经鼻持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征

目的:探讨经鼻持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停综合征(OSAS)的疗效。方法:对15例经多导睡眠图(PSG)监测确诊为重度OSAS的患者进行CPAP治疗3个月,而后再复查PSG ,观察各项指标的变化情况。结果:睡眠结构得到明显改善,低通气指数(HI)、呼吸暂停指数(AI)、呼吸紊乱指数(AHI)、最长呼吸暂停时间(LAT)均显著下降(P <0 . 0 1) ,最低血氧饱和度(LSaO2 )显著升高(P <0 . 0 1)。结论:CPAP治疗可以明显改善重度OSAS患者的睡眠监测指标,疗效显著。     

持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者血管内皮细胞及纤溶系统的影响

睡眠呼吸暂停低通气综合征是睡眠中出现的呼吸障碍 ,其中以阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)最常见 ,OSAHS在一般人群中的发病率为 2 %～ 4 % [1] ,与缺血性心脑血管疾病密切相关。国内对OSAHS患者血管内皮细胞(VEC)、纤溶系统的报道较少 ,特别是经鼻持续气道正压通气(nCPAP)的治疗对上述指标的影响目前尚未见有报道 ,本文旨在探讨nCPAP治疗前后OSAHS患者上述指标的变化及临床意义。1　资料与方法1.1　研究对象1.1.1　OSAHS(观察 )组　 38例患者为 2 0 0 1年 8月— 2 0 0 2年 5月来我院就诊者 ,均无心脑血管疾病 ,男 …     

持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征护理

阻塞型睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypoventilation syndrome，OSAHS）是具有潜在危害的常见病，表现为睡眠打鼾、白天嗜睡和疲倦，易合并心、肺、脑血管和神经精神功能障碍，甚至夜间猝死。持续气道正压通气（continuous positive airway pressure，CPAP）是治疗中、重度OSAHS患者的首选方法，随着临床上OSAHS的患者逐渐增多和使用呼吸机治疗患者的增多，指导患者正确使用呼吸机及其护理尤其重要。本文介绍我们应用持续气道正压通气治疗OSAHS的护理体会。     

持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗的影响

目的探讨经鼻持续气道正压通气（nCPAP）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者胰岛素抵抗（IR）的影响。方法研究20例中重度OSAHS患者CPAP治疗前后多导睡眠图（PSG）监测主要指标与空腹血糖（FPG）、空腹胰岛素（Fins）关系，并设正常对照组20例。结果@OSAHS患者呼吸暂停低通气指数（AHI）、Fins显著高于对照组（P〈0．01），胰岛素敏感性指数（ISI）、最低脉氧饱和度（LSPO2）显著低于对照组（P〈0．01）；（2）CPAP治疗6个月后，AHI、Fins较治疗前显著下降（P〈0．01），ISI、LSPO2较治疗前显著提高（P〈0．01）。结论OSAHS低氧可产生IR；nCPAP治疗能显著改善OSAHS患者IR。     

阻塞性睡眠呼吸暂停低通气综合征患者血管紧张素转换酶基因多态性分析

目的探讨血管紧张素转换酶(ACE)基因多态性与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)之间的关系。方法采用聚合酶链反应(PCR)技术检测95例OSAHS患者及50例正常人的ACE基因多态性。结果OSAHS组患者II/ID基因型频率明显高于正常对照组(分别为86%和68%,P<005)。含插入等位基因的患者快速动眼(REM)期睡眠较不含插入基因的患者明显增多(P<005),睡眠呼吸暂停低通气指数、最长呼吸暂停时间较DD基因型患者有增高趋势(P>005)。结论ACE基因I等位基因和ID基因型可能与OSAHS及OSAHS高血压的发病有关,且可能影响OSAHS的严重程度。     

