Effect on Quality of Life of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome: A Meta-analysis

Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea syndrome (OSAS). However, the impact of CPAP on quality of life (QOL) is controversial. The aim of this study was to systematically review and determine whether CPAP improves QOL in patients with OSAS. We performed a comprehensive literature search to identify studies published between 1966 and 2007 comparing values of CPAP with control. Weighted mean difference (WMD) was used to analyze the data. The pooled WMD was calculated by using a fixed or random-effect model. The outcomes for 1,256 patients from 16 studies, of whom 656 patients underwent CPAP and 600 were controls, were included. CPAP led to significant improvements in the Nottingham health profile part 2 (WMD=1.657; 95% CI=3.005, -0.308; p=0.016), but there was no difference in other general QOL scores. Patients undergoing CPAP scored better in physical function (WMD=3.457; 95% CI=0.144, 6.771; p=0.041), body pain (WMD=4.017; 95% CI= -0.008, 8.042; p=0.05), energy vitality (WMD=6.984; 95% CI = 0.557, 13.411; p=0.033) and physical component summary (PCS) (WMD=2.040; 95% CI=0.045, 4.035; p=0.045) using the SF-36 tool. This meta-analysis shows that CPAP does not improve general QOL scores but does improve physical domains and vitality. Study design and QOL questionnaire tools are important to capture and evaluate information efficiently. However, generic QOL instruments may not be adequate in detecting important changes in quality of life in patients with OSAS.     

Changes in Depressive Symptoms after Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea

It is generally believed that obstructive sleep apnea (OSA) causes depression in some patients, yet it is unknown whether this depression is an actual clinical phenomenon or purely a result of overlapping somatic/physical symptoms shared by both disorders. The present study investigated changes in both somatic and affective/cognitive symptoms of depression associated with the introduction of continuous positive airway pressure (CPAP) treatment for OSA. Participants were 39 outpatients (35 males, 4 females) with no current or past mental health problems, diagnosed with OSA in a hospital sleep disorders clinic. The Beck Depression Inventory (BDI) was administered prior to treatment and again 3 months after CPAP. Total BDI scores improved after CPAP, independent of objectively monitored CPAP compliance rates. Both somatic and affective/ cognitive symptoms of depression improved in a similar manner after treatment. Our findings suggest that depressive symptoms experienced by OSA patients are not solely the result of physical OSA symptoms but include a mood component as well. We introduce a hypothetical model to conceptualize the relationship between OSA and depression.     

Continuous Positive Airway Pressure and Obstructive Sleep Apnea in an Hispanic Population

Objectives: We sought to explore the relationship between the diagnosis of hypertension and obstructive sleep apnea (OSA) in a Hispanic population, describe the effect of continuous positive airway pressure (CPAP) on blood pressure regulation, and assess the effect of CPAP on quality of life. Design: A retrospective, recall interview study. Participants: Patients enrolled at the Home Oxygen Program of the San Juan V.A. Medical Center with the diagnosis of OSA and treatment with CPAP. Measurements: The Calgary Sleep Apnea Quality of Life Index was administered to all patients after informed consent. Information regarding co-morbid conditions and fluctuations in blood pressure and anthropometric variables were obtained on a follow-up evaluation. Results: After excluding for the use of antihypertensive medications, weight, and age, a 10% decrease in mean arterial pressure (MAP) from 100 mm Hg to 92 mm Hg was observed in an average of 40 months of therapy (p < 0.05). With the Calgary Quality of Life Index, 67% of the patients reported an extreme improvement in their quality of life. Compliance with CPAP therapy correlated with improved quality of life (r = 0.33, p < 0.015). Conclusions: In this pilot study, there appears to be a correlation between our intervention and decline of blood pressure, independent of body weight, age, or medication usage. CPAP treatment is an effective modality in improving symptoms and quality of life.     

Gunshot Wound to the Head: An Unusual Complication of Sleep Apnea and Bilevel Positive Airway Pressure

Obstructive sleep apnea syndrome (OSAS) has been associated with motor vehicle accidents and work-related injuries. Proposed mechanisms for this association have included excessive sleepiness, decreased vigilance, inattentiveness, and psychological impairment, all related to the abnormal sleep and nocturnal hypoxia seen in OSAS. This report describes a case of an accidental gunshot wound to the head in an individual with known OSAS who was experiencing progressive cognitive and psychological deterioration due to suboptimal treatment of his sleep-disordered breathing. The literature on the neuropsychological consequences of OSAS is briefly reviewed.     

