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Vol. 35. Issue 5.
Pages 208-213 (May 1999)
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Vol. 35. Issue 5.
Pages 208-213 (May 1999)
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Eficacia de la presión positiva a demanda en el tratamiento del síndrome de apnea obstructiva del sueño
Efficacy of demand positive airway pressure (nDPAP) for treating obstructive sieep apnea syndrome
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I. García Arroyo, J. Terán Santos
Corresponding author
jteran@bio.hgy.es

Correspondencia: Unidad de Trastornos Respiratorios del Sueno. Sección de Neumología. Hospital General Yagüe. Avda. del Cid, s/n. 09005 Burgos.
, J. Cordero Guevara, L. Rodríguez Pascual
Unidad de Trastornos Respiratorios del Sueño. Sección de Neumología. Hospital General Yagüe. Burgos
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El tratamiento de elección del síndrome de apnea obstructiva del sueño es la presión positiva continua nasal. El ajuste preciso del nivel de presión se realiza mediante polisomnografía. Recientemente, se han diseñado sistemas de presión positiva a demanda, que adaptan el nivel de presión en cada ciclo respiratorio según las modificaciones de flujo.

Objetivo

Comparar el sistema de titulación manual (presión positiva continua nasal) con un sistema de presión positiva a demanda en pacientes diagnosticados de síndrome de apnea obstructiva del sueño.

Pacientes y métodos

Se incluyeron 18 pacientes de forma consecutiva, diagnosticados de síndrome de apnea obstructiva del sueño mediante polisomnografía convencional con índices de apnea-hipopnea superior a 10/h (IAH > 10) y síntomas clínicos de somnolencia diurna y/o factores de riesgo cardiovasculares. A todos se les realizó polisomnografía convencional de titulación con presión positiva continua nasal y con presión positiva continua a demanda, analizadas de forma ciega.

Resultados

No se encontraron diferencias significativas entre el sistema de presión positiva continua nasal y a demanda en los parámetros neurofisiológicos analizados (arquitectura del sueño, despertares, eficiencia de sueño) ni en los respiratorios (índice de apnea-hipopnea y saturación de oxígeno) a excepción de la SatO2 mínima en REM que mejoró de forma estadísticamente significativa con presión positiva continua nasal (p<0.03). Las medias de presión final de presión positiva continua nasal y presión a demanda fueron similares y hay que reseñar que los pacientes con presión positiva continua a demanda presentaron como media un 65,7 ±22% del tiempo presiones inferiores a la titulada con presión positiva continua nasal.

Conclusión

El sistema automático de presión positiva continua a demanda es tan eficaz como la presión positiva continua nasal en la titulación del tratamiento de pacientes con síndrome de apnea obstructiva del sueño.

Palabras clave:
Síndrome de apnea obstructiva del sueño
Presión positiva continua a demanda
Tratamiento

The treatment of choice for obstructive sleep apnea syndrome (OSAS) is nasal continuous positive airway pressure (nCPAP). The precise level of pressure is adjusted by polysomnography. Devices to deliver pressure on demand have recently been designed to adapt the level of pressure to each respiratory cycle according to flow modification.

Objective

To compare the manual titering nCPAP System with that of demand continuous positive airway pressure (nDPAP) in patients diagnosed of OSAS.

Patients and methods

Eighteen consecutive patients whose OSAS was diagnosed by conventional polysomnography were enrolled with apnea-hypopnea indexes over 10/hour (AHI > 10) and clinical symptoms of daytime drowsiness and/or cardiovascular risk factors. Titering polysomnographs were performed for all patients with nCPAP and with nDPAP and analyzed blindly.

Results

No significant differences between nCPAP and nDPAP were found in neurophysiological variables analyzed (sleep architecture, arousals, sleep efficiency) or in respiratory variables (AHI, oxygen saturation) with the exception of minimum SatO2 during REM sleep, which was significantly better with nCPAP (p<0.03). Mean end pressure with nCPAP and mean pressure with nDPAP were similar; it is also worth noting that mean pressure was lower with nDPAP than with titered nCPAP pressure a mean 65.7 ± 22% of the time.

