阻塞性睡眠呼吸暂停和肥胖

阻塞性睡眠呼吸暂停(OSA)与肥胖有相关性。Fisher 认为肥胖是 OSA 主要的病因。多数肥胖病人有习惯性鼾声。Block 推测:OSA常发生在吸烟或肥胖者,他们有打鼾的趋势。尽管 OSA 可以发生在非肥胖者,但越是肥胖,越易发生 OSA。Block 发现在氧去饱和、呼吸不     

鼻阻塞在阻塞性睡眠呼吸暂停中的作用

虽然鼻阻力急剧增加易引起有阻塞性睡眠呼吸暂停（OSA）者上呼吸道闭塞，但愎性鼻阻塞和OSA组的关系尚有争论。有人推测增加鼻阻与睡眠期间鼾声增大和呼吸暂停有关。本研究旨在通过测量最高单侧鼻阻力（HUNR）和联合鼻阻力（CNR）评估鼻阻塞在OSA发展和加重方面的重要性。方法：141名症状暗示OSA的患者在作者所在医院的睡眠试验室，在直立位测量鼻阻力、鼻咽压和气流量。CNR计算：1／CNR—1／左鼻阻力十1／右鼻阻力。并做多极睡眠脑电图、心电图、血氧测定和胸腹呼吸运动记录。根据脑电图将病人分为OSA组71名，呼吸暂停呼吸浅慢…     

美国睡眠医学学会2016年版成人阻塞性睡眠呼吸暂停诊断指南解读

睡眠呼吸障碍大体可分为阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)、中枢性睡眠呼吸暂停(central sleep apnea,CSA)及睡眠相关低通气.OSA是指睡眠时上呼吸道狭窄引起的呼吸紊乱.研究显示,14％的男性及5％的女性患有OSA[,而且OSA人群伴发心脑血管系统疾病(高血压、冠心病、充血性心力衰竭、心率失常、短暂性脑缺血发作、脑卒中等)、代谢系统疾病(2型糖尿病、高脂血症等)、多囊卵巢综合征等疾病的比例较一般人群高[2-4].     

零/低负荷睡眠监测在阻塞性睡眠呼吸暂停筛查中的应用及研究进展

阻塞性睡眠呼吸暂停（OSA）是一种被低估的上气道疾病,是新发心脑血管疾病和代谢性疾病等慢病的危险因素,实施OSA的早期诊断及干预具有重要意义。目前多道睡眠监测（PSG）是OSA诊断的金标准,但其操作流程繁琐、测试环境受限、使用成本高,是临床诊断OSA的限速瓶颈。家庭睡眠呼吸暂停监测（home sleep apnea t...     

阻塞性睡眠呼吸暂停与肿瘤相关性进展

阻塞性睡眠呼吸暂停(OSA)作为一种世界流行的慢性疾病,近年来其发生率逐年增加。OSA的主要特点是上气道反复塌陷,由此引起反复的呼吸暂停、低通气和频繁血氧饱和度下降,进而引发睡眠片段化、睡眠结构紊乱,患者通常伴有白天嗜睡、注意力不集中等。长期的睡眠片段化和微觉醒状态与许多慢性疾病结局相关,比如高血压、心肌梗死、2型糖尿病、阿尔兹海默病等。另外,OSA还与肿瘤密切相关。随着OSA和低氧血症严重程度的增加,相关的多种肿瘤的发生率与死亡率也增加,如肺癌、乳腺癌、鼻咽癌、前列腺癌、中枢神经系统的肿瘤等。论文对阻塞性睡眠呼吸暂停的概况、与肿瘤相关的统计学证据进行综述,并讨论了OSA与肿瘤相关的分子机制、治疗等方面的内容,旨在为阻塞性睡眠呼吸暂停与肿瘤的相关研究及临床实践提供参考依据,为进一步研究治疗方法提供新思路。     

