摘要目的 使用表面电极记录膈肌肌电,评价OSAHS患者的呼吸努力及呼吸中枢驱动.方法 选择2007年6月至10月因存在打鼾、嗜睡等症状,怀疑OSAHS前来广州呼吸病研究所睡眠中心行整夜(>7h)多导睡眠(PSG)监测的患者11例,PSG监测同时记录食管压力,并通过胸部表面电极记录膈肌肌电活动信号,其中5例同时记录食管膈肌肌电信号.结果 当发生阻塞性呼吸暂停(OSA)时,表面电极记录的膈肌肌电信号(8.1±7.1)μV、食管膈肌肌电信号(21.1±10.7)μV和食管压信号(18.1±6.8)cm H_2O(1cm H_2O=0.098kPa)均逐渐增加.食管压变化幅度在呼吸暂停末达到最大值(31.1±13.4)cm H_2O,气流恢复后骤然降低(21.0±8.8)cm H_2O;体表膈肌肌电和食管膈肌肌电活动在气流恢复初期[(14.9±13.9)μV、(41.6±22.1)μV]仍继续增加,表面电极记录的膈肌肌电的最大均方根与食管压变化幅度在发生OSA时呈线性相关(r=0.66),而膈肌肌电与食管膈肌肌电在发生OSA时呈线性相关(r=0.72).结论 表面电极所记录的膈肌肌电可作为判断睡眠呼吸事件时呼吸努力存在与否的辅助方法,有助于鉴别睡眠呼吸暂停的类型.

abstractsObjective Measurement of esophageal pressure is considered to be the gold standard for assessing respiratory effort and neural respiratory drive but this requires placement of an esophageal catheter. We hypothesized that neural drive could be reflected by the diaphragm EMG recorded from chest wall surface electrodes. Methods We simultaneously recorded esophageal pressure and the chest wall diaphragm EMG in 11 patients with suspected obstructive sleep apnea/hypopnea syndrome during full night polysomnography. We also recorded the diaphragm EMG from esophageal electrode in 5 of the 11 subjects. Results Diaphragm EMG could be satisfactorily recorded from 9 of the 11 subjects. The root mean square of the chest wall diaphragm EMG increased gradually during the obstructive sleep apnea events and reached a maximal value at arousal. Similarly, the esophageal pressure increased gradually over the obstructive sleep apnea events and reached a maximal value at the end of apnea. There was a relation between the RMS of the diaphragm EMG recorded from the chest wall surface electrodes and esophageal pressure(r =0.66) and the diaphragm EMG(r =0.72) recorded from esophageal electrode during obstructive event. Conclusion The diaphragm EMG could be recorded from the chest wall surface electrodes in most subjects and can be used to demonstrate the presence of respiratory effort during apnoea/hyponea events.