Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease
Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease
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DOI：
10.1183/09031936.06.00075405
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发表时间：
2006-07-01
影响因子：
24.3
通讯作者：
Hanly, P. J.
中科院分区：
文献类型：
--
作者：
Beecroft, J.;Duffin, J.;Hanly, P. J.
虽然睡眠呼吸暂停在终末期肾病患者中非常常见，但这种相关性的生理机制尚未确定。目前的作者假设呼吸化学反应性的改变可能起重要作用，总共招募了58名接受慢性透析治疗的患者进行夜间多导睡眠图检查。一种改良的Read再呼吸技术，用于评估基础通气量，呼吸敏感性和阈值，在夜间多导睡眠图之前和之后完成。患者被分为呼吸暂停组（n = 38;呼吸暂停/呼吸不足指数（AHI）35 +/-22事件. h（-1））和非呼吸暂停组（n = 20; AHI 3 +/-3事件. h（-1）），睡眠呼吸暂停的存在被定义为AHI> 10事件. h（-1）。虽然两组之间的基础通气和呼吸复张阈值相似，但呼吸暂停患者在缺氧（氧分压（Po-2）6.65 kPa）和高氧（Po-2 19.95 kPa）时的呼吸敏感性显著更高。化学反射反应性的夜间变化组之间是相似的。总之，这些数据表明，在睡眠呼吸暂停和终末期肾病患者的中枢和外周化学反射的反应性增强。由于对高碳酸血症的敏感性增加使呼吸控制不稳定，目前的作者认为这有助于该患者人群中睡眠呼吸暂停的发病机制。
Although sleep apnoea is very common in patients with end-stage renal disease, the physiological mechanisms for this association have not yet been determined. The current authors hypothesised that altered respiratory chemo-responsiveness may play an important role.In total, 58 patients receiving treatment with chronic dialysis were recruited for overnight polysomnography. A modified Read rebreathing technique, which is used to assess basal ventilation, ventilatory sensitivity and threshold, was completed before and after overnight polysomnography. Patients were divided into apnoeic (n=38; apnoea/hypopnoea index (AHI) 35 +/- 22 events.h(-1)) and nonapnoeic (n=20; AHI 3 +/- 3 events.h(-1)) groups, with the presence of sleep apnoea defined as an AHI > 10 events.h(-1). While basal ventilation and the ventilatory recruitment threshold were similar between groups, ventilatory sensitivity during isoxic hypoxia (partial pressure of oxygen (Po-2) 6.65 kPa) and hyperoxia (Po-2 19.95 kPa) was significantly greater in apnoeic patients. Overnight changes in chemoreflex responsiveness were similar between groups.In conclusion, these data indicate that the responsiveness of both the central and peripheral chemoreflexes is augmented in patients with sleep apnoea and end-stage renal disease. Since increased ventilatory sensitivity to hypercapnia destabilises respiratory control, the current authors suggest this contributes to the pathogenesis of sleep apnoea in this patient population.