睡眠呼吸暂停综合征的家庭监测

目的了解全电脑无纸记录的多导睡眠图,在家庭自然的环境下监测睡眠呼吸暂停综合征(SAS)的可行性.方法用全电脑无纸记录的多导睡眠图(NW)对15例以打鼾等为主诉的门诊患者,进行家庭睡眠监测,并与实验室有纸多导睡眠图(PSG)进行对照研究.结果 NW测得AHI为27.7±7.6,PSG AHI为23.1±6.7.NW测得的最低血氧饱和度(SaO2)为76.8±3.2%,PSG的SaO2为75.6±4.4%.结论 NW提供了家庭环境下监测睡眠、进而诊断SAS的有效手段,值得临床推广应用.     

解读“睡眠呼吸暂停与心血管疾病专家共识”

本文简介了由中华医学会呼吸病分会睡眠学组与心血管病分会专家制订的睡眠呼吸暂停与心血管病专家共识,包括睡眠呼吸暂停与高血压、冠心病、心律失常、充血性心力衰竭的关系,旨在提高大家对这两类疾病关系的认识和诊断治疗水平。     

非接触式睡眠呼吸监测仪在成人阻塞性睡眠呼吸暂停中的应用价值

目的:评价非接触式睡眠呼吸监测仪在成人阻塞性睡眠呼吸暂停（OSA）患者中的应用价值。方法:本研究选取2018年7月至2019年5月因打鼾就诊于北京大学人民医院睡眠中心的成人患者,在进行多导睡眠监测（PSG）的同时使用非接触式睡眠呼吸监测仪进行监测,利用均数检验、Pearson相关系数及Bland-Altman法评估非接...     

阻塞性睡眠呼吸暂停综合征与心血管疾病

阻塞性睡眠呼吸暂停综合征 (Ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎ ｄｒｏｍｅ,ＯＳＡＳ)是一种以睡眠过程中反复出现呼吸暂停、低通气、血氧饱和度下降和睡眠结构紊乱等为特征的疾病[1 ] 。近年来的研究表明 ,该病如不及时治疗 ,可导致全身多系统器官功能损害 ,如心血管系统、呼吸系统、神经系统、泌尿生殖系统、血液系统、消化系统、内分泌系统等。本文拟就ＯＳＡＳ与心血管疾病的关系作一综述。正常睡眠时心血管系统的变化　根据睡眠时脑电图的变化 ,一般可将睡眠分为快速眼动睡眠 (ＲＥＭ)和非快速眼动睡眠 (ＮＲＥＭ) ,后…     

老年人睡眠呼吸暂停综合征的临床进展

随着科学技术的不断进步和医学科学的发展．睡眠障碍及睡眠相关疾病的研究越来越受到人们的关注，睡眠呼吸障碍包括单纯鼾症、上气道阻力综合征、睡眠呼吸暂停综合征、慢性肺疾患及神经肌肉疾患所致的夜间低氧血症。近20年来对睡眠呼吸暂停综合征研究最多．发病率最高．结合本科曾对老年人夜间睡眠呼吸障碍进行相关方面的临床探讨，为此本文重点谈谈睡眠呼吸暂停综合征。     

老年阻塞性睡眠呼吸暂停综合征睡眠监测分析及临床意义

随着人民生活水平的提高 ,人口老龄化 ,老年性疾病越来越受到人们的重视。睡眠障碍性疾病已严重影响老年人的生活 ,危害老年人的健康。我们通过对 64例老年阻塞性睡眠呼吸暂停综合征(OSAS)患者夜间睡眠监测的研究 ,探讨老年OSAS的特点及临床意义。1　资料与方法1 1　一般资料     

成人阻塞性睡眠呼吸暂停的危险因素分析

目的探讨不同严重程度分级的成人阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的危险因素。方法选取我院呼吸睡眠中心行多导睡眠监测(polysomnography,PSG)确诊的成人OSA患者103例,分析年龄、性别、BMI、颈长、颈围、颈围颈长比、胸围、腹围、腹围/体重等因素与OSA病情严重程度的关系。结果 BMI值、腹围、颈围和颈长是影响OSA患者严重程度的高危因素。结论 OSA患者的严重程度与BMI、颈围、颈长、腹围等危险因素有关,可根据危险因素,早期筛查及诊治。     

