Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes
Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes
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DOI：
10.1378/chest.07-1715
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发表时间：
2007-12-01
期刊：
影响因子：
9.6
通讯作者：
Morgenthaler, Timothy I.
中科院分区：
文献类型：
--
作者：
Allam, Joanne Shirine;Olson, Eric J.;Morgenthaler, Timothy I.
背景：复杂睡眠呼吸暂停综合征(CompSAS)是通过混合或阻塞性事件与中枢性呼吸暂停同时发生而被识别的，后者主要表现为暴露于持续正压通气(CPAP)。适应性伺服通气(ASV)治疗COMPSAS或中枢性睡眠呼吸暂停(CSA)综合征已成为一种选择，但目前尚无大量文献描述ASV的应用和疗效。方法：对梅奥临床睡眠中心接受ASV多导睡眠监测的100例患者进行回顾性分析。结果：ASV滴定适用于CompSAS(63%)、CSA(22%)或CSA/Cheyne Stokes呼吸模式(15%)。诊断睡眠呼吸暂停低通气指数(AHI)的中位数为每小时48次(范围24至62)。使用CPAP后，阻塞性呼吸暂停减少，但中枢性呼吸暂停的出现将呼吸暂停指数维持在每小时31次(范围为17至47次)[p=0.02]。当双水平正压呼吸处于自发模式时，AHI与基线相比有恶化的趋势，中位数为每小时75次事件(范围为46至111次)[p=0.055]。采用备份率的BPAP将呼吸暂停指数提高到每小时15次(范围为11至31次)[p=0.002]。与基线和CPAP(P<；0.0001)相比，ASV的使用显著提高了AH1，平均每小时发生5次事件(范围从1到11)。ASV还导致快速眼动睡眠比基线和CPAP增加(分别为18%比12%和10%；p<；0.0001)。总体而言，患者对ASV治疗的反应平均为每小时10个事件。在所联系的44名成功随访的患者中，32名患者报告睡眠质量有所改善。结论：ASV设备似乎是治疗对CPAP耐药的CompSAS和CSA综合征的有效方法。
Background: Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV.Methods: Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center.Results: ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive apneas decreased, but the appearance of central apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AH1 to a mean of 5 events per hour (range, I to 11) vs baseline and vs CPAP (p < 0.0001). ASV also resulted in an increase in rapid eye movement sleep vs baseline and CPAP (18% vs 12% and 10%, respectively; p < 0.0001). Overall, 64 patients responded to the ASV treatment with a mean AH1 < 10 events per hour. Of the 44 successful survey follow-up patients contacted, 32 patients reported some improvement in sleep quality.Conclusion: The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.