无创正压通气在阻塞性睡眠呼吸暂停综合征治疗中的应用

成人睡眠呼吸暂停综合征包括阻塞型睡眠呼吸暂停低通气综合征(OSAHS)、中枢型睡眠呼吸暂停综合征(CSAS)、睡眠低通气综合征(SHS)等,临床上以OSAHS最为常见。OSAHS是指各种原因引起睡眠状态下反复出现呼吸暂停和低通气,夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱,病情逐渐     

睡眠呼吸暂停低通气综合征患者无创正压通气治疗的依从性

本文探讨了睡眠呼吸暂停低通气综合征(SAHS)依从性的定义及其测量方法。SAHS患者的主观症状及治疗反应和病情轻重程度都会影响患者的依从性，而加强对患者教育和改进无创通气技术将有助于提高患者无创正压通气的依从性。     

睡眠呼吸暂停低通气综合征患者无创正压通气治疗的依从性

本文探讨了睡眠呼吸暂停低通气综合征 (SAHS)依从性的定义及其测量方法。SAHS患者的主观症状及治疗反应和病情轻重程度都会影响患者的依从性 ,而加强对患者教育和改进无创通气技术将有助于提高患者无创正压通气的依从性     

无创持续气道正压通气治疗睡眠呼吸暂停综合征的护理

无创持续气道正压通气是目前治疗睡眠呼吸暂停综合征的不开刀、最简单有效的方法。我科自2002年5月1日～2005年12月31日,采用此方法共治疗了136例患者,取得了良好的效果。现将护理体会介绍如下。1治疗前护理心理护理:由于患者此前从未见过、使用过呼吸机,一听到呼吸机以为是频死患者才用的抢救器材,普遍存在恐惧心理。首先,护士必须尊重患者,对其提出的问题要耐心细致地解释,详细介绍呼吸机治疗既不要插管也不要气管切开,是用面罩安在鼻子上进行正压通气,给于气道一定压力,无创伤、无痛苦、简单有效,并且介绍同种疾病的治疗情况,减轻其恐惧…     

82例睡眠呼吸暂停低通气综合征的诊断与无创正压通气治疗

目的探讨睡眠呼吸暂停综合征(SAHS)的诊断及自动调节持续气道内正压通气(auto-CPAP)对SAHS的治疗价值。方法82例SAHS患者,均行整夜的多导睡眠仪监测,并对18例中重度患者进行auto-CPAP治疗。结果SAHS患者随病情加重Epworth评分、呼吸紊乱程度、最长呼吸暂停时间、鼾声指数、氧减指数等参数明显增加,最低氧饱和度明显降低。Auto-CPAP治疗后呼吸紊乱和低氧血症的程度显著减轻,中枢性呼吸暂停的次数及所占时间没有明显改变。Epworth评分与呼吸紊乱、低氧血症以及打鼾的的时间和次数有明显的相关关系。结论Auto-CPAP可有效的治疗中重度SAHS患者,消除阻塞性及混合性呼吸暂停,减轻低氧血症,明显改善症状,并具有良好的接受性。夜间频繁出现的低氧血症是导致日间过度嗜睡的重要因素。     

儿童睡眠呼吸暂停低通气综合征及无创通气治疗

儿童睡眠呼吸暂停低通气综合征(SAHS)在流行病学、病因、诊断、临床表现、病理生理及治疗方面与成人有很大差异，大多数患儿手术切除扁桃体及／或腺样体效果良好，但仍有部分患儿需家庭无创机械通气治疗，本文将儿童SAHS及应用无创通气治疗的研究进展进行综述。     

儿童睡眠呼吸暂停低通气综合征及无创通气治疗

儿童睡眠呼吸暂停低通气综合征 (SAHS)在流行病学、病因、诊断、临床表现、病理生理及治疗方面与成人有很大差异 ,大多数患儿手术切除扁桃体及 /或腺样体效果良好 ,但仍有部分患儿需家庭无创机械通气治疗 ,本文将儿童SAHS及应用无创通气治疗的研究进展进行综述     

