Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift
Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift
复制标题
DOI：
10.5664/jcsm.4462
复制
发表时间：
2015-01-01
影响因子：
4.3
通讯作者：
Bradley, T. Douglas
中科院分区：
文献类型：
--
作者：
White, Laura H.;Lyons, Owen D.;Bradley, T. Douglas
研究目的：夜间吻端液体从腿部转移到颈部可能使咽部变窄，从而导致阻塞性睡眠呼吸暂停(OSA)的发病。方法：26例阻塞性睡眠呼吸暂停低通气综合征(OSA)患者在入睡前和入睡后14天分别进行两次多导睡眠图检查，测量颈部和腿部液体体积(LFV)、颈围和上呼吸道横截面积。结果：虽然平均AHI在多导睡眠图之间没有差异，但35%的患者AHI和GT；10存在显著的个体内差异。多导睡眠图之间非快眼运动的变化与夜间LFV的变化呈正相关(r=0.440，p=0.036和r=0.005，p=0.982)，仰卧位的变化与夜间LFV的变化无相关性(r=0.483，p=0.020和r=0.269，p=0.280)。夜间多导睡眠图之间的LFV增加与夜间LFV下降(r=0.560，p=0.005)和夜间颈部积液量增加(r=0.498，p=0.016)相关。此外，夜间颈围的增加与多导睡眠图之间夜间颈部积液量的增加(r=0.453，p=0.020)和上呼吸道横截面积的夜间减少(r=-0.587，p=0.005)有关。结论：阻塞性睡眠呼吸暂停严重程度的个体内部差异可能由夜间腿部液体量的逐日变化和夜间吻部液体的移位来解释，这可能是非快速眼动和仰卧睡眠期间阻塞性睡眠呼吸暂停的最重要的发病机制。
Study Objectives: Overnight rostral fluid shift from the legs to the neck may narrow the pharynx and contribute to obstructive sleep apnea (OSA) pathogenesis. We hypothesized that night-to-night changes in the apnea-hypopnea index (AHI) would be associated with changes in overnight rostral fluid shift.Methods: Twenty-six patients with OSA (AHI >= 10) underwent two polysomnograms 14 days apart with measurement of neck and leg fluid volumes (LFV), neck circumference and upper-airway cross-sectional area before and after sleep.Results: Although mean A HI did not differ between polysomnograms, 35% of patients had a difference in AHI > 10, indicating significant intra-individual variability. There were direct correlations between change in non-rapid-eye movement (NREM), but not REM AHI and change in evening LFV between polysomnograms (r = 0.440, p = 0.036 and r = 0.005, p = 0.982, respectively) and between change in supine, but not non-supine AHI and change in evening LFV (r = 0.483, p = 0.020 and r = 0.269, p = 0.280, respectively). An increase in evening LFV between polysomnograms was associated with a greater overnight decrease in LFV (r = 0.560, p = 0.005) and a greater overnight increase in neck fluid volume (r = 0.498, p = 0.016). Additionally, a greater overnight increase in neck circumference was associated with a greater overnight increase in neck fluid volume between polysomnograms (r = 0.453, p = 0.020) and a greater overnight decrease in upper-airway cross-sectional area (r = -0.587, p = 0.005).Conclusion: Intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fluid volume and overnight rostral fluid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep.