OSAHS患者nCPAP治疗前后血管活性物质变化与血压的关系

目的观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清内皮素（ET-1）、-氧化氮（NO）及血栓素A2（TXA2）与前列环素Ⅰ（PGⅠ2）失衡和血压的关系及经鼻持续气道内正压通气（nCPAP）的治疗作用。方法选择OSAHS无原发性高血压（EH）者（A组）、OSAHS合并EH者（B组）、正常对照（C组）,三组均行多导睡眠呼吸监测,用袖带加压法观察血压,测定三组血浆ET-1、6-酮-PGF1α、TXB2、NO水平。结果与C组比较,A、B组nCPAP治疗前睡眠呼吸暂停低通气指数（AHI）、ET-1／NO、TXB：／6-酮-PGFα增高,最低SaO2下降;nCPAP治疗后则情况相反,与治疗前比较差异有统计学意义（P〈0．05）。A组ET-1／NO、TXB2／6-酮-PGF1α分别与AHI和最低SaO：明显相关,B组MBP分别与ET／NO、TXB2／6-酮-PGF1α、AHI及最低Sa02明显相关。结论①OSAHS患者血管舒缩因子比例失衡可能在OSAHS合并EH中起-定作用。②nCPAP治疗OSAHS合并EH有确切疗效。     

连续气道正压通气对阻塞性睡眠呼吸暂停患者血管内皮功能的影响

目的检测阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清一氧化氮（NO）、内皮素-1（ET-1）、血管性血友病因子（vWF）及肱动脉内径变化;评估连续气道正压通气（CPAP）对此类患者血管内皮功能的影响。方法选择OSAHS患者55例和健康对照组55例,分别测定所有受试者血清NO、ET-1、vWF水平,同时使用多普勒彩超测定肱动脉内径变化。对OSAHS患者使用CPAP治疗3月后再次测定以上指标。结果治疗前OSAHS患者血清NO水平和肱动脉内径变化率明显低于对照组（P均〈0．01）;血清ET-1和vWF水平明显高于对照组（P均〈0．01）。NO水平和肱动脉内径变化率与呼吸紊乱指数呈显著负相关（r分别为-0．621,-0．581,P〈0．01）,与最低血氧饱和度正相关（r分别为0．516,0．613,P〈0．01）;ET-1和vWF水平与呼吸紊乱指数呈正相关（r分别为0．534,0．559,P均〈0．01）,与最低血氧饱和度均呈负相关（r分别为-0．479,-0．637,P均〈0．01）。肱动脉内径变化率与NO呈正相关,与ET-1和vWF水平呈负相关（r分别为0．681,-0．541和-0．513,P均〈0．01）。结论OSAHS患者早期已存在血管内皮功能损害,与呼吸紊乱指数和低氧相关;CPAP能够改善患者血管内皮功能。     

高原慢性肺心病合并OSAHS患者血管内皮功能的变化及其与肺动脉高压的关系

目的探讨高原肺心病（HACCP）合并OSAHS患者血管内皮功能的变化及其与肺动脉高压（PAH）的关系。方法 36例HACCP合并OSAHS患者和45例单纯HACCP患者测定了睡眠呼吸暂停低通气指数（AHI）、平均氧饱和度（MSaO2）、平均最低氧饱和度（MmSaO2）、睡眠SaO2〈80%占总睡眠时间百分比（T80）、夜间基础与最低氧饱和度之差（△SaO2）、平均肺动脉压（mPAP）、血浆内皮素-1（ET-1）、血清一氧化氮（NO）和肿瘤坏死因子-α（TNF-α）,并与40例当地健康人对比。结果 HACCP合并OSAHS组、单纯HACCP组与对照组比较,ET-1、TNF-α、mPAP、ET-1/NO比值升高,NO降低（均P〈0.01）。HACCP合并OSAHS组与单纯HACCP组比较,ET-1、TNF-α、mPAP、ET-1/NO比值显著升高,NO显著降低（均P〈0.01）。HACCP合并OSAHS组MSaO2、MmSaO2显著低于单纯HACCP患者（均P〈0.01）,AHI、T80、△SaO2显著高于单纯HACCP患者（均P〈0.01）。结论单纯HACCP及HACCP合并OSAHS患者均存在明显的血管内皮损伤,内皮功能失调在HACCP合并OSAHS患者中更明显,且与其PAH的发生密切相关。     

