Neuroscience Research Australia, Sydney, Australia
Neuroscience Research Australia, Sydney, Australia.
Eur Respir J. 2017 Dec 28;50(6). doi: 10.1183/13993003.01344-2017. Print 2017 Dec.
Hypnotics are contraindicated in obstructive sleep apnoea (OSA) because of concerns of pharyngeal muscle relaxation and delayed arousal worsening hypoxaemia. However, human data are lacking. This study aimed to determine the effects of three common hypnotics on the respiratory arousal threshold, genioglossus muscle responsiveness and upper airway collapsibility during sleep.21 individuals with and without OSA (18-65 years) completed 84 detailed sleep studies after receiving temazepam (10 mg), zolpidem (10 mg), zopiclone (7.5 mg) and placebo on four occasions in a randomised, double-blind, placebo-controlled, crossover trial (ACTRN12612001004853).The arousal threshold increased with zolpidem and zopiclone placebo (mean±sd -18.3±10 and -19.1±9 -14.6±7 cmHO; p=0.02 and p<0.001) but not with temazepam (-16.8±9 cmHO; p=0.17). Genioglossus muscle activity during stable non-REM sleep and responsiveness during airway narrowing was not different with temazepam and zopiclone placebo but, paradoxically, zolpidem increased median muscle responsiveness three-fold during airway narrowing (median -0.15 (interquartile range -1.01 to -0.04) -0.05 (-0.29 to -0.03)% maximum EMG per cmHO epiglottic pressure; p=0.03). The upper airway critical closing pressure did not change with any of the hypnotics.These doses of common hypnotics have differential effects on the respiratory arousal threshold but do not reduce upper airway muscle activity or alter airway collapsibility during sleep. Rather, muscle activity increases during airway narrowing with zolpidem.
催眠药被禁忌用于阻塞性睡眠呼吸暂停（OSA），因为担心咽肌无力松弛和唤醒延迟会加重低氧血症。然而，目前缺乏人类数据。本研究旨在确定三种常见催眠药对睡眠期间呼吸唤醒阈值、颏舌肌反应性和上气道 collapsibility 的影响。21 名有或无 OSA（18-65 岁）的个体在接受替马唑仑（10mg）、唑吡坦（10mg）、佐匹克隆（7.5mg）和安慰剂后，在一项随机、双盲、安慰剂对照、交叉试验中，共完成了 84 次详细的睡眠研究（ACTRN12612001004853）。在稳定的非快速眼动睡眠期间，颏舌肌活动和气道狭窄期间的反应性与替马唑仑和佐匹克隆-安慰剂没有差异，但矛盾的是，唑吡坦在气道狭窄期间将肌肉反应性增加了三倍（中位数-0.15（四分位距-1.01 至-0.04）-0.05（-0.29 至-0.03）%最大 EMG 每 cmHO 会厌压；p=0.03）。在上气道临界关闭压力方面，没有任何一种催眠药发生变化。这些常用催眠药的剂量对呼吸唤醒阈值有不同的影响，但不会减少睡眠期间上气道肌肉活动或改变气道 collapsibility。相反，在气道狭窄期间，肌肉活动随着唑吡坦的增加而增加。
