比较人类上气道在麻醉和睡眠期间的 collapsibility。

Comparison of Collapsibility of the Human Upper Airway During Anesthesia and During Sleep.

机构信息

From the Centre for Sleep Science, School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia.

Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands Western Australia, Australia.

出版信息

Anesth Analg. 2020 Apr;130(4):1008-1017. doi: 10.1213/ANE.0000000000004070.

DOI:10.1213/ANE.0000000000004070

PMID:30896596

Abstract

BACKGROUND

The propensities for the upper airway to collapse during anesthesia and sleep are related, although much of our understanding of this relationship has been inferred from clinical observation and indirect measures such as the apnea-hypopnea index. The aim of this study was to use an identical, rigorous, direct measure of upper airway collapsibility (critical closing pressure of the upper airway) under both conditions to allow the magnitude of upper airway collapsibility in each state to be precisely compared.

METHODS

Ten subjects (8 men and 2 women; mean ± SD: age, 40.4 ± 12.1 years; body mass index, 28.5 ± 4.0 kg/m) were studied. Critical closing pressure of the upper airway was measured in each subject on separate days during (1) propofol anesthesia and (2) sleep.

RESULTS

Critical closing pressure of the upper airway measurements were obtained in all 10 subjects during nonrapid eye movement sleep and, in 4 of these 10 subjects, also during rapid eye movement sleep. Critical closing pressure of the upper airway during anesthesia was linearly related to critical closing pressure of the upper airway during nonrapid eye movement sleep (r = 0.64 [95% CI, 0.02-0.91]; n = 10; P = .046) with a similar tendency in rapid eye movement sleep (r = 0.80 [95% CI, -0.70 to 0.99]; n = 4; P = .200). However, critical closing pressure of the upper airway during anesthesia was systematically greater (indicating increased collapsibility) than during nonrapid eye movement sleep (2.1 ± 2.2 vs -2.0 ± 3.2 cm H2O, respectively, n = 10; within-subject mean difference, 4.1 cm H2O [95% CI, 2.32-5.87]; P < .001) with a similar tendency during rapid eye movement sleep (1.6 ± 2.4 vs -1.9 ± 4.3 cm H2O, respectively, n = 4; unadjusted difference, 3.5 cm H2O [95% CI, -0.95 to 7.96]; P = .087).

CONCLUSIONS

These results demonstrate that the magnitude of upper airway collapsibility during anesthesia and sleep is directly related. However, the upper airway is systematically more collapsible during anesthesia than sleep, suggesting greater vulnerability to upper airway obstruction in the anesthetized state.

摘要

背景

尽管我们对这种关系的理解很大程度上是从临床观察和间接测量（如呼吸暂停低通气指数）推断出来的，但在麻醉和睡眠期间上气道塌陷的倾向是相关的。本研究的目的是在两种状态下使用相同的、严格的、直接的上气道塌陷测量方法（上气道闭合临界压），以便精确比较每种状态下上气道塌陷的程度。

方法

10 名受试者（8 名男性和 2 名女性；平均 ± 标准差：年龄，40.4 ± 12.1 岁；体重指数，28.5 ± 4.0 kg/m）分别在以下两种情况下进行研究：（1）异丙酚麻醉期间和（2）睡眠期间。在上气道的闭合临界压在每个主题的测量都获得了 10 名受试者在非快速眼动睡眠期间，在这些 10 名受试者中的 4 人，也在快速眼动睡眠期间。麻醉期间上气道的闭合临界压与非快速眼动睡眠期间上气道的闭合临界压呈线性相关（r = 0.64 [95%置信区间，0.02-0.91]；n = 10；P =.046），在快速眼动睡眠中也有类似的趋势（r = 0.80 [95%置信区间，-0.70 至 0.99]；n = 4；P =.200）。然而，麻醉期间上气道的闭合临界压系统地高于非快速眼动睡眠期间（分别为 2.1 ± 2.2 和-2.0 ± 3.2 cm H2O，n = 10；受试者内平均差异，4.1 cm H2O [95%置信区间，2.32-5.87]；P <.001），在快速眼动睡眠中也有类似的趋势（分别为 1.6 ± 2.4 和-1.9 ± 4.3 cm H2O，n = 4；未调整差异，3.5 cm H2O [95%置信区间，-0.95 至 7.96]；P =.087）。