睡眠呼吸暂停低通气综合征与患者肱踝脉搏波传导速度的关系

Objective To explore the related factors for the measurement of arterial stiffness by brachial-ankle pulse wave velocity (baPWV) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods The blood pressure and baPWV in 76 patients with OSAHS confirmed by polysomnography (PSG) were measured.Clinical data were collected, and the carotid and extremity arteries were examined by ultrasound.Arterial intima thickening, atherosclerotic plaque formation and calcification,and the morphological changes of the arterial wall were evaluated.The related factors for baPWV in patients with OSAHS were analyzed.Results The baPWV was significantly higher in the severe OSAHS group as compared to the low-moderate group ( P ＜ 0.01 ), as classified according to the apnea hypopnea index and the lowest oxygen saturation.Multiple regression analysis showed that the baPWV of patients with OSAHS was related to age, oxygen desaturation index and systolic blood pressure ( F = 1.726 - 5.574, P ＜ 0.05 ).Conclusions Our study showed that with OSAHS exacerbations, the baPWV value increased.The haPWV of patients with OSAHS was related to age, oxygen desaturation index and systolic blood pressure.The abnormal changes of baPWV were present earlier than the morphological changes of atherosclerosis for OSAHS patients.     

阻塞性睡眠呼吸暂停低通气综合征合并夜间多尿患者尿动力学改变情况分析

目的 观察存在夜间多尿的OSAHS患者的尿动力学变化.方法 前瞻性纳入武汉大学人民医院2002年9月至2008年6月存在夜间多尿、并经多导睡眠监测(PSG)诊断的OSAHS患者,共入选患者23例,其中男19例,女4例,年龄46～81岁,中位年龄68岁.记录患者夜晚及持续气道正压(CPAP)压力滴定夜晚的夜尿次数、夜尿量、夜尿渗透压和尿钠浓度,于研究当夜11时和次晨7时留取静脉血测定脑钠肽及心房利钠肽(ANP)水平.同时对每位患者进行尿动力学检查,包括尿流率,充盈期膀胱压,压力-流率及尿道压测定,并在使用CPAP治疗3个月后再次进行尿动力学检查.结果 PSG检查结果显示,本组患者均存在中重度OSAHS,平均睡眠呼吸暂停低通气指数(AHI)为(48±15)次/h.OSAHS患者夜间尿量明显增多,尿钠浓度增加,尿渗透压降低,次晨7时ANP水平升高,CPAP治疗3个月后可恢复正常.患者行CPAP压力滴定当夜排尿次数明显少于PSG监测当夜排尿次数.尿动力学检查显示本组患者尿动力学主要特征是逼尿肌收缩无力、膀胱感觉迟钝、低顺应性膀胱、逼尿肌尿道外括约肌协同失调.CPAP治疗后,逼尿肌收缩力增强,并恢复膀胱顺应性.结论 CPAP可有效减少OSAHS患者的夜间多尿症状,OSAHS患者夜尿量增多、尿渗透压下降及尿钠浓度增高症状可能与ANP升高有关,OSAHS病程可能损害膀胱逼尿肌功能.CPAP治疗可减少ANP分泌,同时改善膀胱逼尿肌收缩力.

