阻塞性睡眠呼吸暂停患者不同睡眠时相呼吸驱动变化的研究

The breathing control of patients with obstructive sleep apnea syndrome during different sleep stage

目的:通过检测健康人与阻塞性睡眠呼吸暂停(OSAS)患者不同睡眠时相与觉醒状态下呼吸驱动指标的变化,探讨造成睡眠呼吸暂停的可能机制。方法:检测23例经PSG确诊的OSAS患者和17例健康非鼾症对照者在清醒卧位、非快速动眼睡眠时期(NREM)、快动眼睡眠期(REM)的潮气量(VT)、分钟通气量(MV)、呼吸频率(R-R)、口腔阻断压(P0.1)的变化。结果:(1)OSAS组与对照组在睡眠时均表现为VT、MV和P0.1的下降,在REM睡眠期上述指标下降最为明显;呼吸频率因睡眠时相不同而不同。(2)OSAS组与对照组相比,在睡眠时VT、分钟通气量MV和P0.1的下降程度差异有显著性,P<0.01,OSAS高于对照组。结论:(1)睡眠对人们的呼吸是有影响的,主要表现为VT、MV的降低,呼吸中枢驱动指标P0.1的下降,在REM睡眠期尤为显著。(2)在OSAS患者,睡眠时呼吸中枢驱动下降尤为显著;提示除上气道解剖结构狭窄外,OSAS患者睡眠时呼吸中枢驱动的下降也是发生呼吸暂停的重要因素。

Objective： To detect the index about breathing control of the normal and obstructive sleep apnea syndrome （OSAS） patients during wake and different sleep stage; Probe into the possible mechanism of sleep apnea. Methods： In the OSAS patients 23 case and control 17 case, VT, MV, respiratory frequence （R-R）, P0.1 were measured during wake, NREM sleep （Ⅰ,Ⅱ）, REM sleep by a oral-nasal mask connecting the respiratory drive apparatus （GERMANY, Jaeger）, in the same time PSG were done. Results： During sleep, both the controls and OSAS patients, VT, MV, P0.1 were lower than wake stage; In REM sleep the change was remarkable. The change of R-R was uncertain. The change of VT, MV, P0.1 were remarkable in the OSAS patients than in the normals. Conclusion：（1）Sleep effects respiration function of peoples： The decreased of breathing control may be the possible mechanism of apnea, besides the obstruct and stricture of upper airway.