抗反流治疗改善阻塞性睡眠呼吸暂停的机制探讨

Possible Mechanisms of Anti-reflux Therapy for Obstructive Sleep Apnea Syndrome

目的 :抗反流治疗能有效地缓解胃食管反流 (GER)合并的阻塞性睡眠呼吸暂停 (OSA)。本研究旨在探讨抗反流治疗缓解OSA的机制。方法 :18例有反流症状和睡眠打鼾的患者接受了昼夜食管 pH和压力监测并与多导睡眠图 (PSG)同步监测 ;对同时有GER和OSA的 7名患者予以西沙必利和奥美拉唑抗反流治疗 1周后重复以上检查。结果 :(1)发生GER期间出现呼吸暂停 /低通气是未发生GER期间出现呼吸暂停 /低通气总次数的 4.5倍 (2 2 2 .7± 12 .6比49.5± 11.8) ;(2 )GER引起OSA前 30秒内其平均最低远端食管体部基础压为 -16.2± 8.6mmHg ,GER引起OSA后30秒内为 -19.6± 9.1mmHg ,两者均明显低于远端食管平均基础压 (-11.2± 7.6mmHg ,P <0 .0 0 5 ) ;而食管平均基础压从抗反流治疗前的 -11.2± 7.6mmHg上升到抗反流治疗后的 -6.2± 3.6mmHg(P <0 .0 5 )。 (3)抗反流治疗后食管有效加部份有效蠕动收缩百分比明显增加 ,(从 2 4.0± 5 .4%上升到 5 8.6± 6.2 % ,P <0 .0 5 )。 (4 )抗反流治疗后 ,呼吸暂停 /低通气指数从 38.9± 17.6次 /h下降到 11.2± 12 .3次 /h(P <0 .0 0 2 )。结论 :(1)抗反流治疗可能通过提高食管体部基础压 ,使胸内负压下降 ,有利于防止气道塌陷。 (2 )抗反流治疗通过改善食管体部有效蠕动收缩 。

Purpose: To study the possible mechanisms of anti reflux therapy on OSA in patients GERD with OSAS. Methods: 24h esophageal pH and manometric monitoring and polysomnography(PSG) were performed in 18 patients〔M/F=17/1,mean age 44.4 yrs(27～58),body mass index BMI 27.9±3.1 kg/m 2(20.6～33.3 kg/m 2)〕 with snoring, daytime sleepiness and acid reflux, heartburn. Cisapride 10 mg qid combined omprazole 20 mg q 12 h was given for 7 days in 7 patients confirmed with GERD and OSAS. 24h esophageal pH and manometric monitoring and PSG were repeated on the 7th day. Results:(1) Total numbers of GER related OSA was as 4.5 times as GER non related OSA (222.7±12.6 vs 49.5±11.8). (2)The lowest distal esophageal pressure pre 30 seconds GER induced OSA -16.2±8.6 mmHg and post -30 seconds GER induced OSA (-19.6±9.1 mmHg) were significantly lower than the distal esophageal basic pressure (-11.2±7.6 mmHg,P<0.005); the mean distal esophageal basic pressure was increased from -11.2±7.6 mmHg to -6.2±3.6 mmHg (P<0.05) after anti reflux therapy. (3)Complete and partial effective esophageal peristalsis was increased from 24.0%±5.4% to 58.6±6.2% (P<0.05). (4)After anti reflux therapy, apnea hypopnea index (AHI) was dramatically improved in from 38.9 ±17.6 No./h to 15.2±12.3 No./h (P<0.002). Conclusions: (1)Anti reflux therapy enhanced the esophageal body basic pressure and reduced intrathoracic negative pressure to prevent airway collapse and improve sleep/hypopnea. (2)Anti reflux therapy increased effective peristalsis and rapidly clear reflux material to reduce upper airway resistance.