Effects of AVAPS-AE Mode of Non-invasive Ventilation on PSG Parameters，ESS Score and Comfort in Patients with AECOPD and OSA
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摘要:
目的 探讨平均容积保证压力支持-自动呼气压（AVAPS-AE）模式的无创通气对慢性阻塞性肺疾病急性加重期（AECOPD）合并阻塞性睡眠呼吸暂停（OSA）患者多道睡眠监测（PSG）参数、Epworth嗜睡量表（ESS）评分及舒适度的影响。 方法 选取2020年1月至2022年10月自贡市第一人民医院75例AECOPD合并OSA患者，随机分为3组，各25例，均行无创通气治疗，对照A组予以AVAPS模式，对照B组予以S/T模式，观察组予以AVAPS-AE模式。比较3组治疗前、治疗24 h、48 h及72 h血气分析指标[动脉氧分压（PaO2）、动脉血酸碱度（pH）、动脉二氧化碳分压（PaCO2）]、PSG参数[微觉醒指数（MAI）、呼吸暂停低通气指数（AHI）、最低脉搏氧饱和度（miniSpO2）、睡眠效率（TST/TRT）]、颏舌肌肌电值（GGEMG）各变量[清醒期及睡眠NREM期张力性、峰值、时相性GGEMG]、人机对抗发生率、48 h插管率、ESS、Brog、视觉模拟量表（VAS）及健康相关生存质量（HRQL）评分。 结果 治疗24 h、48 h及72 h PaO2组间比较：观察组>对照A组>对照B组（P < 0.05）；PaCO2组间比较：观察组<对照A组<对照B组（P < 0.05）；TST/TRT、miniSpO2组间比较：观察组>对照A组>对照B组（P < 0.05）；AHI、MAI组间比较：观察组<对照A组<对照B组（P < 0.05）；清醒期及睡眠NREM期张力性、峰值、时相性GGEMG组间比较：观察组<对照A组<对照B组（P < 0.05）；3组人机对抗发生率、48 h插管率比较，差异无统计学意义（P > 0.05）；ESS、Brog、VAS评分组间比较：观察组<对照A组<对照B组（P < 0.05）；HRQL评分组间比较：观察组>对照A组>对照B组（P < 0.05）。 结论 AVAPS-AE模式的无创通气用于AECOPD合并OSA有利于改善患者睡眠，减少日间嗜睡，缓解呼吸困难，提高呼吸舒适度及生存质量。 Abstract:Objective To investigate the effects of non-invasive ventilation in mean volumetric pressure support and automatic expiratory pressure （AVAPS-AE） mode on multichannel sleep monitoring （PSG） parameters, Epworth sleepiness Scale （ESS） score and comfort in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with obstructive sleep apnea （OSA）. Methods 75 patients with AECOPD complicated with OSA in our hospital from January 2020 to October 2022 were randomly divided into 3 groups, each with 25 cases, all of which were treated with non-invasive ventilation. Control group A was treated with AVAPS mode, control group B was treated with S/T mode, and observation group was treated with AVAPS-AE mode. Blood gas analysis indexes [arterial partial pressure of oxygen （PaO2）, arterial blood pH （pH）, arterial partial pressure of carbon dioxide （PaCO2）], PSG parameters [arousal index （MAI）, apnea hypopnea index （AHI）, minimum pulse oxygen saturation （miniSpO2）, sleep efficiency （TST/TRT）] and genioglossus muscle of the three groups were compared The variables of GGEMG （tonic, peak and phasic GGEMG during wakefulness and sleep NREM）, the incidence of man-machine confrontation, the rate of intubation at 48 hours, ESS, Brog, visual analogue scale （VAS） and health-related quality of life （HRQL） scores were compared before treatment and after 24, 48 and 72 hours of treatment. Results After 24 h, 48 h and 72 h treatment, PaO2 groups were compared: observation group > control group A > control group B （P < 0.05）. Comparison between PaCO2 groups: observation group < control group A < control group B （P < 0.05）. Comparison of TST/TRT and miniSpO2 groups: observation group > control group A > control group B （P < 0.05）. Comparison between AHI and MAI groups: observation group < control group A < control group B （P < 0.05）. Comparison of tension, peak value and phase GGEMG between awake and NREM sleep groups: observation group < control group A < control group B （P < 0.05）. There was no significant difference in the incidence of man-machine confrontation and 48-h intubation rate among 3 groups （P> 0.05）. ESS, Brog and VAS were compared between groups: observation group < control group A < control group B （P < 0.05）; Comparison of HRQL among groups: observation group > control group A > control group B （P < 0.05）. Conclusion AVAPS-AE mode of non-invasive ventilation for AECOPD combined with OSA is beneficial to improve sleep, reduce daytime sleepiness, relieve dyspnea, and improve breathing comfort and quality of life. -
