老年睡眠呼吸暂停/低通气综合征患者临床特点的分析

目的探讨老年睡眠呼吸暂停/低通气综合征(SAHS)的临床特点。方法对74例可疑老年SAHS患者用多导睡眠图仪(PSG)诊断后,分析病人的主要临床症状、全身各系统并发症和PSG结果,并与199名可疑SAHS患者比较。结果老年SAHS中打鼾、夜间憋醒、夜间尿频、性别比、体重指数(BMI)及心脑血管、呼吸系统并发症与中青年患者比较有明显差别;而白天嗜睡、记忆力下降、失眠、颈围及内分泌系统并发症两组间无明显差别。PSG监测显示老年SAHS患者总的睡眠时间(TST)和Ⅲ、Ⅳ期占总睡眠时间的百分比及病情严重程度(AHI和氧减指数)明显比中青年者低。持续气道正压通气(CPAP)治疗可明显降低老年SAHA患者的AHI和氧减指数(P<0.001),而对微觉醒指数和睡眠结构无明显影响。结论老年SAHS具有区别于中青年SAHS的临床特点,识别这些特点有助于早期诊断。     

老年睡眠呼吸暂停综合症与心脑血管病

老年睡眠呼吸紊乱是老年人常见病。由于老年人睡眠呼吸紊乱以睡眠呼吸暂停低通气综合症(SAHS)较为常见，而且易导致一些严重并发症，如高血压、心脑血管事件及认知功能低下等。因此，有必要加强对老年SAHS的早期诊断与合理治疗。     

老年睡眠呼吸障碍疾病的并发症及死亡风险

<正>睡眠呼吸障碍(SDB)是一种常见病、慢性病,患病率在2%~4%[1],而老年SDB的患病率远远高于中青年人,在30%~80%[2-4];中青年人以阻塞性睡眠呼吸暂停低通气综合征(OSAHS)为主,中枢性睡眠呼吸暂停(CSA)很少见,但在老年人患病率明显增加[3];中青年男性的发病风险高于女性,而在老年人中男、女性发病率相当。老年睡眠呼吸紊乱是否会像中青年患者     

老年睡眠呼吸暂停低通气综合征患者临床特点分析

睡眠呼吸暂停低通气综合征(SAHS)是一常见病,国外流行病学调查显示在成人中其发病率为2%～4%,而且随着年龄的增加而增加[1],老年人SAHS发病率达37.5%[2],而我国目前已进入老龄化社会,有关老年人SAHS的诊断和治疗必须引起高度重视。本文对老年SAHS的临床特点作一初步探讨。1对象     

睡眠诱导的呼吸不稳定性与呼吸暂停

睡眠呼吸暂停低通气综合征（SAHS）以夜间睡眠时反复发生呼吸暂停和低通气为特点。本文通过描述在睡眠期间，由于呼吸调控减弱而诱导出的各种病态和不稳定呼吸的机制和类型，提示了睡眠期易于发生呼吸暂停和低通气的相关机制，以促进对SAHS的认识和治疗。     

老年睡眠呼吸暂停低通气综合征与代谢综合征

睡眠呼吸暂停低通气综合征（sleep apnea-hy-popnea syndrome,SAHS）不仅患病率高,且潜在危害大。因其在睡眠期间反复出现呼吸暂停或低通气导致低氧血症和高碳酸血症,已成为多种全身性疾病的独立危险因素。老年人患病率尤其高,65岁以上社区老人中SAHS患病率高达62%[1]。     

慢性肾脏病合并睡眠呼吸暂停低通气综合征

慢性肾脏病(chronic kidney disease,CKD)合并睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)发病隐匿,易被人们忽视.合并SAHS不仅会加速患者肾功能损害,而且还会增加其并发症的发生,进而影响患者的长期生存.据此,本文针对CKD合并SAHS的流行病学、临床特征、发病机制及治疗方法进行综述.     

睡眠呼吸暂停低通气综合征与心血管疾病相关性的临床分析

目的临床观察不同程度睡眠呼吸暂停低通气综合征(SAHS)患者心血管病发生率及其两者的相关性,为引起心血管科医生对本病的重视提供临床依据.方法 63例疑似SAHS患者进行睡眠呼吸监测,依据多导睡眠图监测结果,分为正常、轻度、中度、重度睡眠呼吸暂停4组,根据临床表现、血液生化指标、心电图、心脏超声、动态血压及冠状动脉造影等检查诊断心血管疾病,分析不同程度睡眠呼吸暂停与心血管疾病发生率的相关性.结果体重指数与呼吸暂停低通气指数、呼吸紊乱指数显著正相关(r=0.355,0373,P＜0.05);中、重度SAHS组心血管病发生率明显高于正常及轻度SAHS组(P＜0.05或0.01).结论睡眠呼吸暂停的程度与心血管疾病的发生密切相关.     

