新疆维汉民族OSAHS患者与血清脂联素研究

目的探讨新疆维汉民族阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与血清脂联素相互关系。方法随机选择OSAHS维族及汉族患者各60例,采用酶联免疫法(ELISA)测定两组血清脂联素水平。结果在OSAHS患者中维族与汉族比较年龄、BMI、睡眠呼吸暂停低通气指数(AHI)、颈围、腰围、腹围、最低血氧饱合度(LSaO2)、最长呼吸暂停时间(Tmax)、脂联素,发现维族患者BMI高于汉族,脂联素水平低于汉族(P<0.05),其余均无统计学意义。在维族与汉族OSAHS患者中比较超重与肥胖所占比例,维族肥胖人数大于汉族(P<0.05)。结论除去年龄、性别的影响,维族OSAHS患者血清脂联素水平低于汉族。     

慢性阻塞性肺疾病患者睡眠呼吸紊乱类型及其与呼吸中枢反应性的关系

目的分析重叠综合征[慢性阻塞性肺疾病（COPD）合并睡眠呼吸暂停低通气综合征（SAHS）]患者睡眠呼吸紊乱的特点，并探讨其与呼吸中枢反应性的关系。方法对300例稳定期COPD患者经问卷、Epworth嗜睡量表及家庭血氧饱和度监测，对氧减饱和指数〉5次／h或嗜睡评分≥10分的患者进行多导生理记录仪睡眠呼吸监测，其中呼吸暂停低通气指数（AHI）≥10次／h的患者有79例（重叠综合征组）。选择年龄、性别及体重指数与其相匹配的118例单纯SAHS患者（SAHS组），对比分析其睡眠呼吸紊乱的特点。另外测定重叠综合征组22例患者的呼吸中枢高CO2反应性和低氧反应性，并与300例COPD患者中17例和SAILS组中17例的相应检测结果进行比较。结果40％（32／79）的重叠综合征患者在睡眠过程中出现延续时间〉1min的持续肺泡通气不足，但单纯SAHS患者此种现象很少见。重叠综合征组的低通气指数占AHI百分比[（69±30）％]、总低通气时间占总睡眠时间百分比[（15±12）％]均较单纯SAHS组[（52±31）％、（12±10）％]明显增高。重叠综合征患者在清醒状态下的△呼气流量／△动脉血氧饱和度[（-0．11±0．05）L·min^-1·％^-1]和△呼气流量／△动脉血二氧化碳分压[（1．1±0．8）L·min^-1·mmHg^-1（1mmHg=0．133kPa）]均明显低于单纯SAHS患者[（-0．35±0．24）L·min^-1·％^-1和（1．6±0．8）L·min^-1·mmHg^-1]。结论重叠综合征患者的睡眠呼吸紊乱模式以低通气为主，其清醒时呼吸中枢的低氧反应性降低。     

急性脑梗死合并睡眠呼吸暂停低通气综合征的初步筛查

目的初步探讨急性脑梗死患者睡眠呼吸暂停低通气综合征（SAHS）的患病情况。方法对2008年1月至2008年12月我科收治的急性脑梗死患者200例进行初步筛查,对配合的40例经知情同意后进行多导睡眠呼吸监测（PSG）检查,并随机抽取40例同期收治的EWW嗜睡自评不符合SAHS的急性脑梗死患者做对照,比较患者年龄、体重指数（BMI）、睡眠打鼾史、高血压史、糖尿病史、吸烟史、AHI、最低动脉血氧饱和度（SaO2）及梗死部位与症状。结果急性脑梗死合并SAHS者占急性脑梗死患者的20%,其中以阻塞型及混合型睡眠呼吸暂停居多;45～60岁组患病率最高,占60%;AHI〉20者占70%,病变累及脑干或出现吞咽困难、饮水呛咳等球麻痹症状者SASH较严重。结论急性脑梗死出现球麻痹者常合并较严重的阻塞型睡眠呼吸暂停,睡眠呼吸暂停是脑梗死的独立危险因素,BMI及上气道周围组织功能异常是引起阻塞型睡眠呼吸暂停的重要因素。     