阻塞性睡眠呼吸暂停综合征伴高血压患者睡眠呼吸指数与同步血压特征

目的:利用PSG阻塞性睡眠呼吸暂停综合征(OSA)伴高血压(HT)患者睡眠呼吸指数及同步血压变化分析其与单纯OSA、HT差异,揭示其变化的特征。方法:PSG与动态血压分别监测2012-2013年确诊的单纯HT(45例)、单纯OSA(50例)及OSA伴HT(56例),比较3组睡眠呼吸参数及同步血压,并行相关性分析。结果:与HT组及OSA组比较,OSA伴HT组AHI增加(P<0.01),氧减指数(ODI)、微觉醒指数(AI)、觉醒时间(WASO)及N1期占总睡眠时间(TST)比例显著增多(P<0.05),平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)、慢波睡眠期(SWS)及REM期(REM)占TST的比例显著减少(P<0.05)。经持续气道正压(CPAP)治疗后,与单纯OSA组比较,OSA伴HT组昼间平均收缩压(dMSP)、昼间平均舒张压(dMDP)、夜间平均收缩压(nMSP)、夜间平均舒张压(nMDP)较治疗前均明显降低(P<0.05),昼夜平均收缩压差(△SBP)、昼夜平均舒张压差(△DBP)明显增加(P<0.05)。AHI、ODI、AI、WASO及N1期占TST百分比与平均收缩压/舒张压(SBP/DBP)呈正相关(P<0.05),与MSaO2、LSaO2呈负相关(P<0.05)。血压变化主要发生在REM时相增多的睡眠后期,该血压以DBP升高为显著特征,并伴有SaO2降低。结论:OSA伴HT睡眠呼吸指数与OSA患者差异有统计学意义,与睡眠期血压变化密切相关;AHI是OSA伴HT高危因素;CPAP可显著OSA伴高血压患者昼夜血压。PSG是判断OSA伴HT病程发展和预后有效手段。     

加速康复外科理念在阻塞性睡眠呼吸暂停外科中的应用

阻塞性睡眠呼吸暂停(OSA)是由于睡眠期间上气道塌陷引起的呼吸暂停、低氧血症以及睡眠结构紊乱,在影响睡眠质量的同时诱发全身多系统疾病。尽管无创正压通气(NPPV)被广泛用于OSA的治疗,但有近50%的患者对之无法耐受或无法长期坚持。外科手术通过对上气道软组织或骨性组织的重构,扩大狭窄的解剖平面,提高气道张力,是OSA重要的治疗方式。但OSA患者常伴发肥胖、全身多种合并症,同时手术部位位于呼吸道起始处,缺乏骨性支撑,这些因素极大地增加了外科治疗的风险,因此保障围手术期的安全一直受到重点关注。加速康复外科(enhanced recovery after surgery,ERAS)理念是围手术期采用经循证医学证据证实有效的优化处理措施,减轻患者心理和生理的创伤应激反应,达到减少并发症,缩短住院时间,降低再入院及死亡的风险,同时达到降低医疗费用的目标,已经在普通外科、心胸外科、骨外科等领域取得显著效果。我科近年来在OSA外科领域也开展了基于ERAS的尝试,现将临床应用体会予以总结和分析。     

小型气管切开术取代气管造口术治疗阻塞性睡眠呼吸暂停综合征

大多数阻塞性睡眠呼吸暂停(OSA)病人均可采取保守疗法获得成功,手术治疗仅限于去除器质性阻塞性病变,但在病情严重或其他疗法无效时,有时仍需作正规气管造口术。鉴于气管造口术有其缺点和危险性,作者曾采用小型气管切开术,套管经环甲膜插入成功地救治了1例严重OSA病人。病人为44岁亚裔男性,因头痛和视神经乳头水肿入院。有日间瞌睡、睡眠时打鼾、呼吸暂停,憋醒和红细胞增多病史。躯体肥胖,有末梢性水肿、中心性发绀、扁桃体肥大和开口反射减弱等体征。生化     

阻塞性睡眠呼吸暂停与动脉粥样硬化相关性的研究进展

阻塞性睡眠呼吸暂停（OSA）是指由于鼻腔、鼻咽部、口及咽喉腔狭窄等原因造成上气道解剖结构的异常或病变,在此基础上,上气道扩张肌张力发生异常,可造成OSA患者气道反复塌陷阻塞,进而造成睡眠呼吸暂停和低氧血症等一系列病理生理改变。OSA的发生是多种心血管疾病发生的独立危险因素,而动脉粥样硬化（atherosclerosis...     

睡眠相关上气道阻塞的外科治疗

上气道的病理学改变可导致狭窄,即所谓的阻塞性睡眠相关呼吸疾病。除了中枢因素外,睡眠疾病的国际分类中区分了单纯打鼾和阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA),OSA又再被细分为成人型和儿童型两个亚型[1]。     

Conservative and non surgical treatments for the sleep disordered breathing adult

Obstructive sleep apnoea (OSA) syndrome is a chronic disease characterised by repetitive obstructive apnoeas and hypopnoeas during sleep leading to sleep fragmentation. The treatment of OSA consists of general and specific measures. The aim of this article is to review the different non surgical approaches to treat OSA in adults. The different therapeutical options can be used in combination, which underlines that the OSA patient needs a careful and multidisciplinary management.     

