INDUCTION OF PERIODIC BREATHING DURING SLEEP CAUSES UPPER AIRWAY-OBSTRUCTION IN HUMANS
INDUCTION OF PERIODIC BREATHING DURING SLEEP CAUSES UPPER AIRWAY-OBSTRUCTION IN HUMANS
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DOI：
10.1152/jappl.1986.61.4.1438
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发表时间：
1986-10-01
影响因子：
3.3
通讯作者：
LOPATA, M
中科院分区：
文献类型：
--
作者：
ONAL, E;BURROWS, DL;LOPATA, M
为了验证阻塞性呼吸暂停是由睡眠引起的周期性呼吸与一定程度的上呼吸道损害相关的假设，在非快速眼动（NREM）睡眠期间，通过给予有和没有施加外部吸气阻力的低氧气体混合物（9 cmH2O .cntdot）诱导周期性呼吸。l - 1 .cntdot。S)在5名正常男性志愿者中。除了用于睡眠分期和呼吸模式监测的标准多导睡眠图外，食管压、潮气量（VT）和气流分别通过食管导管和肺记录仪测量，后者连接在一个紧密的面罩上，可以计算总肺系统阻力（Rp）。在I/II阶段NREM睡眠期间，两名受试者的最小呼吸期明显；然而，在缺氧和/或缓解缺氧期间，有或没有增加阻力的4例受试者中，明显的周期性呼吸随着VT的起伏而发展，有时伴有呼吸暂停期。无缺氧的电阻负荷不引起周期性。在VT周期性变化的最低点，Rp通常最高，Rp与1/VT呈显著的线性关系，提示阻塞性低通气的发生。在没有增加阻力的受试者中，在同一受试者中，在阻力负荷期间，在室速周期性波动的最低点观察到上气道阻塞。我们的结论是，周期性呼吸导致上呼吸道肌肉活动的周期性减少与上呼吸道阻力的增加有关，这容易使上呼吸道塌陷。
To test the hypothesis that occlusive apneas result from sleep-induced periodic breathing in association with some degree of upper airway compromise, periodic breathing was induced during non-rapid-eye-movement (NREM) sleep by administering hypoxic gas mixtures with and without applied external inspiratory resistance (9 cmH2O .cntdot. l-1 .cntdot. s) in five normal male volunteers. In addition to standard polysomnography for sleep staging and respiratory pattern monitoring, esophageal pressure, tidal volume (VT), and airflow were measured via an esophageal catheter and pneumotachograph, respectively, with the latter attached to a tight-fitting face mask, allowing calculation of total pulmonary system resistance (Rp). During stage I/II NREM sleep minimal period breathing was evident in two of the subjects; however, in four subjects during hypoxia and/or relief hypoxia, with and without added resistance, pronounced periodic breathing developed with waxing and waning of VT, sometimes with apneic phases. Resistive loading without hypoxia did not cause periodicity. At the nadir of periodic changes in VT, Rp was usually at its highest and there was a significant linear relationship between Rp and 1/VT, indicating the development of obstructive hypopneas. In one subject without added resistance and in the same subject and in another during resistive loading, upper airway obstruction at the nadir of the periodic fluctuations in VT was observed. We conclude that periodic breathing resulting in periodic diminution of upper airway muscle activity is associated with increased upper airway resistance that predisposes upper airways to collapse.