复杂性睡眠呼吸暂停综合征

<正>经典的睡眠呼吸紊乱主要包括阻塞性睡眠呼吸暂停低通气综合征(obstuctive sleep apnea-hypopneasyndrome,OSAHS)、中枢性睡眠呼吸暂停综合征(central sleep apnea syndrome,CSAS)、陈-施呼吸(Chey-stokes respiration,CSR)和睡眠低通气综合征(sleep hypoventilation syndrome,SHVS)。其中     

便携式睡眠监测仪在阻塞性睡眠呼吸暂停综合征诊断中的应用

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种发病率较高、危害较大的常见慢性疾病。客观可靠地诊断OSAS并且准确评估病情严重程度,对该病的临床防治具有非常重要的意义。多导睡眠监测(polysomnography,PSG)是诊断和研究睡眠呼吸障碍     

动态心电图初筛睡眠呼吸暂停综合征的研究进展

睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)是以呼吸暂停-通气不足指数(apnea hypopnea index,AHI)(在睡眠状态下每小时之中呼吸暂停和通气不足事件发生总数)≥5并伴有白天过度嗜睡为特征的病理生理综合征。SAS包括阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea     

精神障碍伴阻塞性睡眠呼吸暂停综合征 患者的睡眠生理研究

目的 探讨精神障碍伴发阻塞性睡眠呼吸暂停综合征 (obstructive sleep apnea syndrome,OSAS)患者的临床特点及睡眠生理改变。方法 对 420例精神障碍患者进行多导睡眠图 (PSG)检测。将检出的 18例 OSAS与无 OSAS的精神病患者进行比较。 结果 OSAS组打鼾、睡眠憋醒、白天嗜睡、记忆减退症状较无 OSAS组明显增多 (P     

阻塞性睡眠呼吸暂停低通气综合征患者行为干预的研究进展

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是以睡眠结构紊乱和出现反复呼吸暂停、低氧血症为特征,导致多系统器官功能损     

中重度阻塞性睡眠呼吸暂停低通气综合征患儿睡眠问题的调查分析

目的 调查中重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿的睡眠问题及影响.方法 通过问卷调查与多导睡眠监测(Polysomnagraphy,PSG)对近两年来我院睡眠呼吸监测室进行整夜睡眠监测的124例腺样体肥大患儿的睡眠问题进行调查分析,并根据PSG结果中呼吸暂停低通气指数(Apnea hypopnea index,AHI),分为中重度OSAHS合并腺样体肥大组(AHI＞10)和单纯腺样体肥大组(AHI＜5),比较两组患儿睡眠相关问题.结果 试验组主要睡眠相关问题有:睡眠中张口呼吸,反复翻身,脾气急躁、易怒、任性,晨起口唇咽部发干,因憋气醒来,肥胖,有睡眠问题家族史等,发生率高于对照组,差异有统计学意义.中重度OSAHS患儿PSG显示,睡眠中存在Ⅰ期睡眠比例增加,快速动眼睡眠期比例减少,最低血氧饱和度下降至90%以下的人数,发生率高于对照组,差异有统计学意义(P＜0.05).结论 中重度OSAHS合并腺样体肥患儿比单纯腺样体肥大患儿存在的睡眠问题多、发生率高,耳鼻喉科、睡眠门诊及睡眠呼吸监测室的护理人员应给予患儿及家长充分的健康教育及护理指导,提醒家长尽早为患儿行PSG检查.     

阻塞型睡眠呼吸暂停综合征睡眠监测压力滴定护理

阻塞性睡眠呼吸暂停低通气综合征( obstructive sleep apnea hypoventilation syndrome,OSAHS)是一种常见的严重影响人类健康的睡眠呼吸障碍性疾病,其在成人发病率为2%～4%,目前已证明,经鼻持续气道正压(nasal-continuous positive airway pressure,n-CPAP)是治疗中、重度OSAHS的首选方法[1].     

