睡眠呼吸暂停相关性高血压靶器官损害的调查与分析

目的 调查睡眠呼吸暂停相关性高血压靶器官损害及相关临床情况的发生率及特征.方法 在高血压住院患者中进行阻塞性睡眠呼吸暂停(OSA)筛查,根据睡眠呼吸紊乱指数(AHI),诊断为睡眠呼吸暂停相关性高血压(AHI≥5)者603例入选为病例组,进一步分为轻(AHI 5～＜15)、中(AHI 15～＜30)、重(AHI≥30)3...     

OSAHS对老年慢性心力衰竭患者心功能的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对老年慢性心力衰竭患者(CHF)心功能的影响。方法根据60例老年CHF患者的多导睡眠图监测将其分为CHF合并OSAHS组和CHF组,对比分析左心室射血分数(LEVF)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(miniSPO2)及氧减饱和度指数(ODI)。结果与老年CHF组相比,观察组的LVEF较低且随AHI指数的增加而逐渐降低,两者呈负相关;miniSPO2以及ODI与AHI呈正相关。结论 OSAHS会加重老年CHF患者心功能的恶化,且会随其严重程度的增加而加剧。     

阻塞性睡眠呼吸暂停低通气综合征与心律失常相关性及持续正压通气疗效探讨

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与心律失常的关系及经鼻持续正压通气(nCPAP)治疗OSAS所致心律失常的疗效。方法:对82例睡眠打鼾者同步进行夜间7h以上多导睡眠图(PSG)及24h动态心电图监测,根据PSG结果分为OSAS组64例和对照组(单纯鼾症组)18例,比较组间最长呼吸暂停时间(LAT)、平均呼吸暂停时间(MAT)、呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(mSaO2)、心律失常发生率及发生类型;对18例中重度OSAS伴心律失常患者行nCPAP治疗,比较治疗前后监测资料。结果:OSAS组LAT、MAT长于对照组,AHI高于对照组,mSaO2低于对照组(均P<0.01),OSAS组心律失常发生率显著高于对照组(P<0.01);并且随着病情加重而升高(P<0.05)。nCPAP治疗后,AHI下降,mSaO2上升,平均每小时心律失常发生次数较治疗前显著减少(均P<0.01)。结论:OSAS与心律失常之间存在显著相关性,OS-AS患者夜间心律失常与低氧血症密切相关,nCPAP可有效减少心律失常的发生。     

睡眠呼吸暂停对充血性心力衰竭患者预后的影响

目的:评价睡眠呼吸暂停对充血性心力衰竭(CHF)患者预后的影响.方法:前瞻性病例对照研究.对年龄大于18岁、左心室射血分数≤0.45和纽约心功能分级(NYHA)Ⅱ～Ⅳ级的患者进行睡眠呼吸监测,根据结果分为CHF不合并睡眠呼吸暂停组、CHF合并阻塞型睡眠呼吸暂停组和CHF合并中枢型睡眠呼吸暂停组.并对其进行随访.随访结束时比较各组间死亡率.结果:共人选128例患者,其中男性105例,女性23例.128例入选患者中,CHF不合并睡眠呼吸暂停组23例、CHF合并阻塞型睡眠呼吸暂停组55例和CHF合并中枢型睡眠呼吸暂停组50例.平均随访35个月.不合并睡眠呼吸暂停组死亡率明显低于中枢型睡眠呼吸暂停组(分别为6.72/100人年和18.22/100人年,P=0.017),非存活患者中CHF合并睡眠呼吸暂停的比例明显高于存活者(分别为90%和79%,P=0.017).多元分析显示校正年龄、性别、体重指数等混杂因素后,不管睡眠呼吸暂停的发生(包括OSA或CSA),还是睡眠呼吸暂停的严重程度(如呼吸暂停低通气指数和最低血氧饱和度)与CHF患者全因死亡均无明显独立相关.结论:CHF合并中枢型睡眠呼吸暂停患者死亡率高于不合并睡眠呼吸暂停的CHF患者,多因素分析显示睡眠呼吸暂停对CHF患者的预后未达独立相关作用.     

老年人睡眠呼吸暂停综合征醒觉特点探讨

目的　探讨老年睡眠呼吸暂停综合征 (SAS)患者醒觉 (arousal)与呼吸暂停的关系。　方法　 62例老年患者经全导睡眠图检查确诊为SAS ,同时记录实际睡眠时间、呼吸暂停 低通气指数(AHI)、总醒觉发生次数、醒觉指数 (AI)、呼吸事件相关醒觉次数、>15s觉醒次数、低氧血症程度等 ;64例非老年SAS患者作为对照。 10例老年患者应用经鼻持续气道正压 (nCPAP)治疗 ,比较治疗前、后上述各项指标的变化。　结果　 62例老年SAS患者平均AHI为 (3 5 1± 2 3 2 )次 /h ,平均AI为 (15 8±11 4)次 /h ,其中呼吸相关醒觉只占总醒觉的 44 1% ,>15s的觉醒只占总醒觉的 6 1% ;64例非老年组平均AHI为 (3 9 1± 2 7 2 )次 /h ,平均AI为 (2 0 4± 13 0 )次 /h ,呼吸相关醒觉占总醒觉的 5 1 3 % ,>15s的觉醒占总醒觉的 6 7%。老年及非老年SAS组中均有 5 0 %患者发生重度低氧。老年组的醒觉指数和呼吸相关醒觉均显著低于非老年组 (P <0 0 5 )。 10例老年患者经使用nCPAP治疗后 ,AHI、AI、呼吸事件相关醒觉次数及其占总醒觉比例、>15s觉醒次数及其占总醒觉比例均比治疗前明显减低(P <0 0 1)。　结论　老年SAS患者对睡眠中频繁出现的呼吸事件的反应降低 ,甚至不能作出反应 ,睡眠中频繁出现低氧血症 ,nCPAP可纠正呼吸事件的发     

阻塞性睡眠呼吸暂停综合征并发心律失常临床观察

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)与心律失常的相关性。方法对经多导睡眠呼吸监测仪(polysomnogra-phy,PSG)监测确诊的62例患者行同步24 h动态心电图监测,根据PSG结果选20例单纯鼾症患者对照分析。结果观察发现OSAS患者体重、睡眠呼吸暂停低通气指数(AHI)、动态血氧饱和度改变及心律失常发生率较对照组有统计学意义(P0.01),OSAS组心律失常发生率明显高于鼾症患者。结论 OSAS患者心律失常的发生与呼吸暂停低通气指数及低氧血症密切相关。     

阻塞性睡眠呼吸暂停对2型糖尿病患者C肽水平的影响

目的 评价未经治疗的阻塞性睡眠呼吸暂停(OSA)对2型糖尿病患者反映胰岛功能的指标C肽的影响.方法 60例2型糖尿病患者行多导睡眠图(PSG)检查,并抽血检测C肽.根据呼吸暂停-低通气指数(AHI)将受试者分为4组:无OSA组(AHI＜5)20例;轻度OSA组(5≤AHI＜15)21例;中度OSA组(15≤AHI＜30...     

不同年龄呼吸睡眠暂停患者心律失常的发病情况比较

目的探讨不同年龄呼吸睡眠暂停综合征患者发生心律失常的情况。方法选择50例伴有心律失常的呼吸睡眠暂停综合征患者,按照年龄分为A、B、C三组,比较三组患者心律失常的发生情况和睡眠呼吸紊乱指数与心律失常的关系,并进行统计学分析。结果 A组与B组以窦性心律失常和房性心律失常为主,C组以房室传导阻滞为主(P0.05);C组高危心律失常发生率显著高于B组(χ~2=5.05,P0.05);三组患者睡眠呼吸紊乱指数与心律失常次数呈显著相关(r=0.501,0.667,0.701,P0.01)。结论呼吸睡眠暂停综合征与心律失常的发生密切相关,不同年龄患者心律失常的类型和危险性不同,老年患者病情较为严重,应引起临床高度重视。     

阻塞性睡眠呼吸暂停低通气综合征患者血清miR-223、IL-18水平变化及临床意义

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)血清微小RNA-223(miR-223)、白细胞介素18(IL-18)水平变化及临床意义.方法 选取OSAHS患者80例(OSAHS组),另选取同期健康者46例作为对照组(CON组),根据睡眠呼吸暂停低通气指数(AHI)对OSAHS患者进行病情程度分级(AHI≤10...     

