阻塞型睡眠呼吸暂停综合征与动脉粥样硬化

阻塞型睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）是临床上常见的重要慢性睡眠呼吸疾病。近年来的研究已证实，OSAS是动脉粥样硬化性疾病的独立危险因素。OSAS患者在睡眠时由于上气道阻塞或部分阻塞导致反复发作的慢性间歇性缺氧，这可能是其诱发动脉粥样硬化性疾病的重要原因，此过程中可能的分子机制包括：I-κB复合物和P38激酶激活调控NF-κB信号通路；端粒酶和Fas死亡配体依赖性细胞凋亡调控途径；间歇性缺氧诱发肝脏损伤导致高胆固醇血症和脂质过氧化反应代谢紊乱，引起不可逆的血管和周围组织重塑，伴有平滑肌增生和纤维化，导致动脉粥样硬化。     

利用ECG信号检测睡眠呼吸暂停的小波包分析方法

文章根据睡眠呼吸暂停与心率变化的关系。阐述了从心电图中检测睡眠呼吸暂停的方法。该方法首先通过对心率信号进行小波包变换，提取特征向量，然后根据特征向量的变化检测出睡眠呼吸暂停的位置和分布。结果表明，该方法物理意义明确，诊断结果精度高，为睡眠呼吸暂停综合症的早期诊断、监护及预后评估提供了新的分析工具。     

CPAP治疗阻塞型睡眠呼吸暂停综合征前后患者血清IL-6和TNF-α的动态变化

目的：通过研究阻塞型睡眠呼吸暂停综合征（OSAS）患者血浆白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的水平及经持续气道正压通气（CPAP）治疗前后的变化,探讨IL-6和TNF-α在OSAS患者发病机制及病理生理中的作用。方法：①选择我院OSAS患者60例及正常人30例,详细询问病史,对所有观察对象于晨起采集静脉血标本,采用放射免疫分析集中检测血浆IL-6、TNF-α水平。比较OSAS组与对照组间血浆IL-6、TNF-α水平的差异;分析OSAS患者血浆IL-6、TNF-α水平与睡眠呼吸暂停低通气指数（AHI）和最低血氧饱和度的相关性。②OSAS组患者进行CPAP治疗并随访,3个月后复查上述各项指标,比较OSAS患者经CPAP治疗前后血浆IL-6、TNF-α水平等指标变化。结果：OSAS组患者血浆IL-6和TNF-α水平分别为（25.92±4.48）pg/ml,（11.27±2.60）pg/ml。较对照组升高（13.21±1.97）pg/ml,（5.83±0.99）pg/ml差异有统计学意义。②OSAS患者血浆IL-6和TNF-α水平与其AHI均呈正相关,相关系数分别为0.456（P〈0.05）,0.464（P〈0.05）。OSAS患者血浆IL-6和TNF-α水平与其最低血氧饱和度均呈负相关,相关系数分别为-0.495（P〈0.05）,-0.483（P〈0.05）。③OSAS患者进行CPAP治疗并随访,3个月后回访20例,再次测定血浆IL-6、TNF-α水平,分别为（15.37±1.78）pg/ml,（6.79±0.87）pg/ml较治疗前减低,差异有统计学意义。结论：CPAP治疗能有效地降低OSAS患者的血浆IL-6及TNF-α水平。     

睡眠呼吸暂停分析系统

本文介绍了一种用于监测睡眠呼吸疾患的计算机自动分析系统的工作原理和软硬件设计。该系统实时显示、记录存储人体9种不同生理信号,自动分析报告睡眠、呼吸和血氧饱和度的动态变化。临床应用证明该系统可为临床诊断失眠、鼾症和睡眠呼吸暂停等睡眠障碍提供可靠的客观依据,与传统的记录多导睡眠图的方法相比,具有节省人力、时间和记录纸的优点。     

睡眠呼吸暂停监测方法及仪器的研究

介绍了睡眠呼吸暂停监测的基本原理和重要意义,阐述了国内外该领域研究的现状,分析了睡眠呼吸暂停监测的几种方法。在此基础上,研制出了价格低廉的便携式睡眠呼吸暂停监测仪。实验结果表明该仪器使用方便,精度高,性能可靠。     

阻塞性睡眠呼吸暂停综合征并高血压的护理体会

总结阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压（HT）患者的护理特点。对53例OSAS合并HT者，经鼻持续正压气道装置（nCPAP)及抗高血压药物治疗，减肥、体位训练、合理膳食和心理辅导等全方位护理后，35例症状好转，血压恢复正常；4例对nCPAP不耐受，改为双水平气道正压呼吸机（BiPAP)治疗，病情好转，总有效率达73．6％。     

