阻塞性睡眠呼吸暂停低通气综合征伴发肥胖低通气综合征23例诊治分析

本文研究安阳地区医院23例肥胖低通气综合征(OHS)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者资料,报告如下。1资料与方法1.1研究对象2007-2011年我院23例OHS合并OS-AHS患者,男21例,女2例,年龄38～68岁,平均45.6岁。1.2方法经整夜多导睡眠图(PSG)检查,符合OSAHS诊断标准。OHS诊断标准:BMI≥30kg/m2,存在慢性肺泡     

急性脑梗死患者的阻塞性睡眠呼吸暂停低通气综合征临床分析

目的 本研究初步探讨了急性脑梗死合并阻塞性睡眠呼吸暂停低通气综合征的临床特点.方法 评价19例连续收住的首次、非昏迷急性脑梗死患者和同期10例健康成人的年龄、性别、体重指数(BMI)、睡眠打鼾史、高血压病史、吸烟史、饮酒史、动脉血压,研究组还记录入院时和7d时斯堪的纳维亚卒中量表得分(SSS),使用多导睡眠监测系统记录睡眠过程中的多项生理事件,评价AHI和最低动脉血氧饱和度(SaO2).结果 急性脑梗死后74%患者有阻塞性或混合性睡眠呼吸暂停,63%的急性脑梗死患者出现了具有临床意义的睡眠呼吸暂停,AHI与患者年龄、BMI、最低SaO2、睡眠打鼾史、吸烟史、高血压、SSS有关,呼吸事件主要为阻塞性或混合性睡眠呼吸暂停,中枢性睡眠呼吸暂停在所有呼吸事件中约占8%.既往有心脏病史的患者甚至会出现Cheyne-Stokes呼吸.结论 应重视评价急性脑梗死患者OSAHS发生的可能性,对于病情重、存在多种脑血管病危险因素的患者更应作为常规评价的一部分.     

阻塞性睡眠呼吸暂停低通气综合征患者的心理特征

<正>阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopea Syndrome,OSAHS)是一种以睡眠中反复出现的上气道狭窄或阻塞导致的频繁低通气和/或呼吸暂停为特征的睡眠紊乱,常伴有明显的鼾声。呼吸暂停引起血氧饱和度下降,交感神经活性增强,心率和血压波动,进而出现皮层微觉醒和睡眠片断化[1]。由于夜间睡眠质量下降,患者常表现明显的嗜睡、疲劳感、注意力不集中和记忆力下     

老年阻塞性睡眠呼吸暂停低通气综合征的临床特点与护理

本文通过对62例60岁以上老人阻塞性睡眠呼吸暂停低通气综合征的临床观察与护理,总结了老年阻塞性睡眠呼吸暂停低通气综合征临床特点与护理措施如下.     

伴中重度阻塞性睡眠呼吸暂停低通气综合征的抑郁症患者多导睡眠监测特点

目的 探讨伴中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的抑郁症患者多导睡眠监测（PSG）特点。方法 回顾性分析2017年12月-2019年10月在苏州市广济医院睡眠医学中心完成整夜多导睡眠监测（PSG）的门诊和住院患者以及健康体检人群,从中筛选出四组被试,分别为伴中重度OSAHS的抑郁症患者（n=31）、不伴OSAHS的抑郁症患者（n=79）、中重度OSAHS患者（n=96）和正常对照组（n=32）。比较四组被试睡眠进程相关指标（总睡眠时间、睡眠潜伏期、觉醒次数）和睡眠结构相关指标（N1、N2、N3期及REM期占总睡眠时间的比例,REM潜伏期、REM期持续时间）以及睡眠呼吸相关指标（氧减指数）等参数。结果 睡眠进程方面,四组被试总睡眠时间、睡眠潜伏期和觉醒次数差异均有统计学意义（F=2.874、3.959、12.291,P<0.05或0.01）。睡眠结构方面,四组被试N2期、N3期占总睡眠时间比例差异均有统计学意义（F=13.885、48.013,P均<0.01）;四组被试REM潜伏期、REM期持续时间、REM期占总睡眠时间比例差异均有统计学意义（F=41.492、11.827、10.552,P均<0.01）。睡眠呼吸相关指标方面,四组被试氧减指数差异有统计学意义（F=170.585,P<0.05）。结论 伴中重度OSAHS的抑郁症患者存在严重的睡眠进程和结构紊乱,同时伴有更频繁和更严重的呼吸相关事件。     

