氧减延迟时间在评价OSAHS的作用

目的探讨氧减延迟时间在评价阻塞性睡眠呼吸暂停低通气综合征的作用。方法回顾2008年1-2013年10月已经确诊OSAHS患者80例，分为中青年组（40例）和老年组（40例），每组再按病情的严重程度，分为单纯打鼾组，轻度OSAHS组、中度OSAHS组和重度OSAHS组，每组均为10例，记录各组氧减延迟时间。结果中青年组的单纯打鼾组、轻度OSAHS组、中度OSAHS组和重度OSAHS组的平均氧减延迟时间分为为44．47±17．43s、32．08±15．12s、30．46±5．70s、27．57±13．70s；正常组与其他组别，差异均有统计学意义（P〈0．05），而轻度、中度、重度组间两两比较无统计学差异（P〉0．05）．但是发现随着严重程度，平均氧减延迟时间逐渐在缩短。老年组的单纯打鼾组、轻度OSAHS组、中度OSAHS组和重度OSAHS组的平均氧减延迟时间分为为45．47±14．43s、37．08±15．42s、36．41±12．70s、43．52±14．70s；正常组与轻度及中度组，差异均有统计学意义（P〈0．05），与重度组无统计学差异；而重度组与轻度、中度组两两比较有统计学差异（P〈0．05）。而中青年组与老年组的不同组别氧减延迟时间的比较，单纯打鼾组比较差异无统计学意义（P〉0．05），而轻度、中度、重度组间两两比较均有统计学差异（P〈0．05），显示老年组氧减延迟时间要比中青年组时间要明显延长。结论氧减延迟时间则反应了个体在睡眠过程中的血氧变化对睡眠呼吸事件的敏感性及与血氧饱和度变化的时间关系；提示氧减延迟时间对评价OSAHS患者病情有一定意义。     

阻塞性睡眠呼吸暂停低通气综合征患者清醒状态下的呼吸暂停与继之血氧饱和度下降的关系及临床意义

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者清醒状态下呼吸暂停与继之血氧饱和度下降的关系及临床意义.方法:选取夜间打鼾并疑有睡眠呼吸障碍的患者50例,使其在安静状态下平静呼气末暂停呼吸至血氧饱和度下降,记录血氧饱和度开始下降的时间,定义为单次氧减延迟时间;填写Epworth嗜睡问卷;根据整夜睡眠呼吸监测结果,按照呼吸暂停指数(AHI)的不同将打鼾者分为4组:第1组(0～5次/h)、第2组(>5～15次/h)、第3组(>15～30次/h)和第4组(>30次/h).结果:第3组比第1组单次氧减延迟时间显著缩短(P＜0.05),第4组比其他各组均显著缩短(P＜0.01);受试者AHI、血氧饱和度低于90%的时间占总睡眠时间的百分比(TS90%)、平均每小时睡眠呼吸暂停低通气时间、心率、体质指数(BMI)均与单次氧减延迟时间呈线性负相关(r=-0.709、-0.769、-0.682、-0.403、-0.480,均P＜0.01 );最低血氧饱和度(LSaO2) 、平均血氧饱和度(MSaO2)与单次氧减延迟时间呈线性正相关(r=0.702、0.610,均P＜0.01);年龄与单次氧减延迟时间无明显相关性;单次氧减延迟时间、AHI、LSaO2均与Epworth问卷前7项总分(ESS7)呈线性相关(r=-0.688、0.568、 -0.576,均P＜0.01).结论:单次氧减延迟时间随OSAHS患者病情的加重而缩短,重度患者缩短更显著,反应了病情的严重性;单次氧减延迟时间的缩短可能是对OSAHS患者的适应性保护机制,减少其受到呼吸暂停的损害; AHI、LSaO2、TS90%、平均每小时呼吸暂停低通气时间与受试者的单次氧减延迟时间具有密切相关性,表明单次氧减延迟时间可以反应OSAHS的严重程度,尤其对于重度患者;单次氧减延迟时间与ESS7具有密切相关性,表明单次氧减延迟时间对评价OSAHS患者白天的嗜睡程度有一定参考价值.     