表 1 3组一般资料比较[（$\bar x \pm s $）/n（%）]
Table 1. Comparison of general data in the three groups [（$\bar x \pm s $）/n（%）]
组别 n 性别 年龄（岁） 体质量指数 （kg/m2） 病程（a） 男 女 观察组 25 13（52.00） 12（48.00） 48.25±5.29 24.79±0.83 7.88±1.31 对照A组 25 11（44.00） 14（56.00） 48.83±5.12 24.62±0.96 7.92±1.34 对照B组 25 12（48.00） 13（52.00） 47.96±5.38 24.83±0.80 8.05±1.36 χ2/F 0.321 0.177 0.414 0.111 P 0.852 0.838 0.662 0.896 
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表 2 3组各时间点血气分析指标比较（$\bar x \pm s $）
Table 2. Comparison of blood gas analysis indexes at different time points in the three groups （$ \bar x \pm s$）
指标 组别 n 治疗前 治疗24 h 治疗48 h 治疗72 h pH 观察组 25 7.45±0.08 7.44±0.08 7.44±0.08 7.44±0.07 对照A组 25 7.47±0.07 7.46±0.07 7.46±0.08 7.45±0.08 对照B组 25 7.46±0.08 7.46±0.08 7.45±0.08 7.45±0.07 F 0.424 0.565 0.391 0.154 P 0.656 0.571 0.678 0.857 PaO2（mmHg） 观察组 25 59.83±7.45 70.34±5.89 75.67±5.12 82.14±4.35 对照A组 25 60.12±7.26 67.12±5.42 72.83±5.82 76.44±4.41 对照B组 25 59.95±7.83 64.45±4.95 69.41±6.13 73.83±4.12 F 0.009 7.366 7.545 24.473 P 0.991 0.001* 0.001* <0.001* PaCO2（mmHg） 观察组 25 62.74±5.25 56.14±4.02 49.37±6.51 42.31±5.70 对照A组 25 62.56±5.11 58.22±4.13 52.37±5.94 46.88±5.82 对照B组 25 62.70±5.17 60.27±4.26 56.84±6.21 50.44±6.13 F 0.008 6.227 9.118 11.985 P 0.992 0.003* <0.001* <0.001* *P < 0.05。
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表 3 3组各时间点PSG参数比较（$ \bar x \pm s$）
Table 3. Comparison of PSG parameters at each time point in the three groups （$\bar x \pm s $）
指标 组别 n 治疗前 治疗24 h 治疗48 h 治疗72 h TST/TRT（%） 观察组 25 71.82±6.23 78.83±4.78 82.45±4.23 87.24±3.96 对照A组 25 71.90±6.12 76.23±4.25 79.43±4.27 84.31±4.02 对照B组 25 71.85±6.25 74.02±4.11 77.12±4.54 81.25±4.33 F 0.001 7.521 9.444 13.300 P 0.999 0.001* <0.001* <0.001* miniSpO2（%） 观察组 25 78.42±4.63 84.13±4.22 86.17±3.98 88.14±3.95 对照A组 25 78.37±3.98 81.97±4.03 83.89±3.82 86.25±3.78 对照B组 25 78.20±4.45 80.05±3.25 82.04±3.51 84.76±3.52 F 0.018 7.004 7.508 5.090 P 0.983 0.002* 0.001* 0.009* AHI（次/h） 观察组 25 15.62±7.78 10.25±4.83 7.29±2.28 4.32±1.13 对照A组 25 15.47±7.52 12.27±4.05 8.76±3.25 5.41±1.55 对照B组 25 15.60±6.98 14.04±3.12 10.18±3.11 6.78±2.04 F 0.003 5.453 6.158 14.534 P 0.997 0.006* 0.003* <0.001* MAI（次/h） 观察组 25 10.37±4.52 7.58±0.97 6.01±0.82 4.27±0.78 对照A组 25 10.84±5.03 8.46±1.06 7.12±0.95 5.01±0.84 对照B组 25 10.27±4.85 9.23±1.25 8.24±1.02 5.96±1.02 F 0.100 14.095 35.653 22.863 P 0.905 <0.001* <0.001* <0.001* *P < 0.05。
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表 4 3组GGEMG各变量比较（$\bar x \pm s$，%）
Table 4. Comparison of three GGEMG variables （$ \bar x \pm s$，%）