经鼻持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征

目的　探讨经鼻持续气道正压通气 (nCPAP)治疗阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)的疗效及依从性。　方法　经多导睡眠图 (PSG)检查确诊的中、重度OSAHS患者 5 0例 ,采用Auto CPAP作压力滴定 ,取 95 %可信限压力作为nCPAP治疗压力 ,在家庭nCPAP治疗 3～ 6个月后复查PSG ,同时对患者使用情况进行问卷调查 ,比较治疗前后临床症状、PSG有关参数及nCPAP使用依从性情况。　结果　资料完整的 4 0例患者每天晚上坚持使用nCPAP治疗的占 87.5 % ,使用nCPAP的时间平均为每夜 6 .8± 2 .0h ,平均压力为 9.9± 1.5cmH2 O。经nCPAP治疗后 ,鼾声、夜间多尿、白天嗜睡、头晕乏力等症状有明显改善 ;睡眠呼吸暂停低通气指数 (AHI)由治疗前的 6 6 .2± 19.2下降到 7.8± 4 .9,夜间最低血氧饱和度 (LSaO2 )由5 6 .0 %± 17.4 %上升到 88.1%± 4 .2 % ,平均血氧饱和度 (MSaO2 )由 88.1%± 7.0 %上升到 95 .4 %± 1.6 % ,90 %以下氧减饱和度指数 (DOI)由 75 .5± 2 1.5下降到 5 .0± 3.2。治疗前后对比差异均有显著性 (P <0 .0 1)。　结论　nCPAP是治疗中、重度OSAHS的有效措施。严格掌握nCPAP指征、选择合适的压力、正确使用鼻罩、建立正常的随访制度等是提高患者治疗依从性和疗效的关键。     

持续气道正压通气对阻塞性睡眠呼吸暂停患者血液流变学的影响

目的:探讨持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停(OSAS)患者血液流变学的影响。方法:将60例中、重度OSAS患者随机分为试验组和对照组各30例,另选15例健康者作为正常组,OSAS对照组给予一般治疗,试验组给予CPAP,连续治疗6个月。对照组和试验组分别于治疗前和治疗6个月时测定血液流变学指标,包括红细胞压积(HCT)、红细胞聚集指数(RAI)、纤维蛋白原(Fg)和全血黏度高切变率、低切变率,比较两组治疗前、后及与正常组上述各项指标差异。结果:试验组和对照组患者治疗前血液流变学指标均显著高于正常组(P<0.01);试验组治疗后上述指标比治疗前明显下降(P<0.01);而对照组治疗前、后上述指标比较,差异均无统计学意义(P>0.05)。结论:中、重度OSAS患者存在血液流变学异常,CPAP治疗可以改善OSAS患者的血液流变学异常,降低血液黏度。     

自动调节持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征患者依从性的影响因素

目的 探讨自动调节持续气道正压通气（auto-CPAP）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者依从性的相关影响因素。方法 回顾性分析2016年10月至2017年12月以睡眠打鼾症状就诊、经多导睡眠监测（PSG）检查确诊为OSAHS的患者102例,所有患者均接受auto-CPAP治疗。统计患者年龄、性别、体质量指数（BMI）、Epworth嗜睡量表（ESS）评分、鼻阻塞症状评估量表（NOSE）评分以及Mallampati评分。采用Kribbs标准将患者分为依从组和非依从组,采用χ²检验或两样本均数比较的t检验比较两组上述各项指标的差异,采用logistic回归模型分析影响OSAHS患者接受auto-CPAP治疗依从性的危险因素。结果 102例患者中男性89例、女性13例,年龄31～83（42.2±10.0）岁。65例（63.7%）患者治疗依从性好,归入依从组;37例（36.3%）治疗依从性差,归入非依从组。两组间ESS评分、NOSE评分、Mallampati评分差异均有统计学意义（P均<0.01）,而年龄、性别、BMI差异无统计学意义（P均>0.05）。Logistic多因素回归分析结果显示,ESS评分（OR=1.183,95% CI 1.046～1.338;P=0.008）和Mallampati评分（OR=2.075,95% CI 1.121～3.839;P=0.020）是影响治疗依从性的独立危险因素。结论 ESS评分、NOSE评分和Mallampati评分可影响OSAHS患者对auto-CPAP治疗的依从性,其中ESS评分和Mallampati评分是影响患者治疗依丛性的独立危险因素。     

