White Laura H, Lyons Owen D, Yadollahi Azadeh, Ryan Clodagh M, Bradley T Douglas
Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada; Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, ON, Canada.
Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada; Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
Sleep Med. 2015 Feb;16(2):258-64. doi: 10.1016/j.sleep.2014.12.005. Epub 2014 Dec 18.
Overnight fluid shift from the legs to the neck may narrow the upper airway and contribute to obstructive sleep apnea (OSA) pathogenesis. We hypothesized that below-the-knee compression stockings will decrease OSA severity in a general OSA population by decreasing daytime leg fluid accumulation and overnight fluid shift and increasing upper-airway size.
Patients with OSA (apnea-hypopnea index ≥ 10) were randomized to wear compression stockings during the daytime or to a control group for 2 weeks. Overnight polysomnography with measurement of leg and neck fluid volumes and upper-airway cross-sectional area before and after sleep was performed at baseline and follow-up. The primary outcome was change in the apnea-hypopnea index.
Twenty-two patients randomized to compression stockings and 23 to control completed the study. The apnea-hypopnea index decreased significantly more in the compression stockings than in the control group (from 32.4 ± 20.0 to 23.8 ± 15.5 vs. from 31.2 ± 25.0 to 30.3 ± 23.8, p = 0.042), in association with a significantly greater reduction in the overnight decrease in leg fluid volume (p = 0.028), and a significantly greater increase in morning upper-airway cross-sectional area (p = 0.006). Overnight change in neck fluid volume was unchanged.
These observations suggest that in, a general OSA population, below-the-knee compression stockings decrease OSA severity modestly via attenuation of overnight fluid shift and consequent upper-airway dilatation.
夜间液体从腿部转移至颈部可能会使上呼吸道变窄，并促使阻塞性睡眠呼吸暂停（OSA）的发病。我们推测，膝下加压袜可通过减少白天腿部液体蓄积和夜间液体转移以及增加上呼吸道尺寸，来降低一般OSA人群的OSA严重程度。
将阻塞性睡眠呼吸暂停（呼吸暂停低通气指数≥10）患者随机分为白天穿加压袜组或对照组，为期2周。在基线和随访时进行夜间多导睡眠监测，测量睡眠前后腿部和颈部的液体量以及上呼吸道横截面积。主要结局指标为呼吸暂停低通气指数的变化。
随机分配至加压袜组的22例患者和对照组的23例患者完成了研究。与对照组相比，加压袜组的呼吸暂停低通气指数下降更为显著（从32.4±20.0降至23.8±15.5，而对照组从31.2±25.0降至30.3±23.8，p = 0.042），同时夜间腿部液体量减少更为显著（p = 0.028），早晨上呼吸道横截面积增加更为显著（p = 0.006）。颈部液体量的夜间变化未改变。
这些观察结果表明，在一般OSA人群中，膝下加压袜可通过减轻夜间液体转移及随之而来的上呼吸道扩张，适度降低OSA严重程度。