正压通气治疗阻塞性睡眠呼吸暂停综合征

目的 观察持续正压通气（CPAP)对阻塞性睡眠呼吸暂停综合征（OSAS）的治疗效果。方法 应用CPAP呼吸机治疗11例OSAS患,通过多导睡眠图（PSG）的监测结果判断治疗效果。结果 11例OSAS患应用CPAP治疗后,PSG检测结果提示睡眠结构紊乱改善,浅睡稍有减少,深睡增加;低通气次数、阻塞性呼吸暂停次数、呼吸紊乱指数明显减少（P＜0．01）,睡眠时最低血氧饱和度明显增加（P＜0．01）,病情显改善。结论 CPAP的应用使气道保持一定的正压,特别是呼气相,能明显改善液间气道阻塞,进而阻止气道阻塞引起的低氧血症,临床治疗效果显。     

无创正压通气在睡眠呼吸暂停中的应用与护理

目的为了减轻阻塞性睡眠呼吸暂停简称(OSAHS)患者的打鼾时睡眠呼吸暂停,提高患者的生命质量,减少因睡眠呼吸暂停引起的并发症;如高血压,心脏病等。方法睡眠中心对10例OSAHS进行无创持续正压通气治疗。结果10例患者均能纠正夜间低氧血症、呼吸暂停的症状,无并发症。结论无创CPAP是治疗OSAHS的良好方法。     

阻塞性睡眠呼吸暂停综合征的无创正压通气治疗

阻塞性睡眠呼吸暂停综合征（OSAHS）是较常见的呼吸道疾患,其特征是在夜间睡眠中反复发生上气道完全和（或）不完全阻塞,导致阻塞性睡眠呼吸暂停,伴有间断低氧血症或高碳酸血症。国外流行病学调查显示,成人OSAHS患病率为2％-4％,习惯性打鼾者中64％为OSAHS患者,尤以老年及老年鼾症者OSAHS的检出率高。自1981年澳大利亚学者首次报道用持续气道正压通气（CPAP）成功治疗OSAHS以来,无创通气已成为中、重度OSAHS患者最常用的治疗手段,其中无创正压通气（NIPPV）是其首选治疗方法,其疗效肯定。     

阻塞型睡眠呼吸暂停低通气综合征患者CPAP治疗依从性的研究进展

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）是一种影响患者生活质量、工作效率以及增加心血管疾病发病率和死亡率风险的常见疾病。持续正压通气（continuous positive airway pressure,CPAP）治疗是当前中重度OSAHS患者的一线治疗手段,在改善打鼾、白天嗜睡等症状,降低高血压、冠心病等并发症的发生风险等方面效果肯定。但部分患者在临床上很难做到长期治疗,依从性差,导致治疗疗效变不佳,疾病控制率降低。因此,依从性已经成为CPAP治疗过程中存在的一个重要问题。目前研究发现,影响CPAP治疗依从性的因素较多,且个体差异也较大。常见的影响CPAP治疗依从性的因素,包括患者一般情况（如性别、年龄、种族、文化程度、吸烟状况）、疾病情况、心理因素以及CPAP治疗副作用,而提高患者的CPAP使用教育、改变患者认知行为、应用远程医疗监控、以及改善CPAP治疗副作用等干预措施,对于提高OSAHS治疗的依从性具有重要作用。     

OSAHS 患者经 CPAP 治疗后对内皮功能影响临床研究

目的：探讨持续气道正压通气(CPAP)1年后对 OSAHS 患者内皮功能的影响。方法经多导睡眠图(PSG)监测确诊为 OSAHS 组患者66例(男54例,女12例),中位年龄41(20~58)岁。正常对照组54例(男45例,女9例),中位年龄42(18~59)岁。OSAHS 患者(62例)接受 CPAP 治疗,12个月后复查各项指标。各组均于 PSG 监测后采空腹静脉血,应用流式细胞仪检测内皮细胞凋亡(CD146 AnnV+)水平。结果与对照组比较,OSAHS 组内皮细胞凋亡水平升高,差异有统计学意义(P 值均<0.01)。OSAHS 组患者 CD146 AnnV+水平与 AHI、SLT0.9、LSAT、ODI 呈显著正相关(r 值分别0.73、0.61、0.66、0.67,P 值均<0.05),与 SaO 2 min 呈显著负相关(r =-0.61,P <0.01)。CPAP 治疗1年后 AHI、SLT0.9、LSAT、ODI 下降及 SaO 2 min 升高,CD146 AnnV+水平下降,差异均有统计学意义(P值均<0.05)。结论 OSAHS 患者血管内皮功能受损的发病机制与血管内皮细胞凋亡异常相关。CPAP 治疗可显著改善 OSAHS 患者缺氧、降低 CD146 AnnV+水平,改善血管内皮功能。     

