Gates Gregory J, Mateika Susan E, Basner Robert C, Mateika Jason H
John D. Dingell VA Medical Center, 4646 John R (11R), Room 4308, Detroit, MI 48201, USA.
Chest. 2004 Sep;126(3):801-7. doi: 10.1378/chest.126.3.801.
We hypothesized that baroreflex sensitivity is decreased during wakefulness and non-rapid eye movement sleep in normotensive, nonapneic snorers who are otherwise healthy. Moreover, we hypothesized that nocturnal alterations in baroreflex sensitivity are abolished during the application of nasal continuous positive airway pressure (nCPAP).
The sequencing technique was used to measure baroreflex sensitivity in 16 normotensive nonapneic snorers and 16 control subjects matched for age, height, weight, gender, and race. Subsequently, baroreflex sensitivity was measured in 12 of 16 snorers and 14 of 16 control subjects during the application of nCPAP.
Mean (+/- SE) baroreflex sensitivity was reduced during sleep in the nonapneic snoring group (wakefulness, 20.99 +/- 1.46 ms/mm Hg; sleep, 15.85 +/- 1.49 ms/mm Hg), but not in the control group (wakefulness, 21.82 +/- 2.48 ms/mm Hg; sleep, 23.54 +/- 2.18 ms/mm Hg). This reduction was abolished by the application of nCPAP in the snoring group (before nCPAP therapy, 16.30 +/- 2.17 ms/mm Hg; during nCPAP therapy, 20.63 +/- 2.40 ms/mm Hg). The application of nCPAP did not alter baroreflex sensitivity in the control group (before nCPAP therapy, 23.54 +/- 2.18 ms/mm Hg; during nCPAP therapy, 22.56 +/- 1.73 ms/mm Hg). BP was not significantly different between the snoring and control groups either before or during nCPAP application.
Our findings suggest that nocturnal alterations in baroreflex sensitivity may exist in nonapneic snoring subjects prior to alterations in other cardiovascular variables.
我们推测,在血压正常、无呼吸暂停的鼾症患者(其他方面健康)的清醒和非快速眼动睡眠期间,压力反射敏感性会降低。此外,我们推测在应用鼻持续气道正压通气(nCPAP)期间,压力反射敏感性的夜间变化会消失。
采用测序技术测量16名血压正常的非呼吸暂停鼾症患者和16名年龄、身高、体重、性别和种族相匹配的对照者的压力反射敏感性。随后,在16名鼾症患者中的12名和16名对照者中的14名应用nCPAP期间测量压力反射敏感性。
非呼吸暂停打鼾组睡眠期间平均(±标准误)压力反射敏感性降低(清醒时,20.99±1.46毫秒/毫米汞柱;睡眠时,15.85±1.49毫秒/毫米汞柱),但对照组未降低(清醒时,21.82±2.48毫秒/毫米汞柱;睡眠时,23.54±2.18毫秒/毫米汞柱)。在打鼾组应用nCPAP后,这种降低消失(nCPAP治疗前,16.30±2.17毫秒/毫米汞柱;nCPAP治疗期间,20.63±2.40毫秒/毫米汞柱)。nCPAP的应用未改变对照组的压力反射敏感性(nCPAP治疗前,23.54±2.18毫秒/毫米汞柱;nCPAP治疗期间,22.56±1.73毫秒/毫米汞柱)。在应用nCPAP之前或期间,打鼾组和对照组的血压没有显著差异。
我们的研究结果表明,在其他心血管变量改变之前,非呼吸暂停打鼾者可能存在压力反射敏感性的夜间变化。