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1.
目的探讨肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)在阻塞性睡眠呼吸暂停-低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者中的作用和临床意义。方法分别用RT-PCR方法分析患者组和对照组外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)中TNF-α基因的表达及化学发光法检测血清中TNF-α水平。结果OSAHS组与对照组相比,中重度OSAHS患者组TNF.dmRNA表达较正常对照组高[(42.75±20.00)%vs(28.16±12.49)%](P〈0.05),轻度组与中重度组及正常对照组比较差异无统计学意义(P〉0.05);各组间血清TNF-α水平差异无统计学意义(P〉0.05),但血清TNF-α水平与呼吸暂停低通气指数(apnea-hypopnea index,AHI)及氧减指数呈正相关(r分别为0.456、0.552,P均〈0.05),与夜间最低血氧饱和度呈负相关(r=-0.452,P〈0.05)。结论炎症因子TNF-α可能参与OSAHS的病理生理过程。  相似文献   

2.
目的:通过测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压及脉压(PP),探讨血压变异性与OSAHS之间的关系。方法:OSAHS合并高血压患者99例,根据呼吸暂停低通气指数(AHI)分为轻度、中度和重度OSAHS三组;单纯高血压患者20例作为对照组,比较OSAHS各组及单纯高血压组之间血压变化的特点。结果:重度OSAHS组患者的AHI、体重指数(BMI)、平均血压、非杓型血压所占比例及PP均明显高于轻、中度OSAHS组和单纯高血压组,最低血氧饱和度(SaO2)明显低于轻、中度OSAHS组和单纯高血压组。相关分析结果表明,平均PP与AHI呈正相关;SaO2与平均收缩压、舒张压呈负相关;AHI与平均收缩压呈正相关。结论:OSAHS患者夜间血压出现非杓型模式,血压增高的程度以及非杓型血压所占比例随着OSAHS病情加重而逐渐增高;PP与OSAHS的严重程度密切相关。  相似文献   

3.
目的:观察血清同型半胱氨酸(Hcy)水平在阻塞性睡眠呼吸暂停低通气综合征(OSHAS)及冠心病(CHD)患者中的变化和作用。方法:收集临床确诊CHD、OSAHS、CHD+OSAHS患者各30例,分别为CHD组、OSAHS组和CHD+OSAHS组。平行检测各组血清Hcy水平及睡眠呼吸监测指标:呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(SaO2)及平均SaO2,比较各组Hcy水平的差异以及Hcy水平与睡眠呼吸监测指标的相关性。并与30例体检健康者(健康对照组)对比分析。结果:(1)血清Hcy水平:三病例组明显高于健康对照组(P0.01),CHD+OSAHS组明显高于CHD组和OSAHS组(P0.01),CHD组与OSAHS组比较,差异无统计学意义(P0.05)。(2)病例组血清Hcy水平与AHI呈正相关(r=0.64,P0.01),与夜间平均SaO2和夜间最低SaO2均呈负相关(r分别为-0.64、-0.65,P0.01)。结论:血清Hcy水平升高与OSAHS患者SaO2减低有关,可能有利于CHD的发生与发展。  相似文献   

4.
目的 探讨血清肾上腺素(E)和去甲肾上腺素(NE)在重叠综合征(OS)中的表达及与患者缺氧程度的相关性.推测E及NE对重叠综合征的发生发展的作用.方法 选取慢性阻塞性肺疾病患者(单纯COPD组)、阻塞性睡眠呼吸暂停低通气综合征患者(单纯OSAHS组)、重叠综合征患者(OS组)及对照组各30例,四组患者均行肺功能检查及多导睡眠监测,记录睡眠呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)、最长呼吸暂停时间(LAT).并采用酶联免疫法分别检测四组患者的E及NE的表达水平,对各项指标进行统计学处理.结果 (1)多导睡眠检测指标:OS组患者AHI、LAT均高于单纯OSAHS组、单纯COPD组、对照组(P<0.05),而LSaO2、MSaO2均低于单纯OSAHS组、单纯COPD组、对照组(P<0.05).(2)E及NE的表达水平:OS组患者的E及NE表达水平均高于单纯OSAHS组、单纯COPD组、对照组(P<0.01).(3)各组E及NE与睡眠监测指标的相关性:OS组及OSAHS组患者血清E及NE与AHl、LAT呈正相关(P<0.01),与LSaO2及MSaO2呈负相关(P<0.05).COPD组患者血清E及NE与AHI、LAT无相关性(P>0.05),与LSaO2及MSaO2呈负相关(P<0.05).结论 OS患者较单纯COPD和OSAHS患者更易引起交感神经活性增强,E及NE表达水平的失调与病变严重程度密切相关.缺氧可能通过影响E及NE的水平促进重叠综合征病情的发生及发展.  相似文献   

