A Novel Adaptive Servoventilation (ASVAuto) for the Treatment of Central Sleep Apnea Associated with Chronic Use of Opioids
A Novel Adaptive Servoventilation (ASVAuto) for the Treatment of Central Sleep Apnea Associated with Chronic Use of Opioids
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DOI：
10.5664/jcsm.3954
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发表时间：
2014-01-01
影响因子：
4.3
通讯作者：
Kushida, Clete
中科院分区：
文献类型：
--
作者：
Cao, Michelle;Cardell, Chia-Yu;Kushida, Clete
研究目的：比较新型分钟通气量目标自适应伺服通气 (ASVAuto) 结合自动滴定呼气气道正压 (EPAP) 与双水平辅助呼吸频率 (bilevel-ST) 治疗与长期使用阿片类药物相关的中枢性睡眠呼吸暂停 (CSA) 患者的疗效和患者舒适度。方法：前瞻性、随机、交叉多导睡眠图 (PSG) 研究。连续 18 名患者（年龄 >= 18 岁）接受阿片类药物治疗（>= 6 个月），并在夜间睡眠研究或气道正压 (PAP) 滴定期间诊断出患有 CSA（中枢性呼吸暂停指数 [CAI] >= 5）的睡眠呼吸障碍患者，并入组接受 2 项 PSG 研究，一项采用 ASVAuto，另一项采用双水平 ST。每次 PSG 后患者完成 2 份问卷；患者满意度调查问卷和 PAP 舒适度调查问卷后的早晨。结果：患者的平均年龄为 52.9 +/- 15.3 岁。随机分组前的 PSG 显示呼吸暂停低通气指数 (AHI) 为 50.3 +/- 22.2，CAI 为 13.0 +/- 18.7。使用 ASVAuto 与 bilevel-ST 进行滴定表明 AHI 和 CAI 存在显着差异。 ASVAuto 的 AHI 和 CAI 显着低于双水平 ST（分别为 2.5 +/- 3.5 与 16.3 +/- 20.9 [p = 0.0005]，以及 0.4 +/- 0.8 与 9.4 +/- 18.8 [p = 0.0002]）。使用 ASVAuto 的患者呼吸参数正常化率为 83.3%，而使用 bilevel-ST 的患者呼吸参数正常化率为 33.3%。根据晨后患者满意度调查问卷的评分，患者在 ASVAuto 上感觉比双水平 ST 更清醒和警觉 (p = 0.0337)。结论：对于治疗与慢性阿片类药物相关的 CSA，ASVAuto 明显比双水平 ST 更有效。
Study Objectives: To compare the efficacy and patient comfort of a new mode of minute ventilation-targeted adaptive servoventilation (ASVAuto) with auto-titrating expiratory positive airway pressure (EPAP) versus bilevel with back-up respiratory rate (bilevel-ST) in patients with central sleep apnea (CSA) associated with chronic use of opioid medications.Methods: Prospective, randomized, crossover polysomnography (PSG) study. Eighteen consecutive patients (age >= 18 years) who had been receiving opioid therapy (>= 6 months), and had sleep disordered breathing with CSA (central apnea index [CAI] >= 5) diagnosed during an overnight sleep study or positive airway pressure (PAP) titration were enrolled to undergo 2 PSG studies-one with ASVAuto and one with bilevel-ST. Patients completed 2 questionnaires after each PSG; Morning After Patient Satisfaction Questionnaire and PAP Comfort Questionnaire.Results: Patients had a mean age of 52.9 +/- 15.3 years. PSG prior to randomization showed an apnea hypopnea index (AHI) of 50.3 +/- 22.2 and CAI of 13.0 +/- 18.7. Titration with ASVAuto versus bilevel-ST showed that there were significant differences with respect to AHI and CAI. The AHI and CAI were significantly lower on ASVAuto than bilevel-ST (2.5 +/- 3.5 versus 16.3 +/- 20.9 [p = 0.0005], and 0.4 +/- 0.8 versus 9.4 +/- 18.8 [p = 0.0002], respectively). Respiratory parameters were normalized in 83.3% of patients on ASVAuto versus 33.3% on bilevel-ST. Patients felt more awake and alert on ASVAuto than bilevel-ST based on scores from Morning After Patient Satisfaction Questionnaire (p = 0.0337).Conclusions: The ASVAuto was significantly more effective than bilevel-ST for the treatment of CSA associated with chronic opioid use.