口腔矫治器治疗不同严重程度阻塞性睡眠呼吸暂停的疗效分析

目的 分析口腔矫治器治疗不同严重程度阻塞性睡眠呼吸暂停(OSA)的疗效。方法 选择2009年12月至2019年10月广西壮族自治区人民医院口腔正畸科收治的OSA或单纯鼾症患者74例。根据多导睡眠图(PSG)检查结果将其分为轻度OSA组(18例)、中度OSA组(18例)、重度OSA组(21例)和单纯鼾症组(17例),各组均接受下颌前移口腔矫治器治疗。比较四组治疗前后睡眠指标和呼吸指标的变化情况。结果 与治疗前比较,轻度OSA组的N3期占比升高,中度OSA组的觉醒指数(ArI)降低,重度组N1期占比降低,差异均有统计学意义(P<0.05)。与治疗前比较,轻度OSA组呼吸暂停指数(AI)、低通气指数(HI)、呼吸暂停低通气指数(AHI)、最长呼吸暂停时间、最长低通气持续时间均减少,睡眠状态下最低血氧饱和度(LSpO₂)上升;中度OSA组AI、HI、AHI、最长呼吸暂停时间均减少,睡眠状态下LSpO₂上升;重度OSA组AI、HI、AHI、最长呼吸暂停时间、最长低通气持续时间均减少,睡眠状态下LSpO₂、清醒状态下平均血氧饱...     

阻塞性睡眠呼吸暂停低通气综合征患者使用口腔矫治器对颞下颌关节功能的影响

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者使用口腔矫治器治疗对颞下颌关节功能的影响。方法选择2013年5月-2017年12月,在本院呼吸睡眠中心就诊并具有完整临床资料的OSAHS患者。随机分为口腔矫治器组和CPAP治疗组。比较两组治疗后的临床疗效及TMD发病率、慢性疼痛严重程度和颞下颌关节的功能损伤情况。结果治疗前后比较,两组患者PSG、ESS监测相关指标均明显改善。6个月时CPAP组各指标改善优于口腔矫治器组。口腔矫治器组疼痛疾病为主型TMD的发病率高于CPAP组,差异有统计学意义(P 0. 05)。两组下颌关节功能损伤程度无明显差异(P 0. 05)。结论 OSAHS患者使用口腔矫治器治疗疼痛疾病为主型TMD的发病率明显增加,对下颌功能的影响与CPAP治疗比较无明显差异。     

口腔矫正器治疗阻塞性睡眠呼吸暂停综合征的临床观察

目的探讨口腔矫正器对３６例阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者的临床疗效。方法制作“下颌前移型”矫正器让３６例ＯＳＡＳ患者在睡眠时配戴,用多导睡眠图监测患者治疗前后呼吸紊乱指数（ＡＨＩ）、夜间最低血氧饱和度（最低ＳａＯ２）与最长呼吸暂停时间（Ｔ）,用ｔ检验进行统计学比较。结果使用口腔矫正器后患者的ＡＨＩ明显降低（Ｐ＜００５）,最低ＳａＯ２亦有明显改善（Ｐ＜００５）,Ｔ明显缩短（Ｐ＜００５）。结论口腔矫正器能使上气道增宽,使下颌稳定于一个前伸位置,舌和软腭前移,增加睡眠时的有效通气量,改善睡眠质量,是治疗ＯＳＡＳ的一个有效的辅助手段。     

呼吸睡眠暂停低通气综合征多导睡眠监测分析

目的分析呼吸睡眠暂停低通气综合征（OSAHS）患者的多导睡眠监测特点。方法对呼吸睡眠暂停低通气综合征患者141例中并高血压者69例（高血压组）、血压正常者72例（对照组）,进行两组间多导睡眠监测（PSG）资料的比较。结果两组睡眠结构中的微觉指数、非快速眼动睡眠的1、2、3＋4期和快速眼动睡眠间差异均无统计学意义（P〉0．05）。两组患者BMI、呼吸暂停低通气指数、最低血氧饱和度比较差异均有统计学意义（P〈O．05）。结论呼吸睡眠暂停低通气综合征患者呼吸暂停低通气指数及最低血氧饱和度明显重于血压正常患者,但睡眠结构紊乱的程度基本接近。     

