动态心电图筛查睡眠呼吸暂停综合征的临床价值

选择因鼾症在门诊就诊或伴有鼾症的同期住院患者77例,所有患者均同步进行多导睡眠图(PSG)和动态心电图检查.结果 经PSG确诊睡眠呼吸暂停综合征(SAS)60例,非SAS 17例;SAS患者的平均年龄和体质量指数均明显高于非SAS者.动态心电图筛查出56例SAS,动态心电图筛查SAS的灵敏度为90.0%,特异度为88.2%,误诊率为11.8%,漏诊率为10.0%,总的符合率为89.6%,Youden指数为78.2%,Kappa值为0.722.认为动态心电图筛查SAS的灵敏度、特异度和总的符合率等基本评价指标较高,与金标准的一致性较好,可用于SAS患者的初筛.     

应用动态心电图推导呼吸曲线人工分析的方法初筛睡眠呼吸暂停低通气综合征

目的:以多导睡眠分析仪作对照,探讨应用动态心电图推导呼吸曲线(EDR),采用人工分析的方法初筛睡眠呼吸暂停低通气综合征(SAHS)的可行性。方法:2004年4月～2005年10月对120例就诊于睡眠中心的患者进行整夜(>7h)多导睡眠分析仪监测,同时同步进行动态心电图检查。双方在互相不沟通的情况下分别计算睡眠呼吸暂停低通气指数(AHI),并做出SAHS阳性与阴性的诊断,以多导睡眠分析仪结果作为金标准评价应用EDR技术初筛SAHS的可行性。结果:120例患者通过多导睡眠分析仪监测,结果88例患者SAHS阳性,32例患者SAHS阴性,应用动态心电图EDR技术人工分析方法初筛SAHS结果敏感性85.2%、特异性93.8%、阳性预测值97.4%、阴性预测值69.8%、诊断符合率87.5%。受试者工作特性曲线(ROC)下面积0.938,经相关分析两者AHI的相关系数为0.879(P=0.000),两者最长睡眠呼吸暂停时间的相关系数为0.716(P=0.000),两者最长睡眠低通气时间的相关系数为0.281(P=0.005)。结论:应用动态心电图EDR技术,采用人工分析方法对可疑SAHS患者进行初筛的符合率较高,可以作为临床上SAHS诊断的辅助工具。     

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7h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。     

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.     

阻塞性睡眠呼吸暂停综合征与心律失常的相关性探讨

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）是指上气道塌陷阻塞引起的呼吸暂停和低通气反复发作30次以上或睡眠呼吸暂停低通气指数（apnea-hypopneaindex，AHI）≥5。呼吸暂停系指口和鼻气流停止至少10s以上。低通气是指呼吸气流降低超过正常气流强度的50％以上，并伴有血氧饱和度下降4％以上。应用多导睡眠生理仪进行整夜睡眠监测是诊断阻塞性睡眠呼吸暂停综合征的“金标准”。本文对80例患者临床特征及多导睡眠图（polysomnography，PSG），24小时动态心电图监测结果进行分析，了解OSAS与心律失常的关系。     

阻塞性睡眠呼吸暂停综合征与动态血压

阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ，ＯＳＡＳ）与高血压有密切的关系，ＯＳＡＳ病人中有根高的高血压的患病率，高血压的病人中ＯＳＡＳ的患病率也较高，每次呼吸暂停的发作都伴随着短暂的血压升高。动态血压监测（ａｍｂｕｌａｔｏｒｙｂｌｏｏｄｐｒｅｓｓｕｒｅｍｏｎｉｔｏｒｉｎｇ，ＡＢＰＭ）有明显的优于偶测血压（ｃａｓｕａｌｂｌｏｏｄｐｒｅｓｓｕｒｅ，ＣＢＰ）之处，更适于对ＯＳＡＳ病人的血压监测。国外已有人将此技术用于ＯＳＡＳ的研究。     

