眼睑松弛与阻塞性睡眠呼吸暂停关系的初步研究

目的 通过分析眼睑松弛和阻塞性睡眠呼吸暂停综合征（OSAHS）各指标的关系,初步探讨眼睑松弛发生的病理生理基础.方法 福建医科大学附属第二医院呼吸科睡眠监测室于2006年10月至2007年3月期间行多导睡眠监测（PSG）并确诊为OSAHS的患者44例,行眼睑松弛度检查,记录年龄、性别、体重指数（BMI）、睡眠呼吸暂停低通气指数（AHI）、快速动眼期（REM）占睡眠时间的百分数、血氧饱和度（SaO2）＜90%的时间等参数.随机选择在我院体检中心做体检,无睡眠打鼾及睡眠质量问题,且既往无眼病史的正常人100名作为对照.OSAHS与正常对照组眼睑松弛发生率的比较采用卡方检验 OSAHS患者中眼睑松弛者与无眼睑松弛者相关指数的比较采用两独立样本t检验,眼睑松弛与A HI及BMI的相关性采用直线回归分析.结果 44例OSAHS患者中,眼睑松弛者27例（61%）,高于正常对照组（7%）（x2=5.007,P＜0.01）.OSAHS患者中,眼睑松弛者的AHI为（54.5±21.0）次/h,明显高于无眼睑松弛者（31.1±21.9）次/h（t=3.229,P=0.036） 眼睑松弛者的BMI为（29.7±4.8）kg/m2,明显高于无眼睑松弛者（25.3±3.5）kg/m2（t=3.556,P=0.006）.眼睑松弛与AHI及BMI成正相关（r=0.494、0.447,P＜0.05）,而与REM及SaO2＜90%的时间等参数的相关性无统计学意义.结论 眼睑松弛多见于OSAHS患者,高的BMI和AHI是眼睑松弛的危险因素,提示肥胖和低通气可能是眼睑松弛产生和发展的原因.     

Lax eyelid syndrome (LES), obstructive sleep apnea (OSA), and ocular surface inflammation

Purpose

Lax eyelid syndrome (LES) is defined as the association of distensible “floppy” eyelids and chronic papillary conjunctivitis. LES is also found in patients with obstructive sleep apnea (OSA) who have systemic elevation of inflammatory markers, including matrix metalloproteinases (MMP). Locally elevated MMP levels have also been demonstrated co-localized with elastin loss in eyelids of patients with LES, accounting for their “floppiness.” The purpose of this study was to investigate tear film MMP levels and determine their association with eyelid laxity and OSA. We also evaluated 3 previous grading systems to determine the severity of lid laxity and introduced a new “laxometer” device.

Retinal nerve fiber layer thickness changes in obstructive sleep apnea syndrome: a systematic review and Meta-analysis

AIM: To evaluate the retinal nerve fiber layer (RNFL) thickness changes in patients with obstructive sleep apnoea syndrome (OSAS), and detect possible prevalence of glaucoma in this population. METHODS: Comprehensive studies were conducted on the Cochrane Library, PubMed and Embase through March, 2015. Only studies that fit the selection criteria about RNFL and OSAS would be included. For the measures, we calculated the 95% confidence interval (CI) and weighted mean differences (WMD). The systematic review and Meta-analysis was performed by RevMan 5.2 software. RESULTS: Nine case-control studies were analyzed containing a total of 1086 cases and 580 controls. Average RNFL thickness in OSAS was reduced significantly compared with healthy controls in random effects model (WMD=-2.56, 95% CI: -4.82 to -0.31, P =0.003, I² =57%). A significant RNFL thickness reduction were found between the two groups in inferior quadrant (WMD=-3.11, 95% CI: -5.53 to -0.69, P=0.01), superior quadrant (WMD=-2.37, 95%CI: -4.7 to 0.04, P =0.05). In nasal quadrant (WMD=-2.54, 95% CI: -6.53 to 1.45, P =0.21) and temporal quadrant (WMD=-1.26, 95% CI: -2.19 to 0.47, P =0.15) there was no difference of RNFL thickness between the two groups. CONCLUSION: The results show that RNFL thickness is lower in patients with moderate or severe OSAS than in normal subjects or patients with mild OSAS according to the nine homogeneity studies.     

Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnoea

Purpose : To describe the beneficial effects of treatment of obstructive sleep apnoea on the symptoms and signs of floppy eyelid syndrome. Method : A case of sleep apnoea with associated floppy eyelid syndrome is reported. Results : A 32‐year‐old man presented with left floppy eyelid syndrome and a known diagnosis of obstructive sleep apnoea. He underwent treatment for 4 years with continuous positive airways pressure by mask during sleep and the symptoms and signs of his floppy eyelid syndrome disappeared. Conclusion : Treatment of obstructive sleep apnoea may reverse the changes of floppy eyelid syndrome.     

Congenital combined eyelid imbrication and floppy eyelid syndrome: Case report and review of literature

Congenital eyelid imbrication syndrome (CEIS) is an extremely rare, benign, transient, self-limiting eyelid malposition disorder. The classic triad of signs in patients with a CEIS consists of bilateral upper eyelids overriding the lower eyelids when child was in sleep, bilateral medial and lateral canthal tendon laxity and tarsal conjunctival hyperemia. We report a third case of congenital combined eyelid imbrication and floppy eyelid syndrome in healthy neonate that was resolved within a week with conservative treatment.     

视网膜中央静脉阻塞与阻塞性睡眠呼吸暂停综合征的相关性

目的　探讨视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)与阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的相关性。方法　选择CRVO组患者及非CRVO患者（对照组）各24例进行研究。采用多导睡眠呼吸记录仪在夜间对CRVO患者及对照组的呼吸暂停低通气指数(apnea-hypopnea index，AHI)、夜间平均最小氧饱和度等指标进行监测。根据AHI对OSAS进行诊断。对两组的OSAS发生率、AHI、夜间平均最小氧饱和度、年龄、体质量指数(body mass index,BMI)等进行比较。结果　CRVO组BMI（25.49±4.17）kg·m^-2和AHI（18.89±14.54）与对照组［BMI:(22.57±5.25)kg·m^-2、AHI:8.25±6.98］相比均明显升高，而CRVO组夜间平均最小氧饱和度（80.04±11.63）%与对照组（89.14±7.22）%相比明显降低，差异均有统计学意义（均为P<0.05）。其中，CRVO组OSAS患病率为75.00%，显著高于对照组（37.50%），差异有统计学意义（P<0.05）。OSAS组［年龄（59.67±9.32）岁、BMI(27.59±5.19)kg·m^-2和AHI (21.16±12.08)］与非OSAS组［年龄（53.31±7.04）岁、BMI（22.15±4.94）kg·m^-2、AHI（3.76±1.13）］相比均明显升高，而患者夜间平均最小氧饱和度（81.42±6.61）%与非OSAS组（87.08±5.77）%相比明显降低，差异均有统计学意义（均为P<0.05）。13例非缺血型CRVO患者中有OSAS 11例（84.62%），11例缺血型CRVO患者中有OSAS 7例（63.64%），OSAS在非缺血型及缺血型CRVO患者中的患病率差异无统计学意义（P>0.05）。结论　CRVO患者中OSAS的患病率较高，提示OSAS在CRVO的发病进程中起重要作用或者是CRVO发病的使动因素。     

阻塞性睡眠呼吸暂停综合征与视网膜分支静脉阻塞的关系

目的：探讨阻塞性睡眠呼吸暂停综合征(OSAS)与视网膜分支静脉阻塞(BRVO)的相关性。

方法：本研究共纳入70例BRVO患者及70例健康体检者作为对照(与BRVO患者的年龄、性别相匹配)。利用Berlin问卷对BRVO患者及对照组的OSAS患病风险进行评估,借助多导睡眠呼吸监测仪对BRVO患者及对照组的呼吸暂停低通气指数(AHI)、最小氧饱和度(MOS)等指标进行监测。根据AHI对OSAS进行诊断,对BRVO患者及对照组的OSAS发生率、平均AHI、平均MOS等指标进行比较。