阻塞性睡眠呼吸暂停低通气综合征与血压变异性的临床研究

目的:通过测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压及脉压(PP),探讨血压变异性与OSAHS之间的关系。方法:OSAHS合并高血压患者99例,根据呼吸暂停低通气指数(AHI)分为轻度、中度和重度OSAHS三组;单纯高血压患者20例作为对照组,比较OSAHS各组及单纯高血压组之间血压变化的特点。结果:重度OSAHS组患者的AHI、体重指数(BMI)、平均血压、非杓型血压所占比例及PP均明显高于轻、中度OSAHS组和单纯高血压组,最低血氧饱和度(SaO2)明显低于轻、中度OSAHS组和单纯高血压组。相关分析结果表明,平均PP与AHI呈正相关;SaO2与平均收缩压、舒张压呈负相关;AHI与平均收缩压呈正相关。结论:OSAHS患者夜间血压出现非杓型模式,血压增高的程度以及非杓型血压所占比例随着OSAHS病情加重而逐渐增高;PP与OSAHS的严重程度密切相关。     

阻塞性睡眠呼吸暂停的遗传学研究

阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）的遗传学研究尚处在初期,但迄今研究提示OSA有很强的遗传背景,其发病存在着家族聚集性且与相关中间表型有关,如与颅面结构、体内脂肪分布和呼吸调控的异常等有关。目前认为OSA的发病很可能是多基因与环境因素交互作用的结果。对OSA的分子遗传学研究可帮助理解OSA的病因和发病机理,并能促进对OSA的基因诊断和预防。     

睡眠呼吸暂停综合征患者的睡眠分期算法研究

针对可穿戴睡眠监测缺乏有效的自动睡眠分期和睡眠质量评价方法这一问题,提出一种适用于睡眠呼吸暂停综合征患者的自动睡眠分期方法。通过心电图R-R间期序列,分别得到心率变异性、呼吸幅度变异性和呼吸率变异性信号。以此为基础,提取时域、频域及非线性特征共55个。利用门控循环单元网络,分别构建清醒-睡眠二分类、清醒-快速眼动-非快速眼动睡眠三分类、清醒-快速眼动-浅睡-慢波睡眠四分类、清醒-快速眼动-非快速眼动Ⅰ-Ⅱ-Ⅲ期五分类等共4个不同分类粒度的睡眠分期模型;采用损失函数类别加权方法,有效降低数据非平衡对分期结果的影响。验证数据来自SHRS数据库的274例患者。借助准确率、Cohen's Kappa系数和睡眠结构指标对该睡眠分期方法进行性能评价。结果表明4个分类器的准确率分别为85.06%、75.44%、63.80%、62.13%,Cohen's Kappa系数达到了0.54、0.49、0.41、0.41,睡眠结构分析评估与临床结果之间的差异无统计学意义。所提出的方法基本满足睡眠质量评估的需求,适用于可穿戴睡眠监测应用。     

便携式睡眠呼吸暂停监护系统的设计

目的设计一套可以直接佩戴在患者身上的睡眠呼吸心电监护系统,以便于检测患者是否存在睡眠呼吸暂停症状。方法采用ALTERA公司的FPGA和Nios II 32位软核处理器以及相关的开发工具,应用可编程片上系统(system on a programmable chip,SOPC)的设计方法,将复杂的控制系统集成到单一的FPGA器件上,在Nios II IDE集成开发环境下完成软件开发。系统以嵌入式处理器为核心,通过传感器同步检测患者的呼吸和打鼾的次数,并记录平均每小时出现呼吸暂停的次数和时间。结果可穿戴式的传感器和电极能同时检测患者的呼吸信号、心电信号和心率,并判断呼吸暂停期间心电信号或心率有无异常,情况危急时给予预警。结论经过测试与验证,该系统具有操作简单、轻便低功耗等特点,患者不需住院,直接在居家环境下进行睡眠检测,减少了患者的心理负担,提高了检测的准确度。     

Prediction of Obstructive Sleep Apnea with Craniofacial Photographic Analysis

Study Objectives:

To develop models based on craniofacial photographic analysis for the prediction of obstructive sleep apnea (OSA).

Design:

Prospective cohort study.

Setting:

Sleep investigation unit in a university teaching hospital.

Patients:

One hundred eighty subjects (95.6% Caucasian) referred for the initial investigation of OSA were recruited consecutively.

Interventions:

Clinical assessment and frontal-profile craniofacial photographic analyses were performed prior to polysomnography. Prediction models for determining the presence of OSA (apnea-hypopnea index [AHI] ≥ 10) were developed using logistic regression analysis and classification and regression trees (CART).

