Obstructive sleep apnoea (OSA) is often treated with autotitrating continuous positive airway pressure (autoCPAP) devices. Clinical and bench tests of these devices have suggested performance limitations. These studies do not indicate whether this is a failure to detect or a failure to respond to airway obstruction. In this randomised, crossover trial, 34 patients with moderate-to-severe OSA underwent polysomnography on two laboratory visits. The autoCPAP device was randomly set to a fixed subtherapeutic pressure (detection assessment) or autotitrating mode (response assessment). Airflow was measured both from the autoCPAP (autoCPAP flow) and directly from the nasal mask, and recorded on polysomnography. Apnoea/hypopnoea indices (AHIs) measured at the two sites and from the autoCPAP download report were compared. Regarding detection, the AHI measured from the nasal mask showed good agreement with the autoCPAP flow AHI, but agreement was lower with the autoCPAP report AHI. In autotitrating mode, there was significant misclassification of those with and without OSA (AHI ≥ 10 events · h(-1)) on the autoCPAP report. Regarding response, residual OSA (AHI ≥ 10 events · h(-1)) was still evident in 24% of patients during autotitration. In some patients, autoCPAP fails to detect and/or respond to sleep apnoea. Clinicians should consider limitations of each device and use caution when using autoCPAP report statistics to verify effective treatment.

译文

阻塞性睡眠呼吸暂停 (OSA) 通常使用自动滴定持续气道正压通气 (autoCPAP) 设备进行治疗。这些设备的临床和台架测试表明性能存在局限性。这些研究没有表明这是对气道阻塞的检测失败还是反应失败。在这项随机交叉试验中,34例中度至重度OSA患者在两次实验室检查中接受了多导睡眠监测。将autoCPAP设备随机设置为固定的亚治疗压力 (检测评估) 或自动滴定模式 (响应评估)。从autoCPAP (autoCPAP流量) 和直接从鼻罩测量气流,并记录在多导睡眠图中。比较了在两个站点和autoCPAP下载报告中测得的呼吸暂停/呼吸暂停指数 (AHIs)。关于检测,从鼻罩测得的AHI与autoCPAP流量AHI显示出良好的一致性,但与autoCPAP报告AHI的一致性较低。在自动滴定模式下,在autoCPAP报告中,有或没有OSA的患者存在明显的错误分类 (AHI ≥ 10事件·h(-1))。关于反应,在自动滴定过程中,残留OSA (AHI ≥ 10事件·h(-1)) 在24% 患者中仍然明显。在某些患者中,autoCPAP无法检测和/或对睡眠呼吸暂停有反应。临床医生应考虑每种设备的局限性,并在使用autoCPAP报告统计信息验证有效治疗时谨慎使用。

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