[The impact of arousal on sleep-related deglutition in patients with obstructive sleep apnea hypopnea syndrome].

Objective: To investigate the sleep-related deglutition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its correlation with sleep stage and cortical arousals. Methods: From December 2015 to September 2017, simultaneous polysomnography and pharyngeal pressure monitoring were performed in 23 adult patients with OSAHS, Mann-Whitney U test were employed to analyze the following parameters: (1) the relationship between arousal and deglutition; (2) the effect of sleep stage on deglutition; (3) The relationship between the frequency of deglutition and the severity of OSAHS. Results: The subjects in this study aged (43±12) years, and the mean apnea-hypopnea index (AHI) was (49.2±27.7) times/hour. A total of 1 382 deglutition were recorded during sleep, with a median of 9.2[5.8, 13.8]times/person. There was a positive correlation between deglutition frequency and AHI(r=0.570, P=0.005) and negatively correlated with oxygen saturation (r=-0.639, P=0.001). The majority of the deglutition (73.7%) occurred after the respiratory event and in association with respiratory arousal. Deglutition occurred more in Non-rapid eye movement sleep stage 1 (N1) than N2, N3 and REM sleep (Z=-3.680, P<0.001; Z=-2.746, P=0.006; Z=- 3.490, P<0.001). Conclusions: The occurrence of deglutition in patients with OSAHS is associated with cortical arousals. Deglutition frequency increased with the severity of apnea and affected by sleep staging.目的： 研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠时吞咽动作发生规律及其与呼吸事件相关皮层微觉醒的关系。 方法： 2015年12月至2017年9月，首都医科大学附属北京同仁医院睡眠中心同步多道睡眠图监测与下咽压力持续监测，记录23例成人OSAHS患者睡眠时的吞咽动作。分析：呼吸事件相关微觉醒与吞咽发生的关系；秩和检验分析睡眠分期对吞咽的影响；Mann－Whitney U检验比较不同OSAHS严重程度组吞咽发生频率的差异。 结果： 研究对象年龄平均(43±12)岁，呼吸暂停低通气指数(AHI)平均(49.2±27.7)次/h。共记录到1 382次睡眠时吞咽动作，中位数9.2[5.8，13.8]次/例。吞咽动作频率与呼吸暂停低通气指数正相关(r＝0.570, P＝0.005)，与夜间最低血氧饱和度负相关(r＝－0.639, P＝0.001)。多数(73.7%)吞咽动作在呼吸事件结束，呼吸事件相关的微觉醒发生后出现。非快动眼睡眠1期睡眠(N1)与N2、N3和快动眼睡眠期相比，吞咽频率较多(Z＝－3.680，P<0.001；Z＝－2.746，P＝0.006；Z＝－3.490，P<0.001) 。 结论： OSAHS患者吞咽动作的发生与呼吸事件相关的皮层微觉醒存在时间和频率的联系。吞咽频率随呼吸暂停的严重度增加而增多；且受睡眠分期的影响，N1期吞咽较频繁。.