慢性肾脏病合并睡眠呼吸暂停低通气综合征

慢性肾脏病(chronic kidney disease,CKD)合并睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)发病隐匿,易被人们忽视.合并SAHS不仅会加速患者肾功能损害,而且还会增加其并发症的发生,进而影响患者的长期生存.据此,本文针对CKD合并SAHS的流行病学、临床特征、发病机制及治疗方法进行综述.     

阻塞性睡眠呼吸暂停综合征与慢性咳嗽危险因素研究的新进展

阻塞性睡眠呼吸暂停综合征和慢性咳嗽之间有着共同的危险因素如肥胖、性别、遗传等.探究两者之间的联系能够为我们对这两种疾病的认识与治疗提供新的方法与思路.     

Chronic lung disease in the sleep apnea syndrome

Several well controlled epidemiologic and hemodynamic studies suggest that about 20% of sleep apnea syndrome (SAS) patients will have chronic obstructive pulmonary disease (COPD), and the majority of these patients (with combined diseases) will have pulmonary hypertension. Indeed it has been suggested that only patients with underlying hypoxemia, such as that from COPD, will develop right heart failure in the OSA setting. Experience shows that apnea/COPD patients will have severe hypersomnolence associated with the OSA, cough and dyspnea with the airways disease, and edema and plethora related to chronic hypoxemia. Many patients present with respiratory failure and are diagnosed at the time of initial intubation and mechanical ventilation. Episodic nocturnal hypoxemia may be worsened by a steeper rate of desaturation due to lower alveolar and blood oxygen stores, and longer apneas perhaps contributed to by depressed chemosensitivity. Daytime hypoxemia may also add to the severe hemodynamic disturbances. Since COPD cannot be cured, aggressive treatment of SAS is critical. Past studies have shown that tracheostomy or nasal CPAP in this setting not only leads to resolution of episodic nocturnal desaturation but may lead to rapid improvement in daytime oxygenation in many patients. Pulmonary hypertension and other measures of cardiopulmonary function improve when apnea is cured. Elimination of the SAS may disclose nonapneic REM related desaturation that could require supplemental oxygen therapy in addition to tracheostomy or nasal CPAP. Pulmonary function testing in SAS patients with smoking histories, followed by aggressive treatment of SAS, is recommended.     

阻塞性睡眠呼吸暂停综合征与眼部疾病

阻塞性睡眠呼吸暂停综合征(OSAS)作为一种常见的睡眠呼吸障碍性疾病,是多种原因引起的睡眠中反复发生呼吸暂停的病变。OSAS患者睡眠中反复发生上气道塌陷、阻塞,导致不同程度低通气(和)或呼吸中断,进而可导致多系统疾病。近年来,越来越多的证据表明OSAS的相关并发症中包括多种眼病。本文就OSAS与几种眼部疾病的相关性作一小结综述。     

阻塞性睡眠呼吸暂停综合征与难治性高血压

阻塞性睡眠呼吸暂停综合征(OSAS)与难治性高血压关系密切,它可通过交感神经兴奋增强、内皮功能损伤、肾素-血管紧张素-醛固酮系统紊乱等机制引起血压增高,而且临床表现有自己的特点。因此,对于难治性高血压患者应注意有无OSAS以及是否给予了相应治疗。     

慢性阻塞性肺病合并睡眠呼吸暂停综合征的研究

为研究慢性阻塞性肺病（COPD）合并阻塞性睡眠呼吸暂停综合征（OSAS）的临床特点，对50例COPD患者据其第1次睡眠呼吸监测结果分为COPD组和COPD合并OSAS组，两组各选10例在吸氧下行第2次睡眠呼吸监测，其中COPD合并OSAS组在持续正压通气（CPAP）和双水平正压通气（BiPAP）治疗下行第3、4次睡眠呼吸监测，10例COPD合并OSAS患者在吸氧同时加用CPAP和BiPAP治疗下行第5、6次睡眠呼吸监测。结果显示，在COPD合并OSAS发病率为24％。COPD合并OSAS患者体重大，夜间打鼾，缺氧明显，呼吸衰竭和心力衰竭发生率高，睡眠潜伏期短（SLT），呼吸紊乱指数（RDI）大。睡眠时氧可使两组患者RDI增大。COPD合并OSAS组50％耐受CPAP通气治疗，皆能耐受BiPAP治疗，吸氧同时加用机械通气可取得更理想疗效。提示COPD合并OSAS患者病情危重，对其氧疗的同时给予CPAP和BiPAP通气是抢救成功的关键。     

Obstructive sleep apnea hypopnea syndrome was a risk factor for uncontrolled hypertension in adult snorers in South China

