正压通气治疗患者中新发中枢性呼吸暂停的早期检测：一项为期五年的远程监测队列研究
Early detection of emergent central apnoea in patients on positive airway pressure therapy: A five-year telemonitoring cohort study.
文献信息
| PMID | 42922384 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Teresa Díaz de Teran |
| 作者单位 | Department of Pneumology. Sleep and Non-Invasive Ventilation Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain. |
| 期刊 | Pulmonology |
| SCI 分区 | Q1 |
| IF | 5.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
引言： 正压通气（PAP）治疗期间出现的治疗相关中枢性睡眠呼吸暂停（TE-CSA）已被认识，但其发生时间和相关因素仍不清楚。本研究旨在通过远程监测（TM）确定TE-CSA的发生时间并识别相关因素。
方法： 分析2017年至2022年接受PAP治疗并通过TM监测的4,021例阻塞性睡眠呼吸暂停（OSA）患者的回顾性队列。TE-CSA定义为残余呼吸暂停低通气指数（AHI）>15且中枢性事件占50%或以上。此外，若阻塞性呼吸暂停指数（OAI）>5，则排除患者。基线中枢性呼吸暂停指数（CAI）≥5的患者被排除。TE-CSA分为短暂性（<12周）、迁延性（12-24周）或持续性（>24周且在随访期内未缓解）。采用Kaplan-Meier分析评估TE-CSA发生时间。一项巢式病例对照研究评估了人口学、心血管、脑血管、镇静剂使用及PAP治疗类型等危险因素。
结果： 171例（4.3%，95% CI：3.7-4.9）患者发生TE-CSA，以迁延性为主（90.6%），短暂性（5.9%）和持续性（3.5%）形式较少。TE-CSA主要出现在PAP治疗的前60天内。多因素分析确定年龄较大（比值比（OR）=1.03，p<0.001）和男性（OR=2.35，p=0.003）是TE-CSA发生的显著预测因素。
结论： 远程监测发现，TE-CSA的发生最常出现在PAP治疗的前2个月内。年龄较大和男性是关键预测因素。通过TM进行早期检测可能有助于及时干预，尽管在整个观察期内实施了治疗调整，并可能影响所观察到的时间模式。
英文摘要
INTRODUCTION: Treatment-emergent central sleep apnoea (TE-CSA) during positive airway pressure (PAP) therapy is recognised, yet its onset timing and contributing factors remain unclear. This study aimed to ascertain the onset time of TE-CSA via telemonitoring (TM) and identify associated factors.
METHODS: A retrospective cohort of 4,021 obstructive sleep apnoea (OSA) patients treated with PAP and monitored via TM from 2017 to 2022 was analysed. TE-CSA was defined as a residual apnoea-hypopnoea index (AHI) >15 with 50% or more central events. Moreover, if the obstructive apnoea index (OAI) was > 5, patients were excluded. Patients with a central apnoea index (CAI) ≥5 at baseline were excluded. TE-CSA was categorised as transient (<12 weeks), prolonged (12-24 weeks), or persistent (>24 weeks without resolution during the follow-up period). Kaplan-Meier analysis assessed time to TE-CSA onset. A nested case-control study evaluated demographic, cardiovascular, cerebrovascular, sedative use, and PAP treatment type as risk factors.
RESULTS: TE-CSA occurred in 171 (4.3%, 95% CI: 3.7-4.9) patients, predominantly prolonged (90.6%), with transient (5.9%) and persistent (3.5%) forms. TE-CSA primarily emerged within the first 60 days of PAP therapy. Multivariate analysis identified older age (Odds Ratio (OR) = 1.03, p < 0.001) and male sex (OR = 2.35, p = 0.003) as significant predictors of TE-CSA development.
CONCLUSION: Telemonitoring detected that TE-CSA onset was most commonly identified within the first 2 months of PAP therapy. Older age and male sex are key predictors. Early detection through TM could facilitate timely interventions, although therapeutic adjustments were implemented throughout the observation period and may have influenced the temporal patterns observed.