应用心率变异性时域和频域指标初筛阻塞性睡眠呼吸暂停综合征

目的　以多导睡眠分析仪 (PSG)作为金标准,比较心率变异性 (HRV)的时域和频域指标初筛阻塞性睡眠呼吸暂停综合征 (OSAS)的可行性。方法　2003年 7月至 2003年 12月对在我院睡眠中心进行整夜PSG睡眠监测的患者同步进行动态心电图检查,由睡眠中心提供连续 48例OSAS(阳性 )患者作为试验组, 47例OSAS(阴性 )患者作为对照组。动态心电图分析者在不知道患者临床情况和PSG结果的情况下独立作出OSAS(阳性 )与OSAS(阴性 )的诊断,并比较HRV时域指标与频域指标初筛OSAS的可行性。结果　试验组的平均年龄、男女比值、体重指数、高血压和糖尿病的患病率均明显高于对照组 (P<0 .05);HRV时域指标中,试验组SDNN昼 夜、SDNN指数昼 夜、PNN50夜与对照组相比差异有统计学意义 (P<0. 05);频域指标中,与对照组相比,试验组在总功率夜、总功率昼 夜、VLF夜、VLF昼 夜、LF夜、LF昼 夜等频域指标差异均有统计学意义 (P<0 05 )。而LF/HF这一频域指标,无论是昼、夜,还是昼夜差值,与对照组相比差异均有统计学意义 (P<0 .05 )。其他指标中,试验组仅室性心律失常明显多于对照组 (P<0 .05)。当动态心电图睡眠窒息危险评分 >4为阳性标准时,初筛诊断OSAS的敏感性为 81 .25%,特异性为 46 .81%,诊断符合率 64 21%。当分别以睡眠窒息分析评分     

阻塞性睡眠呼吸暂停综合征患者的心率变异性研究

目的研究阻塞性睡眠呼吸暂停综合征(OSAS)患者心率变异性(HRV)昼夜变化,探讨利用HRV指标筛选OSAS的效果。方法对80例研究对象测量体重、身高、血压、计算体重指数(BMI)、询问有无糖尿病史、心肌梗死病史。对可疑OSAS者用多导睡眠图(PSG)行整夜(至少7h)睡眠检测,同步记录脑电图、眼电图、下颌肌电图、口鼻气流、胸腹呼吸、鼾声、血氧饱和度(SaO2)、血压及脉搏情况。所有研究对象同步进行动态心电图及24h HRV检查。以研究OSAS患者HRV昼夜变化。行PSG检测的50例患者,通过PSG、HRV分析各自的诊断标准在互相不沟通的情况下做出OSAS阳性、阴性诊断。以PSG检测为标准,评介HRV分析筛选OSAS的效果。结果△[昼/夜]OSAS阳性组与OSAS阴性组HRV时域指标的平均夜间SDNN、△[昼/夜]SDNN、夜间RMSSD、△[昼/夜]RMSSD、夜间PNN50、△[昼/夜]PNN50有显著性差异;频域指标的平均夜间ULF、夜间VLF、△[昼/夜]VLF、夜间LF、△[昼/夜]LF、夜间HF、△[昼/夜]HF有显著性差异。平均心率变异四项指标评分,≥1分敏感性为75%,特异性为70%,符合率为74%;≥2分敏感性为70%,特异性为80%,符合率为72%;≥3分敏感性为37.5%,特异性为90%,符合率为48%。结论OSAS患者夜间HRV增强;应HRV分析筛选OSAS有其临床实用价值。     

