Mean platelet volume is increased in patients with severe obstructive sleep apnea

Abstract

Increased platelet activation and aggregation which are closely related to cardiovascular complications have been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with OSA. The 95 subjects referred for evaluation of OSA underwent overnight polysomnography. Blood samples were taken for MPV determination. According to the apnea-hypopnea index (AHI), subjects were divided into three groups; group 1: control subjects without OSA (AHI < 5, n = 24), group 2: patients with mild to moderate OSA (AHI: 5–30, n = 42), and group 3: severe OSA (AHI > 30, n = 29). Body mass index (BMI) of patients with severe OSA was significantly higher than control subjects (31.5 ± 4.0 vs. 28.2 ± 5.0; p = 0.02). The MPV was significantly higher in patients with severe OSA than in the control group (8.9 ± 1.0 vs. 8.2 ± 0.7 fl; p = 0.01). Correlation analysis within 71 patients with OSA indicated that MPV was correlated with AHI (p < 0.001, r = 0.44) and DI (p = 0.001, r = 0.37). In multivariate regression analysis, when MPV was taken as independent with other study variables which are potential confounders such as age, gender and BMI, MPV was independently correlated with both AHI (β = 0.44, p < 0.001) and DI (β = 0.38, p < 0.001). We have shown that MPV was significantly higher in patients with severe OSA when compared with control subjects and MPV was correlated with AHI and DI.     

1例淀粉样变继发重度阻塞性睡眠呼吸障碍病人的护理

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发病率占成人的2%～4%,已日益受到重视.OSAHS病人由于长期存在夜间低氧血症、高碳酸血症和睡眠障碍,可以引起多系统、多器官的慢性损伤[1].原发性淀粉样变性是由于浆细胞产生的大量轻链免疫球蛋白沉积于各组织器官,导致组织形态学改变和器官功能衰竭,引起相应临床表现的一组器质性疾病.该病罕见,国外报道其发生率为住院病人的0.45%～0.50%,国内尚无发生率的准确统计[2].淀粉样变在舌体可表现为进行性肥大,最终导致睡眠呼吸障碍.我科于2011年2月收治1例重度OSAHS伴舌体肥大病人,舌体活检示舌体淀粉样变,后行正颌手术,由于OSAHS病人多伴有高血压、肥胖、高血脂、脂肪肝、隐性冠心病等情况,故其围术期治疗具有一定危险性和特殊性.除需加强各种预防措施外,良好的围术期护理对提高病人的安全亦具有重要的意义.现将其护理介绍如下.     

一氧化碳等在阻塞性睡眠呼吸暂停变化的研究

目的：研究阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA)，患者血浆中一氧化碳及间接胆红素（间胆）水平变化及其临床意义，方法：测定111例OSA患者和30名正常人血浆一氧化碳和间胆水平。其中20例中，重度患者使用持续气道内正压通气（continuous airway positive pressure,CPAP)呼吸机治疗30日，于治疗前，治疗第一日、治疗1个月后分别测定一氧化碳和间胆水平。结果：（1）OSA患者血浆中一氧化碳水平显著高于正常人，重度组一氧化碳水平显著高于轻，中度组，OSA合并高血压组的一氧化碳水平亦显著高于无伴高血压组（均为P＜0．05）；（2）正常人血浆中间胆水平显著高于OSA患者；轻、中度组间胆水平显著高于重度组，OSA无伴高血压组血浆间胆显著高于合并高血压组；（3）20例OSA患者血浆一氧化碳于治疗1个月后显著降低，间胆则显著升高（均为P＜0．05）；（4）OSA患者血浆中一氧化碳与舒张压和动脉血氧饱和度小于0．90占总睡眠时间比值均呈正相关，血间胆与动脉血氧饱和度小于0．90占总睡眠时间比值和呼吸暂停低吸气指数均呈负相关，一氧化碳与间胆呈负相关。结论：低血氧是引起OSA患者一氧化碳显著提高或间胆显著降低的原因，一氧化碳和间胆都可能参与了OSA的病理生理过程，患者血浆中一氧化碳和间胆水平可考虑作为考虑其是否有合并症的指标。     

阻塞性睡眠呼吸暂停患者的磨牙症研究

目的研究阻塞性睡眠呼吸障碍患者发生磨牙症的情况。方法使用多导睡眠检测技术对381例阻塞性睡眠呼吸暂停低通气综合征患者的磨牙事件进行分析。结果381例阻塞性睡眠呼吸暂停低通气综合征患者中,共有磨牙症患者238例（62.5%）,出现阻塞性睡眠呼吸暂停事件2520次,在阻塞性睡眠呼吸暂停事件末端出现磨牙事件的有1437次（57.0%）。结论阻塞性睡眠呼吸暂停低通气综合征患者常伴有磨牙症。     

Perioperative considerations of patients with obstructive sleep apnea

This article reviews the condition of obstructive sleep apnea. Various treatment modalities are discussed, including surgery. Specific implications for nursing interventions during this potentially lifethreatening period are suggested.     