打鼾与睡眠呼吸暂停低通气综合征的关系研究

目的调查打鼾患者睡眠呼吸暂停低通气综合征的患病率,探讨打鼾与夜间低氧的关系。方法采用流行病调查的方法对克拉玛依市天山社区1121例35岁以上常住居民进行人户睡眠问卷调查及夜间呼吸血氧监测。结果鼾症高危组与鼾症低危组在颈围、腹围、氧减指数、夜间最低氧饱和度、呼吸暂停指数等方面比较差异有统计学意义（P均〈0．05）。鼾症组与非鼾症组在体重指数、颈围、腹围、氧减指数、夜间最低氧饱和度、呼吸暂停指数、低通气指数比较差异有统计学意义（P均〈0．01）。鼾症高危组与低危组间睡眠呼吸暂停低通气综合征的发生率比较差异有统计学意义（P〈0．05）。结论打鼾与睡眠呼吸暂停低通气综合征、夜间低氧相关,睡眠呼吸暂停低通气综合征与鼾症分级有关,颈围和腹围是打鼾和睡眠呼吸暂停低通气综合征的危险因素。     

阻塞性睡眠呼吸暂停低通气综合征患者夜间缺氧程度的评估

目的 评估阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的夜间缺氧程度。方法对疑诊有睡眠呼吸障碍的患者215例进行夜间睡眠呼吸监测,计算平均血氧饱和度（AO2）、最低血氧饱和度（LO2）、氧减指数（ODI）、平均氧减饱和度、血氧饱和度低于90％占整个记录时间的百分比（T〈90％）,并进行相关分析。结果 依据所有患者的呼吸暂停低通气指数（AHI）分为AHI正常组（AHI〈5次／h）、轻度OSAHS组（5次／h≤AHI〈15次／h）、中度OSAHS组（15次／h≤AHI〈30次／h）、重度OSAHS组（AHI≥30次／h）,4组A02、L02、ODI、T〈90％差异有统计学意义（P〈0．001）。AHI与A02、ODI、L02、平均氧减饱和度、T〈90％显著相关（r分别为-0．610、0．983、-0．789、0．782、0．821,P=0．001）。结论 OSAHS患者缺氧严重程度的评估需结合ODI、LO2、T〈90％三个指标综合判断．不能仅考虑单一指标．     

C+手环对成人睡眠呼吸暂停低通气综合征的初筛价值

目的 探讨C+手环对成人睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)的初筛价值.方法 对145例疑似SAHS患者同时进行多导睡眠图(polysomography,PSG)与C+手环监测,分别统计PSG监测所得睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、PSG与C+手环监测所得氧减饱和度指数(oxygen desaturation index,ODI4)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)以及血氧饱和度＜90％占整个记录时间的百分比(TS90％).结果 C+手环监测所得ODI4与PSG监测所得AHI两者显著相关(r=0.711,P＜0.001).C+手环与PSG监测所得ODI4、LSaO2、MSaO2以及TS90％进行相关性分析(r分别为0.708、0.575、0.486、0.631,P值均＜0.001).分别以PSG-AHI≥5次/h作为诊断SAHS的阳性标准,C+手环监测所得ODI4≥5次/h作为诊断SAHS的初筛标准,配对矿检验显示差异无统计学意义(x2=1.71,P＞0.05,Kappa值=0.524,P＜0.001).以PSG-AHI≥5次/h作为诊断SAHS的阳性标准,以C+手环监测所得ODI4≥11.45次/h作为SAHS初筛标准,灵敏度为77.4％,特异度为83.9％,以ODI4≥15.45次/h作为初筛标准,其对应特异度为90.3％,灵敏度为68.9％.结论 C+手环对SAHS有一定的初筛价值,可作为一种便携式筛查工具.     

