Schäfer H, Ehlenz K, Ewig S, Hasper E, Koehler U, Latzelsberger J, Tasci S, Lüderitz B
Department of Internal Medicine, University of Bonn, Germany.
J Sleep Res. 1999 Sep;8(3):205-10. doi: 10.1046/j.1365-2869.1999.00151.x.
Elevated nocturnal plasma atrial natriuretic peptide (ANP) levels were found in patients with obstructive sleep apnoea (OSA). The purpose of our study was to examine the secretion of ANP during the night and to measure changes in oxygen saturation, pulmonary artery pressure and intrathoracic pressure swings in patients with OSA. Moreover, we analysed the secretion of ANP and the pulmonary artery pressure in different behavioural states, e.g. awake, at exercise and asleep. Consecutive apnoeas in non-rapid eye movement (NREM) sleep at the beginning, middle and end of the sleep study were analysed in six patients with obstructive sleep apnoea. In addition, we measured the plasma levels of ANP. The apnoea duration was significantly longer (P< 0.05) at the middle of the sleep study than at the beginning or end. Correspondingly, the end-apnoeic oxygen saturation and end-apnoeic oesophageal pressure were both significantly lower (P< 0.05) in the middle of the sleep study than at the beginning or end. No significant differences were found in the end-apnoeic systolic transmural pulmonary artery pressure (P(PATM)) and the levels of ANP. Evaluation of the ANP levels during different behavioural states revealed that the asleep levels were slightly, but not significantly, higher than the awake levels (0.235+/-0.088 vs. 0.207+/-0.057 nmol/L). However, the highest levels were found during exercise (0.334+/-0.170 nmol/L) with a significant difference compared with the awake and asleep levels. These data suggest that volume effects may be a potent factor in liberating ANP during exercise, but the role of OSA in ANP secretion when asleep is questionable.
阻塞性睡眠呼吸暂停（OSA）患者夜间血浆心房利钠肽（ANP）水平升高。我们研究的目的是检测OSA患者夜间ANP的分泌情况，并测量其血氧饱和度、肺动脉压和胸内压波动的变化。此外，我们分析了不同行为状态（如清醒、运动和睡眠）下ANP的分泌情况以及肺动脉压。对6例阻塞性睡眠呼吸暂停患者睡眠研究开始、中间和结束时非快速眼动（NREM）睡眠期的连续呼吸暂停进行了分析。另外，我们测量了血浆ANP水平。睡眠研究中间阶段的呼吸暂停持续时间显著长于开始或结束时（P<0.05）。相应地，睡眠研究中间阶段的呼吸暂停末期血氧饱和度和呼吸暂停末期食管压力均显著低于开始或结束时（P<0.05）。呼吸暂停末期跨壁收缩期肺动脉压（P（PATM））和ANP水平未发现显著差异。对不同行为状态下ANP水平的评估显示，睡眠时的水平略高于清醒时，但差异不显著（0.235±0.088 vs. 0.207±0.057 nmol/L）。然而，运动时ANP水平最高（0.334±0.170 nmol/L），与清醒和睡眠时的水平相比有显著差异。这些数据表明，容量效应可能是运动时释放ANP的一个重要因素，但OSA在睡眠时对ANP分泌的作用值得怀疑。