体位改变对阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构和呼吸事件的影响

目的：研究OSAHS患者体位改变对睡眠结构、呼吸事件的影响并进行相关分析。方法：对80例OSAHS患者行ESS嗜睡量表评分,并按AHI分为OSAHS轻度组（5≤AHI〈15）、中度组（15≤AHI〈30）和重度组（AHI≥30）,比较不同程度的OSAHS患者在不同体位时的睡眠结构、呼吸事件之间的差异。结果：体位发生改变时,OSAHS重度组与轻、中度组比较,REM%、NREM%、NREM LSaO2、RDI、仰卧位呼吸暂停指数（SAHI）及侧卧位呼吸暂停指数（L-AHI）差异均有统计学意义（P〈0.05）。OSAHS重度组与轻度组比较,MSaO2、LSaO2差异均有统计学意义（P〈0.05）。OSAHS中度组与轻度组比较,LSaO2、REM LSaO2及RDI差异均有统计学意义（P〈0.05）。3组的LT%均高于ST%,但其差异无统计学意义（P〉0.05）。S-AHI、L-AHI与轻、中度组ESS评分无相关性（P〉0.05）,而L-AHI与重度ESS评分极显著性相关（r=0.551,P〈0.01）,REM L-AHI和NREM L-AHI与重度ESS评分极显著性相关（r分别为0.516、0.528,均P〈0.01）。结论：L-AHI、NREM LAHI、REM L-AHI和NREM LSaO2可作为监测重度OSAHS严重程度的稳定参数,而REM LSaO2主要反映轻、中度OSAHS患者的病情严重程度。     

多平面分期手术对重度阻塞性睡眠呼吸暂停低通气综合征合并代谢综合征患者的影响

目的观察多平面分期手术对重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并代谢综合征（metabolic syndrome,MS）患者颈动脉内膜中层厚度（carotid intimamedia thickness,IMT）及代谢指标的影响。方法选择重度OSAHS合并MS患者45例,均行多平面手术治疗,并对其治疗前及治疗后12个月患者呼吸暂停低通气指数（AHI）、体重指数（BMI）、最低血氧饱和度（LSaO2）、血脂总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、空腹血糖（FBG）及空腹胰岛素（INS）检查,PSG监测及嗜睡评分（ESS）。结果治疗前两组比较除AHI差异具有统计学意义外（P〈0．05）,其余年龄、BMI、LSaO2、LDL—C、HDL—C、TC、TG、FBG、INS、ESS及IMT的比较差异均无统计学意义（P〉0．05）;所有患者治疗前、后AHI、LSaO2、TC、TG、LDL—C、HDL—C、FBG、INS、ESS及IMT的比较,除FBG差异无统计学意义外（P〉0．05）,其余差异均具有统计学意义（P〈0．05）;有效组IMT、ESS、AHI及LSaO2治疗前后比较差异具有统计学意义（P〈0．05）,无效组IMT值和LSaO2治疗前后比较差异无统计学意义（P〉0．05）,而ESS和AHI治疗前后比较有显著性差异（P〈0．05）。结论多平面手术对重度OSAHS合并有MS患者均有效,提示积极手术干预治疗OSAHS同时也可治疗MS;OSAHS可能是MS病情发展的一个重要因素;经过手术治疗可以逆转或延迟颈动脉粥样硬化的进程。     

