成年阻塞性睡眠呼吸暂停患者多导睡眠图及临床特征分析性差异

目的:分析成年男性阻塞性睡眠呼吸暂停(OSA)患者多导睡眠图及临床特征,明确年龄对OSA严重程度的影响。方法:回顾性研究包括836名成年男性OSA患者,按年龄分为三组:青年组312人(平均年龄37.07岁),中年组359人(平均年龄52.14岁),老年组165人(平均年龄69.43岁)。分析其多导睡眠图和临床特征,并进行相关性分析。结果:中年组和老年组呼吸暂停低通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、AHI-NREM和AHI-REM均无显著统计学意义(P>0.05),但均低于青年组(P<0.01);中年组和老年组的最低血氧饱和度(SaO2)均高于青年组;中枢性呼吸暂停指数(CAI)随年龄增长而升高(P<0.05)。在睡眠结构方面,老年组总睡眠时间、非快速眼动(NREM)睡眠时间和快速眼动期(REM)睡眠时间均缩短,睡眠效率亦低于青年组(P<0.01),但睡眠潜伏期和入睡后觉醒时间(WASO)明显延长(P<0.01)。年龄与以下各项均呈现显著的相关性:AHI(P<0.01),OAI(P<0.01),CAI(P<0.01),最低SaO2(P<0.01)。多重回归分析表明年龄作为独立变量分别与AHI,OAI,CAI具有相关性。结论:在成年OSA患者中,年龄与OSA严重程度具有显著的相关性,表现为OSA随年龄增长而降低。本研究为研究年龄与OSA严重程度的关系提供了新的证据。     

关于混合性睡眠呼吸暂停综合征的研讨

目的：探讨MSAS是否存在及其诊治问题。方法：从近一年鼾症患者PSG监测结果中，筛选出MSA次数占呼吸暂停总次数50％以上者，结合其临床资料进行分析。结果：285例PSG监测结果中，MSA次数与呼吸暂停总次数之比大于50％者9例（3．2％）。其中，二者之比介于50％～70％者4例，70％～90％者5例，行外科手术治疗者4例。结论：根据PSG监测结果和本文判断标准，MSAS是存在的。对有上气道狭窄、无中枢神经病变的MSAS患者，可按照OSAS的治疗方法行手术治疗。     

阻塞性睡眠呼吸暂停综合征白天嗜睡的测试及其自动监控系统的研制

目的建立一项简单客观地评价阻塞性睡眠呼吸暂停(obstructivesleepapnea,OSA)患者白天嗜睡的方法。方法先制作一套判断睡眠的自动化睡眠监控系统并用于醒觉维持试验(MWT)。10例OSA患者和5名正常人进行2次相隔约1h的MWT。记录睡眠多导图包括脑电图、眼动图和下颌肌电图。结果建立了一套判断睡眠的自动化睡眠监控系统,由自动化睡眠监控系统检测的醒觉维持时间与睡眠多导图所检测的一致。OSA患者的醒觉维持时间是(21±7)min明显小于正常人(38±2)min(P<0.01)。结论在MWT试验时,自动化睡眠监控系统可代替复杂的睡眠多导图。     

合并及不合并阻塞性睡眠呼吸暂停脑卒中患者的咽部MRI分析

目的　通过对脑卒中阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea,OSA）患者与非OSA患者咽部形态进行比较,了解咽部形态与脑卒中OSA的关系。 方法　发病30 d内的脑卒中患者入院后夜间行多导睡眠图监测后分为脑卒中OSA组及脑卒中非OSA组,两组患者均行咽部MRI检查并测得腭后距离、舌后距离、软腭长度、舌长、咽侧壁软组织的厚度、高口咽区面积、低口咽区面积、咽部最小面积等相关数值,将两组患者咽部测得相关值进行比较,将腭后距离与其他口咽测量指标、AHI、洼田饮水试验分级、年龄、病程、BMI、颈围行Pearson相关分析,并将腭后距离作脑卒中OSA患者受试者工作特征曲线 (Receiver Operating Characteristic Curve,ROC曲线)分析。 结果　脑卒中OSA组患者腭后距离较非OSA患者的偏小（P=0.002）,脑卒中OSA患者腭后距离与舌后距离呈相关（R=0.502, P=0.017）;脑卒中OSA患者洼田饮水试验分级较非OSA患者偏高（P=0.049）;脑卒中OSA患者腭后距离与AHI值呈负相关（R=-0.873, P=0.000）,腭后距离对脑卒中OSA的ROC曲线下面积为0.888,腭后距离对于脑卒中OSA有中等程度的诊断价值。 结论　咽部形态学改变与脑卒中OSA相关,腭后距离对脑卒中OSA有一定的诊断价值,腭后距离与脑卒中OSA严重程度有关;脑卒中OSA患者的洼田饮水分级较非OSA患者高,脑卒中患者OSA可能与吞咽障碍有关。     

阻塞性睡眠呼吸暂停综合征白天嗜睡的测试及其自动监控系统的研制

目的 建立一项简单客观地评价阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者白天嗜睡的方法.方法 先制作一套判断睡眠的自动化睡眠监控系统并用于醒觉维持试验(MWT) . 10例OSA患者和5名正常人进行2次相隔约1 h的MWT.记录睡眠多导图包括脑电图、眼动图和下颌肌电图.结果 建立了一套判断睡眠的自动化睡眠监控系统,由自动化睡眠监控系统检测的醒觉维持时间与睡眠多导图所检测的一致.OSA患者的醒觉维持时间是(21±7) min明显小于正常人(38±2)min(P＜0.01).结论 在MWT试验时,自动化睡眠监控系统可代替复杂的睡眠多导图.     

