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Automatische nCPAP-Therapie auf der Basis der forcierten Oszillationstechnik (APAPFOT)

Automatical nCPAP therapy based on the forced oscillation technique (APAPFOT)

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Zusammenfassung

Trotz der Effektivität der Therapie des obstruktiven Schlafapnoe-Syndroms (OSAS) mit konstantem nasalen Positivdruck (nCPAP) wenden bis zu 30% der Patienten die Behandlung nicht an. Es wurden daher automatische nCPAP-Systeme entwickelt, die den Druck senken und so Beeinträchtigungen der Patienten mindern sollen. Die forcierte Oszillationstechnik (FOT) ist ein sensitives Verfahren zur Erfassung der Widerstände der oberen Atemwege, auch bei OSAS. Ziel dieser Studie war es, die Effektivität eines automatischen nCPAP-Systems auf der Basis von FOT hinsichtlich polysomnographischer Parameter und des notwendigen Druckprofils zu untersuchen. Nach diagnostischer Polysomnographie (PSG) wurden 21 Patienten zunächst einer manuellen CPAP-Titration zur Findung eines Druckes zur konstanten nCPAP-Therapie und anschließend einer Therapienacht mit APAP fot unterzogen. Im Vergleich zum Ausgangswert nahmen der Apnoe-Hypopnoe-Index (AHI [Diagnose] 25,2±21,9/h, AHI [APAP fot ] 3,0±3,4/h, p<0,0001), die Gesamtzahl der Arousals (Arousals [Diagnose] 35,8±15,3/h, Arousals [APAP fot ] 21,7±11,3/h, p<0,01) und die Zahl der respiratorisch bedingten Arousals (resp. Arousals [Diagnose] 20,9±16,6/h, resp. Arousals [APAP fot ] 3,0±3,7/h, p<0,001) ab. Es kam zu einer Verbesserung des Schlafprofils mit Zunahme des REM-Schlaft (REM [Diagnose] 14,6±5,2% TST, REM [APAP fot ] 20,8±5,7% TST, p<0,01). Der mittlere Therapiedruck konnte unter APAP fot im Vergleich zum manuell titrierten konstanten nCPAP deutlich gesenkt werden (manuell titrierter Druck 8,6±1,8 mbar, P mean [APAP fot ] 5,4±1,6 mbar, p<0,0001). Wir schliessen daraus, daß APAP fot eine effektive Therapie des OSAS bei deutlich verringertem Druck erlaubt.

Summary

Although nasal continuous positive airway pressure (nCPAP) has proven effective in the treatment of obstructive sleep apnea syndrome (OSAS) up to 30% of the patients do not accept it for long-term use. Therefore selfadjusting nCPAP devices were developed to reduce treatment pressure, patients' discomfort, and side effects. Measurement of impedance by using the forced oscillation technique (FOT) is a sensitive method to detect upper airway obstructions in OSAS. We now investigated a new automatic nCPAP system based on FOT (APAP fot ) regarding parameters of polysomnography (PSG) and the profile of treatment pressure. 21 patients (20 males) underwent a PSG for diagnosis, one night with manual nCPAP titration and one night with APAP fot (pressure range 4–15.5 mbar). The AHI (AHI [diagnosis] 25.2±21.9/h, AHI [APAP fot ] 3.0±3.4/h, p<0.001), the overall number of arousals (arousals [diagnosis] 35.8±15.3/h, arousals [APAP fot ] 21.7±11.3/h, p<0.01) and the number of respiratory induced arousals (resp. arousals [diagnosis] 20.9±16.6/h, resp. arousals [APAP fot ] 3.0±3.7/h, p<0.001) were reduced. The sleep profile improved with a significant increase of REM sleep (REM [diagnosis] 14.6±5.2%TST, REM [APAP fot ] 20.8±5.7 %TST, p<0.01). The mean treatment pressure was reduced with APAP fot as compared with the manually titrated pressure which would be used for constant nCPAP therapy (manually titrated pressure: 8.6±1.8mbar, P mean [APAP fot ] 5.4±1.6 mbar, p<0.0001). We conclude that the selfadjusting nCPAP therapy based on FOT (APAP fot ) is effective in the treatment of OSAS. Mean treatment pressures can be reduced in a relevant amount.

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Authors and Affiliations

  1. Klinik Ambrock, Klinik für Pneumologie, Allergologie und Schlafmedizin, Ambrocker Weg 60, D-58091, Hagen

    W. J. Randerath, L. Büscher, Galina Gil, Ulrike Domanski & K. -H. Rühle

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  1. W. J. Randerath
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  2. L. Büscher
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  3. Galina Gil
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  4. Ulrike Domanski
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  5. K. -H. Rühle
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Randerath, W.J., Büscher, L., Gil, G. et al. Automatische nCPAP-Therapie auf der Basis der forcierten Oszillationstechnik (APAPFOT). Somnologie 3, 264–269 (1999). https://doi.org/10.1007/s11818-999-0034-3

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