自動壓力模式與固定壓力模式持續氣道正壓通氣治療阻塞性睡眠呼吸暫停綜合征療效的系統評價_《中國循證醫學雜志》

作者：

許婷 ,  李濤平 , 冼樂武 , 李丹青 , 王媛媛

南方醫科大學南方醫院呼吸睡眠中心（廣州?510515）;

關鍵詞：

睡眠呼吸暫停綜合征持續氣道正壓通氣系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20110120

視頻：

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目的　系統評價自動壓力模式持續氣道正壓通氣（Auto-CPAP）與固定壓力模式持續氣道正壓通氣（Fixed-CPAP）治療阻塞性睡眠呼吸暫停綜合征（OSAS）的療效。
方法　計算機檢索PubMed（1990～2010）、Springer Link（1995～2010）、CNKI（1990～2010）、萬方數據庫（1995～2010）和學術搜索引擎（1994～2010），查找公開發表的Auto-CPAP與Fixed-CPAP比較治療OSAS的隨機對照試驗（RCT），并查找相關會議文獻及詢問本領域專家獲取相關資料。由兩名評價者按納入排除標準獨立篩選試驗、提取資料和評價方法學質量，而后采用RevMan 5.0軟件進行Meta分析。
結果　共納入11個RCT，合計327例患者。Meta分析結果顯示：與Fixed-CPAP組相比，Auto-CPAP組平均有效治療壓力更低［WMD= –1.79，95%CI（–3.39，–0.20）］，治療依從性更好［WMD=0.43，95%CI（0.30，0.56）］，但AHI值［WMD=1.17，95%CI（0.25，2.08）］和ESS值［WMD=0.88，95%CI（0.42，1.33）］更高；在病人主觀喜好上，兩組差異無統計學意義［OR=2.06，95%CI（0.46，9.10）］。
結論　Auto-CPAP能明顯降低OSAS患者平均治療壓力，提高其治療依從性，但在降低AHI值與ESS方面卻不及Fixed-CPAP。因研究質量和研究樣本的局限性，上述結論有待設計嚴謹的大樣本隨機對照試驗加以驗證。

引用本文： 許婷,李濤平,冼樂武,李丹青,王媛媛. 自動壓力模式與固定壓力模式持續氣道正壓通氣治療阻塞性睡眠呼吸暫停綜合征療效的系統評價. 中國循證醫學雜志, 2011, 11(6): 687-692. doi: 10.7507/1672-2531.20110120 復制

