睡眠相关呼吸障碍中的夜间低氧血症和动脉血乳酸水平

Nocturnal hypoxia and arterial lactate levels in sleep-related breathing disorders.

作者信息

Ucar Zeynep Zeren, Taymaz Zuhre, Erbaycu Ahmet Emin, Kirakli Cenk, Tuksavul Fevziye, Guclu Salih Zeki

机构信息

Department of Sleep Disorders, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey.

出版信息

South Med J. 2009 Jul;102(7):693-700. doi: 10.1097/SMJ.0b013e3181a93897.

DOI:10.1097/SMJ.0b013e3181a93897

PMID:19487994

Abstract

BACKGROUND

Lactate may be useful in pointing out the higher risk subgroups in sleep-related breathing disorders (SRBD) with various patterns of hypoxemia. We aimed to search whether morning and night lactate levels are related to apnea-hypopnea, hypoventilation, and hypoxemia in patients with SRBD and to compare it with patients without SRBD (No-SRBD).

METHODS

Eighty patients with suspected SRBD underwent polysomnography (PSG) testing. SRBD patients had obstructive sleep apnea syndrome with or without sleep-related hypoventilation/hypoxemic conditions. Patients without SRBD were in the control group. Measurements included pulmonary function testing, PSG, analysis of arterial blood gases, and arterial lactate before and after PSG. Arterial lactate was compared with SRBD and No-SRBD patients.

RESULTS

Morning lactate was significantly higher in the SRBD group than the No-SRBD group (1.65 +/- 0.48 and 1.35 +/- 0.57 mmol/L, respectively) (P = 0.003). Lactate levels at night and the change overnight in lactate levels were not significantly different between groups. After an adjustment for age, gender, and body mass index, lactate levels before PSG were related to the apnea-hypopnea index (beta: 0.004, 95% CI: 0.000-0.008) and the rate of sleep-time spent under 90% oxygen saturation (T90%). The following morning lactate level was correlated with the T90% (beta: 0.005, 95% CI: 0.000-0.010). After an adjustment for lactate levels before PSG, lactate in the morning was correlated with T90% (beta: 0.004, 95% CI: 0.000-0.008).

CONCLUSION

As a marker of tissue hypoxia, arterial lactate may be used to assess the severity of SRBD.

摘要

背景

乳酸可能有助于指出睡眠相关呼吸障碍（SRBD）中具有各种低氧血症模式的高风险亚组。我们旨在研究SRBD患者的早晚乳酸水平是否与呼吸暂停低通气、通气不足和低氧血症相关，并将其与无SRBD患者（非SRBD）进行比较。

方法

80例疑似SRBD患者接受了多导睡眠图（PSG）测试。SRBD患者患有阻塞性睡眠呼吸暂停综合征，伴有或不伴有睡眠相关通气不足/低氧血症情况。无SRBD患者为对照组。测量包括肺功能测试、PSG、动脉血气分析以及PSG前后的动脉乳酸。比较SRBD患者和非SRBD患者的动脉乳酸。

结果

SRBD组的早晨乳酸水平显著高于非SRBD组（分别为1.65±0.48和1.35±0.57 mmol/L）（P = 0.003）。两组夜间乳酸水平及夜间乳酸水平变化无显著差异。在调整年龄、性别和体重指数后，PSG前的乳酸水平与呼吸暂停低通气指数（β：0.004，95%可信区间：0.000 - 0.008）以及血氧饱和度低于90%的睡眠时间比例（T90%）相关。次日早晨乳酸水平与T90%相关（β：0.005，95%可信区间：0.000 - 0.010）。在调整PSG前的乳酸水平后，早晨乳酸与T90%相关（β：0.004，95%可信区间：0.000 - 0.008）。