，2[四分位间距（IQR），1 - 6.0]对12.5[IQR，1.8 - 28.3]；P = 0.003），尽管CPAP水平显著更高（中位数，10 cmH₂O[IQR，9 - 10 cmH₂O]对11 cmH₂O[IQR，10 - 12 cmH₂O]；P = 0.003）。对于口鼻和经口CPAP，侧卧位的残余AHI均显著更低。最后，患者（75%）同意更换并更愿意继续使用鼻面罩，这导致CPAP水平更低且OSA控制更好。