结果：BRVO患者中伴发OSAS者为49例(70%),平均AHI为19.74±7.59、MOS为(82.45±9.17)%; 对照组OSAS患者为23例(33%),平均AHI为13.69±6.35、MOS为(88.44±8.72)%。BRVO患者及对照组OSAS的发病率、平均AHI及MOS均有差异(χ²=19.331,t=5.115、3.954,均P<0.01)。OSAS与BRVO呈正相关(r_s=0.319,P=0.033)。39例急性BRVO患者的平均AHI为16.905±6.31、MOS为(85.14±8.22)%; 31例慢性BRVO患者的平均AHI为17.84±5.47、MOS为(83.81±7.87)%,急性BRVO患者与慢性BRVO患者的平均AHI和MOS均无差异(t=0.653、0.685,P=0.516、0.496)。

结论：OSAS可能是BRVO的重要危险因素,其对于BRVO病情的持续也可能起着关键作用。     

阻塞性睡眠呼吸暂停综合征与青光眼的关系

阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）是涉及全身多器官的呼吸系统的常见病。近年来大量的研究显示,ＯＳＡＳ与青光眼之间有着密切关系。本文从发病率、客观检查、发病机制等方面对ＯＳＡＳ与青光眼之间的关系及研究进展进行综述。     

阻塞性睡眠呼吸暂停低通气综合征患儿血氧指标与呼吸紊乱指标相关性研究

目的 通过研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿血氧指标与呼吸紊乱指标之间的相关性,为临床诊断提供参考.方法 128例经整夜多导睡眠监测（PSG）确诊为重度OSAHS的患儿,着重统计分析最低血氧饱和度（LSpO2）、血氧饱和度低于0.90占监测总时间的百分比（TS90％）与睡眠呼吸暂停低通气指数（AHI）、阻塞性睡眠呼吸暂停指数（OAI）之间的相关性.结果 当AHI＞ 20次/h时：①LSpO2与AHI、OAI呈负相关,Pearson相关系数分别为-0.545、0.380;②TS90％与AHI、OAI呈正相关,Pearson相关系数分别为0.779、0.645.当OAI＞ 10次/h时：①LSpO2与AHI、OAI呈负相关,Pearson相关系数分别为-0.583、-0.418;②TS90％与AHI、OAI呈正相关,Pearson相关系数分别为0.785、0.672.以上均有统计学意义（P＜0.01）.结论 重度OSAHS患儿中,TS90％与AHI、OAI的相关性较LSpO2与之更强,要提高对TS90％在评估儿童缺氧程度中的关注.使用OAI指标判断疾病程度时,血氧指标与AHI及OAI相关性更强,提示儿童睡眠疾病严重程度判断中不能忽视OAI指标.     

阻塞性睡眠呼吸暂停低通气综合征患者主观评估与客观检查的相关性研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者主观评估和客观检查的相关性.方法 分别采用视觉模拟量表(visual analogue scale, VAS)、Epworth嗜睡量表(Epworth sleepiness scale, ESS)和Calgary睡眠呼吸暂停生活质量指数量表(sleep apnea quality of life index, SAQLI)评估200例OSAHS患者的打鼾、嗜睡症状和生活质量,分析它们与多导睡眠仪(polysomno-graphy,PSG)检查间的相关性.结果 VAS、ESS与PSG间有一定的相关性,但不同呼吸暂停低通气指数(apnea hypopnea index, AHI)和最低血氧饱和度(lowest oxygen saturation, LSaO2)组间只有重度组VAS和ESS值与其他各组间差异有统计学意义.SAQLI同PSG间没有良好的相关性,而且不同AHI和LSaO2组间只有重度低血氧组的症状维度分值与其他各组间差异有统计学意义.结论 评估OSAHS患者须结合主观评估和客观检查.VAS和ESS在评估病情严重程度上的价值不大.(中国眼耳鼻喉科杂志,2009,9:145-147)     

