胃食管反流病患者夜间反流与睡眠障碍情况调查

目的 研究胃食管反流病(GERD)患者夜间反流症状、睡眠障碍的发生率及相互关系.方法 全国51个城市的125家医院对7520例门诊GERD患者进行问卷调查.获得有效问卷7515份,男、女比例为1.36∶1.调查项目包括:GERD症状、夜间反流症状发生率、睡眠障碍的表现及夜间反流与睡眠障碍的关系.结果 GERD主要症状为烧心(88.3%)、反流(72.2%)、胸痛(37.6%)、上腹痛(35.5%)、咽部不适(30.4%)、咳嗽(12.1%)及哮喘(3.0%).7515例患者中,有夜间症状者4216例(56.1%),经内镜证实的糜烂性食管炎(EE)及非糜烂性胃食管反流病(NERD)患者夜间反流症状发生率分别为56.1%及53.1%,两者间差异无统计学意义(P＞0.05).有夜间反流症状者80.1%存在睡眠障碍,明显高于无夜间反流症状者的25.8%(P＜0.01).在睡眠障碍中,以睡眠质量下降和日间残留效应为多(分别为78.2%和70.1%),有夜间反流症状者,睡眠障碍病程发生在反流症状之后的占58.7%,明显高于发生在反流症状之前的21.5%(P＜0.01).有夜间反流的EE及NERD患者的睡眠障碍发生率分别为80.0%及77.1%,两者间差异无统计学意义(P＞0.05).在治疗GERD伴睡眠障碍方案中以质子泵抑制剂治疗为主(53.8%),其次为安眠药(24.5%),联合用药(9.5%).结论 GERD患者常有夜间反流症状及睡眠障碍,夜间反流可能是患者睡眠障碍的原因,治疗中应合并使用质子泵抑制剂.     

基于脑-肠轴学说探讨老年功能性消化不良患者睡眠障碍对焦虑抑郁和下消化道症状影响

背景功能性消化不良(functional dyspepsia,FD)是老年患者常见疾病之一,病情容易反复,严重影响患者身心健康.肠-脑互动异常是FD发病主要病因,大多伴有不同程度的睡眠障碍和焦虑、抑郁等负面心理.目前,对于老年FD患者与睡眠障碍和焦虑抑郁、下消化道症状的研究报道较少.目的基于脑-肠轴学说探讨观察老年FD患者睡眠障碍对焦虑抑郁和下消化道症状影响分析.方法选择2017-02/2019-09在我院就诊的236例老年FD患者为研究对象,课题负责人发放量表,对符合罗马Ⅳ标准的老年FD患者进行调查,评估其下消化道症状严重程度,睡眠质量和焦虑和抑郁评分变化情况.结果214例老年FD患者中存在睡眠障碍者103例(48.13%),存在焦虑、抑郁者182例(85.05%).有睡眠障碍老年FD患者的下腹痛发生率为35.92%,下腹不适(非疼痛)发生率为33.98%、羊粪样或硬便发生率为21.36%、用劲排便发生率为32.04%、排便不尽感发生率为43.69%和便急感的发生率为27.18%,均高于无睡眠障碍老年FD患者,差异比较均有统计学意义(P<0.05).有睡眠障碍的老年FD睡眠障碍患者焦虑自评量表评分为65.34分±7.29分,抑郁自评量表评分为66.17分±8.26分,均高于无睡眠障碍的老年FD患者(P<0.05).结论老年FD患者常同时存在睡眠障碍与焦虑、抑郁,睡眠障碍与老年FD患者的下消化道症状关系密切.     

地震后患者抑郁、焦虑及睡眠障碍发生状况的分析

对四川地震灾区伤病员进行抑郁、焦虑及睡眠障碍等精神心理问题评定,发现患者出现抑郁、焦虑症状的人数均占41.8%左右,睡眠障碍占73%,睡眠障碍与抑郁、焦虑症状密切相关.     

