间歇性低压低氧对睡眠障碍的干预作用

Intervention of intermittent hypobaric hypoxia on sleep disorder

目的研究间歇性低压低氧(IHH)干预对睡眠障碍患者睡眠的影响,并初步探讨其作用机制。方法取符合纳入标准的睡眠障碍患者60例,给予IHH(低压氧舱模拟海拔1500 m条件,相当于大气压氧分压为141.22 mmHg,含氧量18.55%,为0海拔含氧量的88.76%)干预50 min/d,连续15 d,于治疗前、治疗后15 d睡眠检测仪记录睡眠时相,采用匹兹堡睡眠质量指数量表(PSQI)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评估患者睡眠质量、抑郁及焦虑水平;于治疗前及治疗后7 d、15 d采集患者空腹静脉血,检测血清褪黑素、皮质醇、低氧诱导因子1α(HIF-1α)的含量变化。结果与治疗前比较,睡眠障碍患者在IHH干预治疗15 d后,入睡时间明显缩短,睡眠持续时间明显延长,夜间深睡眠、中睡眠及浅睡眠时间均明显增加,清醒时间缩短(P<0.01);平均PSQI总分、SDS总分、SAS总分均明显下降(P<0.01);患者血清中皮质醇降低(P<0.05),褪黑素、HIF-1α水平均升高(P<0.05或P<0.01)。结论IHH能改善睡眠障碍患者的睡眠质量,并降低抑郁、焦虑水平,机制可能与低氧增加褪黑素的释放而下调皮质醇水平及诱导HIF-1α的产生有关。

Objective To study the effect of intermittent hypobaric hypoxia(IHH)intervention on sleep in patients with sleep disorders,and to explore its mechanism.Methods Sixty patients with sleep disorders who met the inclusion criteria were given IHH(simulated altitude of 1500 m in low-pressure oxygen chamber,equivalent to atmospheric oxygen partial pressure of 141.22 mmHg,oxygen content of 18.55%,88.76%of oxygen content at 0 altitude)for 50 min/d for 15 days.The sleep phase was recorded by sleep detector before and 15 days after treatment.Pittsburgh sleep quality index(PSQI),Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS)were used to evaluate the sleep quality,depression and anxiety level of patients;Fasting venous blood was collected before treatment and 7 and 15 days after treatment to detect the changes of serum melatonin,cortisol and hypoxia inducible factor 1α(HIF-1α).Results Compared with before treatment,15 days after IHH intervention,the sleep time of patients with sleep disorder was significantly shortened,the sleep duration was significantly prolonged,the time of deep sleep,medium sleep and light sleep at night were significantly increased,and the awake time was shortened(P<0.01);The average total scores of PSQI,SDS and SAS decreased significantly(P<0.01);The levels of serum cortisol decreased(P<0.05),melatonin and HIF-1αincreased(P<0.05 or P<0.01).Conclusion IHH can improve the sleep quality of patients with sleep disorders and reduce the levels of depression and anxiety.The mechanism may be related to hypoxia increasing the release of melatonin,lowering the level of cortisol and inducing the production of HIF-1α.