Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifesta-tions of the Pickwick syndrome
Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifesta-tions of the Pickwick syndrome
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DOI：
10.1016/0006-8993(66)90117-x
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发表时间：
1966-01-01
期刊：
影响因子：
2.9
通讯作者：
DURON, B.
中科院分区：
文献类型：
--
作者：
GASTAUT, H.;TASSINARL, C. A.;DURON, B.
在一名表现出典型Pickwickian综合征的患者中，对呼吸功能和动脉气体测定进行了研究，在白天和晚上进行了多导记录，试图评估睡眠、呼吸、血氧合血红蛋白和呼出空气的CO2浓度。研究表明，在真正的Pickwickian综合征发病时，肥胖学可能仅限于狄更斯在其小说中描述的肥胖和白天嗜睡发作类型。这意味着被某些作者认为是该综合征不可或缺的特征的永久性肺泡通气不足可能完全不存在，因为可能是由它引起的动脉血气分析紊乱，红细胞增多症和发绀的症状。实际上，这些症状构成了肥胖的心肺综合征;虽然它们可能导致皮克-威克综合征的诊断，但它们不是该综合征的基本特征。在所讨论的患者中，作为其病情特征的多次昼夜睡眠发作发生在血氧血红蛋白饱和度和肺泡CO2浓度完全正常的情况下，不能根据大多数作者提出的缺氧和高碳酸血症来解释。我们必须求助于其他假设，记住一个假设并不一定排除另一个假设。第一种假设认为，受试者白天打瞌睡是由于脑干中的中枢的主要干扰，脑干中的中枢通过一种尚未理解的机制调节觉醒和睡眠。根据这一假设，我们面临着某种嗜睡症。第二种假设认为，受试者在白天打瞌睡是因为他在夜间由于睡眠换气不足的生理现象的夸大而没有充分睡眠。夜间多导记录显示，除了口底肌肉张力减退外，睡眠初期还出现呼吸暂停，其速度如此之快，如此之明显，以至于舌头向后移动，导致阻塞性呼吸暂停，导致缺氧，引起受试者，受试者在短时间后恢复睡眠。觉醒和睡眠的循环重复使夜间睡眠减少到每晚2-3小时。这种夜间睡眠的丧失是造成日间嗜睡的原因。不幸的是，受试者的日间睡眠受到的干扰甚至比他的夜间睡眠更大，因为最轻微的睡眠立即产生中枢性或阻塞性呼吸暂停发作。不管这两个假设的各自值如何，大多数患有匹克威克综合征的个体在白天打瞌睡，晚上睡得不好，这是因为觉醒-睡眠调节的主要干扰，这是基于他们的肥胖。这为一个既定事实提供了一个明显的解释，即抑制匹克威克患者睡眠障碍的唯一方法是让他们减肥。|| 摘要编辑：作者
In a patient showing a typical Pickwickian syndrome a study was made of respiratory functions and arterial gasometry, with polygraphic registrations carried out during the day and at night in an attempt to evaluate sleep, respiration, blood oxyhemoglobin and CO2 concentration of the expiratory air. It was demonstrated that, at the onset of an authentic Pickwickian syndrome, the symptomatology may be confined to obesity and diurnal drowsing episodes of the type described by Dickens in his novel. This means that the permanent alveolar hypoventilation regarded by some authors as an indispensable feature of the syndrome, may be entirely absent, as may be the symptoms arising from it disturbed arterial gasometry, polycythaemia and cyanosis. Actually such symptoms constitute a cardio-respiratory sydrome of obesity; while they may lead to the diagnosis of a Pick-wickian syndrome, they are no fundamental features of the syndrome proper. In the patient under discussion, the numerous episodes of diurnal slumber which characterized his condition and occurred while the blood oxyhaemoglobin saturation and alveolar CO2 concentration were entirely normal, cannot be explained on the basis of hypoxia and hypercapnia as suggested by a majority of authors. One must resort to other hypotheses, bearing in mind that the one does not necessarily exclude the other. A 1st hypothesis suggests that the subject drowses during the day as a result of a primary disturbance of centers in the brain stem which regulate wakefulness and sleep by a mechanism not yet understood. According to this hypothesis, we are confronted with some sort of narcolepsy. A 2nd hypothesis holds that the subject drowses during the day because he does not sleep sufficiently at night as a result of an exaggeration of the physiological phenomenon of hypnic hypoventilation. Nocturnal polygraphic registrations disclosed respiratory pauses which occurred in the initial phase of sleep, quite apart from hypotonia of the muscles of the floor of the mouth, so rapid and pronounced that the tongue moves back and causes the obstructive apnoea responsible for a hypoxia which arouses the subject, who returns to sleep after a short while. The cyclic repetition of arousal and slumber reduces nocturnal sleep to 2-3 hr. a night This loss of nocturnal sleep is held responsible for the diurnal somnolence. Unfortunately the subject's diurnal sleep is disturbed even more than his nocturnal sleep because the slightest slumber immediately produces episodes of central or obstructive apnoea. Regardless of the respective values of these 2 hypotheses, the majority of individuals suffering from the Pickwickian syndrome drowse during the day and sleep badly at night because of a primary disturbance in the wakefulness-sleep regulation which as such is based on their obesity. This affords an obvious explanation of the established fact that the only way to suppress hypnic disturbances in Pickwickian patients is to have them lose weight. || ABSTRACT AUTHORS: Authors