阻塞性睡眠呼吸暂停低通气综合征与胰岛素抵抗的关系的临床研究

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与胰岛素抵抗的关系及改良悬雍垂腭咽成形术（MUPPP）和持续正压通气（CPAP）治疗OSAHS对胰岛素抵抗的影响。方法：经PSG确诊为OSAHS患者42例,32例行MUPPP手术及CPAP治疗（治疗组）,10例患者未治疗（未治疗组）,另选择33例不符合OSAHS诊断者为对照组。分别测定MUPPP及CPAP治疗前和治疗后30d空腹血糖及胰岛素,餐后2h血糖及胰岛素水平,分析AHI、最低血氧饱和度（LSaO2）与空腹血糖、胰岛素及餐后血糖、胰岛素的关系。计算胰岛素抵抗指数（IR）和胰岛素敏感指数（IAI）,对AHI、LSaO2、IR、IAI进行多因素相关分析。结果：治疗组治疗前各临床参数指标与对照组比较,治疗前、后比较及治疗后与未治疗组比较,均差异有统计学意义（P〈0．01或P〈0．05）。IR与AHI明显正相关（r=0．690）,与LSaO2明显负相关（r=0．686）,IAI与AHI明显负相关（r=0．654）,与LSaO2明显正相关（r=0．633）,均P〈0．01。结论：OSAHS与IR之间存在独立相关关系;OSAHS低氧可引起胰岛素抵抗,通过MUPPP及CPAP治疗可以提高胰岛素的敏感性,降低IR。     

阻塞性睡眠呼吸暂停低通气综合征患者血氧饱和度相关指标分析

目的分析阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者的血氧饱和度相关指标，寻求能够更好地评估OSAHS患者严重程度及相关并发症的指标。方法选取2016年1月～2018年7月在北京大学人民医院耳鼻咽喉科门诊确诊为OSAHS的患者110例，回顾性分析其多导睡眠监测（polysomography ，PSG）结果。依据睡眠呼吸暂停低通气指数（apnea and hypopnea index，AHI）值将OSAHS患者分为轻度（AHI为5~15次/h）、中度（AHI为＞15~30次/h）、重度（AHI＞30次/h）3组，对比3组间血氧饱和度相关指标。将OSAHS患者根据是否合并高血压分为两组，对比其血氧饱和度指标。结果结果显示轻、中、重3组患者间最低血氧饱和度（lowest oxygen saturation，LSaO2）、平均血氧饱和度（average oxygen saturation,ASaO2）、氧减饱和度指数（oxygen desaturation index，ODI）经比较均有统计学差异（P均＜0.05），且与AHI密切相关，其中ODI与AHI相关性最强，呈高度相关（r=0.879），LSaO2与AHI呈强相关（r=0.613），ASaO2与AHI中等相关（r=0.525）。未合并高血压组与合并高血压组间患者LSaO2经比较没有统计学差异（P=0.266），ASaO2和ODI经比较有统计学差异，P值分别为0.035和0.009。结论ODI以及ASaO2是PSG监测中良好的筛查指标，可作为LSaO2的补充，应用于OSAHS的筛查诊断和严重程度分级。同时ODI以及ASaO2能够更好地反应出氧减饱和度事件的持续时间和频率，后者与OSAHS患者并发高血压的发病机制有关。     

1761例儿童便携式睡眠监测结果数据分析

目的　探讨打鼾儿童睡眠监测各参数的相关性及差异,提高家长和社会对儿童鼾症的认识。方法　回顾性分析1761例打鼾儿童便携式睡眠监测结果,以呼吸暂停低通气指数（AHI）进行诊断分级及分组,对不同组间儿童生长发育、血氧及心率等指标进行相关性及差异的比较。结果　比较所有入组儿童：①不同组儿童体质量指数达标率在统计学上存在显著差异（F =9.2,P＜0.05）;AHI与体质量指数相关性显著（r =0.051,P＜0.05）。②AHI与最长呼吸暂停和低通气时间、氧减指数、血氧饱和度<90%百分比呈正相关（r =0.30、0.65和0.36,P 均＜0.05）,与平均动脉血氧饱和度、最低动脉血氧饱和度呈负相关（r =-0.34和-0.57,P 均＜0.05）;AHI与氧减指数相关性最大。③打鼾儿童的平均心率差异有统计学意义（r =0.193,P＜0.05）。结论　儿童睡眠呼吸障碍与生长发育、氧减指数、最低动脉血氧饱和度及平均心率均密切相关,家长和社会应高度重视本疾病。     

