Coloma Navarro R, Jiménez Caballero P E, Vega G, Ayo-Martín O, Segura Martín T
Servicio de Neumología, Complejo Hospitalario Universitario, C/Hermanos Falcó, s/n, 02006 Albacete, Spain.
Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain.
Springerplus. 2016 Jan 20;5:51. doi: 10.1186/s40064-016-1691-x. eCollection 2016.
According to recent epidemiologic studies, patients with sleep apnea/hypopnea syndrome (SAHS) are at increased risk of cardiovascular diseases, including stroke. However, the mechanisms are not well defined. Nocturnal apneas can trigger acute cerebral ischemia in predisposed patients and impaired vasodilatation is present in SAHS, but few studies have explored vascular cerebral dysfunction and often gave inconclusive results. The aims of our study were to assess whether patients with SAHS have impairment of cerebral hemodynamics with respect to controls, and to investigate a possible relationship with clinical data. We studied two groups, one of 76 SAHS patients and another one of 76 non-SAHS subjects matched for age, sex and main cardiovascular risk factors. All participants underwent a daytime transcranial Doppler study of right middle cerebral artery to record cerebral blood flow velocity and cerebrovascular reactivity by means of breath-holding test (BHT). SAHS patients have a reduction in mean cerebral blood flow velocity (MFV) (52 ± 9 vs 60 ± 12 cms/s, p < 0.001) and BHT (31 ± 12 vs 36 ± 11 %, p = 0.005) when compared to non-SAHS controls. Moreover, MFV correlated negatively with the presence of coronary disease, and BHT with female sex and arterial pressure. On the other hand, in the SAHS group, MFV correlated negatively with oxygen desaturation severity. Patients with SAHS have impaired MFV and cerebrovascular reactivity when compared to controls. Interestingly, poorly controlled or unknown hypertension and severe nocturnal hypoxemia caused additional cerebral hemodynamic disturbances to these patients.
根据最近的流行病学研究，睡眠呼吸暂停/低通气综合征（SAHS）患者患心血管疾病（包括中风）的风险增加。然而，其机制尚不清楚。夜间呼吸暂停可触发易感患者的急性脑缺血，SAHS患者存在血管舒张功能受损，但很少有研究探讨脑血管功能障碍，且结果往往不明确。我们研究的目的是评估SAHS患者与对照组相比是否存在脑血流动力学损害，并研究其与临床数据之间可能存在的关系。我们研究了两组，一组是76例SAHS患者，另一组是76例年龄、性别和主要心血管危险因素相匹配的非SAHS受试者。所有参与者均在白天接受了右侧大脑中动脉的经颅多普勒研究，通过屏气试验（BHT）记录脑血流速度和脑血管反应性。与非SAHS对照组相比，SAHS患者的平均脑血流速度（MFV）降低（52±9 vs 60±12厘米/秒，p<0.001），BHT降低（31±12 vs 36±11%，p=0.005）。此外，MFV与冠心病的存在呈负相关，BHT与女性性别和动脉压呈负相关。另一方面，在SAHS组中，MFV与氧饱和度降低的严重程度呈负相关。与对照组相比，SAHS患者的MFV和脑血管反应性受损。有趣的是，控制不佳或未知的高血压以及严重的夜间低氧血症给这些患者带来了额外的脑血流动力学紊乱。
