脉搏波传导速度评价阻塞性睡眠呼吸暂停低通气综合征患者动脉僵硬度的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种由上呼吸道塌陷引起睡眠过程中反复呼吸暂停和低通气的睡眠障碍性疾病.OSAHS患者动脉僵硬度增加是动脉粥样硬化疾病的高危因素.脉搏波传导速度(PWV)是检测动脉僵硬度的可靠方法,可为早期筛查动脉粥样硬化疾病提供科学依据.本文对OSAHS与动脉僵硬的关系、PWV检测方法以及...     

The overlap syndrome: chronic obstructive pulmonary disease and obstructive sleep apnea

The overlap syndrome defines the relationship between obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), and is a commonly noted but poorly studied disorder. Individuals who have the overlap syndrome have been recognized to have greater risk for pulmonary hypertension, right heart failure, and hypercapnia than patients who have either disorder alone. In patients who have advanced-stage COPD, concomitant OSA likely has significant adverse consequences. The interaction between these two diseases is unclear, however. Further clinical trials of the overlap syndrome are urgently needed.     

Uvulopalatoplasty and obstructive sleep apnea

We present results of uvulopalatoplasty (UPP) in 22 patients with obstructive sleep apnea who had preoperative and postoperative polysomnograms. Symptomatic improvement in daytime somnolence, snoring, and quality of sleep was reported by 20 patients. After operation, ten of 22 patients had more than a 50% improvement in the apnea index and apnea/sleep percentage, and the number of apneas, apnea index, apnea/sleep percentage, apneic duration, lowest oxygen saturation and longest apneas were significantly better (P less than .05). In the remaining 12 patients there was significant improvement in only the lowest oxygen saturation and longest apneic duration categories. We conclude that UPP is an effective alternative to tracheostomy in the treatment of obstructive sleep apnea; we observed symptomatic improvement in 91%, objective improvement in 46%, and cure in 36% of the patients. Because of the discordance in subjective improvement and objective assessment, we believe all patients should have follow-up polysomnograms after UPP.     

Snoring and obstructive sleep apnea

The most common form of sleep apnea is obstructive sleep apnea (OSA). It is characterized by the cessation of nasal airflow with persistence of ventilatory effort, as shown by paradoxical chest and abdominal movement, and varying degrees of oxygen desaturation. This article describes current methods of diagnosing OSA and available treatment for OSA and snoring.     

Snoring and obstructive sleep apnea

Evidence shows that snoring and obstructive sleep apnea have significant negative physiologic consequences. These patients should be treated expeditiously once the diagnosis is made and carefully followed to ensure that improvement is maintained.     

超声评估阻塞性睡眠呼吸暂停综合征患者肺动脉僵硬度与心室重构关系的临床研究

摘 要 目的 应用超声心动图技术评价阻塞性睡眠呼吸暂停综合征（OSAS）患者肺动脉僵硬度（PAS）与心室重构的关系。方法 经多导睡眠呼吸仪（PSG）监测呼吸暂停低通气指数（AHI）≥5次/h确诊为OSAS的患者137例,次日晨行血压、血糖、血脂及超声心动图检查,依据左室质量指数（LVMI）和相对室壁厚度（RWT）分为4组：正常构型（NG）组,向心性重构（CR）组,离心性肥厚（EH）组,向心性肥厚（CH）组。同时选取健康志愿者35例作为对照组。采集左心室、右心室和PAS相关参数,比较组间差异,对PAS和右室参数进行相关性分析,并对PAS的相关危险因素进行回归分析。结果 ①与对照组比较,OSAS 各组PAS增加（均P＜0.05）;与NG组比较,CR组和EH组PAS增加（均P＜0.05）;与NG组、CR组、EH组比较,CH组PAS增加（均P＜0.05）。②OSAS患者PAS与右心室参数的相关性分析显示PAS与Et/At呈负相关（r=-0.376,P＜0.05）,与右室内径（r=0.363,P＜0.05）、Tei指数（r=0.366,P＜0.05）、mPAP（r=0.631,P＜0.05）呈正相关。③PAS与临床、睡眠和超声心动图参数的相关性分析显示PAS与年龄（r=0.154,P＜0.05）、体质指数（r=0.166,P＜0.05）、收缩压（r=0.253,P＜0.05）、舒张压（r=0.153,P＜0.05）、AHI（r=0.336,P＜0.05）、LVMI（r=0.276,P＜0.05）、RWT（r=0.286,P＜0.05）、左室几何构型（r=0.433,P＜0.05）呈正相关,与Lowest Sa02（r=-0.158,P＜0.05）呈负相关。④多元线性回归分析显示PAS与年龄（t=2.426,P＜0.05）、AHI（t=2.477,P＜0.05）、左室几何构型（CR：t=2.422;EH：t=2.334;CH：t=3.101,均P＜0.05）独立相关。结论 OSAS不同左室构型患者PAS变化情况不同,PAS与异常左室几何构型独立相关,说明PAS与心室重构过程相关。     