阻塞性睡眠呼吸暂停低通气综合征对急性脑梗死患者认知功能的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)对急性脑梗死患者认知功能的影响,为血管性认知障碍的早期防治提供依据。方法对经头颅CT或MRI证实的急性脑梗死患者(41例,男21例,女20例)均进行多导睡眠图(polysomnogram,PSG)、简易智能筛查(mini-mental state examination,MMSE)、画钟试验(clock drawing task,CDT)、词语流畅试验(verbal fluency test,VFT)、听觉事件相关电位(P300)检测。结果 41例患者完成所有检查。MMSE评分27分者27例(65.85%),CDT评分4分者19例(46.34%),VFT评分15分者16例(39.02%)。依PSG检查结果分为OSAHS组(21例),非OSAHS组(20例)。OSAHS组MMSE、CDT分值低于非OSAHS组,两组比较无统计学差异(P0.05),亚组分析显示中-重度OSAHS组MMSE、CDT得分为23.67±5.12,2.67±1.53,非OSAHS组为24.85±3.15,3.1±1.2,两组比较有统计学差异(P0.05)。P300检查显示与非OSAHS组比较OSAHS组FZ、CZ、PZ潜伏期明显延长,FZ、CZ潜伏期比较有统计学差异(P0.05),中重度OSAHS组较非OSAHS组PZ潜伏期显著延长(P0.005)。各组P300的波幅无统计学差异(P0.05)。结论 OSAHS可加重急性脑梗死者的认知功能障碍,且与其严重程度相关。P300检查较MMSE、CDT更敏感。     

原发性癫痫合并阻塞性睡眠呼吸暂停低通气综合征的临床特点

目的探讨原发性癫痫合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床特点。方法回顾性分析2007-06-2014-06在我院确诊的16例原发性癫痫合并OSAHS患者的临床资料(包括病史、多导睡眠脑电图及治疗随访)。结果癫痫形式表现为全面强直阵挛发作13例,部分性发作3例,其中夜间发作11例,白天发作5例;多导睡眠脑电图(polysomnography,PSG)显示均为阻塞性睡眠呼吸暂停低通气综合征(OSAHS),其中重度9例,中度4例,轻度3例。所有患者经抗癫痫药物治疗及OSAHS的指导性治疗。其中4例癫痫伴重度OSAHS经单纯药物治疗仍反复发作,联合丙戊酸钠和经鼻持续气道正压通气(CPAP)治疗,随访0.5~3a,发作频率减少3例,发作停止1例。结论原发性癫痫合并OSAHS一般以中老年男性多见,癫痫类型以夜间全面强直阵挛性发作为主,对于单纯抗癫痫药物治疗不佳者,药物联合CPAP治疗可取得明显效果。     

阻塞性睡眠呼吸暂停低通气综合征与高血压之间关系的研究进展

【摘要】 阻塞性睡眠呼吸暂停低通气综合征与高血压关系密切,可能是某些继发性高血压的主要病因之一,对合并阻塞性睡眠呼吸暂停低通气综合征的高血压患者采取综合性治疗对控制高血压及心脑血管病可能有益处。     

伴有惊恐障碍的阻塞性睡眠呼吸暂停低通气综合征睡眠结构特征

目的 分析阻塞性睡眠呼吸暂停低通气综合征合并惊恐障碍(obstructive sleep apnea syndrome com?bined with panic disorder,OCP)患者的睡眠结构特征,探讨OCP睡眠结构变化在临床上的意义.方法 纳入25例OCP患者、29例阻塞性睡眠呼吸暂停低通气综合征(obst...     

阻塞性睡眠呼吸暂停低通气综合征患者的人格心理特征及社会功能的相关分析

目的调查分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的人格心理特征。方法参考多导睡眠监测(PSG)结果,将确诊的60例OSAHS患者和30例单纯鼾症患者(对照组)纳入本研究,采用Epworth嗜睡程度量表(ESS)和多次小睡潜伏期测验(MSLT)评价患者的日间嗜睡情况,采用明尼苏达多相人格量表(MMPI)评估患者的人格心理状况;采用简明健康状况调查表(SF-36)、疲劳量表(FS-14)、注意缺陷量表分别评价患者生活质量、疲劳程度、注意缺陷程度。结果①与对照组相比,OSAHS组MMPI疑病分量表(Hs)平均得分更高[(56.0±9.1)vs.(52.0±6.6),P0.05],高T分临床分量表(T分数60分)的平均个数更多[(2.4±2.1)vs.(0.6±1.0),P0.01],OSAHS组Hs、Hy、Pd、D、Pt、Sc分量表T分数得分60分的患者例数高于对照组(P0.05或0.01)。②MMPI测图中高T分分量表数≥4的患者(残疾组)SF-36总分和各维度平均分均低于高T分分量表数=0的患者(正常组),FS-14、注意缺陷平均分高于正常组;2≤高T分分量表数≤3的患者(中度异常组)SF-36总分和大部分维度平均分低于正常组,注意缺陷平均分高于正常组。③在所有受试者中,MMPI总平均分与总睡眠时间(TST)、总微觉醒指数(TAI)、SF-36总分及各维度平均分呈负相关(P0.05或0.01),与FS-14、注意缺陷平均分呈正相关(P0.01)。结论与单纯鼾症患者相比,OSAHS患者表现了更多的疑病、抑郁、癔症、精神病态行为、精神衰弱和精神分裂症等人格心理问题。OSAHS患者和单纯鼾症患者的夜间睡眠时间、睡眠的连续性和白天功能可能受到其心理症状严重程度的影响。     