对比分析老年与中青年阻塞性睡眠呼吸暂停低通气综合征的临床特点

目的通过与中青年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者比较,探讨老年OSAHS患者的临床特点。方法随机选取161例OSAHS患者,按年龄分为老年组(≥60岁,n=72)与中青年对照组(23~59岁,n=89),对两组临床资料、睡眠多导图结果进行对比分析,并随访比较两组治疗方式的选择。结果老年OSAHS组睡眠呼吸暂停低通气指数(AHI)及最低氧饱和度、氧减饱和指数(ODI)较体质量指数相匹配的中青年组轻(P0.05)。老年OSAHS组的醒后收缩压高于中青年组,但其醒后舒张压、心率均低于中青年组(P0.05)。老年OSAHS醒后血压与AHI、ODI、微觉醒指数呈正相关。老年组选择外科手术及口腔矫治器的治疗率明显低于中青年组(P0.01),而选择持续气道正压通气治疗的比例两组间差异无统计学意义(P0.05)。结论老年OSAHS严重程度明显较中青年组轻。AHI、反复低氧及反复微觉醒可能与老年人醒后血压升高有关。老年OSAHS外科手术及口腔矫治器选择率低于中青年组。     

老年与非老年阻塞性睡眠呼吸暂停患者Auto-CPAP疗效比较

目的老年与非老年阻塞性睡眠呼吸暂停患者Auto-CPAP疗效比较。方法用多导睡眠监测系统通过7h多导睡眠图确诊OSAHS患者35例，并对其进行单晚的Auto-CPAP治疗，按年龄分为老年组与非老年组，对比分析两组Auto—CPAP治疗前与治疗后各参数的变化。结果Auto-CPAP治疗后与治疗前相比两组AHI、MAI、最长暂停时间、最低SaO2、平均SaO2、SaO2〈90％比例均有显著改善（P〈0．01或P〈0．05），但对于睡眠结构影响仅非老年组慢波睡眠（SⅢ-Ⅳ／TST）的增加有统计学意义（P〈0．05）。结论Auto—CPAP治疗老年组和非老年组OSAHS患者均有很好的疗效。     

热塑成形口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征疗效观察

目的　评价热塑成形口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)的效果。方法　 4 5例经多导睡眠图 (PSG)确诊、并符合治疗条件的OSAHS患者 ,用由加热变性的高分子塑料注塑成形的口腔矫治器治疗 ,对比治疗 4周前、后PSG结果 ,并询问主观症状变化。结果　矫治器治疗的客观有效率为 82 % ,睡眠呼吸暂停低通气指数 (AHI)由 (38± 2 2 )次 /h降至 (11± 9)次 /h ,平均暂停时间由 (2 2± 8)s降至 (15± 11)s,最低血氧饱和度 (SaO2 )由 (72± 11) %提高到 (83± 9) % ,鼾声指数由 (30 4± 10 5 )次 /h降至 (10 8± 113)次 /h ,统计学上差异有非常显著性意义 (P值均 <0 0 0 1)。白天困倦缓解。初用时上下颌肌肉有酸痛感 ,多数患者在 3～ 7d后适应。结论　热塑成形口腔矫治器可以作为内科的一个治疗手段 ,效果肯定 ,而且制作简便 ,患者痛苦小。     

