基于谱分析的阻塞型睡眠呼吸暂停研究

目的本文研究发生阻塞型睡眠呼吸暂停时患者的心率功率谱及血压功率谱结构与正常睡眠的差异.方法采用AR模型估计心率及血压的功率谱,并提取低频分量与高频分量的比值(LF/HF)作为特征参数,考察发生阻塞型睡眠呼吸暂停时功率谱结构的变化.结果发生阻塞型睡眠呼吸暂停时LF/HF是正常睡眠时的2～5倍,表明患者在此时的交感神经活动增强,迷走神经活动减弱.     

阻塞型睡眠呼吸暂停综合征与动脉粥样硬化

阻塞型睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）是临床上常见的重要慢性睡眠呼吸疾病。近年来的研究已证实，OSAS是动脉粥样硬化性疾病的独立危险因素。OSAS患者在睡眠时由于上气道阻塞或部分阻塞导致反复发作的慢性间歇性缺氧，这可能是其诱发动脉粥样硬化性疾病的重要原因，此过程中可能的分子机制包括：I-κB复合物和P38激酶激活调控NF-κB信号通路；端粒酶和Fas死亡配体依赖性细胞凋亡调控途径；间歇性缺氧诱发肝脏损伤导致高胆固醇血症和脂质过氧化反应代谢紊乱，引起不可逆的血管和周围组织重塑，伴有平滑肌增生和纤维化，导致动脉粥样硬化。     

呼吸暂停检测方法的进展

呼吸暂停检测方法的进展徐圣普，臧淑琴综述林淑娟审中国医学科学院生物医学工程研究所关键词：呼吸暂停，检测，判断，信号，阈值１引言呼吸暂停综合症是危及人类正常生命活动的疾病之一，由于呼吸暂停的发生是在夜间睡眠过程中，以至很长时间以来被忽视了其危害性和普遍...     

睡眠呼吸暂停监测方法及仪器的研究

介绍了睡眠呼吸暂停监测的基本原理和重要意义,阐述了国内外该领域研究的现状,分析了睡眠呼吸暂停监测的几种方法。在此基础上,研制出了价格低廉的便携式睡眠呼吸暂停监测仪。实验结果表明该仪器使用方便,精度高,性能可靠。     

CPAP治疗阻塞型睡眠呼吸暂停综合征前后患者血清IL-6和TNF-α的动态变化

目的：通过研究阻塞型睡眠呼吸暂停综合征（OSAS）患者血浆白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的水平及经持续气道正压通气（CPAP）治疗前后的变化,探讨IL-6和TNF-α在OSAS患者发病机制及病理生理中的作用。方法：①选择我院OSAS患者60例及正常人30例,详细询问病史,对所有观察对象于晨起采集静脉血标本,采用放射免疫分析集中检测血浆IL-6、TNF-α水平。比较OSAS组与对照组间血浆IL-6、TNF-α水平的差异;分析OSAS患者血浆IL-6、TNF-α水平与睡眠呼吸暂停低通气指数（AHI）和最低血氧饱和度的相关性。②OSAS组患者进行CPAP治疗并随访,3个月后复查上述各项指标,比较OSAS患者经CPAP治疗前后血浆IL-6、TNF-α水平等指标变化。结果：OSAS组患者血浆IL-6和TNF-α水平分别为（25.92±4.48）pg/ml,（11.27±2.60）pg/ml。较对照组升高（13.21±1.97）pg/ml,（5.83±0.99）pg/ml差异有统计学意义。②OSAS患者血浆IL-6和TNF-α水平与其AHI均呈正相关,相关系数分别为0.456（P〈0.05）,0.464（P〈0.05）。OSAS患者血浆IL-6和TNF-α水平与其最低血氧饱和度均呈负相关,相关系数分别为-0.495（P〈0.05）,-0.483（P〈0.05）。③OSAS患者进行CPAP治疗并随访,3个月后回访20例,再次测定血浆IL-6、TNF-α水平,分别为（15.37±1.78）pg/ml,（6.79±0.87）pg/ml较治疗前减低,差异有统计学意义。结论：CPAP治疗能有效地降低OSAS患者的血浆IL-6及TNF-α水平。     