Conclusion

Automatic nDPAP is as effective as titered nCPAP for treating patients with OSAS.

Keywords:
Obstructive sleep apnea syndrome
Demand continuous positive airway pressure
Treatment
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Bibliografía
[1.]
R. Jung, W. Kuhlo.
Neurophysiological studies of abnormal night sleep and the Pickwickian syndrome.
pp. 140-160
[2.]
M.W. Hill, F.B. Simmons, C. Guilleminault.
Tracheostomy and sleep apnea.
Sleep apnea syndromes, pp. 347-352
[3.]
C.E. Sullivan, F.G. Issa, M. Berthon-Jones, L. Eves.
Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares.
Lancet, 1 (1981), pp. 862-865
[4.]
C.E. Sullivan, M. Berthon-Jones, F.G. Issa.
Treatment of obstructive sleep apnea with CPAP applied through the nose.
Am Rev Respir Dis, 125 (1982), pp. 107
[5.]
J.R. Stradling.
Treatment of obstructive sleep apnea with nasal continuous positive airway pressure.
Thorax, 38 (1983), pp. 237
[6.]
M.H. Sanders, S.E. Moore, J. Eveslage.
CPAP via nasal mask: a treatment for occlusive sleep apnea.
Chest, 83 (1983), pp. 144-145
[7.]
R.B. Berry, A.J. Block.
Positive nasal airway pressure eliminates snoring as well as obstructive sleep apnea.
Chest, 85 (1984), pp. 15-20
[8.]
C.E. Sullivan, F.G. Issa.
Obstructive sleep apnea.
pp. 633-650
[9.]
J. Morera, O. Parra, J. Abad.
La CPAP nasal en el tratamiento del síndrome de la apnea del sueño.
Med Clin (Barc), 91 (1988), pp. 627-629
[10.]
J. Lamphere, T. Roehrs, R. Wittig, F. Zorick, W.A. Conway, T. Roth.
Recovery of alertness after CPAP in apnea.
Chest, 96 (1989), pp. 1.364-1.367
[11.]
J. Terán Santos, F. Pascual Lledó, L. Rodríguez Pascual, I. Arroyo Hidalgo, J.P. García Muñoz, F. Gallo Marín, et al.
Síndrome de apnea del sueño. Manifestaciones clínicas y tratamiento con presión positiva continua sobre la vía aérea (CPAP) en 40 pacientes.
Rev Clin Esp, 190 (1992), pp. 64-68
[12.]
H.M. Engleman, S.E. Martin, I.J. Deary, N.J. Douglas.
Effect of continuous positive airway pressure treatment on daytime function in sleep apnea/hypopnea syndrome.
Lancet, 343 (1994), pp. 572-575
[13.]
M.H. Sanders, C.A. Gruendl, R.M. Rogers.
Patient compliance with nasal CPAP therapy for sleep apnea.
Chest, 90 (1986), pp. 330-333
[14.]
R.E. Waldhorn, T.W. Herrick, M.C. Nguyen, E. O’Donell, J. Sodero, S.J. Potolicchio.
Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea.
Chest, 97 (1990), pp. 33-38
[15.]
I. Rolfe, L.G. Olson, N.A. Saunders.
Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea.
Am Rev Respir Dis, 144 (1991), pp. 1.130-1.133
[16.]
H. Rauscher, W. Popp, T. Wanke, H. Zwick.
Acceptance of CPAP therapy for sleep apnea.
Chest, 100 (1991), pp. 1.019-1.023
[17.]
N.B. Kribbs, A.I. Pack, L.R. Kline, P.L. Smith, A.R. Schwartz, N.M. Schubert, et al.
Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea.
Am Rev Respir Dis, 147 (1993), pp. 887-895
[18.]
A.K. Mahadevia, E. Onal, M. Lopata.
Effects of expiratory positive airway pressure on sleep-induced respiratory abnormalities in patients with hypersomnia-sleep apnea syndrome.
Am Rev Respir Dis, 128 (1983), pp. 708-711
[19.]
M.H. Sanders, N. Kem.
Obstructive sleep apnea treated by independently adjusted inspiratory an expiratory positive airway pressure via nasal mask.
Chest, 98 (1990), pp. 317-324
[20.]
M. Berthon-Jones.