持续气道正压通气治疗对阻塞性睡眠呼吸暂停综合征患者难治性高血压的影响

目的:通过观察持续气道正压通气(CPAP)对合并难治性高血压(RH)的阻塞性睡眠呼吸暂停综合征(OSAS)患者的血压和血浆醛固酮(ALD)、血浆肾素活性(PRA)的影响,以探讨CPAP治疗对OSAS合并RH患者血压的疗效及可能的机制.方法:选择13例合并RH的中重度OSAS患者,分别于CPAP治疗前及CPAP治疗3个月时测量和比较睡前(10:00PM)、夜间(02:00AM)和清晨(6:00AM)的血压及晨起(6:00AM)卧位血浆ALD、PRA水平,ALD、PRA检测采用放射免疫分析法.结果:与CPAP治疗前相比,CPAP治疗3个月时相比变化如下:睡前、夜间和清晨血压均显著下降(均为P＜0.01),其中收缩压比较为10:00PM时:(152.2±19.2)mmHg vs(135.5±2.8)mmHg,2:00AM时:(156.6±19.4)mmHg vs(133.1±2.4)mmHg,6:00AM时:(172.1±23.7)mmHg vs(151.5±3.0)mmHg;舒张压比较为10:00PM时:(98.9±15.6)vs(84.2±4.6)mmHg,2:00AM时:(102.8±16.6)mmHg vs(81.5±4.6)mmHg,6:00AM时:(50.9±16.9)mmHg vs(50.7±4.3)mmHg;晨起卧位ALD明显降低[(195.5±15.1)ng/L vs(148.3±19.4)ng/L,P＜0.01],但PRA无明显变化[(0.20±0.12)μg/(L·h)vs(0.27±0.14)μg/(L·h),P＞0.05).结论:CPAP治疗可显著改善OSAS患者的RH并降低血浆ALD浓度.OSAS患者的RH可能与血浆ALD浓度增高有关.     

持续气道正压通气治疗对阻塞性睡眠呼吸暂停综合征患者体内SOD、GSH-PX 和MDA水平的影响

目的 研究持续气道正压通气(CPAP)后阻塞性睡眠呼吸暂停综合征(OSAS)患者体内超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)活力和丙二醛(MDA)含量的变化.方法 选择OSAS患者52例行SOD、GSH-PX活性和血清MDA含量检测;对OSAS患者行持续气道正压通气治疗3个月后,重新检测SOD、GSH-PX和血清MDA含量,并选择50例健康人作为正常对照.结果 SOD、GSH-PX活性和血清MDA含量,正常对照组分别为(94.15±12.53) U/ml、(148.36±12.24)mIU/ml、(7.87±2.82)nmol/ml;OSAS患者含量分别为(69.48±10.79)U/ml、(110.04±11.89)mIU/ml、(20.17±2.57)nmol/ml;持续正压通气(CPAP)治疗3个月后,OSAS患者的SOD、GSH-PX活性和血清MDA含量分别为(90.36±13.19)U/ml、(146.63±14.54)mIU/ml、(8.21±2.73)nmol/ml,与正常对照组相比,OSAS患者MDA明显升高,SOD、GSH-PX活性显著降低,差异均有统计学意义(P<0.01);CPAP治疗3个月后,OSAS患者的SOD、GSH-PX活性、MDA含量与正常对照组相比差异无统计学意义(P>0.05).结论 OSAS患者体内存在严重的氧自由基代谢失衡,CPAP治疗3个月后,氧自由基代谢可基本恢复正常.     

