266例鼾症多导睡眠呼吸监测数据分析

目的:评价睡眠呼吸暂停综合征的一般临床特征。方法 :通过分析 2 6 6例鼾症患者 PSG监测数据 ,了解不同性别、年龄、BMI、病情患者分布差异 ,以及病情和 BMI及年龄的关系。 结果 :2 6 6例鼾症患者中 ,睡眠呼吸暂停综合征者 2 2 2例。男∶女为 7.88∶ 1,年龄 5～ 81岁 ,30～ 6 0岁者 16 9例 (占患病率的 86 .7% ) ,BMI4 9.79～14 .35 ,平均 2 9.32± 4 .92。 结论:患病男性较女性多 ,年龄分布范围广 ,肥胖是 OSAS的易患因素之一。病情和肥胖、年龄间相关关系不明确     

Alcohol effect on sleep electroencephalography by fast Fourier transformation

Abstract The influence of alcohol (ethanol) on sleep was investigated in 10 men. Polysomnography (PS) was recorded on a baseline night (BL-N) and an ethanol (0.8 g/kg) night (Et-N). On visual score rapid eye movement (REM) sleep was reduced, REM latency was prolonged on Et-N as compared to BL-N. Using the fast Fourier transformation method, electroencephalographic power density of REM sleep in δ frequencies band and in the 10–12 Hz range of non-REM sleep were enhanced. REM sleep and non-RJEM sleep changes were prominent in the second-half and first-half of the night, respectively.     

Effect of flunitrazepam on sleep and memory

Flunitrazepam's (FNZ) effect on sleep and memory 1 mg and 2 mg was investigated in 6 healthy volunteers (mean age 21.5 ± 0.8 years) by polysomnography (PSG) and memory testing. A PSG was recorded on each study night. Memory testing was done before sleep (40 min after taking FNZ or placebo), and after waking (560 min after medication). Rapid eye movement (REM) latency was found to be prolonged on the FNZ 2 mg night (FNZ2N) compared to the baseline night (BN). Percentage of stage 2 sleep was increased in the FNZ2N as compared to BN, while REM percentage on both FNZ nights did not significantly differ from BN. The number of total REM and REM density were decreased in the FNZ2N compared to BN. Memory testing showed significant differences between before sleep and after waking on the FNZ2N. There was a significant correlation between the degree of impairment on memory testing and the rate of reduced REM density, but there was no significant correlation between degree of impairment on memory testing and the rate of increased non-REM sleep on the FNZ2N. The results of this study suggest that impairments in memory result from the dose of FNZ, and that there is a possibility of a relationship between memory disturbance and REM sleep suppression caused by this benzodiazepine.     

侧脑室注射cAMP和ATP对大鼠睡眠的影响

运用多导睡眠描记(PSG)观察了Wistar大鼠侧脑室注射环磷酸腺苷(cAMP)和三磷酸腺苷(ATP)对睡眠的影响。cAMP可使觉醒(W)减少,深慢波睡眠(SWS_2)、慢波睡眠(SWS)和总睡眠时间(TST)增加,SWS_2潜伏期缩短而发作频率增加,SWS发作频率降低而发作持续时间延长,但cAMP的作用仅持续1h。ATP引起的睡眠变化出现较迟,直到第4h才引起W减少和TST增加。结果表明中枢运用外源性cAMP不仅减少觉醒和增加慢波睡眠,还使睡眠加深、睡眠质量改善;ATP也有明显的促睡眠效应。提示中枢cAMP和ATP参与睡眠—觉醒周期的调节。     

Improvement in excessive daytime sleepiness after surgical treatment for obstructive sleep apnea syndrome

Abstract The author's goal was to investigate the effects of surgical treatment on psychophysiological measurements in 17 patients with obstructive sleep apnea syndrome (OSAS) and also to clarify the improvement process of each evaluation. Given the changes in respiratory disturbance and sleep architecture, it was obvious that surgical treatment had therapeutic effects on OSAS patients a few months after the surgery. In that process, a dissociation between objective and subjective sleepiness was observed. The improvement in objective sleepiness [multiple sleep latency test (MSLT)] was more delayed than the improvement in subjective sleepiness (Stanford Sleepiness Scale, Spaceaeromedicine fatigue checklist). The improvement of MSLT was associated with an improvement in sleep fragmentation. This finding suggests that the disruption of sleep continuity accompanied by respiratory disturbance might be responsible for the occurrence of objective sleepiness. It can be concluded that the effective management of OSAS needs to address the full range of psychophysiological manifestations, especially objective measurement of daytime sleepiness.     

