床垫式低负荷睡眠检测技术的临床应用

睡得好则百病消。随着人们对睡眠的日益关注，睡眠医学已成为临床医学中一个新的热点。睡眠的客观检测是睡眠医学和睡眠相关研究的基本条件。传统的多导睡眠图(polysomnograph，PSG)提供了一种标准的睡眠测量技术，但方法较复杂，被检者受到较多的约束。床垫式低负荷睡眠检测仪器系统，是空军航空医学研究所最近研制成功并推入市场的新技术，它将成为现行睡眠检测的重要补充和发展，必将在蓬勃发展的睡眠医学领域占据重要地位。     

频率医学睡眠对慢性失眠症的治疗作用

目的:探讨"频率医学睡眠"治疗慢性失眠症的疗效.方法:选取2019 年5-7 月在原乡奥伦达医学博物馆高端医学门诊就诊的慢性失眠症患者15 例作为研究对象,应用"频率医学睡眠",包括Healy微电刺激、睡眠扑满SleepBank、Tim-eWaver时光波量子仪多维干预及精油芳香疗愈.治疗1 周,治疗前后采用匹兹堡睡眠质量指数量表(PSQI)评定临床疗效.结果:PSQI睡眠质量分别为(2.17 ±0.58)和(1.33 ±0.65);睡眠时间分别为(1.58 ±0.90)和(0.67 ±0.49);匹兹堡问卷总分分别为(9.92 ±1.56)和(7.17 ±2.48),以上差异均具有统计学意义(P均<0.05).结论:频率医学睡眠能够改善慢性失眠症患者的睡眠质量、增加睡眠时间.     

加强对睡眠呼吸障碍的诊疗促进我国睡眠医学的发展

在国际上,经过30多年的发展,以睡眠疾病诊疗为主的一门新兴边缘交叉学科——睡眠医学已经形成并逐渐发展壮大。本文重点从国际睡眠医学发展特点、国内睡眠医学发展、睡眠呼吸医学发展及人才培养等几个方面进行了全面的论述。其中,对睡眠呼吸障碍的认识是催生睡眠医学这一新兴边缘交叉学科的学术引擎,而提高睡眠呼吸障碍的诊疗和研究水平将是促进学科建设的持久驱动力。     

危重清醒患者发生睡眠障碍相关因素及脑电活动特征

目的探讨危重清醒患者睡眠障碍的临床特征、产生原因,并试图提出相应对策。方法观察危重症并发睡眠障碍危重症清醒患者的疾病种类、睡眠障碍的临床表现,睡眠脑电活动及眼电图。结果生命体征监测多可发现不同程度的异常改变,甚至严重的心律失常及血流动力学改变。同步描记的脑电图与眼电图可发现:睡眠障碍的主要改变有睡眠总时间减少;快速动眼期睡眠减少、消失或反常增多;非快速动眼期睡眠减少,其中慢波睡眠期减少最为显著。结论危重清醒患者的睡眠障碍是其中枢功能障碍的表现之一,干扰患者生命体征,导致精神心理障碍,可能对患者预后产生不良影响,必须应以对策。     

德国睡眠中心管理

睡眠中心是进行睡眠医学研究及睡眠相关疾病诊断、治疗的重要医疗机构。睡眠中心可以为临床医师提供各类患者有关睡眠全面的数据,支持或确定临床诊断和治疗方案。本文将从人员配置、实验室配备、分级、医师认证、睡眠障碍诊断及治疗等方面阐述德国睡眠中心的规范化管理,从而为睡眠医学中心的建设提供帮助。     

阻塞性睡眠呼吸暂停综合征多导睡眠图分析及监测护理

目的 探讨阻塞性睡眠呼吸暂停综合征(OSAS)的多导睡眠图(PSG)特征及检测护理方法.方法 经多导睡眠图检查66例,确诊OSAS患者52例(OSAS组),单纯鼾症患者14例(对照组),分析比较2组睡眠参数.对监测患者进行检查前心理护理,检查时参数观察,检查后健康教育.结果 与对照组相比,OSAS组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、快速动眼相(REM)睡眠减少、睡眠潜伏期缩短、呼吸暂停或低通气次数增加、夜间平均及最低动脉血氧饱和度下降(P＜0.05).66例顺利接受检查.结论 OSAS患者存在睡眠结构紊乱,做好监测护理是患者完成检查的关键.     

