Ludwig Katharina, Malatantis-Ewert Sebastian, Huppertz Tilman, Bahr-Hamm Katharina, Seifen Christopher, Pordzik Johannes, Matthias Christoph, Simon Perikles, Gouveris Haralampos
Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
Department of Sport Medicine, Rehabilitation and Disease Prevention, Faculty of Social Science, Media and Sport, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
Biology (Basel). 2023 Feb 14;12(2):298. doi: 10.3390/biology12020298.
Patients with sleep-disordered breathing show a combination of different respiratory events (central, obstructive, mixed), with one type being predominant. We observed a reduced prevalence of central apneic events (CAEs) during REM sleep compared to NREM sleep in patients with predominant obstructive sleep apnea (OSA). The aim of this retrospective, exploratory study was to describe this finding and to suggest pathophysiological explanations. The polysomnography (PSG) data of 141 OSA patients were assessed for the prevalence of CAEs during REM and NREM sleep. On the basis of the apnea-hypopnea index (AHI), patients were divided into three OSA severity groups (mild: AHI < 15/h; moderate: AHI = 15-30/h; severe: AHI > 30/h). We compared the frequency of CAEs adjusted for the relative length of REM and NREM sleep time, and a significantly increased frequency of CAEs in NREM was found only in severely affected OSA patients. Given that the emergence of CAEs is strongly associated with the chemosensitivity of the brainstem nuclei regulating breathing mechanics in humans, a sleep-stage-dependent chemosensitivity is proposed. REM-sleep-associated neuronal circuits in humans may act protectively against the emergence of CAEs, possibly by reducing chemosensitivity. On the contrary, a significant increase in the chemosensitivity of the brainstem nuclei during NREM sleep is suggested.
睡眠呼吸障碍患者表现出多种不同呼吸事件（中枢性、阻塞性、混合性）的组合，其中一种类型占主导。我们观察到，以阻塞性睡眠呼吸暂停（OSA）为主的患者，与非快速眼动（NREM）睡眠相比，快速眼动（REM）睡眠期间中枢性呼吸暂停事件（CAEs）的发生率降低。这项回顾性探索性研究的目的是描述这一发现并提出病理生理学解释。我们评估了141例OSA患者的多导睡眠图（PSG）数据，以了解REM和NREM睡眠期间CAEs的发生率。根据呼吸暂停低通气指数（AHI），将患者分为三个OSA严重程度组（轻度：AHI < 15次/小时；中度：AHI = 15 - 30次/小时；重度：AHI > 30次/小时）。我们比较了根据REM和NREM睡眠时间相对长度调整后的CAEs频率，发现仅在重度OSA患者中NREM睡眠期间CAEs频率显著增加。鉴于CAEs的出现与调节人类呼吸力学的脑干核的化学敏感性密切相关，我们提出了一种睡眠阶段依赖性化学敏感性。人类REM睡眠相关的神经回路可能通过降低化学敏感性，对CAEs的出现起到保护作用。相反，提示NREM睡眠期间脑干核的化学敏感性显著增加。
