Guilleminault C, Stoohs R, Skrobal A, Labanowski M, Simmons J
Stanford University Sleep Disorders Clinic and Research Center, California.
J Pediatr. 1993 Jun;122(6):881-6. doi: 10.1016/s0022-3476(09)90011-7.
To investigate the relationship between sudden infant death syndrome and upper airway obstruction, we studied 14 term infants at a mean age of 11 weeks who had been identified as being at risk for sudden infant death syndrome on the basis of clinical and family histories and polygraphic monitoring. Respiratory efforts during sleep were investigated by esophageal pressure monitoring (all 14 infants) and by monitoring of flow with a pneumotachometer (6 infants). During apparently normal sleep, increased respiratory efforts were shown by intermittent increases in the magnitude of the negativity of esophageal pressure. Mild changes in tidal volume occurred occasionally, always at the lowest monitored esophageal pressure of a breath sequence. These tidal volume decreases had no impact on oxygen saturation but led to a short arousal and decreased respiratory efforts, followed by a return to normal breathing. Occasionally the abnormal increase in upper airway resistance did not lead to an immediate arousal but instead to a short obstructive apnea that was then followed by an arousal. This investigation indicates the importance of arousal mechanisms in maintaining normal breathing during sleep. Any disruption of the arousal mechanisms during sleep (including sleep fragmentation caused by repetitive arousals) may place these infants with increased upper airway resistance at risk for obstructive apnea during sleep.
为了研究婴儿猝死综合征与上呼吸道阻塞之间的关系，我们对14名足月婴儿进行了研究，这些婴儿的平均年龄为11周，根据临床和家族病史以及多导睡眠监测，他们被确定为有婴儿猝死综合征风险。通过食管压力监测（所有14名婴儿）和用呼吸流速计监测气流（6名婴儿）来研究睡眠期间的呼吸努力情况。在明显正常的睡眠期间，食管压力负值大小的间歇性增加表明呼吸努力增强。潮气量偶尔会有轻微变化，总是出现在一个呼吸序列中监测到的最低食管压力时。这些潮气量减少对血氧饱和度没有影响，但会导致短暂觉醒并使呼吸努力减弱，随后恢复正常呼吸。偶尔，上呼吸道阻力的异常增加不会立即导致觉醒，而是导致短暂的阻塞性呼吸暂停，随后是觉醒。这项研究表明了觉醒机制在维持睡眠期间正常呼吸中的重要性。睡眠期间觉醒机制的任何破坏（包括由反复觉醒引起的睡眠片段化）可能会使这些上呼吸道阻力增加的婴儿在睡眠期间有发生阻塞性呼吸暂停的风险。
