经鼻气道持续正压通气对OSAHS患者夜间多尿的影响

摘要

目的 探讨经鼻气道持续正压通气(n-CPAP)对OSAHS患者夜间多尿的影响.方法 对睡眠打鼾就诊的患者经多导睡眠图(PSG)监测、记录夜尿量和夜尿次数确诊为中、重度OSAHS合并夜间多尿患者27例,记录和测定n-CPAP治疗前后夜尿量、夜尿次数与血浆心房利钠肽(ANP)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平.结果 中、重度OSAHS合并夜间多尿患者经n-CPAP治疗后夜尿量、夜尿次数及血浆ANP水平较治疗前有明显改善(分别为913.30±94.33与631.67±180.07ml、3.63±0.69与1.85±0.77次/夜、0.19±0.11与0.14±0.05ng/ml,P＜0.05).血浆PRA、AngⅡ、ALD水平无明显变化[2.34 ±2.03与2.24 ±2.04ng/(ml·h)、75.81±62.73与86.23±86.59pg/ml、0.13 ±0.04与0.12±0.04ng/ml,P＞0.05].ANP降低值与夜尿量降低值、夜尿减少次数均呈显著正相关,相关系数分别为0.60、0.86(P均＜0.01).结论 n-CPAP能改善OSAHS患者夜间多尿症状,其机制可能与降低血浆ANP水平有关,与肾素-血管紧张素(RAS)系统关系不明显.%Objective To investigate the effect of treatment with nasal continuous positive airway pressure(n -CPAP) on nocturnal polyuria in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Twenty seven patients with sleep snoring diagnosed with severe obstructive sleep apnea hypopnea syndrome accompanying with nocturnal polyuria by polysomnography figure ( PSG) monitoring and recording the nocturia output and the number of nocturia were included. The nocturia output, the number of nocturia, the plasma atrial natriuretic peptide ( ANP) , renin (PRA) , angiotensin Ⅱ ( Ang Ⅱ ) , and aldosterone ( ALD) level were measured and recorded before and after n - CPAP treatment. Results Compared with the situation before n - CPAP treatment, the situation of the noctu-ria output, the number of nocturia, and the plasma atrial natriuretic peptide ( ANP) were obviously improved after n - CPAP treatment (913.30 ±94.33 and 631. 67 ± 180.07ml, 3.63 ±0.69 and 1.85 ±0.77 timesight, 0. 19 ±0. 11 and 0. 14 ± 0. 05ng/ml,P < 0. 05 , respectively) . Plasma PRA , Ang Ⅱ , and ALD level were of no obvious change (2. 34 ± 2. 03 and 2. 24 ± 2. 04ng/( ml · h) , 75. 81 ± 62.73 and 86.23 ±86.59pg/ml, 0. 13 ±0.04 and 0. 12 ±0.04ng/ml, P >0. 05,respectively). After treatment with n - CPAP, the reduction of ANP was correlated with the reduction of the nocturia output and the number of nocturia, and the correlation coefficient was 0. 60 , 0. 86 (P<0.01). Conclusion Treatment with n - CPAP can improve symptoms on nocturnal polyuria in patients with obstructive sleep apnea hypopnea syndrome. The mechanism probably relates to the reduction of plasma level of ANP, but the relationship with renin -angiotensin system is not obvious.