睡眠障碍与脑血管病

最近的研究表明,睡眠障碍与脑血管病有关,尤其是阻塞性睡眠呼吸暂停综合征(OSAS)。已有大型流行病学调查表明,OSAS与脑血管病独立相关。文章就睡眠障碍与脑血管病的关系做了综述。     

老年人阻塞性睡眠呼吸暂停综合征与高血压

阻塞性睡眠呼吸暂停综合征(OSAS)在老年人中常见，流行病学调查、动物试验及临床研究均提示OSAS与高血压的关系甚为密切，而老年人睡眠呼吸暂停综合征(SAS)的主诉症状常不明确，与多种疾病并存，容易与老年人衰老症状相混淆，病情复杂，鉴别诊断困难，易漏误诊，同时治疗效果显著，有必要提高对老年人SAS诊治的认识。现重点介绍老年人OSAS与高血压关系的近年研究的进展。     

阻塞性睡眠呼吸暂停低通气综合症血管损伤发病机制的研究进展

<正>阻塞性睡眠呼吸暂停低通气综合症(Obstructive sleep apnea syndrome,OSAS)是以夜间睡眠时反复间断性缺氧-低通气循环为特征的疾病,表现为血氧饱和度下降和睡眠中断。西方国家成人中约30%无症状OSAS患者,而有症状OSAS发病率约2%~4%[1]。临床对照试验表明OSAS与高血压病有关,前瞻性流行病学研究证实OSAS是心肌缺血、     

睡眠体位干预在阻塞性睡眠呼吸暂停综合征治疗中作用的研究进展

睡眠体位可一定程度上影响上气道阻塞,改善阻塞性睡眠呼吸暂停综合征（ OSAS）患者夜间通气情况。该文就患者夜间侧睡体位在OSAS治疗中的作用的临床研究进展作一综述。     

乙酰半胱氨酸治疗COPD—OSAS重叠综合征的临床疗效观察

COPD-OSAS重叠综合征是指慢性阻塞性肺疾病（COPD）与阻塞性睡眠呼吸暂停综合征（OSAS）同时并存，由1985年David Henlay首次提出。研究表明，氧化／抗氧化失衡、气道炎症与COPD—OSAS重叠综合征的发病机制及病理生理相关。     

阻塞性睡眠呼吸暂停综合征与高血压

阻塞性睡眠呼吸暂停综合征(OSAS)是一种临床常见疾病,在临床中往往被忽视,未予充分重视。目前,OSAS和高血压发病率明显增高,流行病学研究表明二者合并的发病率远远超过单一发病率。越来越多的证据支持OSAS可导致高血压。本文对OSAS与高血压的相关性、OSAS相关高血压的特点、OSAS相关高血压病理生理学机制的最新进展、OSAS的治疗策略以及治疗OSAS对血压的影响等方面进行了综述。     

OSAS合并心脑血管病的炎性机制及研究的进展

阻塞性睡眠呼吸暂停综合征(OSAS)与心脑血管病密切相关。动脉粥样硬化(AS)的形成和发展是血管性疾病的共同病理基础,炎症贯穿AS进展的整个过程。从炎症方面探讨OSAS引起心脑血管病的机制已成为新的研究方向。     

阻塞性睡眠呼吸暂停综合征患者的肺动脉高压

一些研究表明，阻塞性睡眠呼吸暂停综合征（OSAS）可增加心血管疾病的发生率，其中包括肺动脉压升高。然而，对OSAS患者肺动脉高压严重度和左心室功能不全的影响因素了解甚少。作者对此进行了研究。方法92（男用、女11）例进人本研究，平均年龄为53．Iiil岁，平均体重指数为引．4t5．Ikg，均经夜间多功能睡眠检查仪确诊为OSAS。实验室和临床证实均无慢性肺部疾患。将睡眠时每小时呼吸暂停和呼吸不全发作的平均次数（呼吸暂停指数）和睡眠时血氧饱和度＜90％的时间（t＜90％）作为OSAS严重度的指标。经右心导管测定患者的肺动脉压和…     

