复杂性睡眠呼吸暂停综合征诊断与治疗进展

目前持续气道正压通气(continuous positive airway pressure,CPAP)已被广泛用来治疗阻塞性睡眠呼吸暂停综合征(obstuctive sleep apnea syndrome,OSAS),然而部分OSAS患者经CPAP治疗后,当阻塞性呼吸暂停事件消除后中枢性睡眠呼吸暂停综合征和陈-施呼吸却增加,我们称这种睡眠呼吸紊乱为复杂性睡眠呼吸暂停综合征(complex sleep apnea syndrome,CompSAS).然而,它的概念、机制、治疗尚未完全明确,本文综述了近年来国内外学者对CompSAS的研究进展.     

复杂性睡眠呼吸紊乱

引起睡眠呼吸紊乱有两个主要因素:一是解剖因素,导致阻塞睡眠呼吸暂停;二是呼吸中枢控制因素,导致中枢睡眠呼吸暂停.当呼吸中枢控制不稳定时就可能发生复杂性睡眠呼吸紊乱.本文重点阐述复杂性睡眠呼吸紊乱的定义、病理生理、分类及治疗.     

Clinical manifestations of sleep apnea

Obstructive sleep apnea (OSA) may manifest in a number of ways from subtle intrusion into daily life to profound sleepiness, snoring, witnessed apneas and other classic symptoms. Although there is increasing evidence suggesting OSA can adversely affect health in a variety of ways, this disorder remains underdiagnosed. The most well-escribed health consequences of OSA relate to the cardiovascular system. Hypertension and arrhythmias have a strong association with OSA, and evidence suggests that treatment of OSA in patients with refractory hypertension and in patients planning cardioversion for atrial fibrillation may be of particularly importance. Significant associations between heart failure and OSA as well as complex sleep apnea have also been well-described. Cerebrovascular insult, impaired neurocognition, and poorly controlled mood disorder are also associated with in OSA. Therapy for OSA may ameliorate atherosclerotic progression and improve outcomes post-cerebrovascular accident (CVA). OSA should be considered in patients complaining of poor concentration at work, actual or near-miss motor vehicle accidents, and patients with severe sleepiness as a component of their co-morbid mood disorders. The metabolic impact of OSA has also been studied, particularly in relation to glucose homeostasis. Also of interest is the potential impact OSA has on lipid metabolism. The adverse effect untreated OSA has on glucose tolerance and lipid levels has led to the suggestion that OSA is yet another constituent of the metabolic syndrome. Some of these metabolic derangements may be related to the adverse effects untreated OSA has on hepatic health. The cardiovascular, neurocognitive, and metabolic manifestations of OSA can have a significant impact on patient health and quality of life. In many instances, evidence exists that therapy not only improves outcomes in general, but also modifies the severity of co-morbid disease. To mitigate the long-term sequela of this disease, providers should be aware of the subtle manifestations of OSA and order appropriate testing as necessary.     

Sleep Apnea and Atrial Fibrillation; 2012 Update

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are very prevalent diseases in modern society. Recent years have seen the emergence of a wide body of literature suggesting an important association between these two diseases. This review will provide a summary of this evidence as it currently exists. First, it will review the literature suggesting an association between AF and OSA by highlighting the prevalence of AF in OSA, the correlation of AF prevalence with OSA severity and the trend towards increased AF recurrence in patients with OSA after treatment for AF. Second, it will identify the possible pathophysiologic mechanisms for this association. In doing so, it will discuss the investigated effects of intrathoracic pressure changes, autonomic instability and atrial remodeling. Finally, it will review the evidence of the effect of treatment of OSA on AF, highlighting the role of continuous positive airway pressure (CPAP) in the treatment of OSA and its impact on AF prevalence and recurrence.     

Obesity and obstructive sleep apnea-hypopnea syndrome

Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea) or partial obstruction (hypopnea) of airways during sleep. Obstructive sleep apnea-hypopnea syndrome affects mainly obese individuals and it is defined by an apnea-hypopnea index of five or more episodes per hour associated with daytime somnolence. In addition to anatomical factors and neuromuscular and genetic factors, sleep disorders are also involved in the pathogenesis of sleep apnea. Obesity affects upper airway anatomy because of fat deposition and metabolic activity of adipose tissue. Obstructive sleep apnea-hypopnea syndrome and metabolic syndrome have several characteristics such as visceral obesity, hypertension and insulin resistance. Inflammatory cytokines might be related to the pathogenesis of sleep apnea and metabolic syndrome. Sleep apnea treatment includes obesity treatment, use of equipment such as continuous positive airway pressure, drug therapy and surgical procedures in selected patients. Currently, there is no specific drug therapy available with proven efficacy for the treatment of obstructive sleep apnea-hypopnea syndrome. Body-weight reduction results in improvement of sleep apnea, and obesity treatment must be emphasized, including lifestyle changes, anti-obesity drugs and bariatric surgery.     

Sleep Apnea and Atrial Fibrillation: Role of the Cardiac Autonomic Nervous System

Sleep apnea is highly associated with atrial fibrillation (AF), and both diseases are highly prevalent in the United States. The mechanistic underpinnings that contribute to their association remain uncertain, but numerous possible mechanisms have been proposed, including dysfunction of the cardiac autonomic nervous system (ANS). Studies have reported that apnea induces hyperactivity of the ANS, leading to increases in AF susceptibility. This review compiles the latest evidence on the role of the ANS in sleep-apnea-induced AF.     

