正压通气治疗对改良悬雍垂腭咽成形术后疗效的影响

目的 研究重度睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）患者行改良悬雍垂腭咽成形术（H-uvulopalato phargngoplasty,H-UPPP）术后短期应用持续正压通气（continuous positive airway pressure,CPAP）治疗对疗效的影响.方法 38例重度OSAHS患者分为两组,治疗组18例于手术后一周开始配戴CPAP治疗,平均应用34.3天.20例单纯行H-UPPP手术患者为对照组.两组患者于术后6个月行多导睡眠监测复查,并与术前进行比较.结果 治疗组及对照组术后6个月与术前PSG监测相比,AHI及夜间最低血氧饱和度明显改善（P＜0.001）;治疗组术后6个月与对照组术后6个月相比,夜间最低血氧饱和度明显升高（P＜0.001）,AHI之间的差异无显著性意义（P＞0.05）;睡眠结构中,治疗组的浅睡眠期和慢动眼睡眠期改变较对照组明显（P＜0.05）,而深睡眠期、觉醒指数及睡眠效率的改变无显著性意义（P＞0.05）.结论 改良UPPP术后行CPAP治疗可改善患者夜间低血氧的情况,使慢动眼睡眠期延长,减少浅睡眠期,对提高手术疗效有辅助作用.     

改良悬雍垂腭咽成形术远期疗效观察

目的 观察改良悬雍垂腭咽成形术治疗成人阻塞性睡眠呼吸暂停综合征的疗效.方法 通过对接受改良悬雍垂腭咽成形术的45例病人在术后6个月及18个月进行问卷调查及多导睡眠监测仪测试,对相关数据进行统计学处理.结果 术后6个月总有效率为91.1％,术后18个月总有效率为62.2％.结论 该术式近期疗效较好,但随着时间推移部分病例出现症状复发,其原因包括:手术切除的范围;术后体重的控制;术中对肥大舌体的处理.     

悬雍垂腭咽成形术与激光悬雍垂腭成形术的自我症状前瞻性长期随访对比分析

作者主要目的是对悬雍垂腭咽成形术(UPPP)和激光悬雍垂腭成形术(LUPP)患者的自我症状进行长期的评价对比,以了解两者的临床效果。     

改良悬雍垂腭咽成形术疗效评价

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)严重影响患者的生活质量,其发病率呈逐年升高趋势,目前已日渐受到重视。上呼吸道解剖形态异常是引起该病的重要致病因素,其中II型较常见,其狭窄部位多在口咽部,其手术效果相对较好[1]。改良悬雍垂腭咽成形术(Han-     

悬雍垂腭咽成形术中咽侧壁的成形

目的:探讨悬雍垂腭咽成形术(UPPP)中咽侧壁的成形方法。方法:治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)23例,采用以下方法处理咽侧壁:①保留腭舌弓。②松解腭咽弓与软腭交界处,将软腭游离缘的两端向前移位。③腭咽弓缘固定于扁桃体窝外侧壁,使腭咽弓黏膜面构成口咽腔光滑的外侧壁。观察手术的近、远期效果。结果:患者术后局部反应较轻,腭咽形态保持较好,随访1～5年,疗效满意。结论:咽侧壁的处理与成形是UPPP中的一个重要环节,重视对其处理可提高UPPP的疗效。     

改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征89例分析

目的探讨改良悬雍垂腭咽成形术(H-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法对89例患者行H-UPPP治疗,摘除双侧扁桃体,切除腭帆间隙脂肪组织,完整保留悬雍垂。结果患者术后症状改善明显,无误呛及进食反流等症状,患者术前及术后12个月多导睡眠图(PSG)监测结果各指标比较,差异具有统计学意义。结论 H-UPPP疗效确切,可有效防止腭咽关闭不全等并发症。     

改良悬雍垂腭咽成形术疗效的临床观察

目的:改进经典悬雍垂腭咽成形术(UPPP) 的手术方法,探讨保留悬雍垂的可行性和必要性。方法：全身麻醉下行保留悬雍垂的腭咽成形术,术中完整保留悬雍垂,切除腭帆间隙脂肪,提高软腭最高切点均在2.5?cm 以上。结果：完整保留的悬雍垂术后2周开始回缩,3个月后咽腔接近年轻状态,无腭咽关闭不全及再狭窄。主观问卷调查和PSG客观检测有效率为100%。结论：保留悬雍垂可提高软腭最高切点开大咽腔,扩大软腭鼻咽面和咽后壁间距并防止腭咽关闭不全,可明显提高UPPP手术疗效。     

改良腭咽成形术

目的改良腭咽成形术结合射频技术形成针对不同病态上气道形态的个性化术式。方法34例患者经多导睡眠监测(polysomnography,PSG)确诊为中或重度阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS);根据气道形态将传统腭咽成形术(uvulopalatopharyngoplasty,UPPP)改良为侧重扩大横径和扩大矢径两种术式,并选择性地进行局部射频消融。全部患者以治疗前后的PSG、咽腔测量数据及主观感觉等指标作对照。结果随访30例患者,术后6个月复查睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)值由54.7±18.2降至26.4±8.6(P﹤0.01),总有效率86.7%。结论改良腭咽成形术结合射频技术以气道形态改变为基础选择手术适应证,可明显提高疗效。     

