经鼻持续气道内正压通气与咽手术治疗阻塞性睡眠呼吸暂停 …

目的 对比观察经鼻持续气道内正压通气（ＣＰＡＰ）与悬雍垂腭咽成形术（ＵＰＰＰ）治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的疗效及对睡眠呼吸参数的影响，评价二者在ＯＳＡＳ治疗中的地位。方法 ６０例ＯＳＡＳ患者，ＣＰＡＰ治疗组３６例，手术治疗组２４例，治疗前后作整夜多导睡眠图（ＰＳＧ）监测。结果 两线呼吸紊乱指数减少，夜间低氧血症改善，ＣＰＡＰ组患者优于手术组（Ｐ〈０．０１），有效率ＣＰＡＰ组为９７％。     

经鼻持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征的远期效果

目的探讨经鼻持续气道内正压通气（ＣＰＡＰ）治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的远期效果。方法报告１９８７～１９９５年在家坚持长期应用ＣＰＡＰ治疗的ＯＳＡＳ有完善多导睡眠图（ＰＳＧ）监测记录对比的１８例患者及其临床治疗的效果。结果（１）应用ＣＰＡＰ治疗后，ＯＳＡＳ症状消除。（２）１３例（７２％）患者复查ＰＳＧ参数改善，１８例停用ＣＰＡＰ治疗后ＰＳＧ复查，最长呼吸暂停时间从６６±２１秒缩短至４３±２４秒（Ｐ＜０．０５）；呼吸紊乱指数从６６±１６降低至２８±２０（Ｐ＜０．００１）；最低血氧饱度（ＳａＯ２）从５３％±１９％提高至７５％±１１％（Ｐ＜０．００１）。（３）治疗前、后１８例患者体重、血压改变不明显，１２例合并高血压的患者６例（５０％）血压恢复到正常范围。结论ＣＰＡＰ治疗ＯＳＡＳ有效，长期坚持治疗呼吸暂停引起的低氧血症、最长呼吸暂停时间改善，临床症状减轻或消除。其机制可能与患者呼吸调节功能改善有关     

经鼻持续性气道正压对阻塞性睡眠呼吸暂停综合征患者呼吸中枢驱动性的影响

为了解经鼻持续性气道正压（ｎＣＰＡＰ）通气治疗对阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者呼吸中枢驱动性的影响，研究了２０例无二氧化碳（ＣＯ＿２）储留的ＯＳＡＳ患者（Ｏ组）及２０例单纯鼾症患者（Ｓ组）夜间睡眠前后呼吸方式及口腔阻断压（Ｐ＿（０．１））的改变，并观察了ｎＣＰＡＰ治疗对ＯＳＡＳ，患者呼吸方式及Ｐ＿（０．１）的影响。结果显示：Ｏ组患者睡前的Ｐ＿（０．１）、呼吸频率、有效吸气阻抗明显高于Ｓ组，潮气量则显著低于Ｓ组。ｎＣＰＡＰ治疗组患者经一夜睡眠后的Ｐ＿（０．１）、每分通气量、潮气量、呼吸频率等较睡前显著增高。经ｎＣＰＡＰ治疗后Ｏ组的呼吸紊乱指数较治疗前明显降低，夜间最低氧饱和度明显提高，Ｐ＿（０．１）较睡前则无明显升高。提示ＯＳＡＳ患者睡前的呼吸中枢驱动性高于单纯鼾症患者，其呼吸形式为浅快呼吸；经过一夜睡眠后，其呼吸中枢驱动水平较睡前明显增高，呼吸形式更为浅快；ｎＣＰＡＰ治疗可以有效地解除睡眠呼吸暂停及其继发的低氧血症，从而逆转睡眠前后呼吸方式和呼吸中枢驱动性的改变。     