5.
目的:检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者体内间接胆红素(I-BIL)与尿酸(UA)水平,探讨其对OSAHS患者易患心血管疾病的作用机制。方法:对OSAHS病人和健康对照组进行多导睡眠监测。次晨采空腹静脉血4ml,检测血清I-BIL和UA。结果:I-BIL水平正常对照组14.53±3.64μmol/L,轻度、中度、重度OSAHS组患者均低于正常对照组(P<0.05~0.01);UA水平正常对照组252.05±75.64μmol/L,轻度、中度、重度OSAHS组患者均高于正常对照组(P<0.05~0.01)。相关分析显示I-BIL与呼吸暂停低通气指数(AHI)呈负相关(r=-0.32,P<0.01),最低血氧饱和度(SaO2)与AHI呈负相关(r=-0.56,P<0.01),UA与AHI呈正相关(r=0.27,P<0.05)。结论:OSAHS患者体内I-BIL水平降低,UA水平升高可能是OSAHS患者易患高血压、冠心病等心血管疾病的机制之一。  相似文献   

6.
目的:探讨伴有阻塞性睡眠呼吸低通气暂停综合征的糖尿病患者的临床特点,以提高DM与OSAHS两病关系的认识。方法对在2009年1月~2012年12月资料完整的糖尿病患者进行多导睡眠监测,筛选出符合标准的130例患者。根据呼吸暂停低通气指数(AHI)将DM患者分为OSAHS组患者67例;非OSAHS组患者63例。检测血脂、糖代谢等指标并计算胰岛素抵抗指数,比较两组参数的差异。结果OSAHS组的DM患者在体质量指数(BMI)、睡眠呼吸暂停低通气指数(AHI)、最低脉搏容积血氧饱和度(LSpO2)、血清甘油三酯(TG)、糖化血红蛋白(HbA1c)、空腹胰岛素水平(FIns)、胰岛素抵抗指数(HOMA-IR)等参数均高于未伴有OSAHS的DM患者,差异有统计学意义(P<0.05)。 OSAHS组患者血清FIns及HOMA-IR与LSpO2和AHI均存在相关性。OSAHS组高血压和冠心病并发症明显高于非OSAHS组。结论伴有OSAHS的DM患者由于慢性间歇性低氧与IR相关,发生高血压、冠心病的可能性增大,医务工作者应该提高糖尿病患者人群OSAHS的识别。  相似文献   

7.
阻塞性睡眠呼吸暂停低通气综合症与高血压的相关研究   总被引:1,自引:0,他引:1  
郑泽辉 《医学信息》2010,23(2):359-361
目的 分析伴有高血压的阻塞性睡眠呼吸暂停低通气综合症(oSAHS)的睡眠呼吸障碍特点,并探讨两者之间的关系。方法 对诊断为OSAHS患者中45例高血压和32倒非高血压患者进行基础情况和夜间缺氧程度、睡眠结构和干扰睡眠因素以及OSAHS患者中高血压的危险因素进行分析。结果 高血压组睡眠呼吸暂停低通气指数(AHI)高于非高血压痛组.体重指数(BMI)是引起两组间睡眠呼吸暂停低通气指数(AHI)差异的显著因素。两组间夜间平均Sa02和最低Sa02比较差异无显著性(p〈0.05),睡眠呼吸暂停低通气指数(AHI)是引起夜间缺氧的显著因素。OSAHS患者中高血压病的危险因素是AHI、年龄、BMI。结论 OSAHS伴有高血压的患者的睡眠呼吸障碍程度更重,而夜间低氧血症与高血压无关,但与睡眠呼吸障碍的严重程度有关。年龄、肥胖和睡眠呼吸障碍的严重程度是OSAHS患者中高血压的危险因素。  相似文献   

