OBSTRÜKTİF UYKU APNE SENDROMLU HASTALARDA MANUEL VE OTOMATİK CPAP TİTRASYONUNUN KAN GAZI DEĞERLERİ ÜZERİNE ETKİSİ

Yıl 2010, Cilt: 24 Sayı: 3, 147 - 158, 01.12.2010

Burak Eşkut Zeynep Zeren Uçar Günhan Yavaşoğlu Cenk Kıraklı Nazif Çalış Serir Aktoğu Özden

Öz

Otomatik pozitif hav a yolu basıncı (APAP) cihazları ile devamlı pozitif hava yolu basıncı (CPAP) arasında hasta başarı, apne-hipopne indeksi (AHI) ve kompliyans açısından özel durumlar dışında fark saptanmamıştır ancak aralarında maliyetyarar açısından ciddi farklar bulunmaktadır. Bu çalışmanın amacı APAP cihazları ile manuel CPAP cihazlarının kan gazı, özellikle parsiyel karbondioksit basınçları üzerine etkilerini araştırmaktır. Uyku polikliniğine horlama, gece nefes darlığı, ve / veya tanıklı apne nedeniyle başvuran daha önce polisomnografi (PSG) tetkiki ile obstrüktif uyku apne sendromu (OUAS) tanısıyla CPAP endikasyonu alan 80 hasta çalışmaya dahil edildi. Hastalar CPAP ve APAP titrasyonu yapılmak üzere randomize edilerek 40 kişilik 2 gruba ayrıldı. Manuel CPAP ve APAP titrasyonu sonrası gece boyunca gereken ortalama basınç, gecenin %90'ında gereken maksimum basınç (P%90) ve titrasyon öncesi ve sonrası kan gazı değerleri analiz edildi. CPAP ve APAP titrasyonları karşılaştırıldığında gecenin %90'nında gereken en yüksek basınç ve komplians açısından aralarında fark saptanmamıştır. CPAP ve APAP grupları titrasyon sonrası polisomnografi ve kan gazı değerleri açısından karşılaştırıldığında APAP grubunda AHI ve oksihemoglobin satürasyonunu %90'nın altında geçirdiği süre (T%90) değerlerinin daha düşük ve minimum oksihemoglobin değerinin daha yüksek olduğu, bunun dışında diğer kan gazı değerleri açısından fark olmadığı saptandı. Diğer çalışmalarla uyumlu şekilde bu çalışmada APAP cihazlarının CPAP cihazlarına komplians, uygulanan basınç düzeyleri ve uyku etkinliği ve uyku evreleri açısından bir üstünlük sağlamadı. Bildiğimiz kadarıyla literatürde ilk kez araştırılan APAP tedavisinin arteryal kan gazı değerleri üzerine etkisi CPAP tedavisinden farklı bulunmadı.

Anahtar Kelimeler

Obstrüktif uyku apne sendromu, CPAP, arteriyel kan gazı

THE EFFECT OF MANUEL AND AUTOMATIC CPAP TITRATION ON BLOOD GAS VALUES IN PATIENTS WITH OBTRUCTIVE SLEEP APNEA

Öz

No difference was reported between automatic positive airway pressure (APAP) devices and manuel continious positive airway pressure (CPAP) devices according to apnea-hypopnea index (AHI) and compliance while there was significant differences in terms of cost and benefit. The aim of this study is to investigate the effect of APAP and manuel CPAP devices on blood gases and especially partial carbondioxide pressures. Patients who aplied to sleep outpatient clinic with snoring, shortness of breath at night and/or withnessed apnea were examined with Polisomnography (PSG). Eighty of the patients with obstructive sleep apnea (OSAS) who has CPAP endication were included in the study. Patients were randomised into two groups as manuel CPAP and APAP titration. Data of average pressure for all night, maximum pressure applied %90 of the night (P90%) and blood gases before and after CPAP and APAP titration were analysed. There was no difference between manuel CPAP and APAP titration in terms of the time spent oxyhemoglobin saturation below %90 (T%90) and compliance. Two groups were compared in terms of post titration polysomnography and arterial blood gas values; in APAP group AHI and P90% was lower and minimum oxyhemoglobin saturation was higher but there was no difference for other parameters of blood gases. APAP is not better then CPAP according to compliance, applied pressure levels sleep efficiency and sleep stages in this study like the other studies. To our knowledge this is the first study which investigate the effect of APAP on blood gas value is not different from CPAP treatment.

Anahtar Kelimeler

Obstructive Sleep Apnea Syndrome, CPAP, Arterial Blood Gas

Kaynakça

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