阻塞性睡眠呼吸暂停低通气综合征对青年患者血压的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对青年患者血压的影响。方法选取1999年1月-2011年6月在我院行睡眠监测的1469例青年患者,按2009年中华医学会耳鼻咽喉头颈外科学分会咽喉学组制定的诊断标准,将患者按呼吸暂停低通气指数（AHI）分为11个组,分别统计各组OSAHS伴发高血压病的例数,并进行列联表分析。分析各组患者年龄、体重指数（BMI）、AHI、最低血氧饱和度（LSaO：）与高血压的相关性。结果①1469例患者中,1188例确诊为OSAHS;557例（46．9％）患者伴发高血压,其中301例（54．5％）为单纯性舒张期高血压（isolateddias—tolichypertension,IDH）,233例（42．2％）是双相高血压（systolo—diastolichypertension,SDH）。②年龄、AHI、BMI与舒张期血压和收缩期血压呈正相关（r=0．156、0．289、0．299;r=0．168、0．333、0．255,P〈0．01）,LSaO：与舒张期血压和收缩期血压呈负相关（r=-0．282,-0．307,P〈0．01）并且都是高血压发生的独立相关因素。③组2与组3,组4与组5,组6与组10,其高血压病发率无明显差异（x2=1．361,x2=0．668,r=1．186,P〉0．05）。组1与组2,组2、3与组4,组4、5与组7,组11与其他各组之间高血压病发率存在明显差异（x2=2．251,x2=9．883,x2=4．136,r=4．672,P〈0．05）。结论青年OSAHS对血压,尤其是舒张期血压产生明显影响,年龄、AHI、BMI、LSaO。可能是高血压的独立相关因素。     

阻塞性睡眠呼吸暂停低通气综合征患者血清脑红蛋白测定及其与病情的相关性

目的检测阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清脑红蛋白（NGB）的含量，探讨脑缺氧程度与OSAHS患者的相关性，为临床进行脑保护提供理论依据。方法选取OSAHS患者48例及非OSAHS病例45例作为对照，均经多导睡眠监测（polysomnography，PSG）及血清脑红蛋白检测。所有入选者在睡眠监测结束后晨醒3min内采取肘静脉血，检测血清NGB。结果OSAHS组与对照组比较血清NGB浓度升高，两组比较有统计学意义（P〈0．05）。直线相关分析显示OSAHS患者血清NGB水平与最低血氧饱和度（LSaO2）呈负相关（r=-0．768），血清NGB水平与睡眠呼吸监测指标AHI呈正相关（r=0．788）。结论OSAHS患者睡眠中病情越重脑缺氧越严重。     

鼻腔扩容术的临床疗效观察

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图（PSG）描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表（Epworth sleepiness score,ESS）、鼻塞主观视觉模拟量表（visual analogue scale,VAS）评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术（鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放）。结果鼻腔扩容术后患者鼻腔总阻力显著降低[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L,P〈0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P〈0.01],白天嗜睡ESS评分显著降低（12.7±1.2 vs 8.6±2.9,P〈0.01）,打鼾程度减轻（62.2±25.6 vs 45.6±18.6,P〈0.01）。轻度OSAHS患者呼吸暂停低通气指数（apnea and hypopnea index,AHI）较术前显著下降（P〈0.05）,觉醒指数较术前显著下降（P〈0.01）,最低动脉血氧饱和度（lowest SaO2,LSaO2）较术前显著升高（P〈0.01）。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变（P〉0.05）。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化（P〉0.05）。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。     

