Lin C C
Dept of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Eur Respir J. 1994 Nov;7(11):2005-10.
The purpose of this study was to evaluate the effect of nasal continuous positive airway pressure (CPAP) on the abnormal ventilatory drive in hypercapnic patients with the obstructive sleep apnoea syndrome (OSAS). Six patients with hypercapnic OSAS (Group I) and 24 patients with eucapnic OSAS (Group II) were studied. All patients had arterial blood gas analysis, overnight sleep studies, and an assessment of ventilatory drive (progressive hyperoxic hypercapnic response and progressive isocapnic hypoxic ventilatory response) prior to and during nasal CPAP therapy (at 2 weeks and 1 month of treatment). Nasal CPAP effectively improved the hypopnoea/apnoea index in both groups (Group I: 87 +/- 14 vs 8 +/- 4; Group II: 63 +/- 17 vs 6 +/- 3). Both hypercapnic and hypoxic ventilatory drive before treatment were significantly impaired in Group I as compared to Group II. Both the slope and baseline level of the ventilatory response and the mouth occlusion pressure (P0.1) improved significantly after 2 weeks of nasal CPAP therapy in Group I, with normalization of arterial carbon dioxide tension (PaCO2) (6.3 +/- 0.2 to 5.2 +/- 0.4 kPa). We conclude that it is possible to completely correct the abnormal ventilatory drive in hypercapnic OSAS patients within 14 days of initiating nasal CPAP therapy.
本研究的目的是评估经鼻持续气道正压通气（CPAP）对阻塞性睡眠呼吸暂停综合征（OSAS）合并高碳酸血症患者异常通气驱动的影响。研究了6例高碳酸血症型OSAS患者（I组）和24例正常碳酸血症型OSAS患者（II组）。所有患者在经鼻CPAP治疗前及治疗期间（治疗2周和1个月时）均进行了动脉血气分析、整夜睡眠研究以及通气驱动评估（渐进性高氧性高碳酸血症反应和渐进性等碳酸血症性低氧通气反应）。经鼻CPAP有效改善了两组患者的呼吸暂停低通气指数（I组：87±14 vs 8±4；II组：63±17 vs 6±3）。与II组相比，I组治疗前的高碳酸血症和低氧通气驱动均明显受损。I组经鼻CPAP治疗2周后，通气反应的斜率和基线水平以及口腔阻断压（P0.1）均显著改善，动脉二氧化碳分压（PaCO2）恢复正常（6.3±0.2至5.2±0.4 kPa）。我们得出结论，在开始经鼻CPAP治疗的14天内，有可能完全纠正高碳酸血症型OSAS患者的异常通气驱动。