阻塞性睡眠呼吸暂停患者主观睡眠质量分析

目的　探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者的主观睡眠质量及特点。方法　对 2 17例经多导睡眠图 (PSG)检查确诊的OSAS患者进行Pittsburgh睡眠质量指数 (PSQI)调查。结果　根据PSQI评估结果 ,睡眠较差和睡眠很差的病例数均为 88例 (各占 40 .5 % )。PSQI各成分 (I～VII)的计分分别为 1.6± 0 .9,1.1± 1.1,1.1± 1.1,1.4± 1.2 ,0 .8± 0 .6,0 .3± 0 .9,1.9± 1.1分 (P <0 .0 1)。AHI与PSQI及其各成分 (I～VII)间的相关系数分别为 -0 .2 7(P <0 .0 1) ,-0 .15 (P <0 .0 5 ) ,-0 .42 (P <0 .0 1) ,-0 .2 8(P <0 .0 1) ,-0 .17(P <0 .0 5 ) ,-0 .0 8(P >0 .0 5 ) ,-0 .2 1(P <0 .0 1) ,0 .0 8(P >0 .0 5 )。轻、中、重度OSAS3组患者的年龄差异无显著性 ;各组PSQI分别为 9.6± 5 .3 ,8.0± 4.2 ,6.8± 3 .3 (P <0 .0 1) ;各组PSQI的成分II、III、VI计分差异有非常显著性 (P <0 .0 1) ,其它成分计分差异无显著性。结论　OSAS患者睡眠质量差 ,主要表现为白天功能障碍、主观睡眠质量差以及睡眠效率低 ,但患者主观睡眠质量差的程度与OSAS严重程度反而呈弱负相关 ,提示睡眠呼吸暂停本身并不是影响患者主观睡眠质量的主要因素。     

阻塞性睡眠呼吸暂停综合征患者手术治疗的护理

笔报道88例阻塞性睡眠呼吸暂停综合征患施行悬雍垂腭咽成形术的护理。术前密切观察夜间睡眠呼吸暂停变化情况；术后做好饮食指导，加强口腔护理，局部冷敷减轻疼痛，密切监测呼吸情况，防止呼吸道梗阻，做好出血观察，吞咽障碍及食物返流护理；做好出院指导。笔认为通过术后密切观察护理，可提高UPPP手术效果，减少并发症，减轻患痛苦与不适。     

老年人睡眠呼吸暂停综合征的睡眠质量调查

INTRODUCTIONObstructivesleepapneasyndrome（OSAS）isoneofthecommonsleepdisorders，especiallyintheelderly．PatientswithOSASusu－allycomplainofexcessivedaytimedrowsinessandtiredness，lackofconcentration，memoryimpairment，andsometimespsychologicaldisturbances．Asaresultofthesesymptomsandfunctionalimpair－ments，OSASpatientsoftenreporthavingapoorsleepquality犤１－２犦．Inthisstudy，wewereinterestedinevaluatingthesubjectivesleepqualityinelderlypatientssufferingfromOSAS．MATERIALSAND…     

阻塞性睡眠呼吸暂停低通气综合征患者的术中配合

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）是指成人于7h的夜间睡眠时间内,至少有30次呼吸暂停,每次发作时,口、鼻气流停止流通至少10s以上,它是临床上一种常见病,主要表现为患者睡眠时上气道塌陷阻塞,频繁发生呼吸暂停和低通气,导致血氧饱和度下降,引起低氧血症和高碳酸血症,并伴有打鼾、白天嗜睡等症状。     

中重度阻塞性睡眠呼吸暂停低通气综合征143例围术期护理

目的:探讨中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者围术期护理方法.方法:对47例行局麻手术和96例行全麻手术中重度OSAHS患者给予精心围术期护理.结果:本组术后发生原发性出血5例,继发性出血2例,术腔水肿、呼吸道梗阻行气管切开2例,经及时处理和精心护理,均恢复良好;143例术后嗜睡、睡眠打鼾、呼吸暂停均有不同程度改善或消失.结论:对中重度OSAHS患者进行手术治疗,精心的围术期护理是防止发生严重并发症的关键.     

Sleep quality in elderly patients with obstructive sleep apnea syndrome

To investigate the sleep quality in elderly patients with obstructive sleep apnea syndrome (OSAS),METHODS:54 cases of elderly patients with OSAS were evaluated by the pittsburgh sleep quality index (PSQI) questionnaire,RESULTS:Among 54 OSAS patients 35 cases (65%) reported poor quality of sleep,only 7(13%) cases reported good.A significant negative correlation was found between apnea/hypopnea index (AHI) and PSQI,and part of its components .CONCLUSION:Elderly patients with OSAS ofter complain of poor quality of sleep.Daytime dysfunction,poor subjective sleep quality,low habitual sleep efficiency and long sleep latency constitutes the principal parts of the symptoms about sleep.     

