[Breathing control of patients with obstructive sleep apnea syndrome (OSAS) during sleep]

It is assumed that reduced ventilatory control function during sleep may be one of the mechanisms resulting in obstructive sleep apnea syndrome (OSAS), but the breathing drive has never been measured in patients with OSAS during sleep.

P0.1, delta P0.1/delta SaO2, delta VE/delta SaO2, delta P0.1/delta PaCO2 and delta VE/delta PaCO2 in sixteen patients with severe OSAS were measured via nasopharyngeal tubes connected with nasal mask to maintain upper airway patent, during wake and NREM I + II, NREM III + IV, REM sleep stages, and the same parameters in eleven normal subjects, non-snorers were also measured, by nasal mask as control.

(1) During wake: P0.1 in all the OSAS patients was remarkably higher than that of the normal subjects (P < 0.05), but there was no difference in delta VE/delta SaO2, delta P0.1/delta SaO2, delta VE/delta PaCO2 and delta P0.1/delta PaCO2 between the two groups (P > 0.05). (2) The above parameters measured during sleep compared with that measured during wake: In NREM I + II and NREM III + IV, normal subjects showed no significant decrease in P0.1, delta P0.1/delta SaO2, delta P0.1/delta PaCO2 (P > 0.05), but delta VE/delta SaO2 and delta VE/delta PaCO2 decreased significantly (P < 0.05). In REM1 P0.1 maintained the same level as that during wake, but both hypoxic and hypercapnic responses decreased remarkably (P < 0.05). In the OSAS patients, P0.1 decreased during NREM I + II and REM sleep (P < 0.5), but not during NREM III + IV (P > 0.05). delta VE/delta SaO2, delta P0.1/delta SaO2, delta P0.1/delta PaCO2 and delta VE/delta PaCO2 decreased markedly during all sleep stages (P < 0.01). (3) From wake to sleep, delta VE/delta SaO2 decreased by 51.6 +/- 30.4% (Mean +/- SD) in the OSAS patients vs 33.6 +/- 26.0% decreased in the normal subjects; delta VE/delta PaCO2 decreased by 56.9 +/- 25.5% in OSAS vs 40.8 +/- 17.5% in the normal subjects; The hypoxic and hypercapnic responses in OSAS patients decreased much more than those in the normal subjects during sleep (P < 0.05).

This is the first study to measure the hypoxic and hypercapnic responses successfully in OSAS patients during sleep. It was found that the breathing drive was significantly reduced in sleeping OSAS patients, which may play an important role in the development of OSAS, possibly through the reduced action upon the dilators causing the upper airway in predilection for collapse.