无创性 CPAP 治疗在 OSAHS 合并缺血性心脏病中的临床应用简

目的 探讨长期无创性持续气道内正压通气（CPAP）治疗阻塞型睡眠呼吸暂停低通气综合征（OSAHS）合并缺血性心脏病（IHD）患者的临床疗效.方法 将64例确诊患者随机分为两组.治疗组在传统的内科治疗基础上加用整夜的CPAP治疗,对照组仅采用传统的内科治疗手段.监测两组治疗前后的PSG参数、ECG变化和临床症状改善.结果 治疗组的AHI、MinSpO2、SpO2〈90%占睡眠时间的改善率显著,ST段下降和T波改变明显改善、临床症状亦明显缓解（P〈0.01）.结论 在内科药物治疗基础上采用持续CPAP治疗OSAHS合并IHD效果显著,值得临床推广应用.     

In patients with minimally symptomatic OSA can baseline characteristics and early patterns of CPAP usage predict those who are likely to be longer-term users of CPAP

Background

Long-term continuous positive airway pressure (CPAP) usage varies between individuals. It would be of value to be able to identify those who are likely to benefit from CPAP (and use it long term), versus those who would not, and might therefore benefit from additional help early on. First, we explored whether baseline characteristics predicted CPAP usage in minimally symptomatic obstructive sleep apnoea (OSA) patients, a group who would be expected to have low usage. Second, we explored if early CPAP usage was predictive of longer-term usage, as has been shown in more symptomatic OSA patients.

Methods

The MOSAIC trial was a multi-centre randomised controlled trial where minimally symptomatic OSA patients were randomised to CPAP, or standard care, for 6 months. Here we have studied only those patients randomised to CPAP treatment. Baseline characteristics including symptoms, questionnaires [including the Epworth sleepiness score (ESS)] and sleep study parameters were recorded. CPAP usage was recorded at 2–4 weeks after initiation and after 6 months. The correlation and association between baseline characteristics and 6 months CPAP usage was assessed, as was the correlation between 2 and 4 weeks CPAP usage and 6 months CPAP usage.

Results

One hundred and ninety-five patients randomised to CPAP therapy had median [interquartile range (IQR)] CPAP usage of 2:49 (0:44, 5:13) h:min/night (h/n) at the 2–4 weeks visit, and 2:17 (0:08, 4:54) h/n at the 6 months follow-up visit. Only male gender was associated with increased long-term CPAP use (male usage 2:56 h/n, female 1:57 h/n; P=0.02). There was a moderate correlation between the usage of CPAP at 2–4 weeks and 6 months, with about 50% of the variability in long-term use being predicted by the short-term use.

Conclusions

In patients with minimally symptomatic OSA, our study has shown that male gender (and not OSA severity or symptom burden) is associated with increased long-term use of CPAP at 6 months. Although, in general, early patterns of CPAP usage predicted longer term use, there are patients in whom this is not the case, and patients with low initial usage may need to extend their CPAP trial before a decision about longer-term use is made.     

CPAP对中重度OSAS合并右心衰竭的疗效观察

目的 探讨持续气道内正压通气（CPAP）对中重度阻塞性睡眠呼吸暂停综合征（OSAS）合并右心衰竭患者的治疗作用.方法 收集60例中重度的OSAS合并右心衰竭患者,随机分为对照组和CPAP治疗组.对照组给予常规治疗,治疗组在常规治疗基础上加用CPAP,6个月后观察两组的临床症状、动脉血气分析、肺动脉压、六分钟步行实验变化.结果 CPAP可改善OSAS合并右心衰竭患者的临床症状、动脉血气分析、肺动脉压、以及六分钟步行实验（P〈0.05）.结论 CPAP对中重度OSAS合并右心衰竭患者有较好的治疗效果.     

Evaluating changes in pulse transit time drop index in patients with obstructive sleep apnea before and during CPAP therapy