一种基于改进人工蜂群算法优化支持向量机的睡眠呼吸暂停检测方法

目的 睡眠呼吸暂停综合征(sleep apnea syndrome, SAS)是由于睡眠时上气道通气不畅或堵塞引起的呼吸暂停或低通气,严重影响人类健康和生活。目前的检测方法是多导睡眠仪,检测过程较为复杂,影响患者正常睡眠。为此本文提出了一种针对血氧饱和度信号的引入交叉变异的全局混沌人工蜂群(cross global chaos artificial bee colony, CGCABC)算法优化支持向量机(support vector machine, SVM)的SAS检测方法。方法 从数据集ISRUC-SLEEP中提取25名SAS患者整晚8 h的脉搏血氧饱和度数据,经预处理后对每段数据计算5种非线性特征,包括近似熵、模糊熵、信息熵、排列熵和样本熵。比较发病片段信号特征和未发病片段信号特征之间的差异,使用CGCABC算法优化的SVM模型进行分类检测,并与人工蜂群(artificial bee colony, ABC)算法、粒子群(particle swarm optimization, PSO)算法、麻雀搜索(sparrow search, SS)算法优化SVM模型的检测结果进行对比。...     

利用ECG信号检测睡眠呼吸暂停的小波包分析方法

文章根据睡眠呼吸暂停与心率变化的关系。阐述了从心电图中检测睡眠呼吸暂停的方法。该方法首先通过对心率信号进行小波包变换，提取特征向量，然后根据特征向量的变化检测出睡眠呼吸暂停的位置和分布。结果表明，该方法物理意义明确，诊断结果精度高，为睡眠呼吸暂停综合症的早期诊断、监护及预后评估提供了新的分析工具。     

基于多通道的睡眠呼吸暂停检测

目的 为了提高检测性能和验证不同生理信号对睡眠呼吸暂停的检测结果,本文提出一种信号叠加和通道相加检测睡眠呼吸暂停的方法。方法 首先对100例睡眠呼吸障碍患者的心电(electrocardiogram, ECG)和脑电(electroencephalogram, EEG)信号通过小波阈值方法进行预处理,其次进行通道相加和信号叠加,然后通过Relief特征选择算法对30个特征进行分析,最后采用支持向量机(support vector machine, SVM)构建睡眠呼吸暂停分类模型,并验证该模型的准确性。结果 实验结果表明,通道相加和信号叠加时睡眠呼吸暂停检测的最高准确率分别为96.24%和96.18%。结论 ECG和EEG两种信号叠加和通道相加的方法均可提高睡眠呼吸暂停检测结果,且X2(ECG)和C3-A2(EEG)通道相加检测结果最好。     

一种呼吸信号的检测方法

探讨呼吸波形的检测方法,针对现有方法的不足,提出了从肌电提取呼吸信号的检测方法—肌电频谱法。该方法首先利用FastICA算法消除胸部肌电信号中的心电信号成分,再对处理后的信号进行短时傅立叶变换,提取平均平移曲线得到呼吸波形。通过仿真及对实际信号的处理,表明该方法简单有效,可以准确地从肌电信号中提取呼吸信号。     

