Engleman H M, Martin S E, Deary I J, Douglas N J
Respiratory Medicine Unit, University of Edinburgh, UK.
Thorax. 1997 Feb;52(2):114-9. doi: 10.1136/thx.52.2.114.
Continuous positive airway pressure (CPAP) is an effective treatment in patients with moderate and severe sleep apnoea/hypopnoea syndrome (SAHS), but the minimum illness severity at which patients obtain benefit from CPAP is unclear. A study was therefore undertaken to investigate whether CPAP improves symptoms and daytime function in patients with mild SAHS.
Sixteen consecutively recruited patients with mild SAHS (5.0-14.9 apnoeas + hypopnoeas per hour slept and two or more symptoms of SAHS) participated in a prospective placebo controlled randomised crossover trial to assess the effects of CPAP on symptoms and daytime function. Patients spent four weeks on placebo and four weeks on CPAP, undergoing assessments of sleepiness, symptoms, cognitive performance, and well being on the last day of each treatment. Data from the placebo and CPAP assessments were compared.
The mean (SE) objective effective use of CPAP was 2.8 (0.7) hours per night. Significant improvements in symptom score (-1.7 (0.5), p < 0.01), mental flexibility (-14 (5) seconds, p = 0.02), and depression rating (-1.6 (0.8), p = 0.03) on CPAP were observed. However, no significant differences in subjective or objective sleepiness were found. Ten of the 16 patients preferred CPAP and opted to continue with this treatment, although this proportion was non-significant (p > 0.4). The eight patients with best CPAP use showed an additional CPAP related improvement in quality of life (-4.4 (1.8), p = 0.03). Those who complied better with CPAP therapy also had a higher average microarousal frequency (p < 0.01) and apnoea+hypopnoea index (p = 0.02) than the poorer compliers.
The results of this study provide evidence for improvements in symptoms and daytime function for patients with mild SAHS treated with CPAP.
持续气道正压通气（CPAP）是治疗中重度睡眠呼吸暂停/低通气综合征（SAHS）患者的一种有效方法，但患者能从CPAP治疗中获益的最低疾病严重程度尚不清楚。因此开展了一项研究，以调查CPAP是否能改善轻度SAHS患者的症状和日间功能。
连续招募了16例轻度SAHS患者（每小时睡眠时间中呼吸暂停+低通气次数为5.0 - 14.9次，且有两种或更多SAHS症状），参与一项前瞻性安慰剂对照随机交叉试验，以评估CPAP对症状和日间功能的影响。患者分别接受为期四周的安慰剂治疗和四周的CPAP治疗，并在每种治疗的最后一天进行嗜睡、症状、认知能力和幸福感的评估。对安慰剂评估和CPAP评估的数据进行比较。
CPAP的平均（标准误）有效使用时长为每晚2.8（0.7）小时。观察到CPAP治疗后症状评分显著改善（-1.7（0.5），p < 0.01）、心理灵活性提高（-14（5）秒，p = 0.02）以及抑郁评分降低（-1.6（0.8），p = 0.03）。然而，主观或客观嗜睡方面未发现显著差异。16例患者中有10例更喜欢CPAP并选择继续这种治疗，尽管这一比例无统计学意义（p > 0.4）。CPAP使用情况最佳的8例患者在生活质量方面显示出与CPAP相关的额外改善（-4.4（1.8），p = 0.03）。与依从性较差的患者相比，CPAP治疗依从性较好的患者平均微觉醒频率更高（p < 0.01），呼吸暂停+低通气指数也更高（p = 0.02）。
本研究结果为CPAP治疗轻度SAHS患者可改善症状和日间功能提供了证据。
