心瓣膜病合并OSA患者中环路增益预测CPAP治疗及心脏瓣膜置换术后OSA转归的意义及机理的研究

近年阻塞性睡眠呼吸暂停（OSA）的非解剖学机制越来越被重视。研究发现环路增益（LG）及相关参数可预测和解释某些OSA的发生机制及治疗效果。我们前期研究发现在心瓣膜病合并OSA的患者中，心脏瓣膜置换（CVR）术后，OSA的转归及机制均不明；且术前合并OSA会显著增加CVR围术期不良事件。我们预实验发现①CVR术后OSA的转归可能与呼吸稳定性（LG及相关参数）密切相关；②术前持续气道正压通气（CPAP）治疗OSA可减少围手术期并发症，但CPAP治疗和CVR手术产生的转归效应及相应的LG参数变化均不尽相同。我们推测①LG理论可用于预测CVR手术对OSA的干预作用并能解释其中的机制；②在CPAP治疗和CVR手术对OSA的干预作用中，LG参与的非解剖学机制不同。本研究拟通过在心脏瓣膜病合并OSA患者中观察LG相关参数与OSA转归的规律及机理，阐明LG理论参与此类OSA患者治疗及转归中的非解剖学机制。

More and more attention has been paid to the non-anatomic pathogenesis of obstructive sleep apnea (OSA) in recent years. It has been found loop gain (LG) and associated parameters can predict and explain some pathogenesis and efficacy of OSA. Our previous studies demonstrated that a) OSA’s transform was uncertain with its mechanisms unclear in patients with both cardiac valvular disease (CVD) and OSA; b) In CVD patients, OSA could significantly increase their perioperative adverse events. Our recent preliminary experiments revealed that a) After cardiac valve replacement (CVR) the transform and its extent of OSA was closely associated with LG associated parameters; b) Pre-operative treatment with continuous positive airway pressure (CPAP) could reduce the perioperative complications, even though the LG’s changes and transform effects resulting from either CPAP treatment or CVR were not so uniform. Therefore, we speculate that a) LG theory can be used to predict OSA’s transform following CVR and explain associated mechanisms; b) The LG involved non-anatomic mechanisms are different between the intervention with CPAP and CVR. Through observation on the association of LG with the rule and mechanisms of OSA’s transform, the current study will be important in elucidating the non-anatomic pathogenesis about the role of LG theory in such OSA’s treatment and transform.