我国成人阻塞性睡眠呼吸暂停低通气综合征患病率的Meta分析

目的 通过对我国2000~2017年阻塞性睡眠呼吸暂停低通气综合征流行病学研究的系统回顾,了解我国目前OSAHS整体患病率情况,为该病的科普及健康教育提供依据。方法 计算机检索中国知网数据库、万方数据库、中文科技期刊全文数据库、PubMed、Web of Science等中英文数据库,辅助参考文献追溯及特定文献检索,查找我国成人OSAHS流行病学调查。由2人进行独立检索,利用NoteExpress和Endnote x7文献管理软件进行文献梳理,通过逐步筛选评价,得到研究对象选取方法、诊断标准相同的14项研究,进行OSAHS患病率的Meta分析。结果 我国2000~2017年成人OSAHS总患病率为3.93%[95%CI（3.14%,4.73%）]。亚组分析显示:在性别上,男女OSAHS患病率分别为5.19%[95%CI（4.14%,7.23%）]、2.17%[95%CI（1.00%,3.34%）];各年龄段患病率分别为20~29岁为2.28%[95%CI（0.93%,3.63%）]、30~39岁为2.70%[95%CI（1.42%,3.97%）]、40~49岁为4.91%[95%CI（3.32%,6.50%）]、50~59岁为5.05%[95%CI（3.70%,6.40%）]、60~69岁为2.55%[95%CI（1.54%,3.56%）]。我国OSAHS患病率在性别、年龄存在差异,在研究发表时间未发现明显差异。结论 OSAHS为慢性源头性疾病,在未来的OSAHS流行病学调查中应关注合并症、个人体征、社会学信息与该疾病的相关关系,为进一步了解我国成人OSAHS流行病学分布情况提供依据。     

Obstructive Sleep Apnea Is Associated With Late-Onset Preeclampsia in Overweight Pregnant Women in Korea

BackgroundObstructive sleep apnea (OSA) is closely related to maternal obesity in pregnant women, and the association increases with later pregnancy. Obesity and OSA are risk factors of pregnancy-related complications, including gestational hypertension, gestational diabetes mellitus (GDM), and fetal morbidities. We aimed to determine the prevalence of OSA and to assess the impact of OSA on pregnancy-related disorders in overweight pregnant women.MethodsEligible participants who were overweight [body mass index (BMI) ≥ 23 kg/m²] in gestational age 30 weeks or more, assessed OSA using a portable polysomnography at home. Clinical data were collected from pregnant women and their babies.ResultsThe average age of 51 participants was 34.5 years (27–44 years). The number of primipara was 25 (49%) and that of multipara was 26 (51%). Eight cases of GDM (15.7%) and five cases of preeclampsia (9.8%) were reported, and six patients (11.8%) experienced preterm delivery. In results of polysomnography, 14 patients (27.5%) were diagnosed as OSA. Apnea-hypopnea index moderately correlated with BMI (r = 0.515, P < 0.001). The BMI (P < 0.005) and preeclampsia rate (P < 0.017) were higher in the OSA group compared to the control group. Odds ratios (ORs) adjusting age, BMI, parity, and abortion history were calculated. The presence of OSA increased OR of preeclampsia (OR, 13.1; 95% confidence interval, 1.1–171.3). The majority of preeclampsia patients (4/5, 80%) underwent preterm delivery.ConclusionOSA is an important risk factor for preeclampsia, resulting in preterm delivery. For overweight pregnant women, an OSA evaluation should be mandatory.     

阻塞性睡眠呼吸暂停的遗传学研究

阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）的遗传学研究尚处在初期,但迄今研究提示OSA有很强的遗传背景,其发病存在着家族聚集性且与相关中间表型有关,如与颅面结构、体内脂肪分布和呼吸调控的异常等有关。目前认为OSA的发病很可能是多基因与环境因素交互作用的结果。对OSA的分子遗传学研究可帮助理解OSA的病因和发病机理,并能促进对OSA的基因诊断和预防。     

Prevalence of Snoring and High Risk of Obstructive Sleep Apnea Syndrome in Young Male Soldiers in Korea

There are little information on prevalence of obstructive sleep apnea syndrome (OSAS) and clinical features in the young military population. The purpose of this study was to estimate the prevalence of snoring and high risk of OSAS in young male soldiers in Korea and to identify the risk factors of OSAS. A total of 665 participants (aged 20-23 yr) who visited the Armed Forces Ildong Hospital for regular physical examination were enrolled. All participants completed the Berlin Questionnaire and underwent a physical examination. The participants with high risk for OSAS completed portable sleep monitoring. The prevalence of snoring and high risk of OSAS in young male soldiers in Korea was 13.5% and 8.1%, respectively. The prevalence of high arched palate, tongue indentation, long uvula, large tonsil and retrognathia was significantly higher in the high risk OSAS group. High arched palate, long uvula or low lying soft palate, tonsil size III or IV, Epworth Sleepiness Scale score > 10 and obesity (BMI > 27 kg/m²) were found to independently predict OSAS. For early identification and treatment of young soldiers with OSAS in a military environment, a precise screening by questionnaire and physical examination is needed.     