改善睡眠障碍有助于降血压

目的 研究治疗睡眠障碍对高血压患者血压的影响.方法 高血压同时有睡眠障碍患者261例在常规降压药物治疗基础上随机分为治疗组(132例)和对照组(129例),分别采用舒乐安定和安慰剂治疗,并观察睡眠障碍量表(SDRS)、汉密尔顿焦虑量表(HAMA)、治疗药物不良反应量表(TESS)以及患者血压的变化:坐位舒张压(SiDBP)和坐位收缩压(SiSBP)谷值与基线血压的变化、目标血压(＜140/90 mm Hg)达标率等.结果 舒乐安定对患者入睡困难的疗效明显,对早段失眠症状的减分比较明显,并能改善睡眠质量,延长睡眠时间,达到患者的生理睡眠要求.其有效率为66.7%,疗效优于安慰剂组(P＜0.01).同时舒乐安定也能显著降低HAMA分值,改善患者焦虑的症状,其疗效也优于安慰剂(P均＜0.05).随着睡眠、焦虑的改善,治疗组患者的血压[舒张压(DBP)和收缩压(SBP)]较对照组明显下降(P均＜0.05),目标血压(＜140/90 mm Hg)的达标率也显著高于对照组(P＜0.01).结论 舒乐安定治疗高血压患者睡眠障碍、焦虑有显著疗效.睡眠障碍可严重影响高血压患者的血压变化,改善患者的睡眠有利于改善患者的血压状态.     

普拉克索治疗帕金森病非运动症状的疗效观察

目的 探讨普拉克索对帕金森病非运动症状的影响.方法 对103例帕金森病患者进行回顾性分析,根据其服药情况分为普拉克索治疗组(51例)和非普拉克索治疗组(52例),比较2组各非运动症状的发生率.结果 普拉克索治疗组帕金森病伴发的抑郁、疼痛、下肢痉挛、不宁腿综合征和睡眠障碍的发生率显著低于非普拉克索治疗组(P＜0.05);而流涎、便秘、排尿障碍、性功能障碍、肢体发冷、认知障碍和嗅觉障碍等症状,2组发生率无显著性差异(P＞0.05);普拉克索治疗组出现的口干、头晕、体位性低血压、幻觉、嗜睡的发生率高于非普拉克索治疗组(P＜0.05).结论 普拉克索能减轻部分帕金森病非运动症状如抑郁、疼痛和双下肢不适等,但也可能加重某些帕金森病的非运动症状如口干、头晕和幻觉等.     

急性脑卒中并睡眠障碍患者的临床特点及其影响因素研究

目的分析急性脑卒中并睡眠障碍患者的临床特点,并探讨其影响因素。方法选取2014年5月—2015年5月长沙市第一医院神经内科收治的急性脑卒中患者285例,根据匹兹堡睡眠质量指数(PSQI)分为睡眠障碍组116例和非睡眠障碍组169例。比较两组患者的临床资料,包括性别、年龄、卒中类型(出血性脑卒中、缺血性脑卒中)、美国国立卫生研究院卒中量表(NIHSS)评分、既往史(高血压、冠心病、糖尿病等)、卒中部位(左半球、右半球)、并发症(肺部感染、尿路感染)等,分析急性脑卒中患者睡眠障碍的影响因素。结果 285例患者中出现睡眠障碍116例,睡眠障碍发生率为40.7%,包括出血性脑卒中51例和缺血性脑卒中65例。出血性脑卒中并睡眠障碍患者表现为睡眠过多者29例,入睡困难者13例,睡眠维持困难及早醒者6例,打鼾、多梦、睡眠倒错者3例;缺血性脑卒中并睡眠障碍患者表现为不同形式失眠者46例,睡眠过多者15例,其他类型睡眠障碍者4例。两组患者性别、年龄、卒中部位比较,差异无统计学意义(P0.05);睡眠障碍组患者NIHSS评分及出血性脑卒中、高血压、冠心病、糖尿病、肺部感染、尿路感染发生率高于非睡眠障碍组(P0.05)。多因素logistic回归分析结果显示,NIHSS评分15分〔OR=2.15,95%CI(1.65,5.85)〕、冠心病〔OR=1.55,95%CI(1.01,3.06)〕、肺部感染〔OR=1.86,95%CI(1.21,3.48)〕、尿路感染〔OR=1.53,95%CI(1.03,2.77)〕是急性脑卒中患者睡眠障碍的影响因素(P0.05)。结论急性脑卒中患者睡眠障碍发生率较高,其中出血性脑卒中患者睡眠障碍以睡眠过多为主,缺血性脑卒中患者睡眠障碍以失眠为主;NIHSS评分15分、冠心病、肺部感染、尿路感染是急性脑卒中患者睡眠障碍的影响因素。     