阻塞性睡眠呼吸暂停综合征的睡眠结构改变

目的研究阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）病情严重程度及持续气道内正压（ＣＰＡＰ）治疗对睡眠结构的影响。方法通过分析多导睡眠图，分析了３１例非ＯＳＡＳ者和１４７例ＯＳＡＳ患者的睡眠结构及ＣＰＡＰ治疗对１１例ＯＳＡＳ患者睡眠结构的影响。结果与对照组相比ＯＳＡＳ组的睡眠结构存在如下异常：（１）睡眠期转换次数（ＯＳＡＳ组：１２０±７１，对照组：９２±６０，Ｐ＝０．０１０６）、快波睡眠次数（ＯＳＡＳ组：８８±５４，对照组：６５±４５，Ｐ＝０．００７５）、醒觉次数（ＯＳＡＳ组：２７±２８，对照组：１９±１８，Ｐ＝０．０１７）差异有显著性；（２）慢波睡眠次数（ＯＳＡＳ组：５±９，对照组：８±８，Ｐ＝０．００３５）、占总睡眠时间的比例（ＯＳＡＳ组：５％±８％，对照组：８％±９％，Ｐ＝０．００６２）及慢波睡眠的缺乏率（ＯＳＡＳ组：４８％，对照组：２６％，Ｐ＜０．０５）亦明显不同；（３）睡眠呼吸紊乱指数低于２５的ＯＳＡＳ者与对照组比较睡眠各参数相差不大；（４）ＣＰＡＰ治疗能使上述参数得到不同程度的改善。结论ＯＳＡＳ主要引起睡眠的破碎、深睡减少及浅睡增加，且与病情的严重程度有一定关系。ＣＰＡＰ治疗能够改善这些紊乱。     

阻塞性睡眠呼吸暂停患者持续正压通气治疗前后自主神经系统功能的研究

目的研究阻塞性睡眠呼吸暂停（ＯＳＡ）患者夜间睡眠时自主神经功能的状态，以及有效的持续正压通气治疗对自主神经张力的影响。方法对５６例重度ＯＳＡ患者持续正压通气（ＣＰＡＰ）治疗前和治疗中进行夜间７小时多导睡眠图（ＰＳＧ）及动态心电图监测，另择３０名正常受试者作为对照。采用心率功率谱分析法（ＨＲＰＳＡ）定量分析ＯＳＡ患者治疗前后夜间自主神经功能的变化。结果ＯＳＡ组夜间睡眠时伴随着反复的呼吸暂停和低氧血症，低频（ＬＦ）及高频（ＨＦ）值逐渐增高，与对照组比较差异有显著性（ＬＦ为１３８３±３０５∶１２５±６４，Ｐ＜０．００１；ＨＦ为６６２±１９０∶１６３±７８，Ｐ＜０．００１），表明交感神经和副交感神经张力均明显增高。夜间平均ＬＦ／ＨＦ比率在较高水平（２１１±１０１），与对照组（０８７±０６４）比较差异有显著性（Ｐ＜０．０５），说明以交感神经张力增加更为显著。经过有效的ＣＰＡＰ治疗，ＯＳＡ患者ＬＦ（２２１±８１）、ＨＦ（２２１±１０８）明显降低（Ｐ＜０．００１）。结论ＯＳＡ患者夜间有自主神经功能紊乱。针对ＯＳＡ的有效治疗可以改善自主神经的异常活动     

老年人睡眠呼吸暂停综合征与夜间心绞痛的关系

目的研究睡眠呼吸暂停综合征（ＳＡＳ）与夜间心绞痛的关系。方法对伴有或不伴有ＳＡＳ的老年冠心病患者９２例进行睡眠呼吸暂停和动态心电监测以及夜间心绞痛、无症状心肌缺血的观察。结果ＳＡＳ组夜间心绞痛１６例（３４８％），心肌缺血２７例（５８７％），心律失常４１例（８９１％），均较无ＳＡＳ组的４例（８７％）、８例（１７４％）和１６例（３４８％）明显增加（均为Ｐ＜００１）。夜间心绞痛和无症状心肌缺血发作次数与呼吸暂停次数、持续时间呈显著正相关（ｒ＝０４７５～０６１３，Ｐ＜００１），与血氧饱和度呈显著负相关（ｒ＝－０５２６，Ｐ＜００１）。ＳＡＳ患者经治疗夜间心绞痛和无症状心肌缺血显著改善（Ｐ＜００１）。结论老年人ＳＡＳ与夜间心绞痛有关。     

