Airway PressureWord格式.docx
- 文档编号:17174855
- 上传时间:2022-11-28
- 格式:DOCX
- 页数:11
- 大小:55.94KB
Airway PressureWord格式.docx
《Airway PressureWord格式.docx》由会员分享,可在线阅读,更多相关《Airway PressureWord格式.docx(11页珍藏版)》请在冰豆网上搜索。
1.*FromPulmonaryandCriticalCareMedicine(Drs.TawkandKinasewitz),UniversityofOklahomaHealthSciencesCenter;
andLynnInstituteSleepLaboratory(Drs.GoodrichandOrr),LynnHealthScienceInstitute,OklahomaCity,OK.
Abstract
Studyobjectives:
Patientswithobstructivesleepapnea(OSA)haveaveryhighincidenceofgastroesophagealreflux(GER).Previousstudieshaveshownthattheuseofcontinuouspositiveairwaypressure(CPAP)reducesthefrequencyofrefluxevents,butthesestudiesonlyassessedtheeffectofasinglenightoftreatment.Theaimofthisstudywastoassesstheeffectof1weekofCPAPtreatmentonrefluxinpatientswithOSAandGER.
Design:
SixteenpatientswithOSAandGERwererecruited.Polysomnographyfollowedby24-h,continuousesophagealpHmonitoringwereperformedatbaseline.Patientswithanapnea-hypopneaindex(AHI)>
20/hand24-hacidcontacttime(ACT)ofatleast6%wereincluded.Aspartofthepolysomnography-qualifyingevaluation,allpatientsunderwentCPAPtitrationtoreducetheAHIto<
10/h.PatientswerethensenthomereceivingnasalCPAPfor1week;
after1week,esophagealpHmonitoringwasrepeatedwhilereceivingCPAP.
Measurementsandresults:
TheAHIfellfrom63.3±
38.5to3.2±
2.2/h(mean±
SD)[p<
0.001].TotalACTfellfrom13.9±
11.6to5.6±
2.7%(p<
0.001).TheuprightACTwasreducedfrom12.4±
6.8to6.8±
3.8%(p=0.01),andthesupine(duringthesleepinginterval)ACTwasreducedfrom16.3±
18.8to3.8±
7.6%(p<
0.01).Eighty-onepercentofthepatientshadareductioninsupineACTtowithinthenormalrange(<
4%).
Conclusions:
InOSApatientswithsignificantheartburncomplaints,CPAPwouldappeartobeanefficaciousapproachtothetreatmentofbothdisorders.
∙continuouspositiveairwaypressure
∙gastroesophagealrefluxdisease
∙obstructivesleepapnea
Obstructivesleepapnea(OSA)isacommonabnormality,occurringinapproximately4%ofadultmenand2%ofadultwomen.1Theincidenceriseswithobesityandincreasingage.2Severalstudieshaveexaminedtherelationshipbetweenactualobstructiveapneiceventsandtheoccurrenceofgastroesophagealreflux(GER).Inonestudy,380%ofthepatientswithOSAhadabnormalesophagealacidcontacttime(ACT)with>
4%oftheACTspentatpH<
4.Continuouspositiveairwaypressure(CPAP)deliveredviaanasalorfullfacemaskisthecornerstoneofOSAtherapy.CPAPisthoughttoworkbystentingtheupperairwayopenandpreventingitscollapseduringsleep.Previousreports456intheliteraturehaveindicatedthattheacuteadministrationofCPAPreducestheoccurrenceofGERinpatientswithOSA.However,thesestudiesevaluatedonlyanacuteresponseforasinglenightofCPAPtreatment,andthepersistenceofthisresponsehasneverbeenevaluated.WehypothesizedthatthebeneficialeffectofCPAPtherapyonGERinOSApatientswouldbemaintainedifCPAPusewerecontinued.Toexaminethishypothesis,weassessedtheeffectof1weekofCPAPtherapyonnocturnalanddaytimeesophagealrefluxinpatientswithdocumentedmoderate-to-severeOSAandGER.
PreviousSectionNextSection
MaterialsandMethods
Subjects
TheprotocolwasreviewedandapprovedbytheInstitutionalReviewBoardatTheUniversityofOklahomaHealthSciencesCenter.Appropriateinformedconsentwasobtainedfromallpatients.Patientswereidentifiedaslikelytohavesleepapneabasedonclinicalcriteriaincludingloudsnoring,interruptedsleepatnight,andexcessivedaytimesleepiness.Patientswererequiredtohavesymptomsofrefluxforatleast4daysaweek,andawakeningfromsleepwithheartburnatleastonceaweek.ThestudydesignisillustratedinFigure1.
BaselineStudy
Allpatientsunderwentinitialpolysomnographytodeterminethepresenceofabaselinerateofobstructiveeventsdefinedasanapnea-hypopneaindex(AHI)ofatleast20eventsperhour.Thispolysomnographywasperformedasastandardsplit-nightstudyduringwhichthepatientwasmonitoredforaminimumof2hofsleeptodeterminethebaselineAHI.ThiswasfollowedbyaCPAPtitrationtoreducetheobstructiveeventsto<
10/h.Onthedayfollowingthesleepstudy,patientsunderwenta24-hesophagealpHevaluationstartingat4pmasdescribedbelow.Allpatientswereaskedtostoptheirhistaminetype-2blockersand/orproton-pumpinhibitorsforaweekpriortoenrollmentandforthedurationofthestudy.