阻塞性睡眠呼吸暂停低通气综合征患者血浆血管内皮生长因子、一氧化氮的变化及意义

目的初步探讨血管内皮生长因子（vascular endothelial growth factor，VEGF）及一氧化氮（nitric oxide，NO）在阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea—hypopnea syndrome，OSAHS）病理生理过程中的意义。方法①20例单纯OSAHS患者、26例OSAHS合并心脑血管病患者和20例正常人，经多导睡眠仪监测后，检测血浆VEGF和NO浓度。②将OSAHS合并心脑血管病患者分成两组，一组给予经鼻持续正压通气（nCPAP）治疗6个月，共15例设为nCPAP治疗组；其余11例不给予任何针对OSAHS的治疗，设为对照组；观察治疗前后的血浆VEGF和NO浓度。结果①三组血浆VEGF浓度从高到低分别为：OSAHS合并心脑血管病患者（194．9±67．9）pg／ml、单纯OSAHS患者（140．6±47．8）pg／ml、正常对照组（115．0±54．1）pg／ml，差异有统计学意义；②三组血浆NO浓度从低到高分别为：OSAHS合并心脑血管病患者（58．7±17．7）μmol／L、单纯OSAHS患者（76．0±23．7）μmol／L、正常对照组（86．3±45．0）μmol／L，差异有统计学意义；③接受nCPAP治疗的OSAHS合并心脑血管病患者6个月后血浆VEGF浓度较治疗前下降[（217．6±53．2）pg／ml vs（136．2±29．9）pg／ml，P〈o．013，血浆NO浓度较治疗前升高[（56．0士16.8）／2mol／L协（80．3±16．7）μmol／L，P〈0．01]。结论①OSAHS患者血浆VEGF浓度升高，血浆NO水平下降；②合并心脑血管病的OSAHS患者比无心脑血管并发症的单纯OSAHS患者血浆VEGF浓度升高更显著，血浆NO水平下降更明显；③经nCPAP治疗后，OSAHS合并心脑血管病患者血浆VEGF浓度下降，血浆NO水平增加。     

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。     

OSAHS合并高血压患者血内皮素、一氧化氮、肿瘤坏死因子-α和心钠素的临床研究

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）以及OSAHS合并高血压患者的内皮素（ET）、一氧化氮（NO）、肿瘤坏死因子-α（TNF-α）和心钠素（ANP）水平及其临床意义。方法选择单纯OSAHS患者16例,OSAHS合并高血压患者17例和正常对照组12例,放射免疫法和硝酸还原酶法检测血ET、TNF-α、ANP和NO的含量。结果单纯OSAHS组和OSAHS合并高血压组血ET、ET／NO、TNF-α和ANP均明显高于对照组（P〈0．05或P〈0．01）,而NO低于对照组（P〈0．05）;OSAHS合并高血压组ET、ET／NO和TNF-α高于单纯0SAHS组（P〈0．05）,而NO低于单纯0SAHS组（P〈0．05）。结论OSAHS患者及OSAHS合并高血压患者均存在血管内皮损伤和内皮功能失调。     

