Article record

神经肌肉疾病合并OSA患者使用CPAP时白天PaCO2的演变：一项回顾性研究

Evolution of daytime PaCO2 in patients with neuromuscular disorders and OSA using CPAP: a retrospective study.

临床研究耳科IF 4.5Q1

文献信息

PMID	42887274
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	E Bouabdallah 查看其他 12 位作者 E Stauffer；L Grassion；L Peter-Derex；R Tamisier；C Vuillerot；S Ribault；G Mery；L Folliet；G Devouassoux；M Patout；A Léotard；P Tankéré
作者单位	Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Service de Pneumologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France. 查看其他 11 条单位信息 Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France; Laboratory LIBM EA7424, Team Vascular Biology and Red Blood Cell, University of Lyon 1, Lyon, France.；INSERM U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, CIC 1401, Bordeaux, France; Service de Pneumologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France.；Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (CRNL), INSERM U1028, CNRS UMR5292, PAM Team, Université Claude Bernard Lyon 1, Bron, France.；Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, Grenoble, France; Laboratoire du Sommeil, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France.；L'Escale, Service de Médecine Physique et de Réadaptation Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France; NeuroMyogen Institute, CNRS UMR 5310, INSERM U1217, University of Lyon, Lyon, France.；Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Médecine Physique et Réadaptation Pédiatrique, Bron, France; Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Lyon, France.；Service de Pneumologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.；Service de Pneumologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; CRISALIS F-CRIN Network, INSERM, France; VIRPATH, Université Claude Bernard Lyon 1, Lyon, France.；La Pitié-Salpêtrière University Hospital, Pulmonology and Sleep Department, Sorbonne University, Paris, France.；Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, FHU UMANHYS, Hôpital Raymond Poincaré, Garches, France; Unité de recherche PHARMAColigo, UR 20261, Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, 78000, France.；Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Service de Pneumologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (CRNL), INSERM U1028, CNRS UMR5292, PAM Team, Université Claude Bernard Lyon 1, Bron, France; Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, Grenoble, France. Electronic address: pierre.tankere01@chu-lyon.fr.
期刊	Sleep medicine
SCI 分区	Q1
IF	4.5
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景： 神经肌肉疾病（NMD）常合并阻塞性睡眠呼吸暂停（OSA），后者可能增加阻塞性通气负荷并导致CO2潴留。虽然已确立的低通气推荐使用无创通气（NIV），但持续气道正压（CPAP）对NMD患者白天PaCO2的影响仍缺乏充分记录。
方法： 我们在三级神经肌肉转诊中心开展了一项回顾性单中心队列研究。连续纳入接受呼吸评估的NMD成人患者，条件为：（i）接受CPAP治疗的OSA；（ii）在CPAP开始前后均有白天PaCO2测量。主要结局为配对PaCO2变化。在基线PaCO2≥42和≥45 mmHg的患者中进行了预设分析。使用logistic回归探索PaCO2下降的预测因素。
结果： 共纳入100例患者，中位AHI为36.9次/小时。在中位随访13.6个月时，PaCO2从42.0 [39.0-44.0]降至40.5 [38.3-43.0] mmHg，相当于配对下降1.0 mmHg（95%CI 0.3-2.0；p=0.01）。61%的患者PaCO2下降，9%保持不变，30%升高。在基线PaCO2≥45 mmHg的患者中（n=18），PaCO2中位下降为1.3 mmHg（95%CI 0.25-2.5；p=0.016），8例患者PaCO2恢复正常，但4例出现恶化。基线PaCO2是PaCO2下降的唯一独立预测因素。
结论： 在合并OSA的NMD患者中，CPAP与白天PaCO2适度但显著的下降相关。反应存在异质性，支持对患者进行仔细表型分析并在CPAP开始后开展结构化再评估，以避免对无反应者延迟升级至NIV。

英文摘要

BACKGROUND: Neuromuscular disorders (NMD) are frequently complicated by obstructive sleep apnea (OSA), which may add an obstructive ventilatory load and contribute to CO2 retention. While non-invasive ventilation (NIV) is recommended for established hypoventilation, the impact of continuous positive airway pressure (CPAP) on daytime PaCO2 in NMD remains poorly documented.
METHODS: We conducted a retrospective single-center cohort study in a tertiary neuromuscular referral center. Consecutive adults with NMD undergoing respiratory assessment were included if they had (i) OSA treated with CPAP and (ii) daytime PaCO2 measurements before and after CPAP initiation. The primary outcome was paired PaCO2 change. Prespecified analyses were performed in patients with baseline PaCO2 ≥42 and ≥ 45 mmHg. Predictors of PaCO2 decrease were explored using logistic regression.
RESULTS: One hundred patients were included, median AHI was 36.9/h. At a median follow-up of 13.6 months, PaCO2 decreased from 42.0 [39.0-44.0] to 40.5 [38.3-43.0] mmHg, corresponding to a paired reduction of 1.0 mmHg (95%CI 0.3-2.0; p = 0.01). PaCO2 decreased in 61% of patients, remained unchanged in 9%, and increased in 30%. In patients with baseline PaCO2≥45 mmHg (n = 18), the median PaCO2 reduction was 1.3 mmHg (95%CI 0.25-2.5; p = 0.016) and 8 patients normalized their PaCO2 but 4 experienced a deterioration. Baseline PaCO2 was the only independent predictor of PaCO2 decrease.
CONCLUSIONS: In NMD patients with OSA, CPAP was associated with a modest but significant reduction in daytime PaCO2. Responses were heterogeneous, supporting careful patient phenotyping and structured reassessment after CPAP initiation to avoid delayed NIV escalation in non-responders.