气道正压通气治疗高血压伴阻塞性睡眠呼吸暂停低通气综合征

目的经鼻持续气道正压通气(nCPAP)治疗高血压合并阻塞性睡眠呼吸暂停低通气综合征(OS-AHS)患者,以评价该疗法对血压和睡眠呼吸监测参数的影响。方法临床确诊合并OSAHS的高血压患者,随机分为治疗组和对照组,治疗组在给予常规药物(抗高血压药、抗动脉硬化药物)治疗的同时进行nCPAP治疗,对照组仅给予常规药物治疗。30天后,观察两组治疗前后血压、睡眠呼吸监测参数变化。结果高血压合并OSAHS患者共60例,治疗组和对照组各30例;治疗后治疗组的收缩压(SBP)、舒张压(DBP)、脉压(PP)、心率(HR)、睡眠呼吸暂停低通气指数(AHI)、最长呼吸暂停时间和最低脉搏容积血氧饱和度(SpO2min),与对照组比较差异有统计学意义(P<0.05);部分患者降压药物减量或停用,仅用nCPAP治疗就能维持正常血压。结论nCPAP是非药物治疗合并OSAHS高血压患者的一种安全有效方法。     

持续正压通气对阻塞性睡眠呼吸暂停低通气患者血压影响差异分析

背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是高血压的独立危险因子,持续正压通气是其有效治疗方式。然而,持续正压通气(CPAP)对血压影响的结论并不统一。目的分析 CPAP 对 OSAHS 患者血压的影响。方法对2000-01—2008-01间 CPAP 对血压影响的论文进行检索,筛选经有效 CPAP 治疗不少于两周且治疗前后血压数据完整的随机试验,并对相关数据进行分析。结果经筛选,纳入相关文献16篇、共1309人。CPAP治疗组治疗前后收缩压降低5.4 mmHg(95%CI:2.9～7.8),舒张压降低3.9 mmHg(95%CI:1.9～5.9);持续正压通气后收缩压降低组与未降低组初始收缩压存在显著差异(144.5 mmHg vs 140.0 mmHg,P<0.05)。结论对于合并 OSAHS 的高血压患者,有效的 CPAP 治疗有利于控制血压,且初始血压高的 OSAHS 患者经有效 CPAP 后血压降低明显。但是,对血压的效益大小应根据初始血压情况、呼吸紊乱程度、嗜睡程度(ESS)进行综合评定。     

高血压合并阻塞性睡眠呼吸暂停综合征患者治疗前后的血压昼夜节律变化

目的探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化。方法入选高血压患者105例,根据多导睡眠仪监测结果分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组36例和高血压合并中、重度 OSAS 组22例。CPAP 或手术治疗前后行24 h 动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系。结果治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%。与单纯高血压组比较,差异有统计学意义(P<0.05)。治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%,38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05)。中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显。结论高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与 OSAS 严重性相关,CPAP 或手术治疗后非杓型明显减少。     

阻塞性睡眠呼吸暂停低通气综合征与高血压关系的研究进展

睡眠呼吸暂停综合征是一种睡眠时呼吸停止的睡眠障碍.最常见的原因是上呼吸道阻塞,经常以大声打鼾、身体抽动或手臂甩动结束,主要以睡眠中反复发作的呼吸暂停或低通气导致的低氧血症及高碳酸血症为特点.主要分为中枢型、阻塞型及混合型,其中以阻塞性睡眠呼吸暂停综合征(OSAS)最为常见,是多种全身性疾病的危险因素,肥胖、年纪大、肌肉松弛的人群高发.多导睡眠图(PSG)是诊断此病的金标准,量化指标是呼吸暂停低通气指数(AHI)及夜间最低血氧饱和度.研究表明,OSAS常与高血压、冠心病、脑卒中等疾病并存[1],这一现象受到越来越多的心脑血管专家的关注.值得指出的是,流行病学及临床研究证实OSAS与高血压之间存在密切因果关系[2-4].本文主要就阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压的关系进行综述.     

