中、重度OSAHS患者上气道不同阻塞部位鼾声声压级指标分析

目的：研究中、重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyperpnoea syn-drome,OSAHS）患者上气道不同阻塞部位与鼾声声压级指标的关系。方法对46例经多导睡眠监测诊断为中度或重度OSAHS的患者进行整夜同步上气道测压和鼾声声压级记录,分析上气道阻塞部位构成比、每小时上部（软腭游离缘平面以上）和下部（软腭游离缘平面以下）阻塞次数与鼾声声压级分析指标中等效连续A声级（equivalent continuous A－weightedsound level,LAeq ）和最大声压级（L10）的相关性,以及上气道阻塞部位的类型、呼吸暂停低通气指数（AHI）及体质量指数（BMI）对鼾声声压级指标的影响。结果 OSAHS 患者上气道上／下部阻塞构成比和每小时上部及下部阻塞次数均与LAeq和L10无明显相关性,LAeq和L10的影响因素为AHI,而阻塞部位及BMI 对LAeq和L10无影响。结论 LAeq和L10的大小与AHI有关而与阻塞部位无明确关系,LAeq和L10可能有助于初步判断OSAHS患者的严重程度,对阻塞部位的辨别缺乏临床价值。     

阻塞性睡眠呼吸暂停低通气综合征患者血清脂联素水平的研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者空腹血清脂联素水平的变化。方法:随机选择OSAHS患者组和正常对照组各40例,OSAHS患者组根据体质指数(BMI)分为肥胖组(BMI≥25,26例)和非肥胖组(BMI<25,14例)2个亚组。进行整夜睡眠呼吸监测,用酶联免疫方法测血清脂联素浓度。结果:①扣除BMI的影响后,OSAHS患者组的血清脂联素水平低于对照组(P<0.05)。②OSAHS患者组无论肥胖与否血清脂联素水平均与BMI、AHI呈负相关,与最低血氧饱和度呈正相关。结论:除外年龄、BMI因素的影响,OSAHS患者的空腹血清脂联素水平降低。OSAHS患者脂联素水平的降低独立于年龄、BMI与其AHI和最低血氧饱和度存在相关性,推测OSAHS是引起血浆脂联素水平降低的原因之一。     

腕式睡眠监测仪在阻塞性睡眠呼吸暂停低通气综合征诊断中的应用

目的 评估腕式睡眠监测仪(Watch-PAT 200)在诊断阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的价值.方法 于2010年7～12月对36例疑似OSAHS患者同步使用Watch-PAT 200和整夜多道睡眠图(PSG)两种方法进行监测.记录呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(lowest art...     

阻塞性睡眠呼吸暂停低通气综合征患者鼾声的声学特征研究

目的:描述阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者鼾声的声学特征,为鼾声分析应用于OSAHS的诊断、治疗及结果评价奠定基础。方法:记录31例OSAHS患者整夜睡眠的鼾声和PSG监测。应用Adobe Audition软件提取鼾声,将鼾声信号转为数字信号,分别随机提取每个患者呼吸暂停后的第1个鼾声和不伴有呼吸暂停的鼾声各10个,共计620组鼾声数据。运用Matlab软件程序分析、比较两类鼾声的各项声学指标:鼾声的最大频率、中心频率、平均频率、峰频率、功率比等。结果:OSAHS患者的呼吸暂停后鼾声的最大频率、峰频率、平均频率、中心频率均大于连续鼾声,而800 Hz功率比则相反,这些指标的差异均有统计学意义(P<0.01或0.05)。将患者根据AHI值分为轻、中、重度三组,轻度组两类鼾声的峰频率、中心频率和800Hz功率比差异有统计学意义(P<0.01);而中、重度患者的指标中除了中心频率外,其余指标差异均有统计学意义(P<0.01或0.05)。结论:800Hz功率比可能是区别OSAHS患者呼吸暂停后鼾声与平稳呼吸时产生的连续鼾声不同的声学指标,提示将鼾声监测分析技术应用于OSAHS的诊断与筛查具有一定可行性,为进一步分析研究鼾声在临床中的应用提供了一个很好的线索。     