阻塞性睡眠呼吸暂停低通气综合征并发冠心病患者相关预测因子分析

睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)是指在每晚7 h睡眠中,呼吸暂停反复发作超过30次或呼吸暂停指数(apnea hypopnea index,AHI)超过5次/h的呼吸道疾患。根据发病机制不同可以分为阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea     

应用动态心电图初筛睡眠呼吸暂停低通气综合征

睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)主要表现为在睡眠中频繁的呼吸暂停、低通气.SAHS可以导致多个重要器官的功能障碍乃至衰竭,严重影响生活质量,甚至引起患者死亡,被认为是冠心病、高血压、脑血管疾病以及糖尿病的独立危险因素.诊断SAHS金标准为多导睡眠仪(polysomnogram,PSG),它需要在配备昂贵医疗设备的睡眠监测室,行7 h以上的睡眠监测后才能作出诊断,PSG费用昂贵且资源有限,本文综述应用动态心电图初筛睡眠呼吸暂停低通气综合征的可行性.     

El síndrome de apneas-hipopneas durante el sueño en edades avanzadas

The population pyramid is changing due to the increasing longevity of the population, making it a priority to have better knowledge of those diseases that have an increasingly major impact in advanced age. Sleep apnea-hypopnea syndrome (SAHS) affects 15–20% of individuals over 65 years. However, despite this high prevalence and that one in four sleep studies are conducted on the elderly in this country and that more 60% of these were treated with CPAP, there are few specific studies in this age group on the diagnosis and management of this syndrome. The physiological increase of the number of sleep respiratory disorders with the passing of time may be the biggest obstacle when defining, diagnosing and treating SAHS in the elderly. In any case and while more solid scientific evidence is obtained, the National SAHS Consensus, as well as the Guidelines on the diagnosis and treatment of SAHS, recommend that, within logical limits, age itself should not be an obstacle to offering the elderly diagnostic help and treatment similar to that offered to the rest of the population.     

睡眠呼吸暂停低通气综合征6年临床趋势分析

目的 探讨睡眠呼吸暂停低通气综合征(sleep apnea-hyperpnoea syndrome,SAHS)患者的临床流行病学特征,以及危险因素和合并症,进一步提高临床诊治水平.方法 回顾性分析宁夏医学院附属医院从2002年1月至2007年12月住院诊断为SAHS的466例患者的临床资料及睡眠监测指标.结果 2002年住院人数56例,后逐年递增至2007年91例.在住院患者中,男、女比例为6:1,高发的年龄段在40～49岁.SAHS合并高血压占39.0%,合并高脂血症占24.6%,合并糖尿病占17.6%,合并冠状动脉粥样硬化性心脏病占14.0%,合并脑卒中占4.9%.SAHS患者出现心脑血管等合并症占总数的80.7%.结论 SAHS住院患者人数呈逐年上升的趋势.肥胖、性别是SAHS的危险因素.SAHS患者易出现心脑系统合并症.     

Komplikationen chronisch entzündlicher Darmerkrankungen im Alter

A retrospective study was performed to assess the efficacy of surgical therapeutic concepts for the treatment of ulcerative colitis and Crohn’s disease in elderly patients. The study covered a 12-year period and included all patients undergoing hospital treatment for inflammatory bowel disease (IBD)-related complications at our institution. Patients 50 years and older were analyzed separately. All relevant clinical parameters, course and outcome were recorded, including a detailed complication and mortality analysis. 63 of 356 admissions for IBD were elderly patients. 20% of these were for severe, potentially life-threatening manifestations, with a high proportion of hitherto undiagnosed IBD (23%). Complication rates were significantly higher in elderly patients in all categories of urgency of admission. In a separate univariate analysis the following risk factors were found to be significantly associated with postoperative complications: 3 or more modified criteria according to Truelove, age of 50 or older, associated diseases, blood transfusion requirement. Significant risk factors for mortality were: 3 or more criteria according to Truelove, age of 50 or older, postoperative complications. The modified criteria according to Truelove, originally formulated for the clinical assessment of severity of colitis were thus shown to be of predictive value also for other IBD-related complications. Mortality in elderly patients was 5% and limited entirely to the group of severe manifestations. It was shown that all cases with lethal outcome were directly associated with procedure-related postoperative complications. This carries implications for an optimized operative approach to inflammatory bowel disease in the elderly, which are discussed.     