Investigation into sleep disturbance of patients suffering from cluster headache

The new discoveries relating to cluster headache (CH) encouraged the study of the relationship of the hypothalamus to respiratory physiology and its comorbidity with sleep apnoea. The question is whether the apnoeas are more frequent during REM sleep and the desaturations could be involved as triggers of the cluster attacks. Furthermore, could the connection with the hypothalamus, already proved, be responsible for an alteration in the structure of REM sleep and a chemoreceptor dysfunction. We set out to analyse when polysomnography investigation is necessary in patients with CH. We studied 37 patients suffering from episodic CH, 31 (83.8%) men and six (16.2%) women. For the control group, we selected 35 individuals, 31 (88.6%) men and four (11.4%) women. There was a greater percentage of obstructive sleep apnoea (OSA) in patients with CH (58.3%) compared with the control group (14.3%) and with the general population (2-4%). In cases of pain during sleep, the majority is deflagrated during the REM phase, following a desaturation episode. A stratified analysis of the apnoea/hypnoea index relating to body mass index (BMI) and age showed that patients with CH have 8.4 times more chance of exhibiting OSA than normal individuals (P < 0001). This risk increases to 24.38 in patients with a BMI > 25 kg/m(2) and increases to 13.5 in patients > 40 years old. Surprisingly, the risk decreases sharply in patients with a BMI < 25 kg/m(2) and who are < 40 years old. Due to the fact that polysomnography is a complex, costly and sometimes difficult examination, we suggest, in concordance with the results, that it should be carried out routinely in patients with CH that exhibit a BMI of > 25 kg/m(2) and/or in patients who are > 40 years of age.     

Distraction osteogenesis and glossopexy for Robin sequence with airway obstruction

Background: We present six cases of infants with Robin sequence and severe obstructive sleep apnoea who failed treatment with nasal mask continuous positive airway pressure (CPAP). Surgical intervention with mandibular distraction osteoneogenesis with glossopexy meant tracheostomy was avoided. Polysomnography (PSG) was used to document the severity of the obstructive sleep apnoea. The aim of this report was to assess the value of mandibular distraction osteogenesis with glossopexy in children with Robin sequence using PSG preoperatively and post‐operatively. Methods: Retrospective review of medical records to assess details of preoperative clinical progress, CPAP therapy, endoscopy, PSG and respiratory parameters. Results: Between 2003 and 2008, 20 infants with Robin sequence were admitted to the neonatal intensive care unit of our tertiary paediatric hospital. Six infants (30%) failed a treatment trial of CPAP during that period, but were subsequently successfully managed with mandibular distraction osteoneogenesis and glossopexy. At endoscopy, all had associated airway problems which included congenitally hypoplastic epiglottis (n= 2), laryngomalacia (n= 2), unilateral choanal atresia (n= 1) and long‐segment tracheal stenosis (n= 1). Conclusion: Mandibular distraction osteogenesis with glossopexy provides relief of severe upper airway obstruction for infants with Robin sequence. Epiglottic maldevelopment was present in two infants (33%). Endoscopy and PSG assisted clinical management, but highlighted ongoing respiratory issues.     