阻塞性睡眠呼吸暂停低通气综合征患者性别差异分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者临床及多导睡眠图(PSG)监测性别间差异。方法比较201例OSAHS患者中不同性别的呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSpO2)、体质指数(BMI),AHI和LSpO2不同分级间以及呼吸事件形式。结果男性患者平均年龄(46.2±11.7)岁小于女性(55.4±7.9)岁,男性患者AHI(37.8±25.8)次/h大于女性(27.9±20.4)次/h,男性患者LSpO2(77.0±10.9)%低于女性(81.4±5.4)%,差异均具有统计学意义。男女BMI间差异无统计学意义。男女患者在AHI和LSpO2不同分级间差异无统计学意义。呼吸事件形式上男性患者以呼吸暂停为主,女性以低通气为主,差异具有统计学意义。结论男性OSAHS患者年龄小于女性,病情较女性重,以呼吸暂停表现为主。     

不同睡眠期的阻塞性睡眠呼吸暂停低通气综合征严重程度

目的:普遍认为阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者快动眼睡眠期(REM)病情严重程度要比慢动眼睡眠期(NREM)重,通过对OSAHS患者REM期和NREM期临床及睡眠监测指标的比较分析,探讨不同睡眠期对OSAHS病情严重程度的影响.方法:回顾进行睡眠监测并诊断为OSAHS的118例患者,比较REM期睡眠呼吸暂停低通气指数(AHIREM)和NREM期AHI(AHINREM)的差别.并根据AHIREM和AHINREM将其分为2组:一组为AHIREM≥AHINREM组,另一组为AHIREM＜AHINREM组.比较2组在性别、年龄、体质指数(BMI)、病情严重程度、最低血氧饱和度(Min SaO2)及平均呼吸暂停时间的差别.结果:AHIREM和AHINREM比较差异无统计学意义(t=1.0,P≥0.05);AHIREM/ AHINREM为1.0±0.5;118例OSAHS患者中,AHIREM＜AHINREM组占55.9%;2组在性别、年龄、BMI、 AHI、仰卧位时AHI(AHIsupine)、Min SaO2和平均呼吸暂停时间比较差异均无统计学意义.结论:不同睡眠期的OSAHS病情严重程度差异无统计学意义.     

小柱软腭植入术治疗习惯性鼾声及轻中度睡眠呼吸暂停

目的探讨小柱软腭植入术对习惯性鼾声及轻中度阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的疗效。方法6例经多导睡眠监测(polysomnography,PSG)确诊为轻及中度OSAHS,呼吸暂停低通气指数(apneahypopneaindex,AHI)<40,2例习惯性鼾声患者行小柱软腭植入术,术前、术后均行PSG,鼾声VAS评分及ESS评分。结果术后随访3个月,6例轻及中度OSAHS患者的AHI由术前的23±8.29次/小时下降至11.75±5.62次/小时,鼾声VAS评分从8.5±1.29降至3.5±0.82,ESS评分由术前的15.75±4.11下降至10.25±4.32;2例习惯性鼾声患者的鼾声VAS评分由术前的平均6.5下降至3.5,患者及家属都感满意。1例患者有异物感。未发生植入物排出、感染、出血及腭咽闭合功能不全等并发症。结论小柱软腭植入术对改善鼾声及睡眠呼吸暂停有较确切的近期疗效,而长期疗效有待进一步观察。     

阻塞性睡眠呼吸暂停低通气综合征和单纯鼾症者鼾声的基频及共振峰分析

目的研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OS-AHS)和单纯鼾症(simple snoring,SS)者鼾声的基频和共振峰特点,探讨其可能的临床应用价值。方法对50例OSAHS患者(OSAHS组,轻度16例,中度15例,重度19例)和20例SS者(单纯鼾症组)行同步多导睡眠监测和鼾声监测,截取每例患者不同睡眠时段的10次鼾声,使用Prrat语音分析软件对鼾声的基频和共振峰进行分析。结果 SS组有明显的基频,在100Hz段以下分布聚集,而OSAHS组鼾声基频无规律;SS组鼾声的第一共振峰值(F1)明显小于OSAHS组;OSAHS组中,重度组F1最高,轻度组最低,且各组间两两比较差异均有统计学意义。结论 OSAHS患者与SS者的鼾声基频和共振峰频率特别是F1有明显差别,F1值的大小与OSAHS的严重程度有一定关系,鼾声的基频及共振峰值有助于OSAHS与SS的区分以及OSAHS严重程度的大致判断;根据SS者鼾声的基频可能有助于鼾声来源的鉴别。     