老年肺炎现代诊治与预防策略

肺部感染在老年人各种直接死因中占第4位,是80岁以上老人死因的第一位,老年肺炎起病隐匿,临床表现不典型,基础疾病和合并症多,病原感染复杂、易于产生耐药菌,病死率高。因此,正确识别和早期治疗尤显重要。治疗需要个体化,考虑药物不良反应、兼顾内环境平衡和全身营养,而早期适当的抗生素选择、覆盖耐药菌、足够的剂量和合理的疗程是老年肺炎的治疗关键。     

重叠综合征

慢性阻塞性肺疾病（COPD）是一种以气流受限不完全可逆为特征的常见的慢性呼吸系统疾病。睡眠呼吸暂停低通气综合征（SAHS）也是一种具有潜在危险的常见病。故COPD与SAHS合并存在者即重叠综合征患者的概率相当高。COPD患者睡眠时显著的低氧血症和高碳酸血症发生于快动眼睡眠期。重叠综合征患者较单纯SAHS或COPD患者有更为严重的睡眠有关的低氧血症,表现出更为严重的肺功能损害和肺动脉高压。因此,重叠综合征患者的及时诊断和合理治疗具有重要临床意义。     

The sleep apnea syndrome: diagnosis and management in general practice. A descriptive survey of 579 French general practitioners

General practitioners (GP's) should be the first to recognise the sleep apnoea/hypopnoea syndrome (SAHS) and could play a major role in the follow up of patients treated with continuous positive airways pressure (CPAP) at home. We have carried out a prospective study in order to evaluate the knowledge and diagnostic and therapeutic practice of GP's in relation to SAHS. 579 GP's agreed to participate in the study by means of a telephone questionnaire. Although daytime somnolence and the presence of apnoeas and snoring were the most frequently quoted clinical symptoms suggesting the diagnosis of SAHS, a combination of these symptoms was quoted in only one third of cases. On the other hand the complications of SAHS were not well known by GP's as only 25% of them mentioned the possibility of cardiovascular complications; cerebrovascular accidents and arterial hypertension being quoted by only 15% and 8.8% respectively. With regard to the follow up of patients treated with CPAP more than 50% of GP's did not know the minimum duration of ventilation required and 60% did not understand the method of function. These results, which emphasise the underestimation of SAHS and its complications, confirm the need to develop an educational strategy specifically for GP's in an attempt to improve the diagnosis of this disorder and to allow them to take part in the management and monitoring of treatment with CPAP.     

Imaging techniques for diagnosis of infective endocarditis

With the ability to structurally characterize cardiac manifestations, echocardiography is used for the diagnosis and management of infective endocarditis. In establishing the diagnosis according to the Duke criteria, the findings of endocardial involvement (vegetation, abscess, prosthetic valve dehiscence) or new valvular regurgitation represent "major" diagnostic criteria. As echocardiography cannot reliably differentiate noninfective from infective lesions, however, proper diagnosis lies in correlating echocardiography with clinical findings. The more invasive transesophageal approach provides substantially greater image resolution; this approach should be considered first in the evaluation of patients with higher prior probabilities of endocarditis and those with potential endocardial complications.     

Inflammatory bowel disease after age 60

Opinion statement New-onset idiopathic inflammatory bowel disease (IBD) is not uncommon among the elderly, although more common are colonic infection, ischemia, or neoplasia, all of which may mimic IBD. Although the clinical presentation of IBD in the elderly often resembles that of younger subjects, atypical manifestations are common and may lead to difficulty in diagnosis. Much progress has been made in both medical and surgical therapy for IBD, but such therapy poses additional challenges in the elderly, who are more likely to experience adverse effects of medications or complications of surgery. The elderly generally have a favorable outcome to both medical and surgical therapy for IBD. Although concern about possible untoward effects of therapy is warranted, treatment should not be withheld because of fear of complications.     

老年甲状腺功能亢进症25例临床特点分析

目的探讨老年人甲亢的临床特点，提高患者的生活质量和生存率，降低误诊率和漏诊率。方法回顾性分析我院1998—2007年的25例老年型甲亢性心脏病误诊患者的临床资料。结果25例不同临床表现的老年甲亢患者，误诊时间20d～5年，一经确诊，通过个体化治疗，合理指导，病情均得到缓解和治愈，并发症也得到控制。结论老年甲亢误诊率高，症状不典型，在临床工作中应引起高度重视。     

Crystal-associated arthritis in the elderly

Since the original recognition of these conditions in 1961, a great deal has been learned about the pathogenesis, clinical manifestations, and appropriate treatment of gout and pseudogout, and the role of crystals in osteoarthritis has been further defined. The variable manifestations of crystal-induced arthritis in elderly populations has led to a greater need for proper diagnosis and treatment strategies for these increasingly common forms of arthritis.