Gold A R, Schwartz A R, Wise R A, Smith P L
Department of Medicine, Johns Hopkins Sleep Disorders Center, Francis Scott Key Medical Center, Johns Hopkins School of Medicine, Baltimore.
Chest. 1993 May;103(5):1325-9. doi: 10.1378/chest.103.5.1325.
To determine whether moderately obese, normocapnic, sleep apnea patients are distinguished from normal obese individuals by differences in waking pulmonary function and respiratory chemosensitivity, we compared the waking pulmonary function, hypercapnic, and hypoxic ventilatory responses of 35 nonhypercapnic sleep apnea patients (32 men and 3 women) with those of 17 age-, sex-, weight-, and obesity-matched nonapneic control subjects (16 men and 1 woman). The waking ventilatory response to hypercapnia was lower among sleep apnea patients (mean +/- SD, 2.05 +/- 1.29 L/min/mm Hg) than control subjects (3.02 +/- 2.05 L/min/mm Hg, p < 0.05). Patients with sleep apnea demonstrated a higher waking PaCO2 (40.4 +/- 2.9 vs 37.0 +/- 2.7 mm Hg, p < 0.001), and a lower waking PaO2 (81.4 +/- 11.7 vs 89.7 +/- 10.4 mm Hg, p < 0.03). The waking hypoxic ventilatory response, however, was not significantly different between the groups. Moreover, control subjects had a higher total lung capacity than sleep apnea patients (6.99 +/- 1.12 L and 6.27 +/- 1.09 L, respectively, p < 0.05). The lower hypercapnic ventilatory response, higher waking PaCO2, and lower total lung capacity in the sleep apnea patients resemble the pattern observed in patients with pickwickian syndrome. This suggests that disturbances in pulmonary function and ventilatory control in moderately obese sleep apnea patients are intermediate along a continuum from normal obesity to the pickwickian syndrome.
为了确定中度肥胖、血碳酸正常的睡眠呼吸暂停患者是否通过清醒时肺功能和呼吸化学敏感性的差异与正常肥胖个体相区分，我们比较了35名非高碳酸血症性睡眠呼吸暂停患者（32名男性和3名女性）与17名年龄、性别、体重和肥胖程度相匹配的非呼吸暂停对照受试者（16名男性和1名女性）的清醒时肺功能、高碳酸血症和低氧通气反应。睡眠呼吸暂停患者对高碳酸血症的清醒通气反应（均值±标准差，2.05±1.29L/min/mm Hg）低于对照受试者（3.02±2.05L/min/mm Hg，p<0.05）。睡眠呼吸暂停患者的清醒时动脉血二氧化碳分压（PaCO2）较高（40.4±2.9对37.0±2.7mm Hg，p<0.001），而清醒时动脉血氧分压（PaO2）较低（81.4±11.7对89.7±10.4mm Hg，p<0.03）。然而，两组之间的清醒时低氧通气反应没有显著差异。此外，对照受试者的肺总量高于睡眠呼吸暂停患者（分别为6.99±1.12L和6.27±1.09L，p<0.05）。睡眠呼吸暂停患者较低的高碳酸血症通气反应、较高的清醒时PaCO2和较低的肺总量类似于匹克威克综合征患者的表现模式。这表明中度肥胖睡眠呼吸暂停患者的肺功能和通气控制紊乱在从正常肥胖到匹克威克综合征的连续过程中处于中间状态。
