阻塞性睡眠呼吸暂停综合征患者运动-呼吸耦合的改变

文献信息

中文摘要

引言： 运动是一项复杂的运动任务，通过中枢模式发生器控制整合感觉运动和认知输入。运动-呼吸耦合（LRC）定义为步态与呼吸事件之间的同步，已在跑步和步行中被描述。阻塞性睡眠呼吸暂停综合征（OSAS）患者在清醒时表现出步态模式改变，这似乎部分独立于夜间症状治疗。虽然间歇性缺氧可能诱导长期（“固定”）中枢神经系统改变，但OSAS患者在清醒时也表现出“可逆”的适应机制，旨在防止上气道（UA）塌陷，涉及呼吸控制和姿势的改变。这些适应机制是否影响LRC并导致步态改变仍未知。
方法： 十名接受下颌前移装置（MAD）治疗且病情控制良好的清醒OSAS患者和十名匹配的健康对照者在配备运动捕捉的仪器化跑台上进行了一分钟步行试验。通过胸廓扩张评估通气，并从运动学和测力台数据中提取时空步态参数。LRC使用通气事件与矢状面关节运动学之间的相位锁定值（PLV）进行量化。OSAS患者在佩戴和不佩戴MAD的情况下均接受评估。
结果： 与对照组相比，OSAS患者表现出更长的双支撑相和更短的摆动相。OSAS患者的呼气事件优先发生在双支撑相，而对照组在摆动相的发生率更高。PLV分析显示，OSAS患者中吸气事件与髋、膝运动之间以及呼气事件与躯干、髋运动之间的同步性增加。当患者佩戴MAD时，这些显著差异不再观察到。逻辑回归表明，吸气-髋和呼气-躯干耦合的PLV指标能有效区分OSAS患者与对照组，但在应用UA稳定时则不能。
结论： 病情控制良好的清醒OSAS患者表现出步态模式改变，其特征是运动-呼吸耦合增加。这种增强的同步性可能反映了清醒时旨在限制UA塌陷的可逆适应性策略，而不仅仅是固定的缺氧相关损害。LRC可能代表OSAS日间运动改变的功能标志物，并可能成为针对夜间治疗之外UA力学干预的潜在靶点。

英文摘要

INTRODUCTION: Locomotion is a complex motor task integrating sensory-motor and cognitive inputs through central pattern generator control. Locomotion-respiration coupling (LRC), defined as the synchronization between gait and breathing events, has been described during running and walking. Patients with obstructive sleep apnea syndrome (OSAS) exhibit altered gait patterns during wakefulness, which appear to be partially independent of nocturnal symptomatic treatment. While intermittent hypoxia may induce long-term ("fixed") central nervous system alterations, OSAS patients also display "reversible" adaptive mechanisms during wakefulness aimed at preventing upper airway (UA) collapse, involving changes in respiratory control and posture. Whether these adaptive mechanisms affect LRC and contribute to gait alterations remains unknown.
METHODS: Ten awake patients with controlled OSAS treated with a mandibular advancement device (MAD) and ten matched healthy controls performed a one-minute walking trial on an instrumented treadmill with motion capture. Ventilation was assessed via thoracic expansion, and spatiotemporal gait parameters were extracted from kinematic and force platform data. LRC was quantified using phase-locking values (PLV) between ventilatory events and sagittal-plane joint kinematics. OSAS patients were assessed both with and without their MAD.
RESULTS: Compared with controls, OSAS patients exhibited a longer double-stance phase and a shorter swing phase. Expiratory events occurred preferentially during double stance in OSAS patients, whereas controls showed a higher occurrence during swing. PLV analysis revealed increased synchronization between inspiratory events and hip and knee motion, as well as between expiratory events and trunk and hip motion in OSAS patients. These significative differences were no longer observed when patients wore their MAD. Logistic regression demonstrated that PLV metrics of inspiratory-hip and expiratory-trunk coupling effectively discriminated OSAS patients from controls, but not when UA stabilization was applied.
CONCLUSION: Awake patients with controlled OSAS exhibit altered gait patterns characterized by increased locomotion-respiration coupling. This heightened synchronization likely reflects adaptive, reversible strategies aimed at limiting UA collapsibility during wakefulness rather than fixed hypoxia-related impairments alone. LRC may represent a functional marker of daytime motor alterations in OSAS and a potential target for interventions addressing UA mechanics beyond nocturnal treatment.