阻塞性睡眠呼吸暂停低通气综合征患者睡眠时咽部CT与体质量的关系研究

目的 探讨睡眠状态下阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患者咽部CT测量与体质量的关系.方法 在于天津医科大学总医院行多导睡眠监测被确诊为OSAHS的患者中随机选取40例可以配合的患者进行睡眠状态下螺旋CT扫描,依体质量指数(body mass index,BMI)将其分为BMI<25组和BMI≥25组,比较两组一般资料[平均年龄、颈围、最低血氧饱和度、睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、吸烟情况、醒时血氧饱和度]及咽腔形态学(包括鼻咽和口咽的最小面积,舌体长度、厚度和面积,软腭长度、厚度和横截面积,悬雍垂直径等)的差异.结果 睡眠状态下,BMI≥25的患者颈围、AHI明显高于BMI<25的患者(P<0.01),而最低血氧饱和度明显低于后者(P<0.001),同时BMI≥25患者的舌体长度、舌体面积较BMI<25患者明显增加(P<0.001),软腭后区最小横截面积减小(P<0.05),而舌后区最小横截面积、舌体厚度、软腭长度、软腭厚度、软腭横截面积及悬雍垂直径随着BMI的增大有增加趋势,但两组间差别无统计学意义.相关分析结果也显示AHI与BMI呈正相关(r=0.608,P<0.001).结论 睡眠状态下不同BMI的OSAHS患者之间气道结构存在一定的差异,同时BMI与AHI有相关性,提示BMI可反映OSAHS患者上气道阻塞程度.     

椎基底动脉供血不足支架植入对改善睡眠呼吸暂停低通气综合征的初步观察

目的 观察椎基底动脉缺血发作与睡眠呼吸暂停低通气综合征(SAHS)之间的关系,以及椎动脉内支架植入治疗对SAHS的作用.方法 对20例椎动脉血管内支架成形术患者在治疗前后进行多导睡眠图监测,同时记录患者的一般资料和临床表现,填写Epworth嗜睡程度量表.按照成人SAHS的诊断标准进行诊断、分型,判断其严重程度及缺氧变化.治疗前后的比较采用配对t检验和秩和检验,偏态分布的计量资料以中位数和四分位间距表示.结果 20例椎基底动脉缺血性狭窄患者合并SAHS者17例,其中轻度10例、中度3例、重度4例,临床类型符合阻塞性睡眠呼吸暂停低通气综合征(OSAHS).治疗后患者的呼吸暂停低通气指数[5.0(1.6～12.7)次/h]、最长呼吸暂停时间[(19.5±12.4)s]、呼吸暂停低通气时间占总睡眠时间百分比[2.3(0.6～9.8)%]、每小时动脉血氧饱和度下降4%的次数[5.8(2.7～17.0)次/h]明显低于治疗前[11.3(6.3～23.6)次/h、(31.5±18.6)s、6.9(2.6～14.3)%、10.1(5.3～29.0)次/h],治疗后患者的夜间最低动脉血氧饱和度[(86.1±3.3)%]明显高于治疗前[(83.6±7.1)%].结论 椎基底动脉缺血患者的睡眠结构紊乱,睡眠效率降低.患者具有较高的SAHS患病率,主要造成阻塞性睡眠呼吸暂停.椎动脉血管内支架成形术治疗可改善缺血性脑血管病患者的睡眠呼吸紊乱及缺氧状况.     

体质量指数与老年阻塞性睡眠呼吸暂停低通气综合征严重程度的相关性

目的 探讨体质量指数(BMI)与老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)严重程度的相关性.方法 回顾性分析2015年1月至2017年10月在解放军总医院、北京大学国际医院和甘肃中医药大学附属医院经标准多导睡眠监测诊断为OSAHS的609例老年患者(≥60岁)的病例资料.按BMI水平将研究对象分为体重正常组(n=...     

Validation of the WristOx 3100? oximeter for the diagnosis of sleep apnea/hypopnea syndrome