Measurements and Results:

Obstructive sleep apnea was present in 63.3% of subjects. Using logistic regression, a model with 4 photographic measurements (face width, eye width, cervicomental angle, and mandibular length 1) correctly classified 76.1% of subjects with and without OSA (sensitivity 86.0%, specificity 59.1%, area under the receiver operating characteristics curve [AUC] 0.82). Combination of photographic and other clinical data improved the prediction (AUC 0.87), whereas prediction based on clinical assessment alone was lower (AUC 0.78). The optimal CART model provided a similar overall classification accuracy of 76.7%. Based on this model, 59.4% of the subjects were classified as either high or low risk with positive predictive value of 90.9% and negative predictive value of 94.7%, respectively. The remaining 40.6% of subjects have intermediate risk of OSA.

Conclusions:

Craniofacial photographic analysis provides detailed anatomical data useful in the prediction of OSA. This method allows OSA risk stratification by craniofacial morphological phenotypes.

Citation:

Lee RWW; Petocz P; Prvan T; Chan ASL; Grunstein RR; Cistulli PA. Prediction of obstructive sleep apnea with craniofacial photographic analysis. SLEEP 2009;32(1):46-52.     

The Utility of Three Screening Questionnaires for Obstructive Sleep Apnea in a Sleep Clinic Setting

Purpose

The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea.

Materials and Methods

Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire.

Results

The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) ≥5/h and 58.4% for an AHI ≥15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI ≥5/h, 98% for AHI ≥15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI ≥5/h, 74% for AHI ≥15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ.

Conclusion

The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting.     

阻塞性睡眠呼吸暂停综合征的情绪状况

目的 探讨阻塞性睡眠呼吸暂停综合征（OSAS）患者情绪状况的改变。方法 对63例疑诊OSAS的患者行全夜多导睡眠图（PSG）检查，根据呼吸暂停低通气指数（AHI）分为OSAS组和对照组，对其进行抑郁和焦虑症状评定，比较两组中各指标的差异性。结果 OSAS患者SAS、SDS得分均升高。OSAS患者抑郁和焦虑的发生率分别为44．2％和32．6％，明显高于对照组，以抑郁尤为明显。结论 OSAS患者存在明显情绪障碍。     

Cognitive Function Among Obstructive Sleep Apnea Patients in North East Malaysia

Introduction

Obstructive sleep apnea patients may develop deficits in the cognitive domains of attention, concentration, executive function, verbal and visuospatial memory, constructional abilities, and psychomotor functioning. As cognitive performance will improve with the treatment, early screening for cognitive dysfunction should be done to prevent further deterioration.

Differences in Craniofacial Structures and Obesity in Caucasian and Chinese Patients with Obstructive Sleep Apnea

Study Objectives:

To explore differences in craniofacial structures and obesity between Caucasian and Chinese patients with obstructive sleep apnea (OSA).

Design:

Inter-ethnic comparison study.

Setting:

Two sleep disorder clinics in Australia and Hong Kong.

Patients:

150 patients with OSA (74 Caucasian, 76 Chinese).

Interventions:

Anthropometry, cephalometry, and polysomnography were performed and compared. Subgroup analyses after matching for: (1) body mass index (BMI); (2) OSA severity.

Measurements and Results:

The mean age and BMI were similar between the ethnic groups. Chinese patients had more severe OSA (AHI 35.3 vs 25.2 events/h, P = 0.005). They also had more craniofacial bony restriction, including a shorter cranial base (63.6 ± 3.3 vs 77.5 ± 6.7 mm, P < 0.001), maxilla (50.7 ± 3.7 vs 58.8 ± 4.3 mm, P < 0.001) and mandible length (65.4 ± 4.2 vs 77.9 ± 9.4 mm, P < 0.001). These findings remained after correction for differences in body height. Similar results were shown in the BMI-matched analysis (n = 66). When matched for OSA severity (n = 52), Chinese patients had more craniofacial bony restriction, but Caucasian patients were more overweight (BMI 30.7 vs 28.4 kg/m², P = 0.03) and had a larger neck circumference (40.8 vs 39.1 cm, P = 0.004); however, the ratios of BMI to the mandible or maxilla size were similar.

Conclusions:

Craniofacial factors and obesity contribute differentially to OSA in Caucasian and Chinese patients. For the same degree of OSA severity, Caucasians were more overweight, whereas Chinese exhibited more craniofacial bony restriction.

Citation:

Lee RWW; Vasudavan S; Hui DS; Prvan T; Petocz P; Darendeliler MA; Cistulli PA. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. SLEEP 2010;33(8):1075-1080.     

Obstructive Sleep Apnea: A Risk Factor for Work Disability

Study Objective:

To examine obstructive sleep apnea (OSA) as a risk factor for work disability.

Patients and Setting:

Consecutive patients referred to the University of California San Francisco Sleep Disorders Center with suspected OSA (n = 183).