Abstract：

Objective To investigate the urodynamic changes in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and nocturnal polyuria. Methods From Sept. 2002 to Jun. 2008, 23 patients with nocturnal polyuria were diagnosed as having OSAHS by polysomnography(PSG). The number and output of nocturia, the osmotic pressure and the excretion of Na + were recorded during both the PSG night and CPAP titrating night. Plasma levels of brain natriuretic peptide (BNP) and atrial natriuretic peptides (ANP) were also measured at IIPM in the 2 nights and 7AM in the next mornings. Urodynamic studies including urine flow, bladder pressure during filling, pressure-flow study during voiding and urethral pressure were carried out in these patients. Urodynamic studies were performed again after treatment with CPAP for 3 months. Results PSG showed that the patients with nocturnal polyuria had moderate to severe OSAHS, in which the apnea-hypopnea index (AHI) being 48 ± 15 events per hour. The number of nocturnal voiding during the PSG night was more than that during the CPAP titrating night. During the PSG night, the output of nocturia, the nocturia excretion of Na+, ANP levels (at 7am in the next morning after PSG night)increased and the osmotic pressure of nocturia decreased. CPAP therapy could reverse these abnormalities.The main characteristics of urodynamics in these patients included weak detrusor contraction, hypoesthesia in filling cystometry, and decreased bladder compliance, and detrusor ex-ternal sphincter dyssynergia. After 3 months of CPAP treatment, both the myotility of the detrnsor of bladder and the bladder compliance improved. Conclusions CPAP therapy can effectively reverse the nocturnal polyuria in OSAHS patients. In OSAHS patients, the features of nocturia, including the changes of output, osmotic pressure and the excretion of Na+ , may be related to the secretion of high-level of ANP. During the course of chronic progressively OSAHS pathophysiology, detrusor function of bladder may be damaged. CPAP therapy could decrease the nocturnal excretion of ANP, and improve the myotility of the detrusor of bladder.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

老年2型糖尿病患者胰高血糖素对血糖、血压变化的反应

The response of glueagon to the change of glucose and its relation to blood pressure in 71 eidely patients with type 2 diabetes was investigated. The results showed that the postprandial increment of glucagon in the group of patients with postprandial 2h plasma glucose increment<2.5 mmol/L was significantly higher than that in the group with plasma glucose inerement≥ 2.5 mmoi/L (P<0. 05). The postprandial increment of glucagon in patients with normal blood pressure was significantly higher than that in patients with hypertension (P<0.05). The results suggest that the decreased response of glucagon to the change in plasma glucose in elderly patients with type 2 diabetes is related to increased blood glucose and high blood pressure.     

睡眠呼吸暂停低通气综合征与肱踝脉搏波传导速度的相关性

目的探讨睡眠呼吸暂停低通气综合征(OSAHS)患者与肱踝脉搏波传导速度(baPWV)相关性及其影响因素。方法收集OSAHS患者为OSAHS组,同期健康体检者对照组。分析影响OSAHS患者baPWV的相关指标。结果 OSAHS组baPWV值显著高于对照组(P<0.05)。在AHI或者最低SaO2重度组baPWV显著高于其轻中度组(P<0.05)。分析显示baP-WV与OSAHS组患者年龄、氧减指数、收缩压存在相关性(P<0.05)。结论 OSAHS患者与baPWV具有相关性,作为OSAHS患者动脉形态学改变即动脉粥样硬化早期无创检查baPWV存在明显变化,值得临床进一步应用研究。     

对比分析老年与中青年阻塞性睡眠呼吸暂停低通气综合征的临床特点

目的通过与中青年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者比较,探讨老年OSAHS患者的临床特点。方法随机选取161例OSAHS患者,按年龄分为老年组(≥60岁,n=72)与中青年对照组(23~59岁,n=89),对两组临床资料、睡眠多导图结果进行对比分析,并随访比较两组治疗方式的选择。结果老年OSAHS组睡眠呼吸暂停低通气指数(AHI)及最低氧饱和度、氧减饱和指数(ODI)较体质量指数相匹配的中青年组轻(P0.05)。老年OSAHS组的醒后收缩压高于中青年组,但其醒后舒张压、心率均低于中青年组(P0.05)。老年OSAHS醒后血压与AHI、ODI、微觉醒指数呈正相关。老年组选择外科手术及口腔矫治器的治疗率明显低于中青年组(P0.01),而选择持续气道正压通气治疗的比例两组间差异无统计学意义(P0.05)。结论老年OSAHS严重程度明显较中青年组轻。AHI、反复低氧及反复微觉醒可能与老年人醒后血压升高有关。老年OSAHS外科手术及口腔矫治器选择率低于中青年组。     