影响老年人记忆功能的危险因素

目的 探讨社区老年人记忆障碍及其影响因素.方法 随机选取唐山市社区老年人,应用行为记忆测验第2版(RBMTⅡ)和匹兹堡睡眠质量指数(PSQI)分别进行记忆功能和睡眠质量的测评.结果 647名老年人记忆障碍发生率78.5%,老年人记忆障碍的发生与年龄、性别、学历、职业性质、居住环境、身体状况、睡眠、参加社区活动等相关,高龄、女性、低学历、体力劳动者、居住环境差、身体状况差、睡眠障碍、不参加社区活动的老年人记忆功能的标准分评分较低(P＜0.05或P＜0.01).结论 老年人记忆障碍发生率较高,影响因素复杂.     

老年慢性心衰患者睡眠障碍原因分析及护理干预

目的调查分析老年慢性心衰患者睡眠障碍的主要原因,采取针对性的护理干预措施。方法选取我院2012年7月~2014年12月收治的慢性心力衰竭合并睡眠障碍患者63例作为研究对象,由护理人员与患者进行一对一的访谈式调查,在对患者一般资料进行回顾整理的基础之上,了解患者睡眠障碍的主要症状,并对患者出现睡眠障碍的主要原因进行调查分析。结果早醒症状的发生率为61.90%(39/63),明显高于其他项目数据,对比差异有统计学意义(P0.05)。睡眠障碍产生原因经调查,疾病因素、心理因素、环境因素、以及其他因素构成比例经对比,差异无统计学意义(P0.05)。结论疾病因素、心理因素、环境因素、以及其他因素均是造成慢性心力衰竭患者出现睡眠障碍的主要原因。针对以上原因,需要加强针对性的疾病护理,心理干预,通过改善环境,应用辅助睡眠方法的方式,提高护理干预的整体效果。     

某三级医院老年胃食管反流病患者夜间反流与睡眠障碍关系分析

背景胃食管反流病(gastroesophageal reflux disease, GERD)反流症状严重影响患者生活质量,日间反流明显,但反流时间较短,对生活质量影响较小;而夜间反流虽频率低,但持续时间较长,严重影响患者睡眠质量.因此, GERD夜间反流影响睡眠已成为临床医护人员研究的热点之一,也是当前急需解决的重要问题.目的观察某三级医院老年GERD患者夜间反流与睡眠障碍关系分析.方法选择2017-02/2019-08在浙江省金华市第二医院就诊的老年胃食管反流患者240例为研究对象进行调查,包括夜间反流症状发生率,睡眠障碍的表现及夜间反流与睡眠障碍的关系.结果240例老年GERD患者中无夜间反流者36例(15.0%),有夜间反流者204例(85.0%);过去1 mo内, 204例夜间反流GERD患者平均每周夜间反流发生次数≤1次者34例(16.67%), 2次者78例(38.24%),2次者52例(25.49%).36例无夜间反流症状者中9例(25.0%)存在睡眠障碍. 204例有夜间反流症状者204例(100.0%),均存在睡眠障碍,睡眠障碍发生率明显高于无夜间反流症状者,差异比较有统计学意义(P0.05). 77.94%的患者存在睡眠质量下降; 70.10%的患者存在日间残留效应; 55.88%的患者睡眠潜伏期延长;潜伏期延长时以入睡时间30-40 min为主; 53.92%的患者总睡眠时间缩短,多为4-5 h; 51.96%的患者存在睡眠维持障碍,每周夜醒4-7次. 204例GERD患者夜间反流有106例(51.96%)需要药物治疗,其中口服雷贝拉唑36例(33.96%),口服奥美拉唑20例(18.87%),口服西咪替丁片30例(28.30%),口服安眠药20例(18.87%),有效率达96.23%(102/106).结论夜间反流可能是影响老年GERD患者睡眠障碍的原因之一,在临床中应重视质子泵抑制剂的治疗.     

