睡眠对慢性阻塞性肺疾病患者上气道阻力的影响

Influence of sleep on upper airway resistance in patients with chronic obstructive pulmonary disease

目的探讨睡眠对慢性阻塞性肺疾病（COPD）患者上气道阻力及呼吸动力学的影响。方法选择19例COPD急性加重期住院患者，治疗后病情稳定，通过食道-胃囊管法，检测气道开口压、食道压和胃内压，层流速仪测呼吸流速和容量改变。同步监测多导睡眠图，采集患者在清醒、睡眠仰卧及侧卧位呼吸动力学的变化。结果睡眠时吸气峰流速、平均吸气流速和肺通气量较清醒时显著下降（P〈0．001）；睡眠仰卧较侧卧潮气量下降更严重（P〈0．05）。睡眠时上气道阻力（Rua）较清醒时增加（P〈0．001），睡眠仰卧Rua高于侧位（P〈0．05）；睡眠时动态肺顺应性较清醒下降（P〈0．05）。食道压负值、压力时间乘积较清醒均增加（P〈0．05），侧卧与清醒比较差异无统计学意义（P值均〉0．05）。结论COPD患者存在睡眠时Rua增加，导致低通气及呼吸努力增加。侧卧睡眠有降低Rua，增加吸气流速和肺通气量趋势。

Objective To determine changes in upper airway resistance （Rua）and respiratory dynamics in chronic obstructive pulmonary disease （COPD） during sleep. Methods We recruited 19 hospitalized patients with COPD who got good recoveries following treatment. Esophageal and gastric balloon-catheters were used for the detection of esophageal pressure and gastric pressure and airway opening pressure. Airflow and ventilation were measured with pneumotachograph. Each patient underwent a nocturnal polysomnogram. Data was collected from patients in the state of wake, sleep supine and lateral position in spontaneous breathing. Results The peak inspiratory flow（PIF） ,mean inspiratory flow（VT/Ti）, tidal volume,minute ventilation （VE） in supine sleep were significantly decreased compared with those measured during wake （all P 〈0. 001 ）. The VT was decreased in supine compared with that of lateral sleep（ P 〈0.05）. The Rua in supine and lateral sleep were higher than that during wake （ P 〈0. 001, P 〈0.05 ,respectively）. The dynamic lung compliance in supine sleep was significantly lower than that during wake （ P 〈0.05）. The Pes and inspiratory muscle pressure time product were increased in supine sleep compared with that during wake （all P 〈 0.05）. Conclusions The study suggests that increased Rua and hypoventilation were common during sleep in COPD patients. Upper airway collapsibility is an important factor for hypoventilation and hypoxemia during sleep in stable COPD. Lateral sleeping is beneficial to the decreasing of Rua and respiratory work, improving inspiration volume, ventilation and hypoxemia.