Supine-Dependent Changes in Upper Airway Size in Awake Obstructive Sleep Apnea Patients

The purpose of this study was to define the changes in upper airway size in response to a body position change from upright to supine. A total of 15 male Caucasian obstructive sleep apnea (OSA) patients with a mean apnea hypopnea index of 31.0 ± 13.9/hr were recruited for this study. A set of upright and supine cephalograms was traced and digitized for each patient. The most constricted site in the upright position was located in the velopharynx. When the body position was changed from upright to supine, a significant reduction in the anteroposterior dimension was observed only at the level of the velopharynx (p < 0.05). Sagittal cross-sectional areas of the velopharynx and the oropharynx significantly decreased (p < 0.05), but the soft palate area increased (p < 0.05). We conclude that the velopharynx is not only the narrowest site in both upright and supine body positions but also the most changeable site in response to an alteration in body position during wakefulness. Backward displacement of the soft palate with a change in shape may reflect less functional compensation in the velopharynx than that in the oropharynx and the hypopharynx and partly explain why upper airway occlusion occurs primarily in the velopharynx in OSA patients.     

Effect of Continuous Positive Airway Pressure Therapy on Aortic Stiffness in Patients with Obstructive Sleep Apnea Syndrome

Objective: The most significant complications seen in patients with obstructive sleep apnea syndrome (OSAS) are associated with the cardiovascular system. The present study assessed aortic stiffness in patients with OSAS and evaluated the effect of continuous positive airway pressure (CPAP) therapy on aortic stiffness. Method: Twenty‐four patients with newly diagnosed, previously untreated, moderate or severe OSAS (apnea‐hypopnea index > 15) and a control group of 17 healthy patients were included in the study. M‐mode recordings of the ascending aorta were taken from the parasternal long axis by echocardiograhy, and systolic and diastolic diameters of the aorta were measured. Aortic elastic parameters, aortic strain, and distensibility were calculated. Measurements were repeated after 6 months of CPAP therapy in patients with OSAS and were compared with baseline values. Results: In patients with OSAS, compared with the control group, aortic strain (6.7%± 2.1% vs. 12.4%± 3.1%; P < 0.001) and aortic distensibility (2.8 ± 0.9 × 10^?6 cm² dyn^?1 vs. 5.5 ± 1.7 × 10^?6 cm² dyn^?1; P < 0.001) were evidently lower, and there was a significant correlation between aortic elastic parameters and AHI. After a 6‐month course of CPAP therapy, significant increases were observed in aortic strain (6.1%± 1.5% vs. 7.3%± 1.7%; P < 0.001) and aortic distensibility (2.5 ± 0.7 × 10^?6 cm² dyn^?1 vs. 3.1 ± 0.9 × 10^?6 cm² dyn^?1; P < 0.001) in patients with OSAS. Conclusion: Aortic strain and distensibility were lower in patients with OSAS than in control patients, and CPAP treatment provided improvement in aortic elastic parameters. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

男性高血压病患者长期饮酒与阻塞性睡眠呼吸暂停综合征

目的 探讨男性高血压病患者长期饮酒与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相关关系.方法 以男性高血压患者304例为研究对象,经标准多导睡眠呼吸监测后分为OSAHS组220例和非OSAHS对照组84例.采用回顾性问卷调查所有研究对象的饮酒史,包括饮酒种类、平均饮酒频率、平均每次饮酒量、饮酒年限等,计算平均每月饮酒量及累积饮酒量,分析长期酒精摄入与OSAHS的相关关系.结果 1)OSAHS组和非OSAHS对照组的平均每次饮酒量(白酒)、平均每月饮酒量及累积饮酒量的差异无统计学意义(P＞0.05).2)以平均每月饮酒量≥50 g定义为饮酒者,将研究对象分为饮酒组244例和非饮酒组60例,饮酒组和非饮酒组的睡眠呼吸监测参数及OSAHS患病状况的差异无统计学意义(P＞0.05).3)将所有研究对象按睡眠呼吸暂停低通气指数(AHI)水平分层,在AHI＜20次/h的样本中,均衡了年龄、体质量指数及血压等危险因素后,与非饮酒组比较,饮酒组的AHI增大、平均及最长呼吸暂停时间延长,差异有统计学意义(P＜0.05).4)进一步以累积饮酒量的中位数(108 kg)将饮酒组划分为少量饮酒组和大量饮酒组,与非饮酒组进行睡眠呼吸监测参数的比较;在AHI＜20次/h的样本中,大量饮酒组(累积饮酒量＞108 kg)的最低血氧饱和度(SaO2)、平均、最长呼吸暂停持续时间比非饮酒组明显加重,差异有统计学意义(P＜0.05);但在AHI≥20次/h的样本中比较未见上述结果.结论 在AHI＜20次/h的男性高血压患者中,长期大量饮酒与阻塞性睡眠呼吸暂停的频率、时程及缺氧程度有关.     