老年心血管病患者睡眠呼吸障碍和周期性腿动的研究

目的 探讨老年心血管病患者睡眠呼吸障碍和周期性腿动的患病情况和关系. 方法 采用RS-611床垫式睡眠呼吸监测系统在低生理负荷状态下对老年心血管病患者监测睡眠呼吸和肢体活动并分析. 结果 (1)31例平均年龄(76.4±7.2)岁,检出阻塞性睡眠呼吸暂停综合征(OSAHS)26例,夜间低氧血症27例,睡眠期周期性腿动(PLMS)12例.(2)男性呼吸暂停指数明显高于女性(14.1±9.1和7.2±3.5,P＜0.01);≥80岁组低通气指数(HI)明显高于＜80岁组(9.8±10.6和2.6±1.7,P＜0.01);夜间最低血氧饱和度(LO2)、平均血氧饱和度(AO2)明显低于＜80岁组[(76.4±8.3)%和(81.9±5.9)%、(92.6±2.2)%和(94.0±1.1)%,均P＜0.05].(3)患者年龄与HI呈正相关(r=0.392,P＜0.05),HI与LO2、AO2呈负相关(r=-0.410,-0.644,P＜0.05或P＜0.01).(4)PLMS组冠脉严重病变患者明显多于非PLMS组,超声左室射血分数、短轴缩短率明显低于对照组(均P＜0.05). 结论 老年心血管病患者OSAHS患病率高,程度随增龄加重,睡眠呼吸障碍以低通气为著.PLMS者多合并更为严重的冠脉病变和左室收缩功能减低.     

Validation of the nighttime symptoms score as a clinically relevant measure of allergic rhinitis.

The aim of this study was to validate the nighttime symptoms score (NSS), which incorporates individual scores for difficulty going to sleep and nighttime awakening caused by nasal symptoms and nasal congestion on awakening, as a clinically relevant measure of allergic rhinitis (AR). Fifty-five general season AR (SAR) symptom items were generated by interviews with 14 patients with symptomatic SAR without concomitant asthma for use in an Importance Rating Questionnaire (IRQ). A second group of patients (n = 83) with symptomatic AR without asthma rated the importance of each item on the IRQ. Correlation coefficients were calculated to examine the relationships between the six sleep quality questions on the IRQ and the other AR symptoms and between the symptom questions of the NSS, the Daytime Nasal Symptoms Score (DNSS), and the individual domains of the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ). The majority (94%) of patients with active AR reported some degree of symptoms relating to sleep quality. The six sleep quality items on the IRQ were selected by 71-84% of patients. The sleep quality items were more highly correlated with each other (r = 0.48-0.85) than with the four items of the DNSS (r = 0.01-0.42). There was a moderate-to-strong correlation of the RQLQ sleep domain with the two sleep questions of the NSS (r = 0.44-0.57). The individual symptom questions of the NSS and the DNSS were only moderately correlated with each other. Sleep quality questions measure aspects of SAR that are not captured by daytime SAR symptoms. The results show that the NSS is a valid and relevant clinical measure of the impact of nighttime sleep disturbance on AR patients.     

帕金森病非运动症状的临床分析

目的通过对帕金森病患者非运动症状发生率进行分析,探讨非运动症状的临床特征。方法采用"帕金森病非运动症状筛查量表"对146例帕金森病患者的非运动症状发生率进行排序,并结合临床类型、Hoehn-Yahr分期等因素对非运动症状进行分析。结果帕金森病非运动症状的总发生率为98.6%,其中便秘的发生率最高为82.9%,其次为睡眠障碍(66.4%)、小便障碍(63.7%)、记忆困难(57.5%)、性生活障碍(50.7%)等。非运动症状发生率随Hoehn-Yahr分期的增加而增加,差异有统计学意义(P0.01)。结论自主神经功能障碍是帕金森病最常见的非运动症状。Hoehn-Yahr分期与非运动症状发生率明显相关。     

Functional bowel disorders in rotating shift nurses may be related to sleep disturbances