阻塞性睡眠呼吸暂停低通气综合征患者血浆ET-1、NO水平的变化及nCPAP对其影响

目的　观察阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者经鼻持续气道内正压通气 (nCPAP)治疗前后血浆ET 1、NO水平的变化 ,并探讨其临床意义。方法　选择OSAHS无EH者 (A组 ) ,OSAHS合并EH者 (B组 ) ,正常对照 (C组 ) ,三组行PSG监测。用放免法测血浆ET 1 ,NO采用硝酸还原酶法。A、B两组施以nCPAP治疗。用袖带加压法观察血压。结果　①与C组相比 ,A组AHI、ET 1 /NO增高 ,最低SaO2 下降 ,治疗后情况相反 ;A组治疗前后ET 1 /NO分别与AHI、最低SaO2 均明显相关 (r分别为 0 40 8、- 0 569)。②与C组相比 ,B组MBP、AHI、ET 1 /NO增高 ,最低SaO2 下降 ,治疗后情况相反 ;B组治疗前后MBP分别与ET 1 /NO、AHI、最低SaO2 均明显相关 ,r分别为 0 439、0 51 5、- 0 455。结论　①OSAHS可引起血压升高 ,某些血管舒缩因子比例失衡可能在OSAHS合并EH中起一定的病理作用 ;②nCPAP对治疗OSAHS合并EH及预防OSAHS高的心脑血管并发症均有益处     

老年冠心病合并阻塞性睡眠呼吸暂停低通气综合征患者的血小板活性变化

根据睡眠呼吸暂停指数，将78例老年冠心病患者分为冠心病组及合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）组，另选30例健康同龄人作为对照组，测定各组血浆血小板聚集率（PAG）和P-选择素水平，了解其血小板活性变化。结果合并OSAHS 34例（43．6％）；与冠心病组及对照组比较，合并OSAHS组患者的PAG和P-选择素均明显升高（P〈0．01）。提示老年冠心病患者合并OSAHS的发生率较高，且该类患者血小板活性增加。     

OSAHS合并高血压患者血清ET-1、NO和CRP水平与血压增高的关系

目的探讨血清一氧化氮（NO）、内皮素-1（ET-1）和超敏C反应蛋白（CRP）水平与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者夜间及日间血压增高的关系。方法162例确诊为OSAHS患者根据高血压诊断标准分为OSAHS组和OSAHS并高血压组,进行多导睡眠图（PSG）和动态血压（ABPM）监测。以同期PSG和ABPM监测均正常的61例健康人作为对照组。各组均测定血清ET-1、NO和CRP水平并行相关性分析。结果与对照组比较,单纯OSAHS组和OSAHS合并高血压组血清ET-1和CRP水平升高,NO水平降低,且后两组间亦有统计学差异;血清ET-1水平与日间平均收缩压、日间平均舒张压、夜间平均舒张压呈正相关。结论OSAHS患者尤其合并高血压者血清ET-1和CRP水平增高,NO水平降低;ET—1水平升高与OSAHS患者高血压有关。     

CHF合并中重度OSAHS患者nCPAP治疗前后BNP变化及意义

目的测定慢性充血性心力衰竭（CHF）合并中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者经鼻持续气道正压通气治疗（nCPAP）前后心室钠尿肽（BNP）值的变化,探讨其意义。方法选CHF合并中重度OSAHS患者74例,随机分两组：接受基础药物及nCPAP治疗者35例为治疗组,只接受基础药物治疗者39例为对照组。治疗6个月,测定治疗前后BNP值。结果治疗组nCPAP治疗6月后,BNP值明显下降（P〈0．01）;对照组只接受基础药物治疗6月后,BNP值无明显变化（P〉0．05）。两组治疗前BNP值比较无显著性差异（P〉0．05）;治疗6月后,治疗组BNP值明显较低,两组比较有显著性差异（P〈0．01）。结论BNP浓度与心衰严重程度呈正相关,是判断CHF患者预后和进行危险分层的指标。nCPAP治疗使已接受基础药物治疗的CHF合并中重度OSAHS患者BNP值明显下降,其收益明显,值得推广。     

