Termination of Respiratory Events with and without Cortical Arousal in Obstructive Sleep Apnea
Termination of Respiratory Events with and without Cortical Arousal in Obstructive Sleep Apnea
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DOI：
10.1164/rccm.201106-0975oc
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发表时间：
2011-11-15
影响因子：
24.7
通讯作者：
White, David P.
中科院分区：
文献类型：
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作者：
Jordan, Amy S.;Eckert, Danny J.;White, David P.
理由：阻塞性睡眠呼吸暂停中总共有20-30%的呼吸事件在没有明确觉醒的情况下终止。觉醒被认为是通过促进过度通气、低碳酸血症和上气道扩张肌张力减退而诱发进一步事件。目的：比较美国睡眠障碍协会（ASDA）唤醒与无唤醒呼吸事件终止时的生理变化，并确定无唤醒后继发性呼吸事件是否较ASDA唤醒后更不常见，扩张肌活动是否更高。方法：阻塞性睡眠呼吸暂停患者佩戴睡眠分期、颏舌肌（EMG（GG））和腭肌张肌（EMG（TP））电极以及鼻罩和呼吸速度描记器。在稳定睡眠期间，持续气道正压通气（CPAP）降低3分钟以诱导呼吸事件。比较以（1）ASDA唤醒、（2）无唤醒或（3）CPAP突然增加（CPAP inc，对照）终止的事件之间的生理变量。测量和主要结果：16名受试者有足够的数据。ASDA唤醒后EMG（GG）、EMG（TP）和心率增加（340 +/-57%、215 +/-28%和110.7 +/- 2.3%）和无唤醒（185 +/-32%、167 +/-15%和108.5 +/- 1.6%），但非CPAPinc（90 +/-10%、94 +/-11%和102.1 +/- 1%）。ASDA唤醒后通气量增加多于无唤醒和CPAPinc，但在考虑呼吸事件的严重程度后则没有增加。与ASDA Arousals相比，No Arousals之后发生继发性事件的次数较少。然而，在ASDA唤醒或无唤醒后未发生低扩张肌活动（EMG（GG）从75 +/-5%升至125 +/- 7%），继发事件的严重程度低于初始事件（通气量上升4 +/- 0.4至5.5 +/- 0.51 L/min）。与无觉醒相比，ASDA觉醒终止的呼吸事件更严重地受到流量限制，在事件终止后过度通气增强，并且更经常发生继发性事件。然而，继发性事件与低扩张肌活动无关，无唤醒和ASDA唤醒后气流均得到改善。
Rationale: A total of 20-30% of respiratory events in obstructive sleep apnea are terminated without clear arousal. Arousals are thought to predispose to further events by promoting hyperventilation, hypocapnia, and upper-airway dilator muscle hypotonia. Therefore, events terminated without arousal may promote stable breathing.Objectives: To compare physiologic changes at respiratory event termination with American Sleep Disorders Association (ASDA) Arousal to No Arousal, and determine whether secondary respiratory events are less common and have higher dilator muscle activity after No Arousal compared with ASDA Arousal.Methods: Patients with obstructive sleep apnea wore sleep staging, genioglossus (EMG(GG)), and tensor palatini (EMG(TP)) electrodes plus a nasal mask and pneumotachograph. During stable sleep, continuous positive airway pressure (CPAP) was lowered for 3-minute periods to induce respiratory events. Physiologic variables were compared between events terminated with (1) ASDA Arousal, (2) No Arousal, or (3) sudden CPAP increase (CPAPinc, control). Measurements and MainResults: Sixteen subjects had adequate data. EMG(GG), EMG(TP), and heart rate increased after ASDA Arousal (340 +/- 57%, 215 +/- 28%, and 110.7 +/- 2.3%) and No Arousal (185 +/- 32%, 167 +/- 15%, and 108.5 +/- 1.6%) but not CPAPinc (90 +/- 10%, 94 +/- 11%, and 102.1 +/- 1%). Ventilation increased more after ASDA Arousal than No Arousal and CPAPinc, but not after accounting for the severity of respiratory event. Fewer No Arousals were followed by secondary events than ASDA Arousals. However, low dilator muscle activity did not occur after ASDA Arousal or No Arousal (EMG(GG) rose from 75 +/- 5 to 125 +/- 7%) and secondary events were less severe than initial events (ventilation rose 4 +/- 0.4 to 5.5 +/- 0.51 L/min).Conclusions: Respiratory events that were terminated with ASDA Arousal were more severely flow-limited, had enhanced hyperventilation after event termination, and were more often followed by secondary events than No arousal. However, secondary events were not associated with low dilator muscle activity and airflow was improved after both No Arousal and ASDA Arousal.