Effect of continuous positive airway pressure treatment on elderly Chinese patients with obstructive sleep apnea in the prethrombotic state

Objectives To characterize the prethrombotic state (PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation On their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG),whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease.Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6.00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4.00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.Concluslon In elderly Chinese OSAHS patients,PTS could be effectively eliminated by nCPAP treatment.     

自动调节压力和固定压力持续正压通气呼吸机在阻塞性睡眠呼吸暂停低通气综合征治疗中的对比研究

目的观察自动调节压力持续正压通气呼吸机(A-CPAP)和固定压力持续正压通气呼吸机(F-CPAP)在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中平均压力的对比。方法选择100例诊断为OSAHS的患者随机单盲分成两组,分别使用A-CPAP和F-CPAP呼吸机,观察治疗前后的平均血氧饱和度,以及两种呼吸机的平均压力值。结果两组呼吸机治疗前后的平均血氧饱和度明显升高(P<0.01),A-CPAP治疗组平均压力较低,差异有统计学意义(P<0.01)。结论A-CPAP和F-CPAP呼吸机在治疗OSAHS中均有明显疗效,A-CPAP有更好的舒适性和耐受性。     

Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome

Background Recent research suggested that obstructive sleep apnea syndrome （OSAS） might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes etc. This study was conducted to investigate the effect of continuous positive airway pressure （CPAP） treatment on changes of both serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients. Methods Twenty-three adult male patients with moderate-to-severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood samples were collected and morning mean arterial pressure （MAP） was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay. Results Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment （P〉0.05）. It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur （P〈0.01）. Meanwhile, the MAP showed no statistically significant difference among its levels before CPAP, on day 3 and day 7 of CPAP treatment （P〉0.05）. However, on day 14 of CPAP treatment, a significantly lower MAP than that obtained before treatment was observed （P〈0.05）. Conclusions CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAS patients. Hypoadiponectinemia might be involved in the pathogenesis of OSAS-mediated hypertension.     

Effect of continuous positive airway pressure treatment on vascular endothelial function in patients with obstructive sleep apnea hypopnea syndrome and coronary artery disease

Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels, NO/ET ratio, total ischemic burden (TIB) of the myocardium, apnea hypopnea index (AHI), and minimal and mean pulse oxygen saturation (SpO2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET ［(51.39±11.69) ng/L］ and NO ［(36.67±11.86) μmol/L］, NO/ET (0.71±0.14), AHI (32.4±7.9), minimal SpO2 ［(68.9±11.4)%］, and myocardial TIB ［(66.29±16.37) mm·min］ before treatment, there were significant decreases in ET ［(33.41±10.03) ng/L］ （P&lt;0.05）, increases in NO ［(59.89±10.26) μmol/L］ and NO/ET (1.79±0.38) （P&lt;0.01）, decreases in AHI (1.9±0.5), and increases in minimal SpO2 ［(90.6±1.8) %］ （all P&lt;0.01） and myocardial TIB ［(36.42±10.87) mm·min］ （P&lt;0.05） after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.     

经鼻持续气道内正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征瘦素水平及代谢紊乱的影响

目的评价经鼻持续气道内正压通气(nasal continuous positive airway pressure,nCPAP)治疗对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea/hypopnea syndrome,OSAHS)瘦素水平和代谢紊乱的影响,探讨瘦素水平在OSAHS发病中的作用.方法测定OSAHS患者在nCPAP一夜治疗(18例)和长期治疗(8例,治疗时间7.5个月)前后的血清瘦素浓度,对比治疗前后部分代谢参数的变化.结果nCPAP一夜治疗后,血清瘦素水平下降[(8.47±0.62)μg/L vs(7.32±0.64)μg/L,P=0.022],其余参数未见明显变化(P＞0.05);血清瘦素水平在nCPAP长期治疗后明显下降并独立于体重指数(body mass index,BMI)[(8.35±0.83)μg/L vs(6.05±0.78)μg/L,P=0.036];血清空腹血糖(FBG)和空腹真胰岛素(TI)均在nCPAP长期治疗后明显下降(P值均为0.036),但甘油三酯(TG)和胆固醇(Chol)未见明显变化.结论nCPAP一夜和长期治疗能降低OSAHS的瘦素水平并独立于BMI,OSAHS可能对血清瘦紊水平具有独立的作用;nCPAP长期治疗可改善OSAHS的糖代谢及胰岛素抵抗.     