福州城镇男性阻塞性睡眠呼吸暂停低通气综合征患者睾酮水平研究

目的 研究福州城镇男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血清睾酮水平及经鼻持续气道正压通气(nCPAP)治疗对OSAHS患者血清睾酮水平的影响.方法 182例入选者经多导睡眠监测,按年龄分25～45岁、46～65岁两层,再按睡眠呼吸紊乱严重程度进行分组:分别为正常对照组(20例、21例)、单纯性鼾症组(14例、13例)、轻度OSAHS组(21例、17例)、中度OSAHS组(19例、19例)、重度OSAHS组(18例、20例).在多导睡眠监测次晨抽取外周静脉血用电化学发光法测定血清睾酮.对比正常对照组、单纯性鼾症组、OSAHS组间睾酮水平的差异,分析睾酮水平与睡眠呼吸紊乱指数(AHI)、体质量指数(BMI)之间的相关性.开展nCPAP干预实验,对接受/未接受nCPAP治疗的中重度OSANS患者随访3个月,复查多导睡眠监测及血清睾酮指标.结果 ①正常对照组与单纯性鼾症组2组间血清睾酮差异无统计学意义(P值均＞0.05).OSAHS组血清睾酮较正常对照组及单纯性鼾症组低.②睾酮与AHI、BMI、年龄均呈负相关(r=-0.589,P＜0.01;r=-0.225;P＜0.05;r=-0.454,P＜0.01),睾酮与最低SaO2呈正相关(r=0.459,P＜0.01).③中重度OSAHS患者中,接受nCPAP治疗者随访3个月后,血清睾酮水平升高(P＜0.01).未接受nCPAP治疗者随访3个月后,血清睾酮水平无明显变化(P＞0.05).结论 ①OSAHS患者血清睾酮水平低,血清睾酮水平与AHI、BMI呈负相关.②OSAHS患者血清睾酮水平随年龄增加而降低.③nCPAP治疗可改善OSAHS患者血清睾酮水平.

Abstract：

Objective To explore the testosterone levels in Fuzhou urban male patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and impact of nasal continuous positive airway pressure (nCPAP) treatment. Methods Following polysomnographic examination, 182 sbjucts were assigned to 25-45years and 46-65years two groups. Each group consist of:control group(20,21 case), simple snores(14,13case), mild OSAHS(21,17case) ,moderate OSAHS(19,19 case),and severe OSAHS (18,20case). The serum level of testosterone was measured after sleep at the polysomnographic examination night. Of 76 patients with moderate or severe OSAHS, 29 patients who underwent nCPAP therapy were set as "nCPAP group" ,47 patients who did not undergo nCPAP therapy were set as "control group". 10 patients were excluded from further follow-up. The assessment protocol was then repeated after 3 months follow-up. Results ①There were no statistically significant differences of the serum level of testosterone between simple snores and control group. The serum level of testosterone was significantly lower in OSAHS patient. ② Liner regression analysis showed the serum level of testosterone was negatively correlated with AHI, BMI, year( r = -0.589, P ＜0. 01; r = -0.225, P ＜0.05; r = - 0.454, P＜0. 01), testosterone was correlated with SaO2 ( r =0.459, P ＜0.01). ③After 3 months nCPAP therapy in OSAHS patients, the serum level of testosterone was significantly increased ( P ＜ 0.01). While there were no similar changes in OSAHS patients without nCPAP therapy( P >0. 05). Conclusions ①OSAHS patients have lower level of testosterone. The serum level of testosterone was negatively correlated with AHI,BMI. ②As the age older,the serum level of testosterone lower in OSAHS patients. ③The serum level of testosterone could be improved by nCPAP therapy in OSAHS patients.     

