苯二氮卓类药物
苯二氮卓类药物,如替马西泮,可以减少觉醒频率,但是不能改变AHI。 一项研究表明,替马西泮减少无不良反应的高海拔周期性呼吸,但对氧饱和度和白天症状无实际改善。[73]Nickol AH, Leverment J, Richards P, et al. Temazepam at high altitude reduces periodic breathing without impairing next-day performance: a randomized cross-over double-blind study. J Sleep Res. 2006;15:445-454.http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2006.00558.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17118102?tool=bestpractice.com
CO2治疗
CO2治疗可以降低AHI但是不能改善原发性CSA觉醒频率。[74]Thomas RJ, Daly RW, Weiss JW. Low-concentration carbon dioxide is an effective adjunct to positive airway pressure in the treatment of refractory mixed central and obstructive sleep-disordered breathing. Sleep. 2005;28:69-77.http://www.ncbi.nlm.nih.gov/pubmed/15700722?tool=bestpractice.com[75]Xie A, Rankin F, Rutherford R, et al. Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol. 1997;82:918-926.http://jap.physiology.org/content/82/3/918http://www.ncbi.nlm.nih.gov/pubmed/9074983?tool=bestpractice.com 仅有一些不确定的证据支持用于CSB改善AHI:没有充分证据表明CO2治疗可以改善AHI,同样对于睡眠片段化和患者耐受性以及远期安全性数据也乏善可陈。[75]Xie A, Rankin F, Rutherford R, et al. Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol. 1997;82:918-926.http://jap.physiology.org/content/82/3/918http://www.ncbi.nlm.nih.gov/pubmed/9074983?tool=bestpractice.com[76]Lorenzi-Filho G, Rankin F, Bies I, et al. Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med. 1999;159:1490-1498.http://www.atsjournals.org/doi/pdf/10.1164/ajrccm.159.5.9810040http://www.ncbi.nlm.nih.gov/pubmed/10228116?tool=bestpractice.com[77]Khayat RN, Xie A, Patel AK, et al. Cardiorespiratory effects of added dead space in patients with heart failure and central sleep apnea. Chest. 2003;123:1551-1560.http://journal.publications.chestnet.org/article.aspx?articleid=1081577http://www.ncbi.nlm.nih.gov/pubmed/12740273?tool=bestpractice.com低质量的观察性(队列)研究或者受试者<200名且方法学存在缺陷的随机对照临床试验(RCT)。
心房超速起搏
只能在一定程度上稍减少AHI,不能作为CSA标准治疗推荐。[78]Baranchuk A, Healey JS, Simpson CS, et al. Atrial overdrive pacing in sleep apnoea: a meta-analysis. Europace. 2009;11:1037-1040.http://www.ncbi.nlm.nih.gov/pubmed/19549678?tool=bestpractice.com
心脏瓣膜置换
继发于心瓣膜疾病的心衰患者,心瓣膜置换后心衰改善,AHI也将改善。[79]Abe H, Takahashi M, Yaegashi H, et al. Valve repair improves central sleep apnea in heart failure patients with valvular heart diseases. Circ J. 2009;73:2148-2153.https://www.jstage.jst.go.jp/article/circj/73/11/73_CJ-09-0307/_pdfhttp://www.ncbi.nlm.nih.gov/pubmed/19713650?tool=bestpractice.com
膈神经刺激
已经表明,对于 CHF 合并陈-施呼吸的患者,单侧经静脉膈神经刺激在 3 个月时能产生以下趋势:呼吸稳定并且呼吸事件、氧饱和度和觉醒有所改善。还发现对生活质量和嗜睡存在有利影响。该疗法使用类似起搏器的装置,在预定时间内没有脉冲发送时,该装置通过刺激膈神经诱导呼吸。这些装置目前正处于临床研究中,可能需要更多的长期研究。[80]Costanzo MR, Ponikowski P, Javaheri S, et al. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet. 2016 Sep 3;388(10048):974-82.http://www.ncbi.nlm.nih.gov/pubmed/27598679?tool=bestpractice.com[81]Jagielski D, Ponikowski P, Augostini R, et al. Transvenous stimulation of the phrenic nerve for the treatment of central sleep apnoea: 12 months' experience with the remedē(®) System. Eur J Heart Fail. 2016 Nov;18(11):1386-1393.http://www.ncbi.nlm.nih.gov/pubmed/27373452?tool=bestpractice.com美国食品药品监督管理局于 2017 年批准了一种该类装置,用于治疗中度至重度中枢性睡眠呼吸暂停患者。此项批复以 141 名患者的数据为基础。6 个月后,大约一半植入装置患者的 AHI 降低了至少 50%。在未植入装置的患者中,AHI 降低了 11%。