阻塞性睡眠呼吸暂停低通气综合征与相关因子的研究进展

阻塞性睡眠呼吸暂停低通气综合征(0SAHS)是常见睡眠呼吸性疾病,发病率为3.5％ ～4.8％,其对机体的主要病理生理损害是间歇性睡眠低氧和睡眠结构改变,诱发体内多种活性因子,导致多系统的并发症,严重者可以导致睡眠猝死.作者综述其与相关因子的关系,揭示其风险.     

阻塞性睡眠呼吸暂停综合征免疫网络及其与临床的相关性

目的探讨红细胞表面补体受体Ⅰ型(CR1)活性、红细胞表面CD58表达和血清中可溶性白细胞介素-2受体(SIL-2R)、白细胞介素-6(IL-6)水平在阻塞性睡眠呼吸暂停综合征(OSAS)中的作用、变化规律及其与疾病严重程度的关系。方法采用肿瘤红细胞花环法、流式细胞分析法及酶联免疫吸附法检测20例中、重度OSAS患者(研究组)及15例正常人(对照组)的红细胞CR1活性、CD58表达和血清中SIL-2R、IL-6水平。结果(1)研究组患者肿瘤红细胞花环率(ECR1CaRR)较正常对照组降低(P<0.05);CD58表达明显高于对照组(P<0.01)。(2)研究组患者SIL-2R及IL-6水平均明显高于对照组(P均<0.01)。(3)OSAS患者SIL-2R、IL-6与呼吸紊乱指数(AHI)无相关性(P均>0.05),与动脉血氧饱和度低于90%的时间占总睡眠时间百分比(SIT90%)均呈正相关(P均<0.01)。ECR1CaRR、CD58表达与SIT90%无相关性(P均>0.05)。结论血清中SIL-2R、IL-6水平变化与OSAS患者病情密切相关,可作为临床分度及评价疗效的指标;红细胞免疫功能与细胞因子间存在相互调节作用。     

持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者夜尿增多的疗效分析

目的探讨持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者夜尿增多的疗效。方法选自某院2007年3月~2010年12月收入的行多导睡眠图证实存在OSAHS的患者21例作为观察组,另选20例由PSG诊断排除为OSAHS且无夜间多尿者作为对照组。观察组患者给予CPAP治疗,对比两组患者治疗前年龄、AHI、尿钠排泄量、尿量、夜尿次数、尿渗透压及ANP,并对比观察组治疗前后AHI、尿钠排泄量、尿量、夜尿次数、尿渗透压及ANP等指标,结果行统计学分析。结果对照组与观察组各项指标对比显示,观察组患者AHI、尿钠排泄量、尿量、夜尿次数、尿渗透压与对照组对比差异有统计学意义,P﹤0.05。对照组与观察组治疗前血浆ANP对比中显示,观察组清晨6时的ANP为(896±104)ng/L,对照组为(548±57)ng/L,两组差异对比有统计学意义,P﹤0.05。观察组CPAP治疗前后各项指标对比中,观察组患者治疗后的AHI、尿钠排泄量、尿量、夜尿次数及尿渗透压较治疗前显著改善,治疗前后对比差异有统计学意义,P﹤0.05。观察组治疗后ANP显著低于治疗前水平,治疗前后对比差异有统计学意义,P﹤0.05。结论 OSAHS是患者夜尿增多的原因之一,其主要的原因可能在于ANP分泌增加,此类患者采用CPAP不但可以缓解OSAHS症状,也能够减少夜尿多尿的症状。     

