PHARYNGEAL NARROWING OCCLUSION DURING CENTRAL SLEEP-APNEA
PHARYNGEAL NARROWING OCCLUSION DURING CENTRAL SLEEP-APNEA
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DOI：
10.1152/jappl.1995.78.5.1806
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发表时间：
1995-05-01
影响因子：
3.3
通讯作者：
DEMPSEY, J
中科院分区：
文献类型：
--
作者：
BADR, MS;TOIBER, F;DEMPSEY, J
我们假设睡眠期间咽闭塞不需要大气压下的腔内压力。对6名正常人和6名睡眠呼吸暂停或低通气(SAH)患者在非快动眼睡眠状态下进行了研究。4例自发性中枢性睡眠呼吸暂停(n=4)和10例经鼻腔机械通气(n=10)诱导的中枢性低碳酸血症患者采用纤维鼻咽镜检查咽部通畅度。在中枢性睡眠呼吸暂停综合征患者的160例自发发生的中枢性呼吸暂停中，146例发生了完全咽部闭塞。在诱导性中枢性呼吸暂停期间，咽逐渐变窄。在相对于口咽的腭咽和相对于正常人的SAH受试者中，观察到更明显的狭窄。完全性咽部闭塞在SAH患者中常见(44例呼吸暂停患者中31例)，而在正常人中很少发生(25例呼吸暂停患者中3例)。吸气努力的恢复与持续性狭窄或完全闭塞有关，除非注意到脑电唤醒的迹象。因此，在中枢性呼吸暂停期间，在没有吸气努力的情况下，咽部横截面积减少。即使在正常受试者中，腭咽闭合狭窄也会在诱导性中枢性呼吸暂停期间持续发生。SAH患者发生自发性或诱发性中枢性呼吸暂停时会出现完全咽部闭塞。我们的结论是，咽闭塞的发生不需要大气压下的腔内压力。中心性呼吸暂停时咽部狭窄或闭塞可能是由于被动收缩或主动收缩所致。
We hypothesized that subatmospheric intraluminal pressure is not required for pharyngeal occlusion during sleep. Six normal subjects and six subjects with sleep apnea or hypopnea (SAH) were studied during non-rapid-eye-movement sleep. Pharyngeal patency was determined by using fiber-optic nasopharyngoscopy during spontaneous central sleep apnea (n = 4) and induced hypocapnic central apnea via nasal mechanical ventilation (n = 10). Complete pharyngeal occlusion occurred in 146 of 160 spontaneously occurring central apneas in patients with central sleep apnea syndrome. During induced hypocapnic central apnea, gradual progressive pharyngeal narrowing occurred. More pronounced narrowing was noted at the velopharynx relative to the oropharynx and in subjects with SAH relative to normals. Complete pharyngeal occlusion frequently occurred in subjects with SAH (31 of 44 apneas) but rarely occurred in normals (3 of 25 apneas). Resumption of inspiratory effort was associated with persistent narrowing or complete occlusion unless electroencephalogram signs of arousal were noted. Thus pharyngeal cross-sectional area is reduced during central apnea in the absence of inspiratory effort. Velopharyngeal narrowing consistently occurs during induced hypocapnic central apnea even in normal subjects. Complete pharyngeal occlusion occurs during spontaneous or induced central apnea in patients with SAH. We conclude that subatmospheric intraluminal pressure is not required for pharyngeal occlusion to occur. Pharyngeal narrowing or occlusion during central apnea may be due to passive collapse or active constriction.