Neuromechanical control of upper airway patency during sleep
Neuromechanical control of upper airway patency during sleep
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DOI：
10.1152/japplphysiol.00282.2006
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发表时间：
2007-02-01
影响因子：
3.3
通讯作者：
Smith, Philip L.
中科院分区：
文献类型：
--
作者：
Patil, Susheel P.;Schneider, Hartmut;Smith, Philip L.
阻塞性睡眠呼吸暂停是由上呼吸道机械特性改变和/或神经肌肉控制紊乱引起的咽阻塞引起的。该研究的目的是确定机械负荷和动态神经肌肉反应对睡眠期间咽萎的相对贡献。16名阻塞性睡眠呼吸暂停患者和16名正常受试者在年龄、性别和体重指数上相匹配。在睡眠期间测量咽溃溃性，以临界压力定义。临界压力分为被动力学性能（被动临界压力）和对上气道阻塞的主动动态响应（主动临界压力）。与正常受试者相比，睡眠呼吸暂停患者表现出更高的机械负荷，表现为更高的被动临界压[- 0.05 (SD 2.4) vs. -4.5 cmH(2)O (SD 3.0), P = 0.0003]。睡眠呼吸暂停患者的动态反应受到抑制，这表明在上呼吸道阻塞时未能降低他们的主动临界压[- 1.6 (SD 3.5) vs. -11.1 cmH(2)O (SD 5.3), P < 0.0001]。此外，机械负荷的增加使一些正常人面临睡眠呼吸暂停的风险。在这个子集中，对上气道阻塞的动态反应补偿了机械负荷，并通过降低主动临界压力来维持气道通畅。目前的研究表明，机械负荷的增加和神经肌肉反应的迟钝都是阻塞性睡眠呼吸暂停的发展所必需的。
Obstructive sleep apnea is caused by pharyngeal occlusion due to alterations in upper airway mechanical properties and/or disturbances in neuromuscular control. The objective of the study was to determine the relative contribution of mechanical loads and dynamic neuromuscular responses to pharyngeal collapse during sleep. Sixteen obstructive sleep apnea patients and sixteen normal subjects were matched on age, sex, and body mass index. Pharyngeal collapsibility, defined by the critical pressure, was measured during sleep. The critical pressure was partitioned between its passive mechanical properties ( passive critical pressure) and active dynamic responses to upper airway obstruction ( active critical pressure). Compared with normal subjects, sleep apnea patients demonstrated elevated mechanical loads as demonstrated by higher passive critical pressures [- 0.05 (SD 2.4) vs. -4.5 cmH(2)O ( SD 3.0), P = 0.0003]. Dynamic responses were depressed in sleep apnea patients, as suggested by failure to lower their active critical pressures [- 1.6 ( SD 3.5) vs. -11.1 cmH(2)O ( SD 5.3), P < 0.0001] in response to upper airway obstruction. Moreover, elevated mechanical loads placed some normal individuals at risk for sleep apnea. In this subset, dynamic responses to upper airway obstruction compensated for mechanical loads and maintained airway patency by lowering the active critical pressure. The present study suggests that increased mechanical loads and blunted neuromuscular responses are both required for the development of obstructive sleep apnea.