持续气道正压通气对合并2型糖尿病的OSAHS患者胰岛素抵抗的影响

目的:通过观察了持续气道正压通气(CPAP)治疗对合并2型-糖尿病(2型-DM)的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的胰岛素抵抗(IR)的影响,以验证OSAHS是否为引起糖尿病患者IR增加的独立危险因素.方法:选择25例合并2型-DM的肥胖OSAHS患者,将他们的呼吸暂停/低通气指数(AHI)为37.7±18.0;体重指数(BMI)被控制在29.1±2.3 kg/m2;通过6个月的CPAP治疗观察治疗前后反映IR的稳态模式评估(HOMA)指数变化.结果:在BMI无明显改变的情况下,6个月的CPAP治疗后HOMA指数较治疗前明显降低(1.84±1.98vs 3.33±2.96,P＜0.0001).结论:CPAP治疗可显著改善OSAHS患者的IR增高,提示OSAHS是IR的独立危险因素.     

气道正压通气对中重度阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗的影响

目的：探讨中重度阻塞型睡眠呼吸暂停低通气综合征（OSAHS）与胰岛素抵抗之间的关系,以及持续正压通气（CPAP）治疗OSAHS对胰岛素抵抗的影响。方法：分析58例中重度OSAHS患者CPAP治疗前后及20例未治疗中重度OSAHS患者多导睡眠监测指标与空腹血糖、胰岛素和餐后2h血糖、胰岛素的关系,另选择45例不符合OS-AHS诊断的健康者为对照组。结果：OSAHS组治疗前,餐后血糖、餐后胰岛素明显高于对照组（P〈0.01）,胰岛素敏感指数明显低于对照组（P〈0.01）。CPAP治疗30d,餐后血糖、胰岛素较前显著下降（P〈0.01）,胰岛素敏感指数明显增高（P〈0.01）。结论：OSAHS组治疗前,血糖和血浆胰岛素比对照组高,治疗后OSAHS组比未治疗组低。表明OSAHS可产生胰岛素抵抗,而CPAP治疗可以改善胰岛素抵抗。     

气道正压通气治疗对重度阻塞性睡眠呼吸暂停患者肺动脉压影响的研究

目的:探讨不伴有其他心肺疾病的重度阻塞性睡眠呼吸暂停综合征(OSAS)患者是否伴发肺动脉高压(PH),并比较两种不同方式气道正压通气治疗,即持续气道正压通气(CPAP)和双水平气道正压通气(BiPAP)治疗对肺动脉压(PpA)的影响.方法:选择排除了其他心肺疾病的重度OSAS患者14例,利用超声多普勒检查测量PpA,并根据所采用气道正压治疗方式分成两组,即CPAP治疗组(n=7)和BiPAP治疗组(n=7),分别于接受6个月的CPAP和BiPAP治疗后,复查pA并比较其治疗前后的变化.结果:14例重度OSAS患者中有5位(35.7%)有轻度PH.总体比较显示14例OSAS患者气道正压通气治疗6个月时PpA均较治疗前有所降低[(29.6±7.2)mmHg]vs(26.0±5.0)mmHg,P<0.05].两组治疗前后比较显示,CPAP治疗后PpA虽有降低趋势,但无统计学意义[(29.0±6.6)nnnHg vs(27.7±5.9)mmHg,P>0.05],而BiPAP治疗后PpA显著降低[(30.1±8.3)mmHg vs(24.3±3.6)mm Hg,P<0.05].结论:重度OSAS患者可发生PH,BiPAP治疗可能降低他们的PpA,因而可能防治OSAS患者的PH.