Association between mild or moderate obstructive sleep apnea-hypopnea syndrome and cognitive dysfunction in children

BackgroundChildhood obstructive sleep apnea–hypopnea syndrome (OSAHS), the most common sleep-related breathing disorder, may lead to cognitive impairment. This study aims to investigate the association between mild or moderate childhood OSAHS and cognitive dysfunction.MethodsA total of 59 children (4–12 years of age) diagnosed with mild or moderate OSAHS by polysomnography and 60 age-  and sex-matched healthy children were included in the study. The China-Wechsler Younger Children Scale of Intelligence and China-Wechsler Intelligence Scale for Children were used to evaluate the cognition of the participating children aged <6 years and ≥6 years, respectively.ResultsIn the <6-years-old subgroup, children with OSAHS had significantly lower scores of full-scale IQ (FIQ), verbal IQ (VIQ), comprehension test, and visual analysis than the healthy children (all p < 0.05). In the ≥6-years-old subgroup, VIQ and classification test scores were significantly lower in children with OSAHS than in the healthy controls (all p < 0.05). FIQ, VIQ, and performance IQ (PIQ) scores did not correlate with AHI, OAHI, and the lowest nocturnal SO₂. Notably, in the <6-years-old subgroup of OSAHS, the accumulated time of SO₂<90% (p = 0.046) and the percentage of the accumulated time of SO₂<90% in the total sleep time (p = 0.034) correlated with PIQ negatively and significantly.ConclusionsMild to moderate childhood OSAHS may adversely affect cognitive function, particularly in young children (<6 years of age). This study may increase the awareness of childhood OSAHS-associated cognitive dysfunction and advocate early interventions in childhood OSAHS.     

阻塞性睡眠呼吸暂停低通气综合征及脑卒中与认知功能障碍的关系

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是脑卒中的危险因素,脑卒中患者合并阻塞性睡眠呼吸暂停在流行病学上也远远高于普通人群的发病率.OSAHS及脑卒中都可以发生认知功能障碍,两者并存有可能加剧患者认知功能障碍程度及影响恢复,研究和了解OSAHS对卒中后认知功能的影响,对卒中相关认知障碍的防治有着重要的意义.     

脑血管病与阻塞性睡眠呼吸暂停综合征的关系

目的研究脑血管病与阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的关系。方法对比分析年龄、性别和体重指数均匹配的脑血管病（ＣＶＤ）患者和正常对照各３０例的多导睡眠图。结果发现ＣＶＤ组ＯＳＡＳ发病率高达７０％（对照组２０％，Ｐ＜０．０１），其收缩期血压，低氧时间、平均和最低血氧饱和度以及中枢性呼吸暂停次数均与对照组差别显著。结论认为ＯＳＡＳ是ＣＶＤ被忽视的危险因素，但不排除ＣＶＤ诱发了ＯＳＡＳ的可能，两者形成恶性循环，影响ＣＶＤ康复     

血浆同型半胱氨酸在阻塞性睡眠呼吸暂停低通气综合征和脑梗死关系中的作用

目的探讨血浆同型半胱氨酸在阻塞性睡眠呼吸暂停低通气综合征和脑梗死关系中的作用。方法采用荧光偏振免疫分析检测法测定38例阻塞性睡眠呼吸暂停低通气综合征（Obstructivesleep Apnea-Hyperpnoea Sydrome,OSAHS）、40脑梗死、39例OSAHS合并脑梗死患者和42例正常对照者血浆中同型半胱氨酸水平。结果OSAHS、脑梗死和OSAHS合并脑梗死组的血浆Hcy水平明显高于正常对照组（P〈0．05）;OSAHS合并脑梗死组血浆Hcy高于脑梗死组和OSAHS组（P分别〈0．01和0．05）。结论OSAHS患者血浆Hcy水平增高可能是导致其脑梗死发生的原因之一。     