阻塞性睡眠呼吸暂停综合征免疫网络及其与临床的相关性

目的探讨红细胞表面补体受体Ⅰ型（CR1）活性、红细胞表面CD58表达和血清中可溶性白细胞介素-2受体（SIL-2R）、白细胞介素-6（IL-6）水平在阻塞性睡眠呼吸暂停综合征（OSAS）中的作用、变化规律及其与疾病严重程度的关系。方法采用肿瘤红细胞花环法、流式细胞分析法及酶联免疫吸附法检测20例中、重度OSAS患者（研究组）及15例正常人（对照组）的红细胞CR1活性、CD58表达和血清中SIL-2R、IL-6水平。结果（1）研究组患者肿瘤红细胞花环率（ECR1CaRR）较正常对照组降低（P〈0．05）；CD5。表达明显高于对照组（P〈0．01）。（2）研究组患者SIL-2R及IL-6水平均明显高于对照组（P均〈0．01）。（3）OSAS患者SIL-2R、IL-6与呼吸紊乱指数（AHI）无相关性（P均〉0．05），与动脉血氧饱和度低于90％的时间占总睡眠时间百分比（SIT90％）均呈正相关（P均〈0．01）。ECR1CaRR、CD58表达与SIT90％无相关性（P均〉0．05）。结论血清中SIL-2R、IL-6水平变化与OSAS患者病情密切相关，可作为临床分度及评价疗效的指标；红细胞免疫功能与细胞因子间存在相互调节作用。     

健康教育在治疗阻塞性睡眠呼吸暂停低通气综合征中的临床价值

目的探讨健康教育在治疗阻塞性睡眠呼吸暂停低通气综合征中的临床价值。方法 142例阻塞性睡眠呼吸暂停低通气综合征患者随机分成观察组和对照组各71例。观察组患者在常规治疗及护理的基础上实施健康教育,对照组只进行常规治疗与护理。结果观察组治愈率为85.77%,对照组治愈率为64.79%,两组疗效比较差异有统计学意义(P﹤O.05);观察组并发症发生率11.27%,对照组并发症发生率37.33%,两组并发症发生情况比较差异有统计学意义(P﹤O.05)。结论健康教育可以提高阻塞性睡眠呼吸暂停低通气综合征患者生存质量、提高治愈率、减少并发症的发生,可实现防治阻塞性睡眠呼吸暂停低通气综合征的最佳目标和价值。     

Early recognition of obstructive sleep apnea in patients hospitalized with COPD exacerbation is associated with reduced readmission

Objectives: The combination of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease is known as the “overlap syndrome”, and results in frequent hospitalizations and worse prognosis. We hypothesized that early detection and treatment of this condition in hospitalized patients may reduce clinical events (hospital admissions and emergency room visits) Methods: Between April 2013 and January 2014 all patients consulted for COPD exacerbation and having a BMI of > 30 kg/m² were screened for OSA. If high risk, patients underwent a polysomnography on discharge. Readmission rate in patients compliant with positive airway pressure was compared to patients who were deemed non-compliant based on objective data from the device. Results: Full polysomnogram data and compliance was available on 24 patients. The baseline characteristics were comparable between the compliant and non-compliant groups. The mean change in the total clinical events 6 months prior to intervention compared to 6 months following intervention was ?2.1 ± 0.3 in the compliant group, compared to ?0.8 ± 0.5 in the non-compliant group (p = 0.01). The mean change in the total clinical events 12 months prior to intervention compared to 12 months following intervention was ?2.7 ± 0.5 in the compliant group, compared to ?0.8 ± 0.6 in the non-compliant group (p = 0.03) Conclusion: In conclusion, our data suggest that early recognition and treatment of OSA in patients admitted with COPD exacerbation and compliant with PAP therapy is associated with reduced 6-month hospital readmission rates and emergency room visits. Screening for OSA in patients admitted with COPD exacerbation is a simple and early intervention that should be encouraged to help reduce hospital readmissions in this patient population.     

