阻塞性睡眠呼吸暂停患者的呼吸中枢驱动

目的 探讨阻塞性睡眠呼吸暂停(OSA)患者呼吸中枢驱动的变异性以及持续气道正压通气(CPAP)对OSA患者呼吸中枢驱动的作用.方法 以13例经多导睡眠图(PSG)检查确诊为中重度OSA的患者(OSA组)和6名健康人(对照组)为研究对象.在PSG监测下记录2组受试者睡前清醒期和睡眠期以及OSA组患者睡眠呼吸事件发生和CPAP治疗时食管膈肌肌电,并分析其变异性.结果 对照组清醒期和睡眠期食管膈肌肌电变异系数分别为15.4%±3.8%和17.3%±5.2%,差异无统计学意义(P＞0.05).OSA组患者清醒期、睡眠期、睡眠呼吸事件发生和CPAP治疗时食管膈肌肌电变异系数分别为14.7%±1.9%、40.7%±12.0%、29.1%±7.5%和15.4%±4.6%,睡眠期和睡眠呼吸事件发生时均明显高于清醒期(均P＜0.01),而CPAP治疗时与清醒期相比差异无统计学意义(P＞0.05).结论 OSA患者睡眠时呼吸中枢驱动变异性较大,CPAP具有降低呼吸中枢驱动变异性的作用.

Neural respiratory drive in patients with obstructive sleep apnea

Objective To evaluate the variability of neural respiratory drive in patients with obstructive sleep apnea (OSA) and the effect of continuous positive airway pressure (CPAP) upon neural respiratory drive.Methods We recorded diaphragm electromyogram (EMGdi) with multi-pair esophageal electrodes and its variability during wakefulness,sleep and treatment with CPAP in 13 patients with moderate to severe OSA diagnosed by an overnight full polysomnography (OSA group).Six normal subjects (control group) were also studied.Results Coefficient of variation of EMGdi (CV-EMGdi) during wakefulness (15.4%±3.8%) was similar to that during sleep (17.3%±5.2,P＞0.05) in the control group.The CV-EMGdi during wakefulness,sleep,sleep apnea events and treatment with CPAP in OSA group was 14.7%±1.9%,40.7%±12.0%,29.1%±7.5% and 15.4%±4.6% respectively,CV-EMGdi during sleep or sleep apnea events was larger than that during wakefulness (P＜0.01).However,there was no difference in the CV-EMGdi during wakefulness and during treatment with CPAP (P＞0.05).Conclusion The variability of neural respiratory drive in patients with OSA is higher than that in normal subjects,and CPAP can reduce the variability of neural respiratory drive in patients with OSA.