Yadollahi Azadeh, Gabriel Joseph M, White Laura H, Taranto Montemurro Luigi, Kasai Takatoshi, Bradley T Douglas
Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Institute of Medical Science, University of Toronto, Toronto, Canada.
Sleep. 2014 Oct 1;37(10):1699-705. doi: 10.5665/sleep.4084.
Obstructive sleep apnea (OSA) is commoner in patients with fluid-retaining states than in those without fluid retention, in men than in women, and worsens with aging. In men, OSA severity is related to the amount of fluid shifting out of the legs overnight, but a cause-effect relationship is not established. Our objective was to test the hypothesis that mimicking fluid overload during sleep would increase severity of OSA more in older (≥ 40 years) than in younger men (< 40 years).
Randomized, single-blind, double crossover study.
Research sleep laboratory.
Seven older and 10 younger men with non-severe or no sleep apnea, matched for body mass index.
During the control arm, normal saline was infused to keep the vein open. During intervention, subjects received an intravenous bolus of normal saline (22 mL/kg body weight) after sleep onset while they were wearing compression stockings to prevent fluid accumulation in the legs.
Compared to younger men, infusion of similar amounts of saline in older men caused a greater increase in neck circumference (P < 0.05) and in the AHI (32.2 ± 22.1 vs. 2.2 ± 7.1, P = 0.002).
Older men are more susceptible to the adverse effects of intravenous fluid loading on obstructive sleep apnea severity than younger men. This may be due to age-related differences in the amount of fluid accumulating in the neck or upper airway collapsibility in response to intravenous fluid loading. These possibilities remain to be tested in future studies.
与无液体潴留的患者相比，液体潴留状态的患者中阻塞性睡眠呼吸暂停（OSA）更为常见；男性比女性更常见，且随年龄增长而加重。在男性中，OSA严重程度与夜间从腿部移出的液体量有关，但因果关系尚未确立。我们的目的是检验这一假设：在睡眠期间模拟液体过载对老年男性（≥40岁）阻塞性睡眠呼吸暂停严重程度的增加幅度大于年轻男性（<40岁）。
随机、单盲、双交叉研究。
研究睡眠实验室。
7名老年男性和10名年轻男性，无严重睡眠呼吸暂停或无睡眠呼吸暂停，根据体重指数进行匹配。
在对照期，输注生理盐水以保持静脉通畅。在干预期，受试者在入睡后接受静脉推注生理盐水（22 mL/kg体重），同时穿着加压袜以防止液体在腿部积聚。
与年轻男性相比，老年男性输注等量生理盐水后颈围增加幅度更大（P<0.05），呼吸暂停低通气指数（AHI）也更高（32.2±22.1 vs. 2.2±7.1，P=0.002）。
与年轻男性相比，老年男性对静脉输液负荷对阻塞性睡眠呼吸暂停严重程度的不利影响更敏感。这可能是由于年龄相关的颈部液体蓄积量差异或静脉输液负荷后上气道可塌陷性的差异。这些可能性有待未来研究进一步验证。