老年阻塞性睡眠呼吸暂停综合征患者睡眠监测及临床特点分析

目的分析老年阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome OSAS）患者的多导睡眠监测特点。方法比较中青年组72例、老年组42例的多导睡眠监测（polysomnography，PSG）资料及临床资料。结果老年组呼吸暂停低通气指数（apnea hypopnea index，AHI）、微觉醒指数（arousal index，ArI）与中青年组相比均较低，最低血氧饱和度（SaO2）与中青年相比却较高，睡眠结构两组类似，差异无显著性，P〉0．05；老年OSAS中打鼾、夜间憋醒、觉醒时头痛、白天困倦等症状与中青年患者比较较轻，但各系统并发症较多，差异有显著性。结论老年组OSAS患者呼吸紊乱及缺氧程度较轻，临床症状较轻但睡眠结构紊乱的程度与中青年组基本接近。     

老年心血管疾病患者阻塞性睡眠呼吸暂停综合征的评价

目的 评价老年心血管疾病患者阻塞性睡眠呼吸暂停综合征(OSAS)的患病情况和特点,为临床决策提供参考. 方法 采用便携式睡眠监测仪对入住在老年心内科的患者,进行睡眠呼吸监测,了解其阻塞性睡眠呼吸暂停(OSA)的患病情况. 结果 共监测了317例老年心血管疾病患者的夜间睡眠呼吸紊乱情况,得出符合OSA[睡眠呼吸紊乱指数(AHI)≥5]的有281例,占88.6%;符合阻塞性睡眠呼吸暂停综合征(OSAS)[AHI≥5,Epworth量表(ESS)≥9分]的有47例,占14.8%.多元回归分析结果 提示,以OSA严重程度作为因变量,对它影响有显著性意义的是最低血氧饱和度和血氧饱和度下降指数(简称氧减指数),而年龄、习惯性打鼾、嗜睡评分、体质指数(BMI)、血氧饱和度平均值和低于90%的时间对其影响无显著性意义. 结论 老年心血管疾病患者中OSAS具有高的患病率,而且无白天嗜睡症状的OSA的老年人患病率更高.对睡眠呼吸暂停严重程度的独立预测因子是最低血氧饱和度氧减指数,而老年人的年龄、BMI、是否经常打鼾、是否白天嗜睡与OSA的严重程度关系不密切.     

睡眠呼吸暂停与心血管疾病的研究进展

阻塞性睡眠呼吸暂停(OSA)是一种常见病,表现为睡眠中反复发作呼吸暂停或呼吸减慢,导致肺换气不足,睡眠中反复惊醒和交感神经系统激活。研究发现,高血压、肥胖症、男性、种族因素、酒精、遗传因素及鼻腔阻塞等都参与了OSA的发生。夜间反复发生呼吸暂停或低通气,产生低氧血症和高碳酸血症,对心血管系统危害极大,引发多种心血管疾病。     

Improvement in obstructive sleep apnea diagnosis and management wait times: A retrospective analysis of a home management pathway for obstructive sleep apnea

Obstructive sleep apnea is a common condition within the Canadian population. The current gold standard for diagnosis and management of patients is in-laboratory (in-lab) polysomnography; however, the limited availability of testing options for patients has led to long wait times and increased disease burden within the population. The Sleep Research Laboratory in Saskatoon (Saskatchewan) implemented a home management program to run in parallel with the in-lab system several years ago in an effort to increase their capacity and reduce wait times. The present study was a retrospective analysis of all patients referred to the program between 2009 and 2012. The home management system has improved wait times by diagnosing and managing up to one-half of the referred patient population, reducing the wait for in-lab treatment from a median of 152 days in 2009 to 92 days in 2012 (P<0.0001). Moving forward, home management can provide a viable alternative to in-lab testing for patients who meet strict entry criteria, reducing the in-lab workload and, ultimately, reducing wait times.     

Diagnosis of obstructive sleep apnea in adults

The diagnosis of obstructive sleep apnea syndrome (OSAS) requires the combined assessment of relevant clinical features and the objective demonstration of abnormal breathing during sleep, and current evidence indicates that attempts to base the diagnosis of the clinical syndrome on either aspect alone are unreliable. The present review discusses the clinical assessment of patients with suspected OSAS and also the potential added value of structured questionnaires and clinical prediction models that seek to improve the diagnostic value of clinical assessment from the formalized evaluation of selected clinical features. While the traditional "gold standard" for objective assessment is laboratory-based polysomnography, there is growing evidence that limited sleep studies focused on respiratory and cardiac variables are adequate in most cases, and are particularly suited to home-based assessment. The choice between home versus sleep laboratory studies should be decided by taking into account resource limitations and the clinical index of suspicion for OSAS. At present, patients with either a low or high clinical index of suspicion for OSAS appear most suited to home-based investigation, whereas those with intermediate levels of clinical suspicion, or who present with atypical clinical features, may best be assessed by full polysomnographic studies in the first instance.     