Comparative associations of oximetry patterns in Obstructive Sleep Apnea with incident cardiovascular disease

Study ObjectivesIntermittent hypoxia is a key mechanism linking Obstructive Sleep Apnea (OSA) to cardiovascular disease (CVD). Oximetry analysis could enhance understanding of which OSA phenotypes are associated with CVD risk. The aim of this study was to compare associations of different oximetry patterns with incident CVD in men and women with OSA.MethodsSleep Heart Health Study data were used for analysis. n = 2878 Participants (51.8% female; mean age 63.5 ± 10.5 years) with OSA (Apnea Hypopnea Index [AHI] ≥ 5 events/h) and no pre-existing CVD at baseline or within the first 2 years of follow-up were included. Four oximetry analysis approaches were applied: desaturation characteristics, time series analysis, power spectral density, and non-linear analysis. Thirty-one resulting oximetry patterns were compared to incident CVD using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex.ResultsThere were no associations between OSA oximetry patterns and incident CVD in the total sample or in men. In women, there were some associations between incident CVD and time series analysis (e.g. SpO₂ distribution standard deviation, HR 0.81, 95% CI 0.68–0.96, p = 0.014) and power spectral density oximetry patterns (e.g. Full frequency band mean HR 0.75; 95% CI 0.59–0.95; p = 0.015).ConclusionsComprehensive comparison of baseline oximetry patterns in OSA found none were related to development of CVD. There were no standout individual oximetry patterns that appear to be candidates for CVD risk phenotyping in OSA, but some showed marginal relationships with CVD risk in women. Further work is required to understand whether OSA phenotypes can be used to predict susceptibility to cardiovascular disease.     

The roles of depression and anxiety in the understanding and treatment of Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome (OSAS) is a debilitating condition stemming from disruption to the respiratory system during sleep. At present, the nature of the relationship between OSAS and mood, specifically depression and anxiety, is still unclear. The purpose of this paper is to shed some light on this relationship. PsycINFO was used to locate relevant papers on this topic. This literature search formed the basis of our investigation. Results showed that the anxiety and depression methodology is weak. It is now clear that there is an urgent need to better understand the roles of anxiety and depression in OSAS. For example, the research literature suggests that depression and anxiety covary with OSAS. However, because of methodological issues, such as difficulties involved in diagnosis and the use of inappropriate instruments, this conclusion remains tenuous. Future directions are discussed.     

Effects of Continuous Positive Airway Pressure on Sleep State Misperception in Patients With Obstructive Sleep Apnea

BackgroundLittle is known regarding the effects of continuous positive airway pressure (CPAP) on sleep misperception in obstructive sleep apnea (OSA).MethodsSleep state perception was measured by subtracting the objective total sleep time from the subjective sleep duration. Sleep underestimation and overestimation were defined as ± 60 minutes sleep perception. Insomnia and depressive symptoms were assessed using questionnaires. Finally, nonparametric statistical analyses were performed.ResultsOf the 339 patients with OSA included in the study, 90 (26.5%) and 45 (13.3%) showed sleep underestimation and overestimation, respectively. Overall, a significant underestimation of sleep was noted during CPAP titration comparing to a diagnostic PSG (P < 0.001). OSA patients with insomnia or depressive symptoms did not show any changes in sleep perception between diagnostic and CPAP titration studies, whereas those without insomnia or depressed mood showed significantly underestimated sleep duration during CPAP titration. Patients with OSA and either underestimated or overestimated misperception showed perceptual improvements during CPAP titration regardless of the presence of insomnia or depressive symptoms. However, of 204 patients with normal sleep perception, 138 (67.6%) and 10 (4.9%) had underestimation and overestimation of sleep during CPAP titration.ConclusionCPAP titration may improve sleep perception with moderate to severe OSA who have sleep misperception. However, CPAP titration may result in sleep misperception especially underestimation of sleep in those who have normal sleep perception.     

