The Treatment Of COPD-Obstructive Sleep Apnea Overlap Syndrome By Time-division Pressure Non-invasive Positive Pressure Ventilation Based On The Respiratory Internet Of Things

Part I:Non-invasive Ventilator Remote Management for Overlap Syndrome without Respiratory FailureResearch background and purpose:The incidence of obstructive sleep apnea is increasing year by year,and the number of cases in my country ranks first in the world.The prevalence of COPD patients with obstructive sleep apnea is higher,and there was evidence that obstructive sleep apnea can aggravate COPD air trapping,obstructive ventilation dysfunction,and cause more severe lung function damage.At present,the preferred method for the treatment of obstructive sleep apnea is continuous positive airway pressure at night,but continuous positive airway pressure therapy is rarely used solely for COPD rehabilitation,so whether continuous positive airway pressure will improve the patient lung function is still inconclusive.Based on this,we use our own respiratory IoT platform and mobile phone APP to automatically read and write the ventilator SD card in time intervals,and realize the use of 2.5h fixed pressure 4-6cmH2O to treat overlap syndrome during the day,and evaluate whether it is not accompanied by respiratory failure.Early application of continuous positive airway pressure in patients with overlap syndrome can reduce lung function damage,observe the effect of lung function improvement on night sleep apnea,and explore the clinical significance of remote management of non-invasive ventilation based on the respiratory Internet of Things.Methods:Thirty patients who had been diagnosed with overlap syndrome(without respiratory failure)in Qilu Hospital of Shandong University and were undergoing continuous positive airway pressure therapy were selected,and they were divided into group A and group B by random number table.In the first stage,group A was given day and night continuous positive airway pressure therapy based on the respiratory Internet of things(CPAP fixed pressure 4cmH2O during the day for 2.5 h,and night Auto-CPAP therapy≥4h/night),and group B was given regular night Auto-CPAP treatment≥4h/night.Pulmonary function test and portable sleep monitoring after 3 months.Then the two groups of routine Auto-CPAP treatment was eluted for 1 month,and the treatment methods were exchanged.Group A was given regular night Auto-CPAP therapy≥4h/night,and group B was given day and night continuous positive airway pressure therapy based on the respiratory Internet of Things.(CPAP fixed pressure 4cmH2O treatment during the day for 2.5h,Auto-CPAP treatment at night≥4h/night),recheck the above items after 3 months.Use IBM SPSS Statistics 22.0 software for statistical analysis,using t test,chi-square test and pairwise comparison.Results:A total of 30 patients with overlap syndrome were included in this study,and they were randomly divided into 2 groups,including 15 cases in group A and 15 cases in group B.In the first stage,group B dropped off in one case.Without non-invasive ventilator monitoring data before treatment,there was no statistical difference between the two groups in body mass index,oxygen saturation,lung function(SVC,FVC,SVC-FVC,MVV,FEV1 and FEV1/FVC),blood gas analysis,and AHI.There was no significant difference in oxygen saturation and AHI between the two groups after treatment in the first stage;the SVC-FVC of the CPAP treatment group during the period of the A component was lower than that of the conventional treatment group of the B group(82.4±45.6 vs 130±68.7 ml),and the MVV%was higher than that of the B group In the conventional treatment group(80.1 ± 13.7 vs 68.8±9.9%),P<0.01,which was statistically significant;the average nighttime CPAP pressure and 95%CPAP pressure in the divided CPAP treatment group were lower than those in the conventional treatment group,but no statistics Difference:The difference between the average night use time of patients in group A and group B was statistically significant(6.34±0.96 vs 5.47±1.22 h),P<0.05;the average amount of night air leakage in the treatment group was significantly smaller than that in the control group(20.28±4.91vs 28.14±5.11 L/min),P<0.01.In the second stage,the treatment methods of group A and group B were exchanged.There was no significant difference in the average night time of the two groups and the average amount of air leakage at night.The average night CPAP pressure and 95%CPAP pressure of the group B treatment group were lower than those of the control group A,but there is no statistical difference.There was no statistical difference in morning oxygen saturation and AHI between the two groups,and the number of pulmonary function tests was small,so no statistics were made at this stage.Conclusion:Periodic adjustment of CPAP(fixed pressure during the day)treatment for patients with overlap syndrome can help patients recover from lung function and reduce air trapping.It may help the treatment of night overlap