Clause Didier, Detry Bruno, Rodenstein Daniel, Liistro Giuseppe
Pneumology Unit, Cliniques Universitaires Saint-Luc (UCL Ave. Hippocrate 10, 1200 Brussels, Belgium.
J Appl Physiol (1985). 2008 Dec;105(6):1809-12. doi: 10.1152/japplphysiol.90860.2008. Epub 2008 Oct 23.
A decrease in hemoglobin affinity for oxygen is considered an adaptive mechanism against tissue hypoxia. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by recurrent episodes of apnea and hypopnea resulting in arterial oxygen desaturations during sleep. Maillard et al. (10) observed a right shift of the oxyhemoglobin dissociation curve (ODC) and an increase in 2,3-diphosphoglycerate (2,3-DPG) concentration ([2,3-DPG]) in 15 patients with severe OSAHS, but some had slight daytime arterial hypoxemia while breathing room air. The aim of our study was to measure the ODC and 2,3-DPG concentrations in a group of subjects normoxemic during daytime referred to our sleep laboratory for suspicion of snoring or OSAHS. The patients were recruited during a period of 6 mo. All arterial and venous blood samples were taken early in the morning within 1 h of awakening following a full-night polysomnography. ODC and 2,3-DPG were analyzed in 88 patients: 56 OSAHS (oxygen desaturation index: 27.5 +/- 24.5) and 32 non-OSAHS. We found a significant correlation between the P50 and 2,3-DPG levels in the 88 patients: r = 0.502, P < 0.001. We observed no difference between OSAHS and non-OSAHS for the P50 and for [2,3-DPG]. There was no correlation between the severity of OSAHS and either P50 or [2,3-DPG]. Finally, there was no change in these parameters measured at baseline, after 3 days and after 1 mo of treatment by nasal continuous positive airway pressure in 7 patients with OSAHS. We conclude that patients with OSAHS who are normoxemic during daytime have comparable oxyhemoglobin affinity than nonapneic subjects.
血红蛋白对氧亲和力的降低被认为是一种针对组织缺氧的适应性机制。阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的特征是反复出现呼吸暂停和低通气发作，导致睡眠期间动脉血氧饱和度下降。Maillard等人（10）观察到15例重度OSAHS患者的氧合血红蛋白解离曲线（ODC）右移，2,3-二磷酸甘油酸（2,3-DPG）浓度（[2,3-DPG]）升高，但其中一些患者在呼吸室内空气时存在轻度日间动脉低氧血症。我们研究的目的是测量一组因怀疑打鼾或OSAHS而被转诊至我们睡眠实验室的日间血氧正常的受试者的ODC和2,3-DPG浓度。患者在6个月的时间内招募。所有动脉和静脉血样均在整夜多导睡眠图检查后的清晨醒来后1小时内采集。对88例患者进行了ODC和2,3-DPG分析：56例OSAHS患者（氧饱和度下降指数：27.5±24.5）和32例非OSAHS患者。我们发现88例患者的P50与2,3-DPG水平之间存在显著相关性：r = 0.502，P < 0.001。我们观察到OSAHS组和非OSAHS组在P50和[2,3-DPG]方面没有差异。OSAHS的严重程度与P50或[2,3-DPG]之间没有相关性。最后，7例OSAHS患者在接受鼻持续气道正压通气治疗3天和1个月后，这些参数在基线时测量没有变化。我们得出结论，日间血氧正常的OSAHS患者与非呼吸暂停受试者具有相当的氧合血红蛋白亲和力。