11O例老年阻塞性睡眠呼吸暂停低通气综合征患者多导睡眠监测及相关分析

目的 加深对老年患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)特点的认识,提高老年OSAHS诊治水平.方法 对我院睡眠呼吸障碍与鼾症诊治中心诊断的110例老年OSAHS患者的整夜多导睡眠图(PSG)监测资料进行回顾性分析,应用SPSS 18.0统计软件对患者的一般情况、睡眠结构、呼吸暂停和低通气情况、氧减饱和情况以及各指标间可能的相关关系进行统计分析.结果老年OSAHS患者中位快动眼相(rapid eye movement,REM)和非快动眼相(NREM)睡眠时间分别占2.17%和76.73%;中位觉醒指数为45.60次/h.呼吸暂停最长时间为(51.94±22.06)s,中位呼吸暂停平均时间为22.50 s,低通气最长时间为(47.06±12.52)s,低通气平均时间为(21.50±4.63)s.中位呼吸紊乱指数(respiratory disturbance index,RD1)为21.50,RDI 5～20者占46.40%,20～40者占31.80%,＞40者占21.80%.夜间平均血氧饱和度为(93.45±2.81)%,夜间最低血氧饱和度为(76.30±10.50)%,中位氧减饱和指数为31.65次/h.体质指数(BMI)与夜间最低血氧饱和度(r=-0.378,P＜0.01)和夜间平均血氧饱和度(r=-0.355,P＜0.01)呈负相关,与氧减指数呈正相关(r=0.338,P＜0.01);夜间最低血氧饱和度与阻塞性呼吸暂停最长时间(r=-0.47,P＜0.01)、阻塞性呼吸暂停平均时间(r=-0.31 6,P＜0.01)、低通气最长时间(r=-0.293,P＜0.01)和低通气平均时间(r=-0.277,P＜0.01)呈负相关.仰卧位睡眠时中位氧减时间间隔为2.36 min,左侧卧位睡眠时中位氧减时间间隔为11.54 min,右侧卧位睡眠时中位氧减时间间隔为12.45 min,左侧卧位和右侧卧位睡眠时中位氧减时间间隔均长于仰卧位(Z值分别为-6.12和-7.10,均P＜0.01).结论 老年OSAHS患者存在明显的睡眠结构紊乱和睡眠片段化.依据RDI对患者的病情分级,大多数OSAHS患者为轻、中度,但缺氧程度较重,缺氧严重度与BMI和睡眠呼吸事件的持续时间相关,侧卧睡眠时缺氧程度减轻.     

不同严重度阻塞性睡眠呼吸暂停低通气综合征女性血压影响因素分析

目的:探讨不同严重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)女性患者血压的影响因素。方法:将190例2009至2011年就诊于上海交通大学医学院附属瑞金医院睡眠中心的女性打鼾患者按睡眠呼吸暂停低通气指数(AHI)分成4组:非OSAHS组、轻度OSAHS组、中度OSAHS组和重度OSAHS组,比较这4组患者的一般特征、多导睡眠图(PSG)监测指标及血压的差异,并分析不同OSAHS严重度组血压影响因素。结果:非OSAHS组43例,轻度OSAHS组52例,中度OSAHS组30例,重度OSAHS组65例。随着AHI升高,各组血压值呈升高趋势。各组血压比较,重度OSAHS组收缩压与非OSAHS组比较有显著差异(P<0.05);重度OSAHS组舒张压高于非OSAHS组及轻度OSAHS组(P     

