Ventilatory control and airway anatomy in obstructive sleep apnea.
Ventilatory control and airway anatomy in obstructive sleep apnea.
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DOI：
10.1164/rccm.200404-510oc
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发表时间：
2004-12
影响因子：
24.7
通讯作者：
A. Wellman;A. Jordan;A. Malhotra;R. Fogel;E. Katz;K. Schory;J. Edwards;D. White
中科院分区：
文献类型：
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作者：
A. Wellman;A. Jordan;A. Malhotra;R. Fogel;E. Katz;K. Schory;J. Edwards;D. White
通气不稳定可能在阻塞性睡眠呼吸暂停的发病机制中发挥重要作用。我们假设通气不稳定对这种疾病的影响会根据上呼吸道的潜在塌陷程度而变化。为了检验这一假设，我们根据咽部关闭压力，将三组阻塞性睡眠呼吸暂停患者的仰卧、非快速眼动睡眠期间的环路增益与呼吸暂停低通气指数相关联：负压组（咽部关闭压力小于-1 cm H(2)O）、大气压力组（-1至+1 cm H(2)O）和正压组（大于+1 cm H(2)O）。环路增益的测量是通过依次增加比例辅助通气直至出现周期性呼吸（25 名受试者中有 24 名出现周期性呼吸）。所有三组的平均环路增益为 0.37 +/- 0.11。仅在大气组中，环路增益和呼吸暂停低通气指数之间存在显着相关性（r = 0.88，p = 0.0016）。我们得出的结论是，循环增益对某些睡眠呼吸暂停患者的呼吸暂停严重程度有重大影响，特别是那些咽部闭合压力接近大气压的患者。
Ventilatory instability may play an important role in the pathogenesis of obstructive sleep apnea. We hypothesized that the influence of ventilatory instability in this disorder would vary depending on the underlying collapsibility of the upper airway. To test this hypothesis, we correlated loop gain with apnea-hypopnea index during supine, nonrapid eye movement sleep in three groups of patients with obstructive sleep apnea based on pharyngeal closing pressure: negative pressure group (pharyngeal closing pressure less than -1 cm H(2)O), atmospheric pressure group (between -1 and +1 cm H(2)O), and positive pressure group (greater than +1 cm H(2)O). Loop gain was measured by sequentially increasing proportional assist ventilation until periodic breathing developed, which occurred in 24 of 25 subjects. Mean loop gain for all three groups was 0.37 +/- 0.11. A significant correlation was found between loop gain and apnea-hypopnea index in the atmospheric group only (r = 0.88, p = 0.0016). We conclude that loop gain has a substantial impact on apnea severity in certain patients with sleep apnea, particularly those with a pharyngeal closing pressure near atmospheric.