阻塞性睡眠呼吸暂停综合征与心律失常

阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）对心血管功能的影响越来越引起人们的关注。为探讨ＯＳＡＳ与心律失常的关系，我们对２１２例打鼾者行夜间多导睡眠图监测（ＰＳＧ），呼吸紊乱指数（ＡＨＩ）≥５为ＯＳＡＳ。分析ＰＳＧ心电导联。结果：１４６例病人诊断为ＯＳＡＳ，其中８２例ＯＳＡＳ病人发生心律失常（５６．２％），包括早搏或心动过速、传导阻滞或二者均有。采用经鼻持续气道内正压呼吸（ｎＣ－ＰＡＰ）７小时治疗严重的ＯＳＡＳ合并心律失常１９例，其中治疗后心律失常完全消失者１４例（７３．７％）。ＯＳＡＳ病人的心律失常发生率较非ＯＳＡＳ高（χ２＝１７．２８，Ｐ＜０．０００１）。心律失常发生率与低氧及夜间呼吸暂停严重程度呈正相关。ｎＣＰＡＰ有效治疗呼吸暂停的同时可逆转或改善心律失常。作者认为，低氧血症很可能是ＯＳＡＳ者心律失常的重要原因之一。     

阻塞性睡眠呼吸暂停综合征患者鼻阻力变化

目的探讨阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者鼻阻力的变化在睡眠呼吸暂停发病机制中的作用。方法对３０名正常人、３０例鼾症、６０例ＯＳＡＳ患者在进行多导睡眠监测的基础上,行鼻阻力检测。结果轻、中度ＯＳＡＳ组鼻阻力为（１．０６±４．２５）Ｐａｓ／ｍｌ,重度ＯＳＡＳ组鼻阻力为（２．２９±９．７４）Ｐａ·ｓ／ｍｌ,鼾症组鼻阻力为（０．７１±０．３１）Ｐａ·ｓ／ｍｌ,均明显高于正常对照组（０．４０± ０．１３）Ｐａ· ｓ／ｍｌ（Ｐ＜０．０１）,鼻阻力与鼾声指数呈正相关（ｒ＝０．２５８,Ｐ＜０．０１）,但鼻阻力与睡眠呼吸紊乱指数（ＡＨＩ）、醒觉次数、最低血氧均无相关关系。结论鼾症、ＯＳＡＳ患者鼻阻力增加,可能与ＯＳＡＳ的发病有关。     

睡眠呼吸紊乱患者的警觉性测定

目的检测几种临床常见的睡眠呼吸紊乱患者的警觉性是否受损。方法前瞻性地对因疑诊而接受全晚睡眠监测的患者,在监测前（傍晚）和监测后（早上）,利用电脑模拟开车试验,以碰撞障碍物的百分率,衡量其警觉性。以等级方差分析检验各组间早晚平均碰撞率（％Ｈｍ）的差异,并将％Ｈｍ与睡眠监测有关参数作等级相关分析。结果正常人和按诊断分组后患者的％Ｈｍ［以中位数（范围）表示］为：正常人（１１名）０．６（０～２．５）;睡眠鼾症（７例）１．１（０．２～２．０）;阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ,２２例）２．２（０．２～７．７）;中枢性睡眠呼吸暂停综合征（ＣＳＡＳ,６例）２．７（０．９～５．４）。除睡眠鼾症组外,各组患者％Ｈｍ均高于正常人（Ｐ＜０．０５）。正常、睡眠鼾症及ＯＳＡＳ三组合并分析表明：％Ｈｍ与睡眠累计低血氧饱和度时间％有相关性（ｒ＝０．４１,Ｐ＜０．０５）而与呼吸停顿／低呼吸指数和觉醒指数无明显相关（ｒ分别为０．２２和０．１０,Ｐ＞０．０５）。结论ＯＳＡＳ和ＣＳＡＳ患者的警觉性下降,睡眠鼾症患者的警觉性大致正常。警觉性受损可能与睡眠时缺氧有关     

睡眠呼吸暂停与脑血流关系的研究

目的研究睡眠呼吸暂停综合征（ＳＡＳ）对脑血流及脑血管疾病的影响。方法选择年龄、性别和基础疾病相配对，ＳＡＳ组３０例，对照组３２例。ＳＡＳ经多导睡眠监测仪检查而诊断。用阿克松多功能彩超仪，检测双侧大脑前、中、后动脉的血流速度和频谱形态。结果ＳＡＳ组与对照组收缩期血流峰值（ＶＳ），平均血流速度（ＶＭ），阻力指数（ＲＩ）等９项指标差异均有显著性（Ｐ＜０．０５～Ｐ＜０．０１），血流频谱形态异常ＳＡＳ组增多，并且ＶＳ、ＶＭ与呼吸暂停指数（ＡＩ）呈显著负相关（ｒ＝－０．４１３～－０６２８，Ｐ＜０．０５～００１），与ＳａＯ２呈显著正相关（ｒ＝０．４３５～０７１２，Ｐ＜０．０５～００１）。结论ＳＡＳ患者脑血流速度减慢，频谱形态异常增多，提示ＳＡＳ可促发脑供血不足，脑动脉硬化，易导致缺血性脑卒中等脑血管疾病的发生     

