评估阻塞性睡眠呼吸暂停患者上气道阻力的新方法

A new method for assessing upper airway resistance in patients with obstructive sleep apnea

目的评估通过膈肌肌电(diaphragm electromyography, EMGdi)与流量的比值计算阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)患者上气道阻力,是否可行。方法共招募24个OSA患者,分别利用食道压(esophageal pressure,Poes)与流速的比值和EMGdi与流速的比值计算上气道阻力。分别计算受试者清醒期(W)、稳定的非快速眼动2期(N2)、稳定的非快速眼动2期伴打鼾期(SNORING)、低通气期(HYPOPNEA)、暂停事件前低通气期(PREAPNEA)的上气道阻力。所有受试者行标准的全夜睡眠多导图检查。结果受试者从W,到N2,到SNORING,到HYPOPNEA,到PREAPNEA,上气道阻力依次增高。从W到N2,从SNORING到HYPOPNEA,上气道阻力增高有统计学意义(P<0.05)。我们的研究结果发现上气道阻力在HYPOPNEA期高于SNORING期,但是膈肌肌电和食道压在SNORING期高于HYPOPNEA。结论通过膈肌肌电与流量的比值评估OSA患者睡眠状态上气道阻力是可行的。

Objective To determine whether the ratio of diaphragm electromyography(EMGdi) to flow can be used to assess changes in upper airway resistance in obstructive sleep apnea(OSA) during sleeping. Methods 24 patients with OSA were studied. The upper airway resistance was assessed by the ratio of esophageal pressure(Poes) to flow and the ratio of diaphragm electromyography(EMGdi) to flow in different sleep stages including wakefulness, stable N2, stable N2-snoring, hypopneas, PREAPNEA(the hypopnea before apnea events). All subjects underwent overnight full polysomnography using standard techniques. Results The results indicated that UAR was progressively higher from wakefulness to stable N2, stable N2-Snoring, hypopnea and PREAPNEA in patients with OSA and had obvious difference in statistical significance(P<0.05) between wakefulness and stage N2 as well as between N2-snoring and hypopnea. It found that from wakefulness to hypopnea, the maximum value of Poes and EMGdi was occurred in stable N2-Snoring, not hypopnea, thus the maximum value of upper airway resistance was occurred in hypopnea. Conclusion It is feasible to use the ratio of neural respiratory drive to flow to assess UAR in patients with OSA during sleep.