Gavrilovic Bojan, Bradley T Douglas, Vena Daniel, Lyons Owen D, Gabriel Joseph M, Popovic Milos R, Yadollahi Azadeh
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
Sleep Med. 2016 Jul;23:65-72. doi: 10.1016/j.sleep.2016.05.003. Epub 2016 Jul 20.
Obstructive sleep apnea (OSA) is highly prevalent in patients with fluid-retaining conditions. Using bioimpedance measurements, previous studies have shown that the greater the amount of fluid redistributed from the legs to the neck overnight, the greater the severity of OSA. Our objective was to investigate factors that predispose the development or worsening of OSA in response to experimental fluid overload.
Fifteen normotensive and non-obese adult men with and without OSA underwent polysomnography (PSG) during which normal saline was infused intravenously at a minimal rate to keep the vein open (control) or as a bolus of 22 ml/kg body weight (approximately 2 L) in a random order and crossed over after a week.
Before and after sleep, neck circumference and bioimpedance were measured to calculate neck resistance, reactance, phase angle, and fluid volume. Subjects who experienced more than a twofold increase in apnea-hypopnea index (AHI) or obstructive AHI from control to intervention and had an AHI>10 during intervention were considered susceptible to the development or worsening of OSA. Baseline neck circumference and phase angle before saline infusion were independently associated with increased susceptibility to developing or worsening OSA in response to saline infusion. In non-obese men, a larger neck circumference and bioimpedance phase angle of the neck, which may be associated with larger pharyngeal tissue content, is associated with increased susceptibility for worsening of OSA in response to fluid overloading.
阻塞性睡眠呼吸暂停（OSA）在患有液体潴留疾病的患者中非常普遍。以往研究通过生物阻抗测量表明，夜间从腿部重新分布到颈部的液体量越多，OSA的严重程度就越高。我们的目的是研究在实验性液体超负荷情况下，导致OSA发生或加重的因素。
15名血压正常且非肥胖的成年男性，有或无OSA，接受多导睡眠图（PSG）检查，在此期间以最低速率静脉输注生理盐水以保持静脉通畅（对照组），或以22 ml/kg体重（约2 L）的剂量推注，两种情况随机顺序进行，一周后交叉。
在睡眠前后测量颈围和生物阻抗，以计算颈部电阻、电抗、相角和液体量。从对照到干预，呼吸暂停低通气指数（AHI）或阻塞性AHI增加超过两倍且干预期间AHI>10的受试者被认为易发生OSA或使OSA加重。生理盐水输注前的基线颈围和相角与因生理盐水输注而发生或加重OSA的易感性增加独立相关。在非肥胖男性中，较大的颈围和颈部生物阻抗相角可能与较大的咽部组织含量有关，这与因液体超负荷导致OSA加重的易感性增加有关。
