High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study
High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study
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DOI：
10.1038/s41598-020-65335-z
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发表时间：
2020-05-22
影响因子：
4.6
通讯作者：
Chen, Chung-Yao
中科院分区：
文献类型：
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作者：
Ho, Chien-Hui;Chen, Chia-Ling;Chen, Chung-Yao
阻塞性睡眠呼吸暂停（OSA）与中风复发和死亡风险增加相关。吞咽困难中风患者使用的鼻胃管可能会因漏气而干扰经鼻持续气道正压通气 (CPAP)。本研究评估了高流量鼻插管 (HFNC) 治疗经鼻胃管插管的中风患者 OSA 的效果和短期耐受性。 HFNC 滴定研究是在接受鼻胃插管和 OSA 的急性缺血性中风后患者中进行的。然后，参与者在病房接受为期一周的 HFNC 治疗。 11 名参与者（8 名男性）完成了滴定研究，他们都是中位年龄 72 岁（IQR 67-82）岁、体重指数为 23.5（IQR 22.0-26.6）的老年人。流速高达 50 至 60L/min 的 HFNC 治疗显着降低了呼吸暂停低通气指数，从 52.0 次事件/小时 (IQR 29.9-61.9) 降至 26.5 次事件/小时 (IQR 3.3-34.6)，总唤醒指数从 34.6 (IQR 18.6-42.3) 降至 15.0 (IQR)。 10.3-25.4）。氧饱和度指数也从 53.0 事件/小时 (IQR 37.0-72.8) 显着降低至 16.2 事件/小时 (IQR 0.8-20.1)，同时最低 SpO(2) 水平显着改善。最后，只有 3 名参与者在一周的治疗期间能够耐受 50 至 60 升/分钟的流量。总之，治疗流量下的 HFNC 治疗可有效降低经鼻胃管插管的急性缺血性中风后患者 OSA 的严重程度。由于接受程度不高，HFNC 可能是一种临时治疗选择，建议在拔除鼻胃管后进行 CPAP 治疗。
Obstructive sleep apnea (OSA) is associated with increasing risk of recurrent stroke and mortality. Nasogastric tubes used by dysphagic stroke patients may interfere with nasal continuous positive airway pressure (CPAP) due to air leakage. This study was evaluated the effects and short-term tolerability of high-flow nasal cannula (HFNC) therapy for OSA in stroke patients with nasogastric intubation. The HFNC titration study was performed in post-acute ischemic stroke patients with nasogastric intubation and OSA. Then, participants were treated with HFNC therapy in the ward for one week. Eleven participants (eight males) who were all elderly with a median age of 72 (IQR 67-82) years and a body mass index of 23.5 (IQR 22.0-26.6) completed the titration study. The HFNC therapy at a flow rate up to 50 similar to 60L/min significantly decreased the apnea-hypopnea index from 52.0 events/h (IQR 29.9-61.9) to 26.5 events/h (IQR 3.3-34.6) and the total arousal index from 34.6 (IQR 18.6-42.3) to 15.0 (IQR 10.3-25.4). The oxygen desaturation index was also significantly decreased from 53.0 events/h (IQR 37.0-72.8) to 16.2 events/h (IQR 0.8-20.1), accompanied by a significant improvement in the minimum SpO(2) level. Finally, only three participants tolerated flow rates of 50 similar to 60L/minute in one-week treatment period. Conclusively, HFNC therapy at therapeutic flow rate is effective at reducing the OSA severity in post-acute ischemic stroke patients with nasogastric intubation. Owing to the suboptimal acceptance, HFNC might be a temporary treatment option, and CPAP therapy is suggested after the nasogastric tube is removed.