重叠综合征患者肺动脉压力与血管内皮功能的研究

目的:探讨重叠综合征(OS)患者肺功能、睡眠呼吸参数和肺动脉压力的变化以及肺动脉压力与血管内皮功能的相关性。方法:收集2009年2月至2012年1月我院呼吸科诊断的慢性阻塞性肺疾病(COPD)、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和OS患者各60例,分别测定患者肺功能、睡眠呼吸参数、平均肺动脉压力(mPAP)、血清内皮素1(ET-1)、一氧化氮(NO)和血管内皮生长因子(VEGF)水平。结果:OS组与单纯COPD组和OSAHS组相比,第1秒用力呼气容积(FEV1)(%预测值)、FEV1/用力肺活量(FVC)和快速眼动相睡眠(REM)占总睡眠时间百分比(%)均明显降低(P<0.05);而睡眠呼吸暂停低通气指数(AHI)、Epworth嗜睡量表(ESS)评分和mPAP明显增高(P<0.05);OS患者血清中ET-1和VEGF浓度明显高于单纯COPD和单纯OSAHS患者(P<0.05),并与其mPAP呈正相关,而NO浓度显著降低,与mPAP呈负相关。结论:OS患者较单纯的COPD和OSAHS患者更易合并肺动脉高压,外周血ET-1、VEGF和NO的浓度与肺动脉压力有一定的相关性。     

Big Endothelin-1 and Nitric Oxide in Hypertensive Elderly Patients with and without Obstructive Sleep Apnea-Hypopnea Syndrome

Background

The role of oxidative stress in hypertensive elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is unknown.

Objective

The purpose was to evaluate the levels of big endothelin-1 (Big ET-1) and nitric oxide (NO) in elderly hypertensive patients with and without moderate to severe OSAHS.

Methods

Volunteers were hospitalized for 24 h. We obtained the following data: body mass index (BMI); 24-ambulatory blood pressure monitoring; and current medication. Arterial blood was collected at 7pm and 7am for determining plasma NO and Big ET-1 levels. Pulse oximetry was performed during sleep. Pearson''s or Spearman''s correlation and univariate analysis of variance were used for statistical analysis.

Results

We studied 25 subjects with OSAHS (group 1) and 12 without OSAHS (group 2) aged 67.0 ± 6.5 years and 67.8 ± 6.8 years, respectively. No significant differences were observed between the groups in BMI; number of hours of sleep; 24-h systolic and diastolic BPs; awake BP, sleep BP and medications to control BP between groups. No differences were detected in plasma Big ET-1 and NO levels at 19:00 h, but plasma Big ET-1 levels at 7:00 h were higher in group 1 (p = 0.03). In group 1, a negative correlation was also observed between the mean arterial oxyhemoglobin saturation level, 24-h systolic BP (p = 0.03, r = −0.44), and Big ET-1 (p = 0.04, r = −0.41).

Conclusions

On comparing elderly hypertensive patients with and without OSAHS having similar BP and BMI, we observed higher Big ET-1 levels After sleep in the OSAHS group. NO levels did not differ between the hypertensive patients with or without OSAHS.     

Corrected QT dispersion and cardiac sympathetic function in patients with obstructive sleep apnea-hypopnea syndrome

STUDY OBJECTIVES: Hypoxemia increases corrected QT dispersion (QTcD), which is the difference between the maximum and minimum QT intervals and is a strong risk factor for cardiovascular mortality. The aim of this study was to investigate the QTcD in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and the relationship between the QTcD and (123)I-metaiodobenzylguanidine (MIBG) cardiac imaging, which reflects cardiac sympathetic activity. SETTING: A university hospital. PATIENTS: Forty-eight OSAHS patients without cardiac diseases (mean [+/- SD] age, 45.9 +/- 10.8 years; apnea-hypopnea index [AHI] 51.9 +/- 18.5 events per hour) who underwent polysomnography before treatment and on the first night of nasal continuous positive airway pressure (nCPAP) treatment. METHODS: Before and after nCPAP treatment was started, we measured the QTcD with computer software, before, during, and after sleep, as well as the washout rate of the MIBG administered for cardiac imaging. As a control, QTcD was also measured in the morning from 26 healthy subjects. RESULTS: Before treatment, the mean QTcD during sleep (65.0 +/- 14.6 ms) was greater than that before sleep (57.0 +/- 13.5 ms; p < 0.0001). Meanwhile, after 1 night of nCPAP therapy, the QTcD during sleep (50.6 +/- 11.4 ms) decreased from that before treatment (p < 0.0001) and was smaller than the QTcD before sleep (56.2 +/- 13.3 ms; p = 0.003). Before treatment, the QTcD during sleep correlated with the AHI (r = 0.38; p = 0.009) and the percentage of time that SaO(2) was < 90% (SaO(2) < 90% time) [r = 0.34; p = 0.018]. The QTcD did not correlate with the body mass index or the washout rate of MIBG. However, the washout rate of MIBG correlated with the AHI and the SaO(2) < 90% time. CONCLUSIONS: Nocturnal QTcD is increased in OSAHS patients but is decreased by nCPAP therapy independently of cardiac sympathetic function.     