1.	1 Young T, Palta M, Dempsey J, et al . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl Med , 1993, 328(17): 1230-1235.
2.	2 Series F, Marc I. Importance of sleep stage-and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy. Eur Respir J , 2001, 18(1): 170-175.
3.	3 Teschler H, Berthon-Jones M, Thompson AB, et al . Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med , 1996, 154(3): 734-740.
4.	4 Marrone O, Insalaco G, Bonsignore MR, et al . Sleep structure correlates of continuous positive airway pressure variations during application of an autotitrating continuous positive airway pressure machine in patients with obstructive sleep apnea syndrome. Chest , 2002, 121(3): 759-767.
5.	5 Najib TA, Paltel SR, Malhotra A, et al . Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep , 2004, 27(2): 249-253.
6.	6 Mulgrew AT, Fox N, Ayas NT, et al . Diagnosis and initial management of obstructive sleep apnea without polysomnography. Ann Intern Med , 2007, 146(3): 157-166.
7.	7 Ficker JH, Fuchs FS, Wiest GH, et al . An auto-continuous positive airway pressure device controlled exclusively by the forced oscillation technique. Eur Respir J , 2000, 16(5): 914-920.
8.	8 Ficker JH, Wiest GH, Lehnert G, et al . Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea. Thorax , 1998, 53(8): 643-648.
9.	9 Mulgrew AT, Cheema R, Fleetham J, et al . Efficacy and patient satisfaction with autoajusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath , 2007, 11(1): 31-37.
10.	10 Nolan GM, Ryan S, O’connor TM, et al . Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. Eur Respir J , 2006, 28(1): 159-164.
11.	11 Hertegonne KB, Proot PM, Pauwels RA, et al . Comfort and pressure profiles of two auto-adjustable positive airway pressure devices: a technical report. Respir Med , 2003, 97(8): 903-908.
12.	12 Pevernagie DA, Proot PM, Hertegonne KB, et al . Efficacy of flow-vs impedance-guided autoadjustable continuous positive airway pressure: a randomized cross-over trial. Chest , 2004, 126(1): 25-30.
13.	13 Craig Hukins F. Comparative study of autotitrating and fixed-pressure CPAP in thome: a randomized, single-blind crossover trial. Sleep , 2004, 27(8): 1512-1517.
14.	14 David W, Hudgel MD, Caroline Fung BS, et al . A long-term randomized cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep , 2000, 23(5).
15.	15 Geraldine M, Doherty LS, Mc Nicholas WT, et al . Auto-adjusting vesus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea. Sleep , 2007, 32(2): 189-194.
16.	16 Teschler H, Wessendorf TE, Farhat AA, et al . Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea. Eur Respir J , 2000, 15(6): 990-995.
17.	17 Marie-pia D, Grillier-Lanoir V, Levy P, et al . Constant vs automatic continuous positive airway pressure therapy. Chest , 2000, 118(4): 1010-1017.
18.	18 Syed F, Love L, Burt H, et al . A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment Of obstructive sleep apnea-hypopnea. Respir Med , 2004, 98(4): 330-333.
19.	19 Wolfgang G, AnduleIt N, Richter K, et al . Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study. Respir , 2008, 75(2): 163-169.
20.	20 Kin W, Chan WC, Choo KL, et al . A randomized cross-over study of auto-continuous positive airway pressure versue fixed-continuous positive airway pressure in patients with obstructive sleep apnoea. Respir , 2008, 13(1): 79-86.
21.	21 Vincenzo P, Aiolfi S, Costantino G, et al . Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest , 2007, 131(5): 1393-1399.
22.	22 Fietze I, Glos M, Moebus I, et al . Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea. Respir , 2007, 74(3): 279-286.
23.	23 Wonfied J, Schraeder O, Galetke W, et al . Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med , 2001, 163(3): 652-657.
24.	24 American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure in sleep apnea syndrome. Am J Respir Crit Care Med , 1994, 150(6): 1738-1745.
25.	26 Meardle N, Oeverevx G, Heidaraejad H, et al . Long- term ues of CPAP therayp for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med , 1999, 153: 1108-1114.
26.	27 Series F. Is treatment of obstrustive sleep apnea syndrome with auto-NCPAP useful? Sleep , 2000, 23(4): S163-165.
27.	葉寰, 郭兮恒. 阻塞性睡眠呼吸暫停低通氣綜合征患者睡眠過程中呼吸力學的變化. 中華結核和呼吸雜志, 2008, 31(1): 26-31.
28.	夏淑東, 黃席珍. 自動調節持續氣道正壓通氣系統在阻塞性睡呼吸暫停低通氣綜合征診治中的應用. 國外醫學呼吸系統分冊, 2004, 24(4): 210-213.