睡眠呼吸暂停低通气综合征问卷对阻塞性睡眠呼吸暂停综合征诊断价值

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的流行病学调查表筛查价值.方法 疑似OSAHS的987例患者为研究对象,按照中华医学会呼吸病学分会睡眠学组睡眠呼吸暂停低通气综合征流行病学调查表进行问卷并行多导睡眠监测.将此问卷表进行量化评分,用克隆巴赫信度系数(α系数)进行信度计算,将各相关因素做方差分析及x2检验,筛选出有统计学意义的因素最后做Logistic回归分析.以鼾声中度以上的打鼾及体质量指数≥25 kg/m2为高危,反之为低危,进行敏感性,特异性,假阳性,假阴性,阳性似然比,阴性似然比,阳性预测值等.结果 疑似OSAHS患者987例,其中男800例(81.05％),女187例(18.95％),年龄18～80岁,平均(47±12)岁,平均体质量指数(29±5) kg/m2.＞60岁者156例(15.81％),≤60岁者831例(84.19％).克隆巴赫信度系数(Cronbach'salpha)是0.803,假阳性者20,假阴性者142,真阳性者742,真阴性者83,问卷的敏感性是83.94％,特异性是80.58％,假阳性率19.42％,假阴性率16.06％,阳性似然比4.32,阴性似然比0.20,阳性预测值0.97,阴性预测值0.37,正确率83.59％.结论 该睡眠调查表对OSAHS筛查具有一定意义,可用于临床OSAHS的初筛,尤其适合在社区和基层医院中推广使用.     

动态心电图在睡眠呼吸暂停综合征筛查中的应用价值

目的：探讨动态心电图在睡眠呼吸暂停综合征（sleep apnea syndeome,SAS）筛查中的应用价值。方法选择有不同程度睡眠鼾症的121例患者进行动态心电图检查。采用DMS 公司的第二代 SAS 初筛技术,同步提取动态心电图与呼吸波,并同步对患者行多导睡眠图（polysomnography,PSG）检查,进行阳性率比较。结果121例患者中,PSG 阴性40例、阳性81例,阳性患者中轻度25例、中度42例、重度14例。动态心电图检查阴性46例、阳性75例。动态心电图与 PSG 监测出的阳性患者72例相吻合。其中,两者对中、重度患者诊断的阳性率一致,但对于轻度患者动态心电图检出率偏低,并出现假阳性现象。动态心电图对中、重度SAS 的阳性检出率明显高于轻度患者,差异有统计学意义（P ＜0．05）。结论动态心电图是简便、实用和可靠的检测 SAS 的方法,对该病有较好的筛查效果,可用于临床诊断。     

The predictive value of Holter monitoring in the risk of obstructive sleep apnea

BackgroundPatients with obstructive sleep apnea (OSA) often present with cardiovascular symptoms. Holter monitors were reported to predict sleep apnea, though were rarely used in everyday clinical practice. In this study, by comparing Holter monitoring to polysomnography (PSG), we try to find out an operable way for clinicians to use Holter to predict OSA risk.MethodsPatients (n=63) suspected of OSA underwent Holter monitoring with concurrent PSG at a sleep center. Respiration and heart rate variability (HRV) indices were calculated from the Holter and compared with PSG indices.ResultsThe sensitivity of the Holter-derived respiratory waveform for OSA was 90.0%, and the specificity was 82.6%. The time domain indices including standard deviation of all NN intervals during 24 hours, mean of standard deviation of the averages of NN intervals in all 5-minute segments, square root of the mean squared differences of successive NN intervals, percentage of beat-to-beat NN interval differences that were more than 50 milliseconds, and the frequency domain index of high frequency decreased in participants with OSA and correlated with the PSG derived indices including apnea-hypopnea index (AHI), oxygen reduction index (ODI) and nadir SaO₂. Logistic regression showed that standard deviation of all NN intervals during 24 hours and gender could predict the risk of OSA (P<0.001), with a sensitivity for diagnosing moderate to severe OSA of 87.5% and could accurately distinguish the risk of OSA in 77.8% of patients. Males with standard deviation of all NN intervals during 24 hours ≤177 ms or females with standard deviation of all NN intervals during 24 hours ≤80.9 ms were considered to be at high risk for OSA.ConclusionsCommercial and common parameters from Holter monitoring could predict the risk of OSA with high sensitivity. Therefore, the risk of OSA may be assessed using the Holter examination to improve the diagnosis and treatment rate of OSA.     

