Ruzek Lukas, Svobodova Karolina, Olson Lyle J, Ludka Ondrej, Cundrle Ivan
Department of Anaesthesiology and Intensive Care, St. Anna's University Hospital Brno, Brno, Czech Republic.
International Clinical Research Center, St. Anna's University Hospital Brno, Brno, Czech Republic.
PLoS One. 2017 Sep 1;12(9):e0184291. doi: 10.1371/journal.pone.0184291. eCollection 2017.
Obstructive sleep apnea (OSA) is the most common form of sleep disordered breathing and has been associated with major cardiovascular comorbidities. We hypothesized that the microcirculation is impaired in patients with OSA and that the magnitude of impairment correlates to OSA severity.
Subjects were consecutive patients scheduled for routine diagnostic polysomnography (PSG). OSA was defined by paradoxical rib cage movements together with abdominal excursions and by the apnea-hypopnea index (AHI) (events/hour; no apnea AHI<5; mild apnea 5≤AHI<15; moderate apnea 15≤AHI<30; severe apnea AHI ≥30). Sidestream darkfield imaging was used to assess the sublingual microcirculation. Recordings of sublingual microcirculation (5 random sites) were performed before and after overnight PSG. Data are summarized as mean (±SD); p values <0.05 were considered statistically significant.
Thirty-three consecutive patients were included. OSA was diagnosed in 16 subjects (4 moderate, 12 severe). There was no significant difference in microcirculation between subjects with moderate OSA and without OSA. However, compared to subjects without OSA, subjects with severe OSA (AHI≥30) showed a significant decrease of microvascular flow index (-0.07±0.17 vs. 0.08±0.14; p = 0.02) and increase of microvascular flow index heterogeneity (0.06±0.15 vs. -0.06±0.11; p = 0.02) overnight. Multiple regression analysis (adjusted for age and gender) showed both decrease of flow and increase of flow heterogeneity associated with AHI (b = -0.41; F = 1.8; p = 0.04 and b = 0.43; F = 1.9; p = 0.03, respectively).
Acute overnight microcirculatory changes are observed in subjects with severe OSA characterized by decreased flow and increased flow heterogeneity.
阻塞性睡眠呼吸暂停（OSA）是睡眠呼吸障碍最常见的形式，并且与主要心血管合并症相关。我们推测，OSA患者存在微循环受损，且受损程度与OSA严重程度相关。
研究对象为连续安排进行常规诊断性多导睡眠图（PSG）检查的患者。OSA通过矛盾的胸廓运动与腹部活动以及呼吸暂停低通气指数（AHI）（事件/小时；无呼吸暂停AHI<5；轻度呼吸暂停5≤AHI<15；中度呼吸暂停15≤AHI<30；重度呼吸暂停AHI≥30）来定义。采用旁流暗视野成像评估舌下微循环。在夜间PSG检查前后对舌下微循环（5个随机部位）进行记录。数据以均值（±标准差）总结；p值<0.05被认为具有统计学意义。
纳入33例连续患者。确诊OSA的有16例（4例中度，12例重度）。中度OSA患者与无OSA患者的微循环无显著差异。然而，与无OSA患者相比，重度OSA（AHI≥30）患者夜间微血管血流指数显著降低（-0.07±0.17对0.08±0.14；p = 0.02），微血管血流指数异质性增加（0.06±0.15对-0.06±0.11；p = 0.02）。多元回归分析（校正年龄和性别）显示，血流降低和血流异质性增加均与AHI相关（分别为b = -0.41；F = 1.8；p = 0.04和b = 0.43；F = 1.9；p = 0.03）。
重度OSA患者夜间出现急性微循环变化，其特征为血流降低和血流异质性增加。
