Teschler H, Hoheisel G, Wagner B, Schumann H, Konietzko N
Abteilung Pneumologie, Universitätsklinik, Ruhrlandklinik Essen.
Med Klin (Munich). 1995 Jun 15;90(6):330-7.
Nasally applied continuous positive airways pressure (nCPAP) ventilation is an effective treatment of obstructive sleep apnoea syndrome (OSAS). As the lowest effective nCPAP-level (nCPAPmin) inter-individually is quite variable individual pressure titration under polysomnographic monitoring is necessary.
To determine whether nCPAPmin can reliably be predicted on the basis of clinical and polysomnographic variables.
A set of 77 unselected OSAS-patients was investigated in the sleep laboratory. We used a standard sleep-related questionnaire, examined anthropometric variables, performed lung function tests and blood gas analyses, and measured nasal cross-sectional area as well as nasal flow resistance. In the night prior to the nCPAP titration a cardiorespiratory polygraphy was performed. Stepwise multiple regression analysis using the titrated nCPAPmin as dependent variable and the clinical and polygraphic data as independent variables revealed gender (GES), neck circumference (NCF), body mass index (BMI), and apnoea-/hypopnea index (AHI) as the optimal set of predictors of nCPAPmin in this model.
Multiple regression analysis with these factors yielded the following equation: predicted nCPAPmin = 1.95 + 0.80 x GES + 0.09 x BMI + 0.01 x NCF + 0.03 x AHI (woman: GES = 1; man: GES = 2). The reliability of the equation was tested with a second set of 180 prospective OSAS-patients. In these patients the mean nCPAP-level as titrated in the sleep laboratory was 9.1 +/- 2.0 mbar, whereas the mean predicted nCPAP-level was 8.4 +/- 3.6 mbar (p = n.s.). In 51% of the patients the difference between nCPAPmin measured and predicted was greater than +/- 1 mbar.
This equation is neither sufficient to reliably predict nCPAPmin nor to prescribe nCPAP without individual pressure titration. The calculated nCPAP-level might however contribute to choosing the most suitable flow generator prior to the titration night.
经鼻持续气道正压通气（nCPAP）是治疗阻塞性睡眠呼吸暂停综合征（OSAS）的一种有效方法。由于个体间最低有效nCPAP水平（nCPAPmin）差异很大，因此需要在多导睡眠图监测下进行个体压力滴定。
确定能否根据临床和多导睡眠图变量可靠地预测nCPAPmin。
在睡眠实验室对77例未经选择的OSAS患者进行了研究。我们使用了一份标准的睡眠相关问卷，检查了人体测量学变量，进行了肺功能测试和血气分析，并测量了鼻横截面积以及鼻气流阻力。在进行nCPAP滴定的前一晚进行了心肺多导睡眠图检查。以滴定得到的nCPAPmin作为因变量，临床和多导睡眠图数据作为自变量进行逐步多元回归分析，结果显示性别（GES）、颈围（NCF）、体重指数（BMI）和呼吸暂停/低通气指数（AHI）是该模型中nCPAPmin的最佳预测指标组合。
对这些因素进行多元回归分析得到以下方程：预测的nCPAPmin = 1.95 + 0.80×GES + 0.09×BMI + 0.01×NCF + 0.03×AHI（女性：GES = 1；男性：GES = 2）。用另一组180例前瞻性OSAS患者对该方程的可靠性进行了检验。在这些患者中，睡眠实验室滴定得到的平均nCPAP水平为9.1±2.0 mbar，而预测的平均nCPAP水平为8.4±3.6 mbar（p = 无显著性差异）。在51%的患者中，测量的nCPAPmin与预测值之间的差异大于±1 mbar。
该方程既不足以可靠地预测nCPAPmin，也不能在不进行个体压力滴定的情况下开具nCPAP处方。然而，计算得到的nCPAP水平可能有助于在滴定前一晚选择最合适的气流发生器。
