Standards for polysomnography in Canada. The Standards Committees of the Canadian Sleep Society and the Canadian Thoracic Society.

OBJECTIVE: To develop standards for polysomnography in Canada in order to assist in the uniform provision of diagnostic and therapeutic services related to sleep disorders. OPTIONS: Uniform testing versus no current Canadian standards. OUTCOMES: Uniform delivery of health care; reduction in number of repeat studies and their attendant costs. EVIDENCE: Availability of diagnostic laboratories and services, and survey responses (written and oral) from directors of sleep laboratories; the American Thoracic Society statement on indications and standards for cardiopulmonary sleep studies was used as a template. VALUES: Acceptable standards of practice were based on consensus opinion of the standards committees of the Canadian Sleep Society and the Canadian Thoracic Society. The committees comprised specialists in neurology, psychiatry, psychology, respirology and polysomnographic technology; family practitioners and otolaryngologists were also consulted. BENEFITS, HARMS, COSTS: Improved level of care and reduction in duplicate or unnecessary testing; establishment, with available resources, of diagnostic sleep laboratories by appropriately qualified physicians in areas where polysomnography is unavailable. RECOMMENDATIONS: Health care practitioners involved in the diagnosis and treatment of sleep disorders should possess a minimum amount of training (both clinical and research) in sleep disorders medicine. The variables recorded and findings entered in a patient's report must be relevant to the sleep disorder under investigation. The recording equipment must provide reliable, accurate and reproducible data and lend itself to appropriate calibration and quality-control procedures. Facilities for sleep studies must meet patient care safety standards, with provisions for emergency or resuscitative measures when necessary; all personnel must be trained in basic cardiopulmonary resuscitation. VALIDATION: No previous standards concerning polysomnography in Canada exist. The recommended standards were reviewed by all members of the Canadian Sleep Society and a revised document was approved by the Standards Committee of the Canadian Sleep Society and by the Standards and Executive committees of the Canadian Thoracic Society. SPONSORS: These standards are endorsed by the Canadian Sleep Society and the Canadian Thoracic Society. The cost of preparing this statement was borne by the individual members of the standards committees; no external funding was provided.     

The Teaching of Psychiatry as Applied to Pediatrics: Proposals Based on a Report Prepared by the Education Committee, Canadian Paediatric Society

With changing patterns of pediatric practice, the practising physician needs to acquire a deeper understanding of the emotional and intellectual development of the child. Skill is also required in the techniques of interviewing and counselling parents, and, with a knowledge of the origin of behavioural disorders, in treating these disorders. The Education Committee of the Canadian Paediatric Society was asked to survey the present teaching of psychiatry as applied to pediatrics in all Canadian medical schools. Based on this survey and other studies, a training program for undergraduate medical students and graduates is proposed.     

Prevalence of factor V Leiden in a Canadian blood donor population.

OBJECTIVE: To determine the prevalence of factor V Leiden in a Canadian blood donor population. DESIGN: Cross-sectional laboratory study. SETTING: Hamilton Centre of the Canadian Red Cross Society. PARTICIPANTS: Volunteer donors who attended Hamilton Centre blood donor clinics over a 4-day period in August 1994; blood samples from 356 people were evaluable. OUTCOME MEASURES: Presence of factor V Leiden. RESULTS: Factor V Leiden was detected in 19 of the 356 people, for a prevalence rate of 5.3% (95% confidence interval 3.0% to 7.6%). All 19 people were shown to be heterozygous for the mutation. CONCLUSION: Factor V Leiden is common in the Canadian population. Its prevalence is similar to that reported in other Western countries. These data are relevant in the clinical management of patients at risk for venous thrombosis and those with recurrent thrombotic disorders.     

