经皮电刺激治疗阻塞性睡眠呼吸暂停综合征的研究

目的：采用经皮无创的双向电流脉冲刺激舌下颏舌肌，研究这种方法作为治疗阻塞性睡眠呼吸暂停综合征的可能性和适用性。方法：采用PSG同步监测，根据患者不同的情况，分析给出最佳的电刺激参数，当发生睡眠呼吸暂停时及时给予适当的电刺激信号，以颏舌肌为主的上气道扩张肌使舌体向前运动，扩大舌咽气道，从而降低上气道阻力，改善夜间低氧血症，使睡眠结构得以改善，达到治疗目的。结果：对22名阻塞性睡眠呼吸暂停综合征患者给予经皮无创电刺激舌下神经分支，经治疗后显效17名，好转2名，无效3名，有效率77．27％。结论：这是一种非手术的、有临床价值的、低费用的治疗阻塞性睡眠呼吸暂停综合征的方法。     

Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合症诊断中的应用

目的 探讨Epwoyth嗜睡量表对阻塞性睡眠呼吸暂停低通气综合症（OSAHS）临床诊断意义。方法 对83例鼾症、279例OSAHS患者（轻度65例、中度97例、重度117例）分别进行Epworth问卷调查并判断嗜睡评分（EP），然后行多导睡眠监测（PSG）。依据PSG检查将EP与相关资料做统计学分析。结果 鼾症、OSAHS患者EP评分与睡眠呼吸暂停-低通气指数（AHI）、夜间睡眠呼吸紊乱时间（T）呈明显正相关；EP与最低氧饱和度（SaO2）呈负相关。即OSAHS病情越重，EP评分越高。诊断符合率分别为：鼾症90．36％（75／83），轻度OSAHS92．3％（60／65），中度0SAHS91．75％（89／97），重度OSAHS92．3％（108／117）。结论 EP评分基本与病情相符，诊断符合率较高。可以用Epworth嗜睡量表作为临床OSAHS患者的初筛检查，尤其是在基层医院。     

多项睡眠图联合长程视频脑电图观察未治疗的28例癫癎患者睡眠结构和呼吸事件的变化

目的:探讨成人癫癎患者药物治疗前睡眠结构和睡眠呼吸事件的变化。方法:对确诊为癫癎的成人患者28例进行多项睡眠图(PSG)检查,同步行长程视频脑电图(LTV EEG)检查,分析患者的睡眠结构、睡眠呼吸事件情况。结果:本组病人PSG睡眠结构特点表现为各睡眠参数均有不同程度的改变,以REM潜伏期增加、REM睡眠减少为著,浅睡眠明显增多,而深睡眠则无明显差异。其中2例患者无REM睡眠。所有患者夜间觉醒次数均增多,睡眠效率明显下降。但在觉醒时间、周期性腿动和呼吸暂停指数上,并无明显变化。结论:癫癎患者在药物治疗前存在睡眠结构紊乱。     

伴有多脏器损害的极重度阻塞性睡眠呼吸暂停低通气综合征治疗体会

目的:探讨极重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴有多脏器损害有效的治疗方法.方法:2007年6月～2008年2月,对6例伴有多脏器损害的呼吸紊乱指数(AHI)≥65 次/h的极重度OSAHS患者首先行气管切开术,再根据伴发疾病情况和上气道阻塞的不同位置进行同期或分期手术.结果:6例术后未出现窒息、出血以及心脑血管意外等并发症,带管1～16周拔管,6个月后随诊,夜间打鼾、呼吸抑制症状有不同程度改善,多脏器损害情况得到有效控制;复查多导睡眠监测(PSG)2例显效,4例有效.结论:极重度OSAHS伴有多脏器损害患者的治疗,首先要行气管切开术,再针对不同的患者进行个体化综合治疗.     

