Stradling J R, Barbour C, Pitson D J, Davies R J
Osler Chest Unit, Churchill Hospital, Oxford, UK.
Thorax. 1997 Jan;52(1):72-5. doi: 10.1136/thx.52.1.72.
Manual titration of nasal continuous positive airway pressure (NCPAP) treatment for obstructive sleep apnoea (OSA) is time consuming and expensive. There are now "intelligent" NCPAP machines that try to find the ideal pressure for a patient by monitoring a combination of apnoeas, hypopnoeas, inspiratory flow limitation, and snoring. Although these machines usually find similar pressures to skilled technicians, it is not clear if their use in the sleep laboratory influences subsequent acceptance by patients. This study addresses this question.
One hundred and twenty two patients undergoing a trial of NCPAP were randomly allocated to either manual or automatic (Horizon, DeVilbiss) titration of pressure during their first night on NCPAP in a hospital sleep laboratory. The primary outcome (available on 112 patients) was the acceptance of NCPAP or otherwise six weeks following the initial titration night. Baseline indicators of severity were compared between the groups, as were the pressures selected and the subsequent improvement in the sleepiness of the patients.
The initial severity of OSA was not significantly different in the two groups and the mean (SD) NCPAP pressures were similar (manual 8.7 (2.5) cm H2O, automatic 8.2 (2.1) cm H2O). The percentage of patients successfully established on CPAP at six weeks was 64% and 73% for the manual and automatic groups, respectively; 13% and 2%, respectively, in the manual and automatic groups had given up completely (p < 0.05), and there were about equal numbers (23% versus 25%) in the two groups who were still undecided.
The substitution of automatic NCPAP titration for manual titration during the first night of NCPAP in patients with OSA does not reduce the number accepting the treatment at six weeks and may slightly improve it. This has important cost saving potential.
阻塞性睡眠呼吸暂停（OSA）的鼻持续气道正压通气（NCPAP）治疗手动滴定耗时且昂贵。现在有“智能”NCPAP机器，试图通过监测呼吸暂停、低通气、吸气气流受限和打鼾的组合来为患者找到理想压力。尽管这些机器通常能找到与熟练技术人员相似的压力，但尚不清楚它们在睡眠实验室中的使用是否会影响患者随后的接受度。本研究解决了这个问题。
122名接受NCPAP试验的患者在医院睡眠实验室进行NCPAP治疗的第一晚被随机分配接受手动或自动（地平线，德维比斯）压力滴定。主要结局（112名患者可获得）是初始滴定夜六周后对NCPAP的接受情况。比较了两组之间的严重程度基线指标、所选压力以及患者嗜睡程度的后续改善情况。
两组中OSA的初始严重程度无显著差异，平均（标准差）NCPAP压力相似（手动8.7（2.5）cm H2O，自动8.2（2.1）cm H2O）。手动组和自动组在六周时成功使用CPAP的患者百分比分别为64%和73%；手动组和自动组分别有13%和2%的患者完全放弃（p<0.05），两组中仍未决定的人数大致相等（23%对25%）。
OSA患者在NCPAP治疗的第一晚用自动NCPAP滴定替代手动滴定，不会减少六周时接受治疗的人数，可能还会略有改善。这具有重要的成本节约潜力。
