The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses
The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses
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DOI：
10.5665/sleep.1580
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发表时间：
2012-01-01
期刊：
影响因子：
5.6
通讯作者：
Tracy, Sharon L.
中科院分区：
文献类型：
--
作者：
Aurora, R. Nisha;Chowdhuri, Susmita;Tracy, Sharon L.
国际睡眠障碍分类第二版(ICSD-2)区分了成人中枢性睡眠呼吸暂停综合征(CSAS)的5种亚型。文献回顾表明，触发中枢性呼吸事件的基本机制有两种：(1)过度换气后中枢性呼吸暂停，可由各种临床条件触发；(2)继发于低换气的中枢性呼吸暂停，已被描述为阿片类药物的使用。治疗慢性阻塞性肺疾病的证据优势支持使用持续气道正压治疗(CPAP)。许多证据来自对CSAS与充血性心力衰竭(CHF)相关的研究，但CSAS的其他亚型似乎也对CPAP有反应。支持CSAS亚型的替代疗法的证据有限。对慢性阻塞性肺疾病的治疗建议总结如下：慢性阻塞性肺疾病合并充血性心力衰竭患者的初始治疗应采用以使呼吸暂停低通气指数(AHI)正常化为目标的CPAP治疗。(标准)夜间氧疗适用于治疗与充血性心力衰竭相关的慢性阻塞性肺疾病。(标准)旨在使呼吸暂停低通气指数(AHI)正常化的自适应伺服呼吸机(ASV)用于治疗与充血性心力衰竭相关的慢性阻塞性肺疾病。(标准)旨在使呼吸暂停低通气指数(AHI)正常化的自发性定时(ST)模式的BPAP疗法，只有在足够的CPAP、ASV和氧疗试验没有反应的情况下，才可以考虑用于治疗与CHF相关的CSAS。(选项)以下疗法的支持证据有限，但在优化标准药物治疗后，如果不能耐受PAP疗法，并且如果伴随密切的临床随访，可以考虑用于治疗与CHF相关的CSAS：乙酰唑胺和茶碱。(可选)正压治疗可考虑用于治疗原发CSAS。(可选)乙酰唑胺支持证据有限，但可考虑用于治疗原发慢性阻塞性肺疾病。只有当患者没有呼吸抑制的潜在危险因素时，才可以考虑使用唑吡坦和三唑仑来治疗原发性CSAS。与终末期肾病相关的慢性阻塞性肺疾病可以考虑以下可能的治疗方案：CPAP、补充氧气、透析期间使用碳酸氢盐缓冲液，以及夜间透析。(选项)
The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. The preponderance of evidence on the treatment of CSAS supports the use of continuous positive airway pressure (CPAP). Much of the evidence comes from investigations on CSAS related to congestive heart failure (CHF), but other subtypes of CSAS appear to respond to CPAP as well. Limited evidence is available to support alternative therapies in CSAS subtypes. The recommendations for treatment of CSAS are summarized as follows:CPAP therapy targeted to normalize the apnea-hypopnea index (AHI) is indicated for the initial treatment of CSAS related to CHF. (STANDARD)Nocturnal oxygen therapy is indicated for the treatment of CSAS related to CHF. (STANDARD)Adaptive Servo-Ventilation (ASV) targeted to normalize the apnea-hypopnea index (AHI) is indicated for the treatment of CSAS related to CHF. (STANDARD)BPAP therapy in a spontaneous timed (ST) mode targeted to normalize the apnea-hypopnea index (AHI) may be considered for the treatment of CSAS related to CHF only if there is no response to adequate trials of CPAP, ASV, and oxygen therapies. (OPTION)The following therapies have limited supporting evidence but may be considered for the treatment of CSAS related to CHF after optimization of standard medical therapy, if PAP therapy is not tolerated, and if accompanied by close clinical follow-up: acetazolamide and theophylline. (OPTION)Positive airway pressure therapy may be considered for the treatment of primary CSAS. (OPTION)Acetazolamide has limited supporting evidence but may be considered for the treatment of primary CSAS. (OPTION)The use of zolpidem and triazolam may be considered for the treatment of primary CSAS only if the patient does not have underlying risk factors for respiratory depression. (OPTION)The following possible treatment options for CSAS related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (OPTION)