Shneerson J M
Respiratory support and sleep centre; Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, United Kingdom.
Monaldi Arch Chest Dis. 2004 Jan-Mar;61(1):44-8.
Many of the neuromuscular and thoracic cage disorders are associated with disorders of breathing during sleep. The abnormal mechanics of the chest wall impairs respiratory muscle function and this is compounded if there is underlying muscle weakness. Respiratory abnormalities appear during REM sleep before NREM or wakefulness. Central sleep apnoeas are characteristic, but obstructive apnoeas are also occur because of loss of tone in the upper airway dilator muscles. Arousals from sleep return the blood gases towards normal, but cause fragmentation of sleep, leading to daytime sleepiness. Ventilatory failure occurs particularly if the vital capacity is less than 1.0-1.5 litres or if the maximal inspiratory mouth pressure is less than 20-25cmH2O. Non invasive ventilation effectively prevents both central and obstructive apnoeas and improves the sleep architecture and daytime blood gases.
许多神经肌肉和胸廓疾病都与睡眠期间的呼吸障碍有关。胸壁的异常力学机制会损害呼吸肌功能，如果存在潜在的肌肉无力，情况会更加复杂。呼吸异常在快速眼动睡眠期比非快速眼动睡眠期或清醒时更早出现。中枢性睡眠呼吸暂停是其特征，但由于上气道扩张肌张力丧失，也会出现阻塞性呼吸暂停。睡眠中的觉醒会使血气恢复正常，但会导致睡眠碎片化，进而引起日间嗜睡。特别是当肺活量小于1.0 - 1.5升或最大吸气口腔压力小于20 - 25厘米水柱时，会发生通气衰竭。无创通气可有效预防中枢性和阻塞性呼吸暂停，并改善睡眠结构和日间血气。