Design:

All patients underwent overnight polysomnography after completing a written survey which assessed work disability due to sleep problems, occupational characteristics and excessive daytime sleepiness (EDS) defined as an Epworth Sleepiness Scale score > 10.

Results:

Among 150 currently employed patients, 83 had OSA on polysomnography (apnea-hypopnea index ≥ 5). Compared with patients in whom both OSA and EDS were absent, patients with the combination of OSA and EDS were at higher risk of both recent work disability (adjusted odds ratio [OR], 13.7; 95% confidence interval [CI], 3.9–48) and longer-term work duty modification (OR, 3.6; CI, 1.1–12). When either OSA or EDS were absent, the strength of the association with work disability was less than when both OSA and EDS were present. When OSA was examined without respect to EDS, patients with OSA were at increased risk of recent work disability relative to patients without OSA (OR 2.6; 95% CI 1.2–5.8), but the association of OSA with longer-term work duty modification did not meet standard criteria for statistical significance (OR = 2.0, 95% CI 0.8–5.0).

Conclusions:

The combination of OSA and EDS contributes to work disability, and OSA by itself contributes to recent work disability. These findings should highlight to employers and clinicians the importance of OSA in the workplace to encourage patients to be screened for OSA, particularly in situations of decreased productivity associated with EDS.

Citation:

Omachi TA; Claman DM; Blanc PD; Eisner MD. Obstructive sleep apnea: a risk factor for work disability. SLEEP 2009;32(6):791-798.     

阻塞性睡眠呼吸暂停低通气综合征和超敏C反应蛋白的相关性探究

目的 探究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypoventilation syndrome,OSAHS)与超敏C反应蛋白的相关性探究.方法 选取2011年4月至2013年5月在我院接受治疗的OSAHS的患者40例作为实验组,选取40名健康人为对照组.观察两组患者的超敏C反应蛋白的含量,以及互相之间的相关性.结果 两组患者经过检查后,实验组患者的每小时睡眠内呼吸暂停加上低通气的次数(AHI)为30.5±22.5次/小时,明显高于对照组患者的AHI(2.4±1.6次/小时),实验组患者的最低血氧饱和度(70.5±5.0％)明显低于对照组患者的最低血氧饱和度(97.5±4.9％).实验组患者的超敏C反应蛋白的水平(3.55±2.53mg/L)明显高于对照组患者的超敏C反应蛋白的水平(1.43±1.65mg/L).两者差异具有统计学上有意义(P＜0.05).结论 对于OSAHS患者来说,超敏C反应蛋白的水平明显增高,且病情越重,其超敏C反应蛋白的水平水平越高,超敏C反应蛋白的水平能够反应OSAHS的病情严重程度,可以作为辅助诊断治疗因素.     

Endothelial Function in Normotensive Men with Obstructive Sleep Apnea Before and 6 Months After CPAP Treatment

Study Objectives:

To evaluate endothelium-dependent flow-mediated dilation (FMD) and endothelium–independent nitroglycerin (NTG)-induced dilation of the brachial artery with Doppler ultrasound in patients with obstructive sleep apnea (OSA) and impact of six months of continuous positive airway pressure (CPAP) treatment.

Design:

A prospective, controlled, observational study.

Setting:

Single-site, clinic-based.

Patients:

Twenty-nine normotensive men with OSA (apnea-hypopnea index [AHI], mean ± SD, 60.4 ± 22.1-h), and 17 men without OSA (AHI 2.5 ± 0.6-h).

Interventions:

Six months of CPAP therapy in OSA patients.

Measurements and Results:

FMD was lower in patients with OSA compared with in controls (7.19 ± 1.78 % vs 10.93 ± 2.59 %; P < 0.001) while NTG-induced vasodilation was similar in both groups (13.75 ± 1.01 % vs 14.25 ± 1.83 %; n.s.). An inverse relationship was found between FMD and AHI adjusted for age and body mass index (BMI) (β = − 0.05, P < 0.001). Following 6 months of CPAP treatment in the OSA group, FMD was increased from 7.38 ± 2.06 % to 10.45 ± 1.68; P = 0.001) in 20 patients compliant with the device whereas the corresponding values did not change in the non-user group (7.08 ± 1.50% vs 7.26 ± 1.01%). No significant changes were observed regarding the NTG–induced vasodilation after CPAP compared with the baseline values.

Conclusion:

Our results confirm the previous reports suggesting impaired endothelium-dependent FMD in OSA, and additionally document the sustained improvement in endothelial function after 6 months of CPAP treatment in complaint patients.

Citation:

Bayram NA; Ciftci B; Keles T; Durmaz T; Turhan S; Bozkurt E; Peker Y. Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment. SLEEP 2009;32(10):1257-1263.