BACKGROUND & AIMS: BACKGROUND:The duration of automatic computer-controlled continuous positive airway pressure device (autoCPAP) initiation at home varies largely between sleep centers. Our objectives were to evaluate the cost-effectiveness and to find the optimal trial duration. METHODS:Of the 206 consecutive CPAP-naive patients with obstructive sleep apnea syndrome, who were referred to our hospital, 166 received autoCPAP for a 5-day trial at home. RESULTS:Of the 166 patients, 89 (15 women) showed a successful 5-day autoCPAP trial (normalized oximetry and mask-on time exceeding 4 h/day for at least 4 days). For the first trial day, 88 (53%) patients had normalized oximetry and a mask-on time exceeding 4 h. A 1-day autoCPAP trial EUR 668 was less cost-effective than a 5-day trial EUR 653, with no differences in values of efficient CPAP pressure or residual apnea-hypopnea index (AHI). The systematic requirement of oximetry monitoring raised the cost considerably from EUR 481 to EUR 668. CONCLUSIONS:In selected patients with obstructive sleep apnea, the optimal duration for initiating CPAP therapy at home by autoCPAP is 5 days. Although a 1-day trial was sufficient to determine the CPAP pressure requirement, it was not cost-effective and had a high rate of failure.

背景与目标：

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:Quality of life (QOL) and sleepiness for patients with sleep apnea/hypopnea syndrome (SAHS) might improve with continuous positive airway pressure devices working in auto-adjust mode (autoCPAP) by allowing pressure modulations following patient needs. Clinical comparisons between devices driven by different algorithms are needed. METHODS:We compared the clinical effectiveness of fixed pressure CPAP and four different autoCPAP devices by assessing compliance and QOL (36-item short-form health survey [SF-36]). SAHS patients were randomly allocated to five groups. Polysomnography (PSG) was performed to titrate the effective pressure in the constant CPAP group and evaluate residual apnea/hypopnea index (AHI) under autoCPAP. Follow-up consisted of clinical visits at three and six months by homecare technicians who assessed compliance, symptom scores and SF-36 scores. A laboratory-based PSG using the same CPAP/autoCPAP device as at home was performed at six months. RESULTS:Eighty-three patients (mean age 56+/-10 yrs) with mean body mass index (BMI) 30.8+/-5.3 kg/m(2) and severe SAHS (mean AHI: 52.3+/-17.8/h) were included. There were no differences in clinical symptoms or QOL scores, and similar clinical and PSG improvements were seen in all groups. CPAP use was >5 h per night, without any significant difference between groups. CONCLUSIONS:AutoCPAP is equally as effective as fixed CPAP for long-term home treatment in severe SAHS patients.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVES:To determine the frequency of sleep disordered breathing (SDB) in ischemic and hemorrhagic stroke and transient ischemic attack (TIA) patients by meta-analysis. METHODS:A systematic literature search using Medline, EMBASE and CINAHL and a manual review of references through December 2008 was conducted using specific search terms. The frequency of SDB stratified by apnea hypopnea index (AHI) was extracted by the author. Weighted averages using a random-effects model are reported with 95% confidence intervals. RESULTS:Twenty-nine articles evaluating patients with autoCPAP, limited-channel sleep study, or full polysomnography were included in this study. In meta-analysis of 2,343 ischemic or hemorrhagic stroke and TIA patients, the frequency of SDB with AHI > 5 was 72% and with AHI > 20 was 38%. Only 7% of the SDB was primarily central apnea. There was no significant difference in SDB prevalence by event type, timing after stroke, or type of monitoring. Males had a higher percentage of SDB (AHI > 10) than females (65% compared to 48% p = 0.001). Patients with recurrent strokes had a higher percentage of SDB (AHI > 10) than initial strokes (74% compared to 57% p = 0.013). Patients with unknown etiology of stroke had a higher and cardioembolic etiology a lower percentage of SDB than other etiologies. CONCLUSIONS:SDB is very common in stroke patients irrespective of type of stroke or timing after stroke and is typically obstructive in nature. Since clinical history alone does not identify many patients with SDB, sleep studies should be considered in all stroke and TIA patients.

背景与目标：

BACKGROUND & AIMS: :The efficacy of continuous airway positive pressure ventilation with a nasal mask mainly depends on the appropriateness of the effective positive pressure level. Conventionally, this level is determined from polysomnographic recordings using progressively increasing pressure levels to determine, the point where episodes of apnea, hypopnea and snoring regress in all sleep phases and in all body positions. Since the first description of this method, many other titration methods have been proposed. Some use sophisticated signals such as the analysis of respiratory exertion level or limitation of inspiratory flow to provide a more precise titration which is particularly useful in cases where the classical titration method is insufficiently effective. Inversely, simplified methods have been examined from an economic point of view. These methods do not require the presence of a technician in a specialized laboratory where the waiting list for diagnostic tests is often long. Recordings during naps or short nights have been proposed for the more severe cases. Likewise titrations during simple polygraphy recordings or with an autoCPAP device have been shown to be effective in one-night laboratory recordings. Much work remains to be done to determine the effectiveness of these methods when used in the patient's home as well the long-term effects.

背景与目标： : 带鼻罩的持续气道正压通气的功效主要取决于有效正压水平的适当性。通常，该水平是通过多导睡眠图记录来确定的，该记录使用逐渐增加的压力水平来确定呼吸暂停，呼吸不足和打鼾发作在所有睡眠阶段和所有身体位置中消退的点。自从首次描述该方法以来，已经提出了许多其他滴定方法。有些使用复杂的信号，例如分析呼吸消耗水平或限制吸气流量，以提供更精确的滴定，这在经典滴定方法无效的情况下特别有用。相反，从经济角度研究了简化方法。这些方法不需要在诊断测试的等待名单通常很长的专门实验室中配备技术人员。对于较严重的病例，建议在午睡或短暂的夜晚进行录音。同样，在简单的测距记录过程中或使用autoCPAP设备进行滴定在一夜的实验室记录中也是有效的。要确定这些方法在患者家中使用时的有效性以及长期效果，还有许多工作要做。

BACKGROUND & AIMS: :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.

背景与目标： : 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。