8.
目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者血清IL-6、TNF-α水平测定的临床意义。方法:68例OSAS患者分为轻度组(36例)和中、重度组(32例),同时选取健康对照者30例,采用酶联免疫吸附法(ELISA)测定其血清IL-6、TNF-α水平,同时检测睡眠呼吸暂停低通气指数(AHI)及夜间最低血氧饱和度(SaO2),并进行相关性分析。32例中、重度OSAS患者经鼻持续正压通气(nCPAP)治疗,于治疗前及治疗后监测AHI、SaO2、IL-6和TNF-α水平。结果:OSAS患者AHI和血清IL-6、TNF-α水平显著高于对照组(P<0.01),平均SaO2和最低SaO2与对照组相比明显降低(P<0.01)。中、重度OSAS患者经nCPAP后AHI和最低SaO2明显改善,血清IL-6和TNF-α水平均较治疗前明显降低(P<0.01)。OSAS患者血清IL-6、TNF-α水平分别与AHI呈正相关(r=0.75,r=0.82,P<0.01);与SaO2呈负相关(r=-0.65、r=-0.74,P<0.01)。结论:血清IL-6、TNF-α参与了OSAS的发病,而且与病情严重程度密切相关。  相似文献   

9.
目的分析高血压合并阻塞性呼吸暂停低通气综合征(OSAHS)患者治疗前后血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、氧饱和度及血压的变化及意义。方法选择医院收治的100例高血压患者,按是否合并OSAHS分为高血压组[n=46,呼吸暂停低通气指数(AHI)<5次/h]与合并组(n=54,AHI≥5次/h),均于治疗前后检测血清Hcy、CRP、血氧饱和度(SaO_2)水平,并检测动态血压变化,分析上述指标与高血压合并OSAHS病情变化的关系。结果合并组Hcy、CRP、AHI高于高血压组,最低SaO_2低于高血压组,其治疗后Hcy、CRP、AHI低于治疗前,SaO_2高于治疗前(P<0.05);合并组随OSAHS病情程度的提升,Hcy、CRP、AHI逐渐升高,最低SaO_2降低(P<0.05),各组治疗后Hcy、CRP、AHI水平均低于治疗前,最低SaO_2高于治疗前(P <0.05);高血压+轻度、中度、重度OSAHS组整体血压昼夜节律变化幅度高于高血压组(P<0. 05),治疗后,除高血压+轻度OSAHS组mSBP、mDBP外,各组血压较治疗前降低(P <0.05);高血压合并OSAHS患者Hcy、CRP与AHI、nSBP均呈正相关,与最低SaO_2呈负相关(P <0.05)。结论高血压合并OSAHS患者随OSAHS程度的上升,Hcy、CRP、AHI水平上升,最低SaO_2降低,且其Hcy、CRP的变化可影响患者通气功能及血压变化节律。  相似文献   

10.
刘军祥 《医学信息》2006,19(10):1809-1811
目的 探讨Epwoyth嗜睡量表对阻塞性睡眠呼吸暂停低通气综合症(OSAHS)临床诊断意义。方法 对83例鼾症、279例OSAHS患者(轻度65例、中度97例、重度117例)分别进行Epworth问卷调查并判断嗜睡评分(EP),然后行多导睡眠监测(PSG)。依据PSG检查将EP与相关资料做统计学分析。结果 鼾症、OSAHS患者EP评分与睡眠呼吸暂停-低通气指数(AHI)、夜间睡眠呼吸紊乱时间(T)呈明显正相关;EP与最低氧饱和度(SaO2)呈负相关。即OSAHS病情越重,EP评分越高。诊断符合率分别为:鼾症90.36%(75/83),轻度OSAHS92.3%(60/65),中度0SAHS91.75%(89/97),重度OSAHS92.3%(108/117)。结论 EP评分基本与病情相符,诊断符合率较高。可以用Epworth嗜睡量表作为临床OSAHS患者的初筛检查,尤其是在基层医院。  相似文献   