气道正压通气治疗高血压伴阻塞性睡眠呼吸暂停低通气综合征

目的经鼻持续气道正压通气(nCPAP)治疗高血压合并阻塞性睡眠呼吸暂停低通气综合征(OS-AHS)患者,以评价该疗法对血压和睡眠呼吸监测参数的影响。方法临床确诊合并OSAHS的高血压患者,随机分为治疗组和对照组,治疗组在给予常规药物(抗高血压药、抗动脉硬化药物)治疗的同时进行nCPAP治疗,对照组仅给予常规药物治疗。30天后,观察两组治疗前后血压、睡眠呼吸监测参数变化。结果高血压合并OSAHS患者共60例,治疗组和对照组各30例;治疗后治疗组的收缩压(SBP)、舒张压(DBP)、脉压(PP)、心率(HR)、睡眠呼吸暂停低通气指数(AHI)、最长呼吸暂停时间和最低脉搏容积血氧饱和度(SpO2min),与对照组比较差异有统计学意义(P<0.05);部分患者降压药物减量或停用,仅用nCPAP治疗就能维持正常血压。结论nCPAP是非药物治疗合并OSAHS高血压患者的一种安全有效方法。     

经鼻气道持续正压通气对OSAHS患者夜尿次数变化的影响

目的：探讨经鼻气道持续正压通气(nCPAP)对 OSAHS患者夜尿次数增多的改善作用。方法选择2014年6月至2016年5月夜尿次数增多的中重度 OSAHS 患者74例,其中中度[15次/h≤呼吸暂停低通气指数(AHI)<30次/h]14例、重度(30次/h≤AHI<60次/h)31例和极重度(AHI≥60次/h)29例,进行 Auto-nCPAP滴定、记录 n-CPAP滴定当晚平均压力及治疗前后夜尿次数,并对其结果进行统计学处理。结果 OSAHS 患者夜尿次数与 AHI、ESS 评分、夜间最低血氧饱和度(LSpO2)相关(r=0.728、0.435、-0.293,P 值均<0.05),且随着 AHI 增大,夜尿次数逐渐增多;nCPAP治疗后夜尿次数明显减少,3组治疗前后P值均<0.001,且当晚 nCPAP 压力与夜尿次数呈正相关(r=0.503,P<0.001),nCPAP压力<9 cmH2 O 患者夜尿次数明显比 nCPAP压力≥9 cmH2O 组少,差异有统计学意义(1.30±1.10 vs 2.56±1.50,t=-3.999,P <0.001)。结论 nCPAP能改善 OSAHS患者夜间多尿症状,其治疗压力越低患者夜尿次数越少。     