睡眠呼吸暂停综合征及其多导睡眠图研究进展

近年来,欧洲及美国有关睡眠呼吸暂停综合征（sleep apnea syndrome,SAS）的文献报告逐渐增多,已引起神经精神科、呼吸科、心脏科、耳鼻喉科等多学科的关注。以下综述SAS临床研究进展。     

78例睡眠呼吸暂停综合征患者的睡眠特征及其与夜间低氧血症的关系

目的 :了解SAS患者的睡眠特征及其与夜间低氧血症的关系。方法 :采用PSG对 78例SAS患者和 30例正常对照者进行整夜睡眠监测 ,比较两组间的睡眠特征。并对不同严重程度的夜间低氧血症SAS患者进行睡眠变量比较 ,分析二者的关系。结果 :与正常对照者相比 ,SAS患者夜间睡眠结构紊乱 ,主要为深睡眠减少、浅睡眠相对增加、REM睡眠减少、觉醒增加、睡眠潜伏期缩短、呼吸暂停或低通气次数增加、动脉血氧饱和显著下降 (P <0 .0 5 )。SAS患者夜间最低血氧饱和度与夜间总睡眠时间、睡眠效率、NREM睡眠时间及呼吸紊乱指数呈显著负相关 (r>0 .3,P <0 .0 5 ) ,与觉醒比例呈显著正相关 (r >0 .5 ,P <0 .0 1)。结论 :SAS患者睡眠结构紊乱突出 ,夜间反复发作的低氧血症对睡眠质量产生较大影响。     

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。     

睡眠呼吸暂停综合征患者心理健康状况分析

目的 :探讨睡眠呼吸暂停综合征 (SAS)患者的心理健康状况。方法 :对 63例疑诊SAS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)≥ 5次 小时将 43例分为研究组 ,≤ 5次 小时将 3 9例作为对照组 ,分别对其进行抑郁、焦虑症状评定及症状自评量表 (t =4 42 ,P <0 0 1)测定 ,比较两组中各指标的差异性。结果 :研究组SCL -90总分、各因子分躯体化 (t=3 19)、焦虑 (t =4 42 )、抑郁 (t =4 84)、精神病性 (t=3 2 1)以及SAS (t =2 2 )、SDS (t =4 3 8)得分均明显升高。研究组抑郁和焦虑发生率 (分别为 44 19%和 3 2 5 6% )明显高于对照组 ( χ2 =13 0 5 1,P <0 0 1)。结论 :SAS患者存在显著的心理卫生问题。     

基于小波分析提取心动周期中睡眠呼吸事件信息

为了挖掘心动周期中睡眠呼吸事件信息,为无干扰监测睡眠呼吸事件提供技术支持,本文利用多分辨率小波分析方法,对睡眠呼吸暂停低通气综合征病人的整晚心率序列进行分解和重建,获得与睡眠呼吸事件相关联的特征波形;再根据特征波形的波形特点与睡眠呼吸事件的关系,识别呼吸事件发生的位置和类型.本方法提取的试验结果与标准睡眠图仪提示的结果进行比较表明,基于小波分析提取心动周期中睡眠呼吸事件信息的方法是有效和可行的.     

睡眠剥夺对健康成人睡眠脑电图的变化观察

目的：探索睡眠剥夺对健康成人睡眠脑电图（PSG）的影响.方法：选择34名健康成人志愿者行睡眠剥夺36h,作睡眠剥夺前后的PSG整夜监测.结果：与睡眠剥夺前相比,健康成人PSG表现为睡眠潜伏期缩短（P＜0.05）,NREM中的第1阶段睡眠减少（P＜0.05）,第4阶段（S4）睡眠增多（P＜0.01）.结论：睡眠剥夺后再睡眠,健康成人通过其NREM睡眠阶段中S4的比例作为“补偿”.睡眠剥夺可影响健康成人的脑电生理活动.     

Thermal Infrared Imaging: A Novel Method to Monitor Airflow During Polysomnography

Study Objectives:

This is a feasibility study designed to evaluate the accuracy of thermal infrared imaging (TIRI) as a noncontact method to monitor airflow during polysomnography and to ascertain the chance-corrected agreement (κ) between TIRI and conventional airflow channels (nasal pressure [Pn], oronasal thermistor and expired CO₂ [P_ECO₂]) in the detection of apnea and hypopnea.

Design:

Subjects were recruited to undergo polysomnography for 1 to 2 hours, during which simultaneous recordings from electroencephalography, electrooculography, electromyography, respiratory impedance plethysmography, conventional airflow channels, and TIRI were obtained.

