阻塞型睡眠呼吸暂停低通气综合征患者日间嗜睡、TNF-α水平及微觉醒的关系研究

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者日间嗜睡、TNF-α水平及微觉醒的关系.方法 选取多导睡眠图证实为OSAHS的男性患者40例(OSAHS组),另选择经多导睡眠图检查无OSAHS的健康者15例作为对照组.测定两组受检者血清中TNF-α水平,以Epworth嗜睡量表进行问卷调查并判断嗜睡评分.结果 OSAHS组血清TNF-α水平[(18.42±6.23)ng/L]较对照组[(9.75±3.12)ng/L]明显升高(P＜0.01),两组的嗜睡评分、微觉醒指数比较差异有统计学意义.OSAHS组血清TNF-α水平与微觉醒指数、嗜睡评分呈正相关(r值分别为0.373、0.461,P＜0.01),嗜睡评分与呼吸暂停低通气指数、微觉醒指数呈正相关(r值分别为0.443、0.751,P＜0.01).结论 OSAHS患者嗜睡评分、TNF-α、微觉醒指数升高.OSAHS相关的微觉醒对日间嗜睡的发生起了重要作用,TNF-α水平异常可能是造成睡眠呼吸紊乱的主要原因之一.     

Neurological symptoms in children with intussusception

Aim:  The classical combination of abdominal pain, vomiting, rectal blood loss and a palpable abdominal mass is only present in a minority of children with intussusception. Neurological signs and symptoms have been described, but are not a well understood phenomenon. We performed a retrospective study to ascertain the frequency and nature of these symptoms and to describe the characteristics of the patients presenting in this atypical way.
Methods:  The records of 58 children presenting with intussusception from 2003 to 2008 were reviewed for abdominal and neurological signs and symptoms, duration of symptoms and effectiveness of treatment.
Results:  In 10 out of 58 patients (17%), one or more neurological symptoms were recorded at presentation, with lethargy being the most frequent, followed by hypotonia and fluctuating consciousness. The patients with neurological abnormalities were significantly younger and presented with a shorter duration of symptoms. Therapy was more invasive, although not statistically significant, in this patient category.
Conclusion:  Intussusception should be considered in the differential diagnosis in young children presenting with lethargy, hypotonia and/or sudden alterations of consciousness even in the absence of the classical symptoms of intussusception.     

螺内酯致乏力和嗜睡

1例24岁男性继发性高血压病患者,为排除原发性醛固酮增多症而接受螺内酯的诊断性治疗,分别于午餐后、晚餐后、次日清晨口服螺内酯各20mg。第1次服药后约3h患者突然出现四肢乏力、眩晕、头痛,经卧床休息和吸氧,约30min后症状缓解。第2次服药后3h出现乏力。第3次服药后约2h上述症状复现并伴嗜睡,2h后自行缓解。停用螺内酯。5d后患者于晚餐后口服螺内酯20mg,服药后约2h以及次日清晨再现眩晕、乏力及嗜睡,后自行缓解。     

阻塞性睡眠呼吸暂停综合征对飞行员睡眠、情绪和主观生活质量的影响

目的探讨阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）对飞行员白天过度嗜睡（excessive daytime sleepiness,EDS）、情绪状态和主观生活质量（subjective qualityoflife,QOF）的影响。方法对经多导睡眠仪（polysomnography,PSG）监测诊断的54例OSAS飞行员和30例正常飞行员做人体测量、记录Epworth嗜睡量表评分（Epworth sleepinesss cale,ESS）、睡眠呼吸暂停生活质量指数（calgary sleep apnea quality of life index,SAQLI）和Zung抑郁自评量表（Zungself-rateddepression scale,SE,S）,将所获资料进行描述和均数比较。结果OSAS飞行员中76．6％超重,20．3％肥胖;28．1％存有白天嗜睡,对日常工作及生活有明显影响;41．7％的患者抑郁,抑郁症状与白天嗜睡及疲劳有明显关系。比较正常飞行员和不同程度OSAS飞行员的体质指数、颈围、呼吸暂停低通气指数（sleep apneah ypopnea index,AHI）、ESS、SAQLI和SDS评分,差异均有统计学意义（F=6．28～270．29,P〈0.01）;进一步分析发现,SAQu和AHI在正常和轻度患者之间差异有统计学意义（P〈O．01）,ESS在正常和轻度患者之间差异无统计学意义（P〉0．05）,而在正常和中重度患者之间差异有统计学意义（P〈O．01）。本研究12例OSAS歼击机飞行员中9例轻度,3例中度,经减轻体重,复测PSG参数和ESS评分正常,均飞行合格;42例OSAS运输机飞行员中13例轻度,飞行合格;15例中度,经减轻体重,PSG参数和ESS评分正常,飞行合格;14例重度,其中8例经减轻体重症状好转飞行合格,6例尚在治疗中。结论OSAS飞行员常伴有白天过度嗜睡和抑郁情绪,其主观生活质量较正常者明显下降。中度及重度OSAS飞行员应进行干预治疗。     

