Poyares D, Guilleminault C, Rosa A, Ohayon M, Koester U
Stanford University Sleep Disorders Center, 401 Quarry Road, Suite 3301, CA 94305, USA.
Clin Neurophysiol. 2002 Oct;113(10):1598-1606. doi: 10.1016/s1388-2457(02)00214-6.
Upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS) are associated with arousals and autonomic activation. Pulse transit time (PTT) has been used to recognize transient arousals. We examined the accuracy of PTT to recognize arousals, and the relationship between PTT deflection and visual and non-visual arousals.
Ten UARS and 10 mild OSAS subjects were studied via polysomnography including measurement of esophageal pressure. Electroencephalogram (EEG) spectral power was obtained from central leads. Seven types of events were identified, depending upon the presence or absence of: a sleep-related respiratory event (SRRE), i.e. apnea, hypopnea, and abnormal breathing effort; a PTT signal; or a visually scored arousal (>1.5s).
One thousand four hundred forty-six events were identified in 20 subjects. Fifty-nine percent of all SRREs were associated with a PTT signal and a visual EEG arousal. Nineteen percent of SRREs had no EEG arousals at their termination, and 7.4% had no associated PTT signal. Delta power was significantly increased when non-visual EEG arousals were scored. The time delay for PTT was determined by the presence or absence of EEG arousal. The sensitivity of PTT to recognize EEG arousal was 90.4% and the specificity was 16.8%. The sensitivity and specificity of PTT to recognize SRRE was 90.7 and 21.9%, respectively.
These results preclude the use of PTT by itself. SRREs induce an activation with positive PTT response but without arousal in 14% of cases. This PTT response, however, is much slower than that occurring with arousal. UARS and mild OSAS do not respond in the same way to SRREs, particularly during rapid eye movement sleep.
上气道阻力综合征（UARS）和阻塞性睡眠呼吸暂停综合征（OSAS）与觉醒及自主神经激活有关。脉搏传输时间（PTT）已被用于识别短暂觉醒。我们研究了PTT识别觉醒的准确性，以及PTT偏转与视觉和非视觉觉醒之间的关系。
通过多导睡眠图对10名UARS患者和10名轻度OSAS患者进行研究，包括测量食管压力。从中央导联获取脑电图（EEG）频谱功率。根据是否存在睡眠相关呼吸事件（SRRE），即呼吸暂停、呼吸浅慢和异常呼吸努力；PTT信号；或视觉评分觉醒（>1.5秒），识别出七种类型的事件。
在20名受试者中识别出1446个事件。所有SRRE中有59%与PTT信号和视觉EEG觉醒相关。19%的SRRE在结束时没有EEG觉醒，7.4%没有相关的PTT信号。对非视觉EEG觉醒进行评分时，δ功率显著增加。PTT的时间延迟由EEG觉醒的有无决定。PTT识别EEG觉醒的敏感性为90.4%，特异性为16.8%。PTT识别SRRE的敏感性和特异性分别为90.7%和21.9%。
这些结果排除了单独使用PTT的可能性。SRRE可诱发具有正向PTT反应但无觉醒的激活，在14%的病例中是这样。然而，这种PTT反应比觉醒时出现的反应要慢得多。UARS和轻度OSAS对SRRE的反应方式不同，尤其是在快速眼动睡眠期间。
