Penzel T, Möller M, Becker H F, Knaack L, Peter J H
Department of Medicine, Philipps-University, Marburg, Germany.
Sleep. 2001 Feb 1;24(1):90-5. doi: 10.1093/sleep/24.1.90.
Collapsibility of the upper airways has been identified as an important pathogenic factor in obstructive sleep apnea (OSA). Objective measures of collapsibility are pharyngeal critical pressure (Pcrit) and resistance of the upstream segment (Rus). To systematically determine the effects of sleep stage and body position we investigated 16 male subjects suffering from OSA. We compared the measures in light sleep, slow-wave sleep, REM sleep and supine vs. lateral positions. The pressure-flow relationship of the upper airways has been evaluated by simultaneous readings of maximal inspiratory airflow (Vimax) and nasal pressure (p-nCPAP). With two-factor repeated measures ANOVA on those 7 patients which had all 6 situations we found a significant influence of body position on Pcrit (p<0.05) whereas there was no significant influence of sleep stage and no significant interaction between body position and sleep stage. When comparing the body positions Pcrit was higher in the supine than in the lateral positions. During light sleep Pcrit decreased from 0.6 +/- 0.8 cm H2O (supine) to -2.2 +/- 3.6 cm H2O (lateral) (p<0.01), during slow-wave sleep Pcrit decreased from 0.3 +/- 1.4 cm H2O (supine) to -1.7 +/- 2.6 (lateral) (p<0.05) and during REM sleep it decreased from 1.2 +/- 1.5 cm H2O to -2.0 +/- 2.2 cm H2O (p<0.05). Changes in Rus revealed no body position nor sleep-stage dependence. Comparing the different body positions Rus was only significantly higher in the lateral position during REM sleep (p<0.05). The results indicate that collapsibility of the upper airways is not mediated by sleep stages but is strongly influenced by body position. As a consequence lower nCPAP pressure is needed during lateral positions compared to supine positions.
上气道可塌陷性已被确认为阻塞性睡眠呼吸暂停(OSA)的一个重要致病因素。可塌陷性的客观测量指标是咽部临界压力(Pcrit)和上游段阻力(Rus)。为了系统地确定睡眠阶段和体位的影响,我们对16名患有OSA的男性受试者进行了研究。我们比较了浅睡眠、慢波睡眠、快速眼动睡眠以及仰卧位与侧卧位时的测量指标。通过同时读取最大吸气气流(Vimax)和鼻压力(p - nCPAP)对上气道的压力 - 流量关系进行了评估。对这7名经历了所有6种情况的患者进行双因素重复测量方差分析,我们发现体位对Pcrit有显著影响(p<0.05),而睡眠阶段没有显著影响,体位和睡眠阶段之间也没有显著交互作用。比较不同体位时,仰卧位的Pcrit高于侧卧位。在浅睡眠期间,Pcrit从0.6±0.8 cm H₂O(仰卧位)降至 - 2.2±3.6 cm H₂O(侧卧位)(p<0.01),在慢波睡眠期间,Pcrit从0.3±1.4 cm H₂O(仰卧位)降至 - 1.7±2.6(侧卧位)(p<0.05),在快速眼动睡眠期间,它从1.2±1.5 cm H₂O降至 - 2.0±2.2 cm H₂O(p<0.05)。Rus的变化显示与体位和睡眠阶段均无关。比较不同体位时,仅在快速眼动睡眠期间侧卧位的Rus显著更高(p<0.05)。结果表明,上气道的可塌陷性不是由睡眠阶段介导的,而是受体位的强烈影响。因此,与仰卧位相比,侧卧位时所需的无创持续气道正压通气(nCPAP)压力更低。