阻塞性睡眠呼吸暂停低通气综合征患者血清白介素-6的变化

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清白细胞介素6(IL-6)的变化。方法经过多导生理记录仪(PSG)睡眠呼吸监测把研究对象分为试验组(OSAHS患者65例)、对照组(单纯打鼾者40例),均测量血清IL-6。试验组中32例经鼻持续气道正压通气(nCPAP)治疗,另33例未予nCPAP治疗,2个月后65例都予PSG监测、血清IL-6测量。结果OSAHS患者血清IL-6水平明显高于单纯打鼾者(P<0.05),并与体重指数、整夜睡眠监测中呼吸暂停低通气指数、一整夜睡眠监测中患者脉搏血氧饱和度低于90%时间占整个睡眠监测时间的百分比、匹兹堡睡眠质量指数均有正相关(P<0.05)。nCPAP治疗2个月后血清IL-6水平较治疗前下降(P<0.01),体重指数没有改变(P>0.05)。未予nCPAP治疗组IL-6较前无下降(P>0.05)。结论OSAHS患者血清IL-6水平明显升高,提示此可能与OSAHS患者是心血管事件和糖代谢紊乱发生的高危者有关,经nCPAP治疗能显著降低血清IL-6水平,因而可能降低这些危险性。     

持续气道正压通气治疗老年人阻塞性睡眠呼吸暂停低通气综合征合并高血压的疗效

目的探讨老年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压之间的关系,以及经鼻持续气道正压通气(nCPAP)治疗老年人OSAHS合并高血压的远期效果。方法104例确诊为OSAHS合并高血压的门诊或住院患者,其中52例患者经过6个月的nCPAP治疗作为治疗组,于行nCPAP治疗前及治疗后6个月,进行多导睡眠图(PSG)及24h动态血压测定,另52例患者未行nCPAP治疗或治疗失败作为对照组,6个月后对两组重复上述各项指标的监测并进行统计学处理。结果治疗组治疗前最长呼吸暂停时间、睡眠呼吸暂停低通气指数(AHI)、最低氧分压(SpO2)、收缩压/舒张压分别为(63.5±22.4)s、(46.8±19.2)次/h、(62.4±18.5)%、(146.2±9.5/90.4±8.5)mmHg,经过nCPAP治疗6个月后,上述各项指标分别为(10.5±11.4)s(、4.6±4.0)次/h(、89.81±8.2)%、(134.7±8.3/82.6±9.1)mmHg,均有显著改善(P<0.01),平均血压明显好转,治疗组降压有效率为96%,与对照组比较差异有统计学意义(P<0.01),部分患者停用降压药。结论反复低氧血症、呼吸暂停可能是部分老年OSAHS伴发高血压的发病原因,nCPAP治疗有助于此类患者血压的恢复。     

Exhaled nitric oxide from the central airway and alveoli in OSAHS patients: the potential correlations and clinical implications

Background

The aim of the study was to evaluate exhaled nitric oxide (eNO) derived from different areas of airway in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with NO exchange model and investigate the potential application and interpretation of eNO in clinical setting.

Methods

This study was divided into two parts. Firstly, we performed a case control study in 32 OSAHS patients and 27 non-OSAHS participants. Fractional eNO (FeNO) and eNO from the central airway (J’awNO) and from alveoli (C_ANO) were compared in OSAHS and control groups. Also, correlation of eNO to severity of OSAHS was analyzed. Secondly, a prospective study was conducted in 30 severe OSAHS patients who received a short-term nasal continuous positive airway pressure (nCPAP) treatment. We evaluated eNO, plasma ET-1 concentration, and echocardiography during the treatment process and explored the potential relationship among them.

Results

FeNO and J’awNO were higher in OSAHS and associated with disease severity, while C_ANO was relatively lower. After nCPAP treatment in severe OSAHS patients, FeNO and J’awNO decreased and C_ANO increased significantly. Substantial agreement was shown between the elevation of C_ANO and the decrease of plasma ET-1 concentration after nCPAP by Kappa analysis for consistency. Tei index, which is considered indicative of global right ventricular function, might be predicted by plasma ET-1 levels in severe OSAHS patients.

Conclusions

NO exchange model provides us with more information of eNO derived from different areas. eNO is not only confirmed to be an effective method for airway inflammation evaluation in the follow-up of OSAHS, C_ANO may also serve as a useful marker in monitoring endothelial function, resistance of pulmonary circulation, and right ventricular function for clinical implication.