Evaluation eines neuen Algorithmus zur automatischen CPAP-Therapie beim obstruktiven Schlafapnoe-Syndrom

Zusammenfassung

Hintergrund: Die Therapie mit selbstadjustierenden kontinuierlichen Positivdruck-Geräten (automatisches CPAP, APAP) stellt ein etabliertes Verfahren in der Behandlung des obstruktiven Schlafapnoe-Syndroms (OSAS) dar. Von großer Bedeutung für die Drucksteuerung dieser Geräte ist die sichere Erkennung und Differenzierung obstruktiver und zentraler Ereignisse. In einer Pilot-Studie untersuchten wir die Effektivität eines neu entwickelten Algorithmus zur Behandlung von OSAS-Patienten. Methode: Bei 14 Patienten mit erstmalig diagnostiziertem OSAS erfolgte nach einer diagnostischen Polysomnographie eine Therapienacht mit einem neu konzipierten automatischen CPAP-Algorithmus, basierend auf dem Atemfluss, Schnarchen, dem relativen Atemminutenvolumen und dem Obstructive Pressure Peak-Signal. Ergebnisse: Der Gesamt-Apnoe/Hypopnoe-Index (AHI) lag in der Diagnosenacht bei 30,0 ± 21,4/h und in der APAP-Nacht bei 3,7 ± 5,3/h (p < 0,005), der obstruktive AHI bei 22,7 ± 20,5 bzw. 1,5 ± 3,5/h (p < 0,005) und der zentrale AHI bei 7,3 ± 4,9 bzw. 2,2 ± 2,5/h (p < 0,01). Der Arousal-Index ließ sich unter der Therapie von 25,4 ± 18,1 auf 5,1 ± 3,8/h (p < 0,005) reduzieren. Schlussfolgerungen: Der neu entwickelte Therapiealgorithmus einer automatischen CPAP-Therapie stellt eine effektive Behandlung des obstruktiven Schlafapnoe-Syndroms dar.

Abstract

Background: Automatic continuous positive airway pressure (automatic CPAP, APAP) is an effective treatment option in the obstructive sleep apnoea syndrome (OSAS). The differentiation of obstructive and central respiratory events is crucial in adjusting the optimal pressure in this treatment mode. In this pilot study we evaluated a new automatic CPAP algorithm in OSAS patients. Methods: 14 patients with newly diagnosed obstructive sleep apnoea syndrome were enrolled. After a diagnostic polysomnography, patients were treated for one night with a new APAP device based on flow, snoring, relative minute volume and the obstructive pressure peak signal. Results: The total apnoea/hypopnoea index (AHI) was 30.0 ± 21.4/h at baseline and 3.7 ± 5.3/h with APAP (p < 0.005). Both obstructive AHI (22.7 ± 20.5/h at baseline, 1.5 ± 3.5/h with APAP, p < 0.005) and central AHI (7.3 ± 4.9/h and 2.2 ± 2.5/h, respectively, p < 0.01) as well as the arousal index (25.4 ± 18.1/h and 5.1 ± 3.8/h, respectively, p < 0.005) were reduced significantly with the new algorithm. Conclusions: The new algorithm of an automatic CPAP device is effective in the treatment of obstructive sleep apnoea syndrome.

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