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。     

198例老年睡眠呼吸暂停综合征多导睡眠图分析

目的 分析总结198例老年睡眠呼吸暂停综合征患者（slee papnea／hypopnea syndrome，SAHS）的多导睡眠图（polysonmography，PSG）特点。方法 198例均为在华山医院睡眠诊疗中心诊断为老年SAHS患者，分析其PSG，描述其中139例不同程度阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome OSAS）患者的PSG特征；探讨 OSAS患者体重指数（body mass index，BMI）与呼吸暂停事件及夜间间断性缺氧的相关性；对OSAS患者睡眠结构紊乱与呼吸暂停事什及夜间低氧血症进行相关性分析。结果198例SAHS患者中以阻塞性为主的有139例，占70．2％，140例OSAS患者均有不同程度的夜间间断性低氧和睡眠结构紊乱。相关分析显示Ⅰ期睡眠（S1）与睡眠呼吸暂停低通气指数（AHI）、氧减饱和指数（ODI）及血氧饱和度〈90％／总睡眠时间（％SpO2〈90％）呈正相关，与平均氧饱和度（MSaO2）呈负相关；Ⅱ期睡眠（S2）与最低氧饱和度（LSaO2）及MSaO2呈正相关，与AHI、ODI及％SpO2〈90％呈负相关；Ⅲ＋Ⅳ期睡眠（S3＋4）与MSaO2呈正相关，与％SpO2〈90％呈负相关，AHI、ODI及LAT呈负相关，均有统计学意义。而患者的BMI与AHI和ODI呈正相关；与LSaO2和MSaO2呈负相关，有统计学意义；与最长暂停时间（IAT）和％SpO2〈90％无相关。结论本研究资料表明PSG是目前诊断SAHS的金标准。OSAS是最为多见的SAHS类型，而首次确诊的OSAS患者中以重度患者最多，提示SAS的早期发现率较低。体重指数可提示OSAS的严重程度，OSAS患者存在睡眠结构紊乱，并随呼吸暂停事件及夜间低氧血症的加重而加重。     

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。     

A review of the roles of allergic rhinitis in childhood obstructive sleep apnea syndrome.

The aim of this study was to review the literature to evaluate the association between allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) in childhood. A PubMed literature search (January 1970 to February 2005) was conducted using the following key words: obstructive sleep apnea, allergic rhinitis, and mouth breathing. The retrieved articles were reviewed and the levels of evidence were assessed. AR affected approximately 40% of children and OSAS occurred in 2% of children. AR is a risk factor for OSAS because AR is associated with nasal obstruction, enlargement of tonsils and adenoids, and an elongated face, which, taken together, constitute a smaller upper airway size. Adequate treatment of AR is helpful to decrease the severity of OSAS and prevent emergence of an elongated face, which predispose for OSAS. There is convincing evidence that AR increases the risk of OSAS in children. Appropriate treatment of AR regularly could prevent the occurrence of OSAS and reduce the severity of existing OSAS.     

Familial predisposition and cosegregation analysis of adult obstructive sleep apnea and the sudden infant death syndrome

Previous studies suggest a familial link between adult obstructive sleep apnea syndrome (OSAS) and sudden infant death syndrome (SIDS). However, most of these studies were hampered by the availability of too few cases of SIDS to draw conclusions. To examine the familial nature of this association in Iceland, hospital-based lists of all patients who were diagnosed with OSAS (n = 2,350) and SIDS (n = 58) from 1979 to 1998 were used to separately determine the familial occurrence of OSAS and SIDS and to search for evidence of cosegregation of these conditions in Icelandic families, using a nationwide genealogy database. The risk ratio for a first-degree relative of a patient with OSAS was 2.0 (1.7-2.8, 95% confidence interval). The risk ratio of the more severely affected patients with OSAS was slightly higher (2.3). Likewise, the kinship coefficient (KC) for the OSAS patient group, which determines the relatedness of the patients, was significantly larger than the mean KC of 1,000 matched control groups. Estimation of the KC for the SIDS group showed a trend toward significance when compared with control groups, but after excluding one of the half-siblings in the SIDS group from the analysis, the difference did not show any trend toward significance. Although the results of the analysis of the relatedness between all patients with OSAS and infants who died of SIDS were not significant, a trend toward significance was evident when the data were separately analyzed for the more severely affected patients with OSAS. Collectively, these results demonstrate a strong familial component in OSAS and suggest that infants who died of SIDS may have shared some of the same susceptibility factors with OSAS.     