不同年龄阻塞性睡眠呼吸暂停低通气综合征患者的睡眠监测

目的：分析不同年龄阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS) 患者的多导睡眠监测特点。方法:比较青年组72例、中年组219例、老年组28例的多导睡眠监测(polysomnography, PSG) 资料。结果:青年组呼吸暂停低通气指数(apnea hypopnea index, AHI) 平均(53.5±31.4) 次/h最高,中年组次之(44.1±25.9) 次/h,老年组最低（25.9±18.2）次/h,3组之间均存在差异有统计学意义（P＞0.05）。睡眠结构3组类似。最低血氧饱和度（SaO2）以青年组降低最为明显,中年组、老年组次之。3组之间在呼吸紊乱导致的微觉醒指数(arousal index, ArI)及一夜睡眠中总的微觉醒指数均差异有统计学意义（P＜0.05）,而腿动性微觉醒指数和自发性微觉醒指数差异无统计学意义（P＞0.05）。结论: OSAHS患者以青年组呼吸紊乱及缺氧程度最严重,中年组次之,老年组病情最轻,但睡眠结构紊乱的程度基本接近。     

Videonasopharyngoscopy is useful for identifying children with Pierre Robin sequence and severe obstructive sleep apnea

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) commonly appears in patients with Pierre Robin sequence (PR). Polysomnography (PS) is the gold standard for the diagnosis of OSAS. Videonasopharyngoscopy (VNP) is the best diagnostic tool for visualizing the vocal tract and detecting structural abnormalities which can be associated with OSAS. OBJECTIVE: The purpose of this paper is to study whether VNP can be useful for identifying severe OSAS in a population of children with PR. MATERIALS AND METHODS: Fifty-two children with PR who were present with sleep-disordered breathing were studied. All the parents completed a questionnaire concerning the children's sleeping habits and sleep complaints before consultation. Each child underwent a general pediatric examination and an evaluation of craniofacial features and upper airway permeability. In all children, a PS was performed. Also, all children underwent a VNP. RESULTS: The diagnosis of OSAS was confirmed by PS in 31 patients. VNP showed 87% sensitivity and 100% specificity for the detection of OSAS. VNP findings showed a significant correlation with apnea-hypopnea index, arousal index, snoring time, percentage of sleep time spent at saturation of oxygen <90% and a significant inverse correlation with total sleep time, sleep efficiency and the mean saturation of oxygen during sleep. CONCLUSION: This study shows that in children with PR, airway obstruction as detected by VNP seems to be a risk factor for OSAS. VNP appears to be a safe and reliable tool for the evaluation of sleep-disordered breathing in children with PR.     

阻塞性睡眠呼吸暂停低通气综合征合并高血压患者睡眠结构分析及血清内皮素-1的测定

OBJECTIVE: To explore the role of endothelin-1 (ET-1) in the pathogenesis of hypertension in obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: The levels of serum ET-1 in 30 OSAHS patients accompanied by hypertension, 30 normotensive OSAHS patients and 30 healthy controls were measured by ET-1 enzyme immunoassay kit. Meanwhile the correlation about the concentration of ET-1 in OSAHS patients with the clinic, polysomnography (PSG) parameters was analyzed. RESULTS: OSAHS patients with or without hypertension compared with snoring group and normal people, the sleep structure was significantly disturbed. The time percentages of awake and stage I sleep were increased, while stage II sleep decreased significantly in OSAHS patients than those in snoring group (P < 0.01, respectively). There were no significantly difference about the sleep structure in the two OSAHS groups. The levels of serum ET-1 (mean +/- s) were significantly higher in OSAHS patients accompanied by hypertension and normotensive OSAHS patients(42.5 +/- 8.4) ng/L and (38.6 +/- 4.7) ng/L respectively than those in the healthy controls(33.1 +/- 5.4) ng/L (P < 0.01, respectively). In the two OSAHS groups, the levels of serum ET-1 were significantly higher in OSAHS patients accompanied by hypertension than those in the normotensive OSAHS patients (P < 0.05). There were positive correlations between the concentration of ET-1 and the apnea hypopnea index (AHI) in all the 60 OSAHS patients with and without hypertension (r = 0.334, P < 0.01). There were negative correlations between the concentration of ET-1 and the lowest oxygen desaturation in all the 60 OSAHS patients with and without hypertension (r = -0.230, P < 0.05). CONCLUSION: These results indicate that the sleep disordered breathing and hypoxia may contribute to the elevation of ET-1 in the OSAHS patients and OSAHS patients accompanied by hypertension. ET-1 may play an important role in the pathogenesis of OSAHS-induced hypertension.     