阻塞性睡眠呼吸暂停综合征的心电图分析

目的：探讨阻塞性睡眠呼吸暂停综合征(OSAS)导致心律失常的心电图特点和机理。方法：对32例阻塞性睡眠呼吸暂停综合征的患者用日本铃谦302型12导联心电图机连续监测半小时以上。结果：32例中发生律失常者27例，检出率84．44％。结论：阻塞性睡眠呼吸暂停综合征导致的心律失常可能与植物神经张力变化的影响有关。     

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。     

悬雍垂腭咽成形术62例临床分析

目的 探讨对阻塞性睡眠呼吸暂停综合征（OSAS）患者行悬雍垂腭咽成形术（UPPP）的疗效、适应症的选择以及并发症的防治。方法 利用悬雍垂腭成形术对62例OSAS进行手术治疗。结果 本组62例UPPP经术后的观察症状明显改善者达50%，总有效率90%以上。结果 悬雍垂腭咽成形术对于OSAS的治疗有一定的效果，但要注意适应证的选择，术前术后的治疗。     

睡眠呼吸暂停低通气综合征患者的抑郁焦虑症状研究

目的:探讨睡眠呼吸暂停低通气综合征(SAHS)患者并发抑郁焦虑情况.方法:对50例SAHS患者和30例正常对照者进行整夜多导睡眠图(PSG)检查,分别对其进行抑郁、焦虑症状评定.结果:SAHS组SAS量表、SDS量表标准分均高于正常对照组(P<0.05).SAHS组抑郁和焦虑发生率分别为42.0%和32.0%.SAHS组抑郁焦虑情绪与夜间总睡眠时间、NREM和REM睡眠时间呈显著负相关(r>0.6),与觉醒次数及睡眠潜伏期呈正相关(r>0.3).结论:SAHS患者存在显著的抑郁焦虑症状.     

28例发作性睡病患儿的临床和电生理学研究

目的：探讨儿童发作性睡病的临床特征及多次睡眠潜伏期试验（multiplesleeplatencytest,MSLT）,以及多项睡眠图（PSG）描记在发作性睡病中的诊断价值,并了解患儿夜间睡眠结构的变化。方法：对28例2011年2月～2013年2月确诊的发作性睡病患儿的临床特点、MSLT和PSG结果进行分析,以22例正常儿童作对照。结果：28例患儿多数以睡眠过多为首发症状,伴猝倒发作15例（54％）,伴睡眠瘫痪14例（46％）,伴入睡前幻觉19例（68％）。MSLT结果：23例平均睡眠潜伏期≤5min（占82％）。19例入睡次数≥3次（占68％）。23例入睡开始阶段出现REM≥2次（占82％）,PSG结果：发作性睡病总睡眠时间减少,REM潜伏期缩短。结论：MSLT和PSG对临床表现不典型的儿童发作性睡病的诊断和鉴别诊断具有重要价值。     

腭舌结构特点与改良腭咽成形及舌根消融术治疗重度OSAHS的临床意义

目的　探讨根据腭、舌部解剖结构应用低温等离子辅助行改良腭咽成形及舌根消融术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效并进行评价。 方法　对82例重度OSAHS患者用低温等离子辅助行改良腭咽成形（H-UPPP）及舌根消融术,术前行多导睡眠监测（PSG）：AHI>50,LSaO2<80%;纤维喉镜配合Muller's运动检查（FEMM）及MRI检查,患者均存在腭咽及舌根平面狭窄,术后6、12个月随访并行PSG监测等。 结果　术后6、12个月有效率分别为86.9%、80.2% ,术后与术前比较AHI值下降（P<0.01）,且LSaO2升高（P<0.05）,所有患者主观症状较术前明显改善,有高血压等并发症的患者大部分减轻甚至恢复正常。6例患者术后5～9 d不同程度出血,少数患者1～2月内有味觉稍减退、咽干、返流、咽异物感,后均恢复正常,1例术后第10 d出现肺动脉栓塞,经治疗后好转;其余患者无并发症出现。 结论　根据腭、舌部解剖结构应用低温等离子辅助行改良腭咽成形及舌根消融术治疗重度OSAHS,作为一种微创手术,具有出血少、创伤小,并发症少的优点,是可行、安全而有效的,可成为OSAHS患者手术治疗的主要选择,值得在临床上推广。     

