阻塞性睡眠呼吸暂停低通气综合征患者睡眠呼吸暂停事件前后咽腔呼吸压力的分析

An analysis of pharyngeal respiratory pressure before and after onset of obstruction in respiratory obstructive sleep apnea hypopnea syndrome

目的通过了解阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠呼吸暂停事件前后咽腔呼吸压力变化的规律性,探讨咽腔呼吸压力对OSAHS形成、发展的可能影响。方法采用导管测压法,与多导睡眠图(PSG)同步实时监测8例OSAHS患者和9例健康受试者睡眠状态下鼻咽、口咽和喉咽等部位的咽腔呼吸压力;测平均呼吸压和呼吸负压持续时间比。结果健康受试者睡眠中咽腔呼吸压力波形有良好的规则性,各次呼吸压力波形具有相似性和周期性,呼吸负压持续时间比<0.5。OSAHS患者OSAHS事件发作期咽腔呼吸压力波动剧烈,压力波形不规则,吸气负压极大,平均呼吸压较健康人高1～2个数量级,可高达-990Pa,呼吸负压持续时间比>0.55;OSAHS事件发作间期,咽腔呼吸压力波形规则,并具有一定的周期性,与呼吸暂停事件发作时的压力波形完全不同,而与健康人睡眠中的咽腔呼吸压力波形极为相像,但发作间期的平均呼吸压和呼吸负压持续时间比与健康人相比差异有统计学意义(P<0.05)。结论OSAHS患者睡眠呼吸事件发作间期的咽腔呼吸压力在本质上不同于健康人睡眠中的咽腔呼吸压力,其特性表明,OSAHS患者咽腔结构和功能的病变对气道内呼吸气流的影响是固有的,并不因临床发作与否而影响其持续性,在发作期这种影响表现得更为明显,说明非正常咽腔呼吸压力对咽部软组织产生的生物力学作用对OSAHS发病机制是重要的。

Objective To study the characteristics of pharyngeal respiratory pressure before and after onset of airflow obstruction events in obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods The respiratory pressure in nasopharynx, oropharynx, and hypoharynx in 8 patients with OSAHS and 9 normal persons were evaluated through catheter manometer. Base on mean respiratory pressure and the ratio of negative respiratory pressure persistent time, the characteristics of pharyngeal respiratory pressure before and after the event onset were analyzed. Results During sleep, the pharyngeal respiratory pressure in normal persons had similar and periodical wave shape. The ratio of negative respiratory pressure persistent time was less than 0.5. In patients with OSAHS, when the obstruction of airflow happened, the pharyngeal respiratory pressure fluctuated violently, the wave shape became irregular, and the negative expiratory pressure was evident. The mean respiratory pressure was 1 to 2 order of magnitude larger than in normal persons, even reaching -990 Pa. The ratio of persistent negative pressure time was larger than normal. During the intermittent period, the wave shape of pharyngeal respiratory pressure was regular and periodical, the pressure wave shape was different from onset of obstruction. However, in the intermittent period, the mean respiratory pressure, the ratio of negative respiratory pressure persistent time, and other characteristics were still statistically different from normal persons （ P 〈 0. 05 ）. Conclusions During the intermittent period, the pharyngeal respiratory pressure in patients with OSAHS during sleep is basically different from the pharyngeal respiratory pressure in normal person. The characteristics of pharyngeal respiratory pressure in intermittent period indicates that both structural and functional abnormalities in pharyngeal cavity in patients with OSAHS, which affect the respiratory airflow during sleep are inherent. The effects are more prominent during onset period, suggesting that the characteristics of the pharyngeal pressure of breathing during the onset period will be more important to the mechanism of airflow obstruction.