Current treatment practices in obstructive sleep apnea and snoring

PURPOSE: To determine current management strategies of otolaryngologists involved in the treatment of sleep-disordered breathing. MATERIALS AND METHODS: Survey of practitioners regarding their workup and treatment of patients suspected of obstructive sleep apnea. RESULTS: Of 305 respondents, 280 actively treated patients with obstructive sleep apnea or snoring, form the basis for this study. Respondents were from assorted practice settings, from a diverse geographic background, and varied length of time in practice. Although 48% see more than 3 new outpatients a week for snoring or obstructive sleep apnea, only 46% routinely ask their patients about sleep problems, and 49 % fail to ask all of their patients with sleep apnea about sleep-related automobile accidents. Although most regularly use nasopharyngoscopy, a significant proportion seldom uses the Müller maneuver. Most tend to rely predominantly on whole-night polysomnography, rather than split night or home testing. Half of respondents offer their patients with simple snoring more than 1 method of treatment. Although many different surgical procedures are offered by most, only 28% of respondents offer patients any procedure aimed at airway obstruction at the base of tongue level. CONCLUSIONS: Otolaryngologists, with their unique expertise in airway management, need to be more vigilant for patients with sleep-disordered breathing. The hypopharynx fails to be frequently addressed by the respondents and could lead to inadequate treatment of obstructive sleep apnea. Further research should seek to develop an evidence-based standard of care such that this disorder might be most effectively managed in the future.     

Determining the site of airway obstruction in obstructive sleep apnea with airway pressure measurements during sleep

OBJECTIVE: To determine the site(s) of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) and their changes during sleep with upper airway (UA) pressure measurement; and to analyze the correspondence between the UA pressure measurement and polysomnography (PSG). METHOD: Thirty patients with OSAS underwent UA pressure measurement. The catheter with five solid-state ultraminiature sensors was inserted through the patients' upper airway to the esophagus. The sensors were located at the nasopharynx, oropharynx, tongue base, hypopharynx, and esophagus. The lower limit of UA obstruction was determined by relying on the observed pressure pattern. RESULT: 1) During inspiration, obstruction occurred associated with an increased negative inspiratory pressure inferior to the site of obstruction and a disappeared negative inspiratory pressure above the site of obstruction; 2) three patterns of obstruction were observed; 3) the site of obstruction was located at the site of the palate; 4) velopharyngeal obstruction and tongue-pharynx obstruction were all present; 5) nasopharyngeal obstruction velopharyngeal obstruction and tongue-pharynx obstruction were all present; and 6) peak inspiratory pressure differences between the normal breath and apnea were associated with the longest apnea interval (P <.05). CONCLUSION: UA pressure measurement can evaluate the site of obstruction in patients with OSAS and their changes during sleep. Peak inspiratory pressure differences between normal breath and apnea can show the severity of OSAS.     