睡眠呼吸暂停低通气综合征的护理进展

睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syn-drome,SAHS)是指各种原因导致睡眠状态下反复出现呼吸暂停和(或)低通气,引起低氧血症、高碳酸血症、睡眠呼吸中段,从而使机体发生一系列病理生理改变的临床综合征。临床表     

睡眠呼吸暂停综合征与心血管疾病

睡眠呼吸暂停综合征(sleep apnea hypopnea syndrome,SAHS)是有潜在危险的系统性疾病,可累及全身各个脏器.国外研究表明,美国发病率2%～4%,日本4%左右.入户调查中国承德地区30岁以上人群,调查表明该病发病率为4.63%;北京地区调查,阻塞型睡眠呼吸暂停综合征患病率为3.1%,男女比例为4:1,老年人患病率高.     

睡眠呼吸暂停综合征的诊断和治疗现状

1 引言 睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)是指各种原因导致睡眠状态下反复出现呼吸暂停和(或)低通气,引起低氧血症、高碳酸血症,从而使机体发生一系列病理生理改变的临床综合征.病情逐渐发展将导致心血管系统、呼吸系统、神经系统、内分泌系统、泌尿系统等的并发症,甚至引发事故.该病男性较女性多见.     

Discrepancy in polysomnography scoring for a patient with obstructive sleep apnea hypopnea syndrome

Overnight polysomnography (PSG) is indispensable for diagnosis of obstructive sleep apnea hypopnea syndrome. However, studies on interscorer agreement on PSG scoring between laboratories are few. The purpose of this study was to examine the reliability of interscorer agreement on PSG scoring among 16 sleep laboratories in Japan. We found a relatively moderate interscorer reliability of the index of oxygen desaturation and arousal during sleep, but a relatively low reliability of the index of transient reduction in and complete cessation of breathing (apnea hypopnea index). The median rate of interscorer coincidence of sleep staging was the lowest for slow wave (deep) sleep (23.5%), followed by those for Stage 1 (59.8%), Wake (73.2%) and Stage 2 (74.2%) in this order, and rapid eye movement was the most reliably identified stage (91.3%). The median rate of interscorer coincidence for all stages was 71.8%. The present study demonstrates that scorers tend to analyze PSG data according to a relatively empirical decision as opposed to a rule-dependent decision. Further detailed scoring manuals are required to decrease the interscorer discrepancy in PSG scoring.     

New approaches to treatment of bradyarrhythmia in patients with obstructive sleep apnea syndrome

AIM: To confirm or reject effects of CPAP on sleep asystole and to elucidate possible dependence on correction of respiratory disorders. MATERIAL AND METHODS: Thirteen patients (11 males and 2 females aged 19 to 66 years) with bradyarrhythmia (BA) arising in sleep participated in the study. BA was caused by transient atrioventricular block of the degree II-III in 9 cases (69%), episodes of sinus node arrest and/or synoatrial block in 6 (46%) cases. Two (15%) patients had combination of BA forms. To diagnose sleep respiratory disorders, polysomnography (PSG) was made. Diagnostic criteria of sleep obstructive apnea syndrome (SOAS) were apnea/hypopnea index (AHI) more than 5 episodes for 1 hour sleep. The patients were divided into two groups. Individual selection of therapeutic pressure under PSG control was performed in SOAS patients (the study group). CPAP-therapy was effective in AHI < 5. In the control group (AHI < 5) such selection was made too. CPAP-therapy was effective in the controls if episodes of apnea/hypopnea were not registered through the night of monitoring. RESULTS: In the study group CPAP-therapy was effective. The AHI decreased from 73.2 to 4.4, oxygen saturation of arterial blood increased from 74 to 85%, mean duration of asystoles fell from 5.2 to 1.3 s, pauses with duration more than 2 s disappeared. In the control group sleep apnea/hypopnea episodes disappeared but in asystole CPAP was uneffective. CONCLUSION: CPAP-therapy is effective and pathogenetically sound method of treating patients with nocturnal bradyarrhythmia associated with sleep respiratory disorders.     