Monitoring Obstructive Sleep Apnea by means of a real-time mobile system based on the automatic extraction of sets of rules through Differential Evolution

Real-time Obstructive Sleep Apnea (OSA) episode detection and monitoring are important for society in terms of an improvement in the health of the general population and of a reduction in mortality and healthcare costs. Currently, to diagnose OSA patients undergo PolySomnoGraphy (PSG), a complicated and invasive test to be performed in a specialized center involving many sensors and wires. Accordingly, each patient is required to stay in the same position throughout the duration of one night, thus restricting their movements.This paper proposes an easy, cheap, and portable approach for the monitoring of patients with OSA, which collects single-channel ElectroCardioGram (ECG) data only. It is easy to perform from the patient’s point of view because only one wearable sensor is required, so the patient is not restricted to keeping the same position all night long, and the detection and monitoring can be carried out in any place through the use of a mobile device.Our approach is based on the automatic extraction, from a database containing information about the monitored patient, of explicit knowledge in the form of a set of IF…THEN rules containing typical parameters derived from Heart Rate Variability (HRV) analysis. The extraction is carried out off-line by means of a Differential Evolution algorithm. This set of rules can then be exploited in the real-time mobile monitoring system developed at our Laboratory: the ECG data is gathered by a wearable sensor and sent to a mobile device, where it is processed in real time. Subsequently, HRV-related parameters are computed from this data, and, if their values activate some of the rules describing the occurrence of OSA, an alarm is automatically produced.This approach has been tested on a well-known literature database of OSA patients. The numerical results show its effectiveness in terms of accuracy, sensitivity, and specificity, and the achieved sets of rules evidence the user-friendliness of the approach. Furthermore, the method is compared against other well known classifiers, and its discrimination ability is shown to be higher.     

The Utility of Three Screening Questionnaires for Obstructive Sleep Apnea in a Sleep Clinic Setting

Purpose

The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea.

Materials and Methods

Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire.

Results

The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) ≥5/h and 58.4% for an AHI ≥15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI ≥5/h, 98% for AHI ≥15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI ≥5/h, 74% for AHI ≥15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ.

Conclusion

The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting.     

Obstructive Sleep Apnea: A Risk Factor for Work Disability

Study Objective:

To examine obstructive sleep apnea (OSA) as a risk factor for work disability.

Patients and Setting:

Consecutive patients referred to the University of California San Francisco Sleep Disorders Center with suspected OSA (n = 183).

Design:

All patients underwent overnight polysomnography after completing a written survey which assessed work disability due to sleep problems, occupational characteristics and excessive daytime sleepiness (EDS) defined as an Epworth Sleepiness Scale score > 10.

Results:

Among 150 currently employed patients, 83 had OSA on polysomnography (apnea-hypopnea index ≥ 5). Compared with patients in whom both OSA and EDS were absent, patients with the combination of OSA and EDS were at higher risk of both recent work disability (adjusted odds ratio [OR], 13.7; 95% confidence interval [CI], 3.9–48) and longer-term work duty modification (OR, 3.6; CI, 1.1–12). When either OSA or EDS were absent, the strength of the association with work disability was less than when both OSA and EDS were present. When OSA was examined without respect to EDS, patients with OSA were at increased risk of recent work disability relative to patients without OSA (OR 2.6; 95% CI 1.2–5.8), but the association of OSA with longer-term work duty modification did not meet standard criteria for statistical significance (OR = 2.0, 95% CI 0.8–5.0).

Conclusions:

The combination of OSA and EDS contributes to work disability, and OSA by itself contributes to recent work disability. These findings should highlight to employers and clinicians the importance of OSA in the workplace to encourage patients to be screened for OSA, particularly in situations of decreased productivity associated with EDS.

Citation:

Omachi TA; Claman DM; Blanc PD; Eisner MD. Obstructive sleep apnea: a risk factor for work disability. SLEEP 2009;32(6):791-798.