Kurashina K, Akashiba T, Horie T
First Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Nov;30(11):1923-30.
The prevalence and mechanisms of daytime pulmonary hypertension were examined in 24 cases of obstructive sleep apnea syndrome (OSAS). All patients were free from chronic lung disease. They underwent pulmonary function tests and blood gas analysis in the sitting and supine position, hypercapnic ventilatory response test, exercise test and right heart catheterization. Elevation of mean pulmonary arterial pressure (m-PAP) above 20 mmHg was observed in 5 out of 24 cases (20.8%). The group with pulmonary hypertension (PG+: m-PAP = 22.2 +/- 2.7 mmHg) showed marked obesity (p < 0.001), significant decrease of supine FRC/TLC (p < 0.05), increase of supine CC/FRC (p < 0.01), decrease of supine PaO2 (p < 0.02) and desaturation during exercise (p < 0.05) in comparison with the group without pulmonary hypertension (PH-: 13.9 +/- 3.1 mmHg). m-PAP was positively correlated with %IBW and desaturation during exercise (p < 0.01, p < 0.02) and negatively correlated with supine PaO2 (p < 0.01). Various changes in pulmonary function and pulmonary hemodynamics due to obesity seem to lead to daytime pulmonary hypertension of OSAS.
对24例阻塞性睡眠呼吸暂停综合征(OSAS)患者的日间肺动脉高压患病率及机制进行了研究。所有患者均无慢性肺部疾病。他们接受了坐位和仰卧位的肺功能测试、血气分析、高碳酸通气反应测试、运动测试及右心导管检查。24例患者中有5例(20.8%)平均肺动脉压(m-PAP)升高超过20 mmHg。与无肺动脉高压组(PH-:13.9±3.1 mmHg)相比,肺动脉高压组(PG+:m-PAP = 22.2±2.7 mmHg)表现出明显肥胖(p < 0.001)、仰卧位功能残气量/肺总量(FRC/TLC)显著降低(p < 0.05)、仰卧位闭合气量/功能残气量(CC/FRC)增加(p < 0.01)、仰卧位动脉血氧分压(PaO2)降低(p < 0.02)以及运动期间血氧饱和度下降(p < 0.05)。m-PAP与体重百分比(%IBW)及运动期间血氧饱和度下降呈正相关(p < 0.01,p < 0.02),与仰卧位PaO2呈负相关(p < 0.01)。肥胖导致的肺功能和肺血流动力学的各种变化似乎会引发OSAS患者的日间肺动脉高压。