Bucca Caterina B, Brussino Luisa, Battisti Alberto, Mutani Roberto, Rolla Giovanni, Mangiardi Lucia, Cicolin Alessandro
Department of Biomedical Sciences and Human Oncology, University of Turin, Via Lamarmora 41, 10128 Turin, Italy.
Chest. 2007 Aug;132(2):440-6. doi: 10.1378/chest.07-0311.
Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in patients with heart disease. The aim of this study was to evaluate if intensive unloading with diuretics improves sleep-disordered breathing and increases pharyngeal caliber in patients with severe OSA and diastolic heart failure.
Fifteen patients with severe OSA, hypertension, and diastolic heart failure were hospitalized to receive IV furosemide, 20 mg, and spironolactone, 100 mg, bid for 3 days. Polysomnography was performed for assessment of apnea-hypopnea index (AHI), acoustic pharyngometry was performed for assessment of the oropharyngeal junction (OPJ) area, and forced midinspiratory flow (FIF(50)), forced midexpiratory flow (FEF(50))/FIF(50) percentage, and exhaled nitric oxide (FeNO) were measured before and after diuretic treatment.
Diuretic treatment produced a significant decrease in body weight, BP, and AHI (from 74.89 +/- 6.95 to 57.17 +/- 5.40/h, p < 0.001), associated with an improvement in OPJ area (from 1.33 +/- 0.10 to 1.78 +/- 0.16 cm(2), p = 0.007), FIF(50) (from 3.16 +/- 0.4 to 3.94 +/- 0.4 L/s, p = 0.006), and FEF(50)/FIF(50) percentage (from 117.9 +/- 11.8 to 93.15 +/- 10.1%, p = 0.002). Weight loss was significantly related to the decrease of AHI (R = 0.602; p = 0.018), to the increase of FIF(50) (R = 0.68; p = 0.005), and to the decrease of FEF(50)/FIF(50) (R = 0.635; p = 0.011).
These findings suggest that pharyngeal edema contributes to sleep-disordered breathing in obese patients with severe OSA, hypertension, and diastolic heart failure. Upper airway edema may contribute to the frequent occurrence of OSA in patients with heart disease.
上气道水肿可能导致咽部可塌陷性增加，并解释了心脏病患者阻塞性睡眠呼吸暂停（OSA）的高患病率。本研究的目的是评估利尿剂强化利尿是否能改善重度OSA和舒张性心力衰竭患者的睡眠呼吸紊乱，并增加咽部口径。
15例重度OSA、高血压和舒张性心力衰竭患者住院接受静脉注射呋塞米20mg和螺内酯100mg，每日两次，共3天。进行多导睡眠图检查以评估呼吸暂停低通气指数（AHI），进行声学咽部测量以评估口咽交界处（OPJ）面积，并在利尿治疗前后测量用力吸气中期流速（FIF(50)）、用力呼气中期流速（FEF(50)）/FIF(50)百分比和呼出一氧化氮（FeNO）。
利尿治疗使体重、血压和AHI显著降低（从74.89±6.95降至57.17±5.40次/小时，p<0.001），同时OPJ面积增加（从1.33±0.10增至1.78±0.16cm²，p = 0.007），FIF(50)增加（从3.16±0.4增至3.94±0.4L/s，p = 0.006），FEF(50)/FIF(50)百分比降低（从117.9±11.8降至93.15±10.1%，p = 0.002）。体重减轻与AHI降低显著相关（R = 0.602；p = 0.018），与FIF(50)增加显著相关（R = 0.68；p = 0.005），与FEF(50)/FIF(50)降低显著相关（R = 0.635；p = 0.011）。
这些发现表明，咽部水肿导致重度OSA、高血压和舒张性心力衰竭肥胖患者的睡眠呼吸紊乱。上气道水肿可能是心脏病患者频繁发生OSA的原因之一。