鼾症对儿童睡眠结构及生长发育的影响

目的探讨原发性鼾症(PS)及阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对儿童睡眠效率(SE)、睡眠结构、呼吸事件及生长发育的影响。方法选择2007年12月-2009年7月因打鼾、张口呼吸、呼吸困难等来本院呼吸科及耳鼻喉科就诊的患儿122例,经多导睡眠监测分为PS组(58例)和OSAHS组(64例),对2组患儿的SE、睡眠结构、睡眠事件及生长发育情况进行统计学分析。结果OSAHS组患儿SE低于PS组(P<0.01);OSAHS组Ⅰ期、Ⅱ期睡眠百分比高于PS组,Ⅲ+Ⅳ期及快速动眼睡眠(REM)期睡眠百分比低于PS组(Pa<0.01);OSAHS组呼吸暂停总次数高于PS组(P<0.01);最长呼吸暂停时间OSAHS组明显延长(P<0.01)。二组低通气总次数比较差异有统计学意义(P<0.01),OSAHS组较多;二组最长低通气时间比较差异亦有统计学意义(P<0.01),OSAHS组较长;呼吸紊乱指数、氧减指数二组比较差异均有统计学意义(Pa<0.01),OSAHS组较高。二组患儿身高、体质量、体质量指数、颈围比较差异均无统计学意义(Pa>0.05),OSAHS组腺样体面容发生率较PS组显著增高(P<0.05)。结...     

Prevalence and Severity of Sleep Apnea in a Group of Morbidly Obese Patients

Background Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery. Methods In a cross-sectional study developed in Bahia, northeastern Brazil. 108 patients (78 women and 30 men) from the Obesity Treatment and Surgery Center - “Núcleo de Tratamento e Cirurgia da Obesidade” underwent standard polysomnography. Patients with an apnea-hypopnea index (AHI) ≥ 5 events/hour were considered apneic. Results Mean ± SD for age and BMI were 37.1 ± 10.2 years and 45.2 ± 5.4 kg/m2, respectively. The calculated AHI ranged widely from 2.5 to 128.9 events/hour. Sleep apnea was detected in 93.6% of the sample, wherein 35.2% had mild, 30.6% moderate and 27.8% severe apnea. Oxyhemoglobin desaturation was directly related to the AHI and was more severe in men. Conclusion There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request polysomnography, thus enabling therapeutic management and prognostication.     

Nocturnal hypoxia and sleep disturbances in cystic fibrosis

Disrupted sleep and nocturnal hypoxia are common in cystic fibrosis (CF). However, the predictors of nocturnal hypoxia in CF are still controversial. In order to identify the risk factors for nocturnal desaturation and sleep disturbances, we carried out a clinical and polysomnographic investigation of CF patients. We studied 30 clinically stable CF cases with clinical lung disease (mean age = 12.8; mean FEV1 = 65.2), 10 CF cases without significant lung disease (mean age = 13.3; mean FEV1 = 99.8), and 20 controls (mean age = 15.5). Patients were evaluated by spirometry, 6‐min walk test, the Shwachman–Kulczycki (S–K) score, and full overnight polysomnography. Cases with clinical lung disease had lower body mass index, forced vital capacity, and S–K scores. During sleep, five CF cases with clinical lung disease (15%) had SaO₂ <90% during more than 30% of total sleep time and 11 cases (36.6%) had a nadir SaO₂ below 85%. FEV1 values for CF cases with clinical lung disease were related to nadir SaO₂ (P < 0.03) and to mean SaO₂ (P = 0.02). A receiver operating characteristic (ROC) analysis determined FEV1 at 64% to be predictive of nocturnal desaturation as defined by minimum SaO₂ <85% (sensitivity = 92.3%; specificity = 77.3%) or SaO₂ <90% for 30% of sleep time (sensitivity = 81.8%; specificity = 85.2%). Frequency of impaired sleep was not different in CF cases with (N = 2) and without significant lung disease (N = 5, P = 0.53). Sleep architecture was not significantly different between the two groups. Sleep apnea was present in three CF cases with clinical lung disease and in one case without significant lung disease. In summary, desaturation during sleep can be predicted by FEV1 <64% with good sensitivity and specificity. There are no significant differences in sleep architecture between clinically stable CF cases with and without significant lung disease. Pediatr Pulmonol. 2009; 44:1143–1150. ©2009 Wiley‐Liss, Inc.