Patruno Vincenzo, Tobaldini Eleonora, Bianchi Anna M, Mendez Martin O, Coletti Orietta, Costantino Giorgio, Montano Nicola
Department of Biomedical and Clinical Sciences, University of Milan, Division of Medicine and Pathophysiology, L. Sacco Hospital, Milan, Italy; Division of Pulmonary Rehabilitation, I.M.F.R., Udine, Italy.
Department of Biomedical and Clinical Sciences, University of Milan, Division of Medicine and Pathophysiology, L. Sacco Hospital, Milan, Italy.
Eur J Intern Med. 2014 Feb;25(2):164-8. doi: 10.1016/j.ejim.2013.11.009. Epub 2013 Dec 24.
Treatment with positive airway pressure devices improved signs and symptoms of obstructive sleep apnea syndrome (OSA); however, auto-adjusting positive pressure (APAP) device was not as effective as continuous positive airway pressure (CPAP) in reducing arterial blood pressure and insulin resistance. The role played by autonomic cardiac regulation remains to be clarified. We aimed to test the effects of CPAP and APAP on autonomic regulation and cardiorespiratory coupling during sleep.
We retrospectively analyzed full-night polysomnographic studies. 19 patients newly diagnosed with severe OSA (AHI>30) and 7 obese subjects without OSA (CON) were enrolled. Each OSA subject was assigned to CPAP or APAP treatment and underwent a sleep study after 1 week of treatment. Spectral and cross-spectral analyses of heart rate variability (HRV) and respiration were performed to assess autonomic profile and coherence (K2) between respiration and HF oscillation during sleep in CPAP, APAP and CON groups.
In CPAP and CON, LFnu and LF/HF, markers of sympathetic modulation, decreased from N2 to N3 and increased during REM sleep (p<0.001), while in APAP group, sympathetic modulation was significantly higher compared with those of CPAP and CON during all sleep stages. K2 values were lower in APAP compared with those in CPAP and CON.
APAP treatment was characterized by a greater sympathetic activation and it was associated with a lower cardio-respiratory coupling compared with CPAP. This might account for the different effects on cardiovascular risk factors induced by the two treatments.
使用气道正压装置治疗可改善阻塞性睡眠呼吸暂停综合征（OSA）的体征和症状；然而，在降低动脉血压和胰岛素抵抗方面，自动调压正压（APAP）装置不如持续气道正压（CPAP）有效。自主心脏调节所起的作用仍有待阐明。我们旨在测试CPAP和APAP对睡眠期间自主调节和心肺耦合的影响。
我们回顾性分析了全夜多导睡眠图研究。纳入19例新诊断为重度OSA（呼吸暂停低通气指数>30）的患者和7例无OSA的肥胖受试者（对照组）。每位OSA受试者被分配接受CPAP或APAP治疗，并在治疗1周后进行睡眠研究。对心率变异性（HRV）和呼吸进行频谱和交叉频谱分析，以评估CPAP、APAP和对照组睡眠期间的自主特征以及呼吸与高频振荡之间的相干性（K2）。
在CPAP组和对照组中，交感神经调制指标低频功率（LFnu）和低频/高频比值（LF/HF）从N2期到N3期降低，在快速眼动睡眠期增加（p<0.），而在APAP组中，在所有睡眠阶段交感神经调制均显著高于CPAP组和对照组。与CPAP组和对照组相比，APAP组的K2值较低。
与CPAP相比，APAP治疗的特点是交感神经激活更强，且心肺耦合较低。这可能解释了两种治疗对心血管危险因素产生不同影响的原因。
