体表电极代替多导食道电极在睡眠呼吸暂停中的应用

Application of superficial electrode instead of esophageal electrode in patients with obstructive sleep apnea

目的分别利用体表电极和食道电极监测阻塞性睡眠呼吸暂停(OSA)患者夜间不同睡眠状态的呼吸中枢驱动、呼吸中枢驱动的有效性及上气道阻力,评估两者是否具有一致性。方法共招募24例OSA患者,分别利用体表电极和食道电极测量受试者清醒期(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)的呼吸中枢驱动。流速用流量计测量。所有受试者行标准的全夜睡眠多导图检查。结果我们的研究结果发现从W到N2,到SNORING,到HYPOPNEA,到PREAPNEA,标化后的食道膈肌肌电(EMGdi%max)和标化后的体表膈肌肌电(SEMGdi%max)的变化趋势一致。从W到N2,到SNORING,EMGdi%max、SEMGdi%max依次增高。呼吸中枢驱动在SNORING期高于HYPOPNEA,PREAPNEA期高于HYPOPNEA。EMGdi%max/V和SEMGdi%max/V从W到N2,到SNORING,到HYPOPNEA,到PREAPNEA依次增高。VE/EMGdi%max、VE/SEMGdi%max从W到N2,到SNORING,到HYPOPNEA,到PREAPNEA依次降低。结论体表电极可以代替多导食道电极评估OSA患者的呼吸中枢驱动、呼吸中枢驱动有效性及上气道阻力。

Objective To assess consistency in neural respiratory drive,efficiency of neural respiratory drive and upper airway resistance measured by esophageal electrode and superficial electrode in different sleep stages in patients with obstructive sleep apnea(OSA)during sleep.Methods A total of twenty four patients with OSA were studied.Neural respiratory drive was assessed by the esophageal electrode and superficial electrode in different sleep stages including wakefulness,stable N2,stable N2-snoring,hypopneas,the hypopnea before apnea events(PREAPNEA).Airflow was recorded with a pneumotachography conneted to a facemask.All subjects underwent overnight full polysomnography using standard techniques.Results The results indicate that superficial diaphragm electromyography(SEMGdi)was broadly consistent with esophageal diaphragm electromyography(EMGdi)in different sleep stages in patients with OSA during sleep.Our study find that from wakefulness to hypopneas,the maximum value of neural respiratory drive was occurred in stable N2-snoring,not hypopneas.The results indicate that upper airway resistance is progressively higher from wakefulness to stable N2,stable N2-snoring,hypopneas and PREAPNEA in patients with OSA.The efficiency of neural respiratory drive is progressively reduced from wakefulness to stable N2,stable N2-snoring,hypopneas and PREAPNEA.Conclusions Esophageal electrode could be substituted by superficial electrode to assess neural respiratory drive,the efficiency of neural respiratory drive and upper airway resistance in patients with OSA during sleep.