穿戴式呼吸感应体积描记用于睡眠呼吸事件检测

可穿戴式呼吸感应体积描记(背心式RIP)系统是我们根据呼吸感应体积描记技术的基本原理研发的一种可穿戴、低负荷的呼吸监测系统.在实现通气量无创测量的基础上,我们将该系统用于睡眠期呼吸事件检测,将该系统与多导睡眠图仪(PSG)对9例疑似睡眠呼吸暂停低通气综合症(SAHS)病人和7名健康男性志愿者进行同步对照检测与分析.通过对比实验,根据背心式RIP系统发生呼吸事件的特征性变化,提出了背心式RIP系统判别呼吸事件的规则.依据该规则,所有经背心式RIP系统诊断为SAHS患者的结果与PSG的诊断结果完全一致,背心式RIP系统检测呼吸事件的敏感性为97.8%,特异性为95.8%,实验结果表明背心式RIP系统能够可靠地检测出睡眠呼吸事件.由于其低生理、心理负荷特性,不需要佩带口鼻气流传感器,可用于家庭环境下、自然睡眠过程的睡眠呼吸紊乱性疾病的诊断.     

Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value

This investigation examined the diagnostic value of polysomnography (PSG) for evaluating disorders of initiating and maintaining sleep (DIMS). The sample consisted of 100 outpatients who presented to the Duke Sleep Disorders Center with a complaint of chronic insomnia. All patients were given comprehensive medical, psychiatric, behavioral, and ambulatory PSG evaluations. Sleep disorder diagnoses were assigned using the criteria of the Association of Sleep Disorders Centers. Overall, PSG yielded important diagnostic information in 65% of the sample: 34% were given a primary sleep disorder diagnosis that was heavily dependent on PSG data [periodic movements of sleep (PMS) = 25%, apnea = 3%, and subjective insomnia = 6%]; 15% were given a secondary diagnosis of one of these three disorders; and PSG ruled out suspected PMS in 9% and sleep apnea in 7% of the sample. Patients greater than 40 years of age had a significantly higher rate of positive PSG findings than younger patients. Using only the clinical exam, two experienced sleep clinicians were able to predict only 14 of 25 PMS cases and one of three cases of sleep apnea. Based on these data, we suggest using PSG routinely with older insomniacs and with younger patients who fail initial treatment.     

Sleep apnea monitoring and diagnosis based on pulse oximetery and tracheal sound signals

Sleep apnea is a common respiratory disorder during sleep, which is described as a cessation of airflow to the lungs that lasts at least for 10 s and is associated with at least 4% drop in blood’s oxygen saturation level (S_aO₂). The current gold standard method for sleep apnea assessment is full-night polysomnography (PSG). However, its high cost, inconvenience for patients, and immobility have persuaded researchers to seek simple and portable devices to detect sleep apnea. In this article, we report on developing a new method for sleep apnea detection and monitoring, which only requires two data channels: tracheal breathing sounds and the pulse oximetery (S_aO₂ signal). It includes an automated method that uses the energy of breathing sounds signals to segment the signals into sound and silent segments. Then, the sound segments are classified into breath, snore, and noise segments. The S_aO₂ signal is analyzed automatically to find its rises and drops. Finally, a weighted average of different features extracted from breath segments, snore segments and S_aO₂ signal are used to detect apnea and hypopnea events. The performance of the proposed approach was evaluated on the data of 66 patients recorded simultaneously with their full-night PSG study, and the results were compared with those of the PSG. The results show high correlation (0.96, P < 0.0001) between the outcomes of our system and those of the PSG. Also, the proposed method has been found to have sensitivity and specificity values of more than 91% in differentiating simple snorers from obstructive sleep apnea patients.     

