Pathophysiological siignificance of elevated sympathetic nerve activity during sleep in chronic sleep disorders

睡眠障碍是一种发病率很高的异常状态。它们是由多种因素引起的，即精神压力或抑郁。我们研究了失眠症合并睡眠呼吸紊乱的病理生理机制，包括阻塞性睡眠呼吸暂停综合征(OSAS)和上呼吸道阻力综合征(UARS)，以及胃食道反流(GER)。方法：通过夜间多导睡眠图(PSG)和数字体积图(DPG)的连续测量，通过睡眠时血流量的变化来研究交感神经活动。OSAS患者呼吸恢复后脑电觉醒后即刻数字血流量明显减少，第二次血流量减少，较少出现在第一次发作后5-10秒。UARS患者未见第二次发病，其发病机制可能与低氧血症有关。另一方面，调查了与GER相关的睡眠障碍，以执行我们对工人和退役橄榄球运动员的原始问卷。在大约30%的受试者中发现了胃灼热的主诉，并被澄清为除睡眠呼吸暂停之外导致睡眠问题的一个独立因素。CPAP治疗前后胃电显示，少数OSAS患者经CPAP治疗后胃动过缓、胃动过速有减轻趋势。必须对这些发现进行未来的调查。

Sleep disorders are abnormal states with very high prevalence. They are induced by multiple factors, i.e. mental stress or depression. We investigated the pathophysiological mechanisms underlying insomniacs with sleep disordered breathing including obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS), and those with gastroesophageal reflux (GER). Methodologically, over-night polysomnography (PSG) ware performed with continuous measure of digital plethysmography (DPG) to study sympathetic nerve activity through blood flow volume change during sleep. In the patinets with OSAS, digital blood flow markedly decreased just after the electroencepharographical arousal following the resumption of respiration, and the second blood flow decrement, which did not often occurred 5-10 seconds after the first episode. As the second episode was not observed in the patients with UARS, its pathogenesis may be probably related to hypoxemia. On the other hand, sleep disturbance related to GER was investigated to perform our original questionaires for the workers and retired rugger men. The complaint of heartburn was found in about 30% of the subjects and was clarified to be an independent factor other than sleep apnea to induce sleep problems. Electrogastrography before and after CPAP treatment revealed that CPAP tended to reduce bradygastria and tachygastria in a few patients with OSAS patients. Future investigation about these findings must be needed.