Background: The association of obstructive sleep apnea hypopnea syndrome (OSAHS) with uncontrolled hypertension has not been fully investigated to date. The present article will investigate the associated factors of uncontrolled hypertension in South China Method: A total of 668 patients (531 males, 137 females) in South China were enrolled in this study. All patients completed questionnaires and then underwent an in-hospital polysomnography. Result: Univariate analysis showed that drinking, apnea–hypopnea index, Epworth Sleepiness Scale (ESS) index, the presence of OSAHS, MSaO₂ and the lowest SaO₂, circumference of neck and waist were predictors of uncontrolled hypertension. Multiple logistic regression analysis showed that ESS, presence of OSAHS, and the lowest SaO₂ was independently associated with the risk for uncontrolled hypertension. Conclusion: The lowest SaO₂, ESS index, and OSAHS were risk factors for uncontrolled hypertension.     

阻塞性睡眠呼吸暂停综合征与脑卒中

探讨阻塞性睡眠呼吸暂停综合征（OSAS）与脑卒中在流行病学与人体生物学之间的相关性及其发病机制。睡眠呼吸暂停是脑卒中的危险因素,独立相关于心血管危险因素,对卒中的预防有重大意义。     

阻塞性睡眠呼吸暂停与心肌肥大

阻塞性睡眠呼吸暂停综合征（obstructivesleepapneasyndrome,OSAS）是跳眠呼吸障碍疚病中发病率最高的一种疾病,已有多个研究证实OSAS是引起心血管疾病的独立危险因素之一。夜间慢性间歇性低氧是OSAS的显著病理生理特征。心肌肥大是心血管疾病的一一个非常重要的预后因子,且目前有许多证据表明OSAS与心肌肥大关系密切。     

阻塞性睡眠呼吸暂停低通气综合征与甲状腺疾病的相关性研究进展

研究提示OSAHS与甲状腺疾病并存,目前发现OSAHS与甲状腺功能减退症、亚临床甲状腺功能减退症、桥本甲状腺炎之间具有一定的相关性,因此对OSAHS伴发甲状腺疾病的患者进行早期诊断并积极治疗,对提高治疗效果尤为重要.     

阻塞性睡眠呼吸暂停综合征与内分泌疾病

睡眠呼吸暂停综合征(OSAS)患者睡眠呼吸暂停以及反复低氧所致的应激状态可以引起一系列内分泌和代谢异常,并可产生肥胖、糖尿病等内分泌相关并发症;同时某些内分泌疾病如肥胖、糖尿病、肢端肥大症、多囊卵巢综合征等患者中OSAS的发病率较正常人群为高。文章就OSAS与内分泌疾病的相关性做一综述。     

Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies

Background

The association between obstructive sleep apnea (OSA) and the incidence of cardiovascular disease (CVD) has been examined in many studies. However, the findings are not entirely consistent across studies. Our goal was to evaluate the association between OSA and risk of CVD and all-cause mortality by performing a meta-analysis of prospective cohort studies.

Methods

We used generalized least squares regression models to estimate the dose–response relationship. Heterogeneity, subgroup, and sensitivity analyses and publication bias were performed.

Results

Twelve prospective cohort studies involving 25,760 participants were included in the meta-analysis. The overall combined relative risks for individuals with severe OSA compared with individuals with an AHI of < 5 were 1.79 (95% confidence interval [CI]: 1.47 to 2.18) for CVD, 1.21 (95% CI: 0.75 to 1.96) for incident fatal and non-fatal coronary heart disease, 2.15 (95% CI: 1.42 to 3.24) for incident fatal and non-fatal stroke, and 1.92 (95% CI: 1.38 to 2.69) for deaths from all-causes. A positive association with CVD was observed for moderate OSA but not for mild OSA. The results of the dose–response relationship indicated that per 10-unit increase in the apnea–hypopnea index was associated with a 17% greater risk of CVD in the general population.

Conclusions

This meta-analysis of prospective cohort studies suggests that severe OSA significantly increases CVD risk, stroke, and all-cause mortality. A positive association with CVD was observed for moderate OSA but not for mild OSA.     

阻塞性睡眠呼吸暂停综合征与扩张型心肌病

随着对阻塞睡眠呼吸暂停综合征(OSAS)认识的深入,OSAS与各类心血管疾病的相关性也逐渐得到重视。2009年中华医学会呼吸病学分会睡眠学组会同心血管病学会参照国外有关研究发表了《睡眠呼吸暂停与心血管疾病专家共识》,成为进一步促进、密切两个学科之间研究的新起点。文章对如何早期认识、诊断OSAS合并扩张型心肌病(DCM)做一简要介绍,强调DCM患者合并OSAS诊断的临床意义,分析CPAP治疗对DCM患者恢复心脏功能及心脏结构的临床价值。     

快速眼动睡眠期的阻塞型呼吸暂停与高血压

快速眼动(REM)睡眠期阻塞型睡眠呼吸暂停(OSA)是指发生在REM期的阻塞型睡眠呼吸暂停综合征,由于REM期交感神经活性异常增高,因此发生在此期的OSA可以使交感神经活性更高,心血管功能更不稳定。目前认为REM-OSA很可能是OSA相关高血压发生的主要原因,并且也可能是目前OSA相关高血压用持续正压通气(CPAP)治疗效果不明显的重要原因。临床工作中应重视对REM-OSA的诊断和治疗,这对OSA相关高血压的防治具有重要意义。     

Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor?

