A DOUBLE-BLIND TRIAL OF NOCTURNAL SUPPLEMENTAL OXYGEN FOR SLEEP DESATURATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE AND A DAYTIME PAO2 ABOVE 60 MM HG
A DOUBLE-BLIND TRIAL OF NOCTURNAL SUPPLEMENTAL OXYGEN FOR SLEEP DESATURATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE AND A DAYTIME PAO2 ABOVE 60 MM HG
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DOI：
10.1164/ajrccm/145.5.1070
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发表时间：
1992-05-01
期刊：
影响因子：
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通讯作者：
COSTARANGOSGALARZA, C
中科院分区：
文献类型：
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作者：
FLETCHER, EC;LUCKETT, RA;COSTARANGOSGALARZA, C
在慢性阻塞性肺病、发作性快速眼动睡眠去饱和和日间PaO2 bbb60 mm Hg患者中，评估了睡眠期间鼻吸氧的疗效。这项为期3年的双盲随机试验在两组夜间睡眠去饱和患者中分别使用鼻吸氧和室内空气。实验地点是一家退伍军人医疗中心的胸科门诊。51例中至重度COPD患者，白天PaO2大于或等于60mmhg: 38例证实REM睡眠去饱和，13例无去饱和。通过浓缩器以3l /min的速度向19例去饱和受试者提供夜间氧气，并通过缺陷浓缩器以3l /min的速度向其余19例去饱和受试者提供室内空气。13例非去饱和患者不进行气体治疗。夜间去饱和器组在睡眠中补充氧气超过36个月，与使用室内空气治疗的去饱和患者（+3.9 mm Hg）相比，肺动脉压明显下降（-3.7 mm Hg）。缺氧的非血管参数，如血红蛋白和红细胞质量，在假手术组和氧气治疗组之间没有差异。去饱和患者的死亡率明显高于非去饱和患者，但在氧治疗和假治疗的去饱和患者之间没有显著差异。我们得出结论，对于白天PaO2高于60 mm Hg的COPD患者，在睡眠期间使用鼻腔补充氧来逆转发作性去饱和，对降低肺动脉压有有益的作用。需要进一步的研究来检验补充氧在降低COPD夜间去饱和患者死亡率方面的有效性，这些患者目前不符合家庭供氧标准。
The efficacy of nasal oxygen during sleep was evaluated in patients with COPD, episodic rapid eye movement sleep desaturation, and a daytime PaO2 > 60 mm Hg. The double-blind, randomized 3-yr trial used nasal oxygen versus room air in two groups of nocturnal sleep desaturating subjects. The setting was the outpatient chest clinic of a Veterans Affairs Medical Center. There were 51 patients with moderate to severe COPD, daytime PaO2 greater-than-or-equal-to 60 mm Hg: 38 with proven REM sleep desaturation and 13 without desaturation. Nocturnal oxygen at 3 L/min was delivered by concentrator to 19 desaturating subjects, and room air at 3 L/min was delivered by defective concentrator to the remaining 19 desaturating subjects. There was no gas therapy for the 13 nondesaturating subjects. The nocturnal desaturator group who received supplemental oxygen during sleep over 36 months showed a significant downward trend in pulmonary artery pressure (-3.7 mm Hg) compared with desaturating patients treated with room air (+3.9 mm Hg). Nonvascular parameters of hypoxia, such as hemoglobin and red blood cell mass, did not differ between the sham- and oxygen-treated groups. Mortality was decidedly higher In the desaturating patients compared with nondesaturating subjects, but there was no significant difference between oxygen- and sham-treated desaturating subjects. We conclude that nasal supplemental oxygen used during sleep to reverse episodic desaturation in COPD patients whose daytime PaO2 is above 60 mm Hg has a beneficial effect in reducing pulmonary artery pressure. Further study Is needed to examine the usefulness of supplemental oxygen in reducing mortality in COPD patients with nocturnal desaturation who do not qualify for home oxygen by current criteria.