男性高血压病患者长期饮酒与阻塞性睡眠呼吸暂停综合征

目的 探讨男性高血压病患者长期饮酒与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相关关系.方法 以男性高血压患者304例为研究对象,经标准多导睡眠呼吸监测后分为OSAHS组220例和非OSAHS对照组84例.采用回顾性问卷调查所有研究对象的饮酒史,包括饮酒种类、平均饮酒频率、平均每次饮酒量、饮酒年限等,计算平均每月饮酒量及累积饮酒量,分析长期酒精摄入与OSAHS的相关关系.结果 1)OSAHS组和非OSAHS对照组的平均每次饮酒量(白酒)、平均每月饮酒量及累积饮酒量的差异无统计学意义(P＞0.05).2)以平均每月饮酒量≥50 g定义为饮酒者,将研究对象分为饮酒组244例和非饮酒组60例,饮酒组和非饮酒组的睡眠呼吸监测参数及OSAHS患病状况的差异无统计学意义(P＞0.05).3)将所有研究对象按睡眠呼吸暂停低通气指数(AHI)水平分层,在AHI＜20次/h的样本中,均衡了年龄、体质量指数及血压等危险因素后,与非饮酒组比较,饮酒组的AHI增大、平均及最长呼吸暂停时间延长,差异有统计学意义(P＜0.05).4)进一步以累积饮酒量的中位数(108 kg)将饮酒组划分为少量饮酒组和大量饮酒组,与非饮酒组进行睡眠呼吸监测参数的比较;在AHI＜20次/h的样本中,大量饮酒组(累积饮酒量＞108 kg)的最低血氧饱和度(SaO2)、平均、最长呼吸暂停持续时间比非饮酒组明显加重,差异有统计学意义(P＜0.05);但在AHI≥20次/h的样本中比较未见上述结果.结论 在AHI＜20次/h的男性高血压患者中,长期大量饮酒与阻塞性睡眠呼吸暂停的频率、时程及缺氧程度有关.     

应用便携式多导睡眠监测仪对边远地区慢性心力衰竭伴睡眠呼吸暂停患者的临床意义

目的:应用便携式多导睡眠监测仪(PSG)监测边远地区慢性心力衰竭患者,分析其中睡眠呼吸暂停特别是中枢性睡眠呼吸暂停的临床意义。方法:选择云南省怒江傈僳族自治州人民医院心血管病内科住院的患者40例,应用PSG监测其中瓣膜性心脏病患者16例,其他病因引起的心脏扩大患者24例。根据呼吸暂停低通气指数(AHI)分为两组,即AHI≥5次/h组20例和AHI5次/h组20例,分析比较两组患者中枢性睡眠呼吸暂停与心功能的关系。结果:(1)AHI≥5次/h组患者美国纽约心脏协会(NYHA)心功能Ⅲ/Ⅳ级比例、左心房内径、左心室舒张末期内径、左心室收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、AHI以及氧减指数均明显大于AHI5次/h组,而左心室射血分数低于AHI5次/h组,差异均有统计学意义(P均0.05)。(2)AHI≥5次/h组20例患者中以中枢性睡眠呼吸暂停为主16例,以阻塞性睡眠呼吸暂停为主4例。(3)多元Logistic向前逐步选择(Wald)回归分析结果表明,AHI≥5次/h与左心室射血分数[优势比(OR)=0.9,95%可信区间(CI):0.8~1.0,P=0.017)]、最低氧饱和度(OR=0.9,95%CI:0.7~1.0,P=0.022)以及左心室后壁厚度(OR=0.3,95%CI:0.1~0.9,P=0.034)相关;中枢性睡眠呼吸暂停与NYHA心功能Ⅲ/Ⅳ级相关(OR=15.0,95%CI:3.2~71.4,P=0.001)。结论:睡眠呼吸暂停尤其中枢性睡眠呼吸暂停是严重慢性心力衰竭的一种表现,PSG应用于边远地区慢性心力衰竭患者的评估及治疗随访,具有现实意义。     

利拉鲁肽对睡眠呼吸暂停综合征合并2型糖尿病睡眠的影响

目的探讨利拉鲁肽对睡眠呼吸暂停综合征合并2型糖尿病睡眠的影响。方法选择2019年1月—2020年6月该院收治的阻塞性睡眠呼吸暂停综合征合并2型糖尿病患者80例,对照组使用二甲双胍片,观察组使用利拉鲁肽,比较两组睡眠过程中血氧饱和度变化情况,睡眠呼吸暂停监测主要指标变化情况,干预1疗程后睡眠呼吸暂停和夜间周期性腿动情况,治疗前后空腹血糖水平。结果睡眠监测过程中,观察组睡眠前30 min、快动眼睡眠过程中、慢动眼睡眠过程中和苏醒前30 min血氧饱和度水平均明显高于对照组,差异有统计学意义(P<0.05),观察组睡眠呼吸暂停监测主要指标中AI、OAI水平均显著小于对照组,差异有统计学意义(P<0.05),干预后1疗程后,观察组睡眠呼吸暂停显著少于对照组,差异有统计学意义(P<0.05),且夜间周期性腿动发生比例低于对照组,差异有统计学意义(P<0.05),治疗后观察组空腹血糖水平低于治疗前及治疗后对照组,差异有统计学意义(P<0.05)。结论针对睡眠呼吸暂停综合征合并2型糖尿病者,使用利拉鲁肽治疗,能有效减少夜间缺氧,改善睡眠质量,减少睡眠呼吸暂停严重程度。     

Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome

Purpose

Both obstructive sleep apnea syndrome (OSAS) and sleep bruxism (SB) are commonly related to arousal events. In this study, we examined the effect of SB on the sleep architecture and investigated the relationship between SB and sleep respiratory events in patients with OSAS.

Methods

Patients with OSAS (n?=?67) in whom apnea/hypopnea occurred five or more times per hour were recruited to this study. Healthy volunteers (n?=?16) were recruited as controls. None of the healthy volunteers had any sleep disorders or medical disorders, nor had they taken any medication or alcohol. Data were collected by standard polysomnography during overnight sleep tests in a dark, quiet room.

Results

The frequency of SB was higher in the OSAS than in the control group. The risk of SB was significantly higher in the OSAS than in the control group (odds ratio, 3.96; 95 % confidence interval, 1.03–15.20; P?OSAS than in the control group.

Conclusions

We found that patients with OSAS have a high risk of SB. In particular, this is the first report relating phasic-type SB to obstructive apnea events. This relationship suggests that improvement in OSAS might prevent exacerbations of SB.     

Do patients with sleep apnea die in their sleep?

Patients with sleep apnea syndrome (SAS) show cardiac dysrhythmias in association with cyclical nocturnal hypoxemia; are they at risk of dying during sleep? To assess this claim, we reviewed the clinical course of 91 patients with polysomnographically documented SAS between July 1978 and June 1986. A control group was comprised of 35 patients who were referred with symptoms suggestive of SAS but had negative sleep studies. Follow-up was obtained by survey questionnaire. Nine of 91 SAS and four of 35 control patients had died by completion of the study. There were no statistically significant differences in mortality between the two groups. None of the SAS patients died in their sleep, but they reported a higher incidence of disability and vehicular mishaps than did control subjects. The findings in this study do not support the hypothesis that SAS patients are at increased risk of dying in their sleep.     

Optogenetically induced sleep spindle rhythms alter sleep architectures in mice

Sleep spindles are rhythmic patterns of neuronal activity generated within the thalamocortical circuit. Although spindles have been hypothesized to protect sleep by reducing the influence of external stimuli, it remains to be confirmed experimentally whether there is a direct relationship between sleep spindles and the stability of sleep. We have addressed this issue by using in vivo photostimulation of the thalamic reticular nucleus of mice to generate spindle oscillations that are structurally and functionally similar to spontaneous sleep spindles. Such optogenetic generation of sleep spindles increased the duration of non-rapid eye movement (NREM) sleep. Furthermore, the density of sleep spindles was correlated with the amount of NREM sleep. These findings establish a causal relationship between sleep spindles and the stability of NREM sleep, strongly supporting a role for the thalamocortical circuit in sleep regulation.     

The impact of sleep duration in obstructive sleep apnea patients

Purpose

Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease. Strong associations have been reported among sleep duration, hypertension, obesity, and cardiovascular mortality. The authors hypothesize that sleep duration may play a role in OSA severity. The aim of this study is to analyze sleep duration in OSA patients.

Methods

Patients who underwent overnight polysomnography were consecutively selected from the Sleep Clinic of Universidade Federal de São Paulo database between March 2009 and December 2010. All subjects were asked to come to the Sleep Clinic at 8:00 a.m. for a clinical evaluation and actigraphy. Anthropometric parameters such as weight, height, hip circumference, abdominal circumference, and neck circumference were also measured.

