The heterogeneity of obstructive sleep apnea (predominant obstructive vs pure obstructive apnea).
The heterogeneity of obstructive sleep apnea (predominant obstructive vs pure obstructive apnea).
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DOI：
10.5665/sleep.1040
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发表时间：
2011-06
期刊：
影响因子：
5.6
通讯作者：
A. Xie;Ajay R. Bedekar;J. Skatrud;M. Teodorescu;Yuansheng Gong;J. Dempsey
中科院分区：
文献类型：
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作者：
A. Xie;Ajay R. Bedekar;J. Skatrud;M. Teodorescu;Yuansheng Gong;J. Dempsey
研究目的比较单纯阻塞性睡眠呼吸暂停(阻塞性睡眠呼吸暂停)患者和以阻塞性呼吸暂停为主的阻塞性睡眠呼吸暂停患者(阻塞性和中枢性呼吸暂停共存)患者的呼吸不稳定性和上呼吸道塌陷性。设计一项横断面研究，数据由盲人评分，对受试者的分类视而不见。两组间比较采用非配对学生t检验。背景和干预采用标准多导睡眠图技术记录睡眠-觉醒状态。在二氧化碳储备测定中使用压力支持模式呼吸机引入低碳酸血症呼吸暂停。在测定上呼吸道塌陷性时，采用正负压持续正压持续正压通气(CPAP)造成阻塞性呼吸暂停。研究对象阻塞性睡眠呼吸暂停综合征患者21例，其中中枢性/混合性呼吸暂停与低呼吸暂停并存12例(28%±6%)，单纯阻塞性睡眠呼吸暂停9例。测量通过评估临界闭合压力(Pcrit)来测量上呼吸道塌陷性。呼吸稳定性通过测量非快速眼动睡眠时的CO(2)储备(即ΔPCO(2)[Eupnea-apnea阈值])来评估。结果单纯阻塞性睡眠呼吸暂停低氧组与优势阻塞性睡眠呼吸暂停组的Pcrit差异无统计学意义(2.0±0.4cmH2O与2.7±0.4cmH2O，P=0.27)，但阻塞性睡眠呼吸暂停组二氧化碳储备(1.6±0.7 mm Hg)显著低于单纯阻塞性睡眠呼吸暂停组(3.8±0.6 mm Hg)(P=0.02)。结论目前的数据表明，呼吸稳定性而不是上呼吸道塌陷是阻塞性和中央性事件合并的OSA与单纯OSA的区别。
STUDY OBJECTIVES To compare the breathing instability and upper airway collapsibility between patients with pure OSA (i.e. 100% of apneas are obstructive) and patients with predominant OSA (i.e., coexisting obstructive and central apneas). DESIGN A cross-sectional study with data scored by a fellow being blinded to the subjects' classification. The results were compared between the 2 groups with unpaired student t-test. SETTING AND INTERVENTIONS Standard polysomnography technique was used to document sleep-wake state. Ventilator in pressure support mode was used to introduce hypocapnic apnea during CO(2) reserve measurement. CPAP with both positive and negative pressures was used to produce obstructive apnea during upper airway collapsibility measurement. PARTICIPANTS 21 patients with OSA: 12 with coexisting central/mixed apneas and hypopneas (28% ± 6% of total), and 9 had pure OSA. MEASUREMENTS The upper airway collapsibility was measured by assessing the critical closing pressure (Pcrit). Breathing stability was assessed by measuring CO(2) reserve (i.e., ΔPCO(2) [eupnea-apnea threshold]) during NREM sleep. RESULTS There was no difference in Pcrit between the 2 groups (pure OSA vs. predominant OSA: 2.0 ± 0.4 vs. 2.7 ± 0.4 cm H(2)O, P = 0.27); but the CO(2) reserve was significantly smaller in predominant OSA group (1.6 ± 0.7 mm Hg) than the pure OSA group (3.8 ± 0.6 mm Hg) (P = 0.02). CONCLUSIONS The present data indicate that breathing stability rather than upper airway collapsibility distinguishes OSA patients with a combination of obstructive and central events from those with pure OSA.