OSAHS呼吸事件发生与睡眠时相、体位的关系

目的:研究OSAHS患者呼吸事件发生与睡眠时相、体位的关系。方法:经多导睡眠监测确诊的100例OSAHS患者,按AHI分为轻度(22例)、中度(17例)、重度(61例)3组,分别比较各组快动眼睡眠期(REM)AHI、非快动眼睡眠期(NREM)AHI、仰卧位AHI、非仰卧位AHI等主要参数,REM相关的OSAHS定义为REM期AHI/NREM期AHI≥2,体位相关的OSAHS定义为仰卧位AHI/非仰卧位AHI≥2。结果:轻、中度组多为体位相关的OSAHS,分别为90.91%(20/22)和82.35%(14/17),显著大于重度组的31.15%(19/61)(P<0.05)。轻度组40.91%(9/22)、中度组23.53%(4/17)的患者为REM相关的OSAHS,明显大于重度组的4.92%(3/61)(P<0.05)。轻、中度组仰卧位AHI与AHI呈正相关(r=0.491、0.771,均P<0.05);重度组非仰卧位AHI与AHI、LSaO2呈显著相关性(r=-0.424、0.527,均P<0.01);重度组NREM AHI与LSaO2呈正相关(r=0.470,P<0.01)。结论:轻、中度OSAHS患者病情程度明显受睡眠时体位的影响,而重度OSAHS患者仰卧位和REM的时间明显少于轻、中度患者。     

不同睡眠期的阻塞性睡眠呼吸暂停低通气综合征严重程度

目的:普遍认为阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者快动眼睡眠期(REM)病情严重程度要比慢动眼睡眠期(NREM)重,通过对OSAHS患者REM期和NREM期临床及睡眠监测指标的比较分析,探讨不同睡眠期对OSAHS病情严重程度的影响.方法:回顾进行睡眠监测并诊断为OSAHS的118例患者,比较REM期睡眠呼吸暂停低通气指数(AHIREM)和NREM期AHI(AHINREM)的差别.并根据AHIREM和AHINREM将其分为2组:一组为AHIREM≥AHINREM组,另一组为AHIREM＜AHINREM组.比较2组在性别、年龄、体质指数(BMI)、病情严重程度、最低血氧饱和度(Min SaO2)及平均呼吸暂停时间的差别.结果:AHIREM和AHINREM比较差异无统计学意义(t=1.0,P≥0.05);AHIREM/ AHINREM为1.0±0.5;118例OSAHS患者中,AHIREM＜AHINREM组占55.9%;2组在性别、年龄、BMI、 AHI、仰卧位时AHI(AHIsupine)、Min SaO2和平均呼吸暂停时间比较差异均无统计学意义.结论:不同睡眠期的OSAHS病情严重程度差异无统计学意义.     

Increase of the apnoea–hypopnoea index after uvulopalatopharyngoplasty: analysis of failure1

From 70 patients who had uvulopalatopharyngoplasty (UPPP) operation and a pre‐ and postoperative sleep registration, we could retrospectively determine the failures and the correlation between variables such as age, gender, body mass index (BMI), earlier or concomitant tonsillectomy, unilevel (uvula–palate–tonsil) or multilevel (base of tongue as well) obstruction during sleep endoscopy and treatment outcome. From 70 patients, the preoperative sleep registration classified 15 social unacceptable snorers and 55 obstructive sleep apnoea syndrome (OSAS) patients. In this study we focused on the OSAS patients. From the 55 OSAS patients, 32 were classified as successful after UPPP, because they had a decreased apnoea–hypopnoea index (AHI) after surgery (≤20). Eight patients had a decreased AHI, but more than 20 apnoeas/hypnoeas per hour. Fifteen patients were identified as UPPP failures with an equal or increased AHI and/or subjective deterioration of snoring. We were unable to find a statistically difference between the two groups with respect to variables such as age, BMI and AHI preoperative (P > 0.56) as between the level of obstruction(s) (P > 0.24). For earlier or concomitant tonsillectomy we found a statistically difference (P > 0.039), but a very small number in the high failure group (n = 8). We conclude that although sleep endoscopy adds to better patient selection and better results, paradoxically, the finding of obstruction on palate–uvula level during sleep endoscopy can still give UPPP failures.     

A comparison of sleep nasendoscopy and the Muller manoeuvre

Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.     

Relationship of genioglossus muscle activation and severity of obstructive sleep apnea and hypopnea syndrome among Chinese patients

Conclusion: Variability of GGEMG at sleep onset is associated with apnea severity in OSA patients. At sleep onset, a lower decline in GGEMG might suggest a more severe OSA. Objective: The goal of this study was to evaluate genioglossus (GG) activation in the Chinese population at early sleep onset, and clarify the relationship of GG activation and the apnea severity in patients with Obstructive Sleep Apnea (OSA). Methods: Thirty-five OSA patients and 10 normal controls underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intra-oral electrodes. The upper airway (UA) anatomy was evaluated by three-dimensional computer tomography (3D-CT) in all subjects. Results: The average GGEMG and tonic GGEMG were higher in the apnea patients than in the normal controls during wakefulness and early sleep onset period (three breaths) (p?p?p?相似文献   

小REM期阻塞性睡眠呼吸暂停低通气综合征患者的临床特点及意义

目的探讨小REM（little REM sleep，REM＜20%）期阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS)患者的临床特点及意义。方法回顾性分析经多导睡眠监测（PSG）确诊的717例OSAHS患者，按REM （rapid eyes movement）期占总睡眠时间百分比将其分为A组522例（REM＜20%组）和B组195例（REM≥20%组），分别对各组年龄、体重指数（body mass index, BMI）、睡眠呼吸暂停低通气指数(apnea hypopnea index, AHI)、呼吸暂停指数（apnea index, AI）、低通气指数(hypopnea index, HI)、最低血氧饱和度（the lowest oxygen saturation，LSaO2）、氧减指数 (desaturation index, DI)、微觉醒指数（micro arousal index, MAI）进行比较。对引起小REM期的各参数进行二值Logistic回归分析。结果两组间年龄经比较无统计学意义（P＞0.05），其余各参数BMI、AI、HI、AHI、LSaO2、DI、MAI等A组均明显高于B组，logistic回归分析中显示，LSaO2（P=0.026，OR=1.038，95%CI［1.005-1.073］）、DI （P=0.047,OR=1.037,95%CI［1.000-1.075］）、 MAI（P=0.000,OR=0.887，95%CI ［0.833-0.943］）经比较均具有统计学意义（P均＜0.05）。结论小REM期OSAHS患者病情明显较正常REM期患者严重，反复低氧血症和觉醒是导致小REM期的主要原因.