A CAUSE OF EXCESSIVE DAYTIME SLEEPINESS - THE UPPER AIRWAY-RESISTANCE SYNDROME
A CAUSE OF EXCESSIVE DAYTIME SLEEPINESS - THE UPPER AIRWAY-RESISTANCE SYNDROME
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DOI：
10.1378/chest.104.3.781
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发表时间：
1993-09-01
期刊：
影响因子：
9.6
通讯作者：
MAISTROS, P
中科院分区：
文献类型：
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作者：
GUILLEMINAULT, C;STOOHS, R;MAISTROS, P
单独主诉慢性日间嗜睡的受试者通常被归类为“特发性嗜睡症”，并对症治疗。其中一组受试者在夜间睡眠和白天小睡期间接受了调查。在他们中的一个小组中，睡眠在整个睡眠期间被非常短的阿尔法脑电图唤醒所分割。这些短暂的觉醒通常在睡眠分析中被忽略，但它们的影响是显著的（在15名被确定为该综合征的受试者中，多次睡眠潜伏期测试的平均睡眠潜伏期为5.1±1分钟）。这些唤醒与睡眠期间呼吸努力的异常增加直接相关（在短暂唤醒之前的呼吸周期中，我们的受试者测量的吸气食道压力的平均峰值为- 33 +/- 7 cm H2O）。通常情况下，唤醒发生在一到三次呼吸时，伴有潮气量突然但有限的减少（即睡眠时上呼吸道阻力异常增加）。唤醒恢复了正常的呼吸。15名受试者中有10名打鼾与这些短暂性觉醒有关；然而，打鼾对临床综合征的识别既不是充分的也不是必要的。在受影响的群体中，男女比例相等。所有研究对象的上呼吸道解剖结构都有轻度异常。鼻腔持续气道正压通气作为实验工具，消除了白天嗜睡（多次睡眠潜伏期平均评分= 13.5 min）、短暂性唤醒（平均α脑电图唤醒指数从每小时31.3 +/- 12.4降至每小时8 +/- 2）和异常的上气道阻力。慢性日间嗜睡是造成社会、经济和医疗损害的主要原因。认识到这种综合征及其原因是很重要的，因为可以开发特定的治疗方法来消除这个问题。
Subjects with isolated complaints of chronic daytime sleepiness are usually classified as ''idiopathic hypersomniacs'' and treated symptomatically. A group of these subjects was investigated during nocturnal sleep and daytime naps. In a subgroup of them, sleep was fragmented by very short alpha EEG arousals throughout the sleeping period. These short arousals are usually ignored in sleep analyses, but their impact is significant (in the 15 subjects identified with the syndrome, the mean sleep latency in multiple sleep latency tests was 5.1 +/- 1 min). These arousals are directly related to an abnormal increase in respiratory efforts during sleep (the mean peak inspiratory esophageal pressure measured in our subjects in the respiratory cycle just preceding a transient arousal was - 33 +/- 7 cm H2O). Typically, an arousal occurs within one to three breaths of flow limitation associated with abrupt but limited reduction in tidal volume (ie, abnormal increase in upper airway resistance during sleep). The arousal restores normal breathing. Snoring was noted in association with these transient arousals in 10 of the 15 subjects; however, snoring was neither sufficient nor necessary for the identification of the clinical syndrome. Both sexes were equally represented in the affected group. All studied subjects had upper airway anatomy that was mildly abnormal. Nasal continuous positive airway pressure, used as an experimental tool, eliminated the daytime sleepiness (multiple sleep latency mean score = 13.5 min), the transient arousals (mean alpha EEG arousal index decreased from 31.3 +/- 12.4 to 8 +/- 2 per hour of sleep), and the abnormal upper airway resistance. Chronic daytime sleepiness is a major cause of social, economic, and medical impairment. Recognition of this syndrome and its cause is important, as specific treatments can be developed to eliminate the problem.