Airflow limitation in patients with obstructive sleep apnea (OSA) leads to arousal, increased sympathetic nervous system activity, and elevated blood pressure, which causes a decrease in pulse transit time (PTT). The present study aims to evaluate the effect of CPAP therapy on PTT in patients with moderate to severe OSA. This was a cross‐sectional study. Split‐night polysomnography (PSG) study was performed for each participant with apnea‐hypopnea index (AHI) ≥ 15 before and during CPAP therapy. The PTT was calculated as the time interval between the R wave of the electrocardiogram and the following arrival point in fingertip photoplethysmography. PTT drop was defined as a fall in the PTT curve of ≥15 ms lasting at least for 3 s and at most for 30 s. PTT drop index was defined as the number of drops in PTT that occur per hour of sleep. A total of 30 patients were included. PTT significantly increased, and PTT drop index significantly decreased during CPAP therapy (P < 0.001). PTT was significantly correlated to sleep efficiency (r _s = −0.376, P = 0.049) and oxygen desaturation index (ODI) (r _s = −0.428, P = 0.018). PTT drop index was strongly correlated to AHI (r _s = 0.802, P < 0.001), respiratory disturbance index (RDI) (r _s = 0.807, P < 0.001), ODI (r _s = 0.693, P < 0.001), arousal index (r _s = 0.807, P < 0.001), and periodic leg movement (PLM) index (r _s = 0.400, P = 0.035). Overall, the findings from this study indicated that the PTT drop index is a non‐invasive and useful marker for evaluating the severity of OSA and the effectiveness of treatment in patients with moderate to severe OSA.     

OSAHS患者nCPAP治疗前后血管活性物质变化与血压的关系

目的观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清内皮素（ET-1）、-氧化氮（NO）及血栓素A2（TXA2）与前列环素Ⅰ（PGⅠ2）失衡和血压的关系及经鼻持续气道内正压通气（nCPAP）的治疗作用。方法选择OSAHS无原发性高血压（EH）者（A组）、OSAHS合并EH者（B组）、正常对照（C组）,三组均行多导睡眠呼吸监测,用袖带加压法观察血压,测定三组血浆ET-1、6-酮-PGF1α、TXB2、NO水平。结果与C组比较,A、B组nCPAP治疗前睡眠呼吸暂停低通气指数（AHI）、ET-1／NO、TXB：／6-酮-PGFα增高,最低SaO2下降;nCPAP治疗后则情况相反,与治疗前比较差异有统计学意义（P〈0．05）。A组ET-1／NO、TXB2／6-酮-PGF1α分别与AHI和最低SaO：明显相关,B组MBP分别与ET／NO、TXB2／6-酮-PGF1α、AHI及最低Sa02明显相关。结论①OSAHS患者血管舒缩因子比例失衡可能在OSAHS合并EH中起-定作用。②nCPAP治疗OSAHS合并EH有确切疗效。     

The differences in plasma/serum ghrelin levels between obstructive sleep apnea-hypopnea patients and controls: A protocol for systematic review and meta-analysis

Background:The association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and plasma/serum ghrelin levels remains controversial. We performed a meta-analysis to evaluate the difference in plasma/serum ghrelin levels between OSAHS patients and controls.Methods:Database of PubMed, SCI, and Elsevier were searched entirely. Two independents identified eligible studies of ghrelin levels in OSAHS patients. ReviewManager (version 5.3) was adopted for data synthesis.Results:The meta-analysis A pooled the comparison of ghrelin concentrations in OSAHS patients and controls, which included 7 studies and involving 446 participants. The result of the meta-analysis A indicated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group (standard mean difference (SMD) = 0.08, 95% confidence interval (CI) = −0.12 to 0.28, P = .43). As a supplementary, meta-analysis B pooled the comparison of plasma/serum ghrelin levels in OSAHS patients before and after continuous positive airway pressure (CPAP) therapy, which included 155 participants from 4 studies, it revealed that plasma/serum ghrelin levels were no significant differences between before and after CPAP therapy (SMD = 0.12, 95%CI = −0.07 to 0.31, P = .22).Conclusion:The meta-analysis A demonstrated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group. The meta-analysis B showed plasma/serum ghrelin levels have no significant changes after CPAP therapy in OSAHS patients.     

持续正压通气辅助治疗高血压并发睡眠呼吸暂停综合征的临床研究

目的探讨持续正压通气辅助治疗高血压并发睡眠呼吸暂停综合征（SAS）对血压的影响。方法41例高血压并发睡眠呼吸暂停综合征病人,随机分为常规组（21例）和持续正压通气治疗组（20例）均给予常规降压药物治疗4周,治疗在常规治疗基础上加用气道持续正压通气治疗,观察两组治疗前后24 h血压变化。结果治疗组治疗后24 h平均收缩压、舒张压进一步降低,夜间收缩压及舒张压则显著降低（P〈0.01）。结论高血压并发睡眠呼吸暂停综合征病人,在常规应用降压药物同时应用持续正压通气辅助治疗血压下降更理想。