OBJECTIVE: To evaluate the diagnostic accuracy of the Nonin WristOx 3100 and its software (nVision 5.0) in patients with suspicion of sleep apnea/hypopnea syndrome (SAHS). METHODS: All participants (168) had the oximetry and polysomnography simultaneously. The two recordings were interpreted blindly. The software calculated: adjusted O(2) desaturation index [ADI]-mean number of O(2) desaturation per hour of total recording analyzed time of >/= 2%, 3%, 4%, 5%, and 6% (ADI2, 3, 4, 5, and 6) and AT90-accumulated time at SO(2) < 90%. The ADI2, 3, 4, 5, and 6 and the AT90 cutoff points that better discriminated between subjects with or without SAHS arose from the receiver operating characteristic curve analysis. The sensitivity (S), specificity (E), and positive and negative likelihood ratio (LR+, LR-) for the different thresholds for ADI were calculated. RESULTS: One hundred and fifty-four patients were included (119 men, mean age 51, median apnea/hypopnea index [AHI] 14, median body mass index [BMI] 28.3 kg/m(2)). The best cutoff points of ADI were: SAHS = AHI >/= 5: ADI2 > 19.3 (S 89%, E 94%, LR+ 15.5 LR- 0.11); SAHS =AHI >/= 10: ADI3 > 10.5 (S 88%, E 94%, LR+ 15 LR- 0.12); SAHS = AHI >/= 15: ADI3 > 13.4 (S 88%, E 90%, LR+ 8.9, LR- 0.14). AT90 had the lowest diagnosis accuracy. An ADI2 /= 5 and 10; S 100%, LR- 0) and ADI3 > 4.3 (AHI >/= 5 and 10) or 32 (AHI >/= 15) confirmed SAHS (E 100%). CONCLUSIONS: A negative oximetry defined as ADI2 /= 5 or 10 with a sensitivity and negative likelihood ratio of 100% and 0%, respectively. Furthermore, a positive oximetry defined as an ADI3 > 32 (SAHS = AHI >/= 15) had a specificity of 100% to confirm the pathology.     

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...     

Usefulness of arousals for the detection of sleep breathing disorder]

Because of the difference of sensitivity among measurement techniques, upper airway obstruction events cannot always be scored as apnea or hypopnea. We hypothesized that arousal accompanied with breathing disturbance is a more sensitive index for the diagnosis of sleep breathing disorders than others. We studied 75 patients with sleep breathing disorder by polysomnograph. Breathing disturbance related arousal (B-Ar) was defined as an arousal accompanied with at least one of the following (apnea, hypopnea, more than 4% oxygen desaturation, snoring), and the breathing disturbance indices were compared. There were close relationships between B-ArI and apnea hypopnea index (AHI), oxygen desaturation index (DI), and percent of total sleep time with SpO2 below 90% in all patients (r = 0.93, r = 0.58, r = 0.92, respectively, all p < 0.001). In 25 patients whose AHI was below 20 per hour, no relationship between B-ArI and AHI was found, and B-ArI was significantly greater than AHI. Thus, B-ArI seemed to be more sensitive than AHI. In all 6 patients whose AHI was below 10, B-ArI was lowered decreased by continuous nasal positive airway pressure therapy. These results suggest that B-ArI may be more sensitive in the detection of sleep breathing disorders than the other indices when AHI is below 20 per hour.     

Effect of body mass index on overnight oximetry for the diagnosis of sleep apnea

Overnight oximetry is widely used for screening for the sleep apnea hypopnea syndrome (SAHS). The degree of desaturation at an apnea event is known to be affected by the degree of obesity. We hypothesized that the diagnostic ability of oximetry for SAHS is affected by the degree of obesity. A total of 424 consecutive patients referred for possible SAHS were studied. The subjects were classified into three groups of normal-weight, overweight and obese based on the body mass index (BMI). The apnea-hypopnea index (> or = 15 h(-1)) by polysomnography was used as the diagnostic gold standard. Oximetry data were automatically analyzed to calculate the oxygen desaturation index (ODI2/3/4:at 2%/3%/4% threshold). The diagnostic abilities of the ODI were different in the three BMI-groups at a given cutoff value, e.g. the sensitivity/specificity of ODI4 (cutoff = 15) were 54%/100%, 83%/ 97%, and 98%/78% for the normal-weight, overweight and obese groups, respectively (P < 0.0001). The gender and the age had no significant effect on the ability. We demonstrated the diagnostic sensitivity and specificity of the ODI for SAHS depended on the BMI. Oximetry as a screening tool for SAHS may become more useful by selection of a cutoff value appropriate for the BMI of each subject.     