阻塞性睡眠呼吸暂停综合征和高血压靶器官损害的相关性

目的 探讨阻塞性睡眠呼吸暂停综合征与高血压靶器官损害的相关性. 方法 观察40例阻塞性睡眠呼吸暂停综合征合并高血压患者（观察组）心脏结构指标、血管结构指标、肾功能指标、心律失常及脑血管意外的发生率,并与30例非睡眠呼吸暂停综合征的高血压患者（对照组）对比. 结果 观察组心脏结构和血管结构的改变,心律失常和脑血管意外的发生率显著增高（P〈0.05或0.01）. 结论 阻塞性睡眠呼吸暂停综合征是引发高血压靶器官损害的重要原因之一.     

Difficult‐to‐Control Asthma and Obstructive Sleep Apnea

This study tested the hypothesis that asthma can promote obstructive sleep apnea (OSA) by looking at the prevalence of OSA among patients with difficult‐to‐control asthma receiving long‐term oral corticosteroid (CS) therapy and examined some possible etiological factors. The study design was a prospective cohort study and was conducted in the pulmonary outpatient clinic of a tertiary care center in Haifa, Israel. Twenty‐two consecutive patients with severe unstable asthma, 14 on continuous and 8 on bursts of oral CS, in addition to their standard therapy for a mean of 8.9 ± 3.3 years, underwent a night polysomnography in a sleep laboratory regardless of sleep complaints. A standard questionnaire was completed upon attending the sleep laboratory. The OSA was defined as respiratory disturbance index (RDI) of ≥ 5 and typical complaints. The correlation between RDI to asthma and morphometric parameters was tested. All but one patient had OSA [95.5% prevalence], with mean RDI of 17.7 ± 2.5. The RDI values were significantly higher in the continuous CS therapy subgroup (21.4 ± 3.4 vs. 11.1 ± 1.6, p < 0.05]. The study group had above normal neck circumferences and body mass index. The former increased by 12.1% ± 3.1% to 29.8% ± 1% during the oral CS therapy interval but had no significant effect on RDI as a covariant. This study showed an unexpectedly high prevalence of OSA among patients with unstable asthma receiving long‐term chronic or frequent burst of oral CS therapy. It may be assumed that prolonged and especially continuous oral CS therapy in asthma increases airway collapsibility.     

阻塞性睡眠呼吸暂停低通气综合征患者自动正压通气治疗压力值的影响因素分析

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者自动正压通气(Auto-PAP)治疗压力值的相关影响因素,归纳压力预测值的回归函数.方法:选取于我院通过多导睡眠监测(PSG)符合OSAHS诊断并行自动压力滴定治疗的患者101例,回归性分析患者Auto-PAP滴定的90％治疗压力值(P90)与年龄、体重指数、颈...     

儿童阻塞性睡眠呼吸暂停综合征与高血压的关系

目的探讨儿童阻塞性睡眠呼吸暂停综合征(OSAS)患者中高血压的患病情况。方法选取90例有睡眠打鼾的儿童,实施多导睡眠监测并同步进行24 h 动态血压监测。按呼吸暂停低通气指数(AHI)分为(OSAS 组(AHI≥5次/h)和对照组(AHI<5次/h),比较两组的临床血压指数值、高血压的发病率和非杓型血压的情况。结果 1)OSAS 组的体质量指数(BMI)、氧减指数(ODI)和睡眠期间血氧饱和度<92%的时间(TST92%)均比对照组高(P<0.05);2)OSAS 组夜间睡眠时的收缩压(SBP)和舒张压(DBP)指数,以及白昼的收缩压指数较对照组高(P<0.05);3)OSAS 组的高血压发病率及非杓型血压情况比对照组多(P<0.01)。结论儿童 OSAS 与高血压密切相关,且是高血压发病的危险因素,血压多呈非杓型改变。