Clinical presentations of obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a common but still underrecognized disorder. It affects 2% to 4% of middle-aged adults, a significant proportion of whom are female. The spectrum of clinical presentations of OSAS and their severity is variable, ranging from neurocognitive complaints to cardiorespiratory failure. OSAS has a significant impact on quality of life, cardiovascular morbidity, and mortality. Its major sequelae include daytime somnolence and its consequences (motor vehicle accidents, poor work performance, disrupted social interactions), systemic and pulmonary hypertension, and ischemic heart disease. Treatment of OSAS results in improvement in symptoms, quality of life, and blood pressure control, and may improve mortality. An expansion of our understanding of this condition has resulted in increased awareness of its consequences, but the recognition of OSAS in clinical practice is still delayed. Identification of these patients in clinical practice requires attention to risk factors (history of snoring and witnessed apneas, obesity, increased neck circumference, hypertension, family history) and careful examination of the upper airway. Clinical impression alone, however, has poor (50% to 60%) sensitivity and specificity (63% to 70%) and the diagnosis is usually obtained on polysomnography. Physicians and other health care professionals need to be aware of the progress made in this area and recognize the necessity for prompt evaluation and treatment of these patients.     

阻塞性睡眠呼吸暂停综合征合并高血压患者的睡眠分析

目的 分析阻塞性睡眠呼吸暂停综合征(OSAHS)合并高血压患者的睡眠.方法 将我院收治的OSAHS合并高血压患者作为研究1组,OSAHS血压正常患者作为研究2组,并以单纯鼾症患者作为对照组,应用多导睡眠监测仪对三组患者进行睡眠监测.结果①研究1组、研究2组觉醒时间较对照组明显增多,研究1组浅睡眠较研究2组、对照组明显增多;中度睡眠研究2组、对照组明显减少(P<0.05).② 研究1组呼吸暂停低通气指数、呼吸暂停指数明显高于研究2组(P<0.05).③研究1组呼吸暂停时间占睡眠时间百分比较研究2组升高(P<0.05).④ 研究1组最低血氧饱和度明显高于研究2组(P<0.05).结论 OSAHS合并高血压患者呼吸紊乱较血氧正常患者重,睡眠质量相对较差.     

阻塞性睡眠呼吸暂停低通气综合征的筛查与确诊

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是临床上一种较为常见的综合征,人群患病率较高,在成年男性中其患病率约为2%~4%[1]。OSAHS的诊断主要依赖于多导睡眠图(PSG)监测,不仅可帮助我们诊断OSAHS,还可用于判断病情的程度和指导治疗。但PSG所需的仪器设备昂贵,且需专门的睡眠监测场所和技术人员,基层医院不易普及,因此也使OSAHS的诊治受到了限制。现对各种可以用于诊断OSAHS的方法和技术进行综述,并对其临床价值进行评价。OSAHS的临床表现OSAHS患者典型者多表现有肥胖、颈部粗短,夜间睡眠时习惯性打鼾、且鼾声响亮不均匀,同…     

Portable monitoring in the diagnosis of the obstructive sleep apnea syndrome

Portable monitors are classified into three levels (Level II, III, and IV) with decreasing measurements of sleep and respiratory variables. A full overnight sleep study with respiratory measurements and sleep staging (polysomnography) unattended by a sleep technician is Level II, three or more respiratory channels and heart rate generally without sleep staging either attended or unattended is Level III, and one or two channels attended or unattended, usually including oximetry, is Level IV. To date, some Level III portable monitors appear to have sufficient specificity to diagnose the obstructive sleep apnea (OSA) syndrome but are not sufficiently sensitive to exclude OSA. Attended portable monitoring appears to provide better sensitivity and specificity than unattended portable monitoring and is an option for diagnosis of OSA. The role of portable monitoring is evolving but at this time cannot substitute for attended polysomnography as a standalone approach. The exact place of portable monitoring and the cost-benefit depends on local circumstances and cannot be generalized at this time.     