阻塞性睡眠呼吸暂停低通气综合征合并慢性阻塞性肺疾病的重叠综合征临床特点

目的 探讨重叠综合征（OS）患者的临床特征,为OS的诊断和治疗提供参考.方法 选取96例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）、36例慢性阻塞性肺疾病（COPD）、32例OS患者以及13例正常对照者,询问其Epworth嗜睡评分（ESS）、高血压病史,测定其颈围,计算BMI,所有患者均行多导睡眠监测、肺功能和动脉血气测定,记录呼吸暂停低通气指数（AHI）、最长呼吸暂停时间（LAT）、夜间最低氧饱和度（LSaO2）、夜间平均氧饱和度（MSaO2）、血氧饱和度＜90％时间占监测总时间的百分比（Ts90％）、慢波睡眠（Ⅲ期睡眠）及快速眼动相睡眠（REM）占总睡眠百分比、微觉醒指数、夜间心律失常发生率,第一秒用力呼气容积（FEV1）占预计值百分比、FEV1/用力肺活量（FVC）、PaO2和PaCO2等指标,并对相应结果进行统计分析.结果 OS组和OSAHS组患者的BMI、颈围显著高于COPD组和对照组.OS组患者ESS、AHI、PaCO2等数值明显高于COPD组、OSAHS组和对照组,而夜间最低血氧饱和度、平均氧饱和度、FEV1％和FEV1/FVC等则明显低于其他3组（P＜0.05）.结论 OSAHS伴有肥胖者COPD患者更易患OS.OS患者夜间低氧血症、睡眠质量、肺功能减退程度以及日间低氧血症和高碳酸血症较单纯COPD或OSAHS更严重.应提高对OS的认识.     

Age related differences in electroencephalographic and cardiac arousal at the termination of sleep apnea/hypopnea

OBJECTIVE: The purpose of the present study was to determine whether electroencephalographic (EEG) and cardiac arousal, i.e. heart rate elevation at the termination of apnea/hypopnea are related to aging. METHODS: The subjects were 13 middle-aged (40-60 years of age, 47.8+/-5.35 years) and 10 elderly (>60 years of age, 69.8+/-5.31 years) male patients with obstructive sleep apnea syndrome. We evaluated the number of apneas per an hour of sleep (apnea index: AI), the number of hypopneas per an hour of sleep (hypopnea index: HI), the summation of HI and AI (apnea/hypopnea index: AHI), sleep stage, the amount of time during which nocturnal oxygen saturation was decreased below 90% (oxygen desaturation time: ODT), and EEG and cardiac arousal at the termination of apnea/hypopnea using polysomnography with pulse oximetry. RESULTS: There was no significant difference in AHI, duration of apnea/hypopnea, and sleep stage distribution between the two groups. However, the ratio of apnea/hypopnea with EEG and cardiac arousal was significantly higher in middle-aged than in elderly patients. The ratio of HI to AHI was significantly lower in middle-aged than in elderly patients. In middle-aged patients, EEG and cardiac arousal were significantly correlated with AI, AHI, and ODT, whereas, in elderly patients, these parameters were not similarly correlated. CONCLUSION: Our findings suggest that the differences in EEG and cardiac arousal, and the pattern of sleep-disordered breathing (SDB) between middle-aged and elderly patients with SDB might be a physiological phenomenon of aging.     

Gender differences in sleep apnea: the role of neck circumference

STUDY OBJECTIVES: To determine whether differences in sleep apnea severity between men and women referred to a sleep clinic are related to the differences in neck circumference (NC). STUDY DESIGN: Case series. SETTING: University hospital sleep disorders clinic. PARTICIPANTS: A total of 3,942 patients (2,753 men and 1,189 women) referred to the sleep clinic. MEASUREMENTS AND RESULTS: All patients underwent nocturnal polysomnography. NC was used as a surrogate measure of upper airway obesity. We found that sleep apnea, defined an the apnea/hypopnea index (AHI) > 10/h, was significantly more frequent (60% vs 32%, chi(2) < 0.0001) and severe (mean +/- SE, 25 +/- 26/h vs 12 +/- 19/h, p < 0.0001) in men than in women. Men had significantly larger NC than women, but the difference became much less pronounced when we normalized NC to body height (0.24 +/- 0.02 vs 0.23 +/- 0.03, p < 0.0001). Men had significantly higher AHI than women even after controlling for age, body mass index (BMI), and neck/height ratio (NHR); analysis of covariance showed that mean AHI was 24.4 +/- 0.4 in men vs 14.8 +/- 0.7 in women (p < 0.0001). This difference persisted even when we matched men and women for NHR and BMI. Finally, multiple regression analysis revealed the following: (1) NHR was the most significant predictor of AHI, accounting for 19% of the variability; and (2) the slope of AHI vs NHR was significantly higher in men than in women. CONCLUSIONS: We conclude the following: (1) the frequency and severity of sleep apnea in the sleep clinic population is greater in men than women, and (2) factors other than NC, age, and BMI must contribute to these gender differences.     