阻塞性睡眠呼吸暂停低通气综合征与青光眼关系的研究进展

青光眼是一种病理性眼压升高,伴有视野损害,具有青光眼性视神经损害进而严重影响视功能的相关疾病。阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是指睡眠过程中上呼吸道部分或完全阻塞使呼吸气流减少(低通气)或中断(呼吸暂停),随后通过短暂觉醒恢复上呼吸道通气,从而引起反复发作的夜间低氧和高碳酸血症,可导致高血压、冠心病、糖尿病和脑血管疾病等并发症,甚至出现夜间猝死的睡眠呼吸疾病。OSAHS除了是心脑血管的独立危险因素外,目前许多的研究表明其亦与青光眼具有一定关联,但尚缺少对两者关系的系统性分析,本研究拟对其进行综述分析。     

阻塞性睡眠呼吸暂停低通气综合征与青光眼关联性的Meta分析

背景 已有研究表明阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与青光眼相关,但这些结论仍存在争议. 目的 采用Meta分析方法分析OSAHS是否为青光眼的危险因素. 方法 以“sleeping apnea”和“glaucoma”为主题词检索PubMed数据库的英文文献,检索文献类型为病例对照研究和前瞻性队列研究,发表时间限制在1982年1月1日至2015年1月30日.采用Review Manager 5.2统计学软件进行Meta分析,计算总效应量的比值比(OR)和95％可信区间(CI)以评价OSAHS与青光眼间的关联强度. 结果 共纳入12篇回顾性病例对照研究文献,包括11 592例OSAHS患者和25 931名非OSAHS对照者,纽卡斯尔渥太华量表(NOS)评分法表明纳入文献质量为6～8分.12个研究存在明显的异质性(x2=34.20,P＜0.05,I2=68％),随机效应模型分析显示OSAHS组与对照组比较青光眼的发病率增加(OR=1.87,95％ CI:1.21～2.90),2个组间差异有统计学意义(Z=2.82,P＜0.05).轻、中、重度OSAHS亚组患者中青光眼的发生率均明显高于对照组(轻度:OR=3.61,95％ CI:0.56～23.43;中度:OR=4.17,95％ CI:0.47～36.91;重度:OR=6.95,95％ CI:1.14 ～42.26).敏感性分析显示,OR值波动范围为1.74 ～2.16.漏斗图示分析显示,纳入的文献可能存在发表偏倚.结论 OSAHS是青光眼的危险因素之一,且OSAHS的病情严重程度与青光眼发病率有关,OSAHS病情越重,合并青光眼的可能性也越大.     

Association between central serous chorioretinopathy and Helicobacter pylori infection: a systematic review and Meta-analysis

AIM: To investigate the association between central serous chorioretinopathy (CSC) and Helicobacter pylori (Hp) by summarizing all available evidence. METHODS: The Scopus, Embase, EBSCO, PubMed, Web of Science, and Cochrane Library databases for all relevant studies published from inception to October 2022 were searched, and manually searched for relevant reference lists as a supplement. Studies investigating the association between CSC and Hp infection were included. Finally, 8 case-control studies were included in the Meta-analysis after study selection. RESULTS: The results showed no significant correlation between Hp infection and CSC [odds ratio (OR) 1.89, 95% confidential interval (CI) 0.58–6.15, I2=96%, P=0.29]. After subgroup analysis based on the degree of development of the study (developing/developed countries), it was found that the results of the two subgroups were the same as the whole, and no significant difference between the two subgroups existed. Meta-regression showed that the effect of sample size on heterogeneity among studies was more prominent (P<0.01, adjusted R2=89.72%), which can explain 89.72% of the sources of heterogeneity. CONCLUSION: This Meta-analysis reveals no significant correlation between Hp infection and CSC, which still warrants further well-designed extensive sample studies to reach a more reliable conclusion and promote a better understanding of the treatment of CSC.     