阻塞型睡眠呼吸暂停综合征患者情绪障碍的研究进展

在临床中睡眠呼吸暂停综合征患者患抑郁、焦虑的概率较高,而且同时患有抑郁、焦虑及OSAS的患者比仅患有OSAS患者病情更重。尽管许多研究评估了OSAS与情绪障碍间的关系,OSAS及情绪障碍之间一些可能的因果机制也已被提出,但是OSAS在情绪障碍的因果关系仍不清楚。对于OSAS伴焦虑抑郁状态的患者,情绪障碍的干预治疗有助于改善OSAS患者的嗜睡、疲劳症状及认知功能,提高患者生活质量。     

Explainable fuzzy neural network with easy-to-obtain physiological features for screening obstructive sleep apnea-hypopnea syndrome

Objective/backgroundRecently, several tools for screening obstructive sleep apnea-hypopnea syndrome (OSAHS) have been devised with varied shortcomings. To overcome these drawbacks, we aimed to propose a self-estimation method using an explainable prediction model with easy-to-obtain variables and evaluate its performance for predicting OSAHS.Patients/methodsThis retrospective, cross-sectional study selected significant easy-to-obtain variables from patients, suspected of having OSAHS by regression analysis, and fed these variables into the proposed explainable fuzzy neural network (EFNN), a back propagation neural network (BPNN) and a stepwise regression model to compare the screening performance for OSAHS.ResultsOf the 300 participants, three easily available features, such as waist circumference, mean blood pressure (BP) at the end of polysomnography and the difference in systolic BP between the end and start of polysomnography, were obtained from regression analysis with a five-fold cross-validation scheme. Feeding these three variables into the prediction models showed that the average prediction differences for apnea-hypopnea index (AHI) when using the EFNN, BPNN, and regression model were respectively 1.5 ± 18.2, 3.5 ± 19.1 and 0.1 ± 19.3, indicating none of the tested methods had good efficacy to predict the AHI values. The performance as determined by the sensitivity + specificity-1 value for screening moderate-to-severe OSAHS of the EFNN, BPNN and regression model were respectively 0.440, 0.414 and 0.380.ConclusionsWhen fed with easy-to-obtain physiological features, the understandable EFNN should be the preferred method to predict moderate-to-severe OSAHS.     

中文版NoSAS评分在汉族抑郁障碍患者中筛查阻塞性睡眠呼吸暂停综合征的效能分析

目的评估中文版NoSAS评分在汉族抑郁障碍患者中筛查阻塞性睡眠呼吸暂停综合征(OSAS)的有效性,为临床上筛查汉族抑郁障碍患者是否存在OSAS提供参考。方法回顾性分析在无锡市精神卫生中心进行过多导睡眠监测(PSG)并记录有颈围、BMI、打鼾史、年龄及性别等数据的抑郁障碍患者的临床资料。采用ROC分析NoSAS评分对OSAS的诊断价值。NoSAS评分PSG结果用四格表形式计算其灵敏度、特异度、误诊率及漏诊率等数据,并判断其筛查价值。结果以AHI≥5次/h为截点,将258例抑郁障碍患者分为OSAS组和非OSAS组,两组年龄、性别、BMI、颈围、腰围、NoSAS评分、AHI等差异均有统计学意义(P均<0.01)。以AHI≥5次/h为截点时,NoSAS评分预测OSAS的ROC曲线下面积为0.82(P<0.01)。当以AHI≥5次/h、NoSAS评分>8分为截点时,NoSAS灵敏度为59.32%,特异度为83.42%,误诊率为18.09%,漏诊率为40.68%。结论中文版NoSAS评分对于汉族抑郁障碍患者筛查OSAS有较好的预测效能。     

Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances

Snoring and obstructive sleep apnea form part of a spectrum of sleep disordered breathing affecting a significant proportion of the general population and particularly the middle aged. The consequences can be severe and even life threatening for both the individual directly affected and those more remotely involved. Adverse sequelae can manifest themselves acutely or in the longer term as a result of obstructive breathing induced hypersomnolence, neurocognitive deficits and cardiovascular abnormalities. The combination of anatomical and neuromuscular risk factors in the pathogenesis of OSA has resulted in a varied approach to its management. One such treatment option is mandibular repositioning appliances (MRA), which mechanically stabilize the airway. Whilst the efficacy of this simple intervention has been rigorously proven quite recently in a significant proportion of patients with varying disease severity, individual patient selection in its application remains uncertain. Short-term side-effects are common but usually transient, whilst in the long-term minor permanent adverse developments on the dentition and occlusion have been reported. Considering both the medicolegal implications of snoring and OSA and the increasing popularity of MRA, it is recommended that skilled multidisciplinary respiratory and dental personnel form the primary care team.