11.
This study assessed decision‐making and its associations with executive functions and sleep‐related factors in patients with obstructive sleep apnea. Thirty patients with untreated obstructive sleep apnea and 20 healthy age‐ and education‐matched controls performed the Iowa Gambling Task, a decision‐making task under initial ambiguity, as well as an extensive neuropsychological test battery. Patients, but not controls, also underwent a detailed polysomnographic assessment. Results of group analyses showed that patients performed at the same level of controls on the Iowa Gambling Task. However, the proportion of risky performers was significantly higher in the patient group than in the control group. Decision‐making did not correlate with executive functions and subjective ratings of sleepiness, whereas there was a significant positive correlation between advantageous performance on the Iowa Gambling Task and percentage of N2 sleep, minimal oxygen saturation, average oxygen saturation and time spent below 90% oxygen saturation level. Also, the minimal oxygen saturation accounted for 27% of variance in decision‐making. In conclusion, this study shows that a subgroup of patients with obstructive sleep apnea may be at risk of disadvantageous decision‐making under ambiguity. Among the sleep‐related factors, oxygen saturation is a significant predictor of advantageous decision‐making.  相似文献   

12.
STUDY OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is a disorder that often presents with elevated serum aminotransferase levels. Although it has classically been linked with the metabolic syndrome, recent studies suggest NAFLD may also be associated with obstructive sleep apnea (OSA). This study evaluates the association between serum aminotransferase levels and factors connected with: either the metabolic syndrome (elevated body mass index [BMI], lipid profile, blood pressure, fasting glucose), or with OSA severity (apnea hypopnea index, lowest oxygen saturation level, oxygen desaturation index, percent of time below 90% saturation [%T<90]). DESIGN: Retrospective case series. PATIENTS AND SETTING: 109 adult patients with OSA at a university hospital general clinical research center. MEASUREMENTS AND RESULTS: Markers of hypoxia (lowest oxygen saturation level and %T<90), correlated significantly with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (Pearson's r = -0.31 to -0.38, P <0.003), while apnea hypopnea index, body mass index, blood pressure, fasting glucose, triglyceride, and cholesterol levels did not. Hierarchical linear regression was then done to determine the best predictors of aminotransferase levels. Markers of metabolic syndrome were entered as one block and markers of sleep apnea as another. Regression analyses explained 16.3% of the variance in AST and 18.9% of the variance in ALT, with %T<90 playing the largest role. CONCLUSIONS: In patients with obstructive sleep apnea, serum aminotransferase levels are better predicted by markers of oxygen desaturation than by factors traditionally associated with the metabolic syndrome.  相似文献   

13.
Increased hematocrit (Hct) attributable to splenic contraction accompanies human apneic diving or apnea with face immersion. Apnea also causes heart rate reduction and peripheral vasoconstriction, i.e., a cardiovascular diving response, which is augmented by face immersion. The aim was to study the role of apnea and facial immersion in the initiation of the hematological response and to relate this to the cardiovascular diving response and its oxygen conservation during repeated apneas. Seven male volunteers performed two series of five apneas of fixed near-maximal duration: one series in air (A) and the other with facial immersion in 10°C water (FIA). Apneas were spaced by 2 min and series by 20 min of rest. Venous blood samples, taken before and after each apnea, were analysed for Hct, hemoglobin concentration (Hb), lactic acid, blood gases and pH. Heart rate, skin capillary blood flow and arterial oxygen saturation were continuously measured non-invasively. A transient increase of Hct and Hb by approximately 4% developed progressively across both series. As no increase of the response resulted with face immersion, we concluded that the apnea, or its consequences, is the major stimulus evoking splenic contraction. An augmented cardiovascular diving response occurred during FIA compared to A. Arterial oxygen saturation remained higher, venous oxygen stores were more depleted and lactic acid accumulation was higher across the FIA series, indicating oxygen conservation with the more powerful diving response. This study shows that the hematological response is not involved in causing the difference in oxygen saturation between apnea and apnea with face immersion.  相似文献   