动态心电图对阻塞性睡眠呼吸暂停综合征严重程度的预测价值

目的 评价动态心电图(Hoher)预测阻塞性睡眠呼吸暂停综合征(OSAHS)严重程度的价值.方法 选择2008年1月至2009年7月在我院老年科就诊经多导睡眠分析仪(PSG)检查确诊为OSAHS患者76例,并于1个月内行Hoher检查.其中,28例呼吸暂停低通气指数(AHI)≤20诊断为轻度OSAHS,48例AHI>20诊断为中、重度OSAHS.根据Hoher心率变异性分析对13项睡眠窒息危险指标进行评分,总和为睡眠窒息危险总分.将体质指数(BMI)及13项睡眠窒息危险指标各项得分进行logistic二元回归分析,评估Holler预测OSAHS严重程度的价值.结果 轻度OSAHS和中、重度OSAHS患者的性别、年龄,合并高血压、冠心病、糖尿病、高脂血症及服用B受体阻滞剂的临床特征无显著性差异.严重程度不同的OSAHS患者Hoher睡眠窒息危险评分总分差异无统计学意义(分别为5.64±2.33和6.42±2.22,P>0.05).极低频/总功率百分比>70%和△白天/夜晚低频功率差异<-70以及BMI与中、重度OSAHS相关,OR值分别为3.98(1.087～14.596),3.69(1.106～12.285)和1.28(1.062～1.544)(P<0.05).结论 应用Hoher心率变异性分析指标中的极低频/总功率百分比和△白天/夜晚低频功率差异以及BMI有助于早期识别中、重度OSAHS患者.     

动态心电图筛选睡眠呼吸暂停综合征的初步研究

目的　探讨动态心电图 (Holter)对阻塞性睡眠呼吸暂停综合征 (OSAS)患者的评价功能。方法　北京大学人民医院用多导睡眠分析仪 (PSG)对 2 0 0 3- 0 7～ 2 0 0 4 - 0 195例研究对象进行整夜睡眠监测 ,同步进行Holter检查。双方在互相不沟通的情况下各自作出阻塞性睡眠呼吸暂停综合征阳性 (OSAS )与阴性 (OSAS - )的诊断。结果　心率变异性 (HRV)频域分析指标较时域分析指标敏感 ;动态心电图以睡眠窒息危险分析评分大于 4为阳性诊断标准时 ,诊断OSAS的敏感性为 81 2 5 % ,特异性为 4 6 81% ,诊断符合率 6 4 2 1%。当分别以睡眠窒息危险分析评分大于 5、6和 7为阳性标准时 ,Holter对OSAS诊断的特异性升高 ,但敏感性、诊断符合率均降低。结论　Holter作为一种简单快捷的辅助工具筛选OSAS有一定的临床应用价值。     

Clinical effects of surgical treatment of obstructive sleep apnea syndrome

Aim of this study was to estimate the efficiency of surgical interventions in the treatment of obstructive sleep apnea (OSAS). Inclusion criteria for treatment were: presence of anatomical abnormalities within upper airways, a will to undergo surgical procedure and no medical contraindication for this treatment. Study group consisted of 43 men at age 42.8 +/- 6.8 year with mean pretreatment value of AHI: 49.5 +/- 21.5. Nasal surgery was performed in 26 cases interventions improving patency of nose were performed, uvulopalatopharyngoplasty in 17 and in two the tonsillectomy. Diagnosis of OSAS was made on the basis of typical complains and symptoms and results of nocturnal polysomnography. During follow-up, subjective improvement was reported by 35 (81%) of patients. Polysomnography revealed a significant decrease of AHI to below 15 in 10 (23%) cases; a lowering over 50% of AHI was obtained in 6 (14%) cases: in another 7 (16%) an increase in post-surgery AHI value was noticed. Efficiency of each intervention is presented as follows: tonsillectomy: 100%, uvulopalatopharyngoplasty: 41% and nasal surgery: 4.2%. Deterioration of OSAS in 7 cases was most probably due to more sleep on back during the follow-up.