ROLE OF DIFFUSE AIRWAY-OBSTRUCTION IN THE HYPERCAPNIA OF OBSTRUCTIVE SLEEP-APNEA
ROLE OF DIFFUSE AIRWAY-OBSTRUCTION IN THE HYPERCAPNIA OF OBSTRUCTIVE SLEEP-APNEA
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DOI：
10.1164/arrd.1986.134.5.920
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发表时间：
1986-11-01
期刊：
影响因子：
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通讯作者：
PHILLIPSON, EA
中科院分区：
文献类型：
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作者：
BRADLEY, TD;RUTHERFORD, R;PHILLIPSON, EA
阻塞性睡眠呼吸暂停（OSA）患者发生慢性高碳酸血症的机制尚未明确。因此，我们通过研究50例有明确记录的OSA综合征患者来验证弥漫性气道阻塞可能参与的假设。7例患者出现日间高碳酸血症，平均PaCO 2为51 ±2（SEM）mm Hg，而其他43例患者的PaCO 2为35 ± 1。两组之间夜间阻塞事件的数量或持续时间无差异。相比之下，高碳酸血症患者明显比正常碳酸血症患者重（体重，189 ± 11%对148 ± 6%的理想体重; p < 0.005），并有弥漫性气道阻塞的证据，如残余气量增加和所有呼气流速降低所示。当高碳酸血症患者与9名体重匹配的正常碳酸血症患者（体重为理想体重的196 ± 8%）进行比较时，夜间阻塞事件仍然没有差异，但气道力学测试的差异仍然存在。PaCO 2与多个人体测量、呼吸生理和多导睡眠图变量的多元回归分析显示，只有2个变量（呼气储备量和FEV 1/FVC）与PaCO 2显著相关，这2个变量均受气道力学影响（多重r = 0.78; p = 0.0001）。研究结果表明，即使在肥胖患者中，单独的OSA也不会产生日间高碳酸血症，弥漫性气道阻塞的存在是此类患者发生慢性CO2潴留的重要诱发因素。
The mechanisms responsible for the development of chronic hypercapnia in patients with obstructive sleep apnea (OSA) are not well defined. Therefore, we tested the hypothesis that diffuse airway obstruction may be involved by studying 50 patients with a well-documented OSA syndrome. Seven patients had daytime hypercapnia with a mean PaCO2of 51 ±2 (SEM) mm Hg, compared to a PaCO2of 35 ± 1 in the other 43 patients. There were no differences between the 2 groups in the number or duration of nocturnal obstructive events. In contrast, the hypercapnic patients were significantly heavier than the normocapnic patients (body weight, 189 ± 11 versus 148 ± 6% of ideal; p < 0.005) and had evidence of diffuse airway obstruction, as indicated by an increased residual volume and a reduction in all expiratory flow rates. When the hypercapnic patients were compared with a weight-matched group of 9 normocapnic patients (body weight, 196 ± 8% of ideal), there were still no differences in nocturnal obstructive events, but the differences in tests of airway mechanics persisted. Multiple regression analysis of PaCO2against several anthropometric, respiratory physiologic, and Polysomnographic variables revealed that only 2 variables (expiratory reserve volume and FEV1/FVC), both of which are influenced by airway mechanics, were significantly correlated with PaCO2(multiple r = 0.78; p = 0.0001). The findings suggest that OSA alone does not produce daytime hypercapnia even in obese patients, and that the presence of diffuse airway obstruction is an important predisposing factor to the development of chronic CO2retention in such patients.