Hua-Huy Thong, Le-Dong Nhat-Nam, Duong-Quy Sy, Luchon Laurent, Rouhani Saïd, Dinh-Xuan Anh Tuan
Department of Respiratory Physiology, Cochin Hospital, University Paris Descartes, Sorbonne Paris Cité, 27 rue du faubourg Saint-Jacques, 75679 Paris cedex 14, France.
Department of Pulmonology, St. Elisabeth Hospital, Namur, Belgium.
Nitric Oxide. 2015 Feb 15;45:27-34. doi: 10.1016/j.niox.2015.01.008. Epub 2015 Jan 30.
To assess distal/alveolar inflammation in patients with suggestive symptoms of obstructive sleep apnoea (OSA) using exhaled nitric oxide (NO) measured by two-compartment model (2-CM) after correction for axial NO back-diffusion (trumpet model).
Ninety five patients suspected for OSA prospectively underwent pulmonary function test, overnight polysomnography (PSG), and exhaled NO measurement. Patients with apnoea-hypopnoea index (AHI) < 5/hour were included in non-OSA group. Exhaled NO was repeatedly measured after PSG in 21 OSA patients and 8 non-OSA subjects.
Alveolar NO concentration (C(ANO)) was significantly higher in OSA patients (n = 71; 4.07 ± 1.7 ppb) as compared with non-OSA subjects (n = 24; 2.24 ± 1.06 ppb; p < 0.0001) whilst maximal bronchial NO flux (J'awNO) and fractional exhaled NO (F(ENO)) did not differ between the two groups. C(ANO) was strongly associated to AHI (r = 0.701; p < 0.0001) and to recording time with SaO2 < 90% (ST-90%; r = 0.659; p < 0.0001) in OSA patients but not in non-OSA persons. The area under ROC curve for screening patients with OSA and significant nocturnal oxygen desaturation (ST-90% > 1%) was 0.865 ± 0.036 (95% IC, 0.793-0.937; p < 0.0001). C(ANO) at 4.5 ppb could detect these patients with specificity of 94% and sensitivity of 46%. Increase of C(ANO) measured after PSG was significantly related to oxygen desaturation index (ST-90%) in OSA patients.
Increased alveolar NO concentration was related to the severity of nocturnal oxygen desaturation in patients with OSA, linking the distal airway inflammation to intermittent hypoxia. (250 words).
采用经轴向一氧化氮（NO）反向扩散校正后的两室模型（2-CM）（喇叭模型），通过测定呼出一氧化氮（NO）来评估有阻塞性睡眠呼吸暂停（OSA）提示症状患者的远端/肺泡炎症。
95例疑似OSA患者前瞻性地接受了肺功能测试、整夜多导睡眠图（PSG）和呼出NO测量。呼吸暂停低通气指数（AHI）<5次/小时的患者被纳入非OSA组。对21例OSA患者和8例非OSA受试者在PSG后重复测量呼出NO。
与非OSA受试者（n = 24；2.24±1.06 ppb；p < 0.0001）相比，OSA患者（n = 71；4.07±1.7 ppb）的肺泡NO浓度（C(ANO)）显著更高，而两组之间的最大支气管NO通量（J'awNO）和呼出NO分数（F(ENO)）无差异。在OSA患者中，C(ANO)与AHI（r = 0.701；p < 0.0001）以及SaO2 < 90%的记录时间（ST-90%；r = 0.659；p < 0.0001）密切相关，但在非OSA患者中并非如此。用于筛查有OSA和显著夜间氧饱和度下降（ST-90%>1%）患者的ROC曲线下面积为0.865±0.036（95%置信区间，0.793 - 0.937；p < 0.0001）。C(ANO)为4.5 ppb时可检测出这些患者，特异性为94%，敏感性为46%。PSG后测量的C(ANO)增加与OSA患者的氧饱和度下降指数（ST-90%）显著相关。
肺泡NO浓度升高与OSA患者夜间氧饱和度下降的严重程度相关，将远端气道炎症与间歇性缺氧联系起来。（250字）
