Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome.
Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome.
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DOI：
10.5665/sleep.2460
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发表时间：
2013-03
期刊：
影响因子：
5.6
通讯作者：
L. Young;Zachary H Taxin;R. Norman;J. Walsleben;D. Rapoport;I. Ayappa
中科院分区：
文献类型：
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作者：
L. Young;Zachary H Taxin;R. Norman;J. Walsleben;D. Rapoport;I. Ayappa
背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者，即使是那些一般接受CPAP治疗的患者，也经常间歇性地停止CPAP治疗。研究目的探讨停用CPAP对不同严重程度OSAHS患者的睡眠、睡眠呼吸紊乱(SDB)和日间功能的影响。患者和干预对42例OSAHS(AHI4%=45.2±35.5次/h治疗前)患者在停用CPAP的第二天晚上进行评估。分别在CPAP治疗前、CPAP治疗前和CPAP停药后评估患者的睡眠结构、SDB指数和主客观日间功能。对整个组和轻/中度(AHI4%30/h，n=20)SDB亚组的CPAP治疗前后进行比较。结果总体而言，对于轻/中度受试者，停用CPAP时SDB指数恢复到治疗前的值，但呼吸暂停较少，低呼吸/呼吸次数较多。重度SDB患者停用CPAP时，事件发生频率(AI、AHI4%、RDI)较低，氧减饱和度改善。在SDB严重程度中，与治疗前相比，睡眠结构在CPAP停药时显示出更低的%快速眼动(15.6%比12.9%，P=0.009)。斯坦福嗜睡评分、MSLT和PVT测量在治疗前和停用CPAP之间没有显著差异。结论在广泛的SDB严重程度上，停用CPAP可导致SDB复发，尽管氧减饱和度较轻。主观/客观白天功能恢复到治疗前水平。CPAP停药后的睡眠结构改变(急性SDB)可能反映了与慢性SDB治疗前相比睡眠压力的降低。我们的数据表明，在轻度和重度OSAHS受试者中，即使是短暂地停用CPAP也会产生有害影响。引文Young LR；Taxin ZH；Norman RG；Walsleben JA；Rapoport DM；Ayappa I.轻度和严重阻塞性睡眠呼吸暂停/低呼吸综合征患者对CPAP停用的反应。《睡眠2013》；36(3)：405-412。
BACKGROUND Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS), even those generally compliant with CPAP therapy, often intermittently discontinue CPAP. STUDY OBJECTIVE Examine the impact of CPAP withdrawal on sleep, sleep disordered breathing (SDB), and daytime function in subjects with varying severity of OSAHS. PATIENTS AND INTERVENTIONS Forty-two subjects (26M/16 F) with OSAHS (AHI4% = 45.2 ± 35.5/h pretreatment) on CPAP for 4 months were evaluated on the second night of CPAP withdrawal. Sleep architecture, SDB indices, and subjective/objective daytime function were assessed pretreatment, on CPAP therapy, and after CPAP withdrawal. Comparisons were made between pretreatment and CPAP withdrawal for the entire group, and for subgroups of mild/moderate (AHI4% 30/h, n = 20) SDB. RESULTS Overall, and for mild/moderate subjects, SDB indices returned to pretreatment values on CPAP withdrawal but with fewer apneas and more hypopneas/RERAs. For severe SDB, the event frequency (AI, AHI4%, and RDI) was lower and O2 desaturation was improved on CPAP withdrawal. Across SDB severity, sleep architecture showed lower %REM (15.6% vs 12.9%, P = 0.009) on the CPAP withdrawal compared to pretreatment. Stanford Sleepiness Score, MSLT, and PVT measures were not significantly different between pretreatment and CPAP withdrawal. CONCLUSIONS Over a wide range of SDB severity CPAP withdrawal results in recurrence of SDB, albeit with less severe O2 desaturation. Subjective/objective daytime function returned to pretreatment levels. Sleep architecture changes on CPAP withdrawal (acute SDB) may reflect reduced sleep pressure compared to pretreatment chronic SDB. Our data suggest detrimental effects of even brief withdrawal of CPAP in subjects with both mild and severe OSAHS. CITATION Young LR; Taxin ZH; Norman RG; Walsleben JA; Rapoport DM; Ayappa I. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome. SLEEP 2013;36(3):405-412.