Sullivan C E, Berthon-Jones M, Issa F G
Am Rev Respir Dis. 1983 Jul;128(1):177-81. doi: 10.1164/arrd.1983.128.1.177.
Two patients with the Pickwickian syndrome and with life-threatening sleep hypoxemia were treated with continuous positive airway pressure (CPAP) applied through the nares only during sleep periods. Each patient presented with severe daytime somnolence, disturbed sleep, nocturnal confusion, and daytime awake cardiorespiratory failure (PaCO2, 63 and 55 mmHg). Both patients demonstrated grossly abnormal breathing during sleep with severe sleep hypoxemia, the arterial oxyhemoglobin saturation (SaO2%) falling repetitively to levels below 50%. One patient had a hypoxemic convulsion during the initial sleep evaluation. Low levels (3.5 and 8.0 cm H2O) of continuous positive airway pressure, when applied via a comfortable nose mask, prevented occlusive apnea and obstructive hypopnea during sleep in both patients and maintained steady levels of arterial oxyhemoglobin saturation. There was rapid recovery of mental function and loss of cardiorespiratory failure within 3 days of treatment. After short-term treatment with nocturnal CPAP therapy (23 days and 35 days) both patients were able to sleep, unaided, without sleep-induced upper airway occlusion with arterial oxyhemoglobin levels sustained above 80%. We conclude that nasal CPAP therapy during sleep is an effective noninvasive therapy for patients with the Pickwickian syndrome, and may lead to a stable remission of the underlying severe disordered breathing in sleep.
两名患有匹克威克综合征且存在危及生命的睡眠低氧血症的患者，仅在睡眠期间通过鼻腔接受持续气道正压通气（CPAP）治疗。每位患者均表现为严重的日间嗜睡、睡眠紊乱、夜间意识模糊以及日间清醒时的心肺功能衰竭（动脉血二氧化碳分压分别为63和55 mmHg）。两名患者睡眠期间呼吸均明显异常，伴有严重的睡眠低氧血症，动脉血氧血红蛋白饱和度（SaO2%）反复降至50%以下。其中一名患者在初次睡眠评估时发生了低氧性惊厥。通过舒适的鼻罩施加低水平（3.5和8.0 cm H2O）的持续气道正压通气，可防止两名患者睡眠期间出现阻塞性呼吸暂停和阻塞性低通气，并维持动脉血氧血红蛋白饱和度的稳定水平。治疗3天内精神功能迅速恢复，心肺功能衰竭症状消失。经过短期夜间CPAP治疗（23天和35天）后，两名患者均能够独立入睡，睡眠期间上气道无阻塞，动脉血氧血红蛋白水平维持在80%以上。我们得出结论，睡眠期间的鼻腔CPAP治疗是匹克威克综合征患者有效的非侵入性治疗方法，可能会使潜在的严重睡眠呼吸紊乱得到稳定缓解。