CT comparison of primary snoring and obstructive sleep apnea syndrome: role of pharyngeal narrowing ratio and soft palate-tongue contact in awake patient

Soft palate-tongue contact and automatically calculated pharyngeal narrowing ratio (PNR), defined as a ratio between the airway cross-section at the hard palate level and the narrowest cross-section from the hard palate to the epiglottis, could assist in earlier identification of potential obstructive sleep apnea syndrome (OSA) patients even on awake individuals. Parameters were studied on carotid CTA images from 67 consecutively included awake Caucasians who were later classified by second independent physician into the primary snorers (SNORE, n = 34) or obstructive sleep apnea syndrome patient (OSA, n = 33) group according to the clinical examination, laboratory testing and a full-night video polysomnography (PSG) in the sleep laboratory. Imaging and clinical data were statistically compared between groups. The odd’s ratio calculation showed a 2.95 (P = 0.0354) higher risk for OSA development in snoring person with a PNR greater than 8.6. The loose-contact subgroup among OSA patients showed significantly (P = 0.002) higher values of AHI in contrast to the in-contact subgroup. Authors didn’t have any financial relationship concerning presented study.     

阻塞性睡眠呼吸暂停低通气综合征与夜间咽喉反流的相关性研究

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)与夜间咽喉反流(laryngopharyngeal reflux,LPR)的关系.方法 分析19例OSAHS患者整夜同步多道睡眠监测+咽喉pH监测+食管压力测量数据,研究呼吸紊乱指标、整夜咽喉pH平均值及食管压力指标相关性,并描述每次LPR事件出现时的睡眠周期、体位、食管压力变化以及与呼吸事件的关系.结果 ①19例OSAHS患者中LPR阳性者6例,共记录LPR事件63次;②LPR阳性患者OSAHS严重程度与咽喉pH平均值呈负相关,但未发现反流事件与呼吸事件之间存在明确时间上的一一对应的关系;③LPR阳性组与阴性组患者的食管压(t=3.211,P=0.007)和上食管括约肌压力(t=2.234,P=0.046)差异均有统计学意义;④所有患者整夜咽喉pH平均值与食管压力平均值呈正相关(r=0.592,P=0.033).结论 OSAHS患者严重程度与夜间咽喉部pH值密切相关.OSAHS患者夜间易发生胃食管反流,造成近端食管胃酸暴露增加,进一步增加发生LPR的概率.LPR阳性的OSAHS患者睡眠时静息上食管括约肌压力下降更为明显,可能也是导致反流的另一危险因素.     

Association between obstructive sleep apnea and health-related quality of life in individuals affected with Treacher Collins syndrome

Although the relationship between Quality of Life (QoL) and obstructive sleep apnea (OSA) has been reported in several studies, little is known about this relationship among individuals affected with Treacher Collins syndrome (TCS). The aim of this study was to examine the associations between obstructive sleep and QoL in TCS patients. Thirty-six individuals with TCS (8–75 years) were invited to participate in expanded medical examinations, including a sleep study, polysomnography, as well as to respond to questionnaires about health related Health-related quality of life (HRQoL). Twenty-three (64 %) responded to the invitation, but four were later excluded due to additional diagnoses or unconfirmed TCS, and four were below 12 years and excluded due to different scoring rules for sleep and respiratory disturbances in young children and adults. The remaining group comprised 15 adults and adolescents with TCS, 5 male (33 %) and 10 female (66 %). The participants were between 12 and 75 years of age (mean 38.6, SD 18.5). Obstructive sleep was found in 87 % of the patients and several sleep apnea parameters, among these wake time after sleep, subjective snoring and mean saturation, were associated with poorer HRQoL. OSA appears to account for reduced HRQoL in adolescents and adults with TCS.     

Obstructive Sleep Apnea: A Comparison of Black and White Subjects

Objective To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group. Study Design Cross‐sectional retrospective review. Setting University‐based sleep disorders laboratory. Methods The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m²), respiratory disturbance index (RDI), and lowest oxygen saturation level. Results Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P = .005). Black males with OSA have significantly lower oxygen saturations than white males (P = .025). Conclusion Black males who present to the otolaryngologist‐head and neck surgeon for evaluation of sleep‐disordered breathing may be at increased risk of severe OSA.     