Feasibility of a self-setting CPAP machine.
Sleep, 16 (1993), pp. 120-123
[21.]
D. Robert, P. Banfi, P. Leger, G. Bourdon, B. Langevin, T. Petitjean.
Comparison of automatic continuous adjust CPAP versus CPAP in OSAS.
Ara Rev Respir Dis, 149 (1994), pp. 497
[22.]
O. Polo, M. Berthon-Jones, N.J. Douglas, C.E. Sullivan.
Management of obstructive sleep apnea/hypopnea syndrome.
Lancet, 344 (1994), pp. 656-660
[23.]
J.A. Pareja, J.T. Moore.
Tratamiento con presión nasal positiva continua del síndrome de apnea obstructiva del sueño.
Med Clin (Barc), 98 (1992), pp. 9-13
[24.]
B. Sadrnoori.
Demand positive airway pressure system and obstructive sleep apnea.
American Board of Sleep Disorders Medicine, (1993),
[25.]
B. Sadrnoori, D. Lacasse, J. Tyler, D. Tanguard.
Evaluation of recently released self-adjusting nasal CPAP (DPAP™ demand positive airway pressure).
Sleep Res, 25 (1994), pp. 528
[26.]
American Thoracic Society.
Standarization of spirometry. 1994 Update.
Am J Respir Crit Care Med, 152 (1995), pp. 1.107-1.136
[27.]
A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects,
[28.]
ASDA.
EEG arousals: scoring rules and examples, 15 (1992), pp. 174-184
[29.]
F. Lofaso, A.M. Lorino, D. Duizabo, H.N. Zadeh, D. Theret, F. Goldenberg, et al.
Evaluation of an auto-nCPAP device based on snoring detection.
Eur Respir J, 9 (1996), pp. 1.795-1.800
[30.]
J.C. Meurice, I. Marc, F. Sériés.
Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome.
Am J Respir Crit Care Med, 153 (1996), pp. 794-798
[31.]
F. Sériés.
Auto-CPAP in the treatment of sleep apnea hypopnea syndrome.
Sleep, 19 (1996), pp. 281-283
[32.]
F. Sériés, I. Marc.
Efficacy of automatic continuous positive airway pressure therapy that uses an estimated required pressure in the treatment of the obstructive sleep apnea syndrome.
Ann Intern Med, 127 (1997), pp. 588-595
[33.]
M.B. Scharf, D.E. Brannen, M.D. McDannold, D.V. Berkowitz.
Computerized adjustable versus fixed NCPAP treatment of obstructive sleep apnea.
Sleep, 19 (1996), pp. 491-496
[34.]
M. Konermann, B.M. Sanner, M. Vyleta, F. Laschewski, J. Groetz.
Sturm et al. Use of conventional and self-adjusting nasal continuous positive airway pressure for treatment of severe obstructive sleep apnea syndrome.
Chest, 113 (1998), pp. 714-718
[35.]
H. Teschler, M. Berthon-Jones, A.B. Thompson, A. Henkel, J. Henry, N. Konietzko.
Automated continuous positive airway pressure tritation for obstructive sleep apnea syndrome.
Am J Respir Crit Care Med, 154 (1996), pp. 734-740
[36.]
H. Teschler, A.A. Farhat, V. Exner, N. Konietzko, M. Berthon-Jones.
AutoSet nasal CPAP titration: constancy of pressure, compliance and effectiveness at 8 month follow-up.
Aur Respir J, 10 (1997), pp. 2.073-2.078
[37.]
P. Lloberes, E. Ballester, J.M. Montserrat, E. Botifoll, A. Ramírez, A. Reolid, et al.
Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome.
Am J Respir Crit Care Med, 154 (1996), pp. 1.755-1.758
[38.]
S. Sharma, S. Wali, Z. Pouliot, M. Peters, H. Neufeld, M. Kryger.
Treatment of obstructive sleep apnea with a self-titrating continuous positive airway pressure (CPAP) system.
Sleep, 19 (1996), pp. 497-501
Copyright © 1999. Sociedad Española de Neumología y Cirugía Torácica
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