Hanly P J, George C F, Millar T W, Kryger M H
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Chest. 1989 Apr;95(4):735-9. doi: 10.1378/chest.95.4.735.
We wished to assess the role of increased vagal tone and arterial oxygen saturation (SaO2) as determinants of HR response to voluntary respiratory maneuvers in OSAS. The changes in HR and SaO2 during breath-hold (B), Valsalva (V) and Mueller (M) maneuvers were determined in nine male subjects with OSAS while breathing RA or O2. Oxygen saturation was significantly lower breathing RA than O2 at the end of B (92.6 +/- 1.6 vs 97.2 +/- 0.8 percent), V (92.9 +/- 1.3 vs 95.2 +/- 1.7 percent), and M (92.7 +/- 1.2 vs 95.3 +/- 1.9 percent). Despite this, there was no significant difference between the HR change while breathing RA and O2 during B (12 +/- 18 vs 7 +/- 15 beats/minute), V (-2 +/- 12 vs -5 +/- 17 beats/minute), and M (5 +/- 16 vs 1 +/- 8 beats/minute). The change in HR was not related to the duration of B, V, or M or to the mouth pressure generated during V and M. In order to determine if awake HR response to the maneuvers reflected HR response to obstructive apnea, we examined the relationship between the HR response to B, V, and M during wakefulness and the response to obstructive apnea of similar duration while asleep. A significant correlation was found between the HR response to obstructive sleep apnea during sleep and the response to awake B (r = 0.67, p less than 0.001), V (r = 0.51, p less than 0.05), and M (r = 0.75, p less than 0.001). We conclude that in OSAS, increased vagal tone is a major determinant of HR response to voluntary respiratory maneuvers, that bradycardia can occur in the absence of hypoxemia, and that HR response to these maneuvers, especially to M, during wakefulness predicts HR response to obstructive apnea while asleep.
我们希望评估迷走神经张力增加和动脉血氧饱和度（SaO2）在阻塞性睡眠呼吸暂停（OSAS）患者对自主呼吸动作的心率反应中所起的作用。在9名患有OSAS的男性受试者呼吸常氧（RA）或吸氧时，测定了屏气（B）、瓦尔萨尔瓦动作（V）和米勒动作（M）期间心率和SaO2的变化。在屏气结束时，呼吸常氧时的血氧饱和度显著低于吸氧时（92.6±1.6%对97.2±0.8%），瓦尔萨尔瓦动作时（92.9±1.3%对95.2±1.7%），以及米勒动作时（92.7±1.2%对95.3±1.9%）。尽管如此，呼吸常氧和吸氧时屏气期间的心率变化（12±18对7±15次/分钟）、瓦尔萨尔瓦动作时（-2±12对-5±17次/分钟）以及米勒动作时（5±16对1±8次/分钟）并无显著差异。心率变化与屏气、瓦尔萨尔瓦动作或米勒动作的持续时间无关，也与瓦尔萨尔瓦动作和米勒动作期间产生的口腔压力无关。为了确定清醒时对这些动作的心率反应是否反映了对阻塞性呼吸暂停的心率反应，我们研究了清醒时对屏气、瓦尔萨尔瓦动作和米勒动作的心率反应与睡眠时类似持续时间的阻塞性呼吸暂停反应之间的关系。发现睡眠时对阻塞性睡眠呼吸暂停的心率反应与清醒时屏气的反应（r = 0.67，p < 0.001）、瓦尔萨尔瓦动作的反应（r = 0.51，p < 0.05）以及米勒动作的反应（r = 0.75，p < 0.001）之间存在显著相关性。我们得出结论，在阻塞性睡眠呼吸暂停中，迷走神经张力增加是对自主呼吸动作心率反应的主要决定因素，心动过缓可在无低氧血症的情况下发生，并且清醒时对这些动作，尤其是对米勒动作的心率反应可预测睡眠时对阻塞性呼吸暂停的心率反应。
