30例睡眠呼吸暂停综合征患者睡眠特征及其心身状况

目的 :了解睡眠呼吸暂停综合征 (SAS)患者的睡眠特征和心身状况。方法 :采用多导睡眠分析仪 (PSG)、SCL -90对 3 0例SAS患者和 2 8例正常对照者进行检查。结果 :病例组存在明显的睡眠结构紊乱 ,其SCL -90总因子分以及躯体化、强迫、敌意、抑郁、焦虑和附加因子分高于对照组 (P <0 0 5 ) ;SAS患者的心身症状严重程度与总睡眠时间、夜间觉醒时间呈较强负相关 (r =-0 83 ,-0 87) ,与夜间觉醒时间所占比例呈较强正相关 (r =0 71)。结论 :SAS患者与正常对照者相比心身健康状况较差 ,需要进行适当的医学干预     

睡眠呼吸暂停低通气综合征患者的抑郁焦虑症状研究

目的:探讨睡眠呼吸暂停低通气综合征(SAHS)患者并发抑郁焦虑情况.方法:对50例SAHS患者和30例正常对照者进行整夜多导睡眠图(PSG)检查,分别对其进行抑郁、焦虑症状评定.结果:SAHS组SAS量表、SDS量表标准分均高于正常对照组(P<0.05).SAHS组抑郁和焦虑发生率分别为42.0%和32.0%.SAHS组抑郁焦虑情绪与夜间总睡眠时间、NREM和REM睡眠时间呈显著负相关(r>0.6),与觉醒次数及睡眠潜伏期呈正相关(r>0.3).结论:SAHS患者存在显著的抑郁焦虑症状.     

帕金森患者的睡眠障碍

目的：探讨帕金森病患者睡眠结构紊乱与病程的长短、病情的严重程度以及用药种类的关系。方法：应用多项睡眠图描记分析技术（polysomnography），分析17例帕金森病患者的睡眠总时间、睡眠效率、睡眠潜伏期、睡眠醒觉的次数和时间。结果：睡眠效率低于80％的15例，睡眠潜伏期大于30min者9例．睡眠中醒觉的时间大于60min者15例。病程大于5年的患者的平均睡眠总时间（173min）与病程小于5年者（276min）相比显著减少，差异具有显著意义（P=0．02）。病程大于5年的患者睡眠潜伏期（72min）较病程小f5年者的睡眠潜伏期（35rain）明显延长，呈明显的正相关（r=0．44，P〈0．05）。H—Y分级与总睡眠时间呈负相关（r=0．49，P〈0．05），与睡眠潜伏期呈正相关（r=0．56，P〈0．05）。服用两种以I：药物哲的睡眠潜伏期较用一种药物者的明显延长（P=0．02）。结论：帕金森病患者的睡眠结构存在明显异常，主要表现为睡眠总时间减少、睡眠效率减低、睡眠觉醒的时间和次数增多及睡眠潜伏期延氐。帕金森病患者病程的长短与总睡眠时间成反比，病情的严重程度与睡眠时间及效率成反比，而与睡眠潜伏期及睡眠中醒觉的次数成正比，用药种类的多少与睡眠潜伏期成正比。     

肥胖与阻塞性睡眠呼吸暂停综合征的研究现状

睡眠呼吸暂停综合症 (SAS)是指每晚 7h睡眠中 ,口鼻气流停止超过 10 s且次数大于 30次 ,或平均每小时睡眠呼吸暂停低通气次数 (睡眠呼吸紊乱指数 ,AHI)大于 5。呼吸暂停时仍有胸腹式运动者 ,称为阻塞性睡眠呼吸暂停综合征(OSAS)。它是一种发病率较高 ,具有潜在危险的疾病。睡眠呼吸暂停引起睡眠结构紊乱和反复出现低氧血症、高碳酸血症 ,它产生的一系列病理生理变化 ,会严重危害患者的健康 ,甚至生命。近十几年的研究提高了人们对其重要性的认识 ,同时也发现肥胖是 OSAS最显著的危险因素。其危险度是性别的 4倍、年龄的 2倍。尤其是上…     