阻塞性睡眠呼吸暂停患者软腭平面的手术方式及其应用

阻塞性睡眠呼吸暂停综合征(OSAS)患者中常见软腭平面狭窄,解除该平面狭窄最经典的手术方式是悬雍垂腭咽成形术(UPPP)。本文以UPPP为基础,对OSAS患者软腭平面的各种手术方式及疗效进行综述。     

Efficacy of powered intracapsular tonsillectomy and adenoidectomy

Objectives/Hypothesis: We sought to determine the effectiveness of powered intracapsular tonsillectomy and adenoidectomy (PITA) in the treatment of children with moderately severe obstructive sleep apnea and to measure changes in quality of life that occur with such treatment. Study Design: Prospective, nonrandomized clinical trial in an academic pediatric otolaryngology practice. Methods: Convenience sample of children ages 3 to 12 years diagnosed with obstructive sleep apnea of moderate severity, defined as an apnea‐hypopnea index (AHI) between 5 and 20 on polysomnography. Children with recurrent streptococcal pharyngitis, chromosomal abnormalities, craniofacial abnormalities, neuromotor disease, sickle cell disease, obesity, or coagulopathy were excluded. PITA was performed by using the microdebrider. Polysomnography was performed before surgery and repeated 4 to 8 weeks after surgery. The Obstructive Sleep Apnea (OSA)‐18 questionnaire was completed at surgery and at the time of postoperative polysomnography to assess quality of life changes. The main outcome measure was cure of obstructive sleep apnea, as defined by a postoperative AHI of 1 or less for complete cure and less than 5 for partial cure. Improvements in quality of life were assessed by changes in the OSA‐18 questionnaire. Results: Nineteen children underwent PITA for moderate obstructive sleep apnea syndrome (OSAS), and 14 completed postoperative polysomnography. All 14 subjects who completed the study achieved at least partial cure. Thirteen of 14 (93%) subjects had a complete cure of OSAS after PITA. The median preoperative AHI was 7.9, and the median AHI after surgery was 0.1. The mean number of arousals per hour before surgery was 9.5, and this was reduced to a mean of 5.6 after surgery. Quality of life measures on OSA‐18 also improved, with large improvements in total quality of life scores and in all five domains seen after surgery. Conclusions: PITA cures otherwise healthy children with obstructive sleep apnea of moderate severity, at least in the short‐term, as documented by postoperative polysomnography. Improvements in quality of life measures, as documented by changes in OSA‐18, were seen in all children as well.     

22q11.2 Deletion syndrome and obstructive sleep apnea

Otolaryngologic problems are common in the 22q11.2 deletion syndrome (DS) population. Structural anomalies and retrognathia may predispose these patients to obstructive sleep apnea (OSA). The current association of OSA in this population is not defined.     

Polysomnographic and clinical findings in children with obstructive sleep apnea.

A retrospective study was conducted to determine which types of children might have polysomnographic findings that are most compatible with obstructive sleep apnea (OSA). The charts of 93 patients who were aged 18 months to 12 years were examined. All 93 patients had symptoms that were initially suggestive of OSA, and they underwent polysomnography. The types of presenting symptoms and associated illnesses were noted. Physical findings, including height, weight, and tonsil size, were examined. Of 93 patients with symptoms that were suggestive of OSA, 34 met sleep study criteria for OSA. In 44 patients, OSA was not demonstrated, and 15 patients had other results. On the basis of age, sex, and symptoms, no significant differences could be found between the group with OSA and the group with normal polysomnographic findings. Cor pulmonale, tonsil hypertrophy, and failure to thrive were associated with OSA. Surprisingly, obesity was not significantly associated with OSA.     

The sites of obstruction in OSA, identified by continuous measurements of airway pressure and flow during sleep: ambulatory versus in-hospital recordings

Polysomnography provides information about the severity of obstructive sleep apnoea (OSA), but is less satisfactory in predicting the effect of uvulopalatopharyngoplasty (UVPP). Another possible investigation in patients with suspected OSA is to determine the sites of pharyngeal obstruction or collapse by an overnight recording of airflow and upper airway pressures at several levels during sleep. Before these measurements can be established as a routine investigation, reproducibility studies have to be carried out. In 11 men with suspected OSA, we recorded airway pressure and airflow during sleep for 2 nights, the first in hospital and the second at home (ambulatory). The recording conditions were deliberately different in order to set up a 'worst case' comparison. Transpalatal (upper) or subpalatal (lower) obstructive predominance remained constant in 9 patients despite considerable changes in the absolute number of obstructive events. Only one patient had exclusively upper or lower obstructive events during the initial recording and this suggests that the level diagnosis after an overnight study using pressure and airflow may be more accurately described as percentage upper obstructive events of total. We conclude that the relationship between upper and lower obstructive events is reproducible between ambulatory and hospital recording, but recommend that level diagnosis should be interpreted with caution in patients with low recorded apnoea hypopnoea index (AHI).