14.
STUDY OBJECTIVES: In the absence of heme oxygenase-1 (HO-1), which catalyzes the oxidation of heme to generate carbon monoxide and indirect bilirubin, hypoxia induces severe right ventricular dilation and infarction. Despite severe hypoxemia during sleep, patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) rarely die during sleep. We hypothesized that apnea-related hypoxemia would induce HO-1 and increase bilirubin levels in the morning in OSAHS patients. Therefore, bilirubin levels in OSAHS patients were analyzed before and after nasal continuous positive airway pressure (nCPAP) therapy. DESIGN: Bilirubin levels in the afternoon before sleep and in the morning immediately after sleep were determined before and after nCPAP treatment. SETTING: University Hospital in Kyoto, Japan. PATIENTS: The subjects were 22 patients with OSAHS (mean (SEM) apnea and hypopnea index of 60 (5)) who were treated with nCPAP and 13 controls. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Before nCPAP treatment, total after-sleep bilirubin level was significantly higher than the pre-sleep level (p<0.0001). The difference between the serum indirect bilirubin levels in the morning versus in the previous afternoon [D-(M-A)-IB] decreased significantly with nCPAP treatment (p<0.01). The magnitude of decrease in D-(M-A)-IB after nCPAP treatment correlated significantly with changes in the percent time spent with arterial O2 saturation below 90% (r=0.44; p=0.04) and 85% (r=0.49; p=0.02), respectively, during sleep after nCPAP treatment. CONCLUSIONS: The increase in bilirubin level by HO-1 might protect OSAHS patients from disorders related to hypoxemia.  相似文献   

15.
STUDY OBJECTIVES: Some patients with apparent obstructive sleep apnea hypopnea syndrome (OSAHS) have elimination of obstructive events but emergence of problematic central apneas or Cheyne-Stokes breathing pattern. Patients with this sleep-disordered breathing problem, which for the sake of study we call the "complex sleep apnea syndrome," are not well characterized. We sought to determine the prevalence of complex sleep apnea syndrome and hypothesized that the clinical characteristics of patients with complex sleep apnea syndrome would more nearly resemble those of patients with central sleep apnea syndrome (CSA) than with those of patients with OSAHS. DESIGN: Retrospective review SETTING: Sleep disorders center. PATIENTS OR PARTICIPANTS: Two hundred twenty-three adults consecutively referred over 1 month plus 20 consecutive patients diagnosed with CSA. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Prevalence of complex sleep apnea syndrome, OSAHS, and CSA in the 1-month sample was 15%, 84%, and 0.4%, respectively. Patients with complex sleep apnea syndrome differed in gender from patients with OSAHS (81% vs 60% men, p < .05) but were otherwise similar in sleep and cardiovascular history. Patients with complex sleep apnea syndrome had fewer maintenance-insomnia complaints (32% vs 79%; p < .05) than patients with CSA but were otherwise not significantly different clinically. Diagnostic apnea-hypopnea index for patients with complex sleep apnea syndrome, OSAHS, and CSA was 32.3 +/- 26.8, 20.6 +/- 23.7, and 38.3 +/- 36.2, respectively (p = .005). Continuous positive airway pressure suppressed obstructive breathing, but residual apnea-hypopnea index, mostly from central apneas, remained high in patients with complex sleep apnea syndrome and CSA (21.7 +/- 18.6 in complex sleep apnea syndrome, 32.9 +/- 30.8 in CSA vs 2.14 +/- 3.14 in OSAHS; p < .001). CONCLUSIONS: Patients with complex sleep apnea syndrome are mostly similar to those with OSAHS until one applies continuous positive airway pressure. They are left with very disrupted breathing and sleep on continuous positive airway pressure. Clinical risk factors don't predict the emergence of complex sleep apnea syndrome, and best treatment is not known.  相似文献   

