OBSTRUCTIVE SLEEP-APNEA FOLLOWING TOPICAL OROPHARYNGEAL ANESTHESIA IN LOUD SNORERS
OBSTRUCTIVE SLEEP-APNEA FOLLOWING TOPICAL OROPHARYNGEAL ANESTHESIA IN LOUD SNORERS
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DOI：
10.1164/ajrccm/143.4_pt_1.810
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发表时间：
1991-04-01
期刊：
影响因子：
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通讯作者：
MCNICHOLAS, WT
中科院分区：
文献类型：
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作者：
CHADWICK, GA;CROWLEY, P;MCNICHOLAS, WT
以前的研究支持上呼吸道反射机制的存在，该机制有助于在睡眠期间维持上呼吸道通畅。我们调查了干扰这种反射机制导致阻塞性睡眠呼吸暂停的可能性。8名无症状打鼾者(7名男性和1名女性)，年龄39+/-5.3岁(平均+/-扫描电子显微镜)，接受了连续三个晚上的夜间睡眠研究。在一个习服之夜之后，两个学习之夜被随机分配到对照组(C)和口咽麻醉组(OPA)。OPA夜，用10%利多卡因喷雾剂和0.25%布比卡因含漱液进行表面麻醉。在C夜使用生理盐水安慰剂，所有受试者在两个研究夜都睡得很好(两个研究夜的平均睡眠时间为6.2小时)，两个晚上的睡眠阶段分布相似。阻塞性呼吸暂停和低通气(OAH)从C组的114+/-43例上升到OPA组的170+/-49例(p<；0.02)。中枢性呼吸暂停和低呼吸暂停(CAH)在两个晚上没有变化(8+/-4.9比7+/-3)。两个研究夜的OAH持续时间相似(C组S 20+/-1.9%，OPA组S 20+/-1.5%)。OPA组终止OAH的运动觉醒频率(7+/-2.9/h)高于C组(3+/-0.7)，P=NS。氧合血红蛋白降低的频率在OPA(5+/-2.1/h)也高于C(3+/-1.4)，p<；0.07。这些数据表明，OPA增加了睡眠中OAH的频率，但不增加其持续时间，表明上呼吸道反射缺陷可能影响阻塞性呼吸事件的启动，但不影响其终止。我们得出结论，上呼吸道反射在阻塞性睡眠呼吸暂停的病理生理学中起重要作用。
Previous studies support the presence of an upper airway reflex mechanism that contributes to the maintenance of upper airway patency during sleep. We investigated the possibility that interference with this reflex mechanism contributes to the development of obstructive sleep apnea. Eight otherwise asymptomatic snorers (seven male and one female), age 39 +/- 5.3 yr (mean +/- SEM), underwent overnight sleep studies on three successive nights. An acclimatization night was followed by two study nights randomly assigned to control (C) and oropharyngeal anesthesia (OPA). On the OPA night topical anesthesia was induced using 10% lidocaine spray and 0.25% bupivocaine gargle. A saline placebo was used on night C. All subjects slept well on both study nights (mean sleep duration was 6.2 h on both study nights), and sleep stage distribution was similar on both nights. Obstructive apneas and hypopneas (OAH) rose from 114 +/- 43 during C to 170 +/- 49 during OPA (p < 0.02). Central apneas and hypopneas (CAH) were unchanged between the two nights (8 +/- 4.9 versus 7 +/- 3). The duration of OAH was similar on both study nights (20 +/- 1.9 s during C versus 20 +/- 1.5 s during OPA). The frequency of movement arousals terminating OAH tended to be higher during OPA (7 +/- 2.9/h) than during C(3 +/- 0.7); P = NS. The frequency of oxyhemoglobin desaturations was also higher during OPA (5 +/- 2.1/h) than during C (3 +/- 1.4), p < 0.07. These data indicate that OPA increases the frequency of OAH during sleep but not their duration, suggesting that defective upper airway reflexes may influence the initiation of obstructive respiratory events but not their termination. We conclude that upper airway reflexes are important in the pathophysiology of OSA.