Effect Of Treatment With Nasal Continuous Positive Airway Pressure On Nocturnal Polyuria In Patients With Obstructive Sleep Apnea Hypopnea Syndrome

Objective To investigate the effect of treatment with nasal continuous positive airway pressure(n-CPAP) on nocturnal polyuria in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods30patients with sleep snoring are diagnosed with severe obstructive sleep apnea hypopnea syndrome accompanying with nocturnal polyuria by polysomnography figure (PSG) monitoring and recording the nocturia output and the number of nocturia. The nocturia output, the number of nocturia, and osmolality in the nocturia, electrolytes in the nocturia(Na,K,Cl), the plasma cystatin-C,atrial natriuretic peptide(ANP), renin(PRA), angiotensin Ⅰ(AngⅠ), angiotensin Ⅱ (AngⅡ), aldosterone (ALD) level are measured and recorded before and after n-CPAP treatment.Results1.Compared with the situation before n-CPAP treatment, the nocturia output, the number of nocturia, and cystatin-C, night urine Na, night urine Cl,osmolality in the nocturia, the plasma atrial natriuretic peptide (ANP) are obviously improved after n-CPAP treatment.(are877.57±114.81and597.57±192.23ml,4.90±1.24and2.73±1.17times/night,1.33±0.45and0.91±0.21mg/L,158.92±37.35and136.46±40.99mmol/L,137.55±36.38and116.64±49.88mmol/L,304.90±85.80and346.24±59.02mOsm/L,0.18±0.10and0.13±0.05ng/ml, p<0.05).2.Night urine K, plasma PRA,AngⅠ, AngⅡ, and ALD levels are of no obvious change (36.76±25.69and38.38±31.35mmol/L,2.44±1.96and2.34±1.97ng/ml/h,0.60±0.40and1.09±0.28ng/ml,73.10±60.03and82.35±82.89pg/ml,0.13±0.04and0.12±0.04ng/ml, p>0.05).3.The change index of renal function including cystatin-C,night urine Cl,night urine Na, osmolality in the nocturia and humoral factor ANP of patients before and after treatment are both positively correlated with AHI(40.23±17.97/hr), and the correlation coefficient r are0.950,0.983,0.828,0.994,0.997, and P<0.01as well;there have negative correlation with LSa%(69%±8%),and the correlation coefficient r are-0.743,-0.808, -0.742,-0.820,-0.815, P<0.01as well; there are both positively correlated with ODI (49.84±22.83/hr),and the correlation coefficient r are0.739,0.810,0.667,0.838,0.850, and P<0.01as well; but the correlation with MAI is not obvious, and r are0.009,0.012,-0.077,0.063,0.070, P>0.05.4.The reduction of cystatin-C, the reduction of night urine Na, the reduction of night urine Cl, the increase of osmolality in the nocturia, the reduction of ANP are positively correlated with the reduction of the nocturia output and the number of nocturia, and the correlation coefficient are0.398(P<0.05),0.432(P<0.05);0.703(P<0.01),0.421(P<0.05);0.794(P<0.01),0.535(P<0.01);0.601(P<0.01),0.475(P<0.01);0.403(P<0.05),0.463(P<0.01).Conclusions①.Patients with OSAHS accompanying with nocturnal polyuria have renal autoregulation dysfunction and humoral factors ANP abnormal secretion,and these changes are associated with degree of hypoxia.②. Treatment with n-CPAP can improve symptoms of nocturnal polyuria in patients with obstructive sleep apnea hypopnea syndrome. The mechanism probably relates to the improvement of renal function and the reduction of plasma level of ANP, but the relationship with renin-angiotensin system is not obvious.