老年心血管疾病患者阻塞性睡眠呼吸暂停综合征的评价

目的 评价老年心血管疾病患者阻塞性睡眠呼吸暂停综合征(OSAS)的患病情况和特点,为临床决策提供参考. 方法 采用便携式睡眠监测仪对入住在老年心内科的患者,进行睡眠呼吸监测,了解其阻塞性睡眠呼吸暂停(OSA)的患病情况. 结果 共监测了317例老年心血管疾病患者的夜间睡眠呼吸紊乱情况,得出符合OSA[睡眠呼吸紊乱指数(AHI)≥5]的有281例,占88.6%;符合阻塞性睡眠呼吸暂停综合征(OSAS)[AHI≥5,Epworth量表(ESS)≥9分]的有47例,占14.8%.多元回归分析结果 提示,以OSA严重程度作为因变量,对它影响有显著性意义的是最低血氧饱和度和血氧饱和度下降指数(简称氧减指数),而年龄、习惯性打鼾、嗜睡评分、体质指数(BMI)、血氧饱和度平均值和低于90%的时间对其影响无显著性意义. 结论 老年心血管疾病患者中OSAS具有高的患病率,而且无白天嗜睡症状的OSA的老年人患病率更高.对睡眠呼吸暂停严重程度的独立预测因子是最低血氧饱和度氧减指数,而老年人的年龄、BMI、是否经常打鼾、是否白天嗜睡与OSA的严重程度关系不密切.     

Adenotonsillectomy for obstructive sleep apnea in children with Prader-Willi syndrome

The aim of our study was to evaluate the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea syndrome (OSA) in pediatric patients with Prader-Willi syndrome (PWS), and to describe the postoperative complications. Five patients (4 males; median age, 4.4 years; range, 1.6-14.2 years) were studied. All patients underwent an overnight cardiorespiratory sleep study. All patients had adenotonsillar hypertrophy (ATH), and two were also obese. The preoperative obstructive apnea/hypopnea index (AHI; median and range) was 12.2 (9.0-19.9) events/hr; the mean oxygen saturation was 95 (79-96)%; the nadir oxygen saturation was 71 (58-78)%; and the oxygen desaturation index (ODI) was 15.8 (11.4-35.9) events/hr. Preoperatively, patients were classified as having moderate to severe OSA. A second sleep study, performed 16 (3-43) months after adenotonsillectomy, showed a significant decrease in AHI (P = 0.009) and ODI (P = 0.009). Mean and nadir oxygen saturation did not differ significantly postsurgery (P = 0.188, P = 0.073, respectively). Four out of five children showed at least one postoperative complication. Difficult awakening from anesthesia, hemorrhages, and respiratory complications requiring reintubation and/or supplemental oxygen administration were observed. In conclusion, patients with PWS and OSA who underwent adenotonsillectomy showed a significant decrease in AHI and number of oxygen desaturations.     