Setting:

University-affiliated, American Academy of Sleep Medicine-accredited sleep disorders center.

Patients or Participants:

Fourteen volunteers without a history of sleep disordered breathing and 13 patients with a history of obstructive sleep apnea were recruited.

Measurements and Results:

In the detection of apnea and hypopnea, excellent agreement was noted between TIRI and thermistor (κ = 0.92, Bayesian Credible Interval [BCI] 0.86, 0.96; pκ = 0.99). Good agreement was noted between TIRI and Pn (κ = 0.83, BCI 0.70, 0.90; pκ = 0.98) and between TIRI and P_ECO₂(κ = 0.80, BCI 0.66, 0.89; pκ = 0.94).

Conclusions:

TIRI is a feasible noncontact technology to monitor airflow during polysomnography. In its current methodologic incarnation, it demonstrates a high degree of chance-corrected agreement with the oronasal thermistor in the detection of apnea and hypopneas but demonstrates a lesser degree of chance-corrected agreement with Pn. Further overnight validation studies must be performed to evaluate its potential in clinical sleep medicine.

Citation:

Murthy JN; van Jaarsveld J; Fei J; Pavlidis I; Harrykissoon R; Lucke JF; Faiz S; Castriotta RJ. Thermal infrared imaging: a novel method to monitor airflow during polysomnography. SLEEP 2009;32(11):1521-1527.     

多导睡眠图在儿童鼾症鉴别诊断中的应用研究

目的探讨多导睡眠图在儿童鼾症中的鉴别诊断价值。方法运用多导睡眠图整夜7～8h监测睡眠打鼾的儿童共48例。结果有21例呼吸暂停/低通气指数(AHI)<1,16例AHI≥1且<5,11例AHI≥5,后两组与AHI<1组比较平均SaO2、最低SaO2、最长脱饱和时间及SaO2<95%的时间均有统计学意义(P<0.01),而鼾声指数及总打鼾次数的比较无统计学意义(P>0.05)。结论多导睡眠图是区分儿童鼾症中睡眠呼吸暂停综合征与良性鼾症的良好方法,AHI≥1的标准适合儿童睡眠呼吸暂停综合征的诊断。     

Variability in recording and scoring of respiratory events during sleep in Europe: a need for uniform standards

Uniform standards for the recording and scoring of respiratory events during sleep are lacking in Europe, although many centres follow the published recommendations of the American Academy of Sleep Medicine. The aim of this study was to assess the practice for the diagnosis of sleep‐disordered breathing throughout Europe. A specially developed questionnaire was sent to representatives of the 31 national sleep societies in the Assembly of National Sleep Societies of the European Sleep Research Society, and a total of 29 countries completed the questionnaire. Polysomnography was considered the primary diagnostic method for sleep apnea diagnosis in 10 (34.5%), whereas polygraphy was used primarily in six (20.7%) European countries. In the remaining 13 countries (44.8%), no preferred methodology was used. Fifteen countries (51.7%) had developed some type of national uniform standards, but these standards varied significantly in terms of scoring criteria, device specifications and quality assurance procedures between countries. Only five countries (17.2%) had published these standards. Most respondents supported the development of uniform recording and scoring criteria for Europe, which might be based partly on the existing American Academy of Sleep Medicine rules, but also take into account differences in European practice when compared to North America. This survey highlights the current varying approaches to the assessment of patients with sleep‐disordered breathing throughout Europe and supports the need for the development of practice parameters in the assessment of such patients that would be suited to European clinical practice.     

Dynamic changes in electroencephalogram spectral power with varying apnea duration in older adults

Sleep apnea elicits brain and physiological changes and its duration varies across the night. This study investigates the changes in the relative powers in electroencephalogram (EEG) frequency bands before and at apnea termination and as a function of apnea duration. The analysis was performed on 30 sleep records (375 apnea events) of older adults diagnosed with sleep apnea. Power spectral analysis centered on two 10‐s EEG epochs, before apnea termination (BAT) and after apnea termination (AAT), for each apnea event. The relative power changes in EEG frequency bands were compared with changes in apnea duration, defined as Short (between 10 and 20 s), Moderate (between 20 and 30 s) and Long (between 30 and 40 s). A significant reduction in EEG relative powers for lower frequency bands of alpha and sigma were observed for the Long compared to the Moderate and Short apnea duration groups at BAT, and reduction in relative theta, alpha and sigma powers for the Long compared to the Moderate and Short groups at AAT. The proportion of apnea events showed a significantly decreased trend with increased apnea duration for non‐rapid eye movement sleep but not rapid eye movement sleep. The proportion of central apnea events decreased with increased apnea duration, but not obstructive episodes. The findings suggest EEG arousal occurred both before and at apnea termination and these transient arousals were associated with a reduction in relative EEG powers of the low‐frequency bands: theta, alpha and sigma. The clinical implication is that these transient EEG arousals, without awakenings, are protective of sleep. Further studies with large datasets and different age groups are recommended.