无创呼吸机昼夜不同通气参数对AECOPD合并OSA患者疗效、睡眠效率、Borg评分、AHI的影响

The effect of different ventilation parameter settings of non-invasive ventilators during the day and night in the treatment of patients with AECOPD combined with OSA and its influence on sleep efficiency, Borg score and AHI

摘要:

目的 分析无创呼吸机昼夜不同通气参数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）患者的疗效、睡眠效率、博格自觉劳累程度评分表（Borg评分）、呼吸暂停低通气指数（AHI）的影响。方法 选取2022年3月—2025年2月河北省胸科医院收治的174例AECOPD合并OSA患者，按随机数字表法分为3组，各58例。3组患者白天均选用AECOPD患者的最佳气道正压通气参数治疗，夜间则选用无创气道正压通气参数治疗。A组夜间采用吸气相气道正压（IPAP）维持恒定，呼气相气道正压（EPAP）若在睡眠期无鼾声则保持不变，反之则将EPAP滴定至可消除睡眠期鼾声的最低参数水平。B组在白天参数基础上，于夜间将IPAP和EPAP分别上调3 cmH₂O。C组采取夜晚保持IPAP不变，EPAP在白天参数基础上调高3 cmH₂O，比较3组治疗效果。结果 B组、C组治疗后睡眠效率（TST/TRT）、AHI、微觉醒指数（MAI）水平均低于A组（P <0.05），最低脉搏氧饱和度（miniSpO₂）水平高于A组（P <0.05）。B组、C组治疗前后TST/TRT水平的升高幅度均小于A组（P <0.05），AHI、MAI水平的降低幅度均大于A组（P <0.05），miniSpO₂水平的升高幅度的均大于A组（P <0.05）。B组、C组治疗后Epworth量表（ESS）评分、Borg评分、改良的英国医学委员会呼吸困难量表（mMRC）评分均低于A组（P <0.05）。B组、C组治疗前后ESS、Borg、mMRC评分的差值均大于A组（P <0.05）。B组、C组治疗后动脉血二氧化碳分压（PaCO₂）水平均低于A组（P <0.05），动脉血氧分压（PaO₂）水平均高于A组（P <0.05）。B组、C组治疗前后PaCO₂、pH值的下降幅度均大于A组（P <0.05），PaO₂的上升幅度均大于A组（P <0.05）。C组、B组治疗后CAT评分低于A组（P <0.05），HRQL评分高于A组（P <0.05）。B组、C组治疗前后HRQL评分的上升幅度均大于A组（P <0.05），CAT评分的下降幅度均大于A组（P <0.05）。结论 OSA合并AECOPD患者采用无创正压通气治疗时，采用夜晚保持IPAP不变，EPAP在白天基础上调3 cmH₂O模式，可改善PSG参数和血气分析指标，缓解患者呼吸困难症状和疲劳状态，减轻其白天嗜睡程度。

Abstract:

Objective To analyze the effect of different ventilation parameter settings of non-invasive ventilators during the day and night in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with obstructive sleep apnea (OSA), and its influence on sleep efficiency, Borg score, and AHI.Methods A total of 174 patients with AECOPD combined with OSA admitted to Hebei Provincial Chest Hospital from March 2022 to February 2025 were selected and divided into three groups according to the random number table method, with 58 cases in each group. During the day, all three groups of patients were treated with the optimal positive airway pressure (PAP) parameters for AECOPD patients, while at night, different methods of non-invasive positive airway pressure ventilation PAP treatment parameters were adopted. Group A maintained a constant nocturnal inspiratory pressure (IPAP), while the expiratory pressure (EPAP) remained unchanged if there was no snoring during sleep. Otherwise, the EPAP was titrated to the lowest parameter level that could eliminate snoring during sleep. In Group B, IPAP and EPAP were respectively increased by 3 cmH₂O at night based on the daytime parameters. In group C, IPAP remained unchanged at night and EPAP was increased by 3 cmH₂O based on the daytime parameters. The therapeutic effects of the three groups were compared.Results After treatment, the levels of TST/TRT, AHI and MAI in Group C and group B were all lower than those in group A (P < 0.05), while the level of miniSpO₂ was higher than that in group A (P < 0.05). The increases in TST/TRT from before to after treatment in Groups B and C were smaller than that in Group A (P < 0.05). In contrast, the reductions in AHI and MAI, as well as the increase in miniSpO₂, from before to after treatment in Groups B and C were all greater than those in Group A (P < 0.05). After treatment, the ESS score, Borg score and mMRC score of Group C and Group B were lower than those of group A (P < 0.05). The differences in ESS, Borg, and mMRC scores before and after treatment in Groups B and C were greater than those in Group A (P < 0.05). After treatment, the PaCO₂ levels in Group C and Group B were lower than those in group A (P < 0.05), while the PaO₂ levels were higher than those in Group A (P < 0.05). The reductions in PaCO₂ and pH from before to after treatment in Groups B and C were greater than those in Group A (P < 0.05). Similarly, the increase in PaO₂ was greater in Groups B and C than in Group A (P < 0.05). After treatment, the CAT scores of Group C and Group B were lower than those of group A (P < 0.05), while the HRQL scores were higher than those of Group A (P < 0.05). The increase in HRQL scores from before to after treatment in Groups B and C was greater than that in Group A (P < 0.05). Conversely, the reduction in CAT scores was greater in Groups B and C than in Group A (P < 0.05).Conclusion When patients with OSA combined with AECOPD are treated with NPPV, the IPAP remains unchanged at night, and the EPAP is increased by 3 cmH₂O based on the daytime parameters. This can improve the PSG parameters and blood gas analysis indicators, relieve the patients' dyspnea symptoms and fatigue state, and reduce their daytime sleepiness.