Results

One hundred thirty-three patients were divided into four groups based on total sleep time, sleep efficiency, sleep latency, and wake after sleep onset: very short sleepers (n?=?11), short sleepers (n?=?21), intermediate sleepers (n?=?56), and sufficient sleepers (n?=?45). Apnea–hypopnea index (AHI) was higher in very short sleepers (50.18?±?30.86 events/h) compared with intermediate sleepers (20.36?±?14.68 events/h; p?=?0.007) and sufficient sleepers (23.21?±?20.45 events/h; p?=?0.02). Minimal and mean arterial oxygen saturation and time spent below 90 % oxygen saturation exhibited worse values in very short sleepers. After adjustment for gender, age, AHI, and body mass index, mean oxygen saturation was significantly associated to total sleep time (p?=?0.01).

Conclusions

In conclusion, the present study suggests that sleep duration may be associated to low mean oxygen saturation in OSA patients.     

The accuracy of subjective sleep time in sleep apnoea recordings

Total sleep time is important in investigations of obstructive sleep apnoea, since the diagnosis is usually based on the average number of apnoeas per hour of sleep. Sleep estimates instead of exact EEG-recorded total sleep time is often used in the clinical setting. However, an overestimated sleep time would underestimate the degree of the disease and vice versa. The purpose of this study was to investigate the accuracy of subjective sleep time and time-in-bed as sleep estimates. One hundred patients undergoing diagnostic polysomnography for suspected obstructive sleep apnoea were asked to estimate their sleep time in a questionnaire. Seventy-five patients were diagnosed as suffering from obstructive sleep apnoea syndrome. The mean difference between self-scored and EEG-recorded total sleep time was 4 +/- 74 min. However, 30% scored with a difference greater than 1 h. The intra-class correlation coefficient was fair (0.58, CI: 0.43-0.70). Fifty-three patients overestimated their sleep time and 47 patients underestimated it. All but four patients underestimated their number of awakenings (P<0.001). The mean difference between time-in-bed and EEG-recorded total sleep time was 110 +/- 63 min. This difference was significantly larger than the difference between subjective sleep time and EEG-recorded total sleep time (P<0.001). The intra-class correlation coefficient was poor (0.38, CI: 0.20-0.54). Mean AHI was 27 +/- 27 using subjective sleep time and did not change significantly compared with the mean AHI of 25 +/- 21 based on EEG-recorded total sleep time. Mean AHI decreased significantly to 20 +/- 17 (P<0.001) when time-in-bed was used. In conclusion, 'time-in-bed' time is a poor predictor of total sleep time and should not be used when calculating the apnoea-hypopnoea index. Subjective sleep time is better as an approximation, but the individual differences are large.     

Regulation of respiration during sleep in congenital central sleep apnea

We report on 2 children aged 13 and 14 months with congenital central alveolar sleep apnea which showed depression of respiratory drive during sleep resulting from dysfunction of central chemoreceptors. Hypoventilation was found to be more severe during NREM sleep (minimum of alveolar ventilation in stages 3/4) than during REM sleep. During NREM sleep arousal responses to hypoxia proved to be an important factor in influencing the level of alveolar ventilation and in preventing fatal asphyxia.     

Actimetry in sleep medicine

Actigraphy is more and more used in the longterm record of sleep of patients with insomnia. The correlation with data from polysomnography is reasonable for parameters like total sleep period (TSP) with r = 0,95-0,97 in healthy controls and r = 0,77-0,91 in patients. However for parameters, which inform about sleep fragmentation like wake after sleep onset (WASO) the correlation is not satisfieing with r = 0,87 in healthy controls and r = 0,49-0,63 in patients with fragmented sleep. The question is therefore, if actigraphs are really more useful in the record of sleep in patients with insomnia and fragmented sleep than sleep calenders.     

Arrhythmias in sleep apnea

A 23-year-old black female was referred to the University Hospital of Oklahoma because of “sleep trouble.” She complained of falling asleep easily during the daytime. A sleep study was performed which showed prolonged apnea, up to 35 seconds, and prolonged asystole, up to seven seconds, with second-degree heart block. A tracheostomy was performed. She had lost some weight and did well until six months later, when she developed severe throbbing headache with visual blurring. She came to the emergency room and an ECG showed sinus bradycardia with prolonged sinus pauses, up to 2.6 seconds, and first- and second-degree AV block. She had no hypoxia and atropine was ineffective. Electrophysiologic studies were performed. Details of the case are described and mechanisms of the arrhythmias are discussed.