1. 1 Young T, Palta M, Dempsey J, et al . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl Med , 1993, 328(17): 1230-1235.
2. 2 Series F, Marc I. Importance of sleep stage-and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy. Eur Respir J , 2001, 18(1): 170-175.
3. 3 Teschler H, Berthon-Jones M, Thompson AB, et al . Automated continuous positive airway pressure titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med , 1996, 154(3): 734-740.
4. 4 Marrone O, Insalaco G, Bonsignore MR, et al . Sleep structure correlates of continuous positive airway pressure variations during application of an autotitrating continuous positive airway pressure machine in patients with obstructive sleep apnea syndrome. Chest , 2002, 121(3): 759-767.
5. 5 Najib TA, Paltel SR, Malhotra A, et al . Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep , 2004, 27(2): 249-253.
6. 6 Mulgrew AT, Fox N, Ayas NT, et al . Diagnosis and initial management of obstructive sleep apnea without polysomnography. Ann Intern Med , 2007, 146(3): 157-166.
7. 7 Ficker JH, Fuchs FS, Wiest GH, et al . An auto-continuous positive airway pressure device controlled exclusively by the forced oscillation technique. Eur Respir J , 2000, 16(5): 914-920.
8. 8 Ficker JH, Wiest GH, Lehnert G, et al . Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea. Thorax , 1998, 53(8): 643-648.
9. 9 Mulgrew AT, Cheema R, Fleetham J, et al . Efficacy and patient satisfaction with autoajusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath , 2007, 11(1): 31-37.
10. 10 Nolan GM, Ryan S, O’connor TM, et al . Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. Eur Respir J , 2006, 28(1): 159-164.
11. 11 Hertegonne KB, Proot PM, Pauwels RA, et al . Comfort and pressure profiles of two auto-adjustable positive airway pressure devices: a technical report. Respir Med , 2003, 97(8): 903-908.
12. 12 Pevernagie DA, Proot PM, Hertegonne KB, et al . Efficacy of flow-vs impedance-guided autoadjustable continuous positive airway pressure: a randomized cross-over trial. Chest , 2004, 126(1): 25-30.
13. 13 Craig Hukins F. Comparative study of autotitrating and fixed-pressure CPAP in thome: a randomized, single-blind crossover trial. Sleep , 2004, 27(8): 1512-1517.
14. 14 David W, Hudgel MD, Caroline Fung BS, et al . A long-term randomized cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep , 2000, 23(5).
15. 15 Geraldine M, Doherty LS, Mc Nicholas WT, et al . Auto-adjusting vesus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea. Sleep , 2007, 32(2): 189-194.
16. 16 Teschler H, Wessendorf TE, Farhat AA, et al . Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea. Eur Respir J , 2000, 15(6): 990-995.
17. 17 Marie-pia D, Grillier-Lanoir V, Levy P, et al . Constant vs automatic continuous positive airway pressure therapy. Chest , 2000, 118(4): 1010-1017.
18. 18 Syed F, Love L, Burt H, et al . A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment Of obstructive sleep apnea-hypopnea. Respir Med , 2004, 98(4): 330-333.
19. 19 Wolfgang G, AnduleIt N, Richter K, et al . Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study. Respir , 2008, 75(2): 163-169.
20. 20 Kin W, Chan WC, Choo KL, et al . A randomized cross-over study of auto-continuous positive airway pressure versue fixed-continuous positive airway pressure in patients with obstructive sleep apnoea. Respir , 2008, 13(1): 79-86.
21. 21 Vincenzo P, Aiolfi S, Costantino G, et al . Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest , 2007, 131(5): 1393-1399.
22. 22 Fietze I, Glos M, Moebus I, et al . Automatic pressure titration with APAP is as effective as manual titration with CPAP in patients with obstructive sleep apnea. Respir , 2007, 74(3): 279-286.
23. 23 Wonfied J, Schraeder O, Galetke W, et al . Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med , 2001, 163(3): 652-657.
24. 24 American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure in sleep apnea syndrome. Am J Respir Crit Care Med , 1994, 150(6): 1738-1745.
25. 26 Meardle N, Oeverevx G, Heidaraejad H, et al . Long- term ues of CPAP therayp for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med , 1999, 153: 1108-1114.
26. 27 Series F. Is treatment of obstrustive sleep apnea syndrome with auto-NCPAP useful? Sleep , 2000, 23(4): S163-165.
27. 葉寰, 郭兮恒. 阻塞性睡眠呼吸暫停低通氣綜合征患者睡眠過程中呼吸力學的變化. 中華結核和呼吸雜志, 2008, 31(1): 26-31.
28. 夏淑東, 黃席珍. 自動調節持續氣道正壓通氣系統在阻塞性睡呼吸暫停低通氣綜合征診治中的應用. 國外醫學呼吸系統分冊, 2004, 24(4): 210-213.

《中國循證醫學雜志》

自動壓力模式與固定壓力模式持續氣道正壓通氣治療阻塞性睡眠呼吸暫停綜合征療效的系統評價

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《中國循證醫學雜志》

自動壓力模式與固定壓力模式持續氣道正壓通氣治療阻塞性睡眠呼吸暫停綜合征療效的系統評價

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