持续气道正压通气对老年阻塞性睡眠呼吸暂停患者心脑血管事件的影响

目的 探讨持续气道正压通气(CPAP)治疗对老年阻塞性睡眠呼吸暂停综合征(OSAS)患者心脑血管事件的远期作用.方法 采用前瞻性队列研究对2000至2006年间诊断为中重度OSAS的老年患者进行随访,共纳入106例患者,其中男91例(85.8%),女 15 例(14.2%),年龄60～86岁,平均(73±6)岁,其中坚持进行CPAP治疗者34例,对照组72例,比较CPAP治疗与未治疗2组的心脑血管事件发生率.结果 全部受访的老年中重度OSAS患者接受随访平均观察时间3.5年,到随访结束,CPAP治疗组心脑血管事件的发生率为12%(4/34),对照组为47%(34/72),差别有统计学意义(P<0.001).经Kaplan-Meier生存分析结果显示,随访时间越长,对照组发生心脑血管事件的风险明显高于治疗组(χ2=17.0,P<0.01),是否接受CPAP治疗与心脑血管事件发生呈正相关.结论 合并中重度OSAS的老年心血管疾病患者在接受基础疾病治疗的同时,采用CPAP治疗睡眠呼吸暂停,可以减少心脑血管事件发生的风险,从而利于改善预后.     

Compliance to CPAP treatment and effects of treatment on anxiety and depression in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) causes numerous pathophysiological changes and influences neuropsychological system. Nasal continuous positive airway pressure (CPAP) is the gold standard treatment of OSAS. We aimed to evaluate the compliance of patients with severe OSAS to CPAP treatment and to compare the anxiety and depression scores before and at the 6th month of the treatment. Seventeen patients receiving CPAP treatment for OSAS that continued regular follow-up were accepted to the study. A questionnaire containing questions about demographic features, OSAS symptoms and Epworth sleepiness scale, Beck anxiety scale and depression scale was filled by the patients before and after CPAP treatment. Additionally, information concerning adverse effects of and compliance to CPAP treatment was obtained after CPAP treatment. Mean age of the patients was 48.4 +/- 8.4 (32-63); 14 (82.4%) of them were male and 3 (17.6%) of them were female. Snoring, witnessed apnea and excessive daytime sleepiness symptoms, and Epworth sleepiness scale scores were significantly decreased after CPAP treatment compared with those before treatment. Mean duration of CPAP device use at night was 5.6 +/- 2.1 (2-8) hours. Nine (52.9%) of the patients were using the device regularly every night and 8 (47.1%) of the patients were using it irregularly. The most frequent adverse effect of CPAP treatment was sore mouth, followed by mask discomfort and erythema on the nose. Anxiety and depression scores of the patients were significantly decreased after CPAP treatment compared with those before the treatment. As a conclusion, OSAS patients with high anxiety and depression scores benefit from CPAP treatment.     

Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome

BACKGROUND: Patients with obstructive sleep apnea syndrome (OSAS) are subject to an increased cardiovascular morbidity including systemic hypertension. Little is known about the effects of treatment with nasal continuous positive airway pressure (CPAP) on systemic hypertension. METHODS: Automated ambulatory 24-h blood pressure (BP) monitoring was performed in 88 consecutive patients who were referred for evaluation of snoring or suspected OSAS. In addition, the long-term effects of CPAP therapy on 24-h BP were assessed. RESULTS: A total of 62 patients had OSAS and 26 habitual snoring. Patients with OSAS had significantly higher mean arterial BP values than snorers (102.7 +/- 10.7 v 94.0 +/- 10.2 mm Hg; P < .01). Multiple stepwise linear regression analysis disclosed that the degree of systemic hypertension was independently associated with the severity of OSAS as determined by the apnea/hypopnea index (R = 0.43; P < .001), but not with age, body mass index, or smoking habits. Of the 62 patients with OSAS, 52 were treated with CPAP and reevaluated after 9 months. The CPAP resulted in a significant decrease in mean arterial BP (from 103.7 +/- 10.4 to 99.1 +/- 10.8 mm Hg; P < .05). For those patients with systemic hypertension whose BP improved with CPAP therapy, 24-h mean pulse pressure at baseline (r = -0.36; P < .05) as well as average heart rate during the day (r = -0.35; P < .05) turned out as predictors. CONCLUSIONS: Obstructive sleep apnea syndrome contributes, at least in part, to the development of systemic hypertension, and CPAP may improve BP values in treated OSAS patients. Predictors of a beneficial CPAP effect on BP are a high heart rate and a high pulse pressure before treatment.     

An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome

BACKGROUND: For the treatment of nonsevere obstructive sleep apnea syndrome (OSAS), mandibular advancement devices (MADs) are employed as an alternative to nasal continuous positive airway pressure (CPAP) therapy. However, very few specific data on the effectiveness of MADs in this group of patients are available. We therefore compared an individually adjustable intraoral sleep apnea device (ISAD) that permits movements of the lower jaw in three dimensions, with CPAP in the treatment of patients with an apnea/hypopnea index (AHI) < or = 30/h. METHODS: In a randomized crossover study, 16 men and 4 women (mean +/- SD age, 56.5 +/- 10.2 years; body mass index, 31.2 +/- 6.4; AHI, 17.5 +/- 7.7/h) were treated for 6 weeks with each modality. RESULTS: In the initial phase, a significant improvement in AHI (baseline, 17.5 +/- 7.7/h; ISAD, 10.5 +/- 7.5/h [p < 0.05]; CPAP, 3.5 +/- 2.9/h [p < 0.01]) and in breathing-related arousals (baseline, 8.9 +/- 6.1/h; ISAD, 3.7 +/- 3.3/h [p < 0.01]; CPAP, 1.4 +/- 1.6/h [p < 0.01]) was achieved with both modalities. Considering all 20 subjects, after 6 weeks of treatment, normalization of the respiratory parameters was seen only with CPAP. However, 30% of the patients had a lasting reduction in AHI to < 10/h with the ISAD also. The patients considered the ISAD to be easier to use (scale of 1 to 6: ISAD, 1.8 +/- 1.1; CPAP, 3.1 +/- 1.5 [p < 0.05]), and indicated greater utilization of the device in comparison with CPAP. CONCLUSION: Even in patients with mild-to-moderate OSAS, CPAP is the more effective long-term treatment modality. In the individual case, the better compliance seen with the ISAD may be advantageous.     

Short-term effects of oral theophylline in addition to CPAP in mild to moderate OSAS

Theophylline is effective in the treatment of central apneas and periodic breathing. In obstructive sleep apnea syndrome (OSAS), results of pharmacological monotherapy with theophylline are inconsistent. The present study investigates whether additional theophylline in patients with OSAS and continuous positive airway pressure (CPAP) therapy might improve ventilation, lower effective CPAP pressure levels or affect sleep architecture. Patients with mild to moderate OSAS (mean apnea index [AI] 12.8+/-11.7) and CPAP therapy (Autoset system; n=16, all male) received either 900 mg of oral sustained-release theophylline (T) or placebo (P) on two separate nights, 3 days apart, using a randomized double-blind crossover study design. There was no change in AI (T: 0.7+/-1.4 vs. P: 0.7+/-0.6/h; P=0.3) or apnea-hypopnea index (AHI; T: 4.3+/-3.3 vs. P: 4.5+/-3.7/h; P=0.84) when theophylline was added to CPAP therapy. We observed no difference in mean CPAP pressure (T: 6.9+/-2.1 vs. P: 6.7+/-1.9 cm H2O; P=0.7) or 95% pressure percentiles (T: 9.7+/-2.7 vs. P: 9.3+/-2.1cm H2O; P=0.3) when nights with theophylline were compared to placebo nights. Theophylline reduced significantly total sleep time (T: 290.6+/-58.9 vs. P: 338.0+/-40.1 min; P=0.02) and thus sleep efficiency (SE; T: 70.5+/-14.9%, P: 82.0+/-70.5%; P=0.005). Rapid eye movement and slow wave sleep were not affected. Oral theophylline did not show any additional effects on ventilation parameters or pressures in patients with mild to moderate OSAS once CPAP therapy has been successfully installed. SE was reduced with theophylline with unchanged sleep architecture. The role of oral theophylline may be in patients with predominately central apneas not eligible for ventilation therapy or severe cases.     

Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome

Nasal continuous positive airway pressure (CPAP) is the primary therapy for obstructive sleep apnea syndrome (OSAS). Recent reports have indicated, however, that there is a small but significant number of failures related to patient compliance. Primary surgical treatment, which has been uvulopalatopharyngoplasty (UPPP), has declined because of poor results. A reviewed of UPPP failures has shown that while UPPP eliminated palatal obstruction, it failed to eliminate base of tongue obstruction. Maxillofacial surgery has been reported as treatment of OSAS by correcting base of tongue obstruction. Thirty patients with severe OSAS were evaluated to compare nasal CPAP and maxillofacial surgery. The goal was to determine if our surgical protocol was as effective as nasal CPAP. All patients initially underwent baseline diagnostic polysomnography to document OSAS. A nasal CPAP study was performed to determine the appropriate positive end-expiratory pressure. The patients in this study were using nasal CPAP, but they found it unacceptable as long-term treatment and elected surgery. Maxillofacial surgery consisted of maxillary, mandibular, and hyoid advancement. Polysomnography was performed six months following surgery and compared with the night 2 CPAP results. The parameters included in the investigation were the respiratory disturbance index (RDI), lowest SaO2, number of SaO2 falls below 90 percent, total sleep time (TST), REM sleep percent, stage 3-4 sleep percent, and wake after sleep onset. The mean RDI before treatment was 72.0 (SD 25.7). After completing therapy, the RDI from surgery and CPAP was 8.8 (SD 6.0) and 8.6 (SD 4.1), respectively. The mean low SaO2 prior to treatment was 61.0 (SD 13.5), and the CPAP results and postsurgical results were 86.2 (SD 5.5) and 86.1 (SD 4.2), respectively. An analysis of variance was used to examine the results, and there was no statistical difference between nasal CPAP and surgery for all respiratory variables.     

In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome

BACKGROUND: Patients with obstructive sleep apnea syndrome (OSAS) have an increased risk of cardiovascular events including myocardial infarction and stroke. OBJECTIVE: To determine whether in vivo platelet activation and the generation of procoagulant platelet-derived microparticles (PMP) are increased during sleep in patients with OSAS. METHODS: In vivo platelet activation and PMP formation was determined using flow cytometry in 12 patients with untreated OSAS during and after sleep (4 and 7 a.m.). To study the effect of treatment with continuous positive airway pressure (CPAP), the measurements were repeated at the same time points after initiation of CPAP therapy. Healthy volunteers served as controls (n = 6). RESULTS: Patients with OSAS had an increased percentage of platelets positive for the activation-dependent epitopes CD63 and CD62P during sleep (4 a.m.) compared to controls (4.8 +/- 0.8 vs. 1.9 +/- 0.4% for CD63, p < 0.01, and 2.0 +/- 0.5 vs. 1.1 +/- 0.3% for CD62P, p < 0.05). In OSAS patients, the amount of CD63- and CD62P-positive platelets was significantly elevated at 4 compared to 7 a.m. (4.8 +/- 0.8 vs. 2.6 +/- 0.4% for CD63 and 2.0 +/- 0.5 vs. 1.1 +/- 0.2% for CD62P, p < 0.05), but not in the control group. The levels of PMP were similar in patients with OSAS and controls at 4 and 7 a.m. After 1 night of CPAP therapy, there was a trend to reduced levels of CD63- and CD62P-positive platelets at 4 a.m. CONCLUSIONS: Patients with OSAS have increased in vivo platelet activation during sleep, which may contribute to the increased incidence of cardiovascular events in patients with OSAS.     