阻塞性睡眠呼吸暂停综合征与高血压的关系初探

目的　认识打鼾患者睡眠时血压的改变 ,初步探讨阻塞性睡眠呼吸暂停综合征 (OSAS)与高血压之间的关系。方法　对 2 6 6例打鼾者进行Autoset诊疗系统监测及睡前、醒后肘部血压测定 ,16 6例诊断为OSAS患者作为OSAS组 ,10 0例未达到诊断标准者作为对照组 ,对两组进行上述各项指标的统计学处理 ,同时对OSAS伴高血压患者治疗 6个月左右 ,重复上述测定。结果　OSAS组睡前血压 (12 8 94± 19 32 /87 46± 12 30 )mmHg至次晨醒后血压 (139 6 6± 19 38/99 6 8± 16 2 8)mmHg明显升高 (P <0 0 1) ,与对照组睡前血压 (116 12± 11 17/78 2 2±10 18)mmHg及醒后血压 (116 76± 15 42 /78 6 6± 10 94)mmHg比较呈显著性升高 (P <0 0 1) ,OSAS组最低SaO2 (6 2 38± 18 2 4) % ,较对照组最低SaO2 (89 46± 7 6 6 ) %显著降低 (P <0 0 1) ,OSAS组有 88例 (5 3% )确诊为高血压病 ,经鼻面罩持续正压通气 (nCPAP)治疗 6个月有 5 2例患者血压明显下降 ,其中 2 7例患者血压恢复正常。结论　OSAS患者的低氧血症可能是相当部分OSAS伴发高血压的发病原因 ,nCPAP治疗有助于此类患者血压的恢复 ,本文对OSAS引起血压升高的机制作了初步探讨。     

阻塞性睡眠呼吸暂停综合征与无高血压患者睡眠血压的关系

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)的严重程度和无高血压患者的昼夜血压变化之间的关系。方法连续对60个无高血压[收缩压(SBP)<140mm Hg和/或舒张压(DBP)<90mm Hg)]的门诊患者进行通宵的多导睡眠监测(PSG)和动态血压监测(ABPM)。根据从PSG结果计算的睡眠呼吸暂停低通气指数(AHI)将患者分为四组:非OSAS组,轻度组,中度组,重度组。结果昼夜收缩压和舒张压显示在OSAS的严重程度上没有差异;然而,睡眠SBP,最低SBP,醒前SBP在重度OSAS组显著高于非OSAS组(分别P=0.02,P=0.04,P=0.006)。重度OSAS的睡眠BPD、最低BPD、醒前BPD的显著高于非OSAS(P=0.01,P=0.02,P=0.0003)。结论轻中度OSAS患者夜间血压水平和非OSAS患者无显著差别,血压昼夜显示的OSAS的严重性没有区别。然而,严重的OSAS组显示有显著的睡眠血压变化。     

OSAHS与高血压关系观察

目的测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者醒时血压,探讨其高血压的发病状况与病情轻重的关系。方法随机抽取30例正常人、111例OSAHS患者进行整晚多导睡眠图检查,次晨醒后马上测定血压。结果OSAHS患者的收缩压和舒张压明显高于正常对照组,重度OSAHS患者的收缩压和舒张压高于轻度和中度者,OSAHS合并高血压者醒时血压明显高于睡前。111例OSAHS患者的高血压患病率为51%,其中轻度26.0%,中度37.0%,重度61.0%,多元线性回归示平均血压与年龄呈正相关(r=0.41,P<0.05),与SaO2min呈负相关(r=-0.41,P<0.05),CPAP呼吸机治疗一个月后患者血压降低明显。结论重度OSAHS患者和OSAHS合并高血压者存在着不同的病理生理改变,OSAHS患者高血压发病率与低血氧相关,血压增高的程度和发病率会随着病情加重而逐渐增高,CPAP呼吸机治疗一个月后可明显降低血压。     

经鼻罩持续正压通气治疗OSAHS的临床研究

目的　探讨经鼻罩持续正压通气 (nCPAP)在治疗阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)的价值。方法　根据nCPAP治疗结果把 76例中重度OSAHS患者分为 5 0例治疗成功组和 2 6例对照组 ,分析两组治疗前及治疗时各项监测指标。结果　发现治疗成功组治疗时患者最长和平均呼吸暂停时间、最低末梢脉搏氧饱和度 (SpO2 % )、呼吸紊乱指数 (AHI)及症状较治疗前及对照组均有明显改善 (P <0 0 1)。结论　nCPAP可作为内科治疗中重度OSAHS患者的一种有效、安全、首选的方法。     