198例老年睡眠呼吸暂停综合征多导睡眠图分析

目的 分析总结198例老年睡眠呼吸暂停综合征患者（slee papnea／hypopnea syndrome，SAHS）的多导睡眠图（polysonmography，PSG）特点。方法 198例均为在华山医院睡眠诊疗中心诊断为老年SAHS患者，分析其PSG，描述其中139例不同程度阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome OSAS）患者的PSG特征；探讨 OSAS患者体重指数（body mass index，BMI）与呼吸暂停事件及夜间间断性缺氧的相关性；对OSAS患者睡眠结构紊乱与呼吸暂停事什及夜间低氧血症进行相关性分析。结果198例SAHS患者中以阻塞性为主的有139例，占70．2％，140例OSAS患者均有不同程度的夜间间断性低氧和睡眠结构紊乱。相关分析显示Ⅰ期睡眠（S1）与睡眠呼吸暂停低通气指数（AHI）、氧减饱和指数（ODI）及血氧饱和度〈90％／总睡眠时间（％SpO2〈90％）呈正相关，与平均氧饱和度（MSaO2）呈负相关；Ⅱ期睡眠（S2）与最低氧饱和度（LSaO2）及MSaO2呈正相关，与AHI、ODI及％SpO2〈90％呈负相关；Ⅲ＋Ⅳ期睡眠（S3＋4）与MSaO2呈正相关，与％SpO2〈90％呈负相关，AHI、ODI及LAT呈负相关，均有统计学意义。而患者的BMI与AHI和ODI呈正相关；与LSaO2和MSaO2呈负相关，有统计学意义；与最长暂停时间（IAT）和％SpO2〈90％无相关。结论本研究资料表明PSG是目前诊断SAHS的金标准。OSAS是最为多见的SAHS类型，而首次确诊的OSAS患者中以重度患者最多，提示SAS的早期发现率较低。体重指数可提示OSAS的严重程度，OSAS患者存在睡眠结构紊乱，并随呼吸暂停事件及夜间低氧血症的加重而加重。     

11O例老年阻塞性睡眠呼吸暂停低通气综合征患者多导睡眠监测及相关分析

目的 加深对老年患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)特点的认识,提高老年OSAHS诊治水平.方法 对我院睡眠呼吸障碍与鼾症诊治中心诊断的110例老年OSAHS患者的整夜多导睡眠图(PSG)监测资料进行回顾性分析,应用SPSS 18.0统计软件对患者的一般情况、睡眠结构、呼吸暂停和低通气情况、氧减饱和情况以及各指标间可能的相关关系进行统计分析.结果老年OSAHS患者中位快动眼相(rapid eye movement,REM)和非快动眼相(NREM)睡眠时间分别占2.17%和76.73%;中位觉醒指数为45.60次/h.呼吸暂停最长时间为(51.94±22.06)s,中位呼吸暂停平均时间为22.50 s,低通气最长时间为(47.06±12.52)s,低通气平均时间为(21.50±4.63)s.中位呼吸紊乱指数(respiratory disturbance index,RD1)为21.50,RDI 5～20者占46.40%,20～40者占31.80%,＞40者占21.80%.夜间平均血氧饱和度为(93.45±2.81)%,夜间最低血氧饱和度为(76.30±10.50)%,中位氧减饱和指数为31.65次/h.体质指数(BMI)与夜间最低血氧饱和度(r=-0.378,P＜0.01)和夜间平均血氧饱和度(r=-0.355,P＜0.01)呈负相关,与氧减指数呈正相关(r=0.338,P＜0.01);夜间最低血氧饱和度与阻塞性呼吸暂停最长时间(r=-0.47,P＜0.01)、阻塞性呼吸暂停平均时间(r=-0.31 6,P＜0.01)、低通气最长时间(r=-0.293,P＜0.01)和低通气平均时间(r=-0.277,P＜0.01)呈负相关.仰卧位睡眠时中位氧减时间间隔为2.36 min,左侧卧位睡眠时中位氧减时间间隔为11.54 min,右侧卧位睡眠时中位氧减时间间隔为12.45 min,左侧卧位和右侧卧位睡眠时中位氧减时间间隔均长于仰卧位(Z值分别为-6.12和-7.10,均P＜0.01).结论 老年OSAHS患者存在明显的睡眠结构紊乱和睡眠片段化.依据RDI对患者的病情分级,大多数OSAHS患者为轻、中度,但缺氧程度较重,缺氧严重度与BMI和睡眠呼吸事件的持续时间相关,侧卧睡眠时缺氧程度减轻.