Automated detection of sleep apnea from electrocardiogram signals using nonlinear parameters

Sleep apnoea is a very common sleep disorder which can cause symptoms such as daytime sleepiness, irritability and poor concentration. To monitor patients with this sleeping disorder we measured the electrical activity of the heart. The resulting electrocardiography (ECG) signals are both non-stationary and nonlinear. Therefore, we used nonlinear parameters such as approximate entropy, fractal dimension, correlation dimension, largest Lyapunov exponent and Hurst exponent to extract physiological information. This information was used to train an artificial neural network (ANN) classifier to categorize ECG signal segments into one of the following groups: apnoea, hypopnoea and normal breathing. ANN classification tests produced an average classification accuracy of 90%; specificity and sensitivity were 100% and 95%, respectively. We have also proposed unique recurrence plots for the normal, hypopnea and apnea classes. Detecting sleep apnea with this level of accuracy can potentially reduce the need of polysomnography (PSG). This brings advantages to patients, because the proposed system is less cumbersome when compared to PSG.     

阻塞性睡眠呼吸暂停低通气综合征影响因素分析

目的：分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的影响因素。方法：将155例OSAHS患者的各项身体测量参数和多导睡眠图（PSG）检测参数进行多元线性回归与相关分析。结果：性别、颈围、体重指数（BMI）、夜间最低血氧饱和度（LSaO2)和呼吸暂停类型是OSAHS的主要影响因素。轻度OSAHS的主要影响因素为体重指数，中度OSAHS的主要影响因素是BMI、颈围和呼吸暂停类型，而重度OSAHS的主要影响因素是性别和BMI。结论：OSAHS的影响因素是多方面的，不同程度OSAHS的主要影响因素不同，因此，治疗上也应所不同。     

Contemporary issues in the diagnosis and treatment of obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common disease associated with signifi cant morbidity and use of health care resources. Therapy with continuous positive airway pressure (CPAP) devices has low risk and a potentially large benefit in treating this disease. The Centers for Medicare and Medicaid Services (CMS) recently issued a memo revising their earlier position that authorized payment for CPAP only if formal polysomnography (PSG) was performed and was diagnostic for OSA. The revised memo states that CMS will be pay for CPAP therapy for 12 weeks (and subsequently if OSA improves) for adults diagnosed with either PSG or with unattended home sleep monitoring devices. The use of portable home monitoring devices can greatly increase access to diagnosis and treatment of OSA. However, these devices must be used as part of a comprehensive sleep evaluation program that includes access to board-certifi ed sleep specialists, PSG facilities, and therapists experienced in fi tting and troubleshooting CPAP devices.     

阻塞性睡眠呼吸暂停低通气综合征患者心理状况研究

目的 分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的心理状况。方法 对经多导睡眠监测(PSG)确诊且符合纳入、排除标准的200例OSAHS患者进行SCL 90心理量表测评,并着重分析焦虑、抑郁得分与PSG指标的相关性,探讨两者之间的关系。结果 OSAHS患者整体心理状况较正常人差,其中：躯体化、强迫症状、人际关系敏感、抑郁、焦虑、恐怖、偏执、精神病性因子分较国内常模高（P<0.05）,且不同病情程度的OSAHS患者心理状况差异有统计学意义（P<0.05）。OSAHS患者焦虑、抑郁得分与呼吸暂停低通气指数(AHI)、微觉醒指数(MAI)、血氧饱和度低于90%的时间占睡眠总时间比(TS90)呈正相关（P<0.05）,与最低血氧饱和度(LSaO2)、快动眼睡眠(REM)及深睡眠时间占比呈负相关（P<0.05）。结论 OSAHS患者整体心理状况较正常人差,病情程度不同的患者心理状况也存在差异,其焦虑、抑郁得分与慢性夜间缺氧、睡眠片段化及睡眠结构紊乱有关。     