河南省普通人群睡眠障碍流行病学调查

目的:了解河南省普通人群睡眠障碍的发生率和严重程度。方法:于2006年12月至2007年2月运用随机整群抽样的方法对河南省城乡居民进行匹兹堡睡眠质量指数(PSQI)流行病学现况调查。结果:①PSQI量表总分≥7分的有320人,发生率为21.3%;PSQI量表总分5-6分的有412人,占27.5%;PSQI量表总分≤4分的有768人,为51.2%。②睡眠效率均分女性高于男性(P<0.05)。文盲和中专生的睡眠障碍发生率高于其他人群(P<0.01)。大于60岁人群和20-40岁人群睡眠障碍的发病率较高(P<0.01)。而性别、职业和生活环境对睡眠障碍的发生率影响不大。结论:睡眠障碍和临界失眠症状态的发生率在河南省较高。     

106例儿童睡眠障碍的影响因素分析及管理策略

  目的  研究儿童睡眠障碍的相关影响因素,为制定预防和减少儿童睡眠障碍的干预措施提供科学依据。  方法  选取2020年1月—2022年1月石家庄市人民医院门诊500名儿童作为研究对象,采用多导睡眠监测、儿童睡眠习惯问卷和睡眠日记综合评估和诊断儿童睡眠障碍。对儿童家长进行问卷调查,包括人口统计数据和与睡眠障碍潜在危险因素相关的信息因素,按照是否有睡眠障碍,分为睡眠障碍组和无睡眠障碍组。分别使用单因素和多因素logistic回归分析研究导致儿童睡眠障碍的影响因素。  结果  本研究共回收477份问卷,其中106例儿童患有睡眠障碍,371例儿童无睡眠障碍,单因素分析显示2组儿童体重、是否肥胖、是否早产儿、父母是否打鼾、有无过敏性鼻炎、夜间环境有无噪音、有无哮喘病史、睡前1 h是否看电子产品、睡前1 h是否活动、睡前1 h是否饮食比较差异有统计学意义(均P < 0.05)。多因素logistic回归分析显示肥胖、有过敏性鼻炎、夜间环境噪音、有哮喘病史、睡前1 h看电子产品、睡前1 h活动、睡前1 h饮食是儿童睡眠障碍的独立危险因素(均P < 0.05)。  结论  肥胖、过敏性鼻炎、夜间环境噪音、哮喘病史、睡前1 h看电子产品、睡前1 h活动、睡前1 h饮食会影响睡眠, 减少并预防儿童睡眠障碍对促进儿童身心发育具有重要临床意义。      

中国老年人失能情况及影响因素研究

背景　失能严重影响老年人的生活质量,也给医疗卫生服务和长期照护带来挑战。预计到2020年,我国失能老年人将达到4 600万,其中22.5%的失能老年人无法完成日常活动。因此,了解我国老年人的失能情况及影响因素十分必要。目的　了解我国老年人失能情况及其影响因素。方法　以2015年中国健康与养老追踪调查（CHARLS）数据为基础,应用工具性日常生活活动能力（IADL）评价7 773例60岁以上老年人的失能情况,应用Logistic回归模型分析我国老年人失能的影响因素。结果　7 773例老年人中,失能老年人2 275例（29.27%）。不同性别、年龄、婚姻状况、受教育程度、居住地类型、个人年收入、饮酒、吸烟、睡眠障碍、情绪低落情况的老年人IADL失能率比较,差异有统计学意义（P<0.001）。二分类Logistic回归分析结果显示,高龄、低的受教育程度和年收入、饮酒>1次/月、睡眠障碍及情绪低落是老年人失能的危险因素（P<0.05）。结论　我国老年人失能率较高,低收入、高龄、低的受教育程度、大量饮酒、睡眠障碍及情绪低落是老年人失能的主要预测指标,应为高危老年人提供旨在减少功能丧失的最佳健康教育政策。     

Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society.

OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external financial support has been received by the Canadian Paediatric Society, or its members, for any portion of the statement's preparation.     

