阻塞性睡眠呼吸暂停低通气患者的呼吸调节

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的呼吸调节.方法 OSAHS组肥胖OSAHS患者35例,根据睡眠呼吸暂停及低通气指数(AHI) 分为5≤AHI<40组(23例)和AHI≥40组(12例);对照组15例单纯肥胖者.对2组受试者行肺功能、低氧通气反应HVR,以Δ0.1 s时的口腔内阻断压(P0.1)/Δ脉搏血氧饱和度(SpO2)表示]、高碳酸通气反应HCVR,以ΔP0.1/Δ呼气末CO2分压(PETCO2)表示]检查及睡眠监测.结果 (1) OSAHS组患者ΔP0.1/ΔSpO2、ΔP0.1/ΔPETCO2与对照组相比差异无显著性(t=1.28、0.57,均P>0.05).OSAHS组ΔP0.1/ΔSpO2与睡眠时最低SpO2呈负相关(r=-0.54,P<0.01),与ΔP0.1/ΔPETCO2呈正相关(r=0.57,P<0.01).(2) 5≤AHI<40组患者的ΔP0.1/ΔSpO2较AHI≥40组增高(t=2.74,P<0.01),ΔP0.1/ΔPETCO2无显著差别.5≤AHI<40组ΔP0.1/ΔSpO2与第1秒钟用力呼气容积/最大呼气流量及AHI呈负相关(r=-0.42,P<0.05;r=-0.68,P<0.01);AHI≥40组ΔP0.1/ΔSpO2与睡眠时最低SpO2呈负相关(r=-0.58,P<0.05),与ΔP0.1/ΔPETCO2呈正相关(r=0.59,P<0.05).结论 OSAHS患者HCVR无明显改变,但HVR随AHI的增加呈先升高后降低的双相变化,且与睡眠时最低SpO2及HCVR密切相关.

Respiratory control in obstructive sleep apnea hypopnea syndrome

OBJECTIVE: To evaluate the role of ventilatory control in obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Thirty-five patients with OSAHS were compared with 15 obese controls in pulmonary function, hypoxic ventilatory response (HVR), hypercapnic ventilatory response (HCVR) and polysomnography (PSG). RESULTS: (1) There were no differences in HVR and HCVR between patients with OSAHS and the control (t = 1.28, 0.57; P > 0.05). In OSAHS patients, HVR was correlated with nadir nocturnal oxygen saturation (MmS(P)O(2)) (r = -0.54, P < 0.01) and HCVR (r = 0.57, P < 0.01). (2) Patients with mild and moderate OSAHS had higher HVR than those with severe OSAHS (t = 2.74, P < 0.01). When 5 < or = apnea and hypopnea index (AHI) < 40, HVR was negatively correlated to forced expiratory volume in one second (FEV(1))/peak expiratory flow (PEF) (r = -0.42, P < 0.05) and AHI (r = -0.68, P < 0.01). For those whose AHI > or = 40, HVR was negatively correlated with MmSpO(2) (r = -0.58, P < 0.05) and positively correlated with HCVR (r = 0.59, P < 0.05). CONCLUSION: In OSAHS patients, HCVR did not show significant change, but HVR showed two phasic change-increase first and then decrease-following the elevation of AHI, which was also related to MmSpO(2) and HCVR.