睡眠医学专业委员会２０１６年度学术述评报告

本文概述了2016年度主要学术活动,包括睡眠会议、睡眠标准、杂志编辑等多项工作.在睡眠医学专业委员会学术大会上发表的主要睡眠医学相关论文,介绍了睡眠医学在中医界的发展概况,并且探讨在新形势下如何制定睡眠医学相关标准.最后,对明年的工作提出初步设想.     

睡眠中心的睡眠环境学——以广安门医院南区睡眠中心为例

正中国中医科学院广安门医院南区睡眠医学中心成立于2013年11月,于2014年1月正式运行。中心以临床睡眠及其相关性疾病的中西医诊疗和科研为学科发展方向,以中西医结合治疗睡眠及相关疾病为特色,注重大众睡眠医学健康教育和睡眠科学知识的科普工作。中心由世界中医药学会联合会睡眠医学专业委员会秘书长孙书臣     

斯坦福大学睡眠医学中心见闻——面向科学前沿的睡眠中心

美国睡眠医学发展一直处于世界领先水平,2016年由中国老年学和老年医学学会睡眠科学分会主办,中国医师协会睡眠医学专业委员会、中国睡眠研究会、世界中联睡眠医学专业委员会协办下,中国睡眠医学专业团队赴美访问学习,本文就参访一行所见睡眠医学中心发展模式及机构设置等进行介绍,以供相关学者借鉴,以期共同促进我国睡眠医学事业的发展。     

睡眠医学技术概论

近年来,睡眠医学得到迅速发展,睡眠医学技术也在不断提高,并广泛应用于睡眠医学领域。但当前睡眠医学技术仍不满足市场对睡眠医学新技术的需求,本文就目前睡眠医学技术的发展情况进行简要介绍,以便我们选择应用,启发创新。     

Clinical review: Sleep measurement in critical care patients: research and clinical implications

Sleep disturbances are common in critically ill patients and have been characterised by numerous studies using polysomnography. Issues regarding patient populations, monitoring duration and timing (nocturnal versus continuous), as well as practical problems encountered in critical care studies using polysomnography are considered with regard to future interventional studies on sleep. Polysomnography is the gold standard in objectively measuring the quality and quantity of sleep. However, it is difficult to undertake, particularly in patients recovering from critical illness in an acute-care area. Therefore, other objective (actigraphy and bispectral index) and subjective (nurse or patient assessment) methods have been used in other critical care studies. Each of these techniques has its own particular advantages and disadvantages. We use data from an interventional study to compare agreement between four of these alternative techniques in the measurement of nocturnal sleep quantity. Recommendations for further developments in sleep monitoring techniques for research and clinical application are made. Also, methodological problems in studies validating various sleep measurement techniques are explored. Trial registration: Current Controlled Trials ISRCTN47578325.     

Sleep deprivation in critical care units

Sleep deprivation is a significant problem for patients in critical care units. Sleep is a complex, active process that is divided into 4 stages of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. Noise, lights, discomfort, pain, medications, and stress all contribute to a patient's inability to sleep. Lack of knowledge about the sleep stages, nursing routines, and frequent nursing assessment and interventions also impact the critically ill patient's ability to sleep. Education about sleep deprivation needs to be integrated into critical care courses and orientation programs. Sleep deprivation should be addressed on the multidisciplinary care plan and in health team conference, and nursing care planned accordingly. Sleep medications and their effects should be evaluated for each patient, as well as identifying medications that might be preventing or disturbing sleep.     

Sleep deprivation in critical illness: its role in physical and psychological recovery

Critically ill patients frequently experience poor sleep, characterized by frequent disruptions, loss of circadian rhythms, and a paucity of time spent in restorative sleep stages. Factors that are associated with sleep disruption in the intensive care unit (ICU) include patient-ventilator dysynchrony, medications, patient care interactions, and environmental noise and light. As the field of critical care increasingly focuses on patients' physical and psychological outcomes following critical illness, understanding the potential contribution of ICU-related sleep disruption on patient recovery is an important area of investigation. This review article summarizes the literature regarding sleep architecture and measurement in the critically ill, causes of ICU sleep fragmentation, and potential implications of ICU-related sleep disruption on patients' recovery from critical illness. With this background information, strategies to optimize sleep in the ICU are also discussed.     

