Fietze I, Quispe-Bravo S, Hänsch T, Röttig J, Baumann G, Witt C
Humboldt University, Medical School (Charité), Department of Internal Medicine, Berlin, Germany.
J Sleep Res. 1997 Jun;6(2):128-33. doi: 10.1046/j.1365-2869.1997.00029.x.
Nocturnal arousals are the essential cause of disturbed sleep structure in patients with obstructive sleep apnoea syndrome (OSAS). The aim of this study was to analyse the relationship between sleep stages, respiratory (type-R) and movement (type-M) related EEG arousals. Furthermore, the value of these arousals as a criterion for the efficiency of nCPAP treatment was estimated. We examined 38 male patients aged between 30 and 71 (49.1 +/- 20.9 SD) y. All patients suffered from OSAS. The mean respiratory disturbance index (RDI) was 47.3 +/- 27.8 per h. Polysomnographic monitoring was carried out on 4 subsequent nights: baseline night, 2 nights of nCPAP titration and nCPAP control night. Sleep was visually scored and EEG arousals were classified into type R and M, depending on whether changes of respiration or movement caused the arousal. The RDI, the R index (type-R/h), the M index (type-M/h) and the R and M indices in different sleep stages were calculated. During the baseline night a deficit of slow wave sleep (SWS) and REM sleep was found. Furthermore there were more type-R than type-M arousals registered (17.4 h-1 [3.6-43.6] vs. 5.9 h-1 [1.6-11.8]) (P < 0.01). They occurred during stages NREM 1, NREM 2 and REM (P < 0.01). An SWS sleep rebound and a reduction of the SWS and REM latencies were already found during the first CPAP night. The R index was reduced during the first CPAP night in all sleep stages (P < 0.01) and remained approximately the same in the following 2 nights (3. CPAP night: 1.1 h-1 [0.3-5.0]). Type M arousals occurred more in stages 1 and 2 (P < 0.01), and remained unchanged under nCPAP. We concluded that differentiation of nocturnal arousals may provide more detailed information regarding the influence of breathing disturbances on sleep. Respiratory related, not movement related, arousals may be a useful additional tool in judging the efficiency of OSAS.
夜间觉醒是阻塞性睡眠呼吸暂停综合征（OSAS）患者睡眠结构紊乱的主要原因。本研究旨在分析睡眠阶段、呼吸相关（R型）和运动相关（M型）脑电图觉醒之间的关系。此外，还评估了这些觉醒作为无创持续气道正压通气（nCPAP）治疗效果标准的价值。我们检查了38名年龄在30至71（49.1±20.9标准差）岁之间的男性患者。所有患者均患有OSAS。平均呼吸紊乱指数（RDI）为每小时47.3±27.8次。在随后的4个晚上进行了多导睡眠图监测：基线夜、2个nCPAP滴定夜和nCPAP对照夜。通过视觉对睡眠进行评分，并根据呼吸或运动的变化是否引起觉醒将脑电图觉醒分为R型和M型。计算了RDI、R指数（每小时R型次数）、M指数（每小时M型次数）以及不同睡眠阶段的R和M指数。在基线夜发现慢波睡眠（SWS）和快速眼动睡眠（REM）不足。此外，记录到的R型觉醒比M型觉醒更多（17.4次/小时[3.6 - 43.6]对5.9次/小时[1.6 - 11.8]）（P < 0.01）。它们出现在非快速眼动睡眠1期、非快速眼动睡眠2期和快速眼动睡眠期（P < 0.01）。在第一个CPAP夜就已发现SWS睡眠反弹以及SWS和REM潜伏期缩短。在第一个CPAP夜，所有睡眠阶段的R指数均降低（P < 0.01），并且在接下来的2个晚上保持大致相同（第三个CPAP夜：1.1次/小时[0.3 - 5.0]）。M型觉醒在1期和2期出现更多（P < 0.01），并且在nCPAP治疗下保持不变。我们得出结论，区分夜间觉醒可能会提供有关呼吸紊乱对睡眠影响的更详细信息。呼吸相关而非运动相关的觉醒可能是判断OSAS治疗效果的一个有用的附加工具。