阻塞性睡眠呼吸暂停低通气综合征患者快速眼动睡眠期呼吸紊乱的特点

目的 :研究阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者快速眼动睡眠期 (REM )呼吸暂停低通气的特点。方法 :复习 180例经多导睡眠仪确诊的OSAHS患者的睡眠监测结果 ,使用标准诊断指标睡眠呼吸暂停低通气指数 (AHI)以及睡眠呼吸紊乱时间 (RIT)指数 ,对患者REM期和非快速眼动睡眠期 (N REM)呼吸紊乱的特点进行分析。结果 :轻度患者REM期AHI明显高于N REM期 (P <0 .0 5 ) ,中、重度患者差异无统计学意义。重度患者REM期LSaO2 明显低于N REM期 (P <0 .0 5 )。结论 :①OSAHS患者常随病情加重 ,出现REM期睡眠时间减少甚至消失 ;②REM期呼吸暂停低通气较N REM期严重 ,主要表现在呼吸暂停低通气时间延长 ,而AHI变化不明显 ;③与AHI比较 ,RIT指数与患者呼吸暂停低通气的严重程度更具相关性。     

阻塞性睡眠呼吸暂停低通气综合征患者清醒状态下的呼吸暂停与继之血氧饱和度下降的关系及临床意义

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者清醒状态下呼吸暂停与继之血氧饱和度下降的关系及临床意义.方法:选取夜间打鼾并疑有睡眠呼吸障碍的患者50例,使其在安静状态下平静呼气末暂停呼吸至血氧饱和度下降,记录血氧饱和度开始下降的时间,定义为单次氧减延迟时间;填写Epworth嗜睡问卷;根据整夜睡眠呼吸监测结果,按照呼吸暂停指数(AHI)的不同将打鼾者分为4组:第1组(0～5次/h)、第2组(>5～15次/h)、第3组(>15～30次/h)和第4组(>30次/h).结果:第3组比第1组单次氧减延迟时间显著缩短(P＜0.05),第4组比其他各组均显著缩短(P＜0.01);受试者AHI、血氧饱和度低于90%的时间占总睡眠时间的百分比(TS90%)、平均每小时睡眠呼吸暂停低通气时间、心率、体质指数(BMI)均与单次氧减延迟时间呈线性负相关(r=-0.709、-0.769、-0.682、-0.403、-0.480,均P＜0.01 );最低血氧饱和度(LSaO2) 、平均血氧饱和度(MSaO2)与单次氧减延迟时间呈线性正相关(r=0.702、0.610,均P＜0.01);年龄与单次氧减延迟时间无明显相关性;单次氧减延迟时间、AHI、LSaO2均与Epworth问卷前7项总分(ESS7)呈线性相关(r=-0.688、0.568、 -0.576,均P＜0.01).结论:单次氧减延迟时间随OSAHS患者病情的加重而缩短,重度患者缩短更显著,反应了病情的严重性;单次氧减延迟时间的缩短可能是对OSAHS患者的适应性保护机制,减少其受到呼吸暂停的损害; AHI、LSaO2、TS90%、平均每小时呼吸暂停低通气时间与受试者的单次氧减延迟时间具有密切相关性,表明单次氧减延迟时间可以反应OSAHS的严重程度,尤其对于重度患者;单次氧减延迟时间与ESS7具有密切相关性,表明单次氧减延迟时间对评价OSAHS患者白天的嗜睡程度有一定参考价值.     

Acoustic analysis of overnight consecutive snoring sounds by sound pressure levels

Conclusion: The sound pressure level (SPL) parameters, especially the A-weighted equivalent sound level (LAeq) and accumulative percentile sound level 10 (L10), were significantly different between simple snoring (SS) and obstructive sleep apnea-hypopnea syndrome (OSAHS). The apnea-hypopnea index (AHI) was the most significant factor to affect the SPLs of snoring sounds. LAeq and L10 were valuable acoustic characters of snoring which could reflect the severity of sleep disordered breathing in clinic. Objectives: Due to the limitation of acoustic analysis of single snoring sound for snorers, this study analyzed characteristics of consecutive snoring sounds overnight by the SPLs in patients of SS and OSAHS. Method: Ninety-four patients who underwent simultaneous SPL recording and polysomnography (PSG) were included in this study. Parameters of SPL such as LAeq, peak sound level (Lpeak), L10, L50, and L90 were analyzed. The correlation between these parameters and PSG results was also analyzed. Results: The LAeq and L10 in OSAHS patients were significantly different from patients with SS. The body mass index (BMI) was positively correlated to LAeq and L10. Among various factors of PSG data and demographic factors, the SPLs were mostly affected by the AHI and the lowest oxygen saturation (LSaO₂).     

