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成人中枢性睡眠呼吸暂停综合征患者气道正压滴定模式的选择

Authors
Tomasz J Kuzniar, MD, PhD, FCCP, FAASM
Neil Freedman, MD
Section Editor
Susan M Harding, MD, FCCP, AGAF
Deputy Editor
Geraldine Finlay, MD
Translators
李翀, 主任医师，副教授

引言

气道正压(positive airway pressure, PAP)被用于治疗中枢性睡眠呼吸暂停(central sleep apnea, CSA)和低通气综合征患者的睡眠呼吸障碍。确定最佳的压力设置对于消除呼吸暂停、帮助确保患者依从PAP治疗至关重要。

本专题将讨论如何选择滴定方法来确定CSA患者的最佳压力。CSA治疗概述、CSA患者压力滴定方法选择以及低通气综合征的PAP治疗将单独讨论。 (参见“中枢性睡眠呼吸暂停：治疗”和“神经肌肉疾病或胸壁疾病的夜间无创通气支持类型”和“Continuous noninvasive ventilatory support for patients with respiratory muscle dysfunction”和“肥胖低通气综合征的无创正压通气治疗”)

中枢性睡眠呼吸暂停的诊断和病因

CSA综合征的特点为睡眠期间的气流和呼吸努力均消失。在以看护条件下的实验室内多导睡眠图(polysomnography, PSG)为基础的睡眠检查期间，通常能最佳地作出CSA的诊断，有时，依据家庭睡眠呼吸暂停试验(home sleep apnea test, HSAT)也可诊断。 (参见“Central sleep apnea: Risk factors, clinical presentation, and diagnosis”, section on ‘Diagnostic evaluation’)

CSA可分为原发性CSA(即，特发性CSA)以及继发性于其他疾病[陈-施呼吸，躯体疾病如脑卒中或心力衰竭，使用抑制性药物或者物质滥用，高原型周期性呼吸，或者治疗后出现的中枢性睡眠呼吸暂停(treatment-emergent central sleep apnea, TE-CSA)]的CSA。此外，CSA还可以分为过度通气相关性CSA(如，由陈-施呼吸引起、原发性CSA)和通气不足相关性CSA(如，由中枢神经系统疾病、药物或物质引起)(表 1)。其他还有一系列主要与肺泡通气不足有关的疾病(神经肌肉疾病、严重的胸廓疾病如脊柱后侧凸)，可能表现为CSA或低通气。在许多这些疾病中，中枢性呼吸暂停并不是唯一存在的睡眠呼吸障碍，甚至不是主要存在的呼吸睡眠障碍类型。因此，临床医生最好能够了解该患者的各类睡眠呼吸障碍所占比例，从而可以针对其主要睡眠呼吸障碍类型而选择合适的通气模式。 (参见“Polysomnography in the evaluation of sleep-disordered breathing in adults”)

没有呼吸暂停事件的低通气综合征可能是中枢性的(如，脊髓损伤)或周围性的(如，重症肌无力)，严重时也可能需进行无创气道正压通气治疗，详细内容将单独讨论。 (参见下文‘中枢性低通气综合征患者’和“神经肌肉疾病所致呼吸肌无力的临床表现及诊断”)

                           

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Literature review current through: 2017-07 . | This topic last updated: 2016-05-17.
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