Pulmonary Operative Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy.
Sleep Disorders Center, Department of Neurosciences, University of Parma, Parma, Italy.
J Sleep Res. 2018 Apr;27(2):259-267. doi: 10.1111/jsr.12593. Epub 2017 Sep 12.
The study aims at assessing the changes in electroencephalography (as measured by the A-phases of cyclic alternating pattern) and autonomic activity (based on pulse wave amplitude) at the recovery of airway patency in patients with obstructive sleep apnea syndrome. Analysis of polysomnographic recordings from 20 male individuals with obstructive sleep apnea syndrome was carried out in total sleep time, non-rapid eye movement and rapid eye movement sleep. Scoring quantified the combined occurrence (time range of 4 s before and 4 s after respiratory recovery) or separate occurrence of A-phases (cortical activation), and pulse wave amplitude drops (below 30%) to apneas, hypopneas or flow limitation events. A dual response (A-phase associated with a pulse wave amplitude drop) was the most frequent response (71.8% in total sleep time) for all types of respiratory events, with a progressive reduction from apneas to hypopneas and flow limitation events. The highly significant correlation in total sleep time (r = 0.9351; P < 0.0001) between respiratory events combined with A-phases and respiratory events combined with pulse wave amplitude drops was confirmed both in non-rapid eye movement (r = 0.9622; P < 0.0001) and rapid eye movement sleep (r = 0.7162; P < 0.0006). In conclusion, a dual cortical and autonomic activation is the most common manifestation at the recovery of airway patency. The significant correlation between A-phases and relevant pulse wave amplitude drops suggests a possible role of pulse wave amplitude as a marker of cerebral response to respiratory events.
本研究旨在评估阻塞性睡眠呼吸暂停综合征患者气道通畅恢复时脑电图（以循环交替模式的 A 相测量）和自主活动（基于脉搏波幅度）的变化。总共对 20 名男性阻塞性睡眠呼吸暂停综合征患者的睡眠多导图记录进行了分析，包括总睡眠时间、非快速眼动睡眠和快速眼动睡眠。评分量化了 A 相（皮质激活）和脉搏波幅度下降（低于 30%）的综合发生（呼吸恢复前和后 4 秒的时间范围）或单独发生，以对应呼吸暂停、低通气或流量受限事件。双反应（与脉搏波幅度下降相关的 A 相）是所有类型呼吸事件中最常见的反应（总睡眠时间为 71.8%），从呼吸暂停到低通气和流量受限事件呈逐渐减少趋势。在非快速眼动（r=0.9622；P<0.0001）和快速眼动睡眠（r=0.7162；P<0.0006）中，呼吸事件与 A 相结合以及呼吸事件与脉搏波幅度下降结合的总睡眠时间高度显著相关（r=0.9351；P<0.0001）。总之，气道通畅恢复时最常见的表现是双皮质和自主激活。A 相和相关脉搏波幅度下降之间的显著相关性表明，脉搏波幅度可能作为呼吸事件对大脑反应的标志物发挥作用。