多导睡眠监测在OSAHS患儿中的临床应用

目的探讨多导睡眠监测在OSAHS患儿中应用效果。方法 OSAHS患儿73例为观察组,其中41例轻度为A组,22例中度为B组,10例重度为C组。非OSAHS患儿75例为对照组。行多导睡眠监测。结果观察组平均Sa O2、LSa O2、S2期、SWS期、REM期明显小于对照组,观察组Sa O2≤92%时间、LAT、LHT、NREM期、S1期、RDT、RAT明显大于对照组。依A组、B组、C组顺序,NREM期、S1期、RDT、RAT、LAT、LHT均显著增加,S2期、SWS期、REM期均显著降低。差异显著(P0.05)。结论多导睡眠监测是OSAHS患儿有效评价方法。     

心房纤维颤动与睡眠呼吸障碍

心房纤维颤动(简称房颤)是临床常见的心律失常,可明显降低患者生活质量,显著增加医疗费用.除男性、老龄、卒中、慢性心力衰竭、冠状动脉疾病之外,睡眠呼吸暂停也可增加房颤的发生或易患性.既往研究表明房颤患者阻塞性睡眠呼吸暂停的发病率较高,而近年研究显示,中枢性睡眠呼吸暂停的发生率也较高,尤其是伴中枢性睡眠呼吸暂停的陈-施呼吸.睡眠呼吸障碍与房颤患者的不良预后密切相关,而良好管理睡眠呼吸障碍可改善房颤患者的预后、提高生活质量.     

Clinical characteristics of obstructive sleep apnea in community-dwelling older adults

OBJECTIVES: To examine whether traditional risk factors are common in older adults with obstructive sleep apnea (OSA). DESIGN: Cross-sectional study. SETTING: Atlanta, Georgia. PARTICIPANTS: A convenience sample of 94 community-dwelling adults aged 62 to 91. MEASUREMENTS: Demographic, medical, and sleep-related information obtained using questionnaires. Epworth Sleepiness Scale (ESS) and 72-hour voiding diary were used to determine daytime sleepiness and nocturia frequency, respectively. Overnight ambulatory sleep recording device was used to screen for OSA. RESULTS: Fifteen female and 15 male subjects had an apnea-hypopnea index (AHI) of 15 or more per hour of sleep (moderate to severe OSA). Traditional risk factors such as snoring, body mass index, and neck circumference were not significantly associated with OSA. An AHI of 15 or more per hour was independently associated with not feeling well rested in the morning, higher ESS score, and greater frequency of nocturia. CONCLUSION: Traditional risk factors for OSA were not common presenting symptoms and signs in study subjects with an AHI of 15 or more per hour of sleep; this may contribute to underdiagnosis of OSA in this population. Subjects with an AHI of 15 or more per hour had more sleep-related complaints and excessive daytime sleepiness. Although occult, this suggests that OSA may contribute to disease burden in this group of people.     

阻塞性睡眠呼吸暂停综合征与心律失常

阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）对心血管功能的影响越来越引起人们的关注。为探讨ＯＳＡＳ与心律失常的关系，我们对２１２例打鼾者行夜间多导睡眠图监测（ＰＳＧ），呼吸紊乱指数（ＡＨＩ）≥５为ＯＳＡＳ。分析ＰＳＧ心电导联。结果：１４６例病人诊断为ＯＳＡＳ，其中８２例ＯＳＡＳ病人发生心律失常（５６．２％），包括早搏或心动过速、传导阻滞或二者均有。采用经鼻持续气道内正压呼吸（ｎＣ－ＰＡＰ）７小时治疗严重的ＯＳＡＳ合并心律失常１９例，其中治疗后心律失常完全消失者１４例（７３．７％）。ＯＳＡＳ病人的心律失常发生率较非ＯＳＡＳ高（χ２＝１７．２８，Ｐ＜０．０００１）。心律失常发生率与低氧及夜间呼吸暂停严重程度呈正相关。ｎＣＰＡＰ有效治疗呼吸暂停的同时可逆转或改善心律失常。作者认为，低氧血症很可能是ＯＳＡＳ者心律失常的重要原因之一。     

阻塞性睡眠呼吸暂停群与血压的实时研究

目的　观察阻塞性睡眠呼吸暂停 (OSA)患者OSA连续发生 (OSA群 )时的实时血压改变 ,确定OSA群对血压的影响。方法　全部病例年龄均在 6 0岁以下 ,未服用过任何降血压药物治疗。以多导睡眠图 (PSG)检测睡眠过程的呼吸事件 ,同时以PWTT法连续测量血压。确诊为OSA组病人 ,在连续出现OSA群时 ,对血压作 2 0次等时取样 ,并与经PSG检查排除OSA的对照组病人比较 ,确定OSA群发生时的血压改变情况。结果　 92 %的OSA患者在OSA群发生时均有明显的血压升高 ,平均收缩压升高 5 8mmHg,舒张压升高 3 7mmHg ,最高收缩压升高 18 7mmHg ,舒张压升高12mmHg,明显高于非OSA病人 (P <0 0 1)。结论　考虑到其他影响因素 ,仍可认为 ,OSA(特别是连续发生的OSA群 ) ,与血压升高有直接关系 ,血压升高的程度、持续时间与OSA的严重程度正相关     

关于阻塞性睡眠呼吸暂停治疗方法的新探讨

阻塞性睡眠呼吸暂停(obstructive sleep apnoea,OSA)是临床常见的疾病,主要表现为打鼾,夜间睡眠反复出现呼吸暂停,白天过度嗜睡等症状.目前有许多的临床研究和流行病学的结果都显示了OSA是一种对多器官和多系统都有损害的睡眠呼吸疾病,它是高血压、冠状动脉粥样硬化性心脏病、心律失常、充血性心力衰竭、脑卒中等多种疾病的独立危险因素[1].严重影响着患者的生活质量,其发病率也越来越高.因此,这就使得进一步的研究探讨OSA的治疗方法成为必要.