Characteristics and Consequences of Non-apneic Respiratory Events During Sleep
Characteristics and Consequences of Non-apneic Respiratory Events During Sleep
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DOI：
10.1093/sleep/zsw024
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发表时间：
2017
期刊：
影响因子：
5.6
通讯作者：
A. Sankari;S. Pranathiageswaran;S. Maresh;A. M. Hosni;M. Badr
中科院分区：
文献类型：
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作者：
A. Sankari;S. Pranathiageswaran;S. Maresh;A. M. Hosni;M. Badr
基本原理 当前非呼吸暂停事件（即呼吸不足）的评分标准要求存在氧合血红蛋白去饱和和/或觉醒。然而，其他睡眠研究参数可能有助于识别异常呼吸事件 (RE) 并有助于做出更准确的诊断。目的 调查不伴有去饱和或皮质唤醒的非呼吸暂停 RE 是否与呼吸和心脏后果相关。方法 使用实验室多导睡眠图 (PSG) 对 13 名患有睡眠障碍（打鼾和/或白天过度嗜睡）的参与者进行筛查，同时通过带有呼吸器的鼻罩监测压力和气流。为了区分上气道阻力 (RUA) 和总肺阻力 (RL) 的贡献，使用 Millar 压力导管测量声门上压力和食管压力。 RL 和 RUA 是在基线和呼吸不足期间计算的。 RL 定义为阻力压力除以吸气和呼气期间的最大流量。呼吸不足的定义是流量减少 30%，饱和度降低 3% 和/或皮质唤醒。 RE 被定义为流量减少 30%，而没有去饱和和/或皮质唤醒。八名受试者的持续气道正压通气 (CPAP) 被滴定至最佳压力。 R-R 间隔 (RRI) 定义为基线、RE/呼吸不足和最佳 CPAP 期间单导联心电图 (ECG) 上的连续心跳间隔。结果 RE 与呼气 RUA 增加相关（14.6 ± 11.3 与 7.5 ± 4.5 cmH2O L-1 s-1；p < .05），以及相对于基线的呼气 RL 增加（29.2 ± 14.6 与 20.9 ± 11.0 和 23.7 ± 12.1 与 14.3 ± 5.6 cmH2O吸气和呼气期间分别为 L-1 s-1； .05）。 RE 和呼吸不足后，RRI 相对于基线显着下降（804.8 ± 33.1 vs. 806.4 ± 36.3 vs. 934.3 ± 45.8 ms；p < .05）。最佳 CPAP 降低呼气 RUA（4.0 ± 2.5 对比 7.5 ± 4.5 cmH2O L-1 s-1；p < .05），降低吸气 RL（12.6 ± 14.1 对比 7.5 ± 4.5 cmH2O L-1 s-1；p < .05），并允许 RRI 返回基线（p < .05）。当考虑有症状患者的非呼吸暂停 RE 时，RRI 下降指数是睡眠呼吸障碍 (SDB) 的独立预测因子 (p < .05)。结论 没有皮质唤醒或去饱和的非呼吸暂停 RE 与显着的呼吸和心率变化相关。最佳 CPAP 和阻力负荷的减少与心率正常化相关，表明潜在的临床益处。
Rationale Current scoring criteria of non-apneic events (ie, hypopnea) require the presence of oxyhemoglobin desaturation and/or arousal. However, other sleep study parameters may help to identify abnormal respiratory events (REs) and assist in making more accurate diagnosis. Objectives To investigate whether non-apneic REs without desaturation or cortical arousal are associated with respiratory and cardiac consequences. Methods Thirteen participants with sleep disturbances (snoring and/or excessive day time sleepiness), were screened using attended in laboratory polysomnography (PSG) while monitoring pressure and airflow via a nasal mask with an attached pneumotach. To separate the contribution of the upper airway resistance (RUA) and total pulmonary resistance (RL), supraglottic and esophageal pressures were measured using Millar pressure catheters. RL and RUA were calculated during baseline and hypopneas. RL was defined as the resistive pressure divided by the maximal flow during inspiration and expiration. Hypopnea was defined 30% decrease in flow with 3% desaturation and/or cortical arousal. REs was defined as 30% decrease in the flow without desaturation and/or cortical arousal. In eight subjects continuous positive airway pressure (CPAP) was titrated to optimal pressure. R-R interval (RRI) was defined as consecutive beat-to-beat intervals on single lead electrocardiograph (ECG) during baseline, RE/hypopnea and on optimal CPAP. Results REs associated with increased expiratory RUA (14.6 ± 11.3 vs. 7.5 ± 4.5 cmH2O L-1 s-1; p < .05), and increased expiratory RL relative to baseline (29.2 ± 14.6 vs. 20.9 ± 11.0 and 23.7 ± 12.1 vs. 14.3 ± 5.6 cmH2O L-1 s-1 during inspiration and expiration, respectively; p < .05). RRI decreased significantly following RE and hypopnea relative to baseline (804.8 ± 33.1 vs. 806.4 ± 36.3 vs. 934.3 ± 45.8 ms; p < .05). Optimal CPAP decreased expiratory RUA (4.0 ± 2.5 vs. 7.5 ± 4.5 cmH2O L-1 s-1; p < .05), decreased inspiratory RL (12.6 ± 14.1 vs. 7.5 ± 4.5 cmH2O L-1 s-1; p < .05), and allowed RRI to return to baseline (p < .05). RRI dips index was an independent predictor of sleep-disordered breathing (SDB) when non-apneic REs were accounted for in symptomatic patients (p < .05). Conclusions Non-apneic REs without cortical arousal or desaturation are associated with significant respiratory and heart rate changes. Optimal CPAP and the reduction of resistive load are associated with the normalization of heart rate indicating potential clinical benefit.