自适应伺服通气长期疗效优于持续气道正压通气

波士顿——美国联合专业睡眠学会(APSS)年会上公布的一项研究显示，与持续气道正压通气(CPAP)相比，自适应伺服通气(ASV)长期治疗复杂性睡眠呼吸暂停的疗效更可靠。

这项多中心前瞻性研究由梅奥医院睡眠医学中心的Timothy I. Morgenthaler及其同事进行，旨在评价ASV与CPAP对复杂性睡眠呼吸暂停综合征(CSAS)的长期疗效。该研究纳入66例符合以下标准的患者：多导睡眠检查诊断阻塞性睡眠呼吸暂停、最佳CPAP治疗期间中枢性呼吸暂停指数(CAI)评分≥10、年龄≥18岁且既往未接受过气道正压通气治疗。患者随机接受CPAP(n=33)或ASV(n=33)治疗，两种治疗均调整至最佳设定。患者的平均年龄为59.2岁，平均体重指数(BMI)为35.0 kg/m²，无组间差异。约9%的患者患有充血性心力衰竭，13.6%长期使用阿片。基线时和治疗90天后测定临床和多导睡眠指标。

基线时，平均呼吸暂停低通气指数(AHI)和CAI评分分别为37.7和3.2。第2天晚上调整治疗后，ASV组和CPAP组的AHI评分分别为4.7和14.1，CAI评分分别为1.1和8.8。90天时，ASV组和CPAP组的AHI评分分别为4.4和9.9，CAI评分分别为0.7和4.8。

意向治疗分析显示，ASV组和CPAP组的治疗成功(定义为AHI＜10)率分别为89.7%和64.5%。两组在依从性、Epworth嗜睡量表(ESS)评分变化、睡眠呼吸暂停生活质量指数(SAQLI)评分方面无显著差异。

尽管多导睡眠检查结果显示，ASV组治疗有效的患者显著多于CPAP组，但两组无症状差异。ASV对多导睡眠的改善可能有助于改善其他预后，如在心力衰竭患者中最大抑制潮式呼吸和中枢性睡眠呼吸暂停(CSR-CSA)及改善脑钠肽。

该研究获ResMed资助，后者是该研究中所用ASV设备的生产商。

爱思唯尔  版权所有

By: DIANA MAHONEY, Internal Medicine News Digital Network

BOSTON – Adaptive servoventilation is more reliably effective than continuous positive airway pressure is for the prolonged treatment of complex sleep apnea, a study has shown.

Prior studies have shown that the adaptive ventilatory support method, which continuously monitors and analyzes a patient’s breathing pattern and adds variable amounts of inspiratory pressure support to low levels of background expiratory positive airway pressure as needed, is initially more effective than is continuous positive airway pressure (CPAP) in complex sleep apnea patients. But sustained efficacy over time has not been established, according to Dr. Timothy I. Morgenthaler of the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minn.

"The concern is that residual central breathing events may resolve over time with CPAP therapy, which is less expensive than adaptive servoventilation [ASV] and therefore may be a better option," he said at the annual meeting of the Associated Professional Sleep Societies.

To evaluate the longer-term efficacy of ASV relative to CPAP in individuals with complex sleep apnea syndrome (CSAS), Dr. Morgenthaler and his colleagues conducted a multicenter, prospective trial of 66 patients with CSAS, defined as those meeting the criteria for obstructive sleep apnea on diagnostic polysomnography who also had a central apnea index (CAI) score of 10 or higher while on optimal CPAP. The participants were randomized to treatment with either CPAP (n = 33) or ASV (n = 33), both titrated to optimal settings. Clinical and polysomnographic measures were collected at baseline and after 90 days of therapy, he said.

In addition to having a diagnosis of CSAS, eligible patients were older than 18 years and were naive to positive airway pressure treatment. The mean age of the study participants was 59.2 years, and the mean body mass index was 35.0 kg/m2, with no between-group differences. Additionally, about 9% of the patients had congestive heart failure and 13.6% reported chronic opiate use, Dr. Morgenthaler reported.

At baseline, the mean apnea-hypopnea index (AHI) and CAI scores were 37.7 and 3.2, respectively. After second-night treatment titration, the AHI scores were 4.7 in the ASV group vs. 14.1 in the CPAP group, and the respective CAI scores were 1.1 and 8.8, said Dr. Morgenthaler. At 90 days, the AHI for the ASV group was 4.4, compared with 9.9 for CPAP, and the respective CAI scores were 0.7 and 4.8, he said.

"In the intention-to-treat analysis, treatment was successful [defined as an AHI of less than 10] in 89.7% of the adaptive servoventilation group," while only 64.5% of the CPAP patients attained similar success, Dr. Morgenthaler stated, noting that there were no significant differences between the groups with respect to compliance, Epworth Sleepiness Scale (ESS) changes, or sleep apnea quality of life index (SAQLI) scores.

Although significantly more ASV patients showed evidence of treatment efficacy based on polysomnographic measures than did CPAP patients, "there were no similar symptomatic differences between the groups," Dr. Morgenthaler acknowledged. It is possible, but yet to be determined, that ASV-induced improvements on polysomnography will translate into other positive health outcomes, such as maximal suppression of Cheyne-Stokes respiration and central sleep apnea (CSR-CSA), as well as improvement in brain natriuretic peptide, in patients with heart failure, he said.

Dr. Morgenthaler disclosed that this study was supported by a grant from ResMed, the manufacturer of the ASV device used in the investigation.