阻塞性睡眠呼吸暂停患者心脑血管血栓性疾病高危因素的分析

目的探究分析对于阻塞性睡眠呼吸患者心脑血管血栓性疾病出现的高危因素,以为以后对此类患者进行治疗时有更加明确的根据。方法选自我院2011年-2013年收治的阻塞性睡眠呼吸暂停患者（OSAS）共有20例,以及在我院进行体检结果显示健康的正常成人共20例,分别为观察组与对照组。对2组患者在每天清晨6点以及下午4点的时候进行红细胞压积（Hct）、血液粘滞度（WBV）、凝血酶原时间（PT）、内皮索、血浆纤维蛋白原（Fng）、部分凝血酶原时间（APTT）以及血小板聚集（PAG）等各个方面进行检测。结果阻塞性睡眠呼吸暂停患者清晨6点相对比于下午4点在Hct、血浆Fng、WBV以及PAG等方面均明显升高,两者的对比具有统计学意义（P〉0．05）;而PT还有APTT两个方面距显著缩短,两者具有显著差异（P〈0．05）。而对照组等正常人在清晨6点相对比于下午4点的时候,各项指标相比差异无统计学意义（P〉0．05）。结论OSAS患者存在有导致心脑血管血栓性疾病的高危因素,且患者存在的高危因素在清晨的时候最为明显。     

成人打鼾人群患阻塞性睡眠呼吸暂停低通气综合征的筛查模型建立

目的 探究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的危险因素,建立一种简单、有效的成人OSAHS的筛查模型。方法 根据纳入标准和排除标准连续性纳入2016年6月 - 2018年6月因打鼾、憋气症状到四川大学华西第四医院睡眠呼吸疾病诊治中心就诊的患者696例,其中OSAHS组636例,非OSAHS组60例。分析比较组间差异,分析OSAHS的危险因素,进行多因素logistic回归分析,建立筛查模型,根据ROC曲线选取最佳截断点,并通过外部验证对回归模型进行评价。结果 成人OSAHS的筛查模型建立为:P = ex/(1 + ex),x = - 10.473 + 0.182×ESS评分 + 0.150×颈围 + 0.052×腹围 + 1.259×晨起咽干 + 1.593×夜尿频繁,(其中对于症状,0 = 无,1 = 有)。ROC曲线下面积为0.889(P＜0.05),以x = 0.913作为OSAHS的诊断点,其灵敏度为77.5%,特异度为88.1%。外部验证的灵敏度为85.9%,特异度为80.0%。结论 根据就诊患者的临床症状、ESS量表和人体测量学指标,能快速、有效地筛查OSAHS患者,实现早期诊治,该模型具有较强的临床应用价值。     

阻塞性呼吸睡眠暂停综合征在儿科的研究进展

儿童阻塞性呼吸睡眠暂停综合征与成人相比,有许多共同特征,但又有其显著的特点.该文从儿童阻塞性呼吸睡眠暂停综合征的病因、病理生理、流行病学、临床表现、诊断以及治疗上,对该病目前研究的进展进行阐述.治疗主要以减轻或缓解打鼾、低氧血症、呼吸暂停及睡眠紊乱为主,多采用扁桃体或腺样体切除术、持续正压通气、消除过敏原、减肥、氧疗等措施.     

BMI与腰围对阻塞性睡眠呼吸暂停与2型糖尿病的中介效应

目的  探究BMI和腰围(waist circumference, WC)对阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与2型糖尿病、糖代谢连续测量指标之间的中介效应。方法  纳入分析的1 615名研究对象来自动脉粥样硬化多民族研究(Multi-Ethnic Study of Atherosclerosis, MESA)。OSA评价指标为呼吸暂停低通气指数(apnea-hypopnea index,AHI),由多导睡眠图测定。糖代谢连续测量指标包括FPG和糖化血红蛋白(glycated hemoglobin,HbA1c)。肥胖指标包括全身肥胖指标BMI和腹型肥胖指标WC。结果  OSA与2型糖尿病显著相关,后者的患病风险随OSA严重程度增加而升高(P < 0.001)。BMI和WC均介导重度OSA与2型糖尿病之间的关联,其中腹型肥胖指标WC的中介效应为1.296(95% CI: 1.182~1.466),中介效应比例为56.397%;BMI的中介效应为1.291(95% CI: 1.173~1.479),中介效应比例为55.400%。BMI和WC同样介导重度OSA与FPG、HbA1c之间的关联。结论  OSA与2型糖尿病、FPG和HbA1c的关系,与肥胖程度增加有关。提示OSA患者通过早期的体重干预,特别是控制腹型肥胖对降低糖尿病和心血管并发症的患病率具有重要意义。     

Idiopathic Autoimmune Thrombocytopenic Purpura

Evidence that the serum antiplatelet factor identified with this disorder is an antibody has been strengthened by a new test that gives positive results in most patients with ITP and SLE; the factor meets the criteria for definition of antibody and apparently belongs to the IgG class. These findings shed light on existing therapeutic approaches and may soon open the way to new ones.     

