Martinez-Nicolas Antonio, Guaita Marc, Santamaría Joan, Montserrat Josep M, Rol María Ángeles, Madrid Juan Antonio
Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE, IMIB-Arrixaca, Spain.
Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
Sleep. 2017 Jun 1;40(6). doi: 10.1093/sleep/zsx067.
Our aim was to evaluate the circadian rhythm of distal skin temperature (DST) in sleep-disordered breathing (SDB), its relation to excessive daytime sleepiness and the effect of continuous positive airway pressure (CPAP) on DST.
Eighty SDB patients (53.1 ± 1.2 years old, 27.6% women) and 67 healthy participants (52.3 ± 1.6 years old, 26.9% women) wore a temperature data logger for 1 week. On the last day of that week, SDB patients underwent a polysomnography followed by a Maintenance of Wakefulness Test (MWT), Multiple Sleep Latency Test, and Sustained Attention to Response Task protocol to objectively quantify daytime sleepiness. A subset of 21 moderate to severe SDB patients were treated with CPAP during at least 3 months and revaluated with the same procedure. A nonparametric analysis was performed to characterize DST to assess differences between groups and associations among DST, polysomnography, and daytime sleepiness measures.
SDB patients showed an unstable, fragmented, flattened, phase-advanced, and less robust DST rhythm as compared to healthy participants. The more severe the SDB, the worse the DST pattern was, as indicated by the correlation coefficient. Sleepiness, according to MWT sleep latencies, was also associated with the higher fragmentation, lower amplitude, and less robustness of the DST rhythm. Treatment with CPAP improved DST pattern regularity and robustness.
DST is altered in SDB, exhibiting a direct relationship to the severity of this condition, and improves with CPAP treatment. DST independently correlates with sleepiness, thus, its measurement may contribute to the understanding of the pathophysiology of sleepiness in these patients.
我们的目的是评估睡眠呼吸障碍（SDB）患者远端皮肤温度（DST）的昼夜节律、其与日间过度嗜睡的关系以及持续气道正压通气（CPAP）对DST的影响。
80名SDB患者（年龄53.1±1.2岁，女性占27.6%）和67名健康参与者（年龄52.3±1.6岁，女性占26.9%）佩戴温度数据记录器1周。在该周的最后一天，SDB患者接受多导睡眠图检查，随后进行清醒维持测试（MWT）、多次睡眠潜伏期测试和持续注意力反应任务方案，以客观量化日间嗜睡程度。21名中重度SDB患者的一个亚组接受了至少3个月的CPAP治疗，并采用相同程序进行重新评估。进行非参数分析以表征DST，评估组间差异以及DST、多导睡眠图和日间嗜睡测量指标之间的关联。
与健康参与者相比，SDB患者表现出不稳定、碎片化、扁平、相位提前且不那么稳健的DST节律。相关系数表明，SDB越严重，DST模式越差。根据MWT睡眠潜伏期，嗜睡也与DST节律更高的碎片化、更低的幅度和更低的稳健性相关。CPAP治疗改善了DST模式的规律性和稳健性。
SDB患者的DST发生改变，与该疾病的严重程度呈直接关系，且CPAP治疗可使其改善。DST与嗜睡独立相关，因此，测量DST可能有助于理解这些患者嗜睡的病理生理学机制。