鼾症患者模拟打鼾与药物诱导睡眠内镜下鼾声来源部位的对比研究

目的 对单纯打鼾(SS)及轻度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患者,通过鼻咽纤维喉镜观察清醒状态下模拟打鼾及药物诱导睡眠下打鼾时的鼾声来源,研究这两种检查方法判断鼾声来源部位的一致性及模拟打鼾判断鼾声来源的可靠度。 方法 经多导睡眠监测(PSG)诊断为单纯打鼾患者及轻度OSAHS患者共40例,依次进行清醒状态下模拟打鼾及药物诱导睡眠,通过纤维鼻咽喉镜观察患者仰卧位打鼾时咽部组织的振动情况。 结果 在模拟打鼾及药物诱导睡眠两种状态下咽部组织的振动情况有所不同。统计学McNemar检验结果显示,两种方法对软腭振动及会厌/舌根振动判断的差异无统计学意义(P=0.774, 0.077),对咽侧壁振动判断的差异有统计学意义(P=0.002)。两种检查对软腭及会厌/舌根振动的检出率差异无统计学意义(P=0.770,0.110), 药物诱导睡眠对咽侧壁振动的检出率远高于模拟打鼾(P=0.005)。 结论 与药物诱导睡眠内镜检查相比,模拟打鼾能较好地判断软腭振动,其次为舌根/会厌,对咽侧壁振动则较难判断。     

Analysis of snoring sound by psychoacoustic parameters

The analysis of snoring sounds has been in focus for the past two decades. Conventional approaches by fast Fourier transformation face various limitations and demonstrate the necessity for alternative methods of investigation. Psychoacoustic analyses which are common for environmental noise analyses propose a potential approach. The present study investigates the psychoacoustic qualities (loudness, sharpness, roughness) of three different real snoring sounds (primary snoring, PS; Upper airway resistance syndrome, UARS; obstructive sleep apnea syndrome, OSAS) and their alterations under increasing, artificially created sound pressure levels (SPL) from 60–85 dB. PS and UARS were detected to obtain a greater loudness as well as a higher increase under increasing SPL than OSAS. The sharpness was higher in PS and UARS, remaining stable under rising SPL compared to OSAS. The intensities of roughness were at higher levels for PS compared to URAS and OSAS, with an increase of all snoring sounds under rising SPL. By merging the psychoacoustic qualities, an individual acoustic fingerprint can be created to differentiate the three types of snoring. A potential application is proposed for the analysis of snoring sounds during polysomnography as well as for an adequate evaluation of the annoyance by snoring sounds.     

纤维鼻咽喉镜下观察经药物诱导睡眠的鼾症患者鼾声来源

目的 对睡眠呼吸障碍程度不同的鼾症患者进行药物诱导下睡眠, 通过纤维鼻咽喉镜下观察患者睡眠中鼾声来源, 为治疗鼾症提供依据。方法 经多导睡眠监测(PSG)诊断为单纯打鼾(SS)及轻、中、重度(AHI≤40次/h)阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患者共52例, 用异丙酚复合右美托米啶进行诱导睡眠后, 通过纤维鼻咽喉镜观察不同组鼾症患者仰卧位打鼾时咽部组织的振动及塌陷情况。结果 鼾声可来源于软腭、咽侧壁、会厌及舌根的振动, 其中咽侧壁振动的发生率在各组中的差异有统计学意义。不同患者的鼾声来源表现为单纯软腭振动型(Ⅰ型)和混合振动型(Ⅱ型)两大类型, Ⅱ型又可分为软腭加会厌振动(或加会厌舌根振动, Ⅱa型)、软腭加咽侧壁振动(Ⅱb型)和软腭加咽侧壁及会厌舌根振动(Ⅱc型)3种亚型。Ⅰ型鼾声来源在SS和轻、中、重度OSAHS患者中的比例有逐渐降低的趋势, Ⅱb型来源多见于中、重度患者, Ⅱc型来源在重度患者中最多见。结论 鼾声来源具有多样性, 睡眠呼吸障碍程度不同的鼾症患者鼾声来源有不同的特点, 选择治疗措施时应对主要鼾声来源进行辨别。     

OSAHS患者不同阻塞部位鼾声频域特性分析

目的 通过鼾声监测分析结合上气道压力测定研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea/hypopnea syndrome,OSAHS)患者软腭游离缘平面以上阻塞(上部阻塞)和以下阻塞(下部阻塞)鼾声的频域特性的不同之处.方法 对30例男性OSAHS患者夜间睡眠时同步进行鼾声监测和持...     

