Bossi Roberto, Piatti Gioia, Roma Elisabetta, Ambrosetti Umberto
Laboratory of Sleep Respiratory Disorders, Institute of Respiratory Diseases, University of Milan, Ospedale Maggiore Policlinico, Istituto di Rico-vero e Cura a Carattere Scientifico, Milan, Italy.
Laryngoscope. 2004 Aug;114(8):1431-4. doi: 10.1097/00005537-200408000-00022.
OBJECTIVES/HYPOTHESIS: The objective was to investigate the possible modification of nasal mucosa function and mucociliary clearance in a group of patients with severe obstructive sleep apnea syndrome receiving mechanical ventilation with long-term nasal continuous positive airway pressure (n-CPAP), without nasal diseases.
The study design was experimental. Eight (six male and two female) nonsmoker patients were selected on the basis of two sleep questionnaires, were identified as needing n-CPAP therapy, and showed normal values of mucociliary transport time, ciliary beat frequency, and anterior rhinomanometry.
After a full polysomnographic examination, the authors recorded respiratory disturbance index (RDI), apnea/hypopnea index, nadir arterial oxygen saturation, and sleep stage. Every patient underwent pulmonary function test; arterial blood gas analysis; chest radiography; electrocardiography; ear, nose, and throat evaluation with rhinoscopy; anterior rhinomanometry; a saccharine test to measure the mucociliary transport time; and a brushing of nasal epithelium for study of ciliary beat frequency. All patients underwent polysomnographic examination in basal condition with overnight n-CPAP (without humidifier) and repeated this examination after 1 and 6 months with Auto CPAP (Autoset Res Care, Sidney, Australia) to titrate n-CPAP pressure and measure the new respiratory disturbance index.
The mean basal respiratory disturbance index (number of respiratory events during sleep per hour of recording time) was 53.7 +/- 21.5 events/h; after 6 months of n-CPAP therapy (mean value, 7.5 +/- 0.7 cm H2O) the respiratory disturbance index was 5.7 +/- 3.76 events/h. Values for nasal resistance, mucociliary transport time, and ciliary beat frequency were normal before and after the ventilatory treatment.
In the study group of patients with severe obstructive sleep apnea syndrome, the nocturnal use of n-CPAP without humidifier did not modify the function and mucociliary clearance of nasal epithelium.
目的/假设：目的是研究一组患有严重阻塞性睡眠呼吸暂停综合征且无鼻部疾病的患者，在接受长期经鼻持续气道正压通气（n-CPAP）机械通气时鼻黏膜功能和黏液纤毛清除功能的可能变化。
研究设计为实验性。根据两份睡眠问卷选择了8名（6名男性和2名女性）不吸烟患者，确定他们需要n-CPAP治疗，且黏液纤毛转运时间、纤毛摆动频率和前鼻测压值均正常。
在进行全面的多导睡眠图检查后，作者记录了呼吸紊乱指数（RDI）、呼吸暂停/低通气指数、最低动脉血氧饱和度和睡眠阶段。每位患者均接受了肺功能测试、动脉血气分析、胸部X线检查、心电图检查、鼻内镜检查进行耳鼻喉评估、前鼻测压、糖精试验以测量黏液纤毛转运时间，以及对鼻上皮进行刷检以研究纤毛摆动频率。所有患者在基础状态下使用过夜n-CPAP（无加湿器）进行多导睡眠图检查，并在1个月和6个月后使用自动CPAP（澳大利亚悉尼的Autoset Res Care）重复此检查，以滴定n-CPAP压力并测量新的呼吸紊乱指数。
基础平均呼吸紊乱指数（每小时记录时间内睡眠期间的呼吸事件数）为53.7±21.5次/小时；n-CPAP治疗6个月后（平均值，7.5±0.7 cm H₂O），呼吸紊乱指数为5.7±3.76次/小时。通气治疗前后鼻阻力、黏液纤毛转运时间和纤毛摆动频率的值均正常。
在该严重阻塞性睡眠呼吸暂停综合征患者研究组中，夜间使用无加湿器的n-CPAP未改变鼻上皮的功能和黏液纤毛清除功能。