Assessment of pulmonary arterial stiffness in patients with systemic sclerosis without overt pulmonary hypertension

The International Journal of Cardiovascular Imaging - Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple clinical conditions and complicate most systemic...     

Surgical treatment of obstructive sleep apnea

In selected patients with obstructive sleep apnea, the uvulopalatopharyngoplasty procedure may be performed to remove excessive tissue in the oropharyngeal airway. This may improve the symptoms of sleep apnea as well as snoring. Tracheostomy may be indicated in patients with obstructive sleep apnea with associated severe medical problems.     

Surgical treatment of obstructive sleep apnea

THE PRIMARY TREATMENT for obstructive sleep apnea (OSA) has been continuous positive airway pressure (CPAP) therapy, but the minimum acceptable number of hours of nightly CPAP use remains unclear. INTEGRATED SOFT TISSUE and bone surgery may be a viable alternative for patients who have rejected CPAP as a treatment option. Formal sleep testing has shown that surgery and CPAP therapy are equally successful at resolving OSA. REPEAT SLEEP TESTING conducted several years after patients have undergone combined soft tissue and bone surgery has demonstrated consistent and reliable surgical results. Patients with OSA should be offered surgery as an alternative to life-long CPAP treatment or as an option when CPAP therapy has not been successful.     

Medical therapy of obstructive sleep apnea

Guidelines for the medical therapy of obstructive sleep apnea are difficult to define precisely. While some elegant investigations have been completed, most study populations have been small. Also, the long-term effects of most forms of therapy are not known. Some patients will respond to a given form of therapy or combination of therapies while others will not. In most instances the responders cannot be recognized prior to the institution of therapy and a cycle of trial and error ensues. One of the best nonsurgical approaches appears to be weight loss, albeit unsuccessful in most cases. Almost all experts would agree, however, that in nonemergent situations weight loss should be strongly suggested. Nasal CPAP appears to be the single most promising device. Protriptyline may have a role, although in our opinion its true efficacy remains to be determined. Oxygen will probably serve more an adjunctive role in therapy, and medroxyprogesterone appears to be beneficial only in the treatment of the obesity-hypoventilation syndrome. A reasonable approach to the medical treatment of the obstructive sleep apnea patient should include, first, by history, physical examination, and appropriate laboratory testing, elimination of anatomically correctable, pharmacologic, or endocrinologic causes of OSA. If apnea length, degree of desaturation, cardiac arrhythmias, or levels of hypersomnolence are so severe as to be potentially life threatening, immediate tracheostomy is suggested. In specialized centers, nasal CPAP would be used. In less severely affected patients, medical management, as discussed above, should begin. We believe that in view of the lack of controlled trials demonstrating which form of therapy is best, the clinician must recommend therapy on the basis of local clinical experience and patient acceptance. Of fundamental importance is the need for serial reevaluation so that the impact of therapeutic failure can be minimized.     