精神障碍伴阻塞性睡眠呼吸暂停综合征 患者的睡眠生理研究

目的 探讨精神障碍伴发阻塞性睡眠呼吸暂停综合征 (obstructive sleep apnea syndrome,OSAS)患者的临床特点及睡眠生理改变。方法 对 420例精神障碍患者进行多导睡眠图 (PSG)检测。将检出的 18例 OSAS与无 OSAS的精神病患者进行比较。 结果 OSAS组打鼾、睡眠憋醒、白天嗜睡、记忆减退症状较无 OSAS组明显增多 (P     

X线头影测量分析在肥胖伴睡眠呼吸暂停低通气综合征患者诊疗中的应用

目的 分析肥胖伴睡眠呼吸暂停低通气综合征(OSAHS)患者x线头影软、硬组织测量特征和上气道及周围组织位置,探讨其对临床治疗方法选择的应用价值.方法 对72例肥胖伴OSAHS患者进行头颅定位侧位X线片检查,分析其X线头影软、硬组织测量数据,并与24例正常人检查结果进行比较.结果 ①头影硬组织测量特征:患者上颌骨发育和位置无明显改变;下颌骨位置明显后缩,突度减小,提示在矢状位上发育不足;舌骨明显朝后下移位.软组织测量特征:舌、软腭矢状面积口咽腔矢状面积比例[(TA+SPA)/0PA]明显增加(P＜0.001);软腭后和舌咽后咽径显著减少,最小矢状咽径(PAS)明显减小(P＜0.001).②87.50%0SAHS患者上气道狭窄,其中以软腭和舌后区最多见(51.39%),其次为软腭后狭窄(软腭咽腔阻塞占31.94%);72.22%患者为多部位阻塞.③睡眠呼吸暂停低通气指数(AHI)与PAS呈显著负相关(P＜0.05),与(TA+SPA)/OPA呈显著正相关(P＜0.05);动脉血氧饱和度(SaO2)与(TA+SPA)/OPA呈显著正相关(P＜0.05).结论 肥胖伴OSAHS患者X线头影测量分析,不但能提示患者颅面和上气道形态异常程度,同时与多导睡眠图联合分析能预示上气道狭窄部位、性质,为治疗方案的选择提供依据.     

阻塞性睡眠呼吸暂停低通气综合征患者围手术期护理

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者围手术期的护理方法。方法:选择2008年5月～2011年5月我院OSAHS患者85例,均行悬雍垂腭咽成形术(UPPP),将其随机分为观察组43例和对照组42例,两组均做好围手术期护理,观察组术前行持续正压通气治疗(CPAP),对照组未行CPAP治疗,术后均应用多导睡眠监测仪(PSG)监测,观察两组相关监测参数并比较。结果:观察组患者均能耐受CPAP治疗,OSAHS症状明显缓解,观察组患者最长呼吸暂停时间及呼吸暂停低通气指数均显著低于对照组(P<0.05),而最低血氧饱和度显著高于对照组(P<0.05)。结论:UPPP术前应用CPAP治疗OSAHS可显著缓解临床症状,加强围手术期护理可有效降低手术治疗的危险性。     

超声心动图对阻塞性睡眠呼吸暂停综合征的应用研究

目的应用彩色多普勒超声心动图无创性评价阻塞性睡眠呼吸暂停综合征(OSAS)患者的心脏受累与心功能变化的程度,强调OSAS对心血管功能的影响应引起人们的关注。方法选择经全夜多导睡眠监测仪确诊为OSAS患者68例为病变组,正常对照组20例,对比两组超声心动图心脏结构与血流动力学变化参数。结果OSAS患者心脏结构与心电图异常发生率、舒张末期右室前壁厚度、肺动脉和左(右)肺动脉分支内径、肺动脉血流加速时间、三尖瓣反流程度、三尖瓣反流法估测肺动脉收缩压均明显高于对照组(P<0.01)。结论对常规超声心动图检查显示孤立性右室肥厚而其他检查找不到基础疾病者,应予以高度重视,结合临床考虑到OSAS的可能,及时转专科做出明确诊断,以达到对该病的早期诊断与治疗。     

Telemedicine and lifestyle modifications in obstructive sleep apnea patients

The recent advent of information technology(IT) has led to the application of telemedicine to the diagnosis of sleep-disordered breathing(SDB) such as obstructive sleep apnea(OSA). Trials with automatic SDB analyzers(Night Watch and Alice 4) are investigating the use of home SDB testing via telephone circuits or the internet, home continuous positive airway pressure(CPAP) titration via remote-control, and super-remote polysomnographic monitoring using the time difference between Japan and the United States. In 1994, we developed a computer-controlled lifestyle improvement support system(AILIFE) using a telephone circuit. The support system is expected to heighten the effectiveness of treatments for OSA with CPAP, prosthetic mandibular advancement, or uvulopalatopharyngoplasty by improving the lifestyle of OSA patients through the provision of home-based guidance on nutrition and exercise via telecare.