The Clinical Study Of Almitrine-Raubasine On Sleep Apnea-Hypopnea Syndrome

Objectives: The harm of sleep apnea-hypopnea syndrome is known increasingly bypeople, so convenient and effective treatment is essential. Almitrine-Raubasine canrole in peripheral chemoreceptor and excite breathing, in order to improvealertness,enhance memory, adjust emotion and improve cognitive impairment. In thisstudy, almitrine-raubasine was used in patients of obstructive sleep apnea-hypopneasyndrome. We observed some subjective and objective indicators, in order to explorethe possibility of the use and explain its possible mechanism.Methods: We have chosen 30 patients of the obstructive sleep apnea-hypopneasyndrome, and according to the severity of the disease, derided into the light group,moderate group and severe group. The subjective symptoms observed includeddaytime sleepiness, nighttime awakening, early moming headache and fatigue.Daytime sleepiness was quantified by the Epworth sleepiness scale. Objectiveindicators observed included the relevant indicators of polysomnography (AHI, AI,HI, the longest apnea time, the percentage of the total apnea time, the longesthypopnea time, the percentage of the total hypopnea time, the average oxygensaturation, the lowest oxygen saturation, the percentage of the time that oxygendesaturation below 90％, the number of oxygen desaturation, oxygen desaturationindex, sleep structure, arousal index), lung function (FEV1/FVC), central respiratorydrive (P_0.1), respiratory muscle function (MIP, MEP) and daytime blood gas (PH,PaO2, SaO2, PaCO2). The patients all used oral almitrine - raubasine (Duxil, eachunit containing almitrine 30rag and raubasine 10mg), each a time,two times a day and14 consecutive days.After that we review the above indicators again.Results:①In the course of treatment, one patient had vertigo, and another patienthad mild gastrointestinal reactions. The two cases were all in the mild group, and thesymptoms disappeared after they stopped using the pill.The main changes of the symptoms included improving the mental state during the day, concentrating,nighttime awakening recovery, morning headaches eased and morning fatiguealleviated. There were six patients without any subjective changes in mild group(54.55％), four patients in moderate group (44.44％) and three patients in severegroup (30％). After treatment the EP score of three groups were all lower than before,and were statistically significant;②After treatment hypopnea index of mild group hasimproved, the longest apnea time of severe group has shortened and the otherrespiratory events related indicators has unchanged;③After treatment,in mild groupMinSaO2 increased from (82.05±7.48)％to (84.58±5.71)％,in moderate groupfrom (78.76±11.86)％to (85.67±8.28)％and in severe group from (69.31±10.82)％to (74.92±11.25)％. The average oxygen saturation, oxygen desaturationindex and T90％had no significant change;④Almitrine-raubasine had little impacton sleep structure, only in mild group the arousal index decreased (from 9.59±3.63to 8.30±3.14 P＜0.05);⑤After treatment, in three groups FEV1/FVC and P_0.1 did notchange significantly. In moderate group MIP increased from 6.28±1.71 to 7.85±1.56 (P＜0.05), and MEP increased from 8.36±2.24 to 9.75±2.02 (P＜0.01);⑥Inthe daytime blood gas indicators, only PaO2 and SaO2 increased in severe treatment;⑦by correlation analysis, in mild group the EP score before treatment was positivelycorrelated with arousal index (r=0.805, P＜0.05), in moderate group the EP scorebefore treatment was negatively correlated with MinSaO2 (r=-0.749, P＜0.05) and insevere group the EP score before treatment was negatively correlated with MinSaO2(r=-0.745, P＜0.05) and was positively correlated with oxygen desaturation index(r=0.672, P＜0.05).Conclusions: Almitrine-raubasine can improve a few subjective symptoms in somepatients with OSAHS, including improving mental state during the day. improvingsleepiness, concentrating, reducing nighttime awakening, easing early morningheadaches and fatigue. Almitrine-raubasine can improve significantly daytime sleepiness in patients with OSAHS. Almitrine-raubasine can improve the nightoxygen saturation. MinSaO2 were higher in three groups. But the improvement ofrespiratory events is not obvious. Almitrine-raubasine can improve the arosal index inmild group, But in the other groups almitrine-raubasine can not affect sleep structure.Almitrine-raubasine may improve respiratory muscle function, however, thepulmonary function and the central respiratory drive had little impact.Almitrine-raubasine can increase daytime PaO2 and SaO2 in severe patients. Invarying degrees of OSAHS the pathogenesis of daytime sleepiness may be different,in mild patients sleep fragmentation was likely to play a major role, and in moderateto severe patients hypoxemia was likely to play a major role.