睡眠呼吸暂停综合征患者红细胞压积与夜间缺氧的相关性分析

目的探讨睡眠呼吸暂停综合征(SAS)患者红细胞压积与夜间低氧血症的相关性.方法对290例有夜间打鼾伴超重的男性患者进行夜间持续7小时多导睡眠监测.监测项目包括夜间最低氧饱和度、夜间平均氧饱和度、氧饱和度低于90%所累计的时间(TST90%)、体位;于次日晨空腹抽取静脉血进行血细胞计数测定.SAS定义为睡眠呼吸暂停低通气指数(AHI)≥5次/h,AHI＜5次/h作为对照组(30例),分析夜间血氧指标与红细胞压积的相关性.结果①SAS患者年龄、体重指数、AHI和TST90%显著高于对照组(P＜0.05～0.001),夜间最低氧饱和度、夜间平均氧饱和度则显著低于对照组(P＜0.001);SAS轻-中度组(AHI 5～30,132例)和SAS重度组(AHI＞30,128例)与对照组比较血细胞各参数水平均无统计学差异(P均＞0.05).②调整年龄、体重指数、基础疾病、收缩压、舒张压和血脂等多个因素后,SAS患者的红细胞压积仍与夜间最低氧饱和度呈显著负相关,而与AHI呈显著正相关.结论SAS患者红细胞压积升高与夜间最低氧饱和度和AHI有相关性.     

Oxygen therapy prevents ventricular arrhythmias in patients with congestive heart failure and sleep apnea.

BACKGROUND: Although ventricular arrhythmia is critical for the prognosis of patients with severe congestive heart failure (CHF), it is difficult to control the arrhythmia using conservative therapies. However, many CHF patients also have sleep apnea syndrome (SAS) and oxygen supply improves their prognosis. The beneficial effects of oxygen treatment for ventricular arrhythmia have not yet been clarified, so the present study was designed to evaluate the effects of oxygen treatment for premature ventricular contraction (PVC). METHODS AND RESULTS: Patients with CHF and SAS were divided into 3 groups: (1) the "PVC declined" group that included patients who had frequent PVCs and oxygen treatment that suppressed the number of PVC; (2) the "PVC not affected" group that included patients who had frequent PVCs and oxygen treatment did not affect the number of PVC; and (3) the "few PVC" group that included patients who had no or few PVCs. The group 1 patients showed higher apnea-hypopnea index, standard deviation of all R-R intervals, left ventricular ejection fraction, and brain natriuretic peptide levels than the patients in group 2. Oxygen treatment in group 3 did not affect the PVC frequency. CONCLUSIONS: Oxygen treatment may be useful for preventing ventricular arrhythmia in selected patients with CHF and SAS.     

老年与非老年阻塞性睡眠呼吸暂停低通气合征象患者心律失常的比较

目的探讨老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间心律失常的特点及其与非老年人的差别。方法经多导睡眠图(PSG)确诊的老年OSAHS患者38例,同时作Holter检查,44例非老年患者作为对照组。结果老年与非老年OSAHS患者夜间心律失常发生率分别为63.2%和27.3%,老年组心律失常发生率明显高于非老年组(P<0.01)。夜间心律失常表现为多种形式,同一患者也可同时发生多种心律失常,窦缓在老年组中较常见;心律失常发生率与暂停-低通气指数(AHI)以及缺氧时间成正相关;同等严重程度比较,老年组心律失常的发生率亦明显高于非老年组。结论老年OSAHS患者夜间可发生多种形式的心律失常,并与AHI和缺氧时间密切相关;OSAHS对老年人心血管系统的影响较非老年人更严重。     

血栓弹力图在OSAHS并发慢性心力衰竭患者中的应用价值

目的 通过血栓弹力图评估阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）并发慢性心力衰竭（CHF）患者的血凝状态,探讨血栓弹力图在OSAHS并发CHF患者中的应用价值。 方法 选择确诊为OSAHS并发CHF患者60例,按照2015年我国《阻塞性睡眠呼吸暂停低通气综合征诊治指南（基层版）》诊断标准中的睡眠呼吸指数（AHI）,将OSAHS并发CHF患者分为轻度组（20例,AHI 5~15次/h）、中度组（20例,AHI 16~30次/h）和重度组（20例,AHI>30次/h）。另随机选取同一时段我院健康体检者20例作为正常对照组,所有入组患者均记录一般情况,包括年龄、身高、体质量、性别、高血压病、吸烟史、饮酒史、腰围、睡眠监测结果、血栓弹力图结果（R值、MA值）。 结果 ①随着OSAHS并发CHF患者体质量指数（body mass index,BMI）的升高,AHI相应增大,差异有统计学意义（P<0.05）。②OSAHS并发CHF患者各组与正常对照组比较,R值明显减小,差异有统计学意义（P<0.05）。OSAHS并发CHF患者各组间R值比较,差异有统计学意义（P<0.05）。③OSAHS并发CHF患者各组与正常对照组比较,MA值明显增大,差异有统计学意义（P<0.05,P<0.01）。OSAHS并发CHF患者各组间MA值比较,差异有统计学意义（P<0.05,P<0.01）。 结论 OSAHS并发CHF患者病情越重R值越小、MA值相应增大。     

