经颅磁刺激对阻塞性睡眠呼吸暂停低通气综合征患者膈肌的研究

[Study of transcranial magnetic stimulation on diaphragm in patients with obstructive sleep apnea-hypopnea syndrome].

作者信息

Hou Yu-Hong, Chen Rong-Chang, Luo Yuan-Ming, Zhong Nan-Shan

机构信息

Guangzhou Institute of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical College, Guangzhou 510120, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2008 Jul;31(7):497-500.

PMID:19035227

Abstract

OBJECTIVE

To investigate the changes and possible mechanisms of diaphragm motor evoked potential (MEP) elicited by transcranial magnetic stimulation (TMS) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Sixteen healthy volunteers (control group), 7 primary snorers (snore group), 13 mild-moderate OSAHS patients (mild-moderate group) and 16 severe OSAHS patients (severe group) were recruited for the study from June in 2005 to June in 2006. Esophageal electrodes combined with TMS and cervical magnetic stimulation (CMS) were used to measure the latency and amplitude of right diaphragm MEP, as well as central motor conduction time (CMCT). The study was repeated in 5 OSAHS patients after effective nasal continuous positive airway pressure (nCPAP) treatment for at least 2 months.

RESULTS

The amplitude of right MEP in severe OSAHS group was (152 +/- 116) microV, which was significantly lower than that in the control group (414 +/- 201) microV, the snore group (352 +/- 99) microV and the mild-moderate group (372 +/- 206) microV. The latency and CMCT in the severe OSAHS group were (18.1 +/- 1.8), (10.6 +/- 1.8) ms respectively, which were significantly longer than those in the control group (13.9 +/- 1.6), (7.7 +/- 1.7) ms, the snore group (14.6 +/- 1.6), (8.1 +/- 1.6) ms, and the mild-moderate group (15.4 +/- 2.7) , (9.0 +/- 2.2) ms. The latency and amplitude of diaphragm MEP as well as CMCT correlated significantly with arousal index, longest apnea duration, minimum pulse oxygen saturation (SpO2), oxygen desaturation index, the percentage of total sleep time with SpO2 below 90% and apnea-hypoxia index (AHI). The latency became significantly shorter after effective nCPAP treatment for more than 2 months, which was (17.5 +/- 0.6) and (15.5 +/- 0.7) ms respectively.

CONCLUSIONS

The latency of MEP and CMCT in OSAHS patients prolonged significantly, while the amplitude of MEP lowered, which may be due to repeated hypoxia, carbon dioxide retention and disorder of sleep structure at night.

摘要

目的

探讨经颅磁刺激（TMS）诱发的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者膈肌运动诱发电位（MEP）的变化及可能机制。

方法

2005年6月至2006年6月招募了16名健康志愿者（对照组）、7名原发性打鼾者（打鼾组）、13名轻中度OSAHS患者（轻中度组）和16名重度OSAHS患者（重度组）进行研究。采用食管电极联合TMS及颈部磁刺激（CMS）测量右侧膈肌MEP的潜伏期、波幅以及中枢运动传导时间（CMCT）。5名OSAHS患者经有效的经鼻持续气道正压通气（nCPAP）治疗至少2个月后重复本研究。

结果

重度OSAHS组右侧MEP波幅为（152±116）μV，显著低于对照组（414±201）μV、打鼾组（352±99）μV和轻中度组（372±206）μV。重度OSAHS组的潜伏期和CMCT分别为（18.1±1.8）、（10.6±1.8）ms，显著长于对照组（13.9±1.6）、（7.7±1.7）ms，打鼾组（14.6±1.6）、（8.1±1.6）ms，以及轻中度组（15.4±2.7）、（9.0±2.2）ms。膈肌MEP的潜伏期、波幅以及CMCT与觉醒指数、最长呼吸暂停持续时间、最低脉搏血氧饱和度（SpO2）、氧饱和度下降指数、SpO2低于90%的总睡眠时间百分比及呼吸暂停低氧指数（AHI）显著相关。经有效的nCPAP治疗2个月以上后，潜伏期显著缩短，分别为（17.5±0.6）和（15.5±0.7）ms。