OBJECTIVES: To compare the frequency and severity of bowel disturbances between rotating shift and regular day nurses and to determine whether functional bowel disorders (FBD) were related to sleep disturbances. METHODS: Sixty regular day and 58 rotating shift nurses answered three standardized questionnaires: the Gastrointestinal Symptom Questionnaire; the Hospital Anxiety and Depression Scale; and the Irritable Bowel Syndrome Symptoms Evaluation Questionnaire, which included the Sleep Questionnaire, on the frequency and severity of gastrointestinal symptoms, sleep disturbances and psychological distress. Responses to these questions were numerically rated and the sums of individual symptom scores under the respective categories were computed and analysed using statistical tests, as appropriate. RESULTS: Although 22 out of 58 rotating shift nurses (38%) had FBD, only 12 out of 60 regular day nurses (20%) had it (P=0.04). The mean FBD symptom score (P<0.002), sleep disturbance score (P<0.0001) and anxiety score (P<0.002) were all significantly higher among the rotating shift nurses. FBD symptom scores were positively correlated with the sleep disturbance (P=0.0001), anxiety (P=0.0001), depression (P=0.0001), well-being (P=0.0001), fatigue (P=0.0001), and somatic pain scores (P=0.0001). Sleep disturbance (P=0.04), decreased well-being (P=0.04), anxiety (P=0.02), and somatic pain (P=0.03) were independent predictors of FBD symptoms. CONCLUSION: FBD were more common and severe among rotating shift nurses. The FBD symptom score was positively and independently correlated with the sleep disturbance score, suggesting that poor sleep might be associated with increased FBD symptoms in rotating shift nurses.     

Characteristics of nighttime reflux assessed using multichannel intraluminal impedance pH monitoring and a portable electroencephalograph

Gastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances. Although the mechanisms of this association have not been fully elucidated, nighttime reflux plays a central role. However, the detailed characteristics of nighttime reflux occurring during sleep are unknown. The aim of the present study was to examine the characteristics and prevalence of nighttime reflux in the natural sleep environment of GERD patients. Seventeen patients experiencing daily moderate‐to‐severe heartburn and/or regurgitation were studied using multichannel intraluminal impedance pH monitoring and electroencephalography off‐proton pump inhibitor treatment. Nighttime reflux was divided based on reflux type (liquid or gas), acidity (acidic, weakly acidic, or alkaline) and extent (distal only or proximal migration) according to the standard criteria. Nighttime phases were divided as follows: recumbent‐awake before falling asleep, nonrapid eye movement, rapid eye movement, awakening from sleep, and post‐awakening in the morning. Among 184 nighttime refluxes, 43 (23%) occurred during recumbent‐awake before falling asleep, 28 (15%) during nonrapid eye movement, 14 (8%) during rapid eye movement, 86 (46%) during awakening from sleep, and 13 (7%) during post‐awakening in the morning. Liquid reflux was more common in awakening during sleep (92%), nonrapid eye movement (100%), and rapid eye movement (100%) compared with awakening before falling asleep (68%). The prevalence of proximal migration was significantly lower in nonrapid eye movement and rapid eye movement than in the other phases. There were no differences in acidity and bolus clearance time among the phases. Thirteen (65%) of 20 events with GERD symptoms had nighttime reflux, suggesting that only 7.1% (13 of 184) of nighttime refluxes were symptomatic. Nighttime reflux was observed in 48 (11%) of 425 awakening episodes during sleep. Different reflux patterns at each phase during nighttime might explain the pathogenesis of GERD and its related sleep disturbances.     