Prevalence of sleep apnea in men with metabolic syndrome and controlled hypertension

BACKGROUND: Abdominal obesity and high blood pressure (HBP) are known to be associated with sleep apnea syndrome (SAS). Resistant hypertension commonly leads physicians to prescribe a sleep record because the prevalence of SAS is high in patients with resistant hypertension. Data on the prevalence of SAS in patients with treated and controlled hypertension are lacking. Moreover, while the metabolic syndrome (MS) and insulin resistance frequently occur in association with SAS, few studies have evaluated the prevalence of SAS in patients with MS. Epworth sleepiness scale (ESS) is often proposed to identify patients at high risk for sleep disorders and for which a sleep record should be prescribed. The reliability of this test to identify SAS has not been studied in patients with MS. OBJECTIVES: (i) To assess the prevalence of SAS in men with MS, (ii) to study the relationship between controlled hypertension and SAS in patients with MS, (iii) to assess the reliability of the ESS to diagnose SAS in patients with MS. METHODS: Among 135 men hospitalized for MS, the 125 who had no history of SAS were systematically evaluated by a nocturnal polygraphy was systematically performed in the 125 men without known SAS at the admission. An excessive daytime sleepiness was assessed by the ESS. Results of analyses in patients with controlled HBP (<130/85 mmHg with antihypertensive drug(s), n=41) were compared with those in patients with normotension (<130/85 mmHg without treatment, n=32). RESULTS: The prevalence of SAS (apnea-hypopnea index (AHI) >or=15/h) in men with MS was 44% in the whole population, 28.1% in the subgroup of patients with normotension and 61.0% in patients with treated and controlled HBP. A severe SAS (AHI >or=30/h) was respectively present in 6.3% and 34.1% of patients with normotension and controlled HTA (p<0.01). Compared with patients without SAS, those with SAS displayed higher blood pressure and BMI. Logistic regression analysis showed that controlled HTA was a determinant of SAS which persisted after adjustment for BMI. As suggested by the ROC curve, the ESS is not a good tool to identify patients with SAS. With a threshold of 11/24 the positive and negative values of this scale were of 0.20 and 0.47. CONCLUSION: The prevalence of SAS is high in men with MS. The ESS does not identify patients who should undergo a nocturnal record. Because a severe SAS is found in nearly one third of patients with MS and controlled HBP, we suggest that a nocturnal record should be systematically proposed to these patients irrespective of the degree of daytime sleepiness assessed by questionnaires.     

The effect of successful heart transplant treatment of heart failure on central sleep apnea

STUDY OBJECTIVE: Central sleep apnea (CSA) associated with Cheyne-Stokes respiration in patients with congestive heart failure (CHF) is thought to be an acquired pattern of respiratory control instability related, at least in part, to elevated sympathetic nervous system activity. The effect of restoring heart function to normal with heart transplantation in patients with CHF and CSA has only been reported within weeks of the transplant and with varying results. The purpose of the study was to evaluate the impact of successful heart transplant on sympathetic nervous system activity and CSA severity in patients with CHF. DESIGN: Controlled prospective trial. SETTING: University hospital. PATIENTS: Twenty-two patients with CHF (13 patients with CSA, and 9 patients with no sleep-disordered breathing [SDB]). INTERVENTIONS AND MEASUREMENTS: Polysomnography, left ventricular ejection fraction (LVEF), and overnight urinary norepinephrine excretion (UNE) were measured before and > 6 months after successful heart transplantation. RESULTS: In the CSA group, there was a fall in apnea-hypopnea index (AHI) [mean +/- SD, 28 +/- 15 to 7 +/- 6/h; p < 0.001] and UNE (48.1 +/- 30.9 to 6.1 +/- 4.8 nmol/mmol creatinine, p < 0.001) associated with normalization of LVEF (19.2 +/- 9.3% to 53.7 +/- 6.1%, p < 0.001) at 13.2 +/- 8.3 months following heart transplantation. Of the CSA group following transplantation, seven patients had no SDB (AHI < 5/h), three patients had persistent CSA (AHI, 12.3 +/- 0.9/h) and four patients acquired obstructive sleep apnea (OSA) [AHI, 11.2 +/- 7.4/h]. In comparison, none of the control group acquired CSA or OSA after transplantation. CONCLUSIONS: We conclude that CSA may persist despite normalization of heart function and sympathetic nerve activity.     

