Weitzenblum E, Chaouat A, Charpentier C, Ehrhart M, Kessler R, Schinkewitch P, Krieger J
Department of Pulmonology and Sleep Laboratory, University Hospital, Strasbourg, France.
Respiration. 1997;64(3):187-93. doi: 10.1159/000196669.
Worsening of hypoxaemia during sleep in patients with chronic obstructive pulmonary disease has been extensively investigated in the past 20 years owing to the development of polysomnography and to the advent of reliable transcutaneous oximeters. Sleep-related hypoxaemia is characteristic of rapid-eye-movement (REM) sleep but may be present during other sleep stages. There is a strong relationship between nocturnal O2 saturation and the level of daytime PaO2: the more pronounced daytime hypoxaemia, the more severe nocturnal hypoxaemia. Sleep-related hypoxaemia is due to a variable combination of alveolar hypoventilation and ventilation-perfusion mismatching, alveolar hypoventilation being the preponderant mechanism during REM sleep. The deleterious effects of sleep-related hypoxaemia include cardiac arrhythmias, 'hypoxaemic stress' on the coronary circulation and especially, peaks of pulmonary hypertension. The treatment of nocturnal hypoxaemia is conventional O2 therapy (both nighttime and daytime) in patients who exhibit marked daytime hypoxaemia (PaO2 < 55-60 mm Hg). At present data are not sufficient for justifying the use of isolated nocturnal O2 therapy in patients with nocturnal desaturation who do not qualify for conventional O2 therapy.
在过去20年里，由于多导睡眠图的发展以及可靠的经皮血氧计的出现，慢性阻塞性肺疾病患者睡眠期间低氧血症的恶化情况得到了广泛研究。与睡眠相关的低氧血症是快速眼动（REM）睡眠的特征，但在其他睡眠阶段也可能出现。夜间血氧饱和度与白天动脉血氧分压（PaO2）水平之间存在密切关系：白天低氧血症越明显，夜间低氧血症就越严重。与睡眠相关的低氧血症是由肺泡通气不足和通气/血流不匹配的多种组合引起的，肺泡通气不足是REM睡眠期间的主要机制。与睡眠相关的低氧血症的有害影响包括心律失常、对冠状动脉循环的“低氧应激”，尤其是肺动脉高压峰值。对于白天低氧血症明显（PaO2 < 55 - 60 mmHg）的患者，夜间低氧血症的治疗是采用常规氧疗（夜间和白天）。目前，对于不符合常规氧疗条件但存在夜间血氧饱和度降低的患者，尚无足够数据支持单独使用夜间氧疗。