多项睡眠图联合长程视频脑电图观察未治疗的28例癫癎患者睡眠结构和呼吸事件的变化

目的:探讨成人癫癎患者药物治疗前睡眠结构和睡眠呼吸事件的变化。方法:对确诊为癫癎的成人患者28例进行多项睡眠图(PSG)检查,同步行长程视频脑电图(LTV EEG)检查,分析患者的睡眠结构、睡眠呼吸事件情况。结果:本组病人PSG睡眠结构特点表现为各睡眠参数均有不同程度的改变,以REM潜伏期增加、REM睡眠减少为著,浅睡眠明显增多,而深睡眠则无明显差异。其中2例患者无REM睡眠。所有患者夜间觉醒次数均增多,睡眠效率明显下降。但在觉醒时间、周期性腿动和呼吸暂停指数上,并无明显变化。结论:癫癎患者在药物治疗前存在睡眠结构紊乱。     

阻塞性睡眠呼吸暂停低通气综合征患者早期认知功能损害的事件相关电位研究

探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者早期认知功能损害情况。根据多导睡眠监测(PSG)结果,对符合OSAHS诊断的20例患者和20例正常对照进行事件相关电位失匹配负波(MMN)和P300检测。结果显示OSAHS组Cz点的MMN和P300潜伏期较对照组显著延长(P0.05)。在控制了年龄和体重的影响后,相关分析显示MMN潜伏期与呼吸暂停低通气指数(AHI)、氧减指数、N1期睡眠时间和微觉醒指数呈显著正相关(P0.01),与N3期睡眠时间和平均血氧饱和度呈显著负相关(P0.05);P300潜伏期与AHI和氧减指数呈显著正相关(P0.05);没有发现MMN潜伏期、波幅与P300潜伏期、波幅具有相关关系。OSAHS患者大脑自动加工和控制加工功能受损,与夜间反复低氧和睡眠结构紊乱有关。     

急性脑卒中患者睡眠觉醒昼夜生物节律特征

目的:了解急性脑卒中患者睡眠觉醒的昼夜生物节律特征.方法:选择急性脑卒中患者40例,其中缺血性脑卒中23例,年龄65.4±11.0岁;出血性脑卒中17例,年龄58.6±10.2岁.患者发病72小时内应用三轴体动记录仪,连续72小时观察日间和夜间体动状态、睡眠时间、觉醒时间、睡眠效率、睡眠周期等技术参数.以72小时的每小时活动能耗评估昼夜生物节律日间稳定性(inter-daily stability,IS)和昼夜变异性(intra-daily variabili-ty,IV).同时,体动记录仪佩戴第二日夜间,应用多导脑电监测患者夜间睡眠质量.结果:40例脑卒中患者的日间睡眠时间219.79±122.30min、日间觉醒时间500.21±122.30min、日间睡眠效率30.53±16.95％;夜间睡眠时间302.38±125.78min、夜间觉醒时间417.62±125.78min、夜间睡眠效率42.02±17.49％.日间睡眠时间＞6h/d者8例(20.00％);夜间睡眠时间＜5 h/d者21例(52.50％);昼夜睡眠时间＞10h/d者37例(92.50％);日间睡眠＞夜间睡眠时间者11例(27.50％).脑卒中患者的IS值为0.37±0.11、IV值为1.46±0.40.其中,缺血性脑卒中IS值为0.35±0.11、IV值为1.42±0.44;出血性脑卒中IS值为0.40±0.12、IV值为1.52±0.37,IS值两组间比较无统计学差异(t =-1.259,P = 0.216),IV值两组间比较无统计学差异(t=-0.745,P = 0.461).多导脑电睡眠监测,夜间清醒期59.02±20.94％、N1 期睡眠9.46±10.03％、N2期睡眠30.30±21.46％、N3期睡眠 1.15±3.87％、夜间睡眠效率40.92±20.99％.结论:急性脑卒中患者的基本生物节律仍以24小时类型为主,但其日间稳定性较差,昼夜变异性较大.睡眠～觉醒昼夜节律明显异常,主要表现为以日间睡眠增多和夜间睡眠减少、睡眠质量降低为主要类型的睡眠～觉醒节律障碍.     

