Gold A R, Schwartz A R, Bleecker E R, Smith P L
Am Rev Respir Dis. 1986 Nov;134(5):925-9. doi: 10.1164/arrd.1986.134.5.925.
Administration of nocturnal oxygen for 1 night to patients with obstructive sleep apnea (OSA) causes a moderate reduction in apnea frequency without improving hypersomnolence. Therefore, we administered oxygen chronically to patients with OSA to determine: whether apnea frequency would be further reduced, whether the effect of oxygen upon apnea frequency is correlated with an increased ventilatory response to hypoxia and hypercapnia, and whether hypersomnolence improves with more prolonged oxygen administration. In a single-blinded, nonrandomized trial, we compared the effects of 1 month of oxygen (4 L/min by nasal cannula) with room air (4 L/min by nasal cannula) placebo during sleep in 7 men and 1 woman with obstructive sleep apnea. During non-REM sleep, acute oxygen administration elevated the average low oxy-hemoglobin saturation during apneic events and decreased apnea frequency. These acute effects persisted during chronic oxygen administration but reverted to the preoxygen effects immediately upon discontinuing oxygen. One month of oxygen did not affect the waking ventilatory response to hypoxia or hypercapnia; however, waking PaCO2 increased from 40 +/- 1 mm Hg (mean +/- SE) after placebo to 43 +/- 1 mm Hg after oxygen (p less than 0.01). Neither subjective nor objective hypersomnolence consistently improved after 1 month of oxygen administration. We conclude that: first, oxygen has no effect upon apnea frequency beyond the period of administration, and the reduction of apnea frequency is not correlated with an increased sensitivity to chemical ventilatory stimuli. The reduced apnea frequency may be related to an increased PaCO2 stimulating ventilation during sleep.(ABSTRACT TRUNCATED AT 250 WORDS)
对阻塞性睡眠呼吸暂停（OSA）患者进行1晚的夜间氧疗，可使呼吸暂停频率适度降低，但不能改善嗜睡症状。因此，我们对OSA患者进行长期氧疗，以确定：呼吸暂停频率是否会进一步降低；氧疗对呼吸暂停频率的影响是否与对低氧和高碳酸血症的通气反应增加相关；延长氧疗时间后嗜睡症状是否会改善。在一项单盲、非随机试验中，我们比较了7名男性和1名女性阻塞性睡眠呼吸暂停患者在睡眠期间接受1个月的氧气（经鼻导管4 L/分钟）与室内空气（经鼻导管4 L/分钟）安慰剂的效果。在非快速眼动睡眠期间，急性氧疗可提高呼吸暂停事件期间的平均低氧血红蛋白饱和度，并降低呼吸暂停频率。这些急性效应在长期氧疗期间持续存在，但在停止吸氧后立即恢复到吸氧前的状态。1个月的氧疗对清醒时对低氧或高碳酸血症的通气反应没有影响；然而，清醒时的动脉血二氧化碳分压（PaCO2）从安慰剂后的40±1 mmHg（平均值±标准误）增加到吸氧后的43±1 mmHg（p<0.01）。吸氧1个月后，主观和客观嗜睡症状均未持续改善。我们得出结论：第一，氧疗对呼吸暂停频率的影响仅限于治疗期间，呼吸暂停频率的降低与对化学通气刺激的敏感性增加无关。呼吸暂停频率降低可能与睡眠期间PaCO2升高刺激通气有关。（摘要截断于250字）
