Resolution of Severe Sleep-Disordered Breathing with a Nasopharyngeal Obturator in 2 Cases of Nasopharyngeal Stenosis Complicating Uvulopalatopharyngoplasty

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by episodic decrements in airflow due to upper airway obstruction. Uvulopalatopharyngoplasty (UPPP) is a potential therapy for OSAHS. Nasopharyngeal stenosis is a rare complication of UPPP that worsens OSAHS. We report two patients referred for OSAHS worsened by nasopharyngeal stenosis complicating UPPP. Both patients were treated with carbon dioxide laser release of adhesions and placement of a nasopharyngeal obturator. Follow-up polysomnograms demonstrated resolution of OSAHS correlating with subjective resolution of symptoms. Nasopharyngeal stenosis complicating UPPP can be successfully treated with scar removal and nasopharyngeal stenting. Polysomnographic demonstration of the effectiveness of this therapy has not previously been reported. Future questions include duration of nasopharyngeal stenting and timing of follow-up polysomnography.     

Enzyme replacement therapy for mucopolysaccharidosis I: a randomized, double-blinded, placebo-controlled, multinational study of recombinant human alpha-L-iduronidase (laronidase)

OBJECTIVE: To confirm the efficacy and safety of recombinant human alpha-L-iduronidase (laronidase) in patients with mucopolysaccharidosis I (MPS I). STUDY DESIGN: This was a randomized, double-blinded, multinational study of 45 patients with MPS I administered 100 U/kg (0.58 mg/kg) laronidase, or placebo intravenously weekly for 26 weeks. The coprimary efficacy end points compared the median change from baseline to week 26 between groups in percentage of predicted normal forced vital capacity (FVC) and in 6-minute walk test (6MWT) distance through the use of the Wilcoxon rank sum test. RESULTS: The laronidase (n=22) and placebo (n=23) groups had similar baseline characteristics. After 26 weeks, patients receiving laronidase compared with placebo showed mean improvements of 5.6 percentage points in percent of predicted normal FVC (median, 3.0; P=.009) and 38.1 meters in 6MWT distance (median, 38.5; P=.066; P=.039, analysis of covariance). Laronidase also significantly reduced hepatomegaly and urinary glycosaminoglycans, and, in more severely affected patients, improved sleep apnea/hypopnea and shoulder flexion. Laronidase was well-tolerated. Nearly all patients receiving enzyme had development of IgG antibodies, without apparent clinical effects. CONCLUSIONS: In patients with MPS I, laronidase significantly improves respiratory function and physical capacity, reduces glycosaminoglycan storage, and has a favorable safety profile.     

帕金森病患者睡眠障碍特点分析

目的 使用多导睡眠图（polysomnogram,PSG）分析帕金森病（Parkinson＇s disease,PD）患者睡眠结构特点,探索影响PD患者睡眠结构的机制。方法 对2011年10月-2014年2月在我院神经内科门诊或住院的33例PD患者和33例对照者行一整夜多导睡眠图监测,并对记录数据进行分析。结果 PD组早醒（4例vs 0例）、睡眠破碎（25例vs 16例）、快动眼睡眠期颏肌失张力消失（16例vs 3例）的检出率均高于对照组（P〈0.05）;PD组和对照组比较,PD组觉醒时间占总睡眠时间百分比、一期睡眠占总睡眠时间百分比[S1（%）]高于对照组,而三期睡眠占总睡眠时间百分比[S3（%）]及快速眼球运动（repid eyes movement,REM）期占总睡眠时间百分比[REM（%）]低于对照组;PD病程≤2年组和对照组比较,两者睡眠结构参数均无统计学差异;PD病程〉2年组和对照组比较,前者觉醒时间占总睡眠时间百分比、S1（%）高于后者,S3（%）和REM（%）低于对照组;PD病程≤2年组和〉2年组比较,前者在觉醒时间占总睡眠时间百分比低于后者,而REM（%）高于后者。结论 帕金森病患者睡眠障碍主要表现为早醒、睡眠破碎和快动眼睡眠期颏肌失张力消失;帕金森病患者明显存在睡眠结构紊乱,浅睡期时间延长,深睡期时间缩短;病程是影响PD患者睡眠结构的一个重要因素。     

