Xu Jing, Yuan Hong, Wu Ying-xin, Xiao Si-chang, Zhang Han-jia, Luo Yuan-ming
Department of Respiratory Medicine, Guangzhou Medical College, Guangzhou, China.
Zhonghua Yi Xue Za Zhi. 2013 Feb 5;93(6):411-4.
To explore the effects of neural respiratory drive on ventilation in patients with chronic obstructive pulmonary disease (COPD) during sleep.
Diaphragm electromyogram (EMG) from a multipair esophageal electrodes and airflow derived from pneumotachography were recorded during overnight polysomnography in 13 patients with stable COPD recruited from outpatient clinic of First Affiliated Hospital of Guangzhou Medical College from May 2010 to May 2011. Changes in diaphragm EMG and ventilation during wakefulness and different sleep stages were observed.
Diaphragm EMG decreased by 26% in non-rapid eye movement sleep (NREM) stage and 39% in rapid eye movement (REM) as compared with wakefulness. Coinciding with change in diaphragm EMG, ventilation (VE) (ml×min(-1)×kg(-1)) significantly decreased from wakefulness (156 ± 53) ml×min(-1)×kg(-1) to steady NREM stage (112 ± 35) ml×min(-1)×kg(-1) (P < 0.05) and further decreased from NREM stage to REM stage (95 ± 27) ml×min(-1)×kg(-1) (P < 0.05). Oxygen saturation also decreased significantly from 97.1% ± 1.8% in wakefulness to REM stage (94.0% ± 3.9%) (P < 0.01).
Reduced neural respiratory drive contributes to nocturnal hypoventilation in COPD patients.
探讨神经呼吸驱动对慢性阻塞性肺疾病（COPD）患者睡眠期间通气的影响。
对2010年5月至2011年5月从广州医学院第一附属医院门诊招募的13例稳定期COPD患者进行整夜多导睡眠图监测，记录多对食管电极的膈肌肌电图（EMG）和呼吸流速仪测得的气流。观察清醒及不同睡眠阶段膈肌EMG和通气的变化。
与清醒状态相比，非快速眼动睡眠（NREM）期膈肌EMG下降26%，快速眼动（REM）期下降39%。与膈肌EMG的变化一致，通气量（VE）（ml×min⁻¹×kg⁻¹）从清醒时的（156±53）ml×min⁻¹×kg⁻¹显著下降至稳定NREM期的（112±35）ml×min⁻¹×kg⁻¹（P<0.05），并从NREM期进一步下降至REM期的（95±27）ml×min⁻¹×kg⁻¹（P<0.05）。血氧饱和度也从清醒时的97.1%±1.8%显著下降至REM期的（94.0%±3.9%）（P<0.01）。
神经呼吸驱动降低导致COPD患者夜间通气不足。
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