煤工尘肺合并睡眠呼吸暂停40例分析

目的 综合分析煤工尘肺合并睡眠呼吸暂停的临床特征并评价其意义.方法 对2006年2月至2009年12月我院40例住院煤工尘肺合并睡眠呼吸暂停患者进行多导睡眠监测,并对血常规、尿常规、血压、生化指标等进行检测.结果 煤工尘肺合并睡眠呼吸暂停主要表现为重叠低氧血症以及多器官功能损害,如高血压和心、肺、肾功能损害,红细胞增多,血糖、血脂、血尿酸升高等,并形成恶性循环加重上述损害.结论 煤工尘肺合并睡眠呼吸暂停可引起严重的低氧血症及高碳酸血症,并造成多器官系统损害,临床应充分认识,早期、合理和有效的治疗可逆转或延迟多器官功能的进一步损害,明显改善预后.     

A method to screen obstructive sleep apnea using multi-variable non-intrusive measurements

Obstructive sleep apnea (OSA) is a serious sleep disorder. The current standard OSA diagnosis method is polysomnography (PSG) testing. PSG requires an overnight hospital stay while physically connected to 10-15 channels of measurement. PSG is expensive, inconvenient and requires the extensive involvement of a sleep technologist. As such, it is not suitable for community screening. OSA is a widespread disease and more than 80% of sufferers remain undiagnosed. Simplified, unattended and cheap OSA screening methods are urgently needed. Snoring is commonly associated with OSA but is not fully utilized in clinical diagnosis. Snoring contains pseudo-periodic packets of energy that produce characteristic vibrating sounds familiar to humans. In this paper, we propose a multi-feature vector that represents pitch information, formant information, a measure of periodic structure existence in snore episodes and the neck circumference of the subject to characterize OSA condition. Snore features were estimated from snore signals recorded in a sleep laboratory. The multi-feature vector was applied to a neural network for OSA/non-OSA classification and K-fold cross-validated using a random sub-sampling technique. We also propose a simple method to remove a specific class of background interference. Our method resulted in a sensitivity of 91 ± 6% and a specificity of 89 ± 5% for test data for AHI(THRESHOLD) = 15 for a database consisting of 51 subjects. This method has the potential as a non-intrusive, unattended technique to screen OSA using snore sound as the primary signal.     

Obstructive sleep apnea

Obstructive sleep apnea is a significant medical problem affecting up to 4 percent of middle-aged adults. The most common complaints are loud snoring, disrupted sleep and excessive daytime sleepiness. Patients with apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse and arousal. Although most patients are overweight and have a short, thick neck, some are of normal weight but have a small, receding jaw. Because many patients are not aware of their heavy snoring and nocturnal arousals, obstructive sleep apnea may remain undiagnosed; therefore, it is helpful to question the bedroom partner of a patient with chronic sleepiness and fatigue. Polysomnography in a sleep laboratory is the gold standard for confirming the diagnosis of obstructive sleep apnea; however, the test is expensive and not widely available. Home sleep studies are less costly but not as diagnostically accurate. Treatments include weight loss, nasal continuous positive airway pressure and dental devices that modify the position of the tongue or jaw. Upper airway and jaw surgical procedures may also be appropriate in selected patients, but invasiveness and expense restrict their use.     

脑卒中与睡眠呼吸暂停综合征相关性研究

目的 :探讨脑卒中与夜间睡眠呼吸暂停综合征 (SAS)的关系。方法 :对 32例脑卒中患者及正常对照组采用多导睡眠图 (PSG)进行多项睡眠生理指标的检测和对比分析。结果 :脑卒中患者睡眠呼吸障碍类型以阻塞性睡眠呼吸暂停 (OSA)、阻塞性睡眠低通气 (OSH)为主。脑卒中组睡眠呼吸暂停低通气指数 (AHI)及低氧时间显著高于对照组 (P <0 0 1) ,夜间血氧饱和度 (SaO2 )明显低于对照组 (P <0 0 1)。睡眠血压曲线呈非杓状。结论 :脑卒中与SAS关系密切 ,SAS是脑卒中发病的危险因素之一 ,可能与睡眠期间反复发作的呼吸暂停和低氧血症引起的血压波动增大、脑血流量减少、血液粘滞度增高、动脉硬化加重有关。