Indications for treatment of obstructive sleep apnea in adults

Obstructive sleep apnea is associated with significant daytime sleepiness, reduced quality of life, insulin resistance, motor vehicle crashes, vascular morbidity and mortality. Current evidence supports the belief that all these parameters can be impacted favorably by treatment. Medical therapy with positive pressure eliminates snoring and favorably affects daytime sleepiness, driving risk, vascular function, vascular risk, and quality of life. Treatment may be difficult to accept or adhere to, and some treatment options are not uniformly effective. The long-term impact of treatment is uncertain.     

睡眠呼吸暂停低通气综合征问卷对阻塞性睡眠呼吸暂停综合征诊断价值

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的流行病学调查表筛查价值.方法 疑似OSAHS的987例患者为研究对象,按照中华医学会呼吸病学分会睡眠学组睡眠呼吸暂停低通气综合征流行病学调查表进行问卷并行多导睡眠监测.将此问卷表进行量化评分,用克隆巴赫信度系数(α系数)进行信度计算,将各相关因素做方差分析及x2检验,筛选出有统计学意义的因素最后做Logistic回归分析.以鼾声中度以上的打鼾及体质量指数≥25 kg/m2为高危,反之为低危,进行敏感性,特异性,假阳性,假阴性,阳性似然比,阴性似然比,阳性预测值等.结果 疑似OSAHS患者987例,其中男800例(81.05％),女187例(18.95％),年龄18～80岁,平均(47±12)岁,平均体质量指数(29±5) kg/m2.＞60岁者156例(15.81％),≤60岁者831例(84.19％).克隆巴赫信度系数(Cronbach'salpha)是0.803,假阳性者20,假阴性者142,真阳性者742,真阴性者83,问卷的敏感性是83.94％,特异性是80.58％,假阳性率19.42％,假阴性率16.06％,阳性似然比4.32,阴性似然比0.20,阳性预测值0.97,阴性预测值0.37,正确率83.59％.结论 该睡眠调查表对OSAHS筛查具有一定意义,可用于临床OSAHS的初筛,尤其适合在社区和基层医院中推广使用.     

Role of portable sleep studies for diagnosis of obstructive sleep apnea

PURPOSE OF REVIEW: There is growing awareness of the significance of obstructive sleep apnea in the general population and in the medical community and, as a result, there is a growing demand for diagnosis and treatment. Attended, in-laboratory polysomnography is resource intensive and not readily available in some communities. Alternate diagnostic strategies have been proposed including the use of home sleep studies. Although these portable systems have been in use for many years, only in the past few years have a significant number of studies been performed to evaluate these systems in the home setting. The use of actigraphy and peripheral arterial tonometry for diagnostic purposes has also recently been investigated. RECENT FINDINGS: In the laboratory setting, measurements of sleep-disordered breathing with specific portable sleep systems correspond well with measurements provided by standard polysomnography. In the home setting, portable systems demonstrate several important limitations including lost or inadequate data collection, logistic concerns, and mildly reduced diagnostic accuracy. Data regarding the potential cost benefit of home studies is inconclusive. SUMMARY: Home polysomnography is a viable option for evaluating patients with moderate or high clinical suspicion for sleep-disordered breathing. However, patients with failed or equivocal home studies and those with negative studies but persistent symptoms should undergo standard polysomnography. Further investigations are needed to compare long-term outcomes in patients evaluated using portable devices versus standard polysomnography.     

Portable monitors in the diagnosis of obstructive sleep apnea

The use of portable monitors (PM) devices has been demonstrated in a wide variety of investigational settings with varying results. While most devices correlate very well with in-laboratory polysomnography, some still misclassify a significant numbers of patients and have lower sensitivity. In addition, the failure rate of PM devices is higher than that of in-laboratory polysomnography, requiring repeated investigations. Nonetheless, these devices may reduce the waiting time for diagnosis and could potentially decrease costs. Cost-effectiveness studies have yet to demonstrate an advantage to using PM devices, although their employed modeling techniques may not accurately reflect prevailing practices. The majority of third-party payers do not reimburse unattended studies and consider them still to be investigational. Some health maintenance organizations have begun to recognize PM-based studies in their diagnostic algorithms and will cover their cost; others may do so on a case-by-case basis. There continues to be a dearth of evidence to support widespread implementation of PM devices for use within the general population. Larger-scale validation studies in patients with lower pretest probabilities and a wide range of comorbidities are needed.