Waradekar N V, Sinoway L I, Zwillich C W, Leuenberger U A
Department of Medicine, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1333-8. doi: 10.1164/ajrccm.153.4.8616563.
Obstructive sleep apnea (OSA) is a common disorder associated with systemic hypertension, myocardial infarction, stroke, and premature death. Elevated sympathetic tone has been documented previously in OSA and may contribute to the cardiovascular risk. As OSA therapy appears to reduce mortality, we wondered if decreased apnea activity would attenuate the sympathetic hyperactivity of untreated patients. Muscle sympathetic nerve activity (MSNA) was measured during wakefulness via peroneal microneurography in seven patients with documented OSA before and at least 1 mo after compliance-monitored nasal continuous positive airway pressure (CPAP) therapy. Before institution of CPAP therapy, MSNA was high in all patients and decreased after CPAP therapy (baseline versus CPAP: 69.4 +/- 15.3 versus 53.9 +/- 10.5 bursts/min, mean +/- SD; p<0.01). However, the decrease in MSNA was limited to the four patients with the greatest nightly use of CPAP (> or = 4.5 h/night), whereas it remained unchanged in the three patients who were less compliant. There was a direct linear correlation between the decrease in MSNA (bursts/min) and the average hours of CPAP use per night (r = 0.87, p = 0.01). We conclude that in patients with OSA effective reduction in apnea activity with CPAP therapy diminishes the high sympathetic tone present during resting wakefulness.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，与系统性高血压、心肌梗死、中风及过早死亡相关。此前已有文献记载OSA患者交感神经张力升高，这可能是心血管疾病风险的一个因素。由于OSA治疗似乎能降低死亡率，我们想知道呼吸暂停活动的减少是否会减弱未治疗患者的交感神经过度活跃。通过腓骨微神经ography在7例确诊为OSA的患者清醒状态下测量肌肉交感神经活动（MSNA），测量时间分别为依从性监测的鼻持续气道正压通气（CPAP）治疗前及治疗后至少1个月。在开始CPAP治疗前，所有患者的MSNA均较高，CPAP治疗后降低（基线值与CPAP治疗后：69.4±15.3次/分钟对53.9±10.5次/分钟，均值±标准差；p<0.01）。然而，MSNA的降低仅限于每晚使用CPAP时间最长（≥4.5小时/晚）的4例患者，而在依从性较差的3例患者中则保持不变。MSNA降低值（次/分钟）与每晚CPAP平均使用时长之间存在直接线性相关性（r = 0.87，p = 0.01）。我们得出结论，在OSA患者中，CPAP治疗有效减少呼吸暂停活动可降低静息清醒状态下的高交感神经张力。