睡眠呼吸暂停/低通气综合征体重指数及睡眠特征分析

睡眠呼吸暂停 /低通气综合征 (ＳｌｅｅｐＡｐｎｅａ/Ｈｙ ｐｏｐｎｅａＳｙｎｄｒｏｍｅ ,ＳＡ/ＨＳ)是一种严重的睡眠呼吸疾病 ,指每晚 7小时睡眠中 ,呼吸暂停反复发作 30次以上 ,每次发作呼吸暂停 10秒以上 ,或睡眠呼吸紊乱指数 (ａｐｎｅａ/ｈｙｐｏｐｎｅａｉｎｄｅｘ ,ＡＨＩ ,即平均每小时的睡眠呼吸暂停 低通气次数 )超过 5次以上。在整个人群中的发病率为 2 %～ 4 % [1] ,中年以后的男性和更年期后的女性发病率增高 ,男性发病率高于女性。ＳＡ/ＨＳ以反复发作的夜间呼吸暂停和低氧血症为主要临床特征 ,患者夜间睡眠质量较差 ,不…     

不同程度鼾症患者睡眠结构及醒觉指数分析

目的:分析不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和单纯鼾症患者的多道睡眠图(PSG)的特点.方法:应用60道PSG监测仪对65例睡眠打鼾成人行整夜睡眠监测,并按照呼吸暂停低通气指数(AHI)将患者分为单纯鼾症组(Ⅰ组)、轻度OSAHS组(Ⅱ组)、中度OSAHS组(Ⅲ组)和重度OSAHS组(Ⅳ组),并比较各组间的PSG检测结果.结果:与单纯鼾症组相比,重度OSAHS组的非快速眼动睡眠(NREM)Ⅰ期所占的百分比增加(P＜0.001),快速眼动睡眠期(REM)所占的百分比减少(P＜0.05);四组鼾症患者的总醒觉指数(ArI)和伴有呼吸紊乱的觉醒指数均增加,自发性觉醒指数均减小;但各组间存在明显差异.NREMⅡ期所占的百分比、NREMⅢ Ⅳ期所占的百分比、睡眠效率等在四个鼾症患者组间比较无明显差异.结论:鼾症患者中睡眠结构紊乱及睡眠片段化与AHI的大小有关.     

阻塞性睡眠呼吸暂停综合征并发认知障碍的研究进展

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者常伴有不同程度的认知功能障碍,其认知功能下降的程度与OSAS的严重程度呈非线性关系.影响OSAS患者认知功能的关键因素是睡眠片段和夜间低氧血症.持续气道内正压通气(continuous positive airway Pressure,CPAP)是治疗OSAS的有效手段.     

抑郁症患者主客观睡眠的对照研究

目的:了解抑郁症患者的睡眠特点,探讨其主客观睡眠的异同点。方法:对30例抑郁症患者、20例正常人的主观睡眠(PSQI)和客观睡眠(PSG)特点进行测量。结果:抑郁症的PSG多项指标(睡眠时间、睡眠潜伏期、睡后觉醒次数、觉醒总时间、觉睡比、睡眠总时间、睡眠效率、睡眠维持率、S1、S2)与正常对照有显著差异(P<0.05或P<0.01);抑郁症的PSQI多项指标(PSQI总分、睡眠效率、睡眠时间、睡眠潜伏期)方面与正常对照有显著差异(P<0.01)。抑郁症的PSQI和PSG在睡眠效率、睡眠时间、睡眠潜伏期方面存在显著差异(P<0.01)。结论:抑郁症患者的主观睡眠和客观睡眠均存在一定程度的异常,抑郁症患者有高估自己睡眠障碍的倾向。     

Excessive Muscle Activity Increases Over Time in Idiopathic REM Sleep Behavior Disorder

Study Objectives:

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by excessive electromyographic (EMG) activity due to dysfunction of the brainstem structures modulating REM sleep atonia. Patients with idiopathic RBD often develop a neurodegenerative disease, such as Parkinson disease, over the years, suggesting progression of an underlying pathologic process in the brainstem. It is unknown if the excessive EMG activity in REM sleep changes over time in patients with idiopathic RBD.

