阻塞性睡眠呼吸暂停患者快速动眼睡眠期和非快速动眼睡眠期与肺动脉高压的关系

Changes of pulmonary artery pressure in rapid eye movement and non rapid eye movement sleep in patients with obstructive sleep apnea

目的探讨阻塞性睡眠呼吸暂停综合征患者睡眠时肺动脉压的动态变化及不同睡眠时相对其的特异性影响。方法以１４例阻塞性睡眠呼吸暂停综合征患者为对象，采用肺动脉内留置ＳｗａｎＧａｎｚ导管并同步进行睡眠多导生理记录仪连续记录的方法。结果清醒时平均肺动脉压（ｍＰＡＰ）为２６９±１５３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），非快速动眼睡眠期（Ⅰ期和Ⅱ期）发生呼吸暂停时ｍＰＡＰ升至３４７±１６３ｋＰａ，快速动眼睡眠期呼吸暂停前后ｍＰＡＰ分别为３４７±２２１ｋＰａ和４７５±２４７ｋＰａ；快速动眼睡眠期发生呼吸暂停时ｍＰＡＰ升高１２８±０３６ｋＰａ，动脉血氧饱和度下降的幅度也明显大于非快速动眼睡眠期。

Objective To investigate whether or not the state specific changes related to rapid eye movement sleep (REMS) could contribute to the development of pulmonary hypertension in patients with obstructive sleep apnea syndrome (OSAS). Methods Polysomnography (PSG) was performed in fourteen patients with OSAS. Pulmonary artery pressure was simultaneously monitored with PSG by right cadiac catheterization throughout REMS and non REMS (NREMS). Mean pulmonary artery pressure (PAP) was taken at two different points in each apnea: PAP base is the baseline value when inspiratory efforts during apnea are not elicited, and PAP peak is the peak value observed just after cessation of OSAS. Results PAP peak was higher in REMS (4.75±2.47 kPa) than in NREMS (3.47±1.63 kPa), both of which were significantly higher than the value during awakening (2 69±1.53 kPa). The magnitudes of elevation of PAP (ΔPAP) in REMS and NREMS were 1.28±0.36 and 0.69± 0.25 kPa, respectively. Relative ratios in the response of PAP to decrease of O 2 desaturation (ΔPAP/ΔSaO 2) were similar in REMS (0.058±0.028) and NREMS (0.057±0.027). Conclusion The cause of transient pulmonary hypertension in patients with OSAS could be mainly explained by O 2 desaturation rather than REMS sleep related factors as far as the change in pulmonary vascular hemodynamic is evaluated by the response of PAP to hypoxia.