阻塞性睡眠呼吸暂停中伴有和不伴有皮质觉醒的呼吸事件终止。
Termination of respiratory events with and without cortical arousal in obstructive sleep apnea.
机构信息
Brigham and Women's Hospital, Boston, Massachusetts, USA.
出版信息
Am J Respir Crit Care Med. 2011 Nov 15;184(10):1183-91. doi: 10.1164/rccm.201106-0975OC. Epub 2011 Aug 11.
RATIONALE
A total of 20-30% of respiratory events in obstructive sleep apnea are terminated without clear arousal. Arousals are thought to predispose to further events by promoting hyperventilation, hypocapnia, and upper-airway dilator muscle hypotonia. Therefore, events terminated without arousal may promote stable breathing.
OBJECTIVES
To compare physiologic changes at respiratory event termination with American Sleep Disorders Association (ASDA) Arousal to No Arousal, and determine whether secondary respiratory events are less common and have higher dilator muscle activity after No Arousal compared with ASDA Arousal.
METHODS
Patients with obstructive sleep apnea wore sleep staging, genioglossus (EMG(GG)), and tensor palatini (EMG(TP)) electrodes plus a nasal mask and pneumotachograph. During stable sleep, continuous positive airway pressure (CPAP) was lowered for 3-minute periods to induce respiratory events. Physiologic variables were compared between events terminated with (1) ASDA Arousal, (2) No Arousal, or (3) sudden CPAP increase (CPAPinc, control).
MEASUREMENTS AND MAIN RESULTS
Sixteen subjects had adequate data. EMG(GG), EMG(TP), and heart rate increased after ASDA Arousal (340 ± 57%, 215 ± 28%, and 110.7 ± 2.3%) and No Arousal (185 ± 32%, 167 ± 15%, and 108.5 ± 1.6%) but not CPAPinc (90 ± 10%, 94 ± 11%, and 102.1 ± 1%). Ventilation increased more after ASDA Arousal than No Arousal and CPAPinc, but not after accounting for the severity of respiratory event. Fewer No Arousals were followed by secondary events than ASDA Arousals. However, low dilator muscle activity did not occur after ASDA Arousal or No Arousal (EMG(GG) rose from 75 ± 5 to 125 ± 7%) and secondary events were less severe than initial events (ventilation rose 4 ± 0.4 to 5.5 ± 0.51 L/min).
CONCLUSIONS
Respiratory events that were terminated with ASDA Arousal were more severely flow-limited, had enhanced hyperventilation after event termination, and were more often followed by secondary events than No arousal. However, secondary events were not associated with low dilator muscle activity and airflow was improved after both No Arousal and ASDA Arousal.
理由
阻塞性睡眠呼吸暂停中总共有 20%-30%的呼吸事件在没有明显觉醒的情况下终止。觉醒被认为通过促进过度通气、低碳酸血症和上气道扩张肌张力降低而使进一步的事件更容易发生。因此，没有觉醒而终止的事件可能会促进呼吸稳定。
目的
比较阻塞性睡眠呼吸暂停患者中与美国睡眠障碍协会（ASDA）觉醒与无觉醒相关的呼吸事件终止时的生理变化，并确定与 ASDA 觉醒相比，无觉醒后是否较少发生继发性呼吸事件，且扩张肌活性更高。
方法
阻塞性睡眠呼吸暂停患者佩戴睡眠分期、颏舌肌（EMG（GG））和腭帆提肌（EMG（TP））电极以及鼻面罩和呼吸流量传感器。在稳定睡眠期间，连续气道正压通气（CPAP）降低 3 分钟以诱导呼吸事件。比较（1）ASDA 觉醒、（2）无觉醒或（3）CPAP 突然增加（CPAPinc，对照）后呼吸事件的生理变量。
测量和主要结果
16 名受试者有足够的数据。颏舌肌（GG）、腭帆提肌（TP）和心率在 ASDA 觉醒后增加（340 ± 57%、215 ± 28%和 110.7 ± 2.3%）和无觉醒后增加（185 ± 32%、167 ± 15%和 108.5 ± 1.6%），但 CPAPinc 后没有增加（90 ± 10%、94 ± 11%和 102.1 ± 1%）。与 CPAPinc 相比，ASDA 觉醒后和无觉醒后通气增加更多，但与呼吸事件的严重程度无关。无觉醒后发生继发性事件的次数少于 ASDA 觉醒后，然而，ASDA 觉醒或无觉醒后低扩张肌活性并不发生（颏舌肌（GG）从 75 ± 5 增加到 125 ± 7%），且继发性事件比初始事件严重程度低（通气从 4 ± 0.4 增加到 5.5 ± 0.51 L/min）。
结论
与 ASDA 觉醒相关的呼吸事件在终止时气流受限更严重，事件终止后过度通气增强，且更常发生继发性事件，而无觉醒则不然。然而，继发性事件与低扩张肌活性无关，且无觉醒和 ASDA 觉醒后气流均得到改善。
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