持续气道正压疗法对多系统萎缩和睡眠呼吸障碍患者睡眠和呼吸的即时影响

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY Movement Disorders Pub Date : 2024-09-17 DOI:10.1002/mds.29993

Giulia Lazzeri MD, Marion Houot MSc, Maxime Patout MD, PhD, Cécile Londner MD, Carole Philippe MD, PhD, Stephane Attard MSc, Teddy Delpy MD, Joanna Ruggeri MSc, Bertrand Degos MD, PhD, Florence Cormier MD, Marie Vidailhet MD, Jean Cristophe Corvol MD, PhD, Isabelle Arnulf MD, PhD, David Grabli MD, PhD, Pauline Dodet MD

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引用次数: 0

摘要

背景多系统萎缩（MSA）患者经常出现睡眠呼吸障碍（SDB，包括呼吸困难和睡眠呼吸暂停综合征），但持续气道正压（CPAP）疗法的即时效果尚不完全确定。目的我们试图评估 CPAP疗法对SDB和睡眠结构的急性影响和安全性，以及对 CPAP疗法无反应者的临床特征。方法回顾性收集了 63 名连续两晚（第一晚在环境空气中，第二晚使用或不使用 CPAP，取决于是否存在 SDB 和是否使用 CPAP）接受视频多导睡眠图检查的 MSA 患者的临床特征。线性混合模型评估了两晚睡眠和呼吸指标的变化，并对第二晚使用和未使用 CPAP 治疗的患者进行了比较。使用 CPAP 可立即见效，包括三分之二以上病例的呼吸暂停-低通气指数恢复正常，哮鸣音消失，唤醒指数降低，快速眼动睡眠增加。患者对 CPAP 治疗的耐受性良好，只有两名患者出现了紧急中枢性呼吸暂停。结论 CPAP 在短期内对 MSA 和 SDB 患者似乎是一种耐受性良好且有效的治疗方法。这种治疗方法通过客观改善呼吸紊乱和睡眠结构，显示出明显的立竿见影的效果。© 2024 作者。运动障碍》由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版。

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Immediate Effect of Continuous Positive Airway Pressure Therapy on Sleep and Respiration in Patients with Multiple System Atrophy and Sleep-Disordered Breathing

Background

Sleep-disordered breathing (SDB; including stridor and sleep apnea syndromes) is frequent in multiple system atrophy (MSA), but the immediate effect of continuous positive airway pressure (CPAP) therapy is incompletely determined.

Objective

We sought to evaluate the acute effect and safety of CPAP therapy on SDB and sleep architecture, as well as the clinical characteristics of nonresponders to CPAP therapy.

Methods

The measures of 63 consecutive patients with MSA who underwent a video-polysomnography during two consecutive nights (a first night in ambient air, a second night with or without CPAP, depending on the presence of SDB and availability of CPAP) in routine care were retrospectively collected. Linear mixed models assessed the two-night change in sleep and respiratory measures, comparing those with and without the CPAP therapy on the second night.

Results

SDB was frequent and mainly associated with the cerebellar phenotype. The introduction of CPAP had immediate benefits, including the normalization of the apnea–hypopnea index and a resolution of stridor in more than two-thirds of the cases, decreased arousal index, and increased rapid eye movement sleep. CPAP therapy was well tolerated, and only two patients had emergent central apneas. Nonresponse to CPAP was generally associated with more severe motor disease.

Conclusions

CPAP seems a well-tolerated and effective therapy in patients with MSA and SDB in the short term. This treatment shows remarkable immediate benefits by objectively improving both respiratory disturbances and sleep architecture. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.