Intervention
PatientswithanAHI>
20/handanesophagealACTofatleast6%weresenthomewithaCPAPmachineafterinstructioninthesetupanduseoftheequipment.Theseindividualsthenreceived1weekofCPAPtreatmentattheoptimaltherapeuticlevelasdeterminedintheinitialpolysomnography.
Follow-upEvaluation:
Afterapproximately7nightsofCPAPtreatment,repeat24-hesophagealpHmonitoringandpolysomnographywereperformed(Fig1).ThisevaluationoccurredwithCPAPtreatmentandconcomitantesophagealpHmonitoring.Again,thepHstudybeganat4pmonthenightofpolysomnographyforconsistency.
Polysomnography
PolysomnographyincludedastandardEEG,electrooculogram,andsubmentalelectromyogrammonitoringforsleepstaging.Respirationsweremonitoredusingchestandabdominalimpedanceplethysmography.Airflowwasassessedwithanasalpressurecannula.Arterialoxygensaturationwasmonitoredwithcontinuouspulseoximetry.HeartrateandrhythmwererecordedandmonitoredwithcontinuousECG.Periodiclimbmovementsweremonitoredusingbilateraltibialelectromyographleads.Allpolysomnographieswereadministeredandscoredbyexperiencedsleeplaboratorytechnicians.Apneawasdefinedasacompletecessationofairflowlasting≥10s.Hypopneawasdefinedasreductioninrespiratoryairflow>
30%,lasting≥10s,andaccompaniedbyadecrease≥3%inoxygensaturationand/oranarousal.TheAHIwasdefinedasthenumberofapneasandhypopneasperhourofsleepandwasusedtodiagnoseOSA.ArousalsweredefinedaccordingtotherecommendationsoftheAmericanSleepDisordersAssociationAtlastaskforce.7SleepdatawerestagedaccordingtothesystemofRechtschaffenandKales.8
24-hpHRecording
Standardizedmethodsofesophagealmanometryandambulatory24-hesophagealpHtestingwereemployed.Afteranovernightfast,theloweresophagealsphincter(LES)waslocatedviaesophagealmanometryutilizingastandardnasalcatheterwiththreesolidstatetransducers(SandhillScientific;
Littleton,CO).A2.5-mmdiametercatheterwithtwoantimonypHelectrodeswaspassednasallyandpositionedwiththedistalelectrode5cmabovethecephaladborderoftheLES.Thepositionwasnoted,andtheelectrodeswereplacedinthesameposition,butmanometrywasnotperformedonfollow-upstudytominimizediscomforttothepatient.TheelectrodeswerecalibratedatpH7andpH1usingabuffersolutionbeforeandatthecompletionofeachstudy.Areferenceelectrodewasplacedontheanteriorchest.ElectrodeswereconnectedtoaportabledatastoragedevicethatstoredpHdataevery5s(Medtronics;
Minneapolis,MN;
orSandhillScientific).Subjectswenthomewithinstructionstorecordmealtimes,timeofassumingthesupinepositionforsleep,andtimeofarisinginthemorning.Subjectswereencouragedtoperformnormaldailyactivities.Subjectswereinstructedtoreportsymptomsinadiaryandtopushtheeventbuttononthewhenevertheyhadrelevantsymptoms.
After24hofrecording,dataweredownloadedandanalysiswasperformed,whichincludedthemeasurementoverthetotal24haswellasintheupright(duringwaking)andsupine(duringthesleepinginterval)positions.Thefollowingparameterswerecalculated:
(1)percentageofesophagealACTcalculatedasthedurationinminutestheesophagealpHwas<
4.0dividedbythetotalrecordingtime×
100;
(2)totalnumberofrefluxeventsforthetotalrecordinginterval;
(3)numberofrefluxeventslasting>
5min;
(4)meandurationofrefluxevents;
and(5)meandurationofthelongestrefluxevent.
StatisticalAnalysis
Summarystatisticsarepresentedforeachoftheresponsevariablesatbaselineandatendoftreatment.Dataarepresentedasmean±
SD.Theefficacyofthetreatmentwasbasedonthemagnitudeofthereductionofthesevariablesbytheweek-longtreatment.Initially,pairedttestswereconductedtotestfordifferencesonthedependentmeasuresbeforeandafterCPAPtreatment.Manyvariableswerenotnormallydistributed,however,sotheWilcoxonsigned-ranktestwasperformedonallvariablesinstead.TheresultsofthepairedttestsandWilcoxonranked-sumtestwerealmostidentical,buttheWilcoxonranked-sumresultswillbereportedhere.
Results
Forty-threepatientswerescreened,and16patients(14menand2women)wereenrolledinthestudy.TheotherswereexcludedeitherbecauseofAHI<
20/h(n=13)orbecauseof24-hACT<
6%(n=11).Twopatientswereexcludedbecauseofveryseveresleepapneaassociatedwithsignificantoxygendesaturationthatrequiredsupplementaloxygenduringthenight.TheaverageuseofCPAPwas5.9±
1.7/hpernight.Themeanbodymassindex(BMI)was35.1±
6.6kg/m2(Table1).
EffectofCPAPonOSAandGER
Overall,thestudygrouphadseveresleepapneawithsignificantimprovementafterCPAP.TheaverageAHIwasreducedfrom63.3±
2.2/h(p<
0.001).ResultsoftheCPAPtreatmentfortotalpercentageofACTare
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Airway Pressure
![提示](https://static.bdocx.com/images/bang_tan.gif)