syndrome,but more samples are needed for verification.Part II:Noninvasive Ventrator Remote Management Time-Divided BIPAP Mode for Overlap Syndrome with Respiratory FailureResearch background and purpose:The coexistence of COPD and obstructive sleep apnea is called overlap syndrome.As the disease progresses,COPD may be accompanied by respiratory failure.Bi-level positive airway pressure(BiPAP)is suitable for patients with respiratory failure.Studies have found that although BiPAP can improve carbon dioxide retention during the day,because patients have obstructive sleep apnea at night,the treatment pressure during the day cannot be completely corrected at night.Hypoventilation,so early morning oxygenation indicators are poorly improved;if according to the treatment of obstructive sleep apnea,the pressure of the non-invasive ventilator needs to be increased,then the pressure of the patient during day treatment is too high and it is difficult to adapt;and the ventilator parameters cannot be adjusted after the patient goes home.It is also difficult to manage problems such as patient’s compliance with ventilator use,mask leakage,and mask aging.At present,China cannot achieve extensive remote management of non-invasive ventilation.Based on this,we have completed the establishment of the respiratory Internet of Things in the early stage,which can realize remote adjustment of parameters and is suitable for most ventilator brands.This research innovatively proposes a time-based remote adjustment of BiPAP pressure to treat overlapping syndromes with respiratory failure based on the respiratory Internet of Things.The overall translation of night pressure increases by 2-4 cmH2O,controls obstructive sleep apnea,and observes the effects of different day and night pressures on patients with respiratory failure.The treatment effect of overlapping syndromes,and explore the significance of remote management of non-invasive ventilation of respiratory IoT in the long-term family treatment of overlapping syndromes.Methods:Select 40 patients who have been clearly diagnosed as COPD combined with obstructive sleep apnea overlap syndrome(with respiratory failure)in Qilu Hospital of Shandong University and are undergoing continuous bilevel positive airway pressure therapy.According to the random number table method divided into A group and B group.In the first stage,group A was treated with BiPAP in day and night time intervals(routine setting parameters during the day,the overall pressure at night increased by 2-4 cmH2O treatment duration ≥4h/night),group B night routine BiPAP treatment duration≥4h/night.OCST and lung function were tested one month later.Then the two groups of routine treatments were eluted for 1 month and then exchanged methods,that is,the second stage of the night routine BiPAP treatment duration of group A≥4h/night,group B day and nighttime interval BiPAP treatment(daytime routine setting parameters,the overall pressure shift at night increased 2-4cmH2O treatment duration≥4h/night),recheck the above items after 1 month.Use IBM SPSS Statistics 22.0 software for statistical analysis,using t test,chi-square test and pairwise comparison.Results:Of all the selected patients,31 cases could successfully use this system to upload the ventilator monitoring data,write back the configuration data to the ventilator,4 cases exited,5 cases could not cooperate with the mobile phone APP,and 9 cases were dropped.Without non-invasive ventilator monitoring data before treatment,there was no statistical difference between the two groups in BMI,early morning blood oxygen saturation,PaCO2,pH,AHI,and night minimum oxygen saturation.There was no significant difference in oxygen saturation and oxygen partial pressure in the early morning after the first stage of treatment between the two groups;PaCO2 of the a component period treatment group was lower than that of the B control group(41.5±4.31 vs 47.1 ±6.12 mmHg),and AHI was lower than the B control group(3.1 ±3.7 vs 7.8±4.9),P<0.05;the average daytime use time of the A component period treatment group is longer than that of the B control group(4.26±0.97 vs 3.32± 1.26 h),P<0.05;the average night use time The treatment group of group A was greater than the control group of group B,the difference was not statistically significant.In the second stage,PaCO2 of the treatment group of the B component period was lower than that of the A control group(42.5±4.33vs46.22±5.15mmHg),AHI is lower than the A control group(4.11 ±0.59vs6.21 ±0.82),P<0.05;the average use time at night and the average use time during the day in the group B period treatment group are both greater than Group A was the control group,but the difference was not statistically significant.Conclusion:The breathing of patients with overlap syndrome is assisted by the time-phased pressure BiPAP mode treatment to help patients with carbon dioxide partial pressure return to normal,and better control of sleep apnea.But more samples are needed for verification.