McNicholas W T, Coffey M, McDonnell T, O'Regan R, Fitzgerald M X
Am Rev Respir Dis. 1987 Jun;135(6):1316-9. doi: 10.1164/arrd.1987.135.6.1316.
Previous animal studies support the presence of an upper airway reflex mechanism that when blocked by topical anesthesia of the upper airway results in upper airway occlusion. We sought a similar reflex mechanism in humans. Nine normal male volunteers 20 to 28 yr of age underwent 3 successive overnight sleep studies: a control study (C); a study in which selective topical oropharyngeal anesthesia (OPA) was achieved prior to sleep using a 10% lidocaine spray and 0.25% bupivocaine solution; a study in which selective nasal anesthesia (NA) was achieved prior to sleep using a mixture of 2% lidocaine and 0.25% bupivocaine solutions instilled into the nose while the nasal airway was positioned as the most dependent part of the upper airway. Total sleep times were similar during the 3 study nights as were the amounts of slow-wave and rapid-eye-movement (REM) sleep. Obstructive apneas and hypopneas (OAH) differed significantly between the 3 study nights [13(3.8), mean (SEM), during OPA as compared to 3(1.8) during C and 7(2.5) during NA; p less than 0.01 by ANOVA] and were most frequent during REM sleep. Total apneas and hypopneas also differed significantly between the 3 study nights [19(3.9) during OPA as compared to 8(2.1) during C and 14(3.9) during NA; p less than 0.01 by ANOVA]. Movement arousals terminating periods of abnormal respiration also differed significantly [21(6.1) during OPA as compared to 12(3.6) during C and 14(4.6) during NA; p less than 0.05 by ANOVA]. No subject, however, developed clinically significant sleep apnea or significant oxygen desaturation during sleep.(ABSTRACT TRUNCATED AT 250 WORDS)
先前的动物研究支持存在一种上气道反射机制，当上气道被局部麻醉阻断时会导致上气道阻塞。我们在人类中寻找类似的反射机制。9名年龄在20至28岁的正常男性志愿者进行了连续3次夜间睡眠研究：一次对照研究（C）；一次在睡眠前使用10%利多卡因喷雾和0.25%布比卡因溶液实现选择性口咽局部麻醉（OPA）的研究；一次在睡眠前使用2%利多卡因和0.25%布比卡因溶液混合液滴鼻实现选择性鼻麻醉（NA）的研究，此时鼻气道被置于上气道最低垂的部位。3个研究夜间的总睡眠时间相似，慢波睡眠和快速眼动（REM）睡眠量也相似。3个研究夜间的阻塞性呼吸暂停和低通气（OAH）有显著差异[OPA期间为13（3.8），均值（标准误），而C期间为3（1.8），NA期间为7（2.5）；方差分析p<0.01]，且在REM睡眠期间最为频繁。总呼吸暂停和低通气在3个研究夜间也有显著差异[OPA期间为19（3.9），而C期间为8（2.1），NA期间为14（3.9）；方差分析p<0.01]。终止异常呼吸的运动觉醒也有显著差异[OPA期间为21（6.1），而C期间为12（3.6），NA期间为14（4.6）；方差分析p<0.05]。然而，没有受试者在睡眠期间出现临床上显著的睡眠呼吸暂停或显著的氧饱和度下降。（摘要截断于250字）