阻塞性睡眠呼吸暂停综合征患者葡萄糖代谢研究

目的:观察阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者葡萄糖代谢情况.方法:用多导睡眠图检查确诊的重度OSAS患者162例(OSAS组),行口服糖耐量试验检查、空腹胰岛素及C反应蛋白测定,观察空腹血糖受损及糖耐量异常.并选择同期健康体检者50例作为对照组.结果:OSAS组糖尿病、糖耐量异常发病率及C反应蛋白水平明显高于对照组.结论:OSAS患者存在明显的糖代谢紊乱,可能与炎症有关.     

Sleepiness and relationships in obstructive sleep apnea

This is a qualitative analysis of data from a multisite study of 156 participants with Obstructive Sleep Apnea (OSA). Participants completed a battery of tests, including the Functional Outcomes of Sleep Questionnaire (FOSQ) that contains an item assessing the impact of OSA on relationships. Approximately one third of participants wrote comments; they were predominately male, mean age 44.7, with severe OSA. Interpersonal themes expressed included work and marital problems and social life restriction. Intrapersonal themes included embarrassment and poor mood. This report adds specific details to previous reports of impaired relationships in OSA, and stresses the importance of assessing this critical area.     

阻塞性睡眠呼吸暂停低通气综合征患者亚临床右心室功能障碍的肺动脉硬化度

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者发生亚临床的右心室功能障碍时其肺动脉硬化度(PAS)的变化.方法:实验组选取的是经多导睡眠监测仪(PSG)确诊的80例OSAHS患者,根据AHI的不同分成3组,对照组选取的是同一时间段的35例健康者.使用二维超声收集所需常规超声参数,使用速度向量成像(VVI)技...     

脑卒中与阻塞性睡眠呼吸暂停综合征

目的:综述阻塞性睡眠呼吸暂停综合征(obstructivesleepapneasyn-drome,OSAS)与脑卒中的关系及其防治。资料来源:应用计算机检索Medline1994-01/2004-08的关于OSAS和脑卒中的文章,检索词“obstructivesleepapnea,stroke,并限定语言种类为English。同时计算机检索万方数据资源系统中国期刊全文数据库1994-01/2004-08的关于OSAS和脑卒中的文章,限定文章语言种类为中文,检索词“阻塞性睡眠呼吸困难,卒中”。资料选择:对资料进行初审,选取有关阻塞性睡眠呼吸困难与脑卒中的文章。纳入标准为①随机对照临床试验(RCT),采用单盲、双盲或非盲法。②非随机对照试验。③前后对照试验研究。④专著中的章节。排除标准:重复性研究。资料提炼:共收集到18篇关于OSAS与脑卒中关系相关文章,其中14篇符合纳入标准。排除的4篇文章为重复性研究。资料综合:对14篇有关OSAS和脑卒中之间关系的文章进行分析,探讨两者之间的内在联系。结论:OSAS的基本特征是长期反复的低氧血症和高碳酸血症,高血压是其发展到一定程度必然出现的并发症,脑卒中的防治不能忽视对OSAS的及早诊断和治疗。     

Characteristics of hypotensive effect in patients with arterial hypertension and desaturation signs of obstructive sleep apnea syndrome during sleep

AIM: To estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 +/- 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS--to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters--by Wilcoxon matched pairs test. RESULTS: In group 1 there were no significant differences by most of BP profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. CONCLUSION: Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.     

