EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON DAYTIME FUNCTION IN SLEEP APNOEA/HYPOPNOEA SYNDROME
EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON DAYTIME FUNCTION IN SLEEP APNOEA/HYPOPNOEA SYNDROME
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DOI：
10.1016/s0140-6736(94)91522-9
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发表时间：
1994-03-05
期刊：
影响因子：
168.9
通讯作者：
DOUGLAS, NJ
中科院分区：
文献类型：
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作者：
ENGLEMAN, HM;MARTIN, SE;DOUGLAS, NJ
持续气道正压通气（CPAP）是睡眠呼吸暂停/低通气综合征（SAHS）的首选治疗方法;通常用于改善日间认知功能、情绪和嗜睡。然而，其有效性尚未得到对照试验的验证。我们对32例SAHS患者进行了一项随机、安慰剂对照、交叉研究，研究对象为白天嗜睡、症状、认知功能和情绪，患者平均每小时睡眠呼吸暂停和呼吸不足的频率为28次（范围7-129次），患者分别接受4周的CPAP和口服安慰剂治疗，安慰剂被告知可以改善睡眠期间的上气道肌肉功能。每次治疗最后一天的评估包括多次睡眠潜伏期测试和症状评分、情绪特征和认知表现测试。与安慰剂治疗期间相比，CPAP治疗期间患者的日间嗜睡明显减少（平均睡眠潜伏期7.2 [SE 0.7] vs 6.1 [0.7] min，p = 0.03）。CPAP也改善了症状评分（2.1 [0.2] vs 4.3 [0.3]，p < 0.001），情绪（多项测量P < 0.05）和认知表现，显示警惕性提高（转向清除“驾驶”测试中遇到障碍物76 [5] vs 81 [6]，p < 0.01），心理灵活性（追踪B时间66 [5] vs 75 [5] vs p < 0.05）和注意力（p < 0.05）。客观监测的CPAP使用平均每晚仅为3.4（0.4）小时，但该研究提供了即使在CPAP依从性如此低的情况下认知表现改善的证据。
Continuous positive airway pressure (CPAP) is the treatment of choice for the sleep apnoea/hypopnoea syndrome (SAHS); it is usually given with the aim of improving daytime cognitive function, mood, and sleepiness. However, its efficacy has not been validated by controlled trials. We have carried out a randomised, placebo-controlled, crossover study of objective daytime sleepiness, symptoms, cognitive function, and mood in a consecutive series of 32 SAHS patients with a median apnoea plus hypopnoea frequency of 28 (range 7-129) per hour slept.Patients were treated with 4 weeks each of CPAP and an oral placebo, which they were told might improve upper airway muscle function during sleep. Assessments on the last day of each treatment included a multiple sleep latency test and tests of symptom scores, mood profiles, and cognitive performance. The patients had significantly less daytime sleepiness on CPAP than during the placebo period (mean sleep latency 7.2 [SE 0.7] vs 6.1 [0.7] min, p = 0.03). There were also improvements with CPAP in symptom ratings (2.1 [0.2] vs 4.3 [0.3], p < 0.001), mood (p < 0.05 for several measures), and cognitive performance, which showed improved vigilance (obstacles hit in Steer Clear ''driving'' test 76 [5] vs 81 [6], p < 0.01), mental flexibility (trail-making B time 66 [5] vs 75 [5] vs p < 0.05), and attention (p < 0.05).Objectively monitored CPAP use averaged only 3.4 (0.4) hours per night, but this study provides evidence of improved cognitive performance even at this low revel of CPAP compliance.