Sforza E, Boudewijns A, Schnedecker B, Zamagni M, Krieger J
Sleep Disorders Unit, University Hospital Strasbourg, France.
Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 1):1741-7. doi: 10.1164/ajrccm.154.6.8970364.
We tested the hypothesis that the awake ventilatory response to hypoxia and hypercapnia may contribute to the variability of respiratory effort developed in response to upper airway obstruction in obstructive sleep apnea syndrome. The polygraphic recordings of 38 patients diagnosed as having obstructive sleep apnea on the basis of an apnea+hypopnea index greater than 10 were examined. All subjects received hypoxic and hypercapnic ventilatory tests the day before the nocturnal polysomnography. Thirty apneas during non-rapid eye movement (NREM) sleep and at least 10 apneas during rapid eye movement sleep were analyzed. For each considered apnea, we measured esophageal pressure (Pes) swings during the first three breaths preceding apnea and during the first three and last three occluded efforts occurring during the apnea. We considered as indices of respiratory effort the overall increase from the minimum to the maximum Pes (delta Pes), the rate of increase of Pes during apnea (RPes), and the maximal respiratory effort at the end of apnea (Pes max fin). In NREM sleep, all three indices of respiratory effort were correlated positively with the awake ventilatory response to hypoxia or hypercapnia and with the apnea index. No correlation was found between the indices of respiratory effort and body mass index, age, pulmonary function tests, awake blood gases, apnea duration, and apnea desaturation. In rapid eye movement sleep, none of the considered variables predicted the degree of respiratory effort. In conclusion, our results suggest that the degree of ventilatory response to upper airway occlusion in obstructive sleep apnea may be influenced by the sensitivity of central neural drive to chemical stimuli.
我们检验了这样一个假设，即清醒状态下对低氧和高碳酸血症的通气反应可能导致阻塞性睡眠呼吸暂停综合征患者对上气道阻塞作出反应时呼吸努力的变异性。对38例根据呼吸暂停 + 低通气指数大于10被诊断为患有阻塞性睡眠呼吸暂停的患者的多导睡眠图记录进行了检查。所有受试者在夜间多导睡眠图检查前一天接受了低氧和高碳酸血症通气测试。分析了非快速眼动（NREM）睡眠期间的30次呼吸暂停以及快速眼动睡眠期间至少10次呼吸暂停。对于每一次所考虑的呼吸暂停，我们测量了呼吸暂停前三次呼吸期间以及呼吸暂停期间发生的前三次和最后三次阻塞性努力期间的食管压力（Pes）波动。我们将从最低Pes到最高Pes的总体增加（ΔPes）、呼吸暂停期间Pes的增加速率（RPes）以及呼吸暂停结束时的最大呼吸努力（Pes max fin）视为呼吸努力的指标。在NREM睡眠中，所有三个呼吸努力指标均与清醒状态下对低氧或高碳酸血症的通气反应以及呼吸暂停指数呈正相关。未发现呼吸努力指标与体重指数、年龄、肺功能测试、清醒时血气、呼吸暂停持续时间和呼吸暂停时的血氧饱和度下降之间存在相关性。在快速眼动睡眠中，所考虑的变量均未预测呼吸努力程度。总之，我们的结果表明，阻塞性睡眠呼吸暂停患者对上气道阻塞的通气反应程度可能受中枢神经驱动对化学刺激的敏感性影响。