睡眠障碍的诊断标准与方法

目的了解近年来国内外睡眠障碍的诊断标准与方法的研究进展及动态。方法以近年来国内外有关睡眠障碍的研究成果为基础,采用文献研究法分析与总结有关研究。结果呈现出有关睡眠障碍的诊断标准与方法的研究进展及动态。结论加强针对不同类型睡眠障碍的治疗方法的研究对预防及治疗睡眠障碍具有深远意义。     

A study of sleeping disorders in blind patients

An internal 24-hour biological clock working in tandem with external environmental cues like bright light regulates our daily rhythms specially sleep-wake cycle. In a blind individual, due to absence of external cue endogenous rhythm may take upper hand and free running of sleep-wake cycle starts without any synchronicity with day-night cycle, creating ground for sleep disorders. To evaluate the frequency of sleep disorders, 65 blind individuals without any comorbid medical or surgical problem were interviewed according to the criteria of Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV). Simultaneously 70 persons with no visual impairment were assessed in the same manner as used for blind persons. Blind patients showed far higher presence (44.6%) of sleep problems compared to controls (15.7%), and this difference was highly significant statistically [odd's ratio (OR) = 4.32, CI 95 =1.8-10.54]. Blind patients showed far higher presence (43.1%) of DSM-IV based diagnosis compared to controls (8.6%), and this difference was highly significant statistically [OR = 8.072, CI 95 = 3.059-21.298]. Circadian sleep disorders, insomnia and hypersomnia were relatively higher in blind patients. High incidence of sleep disorders calls for development of short reliable screener for sleep disorders among blind persons and better liaison among ophthalmologists and psychiatrists for early detection of this problem.     

Guidelines for the investigation of individuals who were place under surveillance for tuberculosis post-landing in Canada. Canadian Thoracic Society, the Tuberculosis Directors of Canada and the Department of National Health and Welfare.

There are 2 parts to this article. Part 1 is a preamble, jointly prepared by Immigration and Overseas Health Services, Medical Services Branch and the Bureau of Communicable Disease Epidemiology, LCDC, Department of National Health and Welfare, to provide background information regarding the medical assessment of immigrants prior to landing in Canada. Part 2 is a set of guidelines for the investigation of individuals who were placed under surveillance for tuberculosis post-landing in Canada. It was jointly prepared by the Canadian Thoracic Society, the Tuberculosis Directors of Canada and the Department of National Health and Welfare in consultation with the provincial and territorial epidemiologists and has been approved by the Canadian Lung Association and the Canadian Thoracic Society.     

Guidelines for the identification, investigation and treatment of individuals with concomitant tuberculosis and HIV infection. Bureau of Communicable Disease Epidemiology, Canada Department of National Health and Welfare.

The following recommended guidelines, jointly prepared by the Canadian Thoracic Society, the Tuberculosis Directors of Canada, and the Department of National Health and Welfare in consultation with the provincial and territorial epidemiologists, AIDS coordinators and HIV caregivers, and approved by the Canadian Lung Association and the Canadian Thoracic Society are provided to assist health care workers who are caring for patients in the overlapping group.     

某高校医学生新冠肺炎疫情期间睡眠障碍调查分析

  目的  了解新冠肺炎疫情期间高校医学生睡眠障碍发生率并分析相关影响因素。  方法  采用普查法，在2020年3月，对某高校在校医学生用匹斯堡睡眠质量指数（the Pittsburgh sleep quality index，PSQI）量表及自编睡眠质量影响因素调查表进行调查。  结果  新冠肺炎疫情下某高校医学生睡眠障碍发生率为9.57%，男生较女生更易发生，P = 0.008。不同的年级、专业、学历层次、生源地的学生睡眠障碍发生率无统计学差异（P > 0.05）。作息不规律导致生物钟紊乱，家庭睡眠环境不好，感情受挫对疫情期间医学生睡眠障碍发生有显著影响，P < 0.05。  结论  新冠肺炎疫情下医学生睡眠障碍总体发生率不高，可以依据影响因素对出现睡眠障碍的学生进行有针对性的指导。     

