纤维化间质性肺疾病患者阻塞性睡眠呼吸暂停一晚氧疗的随机交叉试验

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-01-13 DOI:10.1007/s11325-025-03251-0

Teng Han, Bo Yun Xiang, Ze Long Liu, Xin Rui Guo, Lu Si Mao, Xin Liu, Yi Ming Li, Xiao Lei Zhang

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引用次数: 0

摘要

背景与目的：由于气道正压（PAP）治疗耐受性差，对间质性肺疾病（ILD）患者的阻塞性睡眠呼吸暂停（OSA）没有令人满意的治疗方法。补充氧治疗已被证明可以减少低氧血症，并且在ILD患者中耐受性良好。然而，关于夜间补氧（NOS）对ILD患者OSA的影响知之甚少。在这项研究中，我们评估了一晚氧疗对ILD合并OSA患者的影响。方法：41例纤维化性ILD和OSA患者在交叉设计中随机接受补充氧气或空气治疗，各一晚，中间间隔一周洗脱期。进行多导睡眠描记术，监测睡眠呼吸障碍、夜间去饱和、睡眠结构和心血管反应。结果：夜间假氧时，呼吸暂停低通气指数（AHI）中位数（四分位数范围）为14.1/h （10.4/h-24.1/h）。N3睡眠阶段（N3%）占19.5%（14.0 ~ 31.2%）。NOS显著降低AHI，中位数为9.3/h (95% CI, 7.6/h-14.4/h；P < 3.0% (95% CI, 2.6-4.5%；结论：在OSA和ILD患者中，一晚氧疗可显著改善睡眠呼吸障碍、睡眠结构、夜间氧合和心率。NOS可能是ILD合并OSA患者的一种治疗选择。

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A randomized, crossover trial of one night of oxygen therapy for obstructive sleep apnea in patients with fibrotic interstitial lung disease.

Background and objective: There is no satisfactory treatment for obstructive sleep apnea (OSA) in patients with interstitial lung disease (ILD) because of poor tolerance of positive airway pressure (PAP) therapy. Supplemental oxygen therapy has been shown to reduce hypoxemia and is well tolerated in patients with ILD. However, little is known about the effect of nocturnal oxygen supplementation (NOS) on OSA in patients with ILD. In this study, we evaluated one night of oxygen therapy in ILD patients with OSA.

Methods: Forty-one patients with fibrotic ILD and OSA were randomized to receive supplemental oxygen or air for one night each in a crossover design separated by a washout period of one week. Polysomnography was performed, and sleep-disordered breathing, nocturnal desaturation, sleep architecture, and cardiovascular reactions were monitored.

Results: During nights with sham oxygen, the median (interquartile range) apnea-hypopnea index (AHI) was 14.1/h (10.4/h-24.1/h). The percentage of patients in the N3 sleep stage (N3%) was 19.5% (14.0-31.2%). NOS significantly decreased the AHI by a median of 9.3/h (95% CI, 7.6/h-14.4/h; P < 0.001), increased N3% by 4.4% (95% CI, 0.3-10.1%; P = 0.049), and lowered the sleep stage change index by 1.6/h (95% CI, 0.0/h-4.8/h; P = 0.036). NOS improved the oxygen desaturation index (ODI) by -8.8/h (95% CI, -13.4/h to -5.9/h; P < 0.001) and the mean SpO₂ by 3.0% (95% CI, 2.6-4.5%; P < 0.001). The mean heart rate during sleep was reduced with the NOS; however, total sleep time and nocturnal blood pressure did not change.

Conclusions: In patients with OSA and ILD, one night of oxygen therapy significantly improved sleep-disordered breathing, sleep architecture, nocturnal oxygenation, and heart rate. NOS may be a therapeutic option for ILD patients with OSA.

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.