30例睡眠呼吸暂停综合征患者睡眠特征及其心身状况

目的 :了解睡眠呼吸暂停综合征 (SAS)患者的睡眠特征和心身状况。方法 :采用多导睡眠分析仪 (PSG)、SCL -90对 3 0例SAS患者和 2 8例正常对照者进行检查。结果 :病例组存在明显的睡眠结构紊乱 ,其SCL -90总因子分以及躯体化、强迫、敌意、抑郁、焦虑和附加因子分高于对照组 (P <0 0 5 ) ;SAS患者的心身症状严重程度与总睡眠时间、夜间觉醒时间呈较强负相关 (r =-0 83 ,-0 87) ,与夜间觉醒时间所占比例呈较强正相关 (r =0 71)。结论 :SAS患者与正常对照者相比心身健康状况较差 ,需要进行适当的医学干预     

切除腭腱膜和部分硬腭骨质致软腭整体前移治疗OSAHS临床疗效分析

目的探讨应用切除腭腱膜和部分硬腭骨质缩短软腭前后径从而致软愕整体前移治疗因鼻咽平面狭窄阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的方法。方法对经muller动作检测确定的鼻咽阻塞平面所致的睡眠呼吸暂停患者进行了切除腭腱膜,形成可移动的软腭瓣,并且凿除部分硬腭后缘骨质致软腭整体前移。22例中19例行常规扁桃体切除术,并进行了术前术后多导睡眠观测。结果术后半年复查,按照杭州会议标准,总有效率为100%。且术前术后比较差异有统计学意义(P<0.001)。结论切除腭腱膜缩短硬腭骨质致软腭整体前移是治疗鼻咽平面阻塞的OSAHS的一个有效的方法。     

新生儿呼吸暂停临床分析与探讨

目的探讨新生儿呼吸暂停的临床特点。方法对我院儿内科2000年10月～2006年11月收治的156例新生儿呼吸暂停患儿进行回顾性分析。结果本组早产儿发生呼吸暂停114例,足月儿和过期产儿发生呼吸暂停42例,早产儿占73.1%,足月儿和过期产儿占26.9%。体重〈1500g的早产儿发生呼吸暂停明显增高。早产儿发生呼吸暂停每天10次以上的病例数明显多于足月儿和过期产儿。早产儿发生呼吸暂停持续3天以上的病例数明显多于足月儿和过期产儿。早产儿在发生继发性呼吸暂停中,出生后0～7天早产儿由于非感染因素发生呼吸暂停明显高于由于感染因素发生呼吸暂停,出生后≥8天早产儿由于感染因素发生呼吸暂停明显高于由于非感染因素发生呼吸暂停。结论对发生呼吸暂停的新生儿特别是早产儿应作重点监护,及时治疗,以降低死亡率,避免后遗症的发生。     

A multicentric validation study of a novel home sleep apnea test based on peripheral arterial tonometry

Study ObjectivesThis paper reports on the multicentric validation of a novel FDA-cleared home sleep apnea test based on peripheral arterial tonometry (PAT HSAT).MethodsOne hundred sixty-seven participants suspected of having obstructive sleep apnea (OSA) were included in a multicentric cohort. All patients underwent simultaneous polysomnography (PSG) and PAT HSAT, and all PSG data were independently double scored using both the recommended 1A rule for hypopnea, requiring a 3% desaturation or arousal (3% Rule), and the acceptable 1B rule for hypopnea, requiring a 4% desaturation (4% Rule). The double-scoring of PSG enabled a comparison of the agreement between PAT HSAT and PSG to the inter-rater agreement of PSG. Clinical endpoint parameters were selected to evaluate the device’s ability to determine the OSA severity category. Finally, a correction for near-boundary apnea–hypopnea index values was proposed to adequately handle the inter-rater variability of the PSG benchmark.ResultsFor both the 3% and the 4% Rules, most endpoint parameters showed a close agreement with PSG. The 4-way OSA severity categorization accuracy of PAT HSAT was strong, but nevertheless lower than the inter-rater agreement of PSG (70% vs 77% for the 3% Rule and 78% vs 81% for the 4% Rule).ConclusionsThis paper reported on a multitude of robust endpoint parameters, in particular OSA severity categorization accuracies, while also benchmarking clinical performances against double-scored PSG. This study demonstrated strong agreement of PAT HSAT with PSG. The results of this study also suggest that different brands of PAT HSAT may have distinct clinical performance characteristics.     