睡眠呼吸暂停综合征和支气管哮喘相互促进及其作用机制

近年来的研究提示,睡眠呼吸暂停综合征和支气管哮喘（简称哮喘）之间关系密切,睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是哮喘急性发作的独立危险因素。OSAS促进哮喘加重的可能机制包括以下方面：胃食管反流,气道炎症反应,神经反射机制,OSAS相关的心血管损害的间接影响,...     

A meta-analysis of the association between gout,serum uric acid level,and obstructive sleep apnea

Previous epidemiological investigations have evaluated the association between gout, serum uric acid levels, and obstructive sleep apnea syndrome (OSAS), but with inconsistent results. We conducted this meta-analysis aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout. Relevant studies were identified via electronic databases from inception to December 17, 2018. Study selection was conducted according to predesigned eligibility criteria, and two authors independently extracted data from included studies. The hazard ratio (HR) and weighted mean difference (WMD) and their corresponding 95% confidence interval (CI) were derived using random-effects models. We conducted meta-, heterogeneity, publication bias, sensitivity, and subgroup analyses. Eighteen studies, involving a total of 157,607 individuals (32,395 with OSAS, 125,212 without OSAS) and 12,262 gout cases, were included. Results show that serum uric acid levels are elevated in patients with OSAS (WMD?=?52.25, 95% CI 36.16–64.33); OSAS did not reach statistical significance as a predictor of gout (but there was a trend, HR?=?1.25, 95% CI 0.91–1.70) and that the association between OSAS and serum uric acid was quite robust. OSAS may be a potential risk factor for hyperuricemia and the development of gout and thus, effective OSAS therapy may present as a valuable preventive measure against gout. Still, it is vital to undertake clinical studies with better designing to corroborate these associations and shed new light on it.

     

Unrecognized sleep apnea in the surgical patient: implications for the perioperative setting

Anesthesia and surgery both affect the architecture of sleep. Aside from the postoperative effects of anesthesia and surgery, sleep deprivation and fragmentation have been shown to produce apneas or desaturations even in patients without presumed sleep apnea. Recent epidemiologic data have placed the prevalence of obstructive sleep apnea syndrome (OSAS) at about 5% among Western countries. The problem is further hindered by the difficulty in diagnosing OSAS, as patients with OSAS may present for surgery without a prior diagnosis. Clinical suspicion for OSAS may first be recognized intraoperatively. Adverse surgical outcomes appear to be more frequent in OSAS patients. Immediate postoperative complications may intuitively be attributed to the negative effects of sedative, analgesic, and anesthetic agents, which can worsen OSAS by decreasing pharyngeal tone, and the arousal responses to hypoxia, hypercarbia, and obstruction. Later events are, however, more likely to be related to postoperative rapid eye movement (REM) sleep rebound. In the severe OSAS patient, REM sleep rebound could conceivably act in conjunction with opioid administration and supine posture to aggravate sleep-disordered breathing. REM sleep rebound has also been suggested to contribute to mental confusion and postoperative delirium, myocardial ischemia/infarction, stroke, and wound breakdown. Although the data to guide the perioperative management of patients with moderate-to-severe OSAS is scarce, heightened awareness is recommended. The selected use of therapy with nasal continuous positive airway pressure before surgery and after extubation may be beneficial.Learning OBJECTIVES: 1. Identify common sleep architectures affected by anesthesia and surgery in the perioperative period. 2. State a perioperative complication in Obstructive Sleep Apnea Syndrome patients. 3. Identify perioperative interventions and management techniques that best facilitate improved obstructive sleep apnea syndrome patient care.     