原发性甲状腺功能减退合并睡眠呼吸暂停综合征的临床分析

目的:探讨原发性甲状腺功能减退(以下简称甲减)合并睡眠呼吸暂停综合征(SAS)的临床特点,提高临床诊治水平。方法:对北京安贞医院呼吸科2002年5月至2009年12月诊治的甲减合并睡眠呼吸暂停综合征15例患者的临床资料进行回顾性分析。结果:甲减合并睡眠呼吸暂停综合征患者女性略多于男性(男性7例,女性8例),年龄29～70岁。15例患者中,4例有甲减病史,均为同位素治疗后甲减,病程3～30年;11例为新诊断甲减患者。临床表现为白天嗜睡(15/15)、打鼾(15/15),夜间憋醒(5/15),记忆力减退、注意力不集中、疲倦(15/15)、畏寒(12/15)、便秘(10/15)及黏液性浮肿(12/15)。多导睡眠监测结果:睡眠呼吸暂停指数(AHI)14.9～91.9次/h,平均(52.0±19.8)次/h,重度SAS12例,中度SAS2例,轻度SAS1例;其中阻塞性9例,中枢性1例,阻塞性并混合性5例。最低血氧饱和度(LSaO2)86%～47%,平均(70.1±11.7)%。嗜睡评分(ESS)11～18分,平均(14.3±1.7)分。7例患者首诊为冠心病。结论:甲减合并睡眠呼吸暂停综合征,以重度阻塞性睡眠呼吸暂停综合征居多,发病年龄广、病程长,二病有许多相似的临床表现,容易漏诊,应引起重视。     

Breathing abnormalities during sleep in patients with chronic heart failure

Polysomnography was carried out in 11 adult outpatients with stable chronic heart failure (CHF) due to valvular heart disease in order to investigate respiratory abnormalities during sleep. The subjects consisted of 6 males and 5 females and their ages ranged from 54 to 76 years. A coexisting central dominant sleep apnea syndrome (SAS) was found in 4 males, 3 of whom had evidence of nasal obstruction. A successful mitral valve replacement in one patient with central dominant SAS was associated with a reduction in the frequency of sleep apnea. The results suggest complications caused by respiratory abnormalities during sleep are common and should be considered in the management of patients with CHF.     

人性化护理干预对老年冠心病并慢性心力衰竭患者生活质量和负性情绪的影响

目的观察人性化护理干预对老年冠心病(CAD)并发慢性心力衰竭(CHF)患者生活质量和负性情绪的影响。 方法将94例CAD并发CHF患者按随机数表法分为A、B两组,各47例。A组接受常规护理,B组接受人性化护理。对比两组患者护理前后MLWHFQ、SAS和SDS评分,对比两组患者护理满意度评分。 结果B组患者护理干预后MLWHFQ评分低于A组(P<0.05);B组患者护理后SAS和SDS评分均低于A组(P<0.05);A组护理满意度评分低于B组(P<0.05)。 结论人性化护理对改善老年CAD并发CHF患者生活质量和负性情绪具有积极作用,可在临床推广。     

Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure

BACKGROUND: Nocturnal Cheyne-Stokes respiration (CSR) occurs frequently in patients with chronic heart failure (CHF), and it may be associated with sympathetic activation. The aim of the present study was to evaluate whether CSR could affect prognosis in patients with CHF. METHODS AND RESULTS: Sixty-two CHF patients with left ventricular ejection fraction /=30/h and left atria >/=25 cm2. CONCLUSIONS: The AHI is a powerful independent predictor of poor prognosis in clinically stable patients with CHF. The presence of an AHI >/=30/h adds prognostic information compared with other clinical, echocardiographic, and autonomic data and identifies patients at very high risk for subsequent cardiac death.