阻塞性睡眠呼吸暂停患者夜间血压变化及影响因素研究

目的 观察阻塞性睡眠呼吸暂停（OSA）患者整夜血压波动特点,探讨引起血压波动的相关因素以及OSA对血压变化的影响。方法 选取2021年5月—2022年5月期间于四川大学华西第四医院睡眠中心行多导睡眠监测（PSG）的645例患者,分为正常组、轻度组、中度组和重度组。对四组进行PSG的同时,采用脉搏波传导时间法（PTT）对OSA患者夜间血压进行无创血压监测,分析四组的一般特征、PSG参数及血压指标,并进一步分析引起血压波动的影响因素及血压与OSA间的关联。结果 随OSA病情加重,SBP、DBP和夜间血压波动指数（NBPF）均呈上升趋势。经多元线性回归分析,SBP与最低血氧饱和度（LSpO2）呈负相关（P＜0.05）;DBP与氧减指数（ODI）呈正相关（P＜0.05）;NBPF与ODI、微觉醒指数（MAI）呈正相关（P＜0.05）,与LSpO2和平均血氧饱和度（MSpO2）呈负相关（P＜0.05）。对OSA发生的影响因素采用二元logistic回归分析,NBPF是引起OSA发生的危险因素（P = 0.034, OR = 1.042, 95%CI:1.003～1.083）。 结论 随OSA严重程度增加,夜间血压值升高,ODI、MAI、LSpO2和MSpO2是引起夜间血压变化的重要因素,为OSA患者高血压预防和诊治提供理论依据。     

Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study

BackgroundEffects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA).MethodsHypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age.Results2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m²), 1164 overweight (25–29.9 kg/m²) and 670 obesity (≥30 kg/m²). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01–2.32, P = 0.047) and obesity groups (1.85, 1.19–2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04–2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030).ConclusionsBMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.     

围绝经期及绝经后妇女睡眠呼吸暂停低通气综合征与冠心病/心功能关系的研究

目的:探讨围绝经期及绝经后妇女阻塞性睡眠呼吸暂停低通气综合征(OSAS)与冠心病(CHD)及心功能的关系。方法:选取因发作性胸痛胸闷症状拟诊CHD入院的妇女39例,根据月经状况,分为围绝经期组16例,绝经后组23例。所有病例均经Embletta×30型便携式睡眠呼吸监测仪(扩展了心电监测功能)监测7h以上,均确诊为OSAS(2002杭州标准),并选择性冠状动脉造影(SCAG)确定CHD的诊断,检测血清雌二醇(E2)水平,及使用左.M右心导管法测定血流动力学参数,对比统计分析两组间E2、CHD危险因素、SCAG结果及血液动力学参数等改变。结果:①绝经后组的平均年龄、睡眠呼吸暂停低通气指数(AHI)及血胆固醇水平显著高于围绝经期组(P<0.01),E2显著低于后者(P<0.01);②绝经后组的SCAG阳性率(65.2%)显著高于围绝经期组(6.25%,P<0.01),而心律失常(房性及室性早搏)发生率在两组间无统计学差异(P=0.052)。③绝经后组的左.M右心室功能指标:左室射血分数(LVEF)显著低于围绝经期组(P<0.01),左室舒张末压(LVEDP)、右室舒张末压(RVEDP)及平均肺动脉压(mPAP)则显著高于后者(P<0.05)。结论:在女性OSAS患者中,年龄较大的绝经后妇女较年龄较轻的围绝经期妇女,呼吸紊乱程度更重,更易发生冠心病、左.M右心室收缩与舒张功能受损及肺动脉高压,其机制可能与绝经后妇女血清雌激素水平进一步降低有关。     

Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

Obstructive sleep apnea syndrome(OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease(CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein(CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.