Decreased plasma levels of orexin-A in sleep apnea

BACKGROUND: Orexin-A, also known as hypocretin, is a neuropeptide implicated in appetite and sleep regulation. Because the obstructive sleep apnea syndrome (OSAS) is characterized by obesity and excessive daytime sleepiness, we hypothesized that orexin-A levels may be abnormal in patients with OSAS. Further, since treatment with continuous positive airway pressure (CPAP) in patients with OSAS is very effective in normalizing daytime sleepiness, we also hypothesized that the chronic use of CPAP may influence plasma levels of orexin-A in these patients. OBJECTIVE: To evaluate plasma levels of orexin-A in patients with OSAS and the effect of CPAP treatment. PATIENTS AND METHODS: We compared the plasma levels of orexin-A in 13 healthy controls, 27 untreated patients with OSAS and 14 patients treated with CPAP during at least 1 year (4.5 +/- 0.5 h/night; mean +/- SEM). All patients had severe OSAS (apnea-hypopnea index, 57 +/- 4 h(-1)). Results: Orexin-A plasma levels were significantly lower in untreated (9.4 +/- 1.9 pg.ml(-1), p < 0.01) and treated patients with OSAS (4.2 +/- 1.5 pg.ml(-1), p < 0.001) than in healthy subjects (20.6 +/- 4.5 pg.ml(-1)). In untreated patients, orexin-A levels were not significantly related to daytime somnolence assessed by Epworth scale (r = -0.18, p = 0.37) or the body mass index (r = -0.13, p = 0.52). CONCLUSIONS: Orexin-A plasma levels are abnormally low in patients with OSAS, independently of the level of somnolence and/or presence of obesity. These results suggest that these low orexin-A levels may be related to the pathogenesis of OSAS.     

Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome

OBJECTIVE: To assess changes in response to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) concerning excessive daytime sleepiness (EDS), depressive state, and quality of life (QOL). PATIENTS AND METHODS: We assessed for EDS using the Epworth sleepiness scale (ESS), for mood using The Zung self-depression scale (SDS), and for QOL using Short-Form 36 (SF-36) in 132 patients with obstructive sleep apnea syndrome (OSAS) and control subjects. Patients had severe OSAS (apnea-hypopnea index, 59.4+/-23.8/h) and were more hypersomnolent and depressed, and had poorer QOL than 38 age- and gender-matched controls. RESULTS: Before treatment most QOL domains in the SF-36 were significantly associated with patients' SDS scores. With nasal CPAP, ESS and SDS scores were respectively decreased from 9.7+/-4.5 to 4.0+/-2.4 (p<0.0001) and from 49.2+/-10.4 to 45.1+/-9.6 (p<0.0005). Total SF-36 score and scores for seven of eight domains were increased significantly with treatment. Thus, nasal CPAP lessens EDS and depression, and improves QOL, in patients with severe OSAS. Further, magnitudes of changes in total SF-36 scores and in five of eight domains correlated significantly with magnitude of change in SDS score upon nasal CPAP treatment. No relationship was evident between treatment-associated score changes in SF-36 domains and ESS score change. CONCLUSION: Although patients with severe OSAS have poorer QOL than control subjects, nasal CPAP appears to improve QOL by alleviating depression.     

自动持续正压系统对睡眠呼吸障碍的诊治

目的探索简便、临床易于推广应用的睡眠呼吸障碍疾患的诊治手段。方法对１１例睡眠呼吸障碍患者同步进行经典的多导睡眠图监测和自动持续正压系统监测，将监测结果进行比较；对２３例已确诊的阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者使用自动持续正压系统治疗，并对治疗效果进行评价。各监测指标比较采用ｔ检验。结果（１）自动持续正压系统与多导睡眠图相比较，自动持续正压系统虽无睡眠及心电记录，但可记录鼾声及上气道阻力；最高及最低血氧饱和度、最长呼吸暂停时间、呼吸暂停低通气（ＡＨＩ）指数等监测结果，两者相比，差异无显著性（Ｐ＞０．０５）；自动持续正压系统诊断ＯＳＡＳ的敏感性为７０％，特异性为１００％。（２）ＯＳＡＳ患者使用自动持续正压系统治疗后症状改善；ＡＨＩ显著减低，最低血氧饱和度显著升高（Ｐ＜０．００１）；此外，平均和最高压力与９５％可信压力比较差异有显著性。结论自动持续正压系统使用简便，并减轻了技术员监测时的劳动强度；在持续正压通气（ＣＰＡＰ）治疗时可采用９５％可信限所需的压力