持续正压通气治疗阻塞性睡眠呼吸暂停低通气综合征依从性问题研究

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是睡眠时上气道塌陷阻塞引起呼吸暂停及通气不足,伴有打鼾、睡眠结构紊乱、血氧饱和度频繁下降及白天嗜睡等病症.目前无创正压通气作为成人OSAHS患者的首选治疗,方法以持续正压通气(CPAP)最为常用,但依从性差仍是目前不容忽视的问题.相关分析研究显示CPAP治疗OSAHS患者依从性为30％～60％,影响了患者生活质量,同时增加合并心脑血管等全身疾病的风险.进一步探究CPAP依从性差的影响因素及积极采歇干预措施有助于提高CPAP的治疗效果及改善OSAHS患者的生活质量.     

远程睡眠医疗在阻塞性睡眠呼吸暂停低通气综合征中的应用

远程睡眠医疗是通过电子通信技术在不同地域站点间交换睡眠医学相关信息,促进患者健康的新型医疗模式,已广泛应用于失眠及白天嗜睡的患者,在阻塞性睡眠呼吸暂停低通气综合征患者中的应用已逐步开展,包括疾病监测、诊断治疗、健康教育及随访等方面,显示出良好的应用前景,在保证疗效的基础上补充患者就诊方式,减轻医疗负担。本文就远程睡眠医疗在阻塞性睡眠呼吸暂停低通气综合征中的应用现状进行综述。     

同期鼻腔扩容术联合改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征

目的探讨鼻腔扩容术同期联合改良悬雍垂腭咽成形术（Han—uvulopalatopharyngoplasty,H．UPPP）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapneahypopneasyndrome,OSAHS）的疗效。方法多道睡眠图（polysomnography,PSG）监测及临床检查确诊的OSAHS且阻塞平面为鼻腔及腭咽腔患者132例,同期行鼻腔扩容术和H．UPPP,术后6个月～1年复查PSG监测,观察联合手术治疗的效果。结果成功随访108例患者,有效率为83．33％（90／108）,术后患者夜间平均动脉血氧饱和度、血氧饱和度低于90％的时间占总睡眠时间的百分比、最低动脉血氧饱和度、Epworth嗜睡量表4个指标均较术前有明显改善（P〈0．01）;术后发生2例鼻腔出血,1例扁桃体窝出血,7例鼻腔粘连,未发生其他并发症。结论对存在鼻腔及腭咽腔平面狭窄的OSAHS患者,同期行鼻腔扩容联合H-UPPP,安全有效,可以作为此类患者的首选手术治疗方式。     

呼吸面罩内压力变化对咽气道容积的影响

目的研究呼吸面罩内压力变化对咽气道容积的影响,比较阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者组和正常对照组咽气道各节段容积及单位压力容积变化异同。方法采用螺旋CT从鼻咽顶部到声门区域进行连续扫描,经多道睡眠图(polysomnography,PSG)监测确诊的OSAHS患者33例和正常对照30例;改变呼吸面罩压力,重复扫描过程,测量咽气道容积和单位压力容积变化,比较两组异同。结果OSAHS患者组的咽气道容积和软腭后区、悬雍垂后区咽气道单位压力容积变化小于正常对照组。结论该方法可以实现咽气道容积和单位压力容积变化的定量评估;咽气道解剖性狭窄和扩张程度降低是OSAHS发病的主要因素。     

上气道CT测量在持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的意义

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的上气道形态学与多道睡眠图监测和自动持续气道正压通气（auto-CPAP）治疗数据的相关性。方法选择2015年6～12月北京同仁医院收治的34例OSAHS患者,采用螺旋CT连续扫描,在硬腭水平、悬雍垂尖水平、舌根水平和会厌水平测量平静呼吸时各区前后径和左右径,并予auto-CPAP治疗,分析相关性。结果上气道最窄平面在悬雍垂尖水平。AHI与平均血氧饱和度（mean SaO2,MSaO2）（r=-0.724）、下颌骨下缘至舌骨下缘（r=-0.755）和硬腭水平左右径（r=-0.404）负相关;最低血氧饱和度（lowest SaO2,LSaO2）与MSaO2（r=0.624）、身高（r=0.501）正相关,与舌后隙左右径（r=-0.468）负相关;auto-CPAP 90%有效治疗压力与体质量指数（r=0.406）正相关,与LSaO2（r=-0.384）和硬腭水平左右径（r=-0.367）负相关。结论上气道CT对预测OSAHS患者病情严重程度和auto-CPAP治疗压力有参考价值,尤其是硬腭水平左右径的狭窄明显影响AHI和CPAP治疗压力。     

OSAHS患者血液流变学变化的临床研究

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）是由于睡眠时上气道部分或完全阻塞,引起的呼吸暂停和通气不足,伴有打鼾、睡眠结构紊乱,频繁发生血氧饱和度下降、白天嗜睡等症状。它是一种具有潜在危险的常见病症,长期患病易诱发心脑血管方面的疾病。本研究观察55例OSAHS患者和36例正常人血流动力学的改变,探讨OSAHS患者病理生理改变的规律,进一步认识其影响全身情况的机制。     

Adherence to Continuous Positive Airway Pressure therapy in Singaporean patients with Obstructive Sleep Apnea

Purpose

To investigate the rates of Continuous Positive Airway Pressure (CPAP) uptake and adherence amongst Singaporean patients diagnosed with Obstructive Sleep Apnea (OSA), and to evaluate factors correlated with CPAP uptake and adherence.