Setting:

University hospital sleep disorders center.

Participants:

Eleven patients with idiopathic RBD who were studied at baseline and after a mean follow-up of 5 years.

Interventions:

NA.

Measurements and Results:

Eleven patients with idiopathic RBD underwent polysomnography (PSG) at the moment of the diagnosis of RBD (PSG1) and after a mean follow-up of 5 years (PSG2). Tonic EMG activity in PSG1 and PSG2 was blindly quantified and compared in the mentalis muscle during REM sleep. Phasic EMG activity in PSG1 and PSG2 was blindly quantified and compared in the mentalis muscle, both biceps brachii, and both anterior tibialis during REM sleep. Patients were 9 men and 2 women with a mean age of 73.2 ± 5.4 years and a mean RBD duration of 10.7 ± 5.3 years at PSG2. In each of the 5 muscles and combination of muscles evaluated, phasic EMG activity was significantly greater in PSG2 than in PSG1 (P < 0.022 in all muscles studied). Mentalis tonic EMG activity increased from 30% to 54% (P = 0.013). No correlation was found between age of the patients and quantity of EMG activity at PSG1 (tonic; P = 0.69, phasic P = 0.89) and at PSG2 (tonic; P = 0.16, phasic; P = 0.42).

Conclusion:

Excessive tonic and phasic EMG activity during REM sleep increases over time in subjects with idiopathic RBD. This finding suggests that, in subjects with idiopathic RBD, there is an underlying progressive pathologic process damaging the brainstem structures that modulate REM sleep.

Citation:

Iranzo A; Ratti PL; Casanova-Molla J; Serradell M; Vilaseca I; Santamaria J. Excessive muscle activity increases over time in idiopathic REM sleep behavior disorder. SLEEP 2009;32(9):1149-1153.     

Sleep during titration predicts continuous positive airway pressure compliance

STUDY OBJECTIVES: Poor compliance with continuous positive airway pressure (CPAP) has been identified as a significant obstacle in the treatment of obstructive sleep apnea. While previous studies have focused on diagnostic screening variables, side effects, health beliefs, and measures of disease severity, investigators have generally ignored sleep parameters assessed during CPAP titration as predictors of compliance. As the titration night represents patients' initial exposure to nocturnal CPAP treatment, we hypothesized that nocturnal polysomnographic (PSG) variables, representing improved sleep at this time, would predict higher subsequent compliance. DESIGN: Prospective analyses of a sequential case series were undertaken using nocturnal PSG variables during titration as early predictors of CPAP compliance. SETTING: Accredited sleep center. PATIENTS: Seventy-one patients with sleep apnea, aged 31-78 years, with a mean respiratory disturbance index of 62.0 +/- 32.2. Interventions: N/A MEASUREMENTS AND RESULTS: Compliance was calculated as mean hours per night of CPAP use over the initial follow-up period (mean 46.9 days). Standard PSG variables and subjective reports of sleep were used as predictive variables in multivariate analyses. Mean objective compliance was 5.04 hours per night +/- 2.59. Consistent with our hypothesis, the best predictor of compliance was change in sleep efficiency (SE) from diagnostic to titration night [F (1,66) = 17.31, p < .000 (r = .48)], indicating that patients whose sleep improved most on the titration night had the highest levels of compliance. This relationship was also significant after controlling for measures of disease severity obtained during the diagnostic testing night. Importantly, individuals whose sleep improved on the CPAP titration night had nightly compliance rates of approximately 2 hours greater than patients whose sleep did not improve during titration. CONCLUSIONS: The findings suggest that patients' initial experience with CPAP treatment and, in particular, the degree of improvement in sleep during CPAP titration may be crucial factors in determining their subsequent use of this treatment modality.     

