Milross M A, Piper A J, Norman M, Becker H F, Willson G N, Grunstein R R, Sullivan C E, Bye P T
Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
Am J Respir Crit Care Med. 2001 Jan;163(1):129-34. doi: 10.1164/ajrccm.163.1.2005130.
We measured ventilation in all sleep stages in patients with cystic fibrosis (CF) and moderate to severe lung disease, and compared the effects of low-flow oxygen (LFO2) and bilevel ventilatory support (BVS) on ventilation and gas exchange during sleep. Thirteen subjects, age 26 +/- 5.9 yr (mean +/- 1 SD), body mass index (BMI) 20 +/- 3 kg/m2, FEV1 32 +/- 11% predicted, underwent three sleep studies breathing, in random order, room air (RA), LFO2, and BVS +/- O2 with recording of oxyhemoglobin saturation (SpO2) (%) and transcutaneous carbon dioxide (TcCO2) (mm Hg). During RA and LFO2 studies, patients wore a nasal mask with a baseline continuous positive airway pressure (CPAP) of 4 to 5 cm H2O. Minute ventilation (V I) was measured using a pneumotachograph in the circuit and was not different between wake and non-rapid eye movement (NREM) sleep on any night. However, V I was reduced on the RA and LFO2 nights from awake to rapid eye movement (REM) (p < 0.01) and from NREM to REM (p < 0.01). On the BVS night there was no significant difference in V I between NREM and REM sleep. Both BVS and LFO2 improved nocturnal SpO2, especially during REM sleep (p < 0.05). The rise in TcCO2 seen with REM sleep with both RA and LFO2 was attenuated with BVS (p < 0.05). We conclude that BVS leads to improvements in alveolar ventilation during sleep in this patient group.
我们对患有囊性纤维化（CF）且有中度至重度肺部疾病的患者在所有睡眠阶段的通气情况进行了测量，并比较了低流量氧气（LFO2）和双水平通气支持（BVS）对睡眠期间通气和气体交换的影响。13名受试者，年龄26±5.9岁（均值±1标准差），体重指数（BMI）20±3kg/m²，预测第一秒用力呼气容积（FEV1）为32±11%，随机依次进行了三项睡眠研究，分别呼吸室内空气（RA）、LFO2以及BVS±O2，并记录氧合血红蛋白饱和度（SpO2）（%）和经皮二氧化碳（TcCO2）（mmHg）。在RA和LFO2研究期间，患者佩戴鼻罩，基线持续气道正压通气（CPAP）为4至5cm H2O。使用回路中的呼吸流速仪测量分钟通气量（VI），在任何一晚的清醒和非快速眼动（NREM）睡眠之间，VI没有差异。然而，在RA和LFO2的夜晚，从清醒到快速眼动（REM）睡眠以及从NREM到REM睡眠时，VI均降低（p<0.01）。在BVS的夜晚，NREM和REM睡眠之间的VI没有显著差异。BVS和LFO2均改善了夜间SpO2，尤其是在REM睡眠期间（p<0.05）。在RA和LFO2时，REM睡眠时出现的TcCO2升高在BVS时减弱（p<0.05）。我们得出结论，在该患者组中，BVS可改善睡眠期间的肺泡通气。