Introduction  Erectile dysfunction (ED) is a well-known entity with determined risk factors, which generally has a negative impact on quality of life. Obstructive sleep-disordered breathing (SDB), often referred to as obstructive sleep apnea, stands among the possible risk factors for ED. Discussion  Literature review suggests that SDB induces a spectrum of abnormalities in neural, hormonal, and vascular regulation that may contribute to the development of ED. While more studies are required to imply SDB as a risk factor for ED, several case series and expert opinion have contributed evidence for a causal relationship. Conclusion  In clinical practice, men presenting with symptoms of sexual dysfunction often have concomitant sleep disorders requiring treatment. There is now evidence to suggest that treating SDB may be an effective treatment for ED. It is the authors’ opinion that patients with erectile dysfunction would benefit from a sleep evaluation.     

阻塞性睡眠呼吸暂停低通气综合征与哮喘

最近研究表明阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是支气管哮喘急性加重的独立危险因素。OSAHS常涉及睡眠时上气道吸气气流受限及气道塌陷,常与日间症状如嗜睡、抑郁、精力难以集中等相关。支气管哮喘常表现为气道慢性炎症、气道高反应、可逆性气道气流受限等。现已有大量学者对其相关性作出研究,但未达成统一共识。目前认为神经反射因素、胃食管反流、气道及全身炎症反应、睡眠结构紊乱、肥胖、心血管疾病、激素治疗及鼻部疾病等可能是OSAHS与哮喘相互影响及作用的机制。本文就OSAHS与哮喘的相关性及其机制作一综述。     

阻塞性睡眠呼吸暂停综合征与夜间心律失常

阻塞性睡眠呼吸暂停综合征(OSAS)是一种常见的临床病症。文章通过2例OSAS同时合并心律失常患者的临床特点就OSAS与心律失常的相关性做进一步探讨。     

Obstructive sleep apnea: an update on mechanisms and cardiovascular consequences

Background and aimThere is growing recognition of the widespread incidence and health consequences of obstructive sleep apnea (OSA). This review examines the evidence linking sleep apnea with cardiovascular disease and discusses potential mechanisms underlying this link.Data synthesisThe weight of evidence provides increasing support for a causal relationship between OSA and hypertension. Furthermore, OSA may contribute to the initiation and progression of cardiac ischemia, heart failure and stroke. Chronic sympathetic activation appears to be a key mechanism linking OSA to cardiovascular disease. Other potential mechanisms include inflammation, endothelial dysfunction, increased levels of endothelin, hypercoagulability and stimulation of the renin angiotensin system. OSA, hypertension and obesity often coexist and interact, sharing multiple pathophysiological mechanisms and cardiovascular consequences. Effective treatment of OSA may attenuate neural and humoral abnormalities in circulatory control, improve blood pressure control and conceivably reduce the risk of future cardiovascular events.ConclusionPatients with OSA are at increased risk for cardiovascular disease. OSA should be considered in the differential diagnosis of hypertensive patients who are obese. In particular, OSA should be excluded in patients with hypertension resistant to conventional drug therapy.     

阻塞性睡眠呼吸暂停与抑郁

多项研究提示阻塞性睡眠呼吸暂停常伴有抑郁.受评定工具、混杂因素及重叠症状等因素的影响,使得目前对于二者相关性的研究进展缓慢.对阻塞性睡眠呼吸暂停伴发抑郁的患者进行早发现并积极治疗,对提高患者生活质量尤为重要.     

阻塞性睡眠呼吸暂停综合征与认知功能损害

阻塞性睡眠呼吸暂停综合征(OSAS)患者认知功能的损害普遍存在,不同程度的影响了患者的生存质量。这个常见的OSAS合并症却经常被漏诊,使患者得不到及时的诊断和治疗。认知功能损害的机制主要与睡眠间歇低氧和睡眠结构紊乱有关,间歇低氧引发的炎症和氧化应激反应对认知功能相关部位的中枢神经损伤是认知功能障碍的解剖学基础。充分治疗OSAS对认知功能的改善有益,提倡对患者的早期诊断和治疗。