功能性消化不良就诊患者的人格特征研究

目的 使用通用、可靠的评估工具了解功能性消化不良(FD)就诊患者的人格偏离的类型和患病率,分析相互之间的联系.方法 246例FD患者纳入本研究,根据消化道症状的类型将患者分为4组,即单纯FD组、FD重叠反流样症状组(FD+RS组)、FD重叠肠易激综合征组(FD+IBS组),以及FD重叠反流样症状及肠易激综合征组(FD+RS+IBS组).使用人格诊断问卷4(PDQ-4)进行人格偏离筛查.结果 患者中160例(65%)被检出1种或1种以上的人格偏离,无明显性别差异,以焦虑和回避类为特征的C组人格(焦虑-抑制类)最为常见(142例,57.7%).FD+IBS组及FD+RS+IBS组患者的PDQ-4积分显著高于单纯FD组患者(23.39±8.77和24.22±10.97比18.98±11.88,P值均＜0.05),提示人格偏离程度较重患者的消化道症状倾向于涉及食管、胃、肠道等多器官.伴有反流样症状(而无病理性酸反流证据)对A组人格(奇特及怪僻类)有一定提示作用.结论 就诊的FD患者人格偏离较多见.较多负性情感、较低的应对压力能力、较少的社会支持等因素可能在FD患者的就医行为中起了重要作用.存在人格偏离的FD患者,消化道症状倾向于涉及食管、胃、肠道等多器官,而不是局限于消化道的某一部分.     

Sleep Disturbance Influences Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome

This analysis evaluated the association between sleep disturbance and gastrointestinal symptoms in women with and without irritable bowel syndrome (IBS), and examined the role of psychological distress in this relationship. Women with IBS (N = 82) reported considerably higher levels of sleep disturbance compared to controls (N = 35), using both retrospective seven-day recall and daily diary recall for two menstrual cycles (P < 0.05 on 8 of 10 measures). We used daily diary data to estimate the association between sleep disturbance and gastrointestinal symptoms, both across women (ie, whether women with high average sleep disturbance have higher average gastrointestinal symptoms) and within woman (ie, whether poorer than average sleep on one night is associated with higher than average gastrointestinal symptoms the following day). The regression coefficients for the across-women effect are large and highly significant in both groups (IBS, ± se = 0.46 ± 0.08, P < 0.001; controls, 0.57 ± 0.13, P < 0.001). The regression coefficients for the within-woman effect are considerably smaller and statistically significant only in the IBS group (IBS, 0.06 ± 0.02, P = 0.006; control, 0.01 ± 0.03, P = 0.691). These regression coefficients showed little change when daily psychological distress or stress was controlled for, the one exception being the coefficient for the across-women effect in the IBS group, which decreased substantially but still remained highly significant. Because it is possible that gastrointestinal symptoms could, in fact, cause poor sleep, we also fitted the temporally reversed model to evaluate the association between gastrointestinal symptoms on one day and sleep disturbance that night. The within-woman regression coefficients were nonsignificant in both the IBS and control groups. In conclusion, these results are consistent with the hypothesis that poor sleep leads to higher gastrointestinal symptoms on the following day among women with IBS.     

Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group

INTRODUCTION: As part of the baseline examination in the Cardiovascular Health Study, sleep disturbance symptoms including snoring and daytime sleepiness, were assessed as potential risk factors or precipitants of cardiovascular disease (CVD). Because of the association of sleep disturbance with poorer health and the possible associations of sleep apnea with CVD, we hypothesized that those with poorer sleep or daytime sleepiness may be at increased risk of mortality or incident CVD. SETTING: Participants (n = 5888) were recruited in 1989, with an additional minority cohort recruited in 1993, in four US communities for a cohort study designed to evaluate risk factors for cardiovascular disease. METHODS: An interview-administered questionnaire regarding health and sleep habits with ongoing ascertainment of total mortality and cardiovascular disease morbidity and mortality, including total CVD morbidity and mortality, incident myocardial infarction, and congestive heart failure. RESULTS: Daytime sleepiness was the only sleep symptom that was significantly associated with mortality in both men and women. The unadjusted hazard ratio was 2.12 (1.66, 2.72) in women and 1.40 (1.12, 1.73) in men. Men who reported difficulty falling asleep also had an increased mortality rate (HR = 1.43 (1.14, 1.80)) which was not seen in women. The risks were attenuated with adjustment for age but remained significant for daytime sleepiness in women (HR = 1.82 (1.42, 2.34)) and for difficulty falling asleep in men. (HR = 1.29 (1.03, 1.63)). Frequent awakenings, early morning awakening, and snoring were not associated with a significantly increased risk of mortality in these older men and women. Crude event rates were evaluated for total incident cardiovascular morbidity and mortality, incident myocardial infarction, and incident congestive heart failure (CHF). Incident CVD rates were higher in both men and women with daytime sleepiness. The aged adjusted HR was 1.35 (95% CI = 1.03, 1.76) in men and was 1.66 (95% CI = 1.28, 2.16) in women. Incident CVD was not higher in those with any other sleep disturbance including snoring. The risk of CVD events associated with daytime sleepiness was attenuated but remained significant in women after adjustment for age. Incident myocardial infarction (MI) rates were also higher in women with daytime sleepiness but were not significantly higher in men. Incident CHF rates were increased in both men and women with daytime sleepiness. In men, the age adjusted HR was 1.49 (95% CI, 1.12- 1.98) and in women, was 2.21 (95% CI, 1.64-2.98). Women reporting both daytime sleepiness and frequent awakening had a hazard ratio of 2.34 (95% CI, 1.66-3.29) for incident CHF compared with those with daytime sleepiness but without frequent awakening. This interaction was not found in men. CONCLUSIONS: In this study, daytime sleepiness was the only sleep disturbance symptom that was associated with mortality, incident CVD morbidity and mortality, MI, and CHF. These findings were stronger in women than men, i.e., the associations persisted for mortality, CVD, and CHF in women after adjustment for age and other factors. Thus, a report of daytime sleepiness identifies older adults at increased risk for total and cardiovascular mortality, and is an independent risk factor in women.     