Avoidance of physical activity is a sensitive indicator of illness

Although fever and sickness behavior are common responses to infection, it has been proposed that the sickness behaviors associated with infection, in particular lethargy and fatigue, may be more valuable clinical markers of illness and recovery in patients, than is body temperature alone. Measuring abdominal temperature, food intake and wheel running we therefore determined the dose thresholds and sensitivities of these responses to lipopolysaccharide (LPS). Male Sprague-Dawley rats were randomly assigned to receive one of three LPS doses (10, 50, 250 μg/kg), or saline, subcutaneously. Administration of LPS induced a dose-dependent increase in abdominal temperature and decrease in wheel running, food intake and body mass. Regression analysis revealed that decreased running was the most-sensitive of the sickness responses to LPS administration, with a regression slope of − 41%/log μg, compared to the slopes for food intake (− 30%/log μg, F_(1,2) = 244, P = 0.004) and body mass (− 2.2%/log μg, F_(1,5) = 7491, P < 0.0001). To determine the likelihood that exercise training influenced the sickness responses we measured in our dose-response study we performed a second experiment in which we investigated whether fever and anorexia induced by LPS administration would present differently depending on whether rats had been exercising or sedentary. Six weeks of wheel running had no effect on the magnitude of fever and anorexia induced by LPS administration. Avoidance of physical activity therefore appears to be a more-sensitive indicator of a host's reaction to LPS than is anorexia and fever.     

Behavioral and physiological effects of a single injection of rat interferon-alpha on male Sprague-Dawley rats: a long-term evaluation

Interferon-alpha (IFN-alpha) is a cytokine used as a first line of defense against diseases such as cancer and hepatitis C. However, reports indicate that its effectiveness as a treatment is countered by central nervous system (CNS) disruptions in patients. Our work explored the possibility that it may also cause long-term behavioral disruptions by chronicling the behavioral and physiological disturbances associated with a single injection of vehicle, 10, 100, or 1,000 units of IFN-alpha in male Sprague-Dawley rats (n = 5/dose). Following 1 day of locomotor baseline collection, we monitored sickness behaviors (ptosis, piloerection, lethargy, and sleep), food and water intake, body weight, temperature, and motor activity. Observations were recorded 4 days prior to and 4 days following the IFN-alpha injection. Temperature and sickness behaviors were recorded three times daily at 9:00, 15:00, and 21:00 h, and all other indices, once daily. On the injection day, temperature values were highest in the animals receiving the 10-unit IFN-alpha dose 15 min and 13 h post-injection. In the case of sickness behaviors, a significant increase was observed in piloerection in all IFN-alpha groups at each time point measured, while the scores of the rats in the vehicle condition remained unchanged between pre- and post-injection days. Analyses of overall sickness behaviors during morning and night observation periods indicated increased scores in all IFN-alpha groups following injection. Cumulatively, these data suggest that a single IFN-alpha exposure may elicit long-term behavioral disruptions and that its consequences should be thoroughly investigated for its use in clinical populations.     

飞行员发作性睡病一例并文献复习

目的 提高对飞行员发作性睡病临床特征和诊断的认识. 方法 分析1例飞行员发作性睡病的临床资料及诊断并复习相关文献. 结果 本例临床表现为白天嗜睡、发作性猝倒、睡眠幻觉以及夜间睡眠紊乱,多次睡眠潜伏时间试验证实其平均睡眠潜伏时间为2.9 min,并出现3次睡眠始发快速眼动睡眠期,完全符合国际睡眠障碍性疾病分类第2版关于发作性睡病的诊断标准,并与文献报告一致.确诊后飞行结论为飞行不合格. 结论 发作性睡病在飞行员中极其罕见,诊断应谨慎.招飞体检和航医实践中应重视嗜睡症状,关注猝倒的特殊意义,增强对发作性睡病等少见睡眠疾病的诊断意识.     

