Zamagni M, Sforza E, Boudewijns A, Petiau C, Krieger J
Sleep Disorders Unit, University Hospital, Strasbourg, France.
Chest. 1996 Mar;109(3):651-8. doi: 10.1378/chest.109.3.651.
To test the hypothesis that respiratory effort during obstructive apneas contributes, together with hypoxemia and sleep fragmentation, to excessive daytime sleepiness, we investigated the relationship between daytime sleepiness and polysomnographic variables in 44 patients with obstructive sleep apnea (OSA). In all patients, daytime sleep propensity was assessed by an 11-item standardized self-questionnaire yielding a sleepiness score and by a modified sleep latency test yielding a mean sleep latency. Respiratory effort during apneas was evaluated by measuring esophageal pressure swings using an esophageal balloon. Within each apneic cycle, we measured the esophageal pressure swings during the first three and the last three occluded efforts during the apnea to define the overall increase, its ratio to apnea duration, and the maximal effort developed during obstruction. In the group of patients as a whole, the sleepiness score was negatively correlated with the mean sleep latency (r=-0.38, p=0.01). The sleepiness score was correlated with the indexes of respiratory effort during apneas (ie, the overall increase, its ratio to apnea duration, and the maximal end-apneic swing in esophageal pressure) and with the apnea+hypopnea index. The mean sleep latency was correlated with all indexes of nocturnal hypoxemia (ie, the mean lowest oxyhemoglobin saturation [SaO2] and the index of apnea associated with a fall in SaO2 below 90% and 80%). We conclude that the degree of respiratory effort during obstructive apneas contributes to self-rated sleep propensity in patients with OSA.
为了验证阻塞性呼吸暂停期间的呼吸努力与低氧血症和睡眠片段化共同导致日间过度嗜睡这一假设，我们调查了44例阻塞性睡眠呼吸暂停（OSA）患者日间嗜睡与多导睡眠图变量之间的关系。在所有患者中，通过一份包含11项内容的标准化自我问卷得出嗜睡评分来评估日间睡眠倾向，并通过改良的睡眠潜伏期测试得出平均睡眠潜伏期。使用食管气囊测量食管压力波动来评估呼吸暂停期间的呼吸努力。在每个呼吸暂停周期内，我们测量呼吸暂停期间前三次和最后三次阻塞努力时的食管压力波动，以确定总体增加量、其与呼吸暂停持续时间的比值以及阻塞期间产生的最大努力。在整个患者组中，嗜睡评分与平均睡眠潜伏期呈负相关（r = -0.38，p = 0.01）。嗜睡评分与呼吸暂停期间的呼吸努力指标（即总体增加量、其与呼吸暂停持续时间的比值以及食管压力的最大呼吸暂停末波动）以及呼吸暂停+低通气指数相关。平均睡眠潜伏期与夜间低氧血症的所有指标（即平均最低氧合血红蛋白饱和度[SaO2]以及与SaO2降至90%和80%以下相关的呼吸暂停指数）相关。我们得出结论，阻塞性呼吸暂停期间的呼吸努力程度对OSA患者的自我评估睡眠倾向有影响。