阻塞性睡眠呼吸暂停综合征与脑血管病关系20年随访研究

目的 调查随访阻塞性睡眠呼吸暂停综合征(OSAS)与脑血管病的关系.方法 对1989年11月至2009年11月南京军区所属3市及地区军队和地方离退休干部休养所进行体检的人群进行随访调查,随访期间每年进行1次体检,检查血压、血脂、血糖、心电图及X线胸片等,发现存在脑血管病表现时行头颅CT检查,以发生脑血管病为随访终点,随访时间为20年.结果 共纳入患者1868例,年龄53～82岁,平均(63±6)岁,其中男956例,平均(65±7)岁,女912例,平均(60±6)岁.其中确诊OSAS者598例(32.0%),纳入OSAS组,其中男496例(82.9%),女102例(17.1%);其余为对照组.随访终点比较结果显示,OSAS组白天嗜睡、头痛、记忆力减退、痴呆及语言障碍等发生率明显高于对照组(P＜0.05).OSAS组276例(46.2%)发生脑血管病,对照组发生150例(11.8%)(P＜0.01).随访期间死亡患者817例,其中OSAS组396/598例(66.2%),对照组421/1270例(33.1%,P＜0.01).随访结束时OSAS组脑血管病患病率为276/598例(46.2%),对照组170/1270例(13.4%,P＜0.01).结论 OSAS患者发生脑血管病可能性较一般人群高,考虑OSAS与发生脑血管病存在相关性,提示OSAS可能是脑血管病的独立危险因素.

Abstract：

Objective To explore the correlation between obstructive sleep apnea syndrome (OSAS) and cerebrovascular disease(CVD). Methods A cohort of 1868 people was screened for OSAS,and followed from November 1989 to November 2009. Annual medical examinations including blood pressure,blood fat, serum glucose, electrocardiogram and chest x-ray were performed. Computer tomography was carried out when CVD, the endpoint of the study, was manifested. Results Among the 1868 elderly people, 598 ( 32.0% ) were confirmed to have OSAS, including 496 ( 82.9% ) males and 102 ( 17. 1% )females. Compared with the non-OSAS group, patients with OSAS had more symptoms including daytime somnolence, headache, decreased ability of memory, aphronesia and allolalia( P ＜ 0. 05 ). CVD occurred in 276(46. 2% )patients of the OSAS group, but in 150( 11.8% , P ＜ 0. 01 )subjects of the non-OSAS group.During the 20-year follow-up, 817 people died, 66. 2% (396/598) in the OSAS group, but 33. 1% (421/1270) in the non-OSAS group ( P ＜0. 01 ). Conclusion Patients with OSAS are more likely to suffer from CVD. OSAS may be an independent risk factor for CVD.