16.
Chung S  Yoon IY  Shin YK  Lee CH  Kim JW  Lee T  Choi DJ  Ahn HJ 《Sleep》2007,30(8):997-1001
STUDY OBJECTIVES: To investigate flow-mediated dilatation (FMD) and C-reactive protein (CRP) levels in patients with obstructive sleep apnea syndrome (OSAS) in relation with the severity of respiratory disturbances and hypoxemia. DESIGN: After subjects had completed nocturnal polysomnography, FMD was measured in the brachial artery, and blood samples were obtained to determine serum CRP levels. SETTING: Sleep laboratory in Seoul National University Bundang Hospital. PATIENTS: Ninety men: 22 normal controls, 28 subjects with mild to moderate OSAS, and 40 with severe OSAS. MEASUREMENTS AND RESULTS: FMD was found to be correlated with oxygen desaturation index (ODI), percentage of time below 90% O2 saturation, average O2 saturation, lowest O2 saturation, systolic blood pressure, apnea hypopnea index (AHI), and body mass index. In addition, CRP was correlated with body mass index, waist-to-hip ratio, neck circumference, diastolic pressure, average O2 saturation and percentage of time below 90% O2 saturation but not with AHI. Stepwise multiple regression showed that the ODI was a significant determinant of FMD (adjusted R2 = 10%, beta = -0.33, P < 0.01). In addition, body mass index (beta = 0.25, P < 0.05) and waist-to-hip ratio (beta = 0.21, P < 0.05) were found to be significantly correlated with CRP (adjusted R2 = 12%, P < 0.05), independently of other factors. There was no correlation between FMD and CRP. CONCLUSION: As a marker of nocturnal hypoxemia, ODI rather than AHI might better explain the relationship between OSAS and FMD. Because body mass index and waist-to-hip ratio were identified as risk factors of high serum CRP in OSAS, obesity should be considered when predicting cardiovascular complications in OSAS.  相似文献   

17.
Obstructive sleep apnea is associated with an increased risk of hypertension, diabetes and dyslipidaemia. Both obstructive sleep apnea and its comorbidities are at least partly heritable, suggesting a common genetic background. Our aim was to analyse the heritability of the relationship between obstructive sleep apnea and its comorbidities using a twin study. Forty‐seven monozygotic and 22 dizygotic adult twin pairs recruited from the Hungarian Twin Registry (mean age 51 ± 15 years) attended an overnight diagnostic sleep study. A medical history was taken, blood pressure was measured, and blood samples were taken for fasting glucose, total cholesterol, triglyceride, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol and lipoprotein (a). To evaluate the heritability of obstructive sleep apnea and its comorbidities bivariate analysis was performed with an adjustment for age, gender, body mass index (BMI) and smoking after false discovery rate correction and following exclusion of patients on lipid‐lowering and antidiabetic medications. There was a significant correlation between indices of obstructive sleep apnea severity, such as the apnea–hypopnea index, oxygen desaturation index and percentage of sleep time spent with oxygen saturation below 90%, as well as blood pressure, serum triglyceride, lipoprotein (a) and glucose levels (all p < .05). The bivariate analysis revealed a common genetic background for the correlations between serum triglyceride and the oxygen desaturation index (r = .63, p = .03), as well as percentage of sleep time spent with oxygen saturation below 90% (r = .58, p = .03). None of the other correlations were significantly genetically or environmentally determined. This twin study demonstrates that the co‐occurrence of obstructive sleep apnea with hypertriglyceridaemia has a genetic influence and heritable factors play an important role in the pathogenesis of dyslipidaemia in obstructive sleep apnea.  相似文献   

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