OSA H S患者与单纯打鼾者鼾声声学特性初步研究

目的利用鼾声监测及分析技术对OSAHS患者和单纯打鼾者的鼾声的声学特性进行初步研究。方法阻塞性睡眠呼吸暂停低通气综合征（OSAHs）患者22人,单纯打鼾（simple snoring）者15人,分别同步进行鼾声监测和睡眠呼吸监测。取每例单纯打鼾者10次鼾声和每例OSAHS患者10次阻塞性呼吸暂停后的第一次鼾声进行时域和频域特性分析。结果单纯打鼾者鼾声片断时域曲线表现为多个振幅、间隔大致相仿的复合波,频域曲线表现出明显的基一频谐波结构;OSAHS患者鼾声的时域曲线表现为多个振幅、间隔不规则的复合波,频域曲线中无明显的基频一谐波结构。OSAHS患者鼾声的峰频率、中心频率较单纯打鼾者高,800Hz功率比率较单纯打鼾者低,OSAHS组,中重度OSAHS患者的鼾声峰频率、中心频率较轻度者高,800Hz功率比率较轻度者低,中心频率和800Hz功率比率的差异有统计学意义（P〈0．05）。结论0SAHS患者和单纯打鼾者鼾声具有不同的时域特性和频域特性,表明两种鼾声在声学上有质的差别,提示将鼾声监测分析技术应用于OSAHS的研究具有一定可行性,并可能为确定阻塞部位及鼾声来源提供新的临床研究思路。     

Acoustic analysis of snoring sounds originating from different sources determined by drug-induced sleep endoscopy

Objective: To discuss the possibility of fundamental frequency (F0) and formant frequency (FF) to generally differentiate the sources of snoring sounds determined by drug-induced sleep endoscopy (DISE).

Methods: A total of 74 snoring subjects underwent DISE and snoring sounds were recorded simultaneously. The noise-suppressed snoring sounds were analyzed and classified into different groups based on the sources of vibration identified by DISE. F0 and FFs were calculated.

Results: Totally, 516 snoring sounds from three vibrating sources (the palate, combined the palate and the lateral wall, the lateral wall) of 47 patients were divided into three groups then analyzed. The levels of F0 and FFs for each group follow the order: Group 1?p?Conclusions: F0 and the second formant frequency (F2) are found to be significantly lower in palatal snoring sound. F0 might be a significant in distinguishing palatal snoring sound from non-palatal snoring sound. F2 is more significant than F1 and F3 in identifying the sources of the snoring sounds but is less sensitive than F0.     

Multilevel radiofrequency ablation for snoring and OSAHS patients therapy: long-term outcomes

Our objective is to evaluate the outcomes of the Radio-Frequency (RF) energy for tissue thermo-ablation therapy in sleep-disordered breathing patients and retrospective evaluation of the RF therapy after a 5-year follow-up period, in terms of snoring and apnea reduction. From June 1999 to June 2009, we enrolled patients suffering from simple snoring and patients with obstructive apnea hypopnoea syndrome (OSAHS). A visual analog scale (VAS) questionnaire was used to evaluate the level of snoring and was filled out in short- and long-term periods, whereas in OSAHS patients an unattended polysomnography was performed before and after a minimum of 6 months from the last RF therapy treatment session. The presence of post-operative pain was assessed by means of a specific VAS. Results stated that 187/250 patients finished the RF therapy. In the simple snoring group, mean snoring VAS decreased from 7.48 to 3.7 (P < 0.0001). In the post-operative snoring group, mean snoring VAS decreased from 7.6 to 3.6 (P < 0.0001). In the mild-to-moderate grade OSAHS group, AHI decreased from a mean value of 18.1 to a mean value of 12.9 (P < 0.0001). Furthermore, we recorded a mean post-operative pain VAS of one in each group of patients. Our results suggest an important role of RF therapy in the improvement of snoring solution, but not for a significant AHI reduction. Level of evidence 2c.