The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea
The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea
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DOI：
10.5665/sleep.5166
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发表时间：
2015-11-01
期刊：
影响因子：
5.6
通讯作者：
Shea, Steven A.
中科院分区：
文献类型：
--
作者：
Butler, Matthew P.;Smales, Carolina;Shea, Steven A.
研究目的：检验呼吸事件持续时间表现出内源性昼夜节律的假设。设计：受试者内和受试者间。设置：布莱根妇女医院的住院强化生理监测单元。参与者：7 名患有中度/重度睡眠呼吸暂停的受试者和 4 名对照者，年龄 48 (SD = 12) 岁，7 名男性。干预措施：受试者在昏暗的灯光下完成为期 5 天的住院治疗方案。在通常睡眠时间安排的初始控制 8 小时夜间记录多导睡眠图，然后通过均匀分布在所有昼夜节律阶段的 2 小时 40 分钟睡眠和 2 小时 40 分钟觉醒的 10 个循环周期，最后在另一个 8 小时控制睡眠期间记录。测量和结果：根据昼夜节律阶段评估每个睡眠机会的事件持续时间、饱和度降低和呼吸暂停低通气指数（源自唾液）褪黑激素）、入睡时间和睡眠阶段。 NREM 睡眠中的平均呼吸事件持续时间在两个对照夜晚均显着延长（分别为 21.9 秒至 28.2 秒和 23.7 秒至 30.2 秒）。在昼夜节律方案中，NREM 事件持续时间在与通常睡眠周期相对应的昼夜节律阶段中增加，占正常 8 小时对照夜间增加的 50% 以上。 AHI 和去饱和度也是有节律的：AHI 在生物白天最高，而去饱和度在生物夜间最大。结论：内源性昼夜节律系统在夜间呼吸事件的延长中发挥着重要作用，并可能为调节睡眠呼吸暂停提供新的治疗靶点。
Study Objective: To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. Design: Within-subject and between-subjects.Settings: Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital.Participants: Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males.Interventions: Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period.Measurements and Results: Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night.Conclusions: The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea.