阻塞性睡眠呼吸暂停综合征患者睡眠状态下呼吸中枢控制功能的改变及测定方法被引量：28

Breathing control of patients with obstructive sleep apnea syndrome (OSAS) during sleep

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摘要目的探讨阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者上气道阻塞与睡眠状态下呼吸中枢控制功能的低下是否有关。方法通过经鼻气管插管建立鼻咽通气道测定了１６例重度ＯＳＡＳ患者在清醒状态、非快动眼（ＮＲＥＭ）Ⅰ＋Ⅱ睡眠期、Ⅲ＋Ⅳ睡眠期、快动眼（ＲＥＭ）睡眠期的口腔阻断压（Ｐ０１）、低氧反应指标（ΔＰ０１／ΔＳａＯ２、ΔＶＥ／ΔＳａＯ２）及高二氧化碳反应指标（ΔＰ０１／ΔＳａＯ２、ΔＶＥ／ΔＳａＯ２）。应用鼻罩经鼻测定了１１名非打鼾的正常人，观察各睡眠时相呼吸控制功能的变化情况，作为对照。结果（１）在清醒状态下，插管前后ＯＳＡＳ组的Ｐ０１、ΔＰ０１／ΔＳａＯ２、ΔＶＥ／ΔＳａＯ２、ΔＰ０１／ΔＰａＣＯ２、ΔＶＥ／ΔＰａＣＯ２相关性好，差异无显著性（Ｐ＞０．１）。受试者耐受性好，无明显副作用。ＯＳＡＳ组的Ｐ０１高于对照组，呼吸中枢的低氧及高二氧化碳（ＣＯ２）反应性与对照组差异无显著性（Ｐ＞０．１）。（２）与清醒状态相比：在ＮＲＥＭⅠ＋Ⅱ、Ⅲ＋Ⅳ睡眠期，对照组的Ｐ０１、ΔＰ０１／ΔＳａＯ２、ΔＰ０１／ΔＰａＣＯ２无变化（Ｐ＞０．０５），但ΔＶＥ／ΔＳａＯ２、ΔＶＥ／ΔＰａＣＯ２明显下降（Ｐ＜０．０５），Ｒ? Objective It is assumed that reduced ventilatory control function during sleep may be one of the mechanisms resulting in obstructive sleep apnea syndrome (OSAS), but the breathing drive has never been measured in patients with OSAS during sleep. Method P0.1,ΔP0.1/ΔSaO2, ΔE/ΔSaO2, ΔP0.1/ΔPaCO2 and ΔE/ΔPaCO2 in sixteen patients with severe OSAS were measured via nasopharyngeal tubes connected with nasal mask to maintain upper airway patent, during wake and NREMⅠ+Ⅱ, NREMⅢ+Ⅳ, REM sleep stages, and the same parameters in eleven normal subjects, nonsnorers were also measured, by nasal mask as control.Result (1) During wake:P0.1 in all the OSAS patients was remarkably higher than that of the normal subjects (P<0.05), but there was no difference in ΔE/ΔSaO2, ΔΡ01/ΔSaO2, ΔE/ΔPaCO2 and ΔP01/ΔPaCO2 between the two groups (P>0.05). (2) The above parameters measured during sleep compared with that measured during wake: In NREMⅠ+Ⅱ and NREMⅢ+Ⅳ, normal subjects showed no significant decrease in P0.1, ΔP0.1/ΔSaO2, ΔP0.1/ΔPaCO2 (P>0.05), but ΔE/ΔSaO2 and ΔE/ΔPaCO2 decreased significantly (P<0.05). In REM1 P0.1 maintained the same level as that during wake, but both hypoxic and hypercapnic responses decreased remarkably (P<0.05). In the OSAS patients, P0.1 decreased during NREMⅠ+Ⅱ and REM sleep (P<0.5), but not during NREM Ⅲ+Ⅳ(P>0.05). ΔE/ΔSaO2, ΔP0.1/ΔSaO2, ΔP0.1/ΔPaCO2 and ΔE/ΔPaCO2 decreased markedly during all sleep stages (P<0.01). (3) From wake to sleep, ΔE/ΔSaO2 decreased by 51.6±30.4% (Mean±SD) in the OSAS patients vs 33.6±26.0% decreased in the normal subjects; ΔE/ΔPaCO2 decreased by 56.9±25.5% in OSAS vs 40.8±175% in the normal subjects; The hypoxic and hypercapnic responses in OSAS patients decreased much more than those in the normal subjects during sleep (P<0.05). Conclusion This is the first study to measure the hypoxic and hypercapnic responses successfully in OSAS patients during sleep. It was found that the breathing drive was significantly reduced in sleeping OSAS patients, which may play an important role in the development of OSAS, possibly through the reduced action upon the dilators causing the upper airway in predilection for collapse.

作者韩芳陈尔璋魏海琳丁东杰何权瀛

机构地区北京医科大学人民医院呼吸科

出处《中华结核和呼吸杂志》 CSCD 北大核心 1998年第8期471-476,共6页 Chinese Journal of Tuberculosis and Respiratory Diseases

关键词睡眠呼吸暂停综合征 OSAS 呼吸中枢控制 Sleep apnea syndromes Respiration

分类号 R563.8 [医药卫生—呼吸系统]