Januel B, Laude D, Elghozi J L, Escourrou P
Laboratoire du Sommeil, INSERM CJF 89 09, Hôpital A. Béclère, Clamart, France.
Blood Press. 1995 Jul;4(4):226-31. doi: 10.3109/08037059509077599.
To determine the impact of the autonomic nervous system on hemodynamic responses to sleep apnea we studied 7 male patients (48 +/- 6 years, BMI = 29.7 +/- 2.9 kg/m2) with an apnea index = 33 + 11/h. In two hypertensives, therapy was withdrawn 2 weeks before the study. During a full night polysomnography EEG, EOG, EMG, respiration, oximetry, heart rate (HR) and blood pressure (BP) (Finapres 23OOE) were recorded. Placebo and 3 short-acting autonomic blockers were randomly i.v. administered: antimuscarinic (atropine 1 mg, A), beta 1 blocker (esmolol 40 mg, E), alpha blocker (nicergoline 2.5 mg, N). A total of 367 obstructive apneas in NREM sleep were studied. With atropine, HR was increased at the beginning of apnea (P1)(74.5 +/- 2 bpm vs 65.4 +/- 2 bpm with placebo) and at the end apnea (P3) (76.6 +/- 1.9 bpm vs 67.1 +/- 1.76 bpm). At the resumption of breathing (RB), HR still increased (83.5 +/- 1.5 bpm vs 80.1 +/- bpm). Nicergoline had no significant effect on HR but significantly decreased SBP (117.8 +/- 1.4 mmHg vs 127 +/- 1.6 with placebo, p < 0.001). Nevertheless, the rise in BP from P3 to RB remained significant (p < 0.001). Esmolol significantly decreased HR at P1 (68.1 +/- 1.9 bpm vs 73.9 +/- 1.9 bpm) and at RB (75.9 +/- 1.9 vs 81.6 +/- 1.8). With A, the rise in HR at end-apnea (P3) suggests a vagal hyperactivity during this phase which is blunted at resumption when HR is unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
为了确定自主神经系统对睡眠呼吸暂停血流动力学反应的影响，我们研究了7名男性患者（年龄48±6岁，体重指数=29.7±2.9kg/m²），呼吸暂停指数为33+11/小时。在两名高血压患者中，研究前2周停用治疗。在整夜多导睡眠监测期间，记录脑电图（EEG）、眼电图（EOG）、肌电图（EMG）、呼吸、血氧饱和度、心率（HR）和血压（BP）（Finapres 23OOE）。安慰剂和3种短效自主神经阻滞剂通过静脉随机给药：抗毒蕈碱药（阿托品1mg，A）、β1阻滞剂（艾司洛尔40mg，E）、α阻滞剂（尼麦角林2.5mg，N）。共研究了367次非快速眼动睡眠期的阻塞性呼吸暂停。使用阿托品时，呼吸暂停开始时（P1）心率增加（74.5±2次/分钟，而安慰剂组为65.4±2次/分钟），呼吸暂停结束时（P3）心率也增加（76.6±1.9次/分钟，而安慰剂组为67.1±1.76次/分钟）。呼吸恢复时（RB），心率仍增加（83.5±1.5次/分钟，而安慰剂组为80.1±次/分钟）。尼麦角林对心率无显著影响，但显著降低收缩压（117.8±1.4mmHg，而安慰剂组为127±1.6mmHg，p<0.001）。然而，从P3到RB血压的升高仍然显著（p<0.001）。艾司洛尔在P1时显著降低心率（68.1±1.9次/分钟，而安慰剂组为73.9±1.9次/分钟），在RB时也降低心率（75.9±1.9次/分钟，而安慰剂组为81.6±1.8次/分钟）。使用A时，呼吸暂停末期（P3）心率升高表明此阶段迷走神经活动亢进，而呼吸恢复时心率未改变，这种亢进被减弱。（摘要截断于250字）
