Deegan P C, Mulloy E, McNicholas W T
Department of Respiratory Medicine, University College, Dublin, Ireland.
Am J Respir Crit Care Med. 1995 Apr;151(4):1108-12. doi: 10.1164/ajrccm/151.4.1108.
Topical oropharyngeal anesthesia (TOPA) increases obstructive sleep apnea (OSA) frequency in both normal subjects and loud snorers. The effects of TOPA in established OSA were assessed in six male patients with a mean age (+/- SEM) of 50 +/- 5.3 yr. Following an acclimatization night, each subject underwent two overnight sleep studies, randomly assigned to TOPA (10% lidocaine spray and 0.25% bupivocaine gargle) and control (C) (saline placebo). Patients demonstrated sleep efficiencies of 93 +/- 2.9% (mean +/- SEM) during C and 88 +/- 2.9% during TOPA. Overall apnea-hypopnea (AH) frequency, using inductance plethysmography, showed little change: 21.2 +/- 3.6 on C versus 25.1 +/- 3.5 events/h on TOPA nights (p = 0.12). There was no significant increase in AH duration with TOPA, and oxygen desaturation (> or = 4%) frequency was similar: 21.1 +/- 3.9 per hour during TOPA versus 23.6 +/- 5.9 during C. However, obstructive AHs showed a change in thoracoabdominal motion from C to TOPA nights, with an increase in events with abdominal paradox from 3.1 +/- 1.1 to 10.3 +/- 3.1 per hour (p = 0.03), and a reduction in events with ribcage paradox from 13.1 +/- 1.6 to 8.2 +/- 2.4 per hour (p = 0.08). Central and mixed AHs demonstrated similar frequencies on both nights. These data support an impairment of upper airway (UA) protective reflexes among patients with OSA.
局部口咽麻醉（TOPA）会增加正常受试者和大声打鼾者的阻塞性睡眠呼吸暂停（OSA）频率。在6名平均年龄（±标准误）为50±5.3岁的男性患者中评估了TOPA对已确诊OSA的影响。在适应一晚后，每位受试者进行了两次夜间睡眠研究，随机分为TOPA组（10%利多卡因喷雾和0.25%布比卡因漱口）和对照组（C）（生理盐水安慰剂）。患者在C期间的睡眠效率为93±2.9%（平均±标准误），在TOPA期间为88±2.9%。使用电感式体积描记法，总体呼吸暂停低通气（AH）频率变化不大：C期间为21.2±3.6次/小时，TOPA夜间为25.1±3.5次/小时（p = 0.12）。TOPA期间AH持续时间无显著增加，氧饱和度下降（≥4%）频率相似：TOPA期间为每小时21.1±3.9次，C期间为每小时23.6±5.9次。然而，阻塞性AHs显示从C到TOPA夜间胸腹运动发生了变化，腹部矛盾运动事件从每小时3.1±1.1次增加到10.3±3.1次（p = 0.03），胸廓矛盾运动事件从每小时13.1±1.6次减少到8.2±2.4次（p = 0.08）。中枢性和混合性AHs在两个晚上的频率相似。这些数据支持OSA患者上呼吸道（UA）保护反射受损。