Autonomic arousals related to traffic noise during sleep

AIM: To analyze the heart rate (HR) response to traffic noise during sleep and the influence of acoustic parameters, time of night, and momentary sleep stage on these responses. PARTICIPANTS: Twelve women and 12 men (19-28 years). MEASUREMENTS AND RESULTS: The participants slept in the laboratory for 4 consecutive nights in each of 3 consecutive weeks and were exposed to aircraft, road, or rail traffic noise with weekly permutations. The 4 nights of each week consisted of a random sequence of a quiet night (32 dBA) and 3 nights during which aircraft, rail traffic, or road traffic noises occurred with maximum levels of 45-77 dBA. The polysomnogram and the electrocardiogram were recorded during all nights. In case of awakenings, the HR alterations consisted of monophasic elevations for >1 min, with mean maximum HR elevations of 30 bpm. Though obviously triggered by the noise events, the awakenings per se rather than the acoustical parameters determined the extent and pattern of the response. Without awakenings, HR responses were biphasic and consisted of initial accelerations with maximum HR elevations of about 9 bpm followed by decelerations below the baseline. These alterations were clearly influenced by the acoustic parameters (traffic mode, maximum level, rate of rise) as well as by the momentary sleep stage. CONCLUSIONS: Cardiac responses did not habituate to traffic noise within the night and may therefore play a key role in promoting traffic noise induced cardiovascular disease. If so, these consequences are more likely for responses accompanied by awakenings than for situations without awakenings.     

A study on polysomnographic observations and subjective experiences under sensory deprivation

We investigated the relationship between subjective experiences and polysomnographic observations under sensory deprivation (SD). The results can be divided into two types: (i) visual images were perceived frequently, accompanied by alpha waves or theta waves in electroencephalogram and frequent rapid eye movements (REM); (ii) the subjects fell in deep sleep without perception of visual images. The perceptions of visual images with alpha waves or theta waves and REM are supposed to be different from those in usual wakefulness and sleep. These results suggest that the SD could disclose different aspects of consciousness from the conventionally categorized states such as wakefulness and sleep.     

艾司西酞普兰片治疗抑郁症的PSG及BDNF监测分析

目的 考察艾司西酞普兰片治疗对抑郁症患者的多导睡眠图（polysomnogram，PSG）及脑源性神经营养因子（brain-derived neurotrophic factor，BDNF）变化的影响。方法 选择2018年10月-2020年7月60例抑郁症患者，入组第2天开始接受艾司西酞普兰片抗抑郁治疗：每天早餐后服用1次，10 mg·d^-1；2周后统一加量至20 mg·d^-1。观察治疗前后患者的PSG相关指标包括睡眠进程、睡眠结构、快速眼动睡眠阶段（rapid eye movement，REM）睡眠指标，采用ELISA法测定患者治疗前后血清BDNF表达水平。结果 各病例治疗后睡眠潜伏期及其觉醒时间变短、觉醒次数变少、睡眠效率提高，觉睡比升高（P<0.05）；但治疗前后，各病例的总睡眠时间差异不具有统计学意义。睡眠结构指标与治疗前比较，治疗后S1、S2百分比降低（P<0.05），SWS百分比升高（P<0.05）；而REM百分比差异不具有统计学意义。REM睡眠指标与治疗前比较，REM睡眠时间增加、REM睡眠潜伏期降低、REM活动度缩短、REM强度变弱、REM密度减小、REM睡眠出现次数增加（P<0.05）。与治疗前比较，各病例治疗后BDNF平均表达水平升高（P<0.05）。结论 经过艾司西酞普兰片抗抑郁治疗后，患者的睡眠质量改善，且BDNF平均表达水平提升。