Inflammation accelerates atherosclerotic processes in obstructive sleep apnea syndrome (OSAS)

Obstructive sleep apnea syndrome (OSAS) is an often underestimated sleep disorder that has been associated with cardiovascular disease. OSAS is characterized by cycles of apnea and/or hypopnea during sleep caused by the collapse of the upper airways. Intermittent hypoxia deriving from the cycles of apnea/arousals (to retrieve the ventilation) plays a pivotal role in the pathogenesis of the disease. Obesity is the most frequent predisposing condition of OSAS. Recent evidence suggests that OSAS could be considered as a pro-atherosclerotic disease, independently of visceral fat amount. Oxidative stress, cardiovascular inflammation, endothelial dysfunction, and metabolic abnormalities in OSAS could accelerate atherogenesis. The present review is focused on the possible pathophysiological mediators which could favor atherosclerosis in OSAS.     

Obstructive sleep apnea syndrome and cardiovascular diseases

Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of partial or complete upper airway collapse and obstruction during sleep, associated with intermittent oxygen desaturation, sleep fragmentation, and symptoms of disruptive snoring and daytime sleepiness. Increasing focus is being placed on the relationship between OSAS and all-cause and cardiovascular disease-related mortality, but it still largely unclear whether this association is causative or simply speculative and epidemiological. Basically, reliable clinical evidence supports the hypothesis that OSAS might be associated with essential and resistant hypertension, as well as with an incremental risk of developing stroke, cardiac rhythm perturbations (e.g., atrial fibrillation, bradyarrhythmias, supraventricular and ventricular arrhythmias), coronary artery disease, acute myocardial infarction, and heart failure. Although it is still unclear whether OSAS might represent an independent risk factor for several acute or chronic conditions, or rather might trigger cardiovascular disease in the presence of traditional cardiovascular risk factors (e.g., obesity, diabetes, and dyslipidemia), there is a plausible biological background underlying this association, in that most of the mechanisms implicated in the pathogenesis of OSAS (i.e., hypoxia, hypercapnia, negative intrathoracic pressure, micro-arousal, sympathetic hyperactivity, metabolic and hormonal changes, oxidative stress, phlogosis, endothelial dysfunction, hypercoagulability, and genetic predisposition) might also be involved in the pathogenesis of cardiovascular disorders. In this article we discuss the different aspects of the relationship between OSAS and pathogenically different conditions such as systemic hypertension, coronary artery disease, stroke, metabolic abnormalities, arrhythmias, and heart failure, and we also discuss the kaleidoscope of phenomena implicated in the pathogenesis of this challenging disease.     

Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea

We examined the effects of percutaneous electrical stimulation of the genioglossus in six patients with obstructive sleep apnea syndrome (OSAS) during sleep and investigated the possible applicability of this procedure as a treatment of OSAS. Six patients with OSAS were polysomnographically studied in the supine position during all-night sessions with and without electrical stimulation of the genioglossus. Using an apnea demand-type stimulator that we developed, electrical pulses of 0.5 ms (repetition rate, 50 Hz) and 15 to 40 V were delivered through bipolar electrodes (10 mm in diameter) attached to the skin of the submental region when apnea lasted more than 5 s, and was stopped immediately after breathing resumed or after 10 s at the longest. With submental stimulation, the apnea index, apnea time/total sleep time, longest apnea duration, and the number of times per hour that oxygen saturation dropped below 85% decreased significantly compared with those on control nights. The lowest arterial oxygen saturation and the duration of sleep stages III and IV increased significantly. The stimulation employed did not cause arousal, and it did not affect blood pressure or heart rate significantly. These findings show that submental stimulation decreases the incidence of apnea episodes and promotes deeper sleep without accompanying serious side effects, suggesting that the apnea demand-type stimulator may be a noninvasive and effective treatment for OSAS.