Hospital use in the treatment of sleep apnea

OBJECTIVES: Evaluate hospital use for treatment of sleep apnea. STUDY DESIGN: Retrospective database review. MATERIALS AND METHODS: The 1998 to 2000 National Inpatient Sample (NIS) was searched for admissions with a diagnosis of sleep apnea. Records were examined for demographics, diagnoses, procedures, and complications. Data were analyzed to identify factors affecting length of stay (LOS) and charges. RESULTS: There were 5864 (0.03% NIS) admissions for sleep apnea. The sleep apnea group had lower mean age (43.1 vs. 47.2 years), higher percentages of males (71.6% vs. 41.0%) and African Americans (18.7% vs. 13.7%), and higher rates of obesity, hypertension, and anatomic airway diagnoses than the NIS population. Of sleep apnea group adults, 77.1% underwent a mean 2.3 procedures, whereas of those patients under 18 years of age, 60.8% underwent a mean of 1.2 procedures. Tracheotomy and procedures for hypopharyngeal airway compromise were used infrequently. Within the sleep apnea group, there were significant differences in LOS and charges on the basis of age, sex, race, payment method, procedures, and number of secondary diagnoses (all P <.05). Patients over 18 admitted for other diagnoses, but with secondary diagnosis of sleep apnea, had longer LOS (5.38 vs. 4.95 days) and higher charges (US dollars 16562 vs. US dollars 13928) than patients without sleep apnea. CONCLUSIONS: Hospital use for sleep apnea remains largely for surgical treatment of the disease. Procedures directed at hypopharyngeal obstruction are seldom used. Multiple factors including patient age, number of secondary diagnoses, and procedures affect LOS and charges. The presence of sleep apnea also increases charges and LOS in patients admitted for other diagnoses.     

The effects of sleep position change in sleep apnea syndrome

Changing the sleep position from supine to non-supine is a simple but effective treatment for some patients with sleep apnea syndrome. In the present study, we compared the clinical data for good responders (GRs), those who responded well to the sleep position change, with those for poor responders (PRs), and also evaluated the effect of surgical treatment on the positional improvement of ventilation in the PR group. Forty-one adult patients with sleep apnea syndrome (mean age: 47.1 years, mean obesity index: 125.8%) were divided into two groups based on their polysomnographic responses to sleep position change. Thirty-two patients were classified as the GR group, whose apnea-hypopnea index (AHI) in the non-supine position declined to less than half of their AHI in the supine position, and nine whose non-supine AHI remained greater than half of their supine AHI were classified as the PR group. The AHI and the desaturation index (DI) for the PR group were significantly higher than those for the GR group, and the obesity index was also higher in the PR group. For the eight PRs who had surgical therapy, their polysomnographic data improved much more in the non-supine position than in the supine position. Of six patients whose total AHI was still 10 or more after surgery, four changed into GRs. The combination of surgery and sleep position change seemed to be an effective treatment even for patients with a little improvement before surgery.     

