持续气道正压通气治疗对纠正中-重度阻塞性睡眠呼吸暂停患者颏舌肌肌电过高活性反应的评估

摘要

目的 分析比较持续气道正压通气(CPAP)治疗前后中-重度阻塞性睡眠呼吸暂停(OSA)患者颏舌肌肌电值(GGEMG)的差异.方法 对2016年8月至2017年9月在北京清华长庚医院耳鼻咽喉头颈外科睡眠中心的打鼾男性患者和无打鼾男性健康志愿者进行整夜多导睡眠监测(PSG)同步口内表面氯化银球状电极的GGEMG测量.对确诊中-重度OSA的患者进行手动CPAP压力滴定同步GGEMG的测量.采用t检验分析比较OSA组[12例,呼吸暂停低通气指数(AHI)为(65.90±23.67)次/h)与健康对照组(6名,AHI为(2.30±1.93)次/h)、OSA组CPAP治疗前后的GGEMG的变化.结果 OSA组清醒期及NREM期的张力性GGEMG、峰值GGEMG及时相性GGEMG均显著高于对照组.而CPAP治疗后,OSA患者组NREM期的GGEMG各变量较治疗前明显降低(张力性GGEMG:1.23％±0.73％比2.54％±1.12％,t=4.024,P=0.002;峰值GGEMG:12.37％±13.19％比26.98％±15.52％,t=2.795,P=0.017;时相性GGEMG:3.81％±2.47％比8.82％±3.84％,t=5.113,P＜0.001).结论 应用CPAP治疗可消除呼吸事件并维持气道通畅性,有利于纠正睡眠时OSA患者颏舌肌的过高肌电反应,具有缓解并预防颏舌肌神经肌肉损伤的治疗意义.%Objective To compare the changes of genioglossus electromyography(GGEMG) with and without continuous positive airway pressure (CPAP) ventilation in moderate to severe obstructive sleep apnea (OSA) patients.Methods Each of subjects,including male snorers and non-snorers,underwent polysomnography (PSG) with synchronous GGEMG recording with intra-oral bipolar silver ball electrodes at the Sleep Center of Beijing Tsinghua Changgung Hospital from August 2016 to Sepember 2017.Manual CPAP pressure titration and with GGEMG were performed in patients diagnosed moderate to severe OSA.T-test was used to compare the changes of GGEMG in OSA group (n=12,AHI (65.90+23.67) events/h) and control group (n=6,AHI(2.30+ 1.93) events/h) before and after CPAP treatment.Results Variables of GGEMG (including tonic,peak and phasic GGEMG) were higher in OSA group than in control group during both wakefulness and non rapid eye movement(NREM) sleep.However,with CPAP treatment,the GGEMG variables were significantly decreased in OSA group during NREM sleep(tonic GGEMG:1.23％±0.73％ vs.2.54％ ± 1.12％,t=4.024,P=0.002;peak GGEMG:12.37％ ± 13.19％ vs.26.98％ ± 15.52％,t=2.795,P=0.017;phasic GGEMG:3.81％±2.47％ vs.8.82％±3.84％,t=5.113,P＜0.001).Conclusions CPAP treatment can eliminate respiratory events and maintain airway patency.It is helpful to normalize the excessive GGEMG response in OSA patients during sleep,which has therapeutic significance to alleviate and prevent genioglossal neuromuscular lesions.