指标 组别 n 治疗前 治疗24 h 治疗48 h 治疗72 h 清醒期张力性GGEMG 观察组 25 5.54±1.53 3.89±0.84 3.24±0.60 2.64±0.41 对照A组 25 5.52±1.42 4.39±0.82 3.85±0.62 2.89±0.45 对照B组 25 5.47±1.48 4.78±0.80 4.37±0.65 3.12±0.48 F 0.015 7.397 20.561 7.192 P 0.985 0.001* <0.001* 0.001* 清醒期峰值GGEMG 观察组 25 37.11±18.23 25.41±7.32 22.41±5.03 17.42±4.02 对照A组 25 36.92±15.69 28.44±5.98 25.83±5.24 19.83±4.25 对照B组 25 37.08±17.42 32.83±6.01 29.14±5.14 22.14±4.23 F 0.001 8.320 10.727 8.016 P 0.999 0.001* <0.001* 0.001* 清醒期时相性 观察组 25 13.19±4.27 9.41±2.03 7.89±1.53 6.61±1.25 对照A组 25 13.15±4.33 10.56±2.11 8.94±1.68 7.45±1.27 对照B组 25 13.18±4.25 11.68±2.05 9.78±1.72 8.12±1.33 F 0.001 7.563 8.281 8.683 P 0.999 0.001* 0.001* <0.001* 睡眠NREM期张力性 观察组 25 2.54±1.12 1.68±0.40 1.32±0.35 0.98±0.30 对照A组 25 2.57±1.27 1.89±0.42 1.58±0.38 1.24±0.32 对照B组 25 2.55±1.18 2.24±0.45 1.87±0.36 1.43±0.31 F 0.004 11.138 14.319 13.267 P 0.996 <0.001* <0.001* <0.001* 睡眠NREM期峰值 观察组 25 26.97±15.25 17.41±5.31 10.27±3.78 5.62±1.94 对照A组 25 26.82±14.33 20.23±5.06 12.33±3.84 6.84±1.98 对照B组 25 26.98±15.12 22.98±5.12 14.01±3.92 7.89±2.03 F 0.001 7.271 5.927 8.200 P 0.999 0.001* 0.004* 0.001* 睡眠NREM期时相性 观察组 25 8.84±3.48 5.41±1.26 4.12±1.06 2.63±0.95 对照A组 25 8.78±3.27 6.13±1.37 4.89±1.12 3.12±1.02 对照B组 25 8.82±3.50 7.02±1.40 5.94±1.25 3.67±1.08 F 0.002 8.993 15.886 6.530 P 0.998 <0.001* <0.001* 0.002* *P < 0.05。
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表 5 3组人机对抗发生率、48 h插管率比较[n（%）]
Table 5. Comparison of incidence of man-machine confrontation and 48-h intubation rate among the three groups [n（%）]
组别 n 人机对抗发生率 48 h插管率 观察组 25 1（4.00） 0（0.00） 对照A组 25 3（12.00） 1（4.00） 对照B组 25 4（16.00） 3（12.00） χ2 1.959 3.697 P 0.376 0.158
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表 6 3组ESS、Brog、VAS及HRQL评分比较（$ \bar x \pm s $，分）
Table 6. Comparison of ESS，Brog，VAS and HRQL scores in the three groups （$\bar x \pm s$，score）
指标 组别 n 治疗前 治疗后 t P ESS评分 观察组 25 11.37±2.13 5.63±1.12 11.926 <0.001* 对照A组 25 11.20±2.34 6.37±1.16 9.247 <0.001* 对照B组 25 11.34±2.27 7.41±1.30 7.512 <0.001* F 0.041 13.979 P 0.960 <0.001* Brog评分 观察组 25 6.47±1.58 0.87±0.12 17.671 <0.001* 对照A组 25 6.39±1.66 1.23±0.18 15.452 <0.001* 对照B组 25 6.45±1.59 1.58±0.20 15.195 <0.001* F 0.017 108.900 P 0.983 <0.001* VAS评分 观察组 25 7.14±2.13 1.73±0.45 12.425 <0.001* 对照A组 25 6.98±2.25 2.48±0.52 9.743 <0.001* 对照B组 25 7.09±2.17 2.92±0.47 9.391 <0.001* F 0.035 39.136 P 0.966 <0.001* HRQL评分 观察组 25 77.29±8.14 93.25±4.13 8.743 <0.001* 对照A组 25 78.31±7.62 89.41±4.57 6.246 <0.001* 对照B组 25 77.94±8.25 85.41±4.25 4.025 <0.001* F 0.104 20.581 P 0.901 <0.001* *P < 0.05。
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[1] 陈亦晨,曲晓滨,陈华,等. 2010—2020年上海市浦东新区居民慢性阻塞性肺疾病死亡率及早死概率空间流行病学特征分析[J]. 公共卫生与预防医学,2023,34(1):44-48. [2] Zhang P,Chen B,Lou H,et al. Predictors and outcomes of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in China[J]. BMC Pulm Med,2022,22(1):16. doi: 10.1186/s12890-021-01780-4 [3] Iannella G,Magliulo G,Greco A,et al. Obstructive sleep apnea syndrome: From symptoms to treatment[J]. Int J Environ Res Public Health,2022,19(4):2459. doi: 10.3390/ijerph19042459 [4] Freire C,Sennes LU,Polotsky VY. Opioids and obstructive sleep apnea[J]. J Clin Sleep Med,2022,18(2):647-652. doi: 10.5664/jcsm.9730 [5] Lastra A C,Masa J F,Mokhlesi B. CPAP titration failure is not equivalent to long-term CPAP treatment failure in patients with obesity hypoventilation syndrome: A case series[J]. J Clin Sleep Med,2020,16(11):1975-1981. doi: 10.5664/jcsm.8712 [6] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版)[J]. 