阻塞性睡眠呼吸暂停低通气综合征患者多导睡眠监测及护理

目的总结多导睡眠监测的监测方法及护理要点。方法 2010年3月-2011年3月采用美国伟康多导睡眠呼吸监测仪对睡眠中心78例患者进行不少于7 h的整夜连续监测和护理。结果 76例患者顺利完成监测,确诊阻塞性睡眠呼吸暂停低通气综合征73例(重度17例,中度31例,轻度25例),单纯鼾症3例。1例因环境陌生、导联多无法入睡而监测失败,另1例因鼻气流导管脱落而监测失败。结论对症有效的护理方法是多导睡眠监测得以顺利完成的根本保证。     

Sleep in mechanically ventilated patients

People dependent on mechanical ventilation in an intensive care unit sleep poorly. Less than half of their sleep occurs at night. Sleep architecture is abnormal, with occasional disappearance of some stages of sleep, and there are frequent arousals and awakenings. Because most arousals are associated with caregiving activities or noise, caregivers should consolidate care and decrease environmental noise. More research is needed on sleep and sleep promotion in mechanically ventilated patients.     

Sleep and Brain Development: The Critical Role of Sleep in Fetal and Early Neonatal Brain Development

Sleep and sleep cycles begin at around 26 to 28 weeks' gestational age. They were originally recognized by observing infant behaviors. This observation of behaviors and changes in physiology has now added electoenchephalography (EEG) and continuous electoenchephalography (aEEG) to the studies of sleep and sleep cycles. Sleep partitions from indeterminate sleep EEG patterns to quiet sleep or non–rapid eye movement (REM) sleep, REM sleep, and quiet awake intervals. The REM sleep follows the quiet or slow wave sleep in the cycles. Sleep and sleep cycles are essential for the development of the neurosensory and motor systems in the fetus and neonate. They are essential for the creation of memory and long-term memory circuits, and they are essential for the maintenance of brain plasticity over the lifetime of the individual. The importance of sleep and preservation of sleep cycles in infants has been known for more than 40 years. They are critical for the fetus in utero and the preterm infant in the newborn intensive care unit (NICU). The infants' state and sleep-wake cycles have been studied as part of developmental care since the 1980s. A major part of the implementation of developmentally appropriate care involves using the infant state and cues to plan care and interventions. This is also essential for the preservation of sleep and sleep cycles that are essential for early neurosensory development. Interference with sleep and disruption of sleep cycles can significantly interfere with the early processes of sensory development. Parents are playing an increasingly important role in supporting early development.     

Sleep during and following critical illness: A narrative review

Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.     

Sleep in the intensive care unit setting

Sleep is essential to human life. Sleep patterns are significantly disrupted in patients who are hospitalized, particularly those in the intensive care unit. Sleep deprivation is pervasive in this patient population and impacts health and recovery from illness. Immune system dysfunction, impaired wound healing, and changes in behavior are all observed in patients who are sleep deprived. Various factors including anxiety, fear, and pain are responsible for the sleep deprivation. Noise, light exposure, and frequent awakenings from caregivers also add to these effects. Underlying medical illnesses and medications can also dramatically affect a patient's ability to sleep efficiently. Therapy with attempts to minimize sleep disruption should be integrated among all of the caregivers. Minimization of analgesics and other medications known to adversely affect sleep should also be ensured. Although further research in the area of sleep deprivation in the intensive care unit setting needs to be conducted, effective protocols can be developed to minimize sleep deprivation in these settings.     

Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography

Objective  Sleep loss and sleep disruption are common in critically ill patients and may adversely affect clinical outcomes. Although polysomnography remains the most accurate and reliable way to measure sleep, it is costly and impractical for regular use in the intensive care unit. This study evaluates the accuracy of two other methods currently used for measuring sleep, actigraphy (monitoring of gross motor activity) and behavioural assessment by the bedside nurse, by comparing them to overnight polysomnography in critically ill patients. Design  Observational study with simultaneous polysomnography, actigraphy and behavioural assessment of sleep. Setting  Medical-surgical intensive care unit. Patients and participants  Twelve stable, critically ill, mechanically ventilated patients [68 (13) years, Glasgow coma scale 11 (0)]. Interventions  None. Measurements and results  Sleep was severely disrupted, reflected by decreased total sleep time and sleep efficiency, high frequency of arousals and awakenings and abnormal sleep architecture. Actigraphy overestimated total sleep time and sleep efficiency. The overall agreement between actigraphy and polysomnography was <65%. Nurse assessment underestimated the number of awakenings from sleep. Estimated total sleep time, sleep efficiency and number of awakenings by nurse assessment did not correlate with polysomnographic findings. Conclusions  Actigraphy and behavioural assessment by the bedside nurse are inaccurate and unreliable methods to monitor sleep in critically ill patients.