Hu Ke, Tu Zuo-sheng, Lü Sheng-qi, Li Qing-quan, Chen Xue-qin
Department of Respiratory Disease, Renmin Hospital of Wuhan University, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2011 Mar;34(3):182-6. doi: 10.3760/cma.j.issn1001-0939.2011.03.007.
To investigate the urodynamic changes in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and nocturnal polyuria.
From Sept. 2002 to Jun. 2008, 23 patients with nocturnal polyuria were diagnosed as having OSAHS by polysomnography (PSG). The number and output of nocturia, the osmotic pressure and the excretion of Na(+) were recorded during both the PSG night and CPAP titrating night. Plasma levels of brain natriuretic peptide (BNP) and atrial natriuretic peptides (ANP) were also measured at 11PM in the 2 nights and 7AM in the next mornings. Urodynamic studies including urine flow, bladder pressure during filling, pressure-flow study during voiding and urethral pressure were carried out in these patients. Urodynamic studies were performed again after treatment with CPAP for 3 months.
PSG showed that the patients with nocturnal polyuria had moderate to severe OSAHS, in which the apnea-hypopnea index (AHI) being 48 ± 15 events per hour. The number of nocturnal voiding during the PSG night was more than that during the CPAP titrating night. During the PSG night, the output of nocturia, the nocturia excretion of Na(+), ANP levels (at 7am in the next morning after PSG night) increased and the osmotic pressure of nocturia decreased. CPAP therapy could reverse these abnormalities. The main characteristics of urodynamics in these patients included weak detrusor contraction, hypoesthesia in filling cystometry, and decreased bladder compliance, and detrusor external sphincter dyssynergia. After 3 months of CPAP treatment, both the motility of the detrusor of bladder and the bladder compliance improved.
CPAP therapy can effectively reverse the nocturnal polyuria in OSAHS patients. In OSAHS patients, the features of nocturia, including the changes of output, osmotic pressure and the excretion of Na(+), may be related to the secretion of high-level of ANP. During the course of chronic progressively OSAHS pathophysiology, detrusor function of bladder may be damaged. CPAP therapy could decrease the nocturnal excretion of ANP, and improve the motility of the detrusor of bladder.
探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并夜间多尿患者的尿动力学变化。
2002年9月至2008年6月，23例夜间多尿患者经多导睡眠图（PSG）诊断为OSAHS。记录PSG监测夜和持续气道正压通气（CPAP）滴定夜的夜尿次数、尿量、渗透压及尿钠排泄量。于两晚的晚上11点及次日上午7点测定血浆脑钠肽（BNP）和心房钠尿肽（ANP）水平。对这些患者进行尿动力学检查，包括尿流率、膀胱充盈期压力、排尿期压力-流率测定及尿道压力测定。CPAP治疗3个月后再次进行尿动力学检查。
PSG显示夜间多尿患者存在中度至重度OSAHS，呼吸暂停低通气指数（AHI）为每小时48±15次。PSG监测夜的夜尿次数多于CPAP滴定夜。PSG监测夜，夜尿量、夜尿钠排泄量、ANP水平（PSG监测夜后次日上午7点）升高，夜尿渗透压降低。CPAP治疗可逆转这些异常。这些患者尿动力学的主要特征包括逼尿肌收缩力减弱、膀胱充盈测压感觉减退、膀胱顺应性降低及逼尿肌-外括约肌协同失调。CPAP治疗3个月后，膀胱逼尿肌活动及膀胱顺应性均改善。
CPAP治疗可有效逆转OSAHS患者的夜间多尿。在OSAHS患者中，夜尿的特征，包括尿量、渗透压及尿钠排泄量的变化，可能与高水平ANP的分泌有关。在慢性进行性OSAHS病理生理过程中，膀胱逼尿肌功能可能受损。CPAP治疗可降低夜间ANP排泄量，改善膀胱逼尿肌活动。
