ACCESSORY MUSCLE-ACTIVITY DURING SLEEP IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
ACCESSORY MUSCLE-ACTIVITY DURING SLEEP IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
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DOI：
10.1152/jappl.1984.57.4.1011
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发表时间：
1984-01-01
影响因子：
3.3
通讯作者：
REMMERS, JE
中科院分区：
文献类型：
--
作者：
JOHNSON, MW;REMMERS, JE
严重慢性阻塞性肺疾病（COPD）患者在快速眼动（REM）睡眠期间通气不足导致HbO2去饱和。由于肺过度膨胀，这些患者在清醒时横膈膜机械受损，其他吸气肌活动增加。肋骨笼（RC）吸气肌肉可能会在REM期间失去活动，从而导致通气不足。对6例重度COPD患者进行斜角肌（SCA）和胸锁乳突肌（SCM）肌电图检查。从非快速眼动（NREM）到紧张性快速眼动，SCA活性下降76%（P < 0.001），在阶段性快速眼动期间又下降17%。SCM活动在NREM期间变化更大，但当存在时，在REM期间也会减少。SCA活性与RC漂移密切相关。SCA和SCM活动、RC偏移、每分钟通气量估计值和HbO2饱和度均平行降低。SCA和SCM的呼气活动，在清醒和NREM期间出现，在REM期间消失。REM期间胸廓肌肉吸气活动的丧失导致严重COPD患者的胸壁变形和通气不足。这些肌肉的呼气活动的丧失可能导致呼气末容量的减少，从而导致肺气体交换的恶化。
Hypoventilation contributes to HbO2 desaturation during rapid-eye-movement (REM) sleep in patients with severe chronic obstructive pulmonary disease (COPD). Due to hyperinflated lungs these patients have mechanically impaired diaphragms and increased activity of other inspiratory muscles while awake. Rib cage (RC) inspiratory muscles might lose activity during REM, thereby contributing to hypoventilation. Scalene (SCA) and sternocleidomastoid (SCM) electromyograms were recorded in 6 subjects with severe COPD. SCA activity decreased 76% (P < 0.001) from non-REM (NREM) to tonic REM and decreased an additional 17% during phasic REM. SCM activity was much more variable during NREM but when present also decreased during REM. SCA activity correlated strongly with RC excursion. SCA and SCM activity, RC excursion, estimates of minute ventilation, and HbO2 saturation all decreased in parallel. Expiratory activity of the SCA and SCM, present during wakefulness and NREM, disappeared during REM. Loss of inspiratory activity of rib cage muscles during REM causes chest wall distortion and hypoventilation in patients with severe COPD. Loss of expiratory activity of these muscles may contribute to a decrease in end-expiratory volume and thereby to a deterioration of pulmonary gas exchange.