小波变换在睡眠呼吸暂停脑电分析中的应用

目的：利用小波转换方法对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者脑电信号进行处理分析。方法：对人选142例鼾症患者分为对照组、轻度组、中度组和重度组。利用Morlet小波函数对脑电信号进行变换处理得到平均能量尺度图,通过对单位时间能量的计算得到脑电能量变异的两个指标divl和div2,并分别提取两个特征参数P1、P50和P10（Pdiv2≥1．0）、P20（Pdiv2≥1.0）。检验各个指标的正态分布性和各指标在各样本组间的差异性,以及各指标与临床指标的相关性。结果：发现变异指标的四个参数各组之间的检验结果均表现出相似的规律：重度组与对照、轻、中度组之间的差异均有显著意义（P〈0．05）;其它各组之间的差异无显著意义,但有显著性趋势（0．05〈P〈0．1）;各参数与多项睡眠图（PSG）检测指标的多元回归分析结果显示：与参数P1、P50、P10（Pdivz≥1.0）、P20（Pdiv2≥1.0）相关性最强的一个指标分别为呼吸暂停总时间／睡眠总时间（TAT／TST）、呼吸暂停指数、指端血氧饱和度（SpO2）％90％时间／TST、呼吸暂停指数（标准化偏回归系数分别为-0．369、-0．720、0．317、-0．602,P均〈0．05）。结论：脑电能量变异性的定量指标div1和div2的四个参数P1、P50和P10（Pdiv2≥1.0）、P20（Pdiv2≥1.0）表现出随病情加重而变化的趋势,并且对重度OSAHS有一定的区分意义;呼吸暂停是影响脑电能量变化的主要因素。     

The effect of in-laboratory polysomnography on sleep and objective daytime sleepiness

MSLT guidelines recommend performing MSLTs following polysomnography (PSG) to document the preceding night's sleep. We tested the hypothesis that patients are objectively sleepier after in-laboratory full diagnostic PSG than after a sleep recording at home. Sixteen patients with the sleep apnea/hypopnea syndrome (SAHS; AHI 35+/-SD 28 per hour slept) were recruited into a randomized crossover study. To monitor sleep with minimal disruption at home, only sleep was recorded on 2 consecutive nights, the first for acclimatization. The laboratory limb followed standard PSG. Both study nights were followed next day by MSLT and MWT. There were no differences in MSLT (12.0 SD 5.1 home, 11.6+/-4.7 min laboratory; p=0.7), MWT (32.7+/-8.7, 31.6+/-9.3 min; p=0.6) or total sleep time (362+/-53, 343+/-51 min; p=0.15) between home and laboratory limbs. However, on the home night, fewer microarousals (31+/-14, 54+/-25/hr slept; p<0.0001) and less % wake (15+/-10, 24+/-11; p=0.006) were found. On the home study night, patients had greater % REM sleep, slow-wave sleep and sleep efficiency (all p<0.009). This study does not support the hypothesis that patients are sleepier after laboratory PSG compared to home study night. However, the improved sleep at home raises the question whether laboratory-based polysomnography is always required prior to MSLT/MWT testing or whether less obtrusive monitoring of sleep duration at home would sometimes suffice.