夜尿对飞行人员夜间睡眠时间和白天嗜睡的影响

目的 探讨夜尿对飞行人员夜间睡眠时间、嗜睡评分以及白天精神状态的影响. 方法 采取整群抽样方法对1397名男性飞行人员进行问卷调查,回收1392份问卷.排除慢性疾病和其他可能导致睡眠时间变化和嗜睡的因素,研究对象510名飞行人员.根据“每夜因排尿必须醒来≥1次”的夜尿标准,对170名夜尿飞行人员(夜尿组)和340名非夜尿飞行人员(非夜尿组)的夜间睡眠时间和爱泼沃斯嗜睡量表(Epworth sleepiness scale,ESS)评分进行分析,并对夜尿与非夜尿组睡眠质量不良、白天困倦、精力不足和焦虑或抑郁的发生率进行比较. 结果 夜尿组夜间睡眠时间较非夜尿组更短(t=2.745,P＜0.01);夜尿组ESS评分(6.23±4.62)明显高于非夜尿组(4.01±3.87),差异具有统计学意义(t=5.377,P＜0.01).夜尿组睡眠质量不良、白天困倦、精力不足和焦虑或抑郁的发生率(23.53％、37.65％、12.35％和40.00％)均高于非夜尿组(10.88％、20.59％、5.59％和25.59％),差异具有统计学意义(x2=7.175～17.026,P＜0.01). 结论 夜尿可导致飞行人员夜间睡眠时间减少,白天嗜睡增加,可能对飞行操作和安全产生一定影响.建议航空卫生部门加强卫生宣教,重视其对飞行操作的影响,积极防治.     

Differences in the relative involvement of peripherally released interleukin (IL)-6, brain IL-1β and prostanoids in mediating lipopolysaccharide-induced fever and sickness behavior

Although peripherally released interleukin (IL)-6 is critical for fever, its role in sickness behaviors, in particular anorexia and lethargy, induced by lipopolysaccharide (LPS) administration appears to be less important. Using quantifiable measures of fever, anorexia and lethargy, that is, body temperature, food intake and voluntary wheel-running, we investigated whether the less-than-essential role for IL-6 in mediating sickness behaviors compared to fever implies important roles for other inflammatory mediators, particularly IL-1β and prostanoids, in these responses. Male Sprague-Dawley rats were randomly assigned to receive one of the following three injections before receiving a subcutaneous (SC) injection of LPS (250 μg/kg) or saline: (1) intraperitoneal injection of pre-immune serum or antiserum to IL-6 (IL-6AS), to reduce the biological activity of peripherally released IL-6; (2) intracerebroventricular injection of vehicle or a caspase-1 inhibitor, to inhibit the production of mature IL-1β; or (3) intraperitoneal injection of vehicle or one of the two doses (1 or 10 mg/kg) of diclofenac, a nonselective cyclooxygenase inhibitor shown to block the formation of prostanoids. LPS administration induced fever, anorexia and lethargy with an accompanying increase in IL-6 and IL-1β concentrations in the circulation and IL-1β in the brain. Rats pre-treated with: (1) IL-6AS had reduced plasma levels of bioactive IL-6, no fever and attenuated sickness behaviors; (2) the caspase-1 inhibitor had reduced concentrations of IL-1β in the pre-frontal cortex, hypothalamus and hippocampus, and attenuated fever and sickness behaviors; (3) diclofenac had a dose-dependent attenuation in fever and sickness behaviors. Doses of diclofenac which completely abolished fever however had lesser effects on anorexia and lethargy. Our results confirm a difference in the sensitivity of sickness responses to IL-6 antagonism and identify that it may be related to different levels of sensitivity or responsiveness in brain regions and/or mechanisms, to prostanoids, IL-1β, or IL-6 itself.     

阻塞型睡眠呼吸暂停低通气综合征患者日间嗜睡、TNF－α水平及微觉醒的关系研究

目的探讨阻塞型睡眠呼吸暂停低通气综合征（OSAHS）患者日间嗜睡、TNF—α水平及微觉醒的关系。方法选取多导睡眠图证实为OSAHS的男性患者40例（OSAHS组）,另选择经多导睡眠图检查无OSAHS的健康者15例作为对照组。测定两组受检者血清中TNF-α水平,以Epworth嗜睡量表进行问卷调查并判断嗜睡评分。结果OSAHS组血清TNF-α水平[（18．42±6．23）ng／L]较对照组[（9．75±3．12）ng/L]明显升高（P〈0．01）,两组的嗜睡评分、微觉醒指数比较差异有统计学意义。OSAHS组血清TNF-α水平与微觉醒指数、嗜睡评分呈正相关（r值分别为0．373、0．461,P〈0．01）,嗜睡评分与呼吸暂停低通气指数、微觉醒指数呈正相关（r值分别为0．443、0．751,P〈0．01）。结论OSAHS患者嗜睡评分、TNF-α、微觉醒指数升高。OSAHS相关的微觉醒对日间嗜睡的发生起了重要作用,TNF-α水平异常可能是造成睡眠呼吸紊乱的丰耍原因方一．