Treatment of obstructive sleep apnea in primary care

Obstructive sleep apnea should be suspected in patients who are overweight snore loudly, and have chronic daytime sleepiness. The diagnosis of sleep apnea may be confirmed by sleep laboratory studies. Patients' symptoms and the frequency of respiratory events on laboratory testing are important factors in determining the severity of disease. In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep. Continuous positive airway pressure (CPAP) is the most consistently effective treatment for clinically significant obstructive sleep apnea. In general, heavier patients with thicker necks require higher pressure settings. As patients age or gain weight, additional pressure may be necessary. Bilevel pressure machines or machines that slowly ramp up the pressure may increase patient acceptance of CPAP therapy. Complications of CPAP use include nasal dryness and congestion, claustrophobia, facial skin abrasions, air leaks, and conjunctivitis. Strategies to improve patient compliance include allowing patients to try a number of masks to find the most comfortable fit, adding humidification, treating nasal disease and, most importantly, providing close follow-up and encouragement. Oral appliances are inconsistently effective in the management of obstructive sleep apnea but may be an option in patients with mild disease who cannot tolerate CPAP. Palatal surgery often decreases snoring but may not reduce the occurrence of sleep apnea. Patients with severe disease and intolerance of CPAP may be candidates for more invasive surgical procedures. Supplemental oxygen and drug therapy may have limited, adjunctive roles in the treatment of obstructive sleep apnea.     

阻塞性睡眠呼吸暂停综合征仰卧位肺功能和神经电生理评估及其相关性

目的 目的初步探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者仰卧位肺功能和相关神经电生理指标及其相关性.方法 将OSAS患者60例设为OSAS组,并根据呼吸暂停低通气指数将其分为轻度OSAS组15例、中度OSAS组18例和重度OSAS组27例共3个亚组,另选取30例无呼吸系统疾患的志愿者作为对照组.2组入选者均进行仰卧位肺功能及膈神经运动传导(PNC)检测.肺功能检测指标包括肺活量(VC)、第一秒用力呼气容积(FEV1)、最大通气量(MVV)及其占预计值的百分比、深吸气量(IC)、补呼气量(ERV).PNC检测记录潜伏期、膈肌复合动作电位(dCMAP).结果 与对照组比较,OSAS组患者的VC%预计值、MVV%预计值、FEV1%预计值、IC以及ERV等差异均有统计学意义(P＜0.05).与对照组比较,轻度OSAS组患者仅FEV1%预计值与对照组比较差异有统计学意义(P＜0.01),其余各项2组间比较差异均无统计学意义(P＞0.05);中、重度OSAS组患者的肺功能各项指标与对照组比较,差异均有统计学意义(P＜0.01).OSAS组与对照组比较,2组间的PNC潜伏期差异无统计学意义(P＞0.05),而2组间的dCMAP波幅比率差异有统计学意义(P＜0.01).提示dCMAP波幅比率与VC%预计值、MVV%预计值、FEV1%预计值、ERV、IC呈正相关,与呼吸暂停低通气指数(AHI)呈负相关.结论 OSAS患者卧位肺功能存在异常,通过PNC检测可为OSAS患者提供膈肌功能障碍的信息.OSAS患者dCMAP波幅的减低可能与肺功能异常相关.

Abstract：

Objective To observe neurophysiological changes and pulmonary function in obstructive sleep apnea syndrome (OSAS) and analyze their inter-relationship. Methods Sixty OSAS patients were studied. Their lung function and phrenic motor nerve conduction (PNC) were examined. Thirty cases without respiratory disorder served as controls. The lung function tests included percentage of the predicted value of vital capacity ( VC% ), percentage of the predicted value of maximal voluntary ventilation ( MVV% ), percentage of the predicted value of forced expiratory volume in one second ( FEV1% ), inspiratory capacity ( IC), and expiratory reserve volume (ERV). The phrenic nerve was stimulated electrically, and the latent period and the diaphragmatic compound muscle action potential (dCMAP) were recorded. Results The VC%, MVV%, FEV1% , IC and ERV of the patients with OSAS were significantly lower than those of the controls. There was no significant difference between the patients and the controls with regard to their PNC latency. In the OSAS patients the amplitude ratio of their dCMAPs was positively correlated with VC% , MVV% , FEV1% , IC and ERV, and negatively with an apnea hypopnea index (AHI).Conclusions PNC examination can provide valuable information for evaluating diaphragmatic dysfunction in those with abnormal lung function. Decreased dCMAP might be associated with abnormal lung function.