阻塞性睡眠呼吸暂停低通气综合征儿童手术前后注意力缺陷和多动症状

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)儿童是否更易出现注意力缺陷和多动症状,并观察手术治疗前后睡眠呼吸紊乱及注意力缺陷和多动症状有无好转.方法 2004年6月至2007年5月经多道睡眠监测(polysomnography,PSG)确诊的OSAHS儿童80例为患儿组,其中有手术前后完整PSG监测资料的16例儿童进行睡眠结构和呼吸紊乱相关指标的分析.选择因声带小结就诊经PSG监测睡眠呼吸正常儿童30例为对照组.由神经科医生对所有儿童进行注意缺陷和多动症状分数(inattentionhyperactivity score,IHS)的评估,以IHS＞1.25判定为明显注意力缺陷和多动症状.患儿组均行腺样体切除或扁桃体+腺样体切除的手术治疗,术后6个月再次接受PSG监测及神经科医师的IHS评估,比较对照组与OSAHS患儿有关数据的差异.结果 ①患儿组术前和对照组的IHS的中位数分别为0.89和0.17,秩和检验差异有统计学意义(Z=-4.276,P＜0.05);手术前后患儿组的IHS的中位数分别为0.89和0.44,配对t检验差异有统计学意义(t=6.219,P＜0.05).②患儿组术前、术后和对照组分别有25例、9例和3例儿童的IHS>1.25,卡方检验示患儿组术前与对照组、术前与术后比较出现症状患儿的比率差异有统计学意义(x2值分别为5.192和9.56,P值均＜0.05).③患儿组中有完整资料的16例手术后呼吸紊乱指标及睡眠结构有明显改变,睡眠Ⅰ期减少,睡眠Ⅱ期、慢波睡眠及快动眼睡眠的比例显著增加(配对t检验t值分别为12.2、-5.4、-6.3和-8.1,P值均＜0.001)呼吸暂停低通气指数从13.9次/h下降到1.5次/h,最低血氧饱和度从0.855上升到0.940(t值分别为5.3和-3.7,P值均<0.01);术后和对照组相比,快速动眼睡眠的比例及最低血氧饱和度仍未达到对照组的水平.结论 较睡眠呼吸正常儿童而言,OSAHS患儿较易出现多动症状和注意缺陷的表现,手术治疗可明显改善OSAHS患儿的睡眠结构和多动、注意缺陷的症状.在诊断注意力缺陷多动障碍时,应注意有无睡眠呼吸紊乱的存在.     

Characterization of sleep disturbance in patients with tinnitus

BACKGROUND: Approximately 60 % of patients with tinnitus experience disturbances of the normal sleep pattern. METHODS: Polysomnography was performed on 26 patients with tinnitus and sleep disturbances. RESULTS: In 17 of 26 patients polysomnography revealed a pathological sleep analysis: 10 patients were diagnosed with obstructive sleep apnea syndrome, 4 with insomnia and an increased index of arousals as well as a reduction of deep sleep- and REM-phases. Pathological movements of the legs were seen in 3 cases. Six of 9 patients with a normal sleep during the whole night displayed a prolonged latency period until falling asleep. CONCLUSIONS: Many studies show that sleep disturbances are a factor that strongly predicts decreased tolerance to tinnitus. This and the findings of this study implicate, that somnographic workup is helpful in patients with tinnitus in order to integrate adequate therapy of the sleep disturbance in the concept of tinnitus therapy and to avoid adaptive difficulties to tinnitus.     

Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: polysomnographic results

INTRODUCTION: The therapy of choice in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) consists of tonsillectomy or tonsillotomy combined with adenoidectomy. While tonsillectomy unfortunately has a notable risk of secondary hemorrhage and postoperative pain, tonsillotomy is safer and less painful for children. The effect of both surgical methods on symptoms of OSAS seems to be equal, but up to now postoperative polysomnographic data for children treated by tonsillotomy are missing. MATERIALS AND METHODS: Twenty children aged 2-9 years (mean age: 4.1+/-2.0 years) with OSAS diagnosed by full-night polysomnography were included in the study. OSAS was defined as an apnea-hypopnea index (AHI) of 5 or more with minimum oxygen saturation (SaO(2) min) of less than 90%. Exclusion criteria were obesity, craniofacial abnormalities or other pulmonary, cardiac or metabolic diseases as well as a history of recurrent tonsillitis. All children were treated by CO(2) laser tonsillotomy and adenoidectomy. Three to 12 months (mean: 7.7 months) after the procedure a control-polysomnography was performed in all children. RESULTS: No statistically significant changes were seen in the pre- and postoperative distribution of sleep stages, sleep efficacy and total sleep time. The AHI decreased from 14.9+/-8.7 to 1.1+/-1.6 (p<0.001), SaO(2) min increased from 71.1+/-11.1% to 91.2+/-3.5% (p<0.001). Thus, all children were cured by the operation. DISCUSSION: These polysomnographic data show that CO(2) laser tonsillotomy in combination with adenoidectomy is highly effective in the treatment of pediatric OSAS and should be preferred over tonsillectomy because of less postoperative pain and a lower risk of postoperative bleeding.