在阿片类药物使用环境中睡眠呼吸障碍的发病:使用生理学的多重调解分析
Jeremy E Orr1, Atul Malhotra1, Eli Gruenberg1
1Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego, La Jolla, CA, USA.
Sleep
|April 12, 2024
概括
吸食阿片类药物会增加中枢睡眠呼吸暂停,并通过影响呼吸控制来加剧低氧症. 针对这些生理变化可能会减少慢性阿片类药物治疗对呼吸系统的负面影响.
科学领域:
- 肺部医学 肺部医学
- 睡眠医学 睡眠医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 片类药物被广泛处方,已知会影响呼吸和睡眠模式.
- 慢性阿片类药物使用在临床上与中心睡眠呼吸暂停有关,并可能加剧阻塞性睡眠呼吸暂停.
- 将阿片类药物与睡眠呼吸障碍 (SDB) 联系在一起的确切机制尚不清楚.
研究的目的:
- 调查阿片类药物影响睡眠呼吸障碍病变的生理机制.
- 为了比较使用阿片类药物和匹配的对照人群之间的多睡眠学和生理学参数.
主要方法:
- 一项病例控制研究涉及多睡眠学证实SDB (呼吸暂停-呼吸暂停指数≥5/小时) 的患者.
- 阿片类药物使用者与非阿片类药物对照者根据性别,年龄和BMI相匹配1:3.
- 影响SDB的生理参数从多睡眠学信号中分析,并使用调解分析来评估阿片类药物影响.
主要成果:
- 与对照组 (n=534) 相比,阿片类药物使用者 (n=178) 显著增加了中央呼吸暂停 (2.8 vs. 1.7事件/小时) 和恶化的低氧症 (5% vs. 3%睡眠与SpO2 <88%).
- 使用阿片类药物与更高的循环增益,更低的呼吸速率和更高的呼吸速率变化有关.
- 较高的循环增益和增加的呼吸速率变异性介导了阿片类药物对中央呼吸暂停的作用,但不是对低氧症的影响.
结论:
- 阿片类药物具有多层次的生理效应,有助于睡眠呼吸障碍.
- 针对循环增加和呼吸速率变化的干预措施可以减轻慢性阿片类药物使用对呼吸系统的不良影响.
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