长沙地区部分健康体检人群饮食模式与睡眠障碍的关系

目的： 睡眠障碍直接影响健康相关生活质量,因此了解睡眠障碍的危险因素,并积极进行干预意义重 大。本研究旨在分析长沙地区部分健康体检人群不同饮食模式与睡眠障碍的关联及其相关影响因素。方法： 采用横 断面调查,以2017 年7 月至2018 年6 月在长沙地区某大型综合医院健康管理中心参加健康体检的86 073 名18~70 岁 人群为研究对象,进行问卷调查、体格检查和实验室检测。采用主成分分析法进行饮食模式分类,运用非条件 logistic 回归模型,分析各饮食模式与睡眠障碍的关联,并基于分类树模型分析睡眠障碍的影响因素。结果： 共检出 睡眠障碍者16 048 例,检出率18.64%。由主成分分析法分解成4 种饮食模式,即健康模式、零食模式、粗粮模式和 油荤模式。在调整相关因素后行logistic 回归分析,发现零食模式、油荤模式是睡眠障碍的危险因素;而粗粮模式是 睡眠障碍的保护因素。分类树模型筛选出年龄、容易焦虑不安、零食模式、感觉压抑沮丧、慢性疼痛、经常运动、 文化程度、性别和体重分组9 个影响因素,以及9 类睡眠障碍高危人群。结论： 长沙地区部分健康体检人群睡眠障碍 发生率较高,零食摄入多的饮食模式与其关系较密切,倡导优化饮食结构并加强监测和控制相关危险因素对改善睡 眠具有积极意义。体检后应对不同特征睡眠障碍高危人群采取差异化的健康干预措施。     

Management of Anxiety and Sleep Disorders: Role of Complementary and Alternative Medicine and Challenges of Integration with Conventional Orthodox Care

There is renewed attention and greater focus on anxiety and sleeprelated disturbances because of the high prevalence,complexity,and their health implications.The role of complementary and alternative medicine(CAM),which refers to therapeutic approaches that are "complementary to the end goals of decreasing illness and enhancing wellness,but are alternative to conventional medical treatment" is also increasingly recognized.In this review,we considered CAM approach to the management of anxiety and sleep disorders and discussed a few challenges associated with the effective integration of alternative therapy with conventional orthodox medical care.     

350例老年糖尿病足患者睡眠质量评估及影响因素调查分析

目的对老年糖尿病足患者睡眠质量进行评估,并研究影响老年糖尿病足患者睡眠质量的因素。方法应用匹兹堡睡眠质量指数（PSQI）和自制睡眠影响因素调查问卷对2005年1月～2013年6月在笔者医院住院治疗的350例老年糖尿病足患者睡眠质量进行测评,并使用相关统计软件进行数据分析。结果350例患者PSQI总均分为5～19（11．76±5．78）分。无睡眠障碍患者117例,占33．43％;有睡眠障碍患者233例,占66．57％。其睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍等因子得分均高于国内常模,其差异存在统计学意义（P均〈0．05）。Logistic多因素回归分析,治疗因素、生理因素、心理因素与老年糖尿病足患者睡眠质量均存在显著的相关性。结论治疗因素、生理因素、心理因素是影响老年糖尿病足患者睡眠质量的重要因素,加强对该类患者的睡眠质量管理,制订有效的护理干预措施,能够有效提高老年糖尿病足患者睡眠质量,促进疾病康复。     

Taiwan consensus of pharmacological treatment for bipolar disorder

Bipolar disorder is an important psychiatric disorder with different disease phases. The pharmacological treatment is complicated, and is updated frequently as new research evidence emerges. For the purpose of international collaboration, research, and education, the Taiwan consensus of pharmacological treatment for bipolar disorders was initiated by the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN) – the Bipolar Chapter, which was established in August 2010 and approved as a member of International Society of Bipolar Disorder. TSBPN is the country member of the World Federation of Societies of Biological Psychiatry (WFSBP). The development of the Taiwan consensus for bipolar disorder was mainly based on the template of WFSBP Guidelines, with references to other international guidelines including the Canadian Network for Mood and Anxiety Treatments, and British Association for Psychopharmacology. We have also added Taiwanese experts’ experience, Taiwan national health insurance data, and the indications for the pharmacological treatment of bipolar disorder given by the Taiwan Department of Health, to emphasize the balance between efficacy and safety, and to make this consensus a concise, empirical, and important reference for clinical psychiatric practice.     

Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients

Background:

Studies have reported the presence of sleep disorders in approximately 50–70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels).

Methods:

We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels.

Results:

The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders.

Conclusions:

Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.     

ICU患者家属睡眠障碍现状及其影响因素研究

目的 了解和评估我国ICU患者家属睡眠障碍的现状,并分析其影响因素,为临床护理工作者采取干预措施降低我国ICU患者家属睡眠障碍提供参考依据。 方法 采用便利抽样法抽取杭州市3所三甲医院的183名ICU患者家属,采用自行设计的一般情况调查表、匹兹堡睡眠指数(PSQI)、疾病不确定感家属量表(MUIS-FM)和贝克焦虑量表(BAI)对ICU家属进行问卷调查,对研究对象的一般资料进行统计描述,采用单因素分析、Pearson相关和逐步多元回归分析进行统计分析。 结果 ICU患者家属PSQI总分为(12.56±5.52)分,MUIS-FM总分为(85.29±13.80)分,BAI总分为(50.39±8.48)分。Pearson相关分析显示,ICU患者家属睡眠状况与焦虑、疾病不确定感呈正相关,MUIS-FM总分与PSQI及其各维度得分的相关系数范围为0.112～0.328;BAI总分与PSQI及其各维度得分的相关系数范围为0.115～0.285;逐步多元回归分析显示,患者是否插管、付费方式、家属的文化程度、职业、疾病不确定感和焦虑水平是ICU患者家属睡眠障碍的主要影响因素,共可以解释ICU患者家属睡眠障碍42.8%的变异量。 结论 临床护理工作者应更加关注ICU患者家属睡眠障碍,及时对ICU患者家属的睡眠障碍程度进行评估,对睡眠障碍严重者,可以通过采取针对性的干预措施,降低ICU患者家属的疾病不确定感和焦虑水平,以对其睡眠障碍进行改善。      

Report of the Canadian Cardiovascular Society's consensus conference on the Management of the Postmyocardial Infarction Patient.

In October 1989, the Canadian Cardiovascular Society announced a program to achieve consensus on important issues in the care of patients with cardiovascular disease. This report on the management of the postmyocardial infarction patient represents the first in a series of these consensus conferences. The process for establishing consensus recommendations involved several steps. A primary panel of 11 experts from various fields was selected to review the available clinical evidence and to make a list of recommendations about management decisions in the postmyocardial infarction period. The initial report was distributed to a secondary panel of 16 reviewers* representing allied health care constituencies from across Canada. On the basis of the critical reviews and feedback from these reviewers, a revised report was distributed to all members (over 800) of the Canadian Cardiovascular Society for further review and feedback. This iterative approach resulted in a penultimate report that was presented at a plenary session of the annual scientific meeting of the Canadian Cardiovascular Society on Oct. 18, 1990, in Halifax, NS. On the basis of discussion and feedback from this symposium, the consensus review was completed.     

社区卫生服务机构常用抗高血压药物对睡眠的影响

高血压和睡眠障碍是社区常见慢性病,且近年来的发病率呈上升趋势。高血压患者常并发睡眠障碍,而睡眠障碍也会引起血压的异常。本文阐述了高血压与睡眠障碍的关系,深入分析了社区卫生服务机构常用抗高血压药物对患者睡眠的影响,建议社区全科医生在接诊高血压患者时,应注意其个体化特征,考虑其是否伴有肥胖、睡眠障碍等问题,从而合理、恰当地使用抗高血压药物,减少抗高血压药物对睡眠的不良影响。