Langevin B, Petitjean T, Philit F, Robert D
LTRS, Croix-Rousse Hospital, Lyon, France.
Sleep. 2000 Jun 15;23 Suppl 4:S204-8.
Decrease of respiratory muscle capacities in neuromuscular disease can lead to chronic respiratory failure with permanent alveolar hypoventilation. Respiratory centers elaborate a strategy of breathing dedicated to prevent overt respiratory muscles fatigue. This strategy may worsen chronic hypercapnia. During sleep, ventilation decreases because a lessening in respiratory centers function. During NREM sleep hypoventilation is only an exacerbation of what is seen during wakefulness. During REM sleep, atonia worsens much more hypoventilation particularly when diaphragmatic function is impaired. The effects of atonia are amplified by a very low reactivity of respiratory centers. Nocturnal mechanical ventilation improves nocturnal hypoventilation and daytime arterial blood gases (ABG). Mechanism of improvement in ABG and how nocturnal hypoventilation and diurnal hypoventilation interact, are still a matter of debate.
神经肌肉疾病中呼吸肌能力下降可导致慢性呼吸衰竭及永久性肺泡通气不足。呼吸中枢会制定一种呼吸策略以防止明显的呼吸肌疲劳。这种策略可能会使慢性高碳酸血症恶化。睡眠期间，由于呼吸中枢功能减弱，通气量会下降。在非快速眼动睡眠期间，通气不足只是清醒时所见情况的加重。在快速眼动睡眠期间，肌张力缺失会使通气不足更加恶化，尤其是当膈肌功能受损时。呼吸中枢极低的反应性会放大肌张力缺失的影响。夜间机械通气可改善夜间通气不足及日间动脉血气（ABG）。ABG改善的机制以及夜间通气不足与日间通气不足如何相互作用，仍是一个有争议的问题。