交感神经活性和血管内皮功能在阻塞性睡眠呼吸暂停低通气综合征合并高血压发病机制中的作用

目的探讨交感神经活性、血管内皮功能在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压发病机制中的作用。方法根据整夜多导睡眠监测（PSG）、血压测量和病史采集将93例患者分为：OSAHS血压正常组、OSAHS合并高血压组、高血压不合并OSAHS组和健康对照组。测定PSG当晚睡眠前后血压、血浆去甲肾上腺素、血浆内皮素和血清一氧化氮；收集PSG当晚22点至次晨6点的所有尿液送检尿3-甲氨基4-羟苦杏仁酸（VMA）。结果OSAHS组患者不论有无高血压，各指标变化为：晨起血浆去甲肾上腺素均显著高于睡前，OSAHS合并高血压组升高更明显；醒后去甲肾上腺素与醒后平均动脉压、睡眠呼吸暂停低通气指数（AHI）、氧减次数、氧减指数、睡眠期间血氧饱和度低于90％的时间占总睡眠时间的百分比（T90）呈显著正相关，与睡眠时最低血氧饱和度（minSaO2）和夜间平均血氧饱和度（MSaO2）呈显著负相关；醒后内皮素显著增高、一氧化氮明显下降，而另外两组则相反；醒后内皮素与醒后平均动脉压、AHI、最长呼吸暂停时间、呼吸暂停总时间、氧减次数、氧减指数、T90呈显著正相关，与minSaO2、MSaO2呈显著负相关；醒后一氧化氮与醒后平均动脉压、AHI、最长呼吸暂停时间、呼吸暂停总时间、氧减次数、氧减指数、T90呈显著负相关。与minSaO2、MSaO2呈显著正相关。各组间尿VMA无明显变化。结论在OSAHS患者夜间一过性血压升高和持续性高血压形成方面，交感神经系统活性增强、血管内皮功能紊乱导致的内皮源性舒、缩因子失衡可能起着重要的作用。     

基于Go/Nogo任务的重度OSAHS患者认知功能研究

目的 研究重度OSAHS患者认知功能的改变.方法 对25例重度OSAHS患者(重度OSAHS组)和年龄、性别、教育等方面与患者匹配的25名健康志愿者(正常对照组)进行基于Go/Nogo任务的行为学和事件相关电位分析.结果 重度OSAHS组患者年龄、性别、受教育时间、总睡眠时间、睡眠效率、REM期睡眠时间与正常对照组比较差异均无统计学意义.与正常对照组比较,重度OSAHS组体质量指数、N1期及N2期睡眠时间和呼吸暂停低通气指数升高,N3期睡眠时间减少,最低血氧饱和度降低,差异均有统计学意义(P值均＜0.05).重度OSAHS组对Go刺激的反应正确率低于正常对照组(t =2.049,P＜0.05);重度OSAHS组对Nogo刺激的正确率、反应时与正常对照组比较差异无统计学意义.重度OSAHS组FCz非靶N2波幅显著高于正常对照组(f=3.103,P＜0.05),重度OSAHS组FCz靶N2波幅与正常对照组比较差异无统计学意义.结论 重度OSAHS患者的持续注意能力降低,冲突监测功能可能存在损害.基于Go/Nogo任务的行为学及事件相关电位测试有助于早期发现重度OSAHS患者的认知功能异常.     

气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者脉压的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者脉压的变化及经鼻持续气道正压通气（nCPAP）的影响。方法选择85例经多导睡眠图仪（PSG）诊断的OSAHS患者，同时随机选取15例中重度OSAHS患者进行nCPAP治疗，在PSG监测前后及期间每2小时测量其血压，计算出脉压、脉压变化幅度、平均收缩压及平均舒张压，并计算体重指数。结果41％OSAHS患者同时合并有高血压；OSAHS合并高血压组患者的呼吸紊乱指数、脉压及体重指数明显高于单纯OSAHS患者，其最低血氧饱和度以及平均血氧饱和度均低于单纯OSAHS患者；重度OSAHS患者的脉压、体重指数、平均收缩压及平均舒张压均明显大于轻、中度OSAHS患者，而轻、中OSAHS患者之间差异无显著性意义。nCPAP可提高OSAHS患者最低血氧饱和度，同时降低其呼吸紊乱指数、平均收缩压、平均舒张压及脉压。相关分析结果表明，呼吸紊乱指数与脉压（r=0．395，P〈0．01）、平均收缩压（r=0．403，P〈0．01）、平均舒张压（r=0．313，P〈0．01）呈正相关，与最低氧饱和度（r=-0．424，P〈0．01）呈负相关，与体重指数、平均氧饱和度无相关。结论脉压是OSAHS的严重程度及是否并发高血压心血管事件的预测因子；nCPAP能下调OSAHS患者脉压及血压，是缓解OSAHS病情进展的有效治疗措施。     