阻塞性睡眠呼吸暂停低通气综合征与糖尿病视网膜病变的关系

阻塞性睡眠呼吸暂停低通气综合征（ obstructive sleep apnea hypopnea syndrome,OSAHS）是一种以上气道塌陷反复发作为特征的,最终导致夜间间歇性低氧血症的一类疾病。近年来OSAHS与糖尿病视网膜病变的关系已有报道,我们就两者的临床联系、相关检查及其可能的作用机制进行综述。     

视网膜母细胞瘤眼动脉内化疗有效性及安全性的系统评价

背景 视网膜母细胞瘤(RB)是儿童最常见的眼内恶性肿瘤.目前临床上已有多种方法治疗RB.近些年发展起来的眼动脉内化疗(IAC),在增加视网膜局部药物浓度的同时又可降低全身不良反应,成为近年来眼内进展期RB的一种重要治疗手段. 目的 系统评价IAC在用于RB治疗时的疗效及安全性.方法 按照检索策略,计算机检索PubMed、Medline、Embase、EBSCO、Web of Science、万方数据库、中国知网(CNKI)、维普网(VIP)及中国生物医学文献数据库(CBM),检索时限为建库起至2016年4月.文章筛选、数据提取、质量评级及数据分析参照系统综述和荟萃分析优先报告条目的PRISMA声明进行. 结果 共纳入27个研究,报道了超过1 067例RB患者1 314眼,超过3 818次治疗.总体保眼率为70.3％,一线治疗保眼率为76.2％,进展期RB的保眼率为57.5％,在IAC治疗期间及治疗后未接受其他治疗的患者的保眼率为76.4％.共报道23例转移,21例死亡.恶心呕吐、中性粒细胞减少等轻度全身不良反应和视网膜色素上皮改变、结膜充血、视网膜脱离等局部不良反应较为常见,但严重不良反应鲜有报道. 结论 IAC作为RB的一种治疗手段具有广阔的应用前景,严重不良反应少见,但仍需随访时间长、前瞻性的研究来明确其用于RB治疗的适应证.     

匹克威克综合征和阻塞性睡眠呼吸暂停综合征相关性假性脑瘤

目的:报告1例男性患者合并有匹克威克综合征和阻塞性睡眠呼吸暂停(OSA),其临床表现为假性脑瘤和视力下降。方法:病例报告。结果:患者,男,54岁,过度肥胖,诉双眼视力渐降3mo,检查示:视力:右眼20/200,左眼20/400,左眼合并色觉异常,眼底镜示双视乳头水肿和视盘旁出血,左眼合并黄斑部渗出。体格检查和实验室检查符合阻塞性睡眠呼吸暂停与匹克威克综合征诊断。腰椎穿刺:开放压350mmHg,脑部扫描正常。诊断:OSA和匹克威克综合征相关性假性脑瘤。眼底表现和视力随采血治疗、血压控制、体重控制及双层正压通气治疗而改善。结论:对于患有假性脑瘤的患者,必须对阻塞性睡眠呼吸暂停与匹克威克综合征有所警惕。     

Correlation between obstructive sleep apnea and central retinal vein occlusion

To investigate the possible correlation between obstructive sleep apnea (OSA) and central retinal vein occlusion (CRVO). Thirty consecutive patients with a recent (<3mo) CRVO and an age- and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). The average AHI and ODI were significantly higher in CRVO patients (AHI: 13.86±8.63, ODI: 9.21±4.47) than in control subjects (AHI: 8.51±6.36, ODI: 5.87±3.18; P=0.008 and 0.001 respectively). Additionally, the AHI was positively correlated with body mass index (BMI; r=0.476, P=0.017) and ODI (r=0.921, P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two (73.33%) CRVO patients had OSA and 12 (40.00%) control subjects had OSA, a difference that was statistically significant (P=0.019). OSA may be a risk factor for or a trigger of CRVO development.