中华结核和呼吸杂志,2013,36(4):255-264. [7] Sterling K L,P é pin J L,Linde-Zwirble W,et al. Impact of positive airway pressure therapy adherence on outcomes in patients with obstructive sleep apnea and chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med,2022,206(2):197-205. doi: 10.1164/rccm.202109-2035OC [8] Maheshwari A,Khatri J,Soni G,et al. Role of average volume assured pressure support mode(avaps) in the management of acute exacerbation of chronic obstructive pulmonary disease with type 2 respiratory failure[J]. Cureus,2022,14(12):32200. [9] Abubacker A P,Ndakotsu A,Chawla H V,et al. Non-invasive positive pressure ventilation for acute cardiogenic pulmonary edema and chronic obstructive pulmonary disease in prehospital and emergency settings[J]. Cureus,2021,13(6):15624. [10] Söyler Y,Akın Kabalak P,SaralÖztürk Z,et al. Comparing effectiveness of intelligent volume-assured pressure support(iVAPS)vs bi-level positive airway pressure spontaneous/timed(BPAP S/T)for hypercapnic respiratory failure in chronic obstructive pulmonary disease[J]. Int J Clin Pract,2021,75(10):14595. [11] 牛驰,郭伟,何小军,等. 中国急诊科无创正压通气应用现状调查[J]. 中华急诊医学杂志,2018,27(2):204-207. [12] Saddi V,Thambipillay G,Pithers S,et al. Average volume-assured pressure support vs conventional bilevel pressure support in pediatric nocturnal hypoventilation: A case series[J]. J Clin Sleep Med,2021,17(5):925-930. doi: 10.5664/jcsm.9084 [13] Levri J M,Watanabe N,Peng VT,et al. Use of average volume-assured pressure support as a therapeutic option in patients with central sleep apnea syndrome[J]. Sleep Breath,2022,26(1):225-230. doi: 10.1007/s11325-021-02379-z [14] 冯滨,邵忠华. 平均容积保证压力支持与无创自动调节通气对高碳酸血症患者PaCO2影响的比较[J]. 中国老年学杂志,2019,39(13):3207-3211. [15] Antonaglia C,Passuti G. Obstructive sleep apnea syndrome in non-obese patients[J]. Sleep Breath,2022,26(2):513-518. doi: 10.1007/s11325-021-02412-1 [16] 王建青,彭程,许绍蓉,等. NoSAS评分、STOP-BANG问卷、Epworth嗜睡量表在评估呼吸系统疾病患者发生OSAHS风险的价值[J]. 国际生物医学工程杂志,2022,45(1):58-63. [17] Soltis M E,Spector A R. A concise review of polysomnography and obstructive sleep apnea for the neurophysiologist[J]. J Clin Neurophysiol,2023,40(3):191-197. doi: 10.1097/WNP.0000000000000935 [18] Xiao L,Kaspy K,Zielinski D,et al. Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO-CON debate[J]. Pediatr Pulmonol,2022,57(3):609-615. doi: 10.1002/ppul.25773 [19] 周颖倩,赵迪,尹国平,等. 持续气道正压通气治疗对纠正中-重度阻塞性睡眠呼吸暂停患者颏舌肌肌电过高活性反应的评估[J]. 中华耳鼻咽喉头颈外科杂志,2019,54(8):584-590. [20] Hern á ndez G,Paredes I,Moran F,et al. Effect of postextubation noninvasive ventilation with active humidification vs high-flow nasal cannula on reintubation in patients at very high risk for extubation failure: A randomized trial[J]. Intensive Care Med,2022,48(12):1751-1759. doi: 10.1007/s00134-022-06919-3 [21] Patout M,Gagnadoux F,Rabec C,et al. AVAPS-AE versus ST mode: A randomized controlled trial in patients with obesity hypoventilation syndrome[J]. Respirology,2020,25(10):1073-1081. doi: 10.1111/resp.13784 -
