体表膈肌肌电对睡眠呼吸暂停事件的鉴别作用

Distinguishing central from obstructive sleep apnea with chest wall surface electrodes

目的探讨体表电极记录膈肌肌电是否有助于准确区分阻塞性睡眠呼吸暂停（OSA）与中枢性睡眠呼吸暂停（CSA）事件。方法选择2009年1—9月广州呼吸疾病研究所就诊并疑有睡眠呼吸暂停综合征的10例患者，其中男8例，女2例；年龄（44±10）岁，体质指数（25．9±1．8）kg／m^2。对患者进行整夜常规多导睡眠监测的同时记录体表膈肌肌电信号、食管膈肌肌电信号，分析体表膈肌肌电与食管膈肌肌电的相关性，并比较胸腹带、体表膈肌肌电和食管膈肌肌电在判断CSA事件方面的差异。结果除1例患者外，其他9例患者均能耐受多导食管电极检查，并可记录到高质量的食管膈肌肌电信号和体表膈肌肌电信号。食管膈肌肌电和体表膈肌肌电信号强度有良好的相关性（r=0．81±0．06，P〈0．05）。根据胸腹带所的判断的CSA事件为（28±31）次／夜，显著大于食管膈肌肌电信号和体表膈肌肌电信号判断的CSA事件次数[均为（7±11）次／夜]（P〈0．05）。结论体表电极记录的膈肌肌电信号可用于鉴别OSA与CSA。

Objective To determine whether or not diaphragm eleetromyography recorded from chest wall surface electrodes （EMGsur） can be used to distinguish central from obstructive sleep apnea. Methods Ten patients （age （44 ± 10） years, body mass index （25. 9 ± 1.8） kg/m2） with suspected obstructive sleep apnea referred from Guangzhou Institute of Respiratory Disease were studied between January and September 2009. EMGsur and diaphragm electromyography from esophageal electrode （EMGeso） were recorded during conventional overnight full polysomnography. And chest-abdominal movement was measured with chest and abdominal bands. Results High-quality EMGsur and EMGeso were recorded in all subjects except for one who could not tolerate a multlpair esophageal electrode. Excellent correlation was found between EMGsur and EMGeso during sleep including apnea events （r = 0. 81 ± 0. 06, P 〈 0.05 ）. The central sleep apnea events diagnosed by EMGeso were exactly the same as those diagnosed by EMGsur. However, the central sleep apnea events diagnosed by EMGsur were less than those diagnosed by conventional thoracic-abdominal bands （7 ± 11 vs 28 ± 31, P 〈 0. 05 ）. Conclusion EMGsur may be used to distinguish central from obstructive sleep apnea events.