摘要
目的研究阻塞性睡眠呼吸暂停（ＯＳＡ）与胃食管反流（ＧＥＲ）的关系及西沙必利和奥美拉唑对两者的治疗效果。方法１８例有睡眠打鼾和反流症状的患者接受了昼夜食管ｐＨ和压力监测，并在夜间睡眠时与多导睡眠图（ＰＳＧ）同步监测；对同时有ＧＥＲ和ＯＳＡ患者予以西沙必利（１０ｍｇ，４次／日）和奥美拉唑（２０ｍｇ，２次／日）治疗１周后重复以上检查。结果７例（３８９％）同时合并有ＯＳＡ及重度ＧＥＲ，除１例外不仅存在夜间ＧＥＲ，还有白天ＧＥＲ；夜间ＧＥＲ发生之后常伴有吞咽动作（５８６％，对照为２０６％，Ｐ＜０．０５）、醒觉反应（２６８％，对照为１６８％，Ｐ＜０．０５）、大的躯体活动（１８６％，对照为４８％，Ｐ＜０．００５）；ＧＥＲ前３０秒内其平均最低食管体部压力为（－１５２±９６）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），ＧＥＲ后３０秒内为（－１８６±１０１）ｍｍＨｇ，两者明显低于对照期的（－１０６±８１）ｍｍＨｇ（Ｐ＜０．００５）。抗ＧＥＲ治疗显示，总的呼吸暂停时间从（５２７±２７１）分缩短至（２１６±２１２）分（Ｐ＜０．００２），呼吸暂停／低通气指数从（３８９±１７６）次／小时缩短至（１５２?
Objective To evaluate the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) and the effect of combined therapy with cisapride and omeprazole. Methods 24 hour esophageal pH and manometric monitoring and polysomnography (PSG) were performed in 18 patients with snoring, daytime sleepiness and acid reflux, heartburn and regurgitation. Cisapride 10 mg qid and omeprazole 20 mg q12h were given to patients with GER and OSA. these tests were repeated on the 7th day. Results 7 of the 18 patients with OSA had severe GER. All except one had daytime GER as well as nocturnal GER. Nocturnal recordings were analyzed and it was found that esophageal pH below 4.0 was frequently followed by swallow action (58 6%, control=20.6%, P <0.05), gross body movement (18.6%, control=4.8%, P <0.05) and arousal (26.8%, control=16.8%, P <0.05). The mean lowest esophageal pressure [(-15.2±9.6) mmHg] before and [(-18.6±10.1) mmHg] after the drops of pH were significantly lower than that during control periods [(-10.6±8.1) mmHg, P <0.005]. After antireflux therapy, there was dramatical improvement in total apnea time [from (52.7±27.1) to (21.6±21.2) minutes, P <0.002)] and apnea hypopnea index (AHI) [from (38.9±17.6) to (15.2±12.3) No./h, P <0.002].Conclusion GER is a predisposing factor for OSA, they may coexist and aggravate each other. Combined therapy with cisapride and omeprazole is a new, simple and effective method for GER with OSA.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1999年第1期33-36,共4页
Chinese Journal of Internal Medicine
关键词
呼吸暂停
睡眠性
胃食管反流
Sleep apnea syndromes Gastroesophageal reflux Cisapride