Twenty-four-hour ambulatory blood pressure in children with sleep-disordered breathing

Obstructive sleep apnea causes intermittent elevation of systemic blood pressure (BP) during sleep. To determine whether obstructive apnea in children has a tonic effect on diurnal BP, 24-hour ambulatory blood pressure was obtained from 60 children with mean age of 10.8 +/- 3.5 years. Thirty-nine children had obstructive apnea and 21 had primary snoring. Children with obstructive apnea had significantly greater mean BP variability during wakefulness and sleep, a higher night-to-day systolic BP, and a smaller nocturnal dipping of mean BP. Variability of mean arterial pressure during wakefulness was predicted by the desaturation, body mass, and arousal indices, whereas variability during sleep was predicted by apnea-hypopnea and body mass indices. Nocturnal BP dipping was predicted by the desaturation index. There were no significant differences in systolic, diastolic, or mean arterial BP during sleep between the groups. Diastolic BP during wakefulness was significantly different between the groups and correlated negatively with apnea-hypopnea index. We conclude that obstructive apnea in children is associated with 24-hour BP dysregulation and that, independent of obesity, the frequency of obstructive apnea, oxygen desaturation, and arousal contributes to abnormal BP control.     

阻塞性睡眠呼吸暂停低通气综合征患者自动正压通气治疗压力值的影响因素分析

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者自动正压通气(Auto-PAP)治疗压力值的相关影响因素,归纳压力预测值的回归函数.方法:选取于我院通过多导睡眠监测(PSG)符合OSAHS诊断并行自动压力滴定治疗的患者101例,回归性分析患者Auto-PAP滴定的90％治疗压力值(P90)与年龄、体重指数、颈...     

急性低氧及高二氧化碳刺激对阻塞性睡眠呼吸暂停低通气综合征患者外周动脉硬度及血压的影响

目的 探讨急性低氧及高CO2刺激对OSAHS患者外周动脉硬度和血压的影响.方法 选取2006年1月至12月到北京大学人民医院睡眠中心进行多导睡眠呼吸生理监测者,试验组包含呼吸暂停低通气指数(AHI)≥10次/h的OSAHS患者28例,男22例,女6例,平均年龄(40±14)岁;对照组包含26名AHI<5次/h的健康志愿者,男20名,女6名,平均年龄(40±15)岁,均排除高血压、糖尿病、冠状动脉粥样硬化性心脏病及其他心、肺、血管疾病.两组均按相同方法测定四肢血压及心脏-踝血管指数(CAVI),以清醒平卧休息时为基础值,通过重复呼吸法利用特制的密闭呼吸回路分别进行急性高CO2、低氧、低氧合并高CO2吸入刺激,每次刺激结束后立即重复测定四肢血压及CAVI值.计数资料的对比采用χ2检验,多组间比较采用单因素方差分析,组间两两比较采用t检验.结果 两组间基础状态下收缩压、舒张压、平均压及CAVI值比较差异均无统计学意义(t值分别为1.720、1.891、1.828及0.103,均P>0.05).给予高CO2刺激后两组CAVI均呈下降趋势,但试验组[(7.3±1.2)m/s]下降的程度与基础状态[(7.3±1.3)m/s]比较差异无统计学意义(t=0.333,P>0.05),对照组[(7.0±1.4)m/s]出现明显下降(t=2.587,P<0.05);两组的收缩压均明显升高.给予低氧刺激后两组CAVI均呈升高趋势,试验组[(7.3±1.1)m/s]改变不明显,对照组[(7.6±1.6)m/s]明显升高,差异有统计学意义(t=-3.882,P<0.01),血压没有明显改变(t值分别为-0.434及-0.400,均P>0.05).给予低氧合并高CO2刺激后两组CAVI均呈升高趋势,对照组[(7.5±1.7)m/s]明显升高,但程度较单纯低氧刺激时低,血压的改变与单纯高CO2刺激时类似.结论 CO2升高及低氧均可影响外周动脉硬度.OSAHS患者对低氧和高CO2刺激的反应性明显低于健康对照组.