Comparison of treatment modalities in syndromic children with Obstructive Sleep Apnea—A randomized cohort study

Introduction

Obstructive Sleep Apnea (OSA) is a common medical problem in adults that is becoming increasingly recognized in children. It occurs in the pediatric age group, from newborns to teens. More recently, many specialists have estimated OSA prevalence to be between 5 and 6%. However, in syndromic children, the prevalence of OSA can be from 50 to 100%, having a significant effect on their Quality-of-Life. As they are a challenging population for management, it is essential to evaluate them thoroughly before planning appropriate intervention.

Objective

To compare the efficacy of Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) in syndromic children [Down syndrome (DS) and Mucopolysaccharidoses (MPS)] with Obstructive Sleep Apnea (OSA).

Materials and methods

In a prospective, randomized, cohort comparative study, 124 syndromic children (DS and MPS) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society, Chennai. A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C) and Quality-of-Life (QOL) tool OSA-18. The children with positive PSG who consented for the study (n = 80) were randomly distributed to two groups, T&A group & CPAP group. The children were followed up with repeat PSG, clinical evaluation, ESS-C and Quality-of-Life (QOL) tool OSA-18 for a period of 1 year.

Observation and results

Follow-up was available for 73 syndromic children. Both the groups, T&A group and CPAP group, showed statistically significant (p < 0.05) improvement in Apnea-Hypoapnea Index (AHI), ESS-C, QOL from the intervention. In our study, T&A showed equal outcome compared to CPAP. The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year.

Conclusion

On average, T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children.     

The Impact of National Health Insurance Coverage on Compliance With Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea

Objectives. Compliance with positive airway pressure (PAP) in patients with obstructive sleep apnea (OSA) directly affects its treatment efficacy. Since July 2018, polysomnography and PAP therapy have been covered by the National Health Insurance (NHI), which has reduced the price barrier and promoted PAP therapy in Korea. This study aimed to compare changes in PAP compliance before and after NHI implementation.Methods. This study is a retrospective analysis in a tertiary hospital setting in Korea. From 2011 to 2019, patients with OSA (apnea-hypopnea index ≥5) treated using a PAP device for ≥1 month were included. They were classified as belonging to the pre-insurance (PI) group (having started PAP before July 2018) or the NHI group (having received a PAP reimbursement by the NHI service). We collected and analyzed medical records and PAP use information for between-group comparisons of compliance. We defined compliance as the percentage of usage days, the percentage of days with usage for ≥4 night hours, and average daily usage hours.Results. We included 146 and 100 patients in the PI and NHI groups, respectively. Automatic PAP mode and NHI were independent predictors of compliance B at the 3- and 9-month follow-up points. The NHI group showed significantly higher compliance A at 3, but not 9 months. For compliance B, the NHI group showed significantly higher compliance than the PI group at 1 month and 3 months, but not at 9 months. Compared with the PI group, the NHI group showed significantly higher compliance C only at 3 months.Conclusion. The NHI has positively affected PAP therapy in patients with OSA. Insurance policy may affect compliance within the first 3 months of PAP therapy.     

中重度阻塞性睡眠呼吸暂停低通气综合征患者低氧血症与肿瘤坏死因子-α相关研究

目的探讨中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者序贯治疗前后,夜间低氧血症与血清肿瘤坏死因子-α（tumornecrosisfactoralpha,TNF—α）水平的相关性。方法对44例中重度OSAHS患者检测低氧血症指标及血清TNF-α浓度后予以手术治疗。其中,27例患者先后行鼻平面手术和口咽平面UPPP,11例行UPPP,6例鼻平面手术。术后6个月复查血清TNF-α浓度及低氧血症指标,仍异常者采用持续气道正压通气（CPAP）治疗6个月后复查。另选择38例年龄、性别和体重指数（BMI）等均相匹配者作为对照。结果①OSAHS患者清晨与睡前血清TNF—α浓度变化值与低氧血症各指标密切相关;②OSAHS组患者术后6个月低氧血症指标仍异常者,TNF-α浓度变化值与低氧血症各指标相关性密切;③术后6个月低氧血症指标仍异常者,CPAP治疗6个月前后,低氧血症指标与TNF—α浓度变化值已无相关性。结论OSAHS患者清晨与睡前、手术治疗前后,血清TNF-α与低氧血症参数间存在相关性。术后联合CPAP的序贯治疗可进一步降低TNF-α浓度和低氧血症参数。