卒中后抑郁患者的多项睡眠图研究

目的：探讨多项睡眠图（PSG）各项指标对卒中后抑郁（PSD）患者的诊断价值。方法：卒中后抑郁组（PSD组）和卒中后无抑郁组（对照组）以年龄1：1配对,用PSG仪对两组各59例患者进行整夜睡眠描记并对结果进行分析。结果：睡眠进程：PSD组睡眠潜伏期延长,觉醒时间增多,睡眠总时间减少,睡眠效率下降,睡眠维持率下降,两组比较差异有统计学意义;非快速眼动睡眠（NREM）：PSI）组S1增多,S2减少,但S3＋S4两组比较差异无显著意义;快速眼动睡眠（REM）：PSD组REM潜伏期缩短,REM时间减少,REM周期数减少。结论：PSI）患者存在PSG指标变化,PSG对PSD的诊断和鉴别诊断有临床价值。     

An ambulatory respirometer (Hotmate) as a tool for screening of sleep apnea syndrome

The gold standard diagnostic method for sleep apnea syndrome(SAS) is overnight polysomnography(PSG), but is costly in terms of time and money. We studied the usefulness of a 24-hour ambulatory respirometer equipped with oximeter(Hotmate) for screening of SAS. Seventy-six cases of suspected SAS were enrolled(68 males and 8 females, mean age 51). The correlation between data from Hotmate and PSG was evaluated in 24 cases who underwent both of the tests for the final diagnosis of SAS. There was a good correlation between the two parameters of the data obtained by Hotmate(H) (H-apnea index(AI) vs H-desaturation index(DI)). Among 24 cases who underwent both Hotmate and PSG, there was a good correlation between the data from PSG and Hotmate(PSG-AI vs H-AI: r = 0.80, p < 0.001). Both sensitivity and specificity were highest when screening criteria of H-DI > 15 was utilized(sensitivity = 91.7%, specificity = 66.7%). Our findings suggest that the respiromonitor with oximeter is useful for the screening the patients with SAS.     

Sleep and breathing at altitude of 3800 m--the acclimatization effect

Periodic breathing (PB) is a very common phenomenon occurring during sleep at high altitude. It consists of repetitive apneas or hypopneas of central origin and clusters of hyperpneic breaths. The aim of this study was to analyze sleep structure and periodic breathing in shift workers of a gold mine situated in Tien-Schan Mountains at 3800 m. In 12 subjects aged 36.1 +/- 9.3 yrs, polysomnography (PSG) was performed twice, on the night after the first working shift or during the day following first night shift, and the second PSG at the end of the first week of work. After one week, significant increase in REM sleep was noticed (5.2 +/- 4.0% vs. 12.0 +/- 6.7%, p < 0.05). There were no differences in sleep pattern between night sleep and sleep during daytime. During first PSG periodic breathing was seen in all subjects and occupied 14.7 +/- 16.6% of total sleep time. After one week PB decreased in 8 subjects however, in 4 subjects an increase in PB was observed (15.4 +/- 11.2 vs. 29.0 +/- 11.8% of sleep time). CONCLUSIONS: Sleep at altitude is characterized by reduction of REM sleep, which improves after a week of acclimatization. There are great individual variations in duration of periodic breathing; in some subjects an increase in PB can be seen.     

Sleep education for paradoxical insomnia

This case study series investigated a new treatment for paradoxical insomnia patients as there is no standard treatment for this patient group at this time. Four paradoxical insomnia patients had a polysomnography (PSG) sleep study, an unsuccessful brief course of behavioral treatment for insomnia, and then a novel sleep education treatment comprising review of their PSG with video and exploration of the discrepancy between their reported and observed sleep experience. Two patients responded well to sleep education, mainly with improved self-reported sleep onset latency, total sleep time, and Insomnia Severity Index scores; and the other two, who exhibited sleep architecture anomalies, were unresponsive. These findings suggest that sleep education holds promise for some paradoxical insomnia patients. Suggestions for future studies are given.