高原疗养员脱适应期睡眠障碍及康复治疗研究进展

高原人员长期生活在高海拔、低压低氧环境,生理机能发生了代偿性甚至病理性改变以适应高原特殊环境,到平原地区后,身体机能难以迅速调节以适应环境变化,在建立新的内环境稳态过程中会出现高原脱适应反应。睡眠障碍是脱适应期最主要的症状之一,主要表现为入睡困难、睡眠浅和易醒早醒等情形,睡眠不足和睡眠质量低下不仅损害身心健康,还影响工作效率和生活质量。康复治疗通过综合运用物理、药物治疗和心理、行为干预等措施,帮助高原疗养人员改善睡眠节律,缓解甚至消除脱适应期睡眠问题。本文围绕高原疗养员脱适应期睡眠障碍问题,总结主要影响因素及其潜在致病机制,探讨睡眠评估工具的评估效果和强调改善脱适应期睡眠状况的康复治疗策略。     

重庆市主城区人群睡眠障碍状况的调查研究

目的了解重庆市主城区人群睡眠障碍状况及其影响因素。方法采用多阶段分层随机抽样方法抽取重庆市主城区1 507名居民作为调查对象,采用匹兹堡睡眠质量指数(PSQI)问卷评定调查对象睡眠质量并分析其影响因素。结果调查对象睡眠障碍发生率为15.89%,不同睡眠状况者PSQI总分和各部分评分间存在统计学差异(P<0.05)。调查对象睡眠障碍发生率在性别、年龄、文化程度、婚姻状况以及职业方面存在统计学差异(P<0.05)。年龄、文化程度、性别、婚姻状况和职业是影响睡眠障碍发生的因素。结论重庆市主城区睡眠障碍的发生率较高,应重视并改善居民睡眠问题,提高居民睡眠质量。     

阶梯递进与高原适应(习服)中的睡眠——从古代马帮和使者行走高原说起

本文从军事和旅游的角度,介绍了阶梯递进与高原适应(习服)中的睡眠问题。内容包括:阶梯递进与非阶梯递进的概述、阶梯递进方法、高原适应(习服)与高海拔睡眠、高原适应与低海拔睡眠(脱习服)、高原习服及脱习服研究方法、以及预防高原睡眠障碍几个方面的内容。     

《四部医典》中的睡眠文献述评

藏医著作《四部医典》是藏医经典著作的一部分,书中涵盖了人体的生理、病理、疾病诊疗、卫生保健知识以及药物性能等,内容丰富,其中亦有睡眠相关疾病的阐述。研究藏医中对睡眠及睡眠障碍的有关论述,有助于我们了解高原睡眠问题,进一步为高原睡眠障碍的治疗提供技术支持。因此,笔者根据罗达尚翻译成汉语版的《四部医典》进行检索学习,将其中有关的睡眠医学内容,进行整理,以飨读者。     

世界中医药学会联合会睡眠医学专业委员会第一届高原睡眠医学高峰论坛暨甘肃省第四届中西医结合睡眠障碍诊治新进展学习班通知

<正>近年来,随着现代生物研究技术、传感技术及计算机技术的不断进步,睡眠医学进入了一个飞速发展的时期。但人们对于高原睡眠障碍却了解的甚少,为进一步深化传统与现代多学科、多领域对高原睡眠医学的学术研究、推动睡眠医学快速、积极发展;深入探讨高原睡眠学科和科室建设的先进、完善的运行模式,交流睡眠医学学术研究和建设的创新和实战成果,唤起全社会对睡眠疾患、睡眠健康的重视及关注。由世界中医药学会联合会睡眠医学专业委员会和甘肃中医药大学附属医院主办,世界中医药学会联合会睡眠医学专业委员会高原睡眠学组筹备组和甘肃中医药大学附属医院国家临床重点     

夜间护理干预对神经外科重症监护室病人睡眠质量及护理满意度的影响

目的:探讨夜间护理干预对神经外科重症监护室(NSICU)病人睡眠质量及护理满意度的影响。方法:选取2021年1月—2021年6月某三级甲等医院NSICU95例住院病人作为调查对象,采用匹兹堡睡眠质量指数量表(PSQI)及纽卡斯尔护理满意度量表(NSNS)调查病人睡眠质量及护理满意度,自制NSICU夜间护理干预表调查夜间护理干预情况。结果:58.95%的病人存在睡眠障碍,36.84%的病人因夜间护理干预导致睡眠障碍,夜间护理干预频率为(23.34±4.76)次,护理满意度得分为(93.25±10.74)分。NSICU住院时间、睡眠障碍、因夜间护理干预导致睡眠障碍以及夜间护理干预频次对病人护理满意度的影响无统计学意义(P>0.05)。结论:夜间护理干预未对病人护理满意度造成影响。为了减少夜间护理干预引起的睡眠障碍,应制订规范的护理干预方案,提高病人睡眠质量。     

维持性血液透析患者睡眠障碍的原因分析及护理干预

目的探讨维持性血液透析（以下简称“血透”）患者睡眠障碍的常见原因及护理干预措施,以提高其睡眠质量。方法采用症状自评量表（SCL-90）对维持性血透至少3个月、匹兹堡睡眠质量指数（PSQI）得分〉7分的睡眠障碍患者进行调查,根据引起其睡眠障碍的身心原因,采取不同的干预措施。结果调查发现,维持性血透睡眠障碍患者睡眠障碍原因有多方面,主要为躯体症状和心理问题。SCL-90调查发现,本组患者总均分、躯体化症状、抑郁、焦虑等4项的得分显著高于国内常模（P〈0．01）。结论血液透析患者睡眠障碍受多种因素的影响,医护人员应根据其不同原因制定不同的干预措施,以改善其睡眠质量和生活质量。     

肺结核患者睡眠障碍分析及护理

总结了影响肺结核患者睡眠障碍的因素及护理措施。采用自行设计的问卷对肺结核患者睡眠障碍原因进行调查。导致肺结核睡眠障碍各因素中以生理因素对肺结核患者睡眠的影响最大,其次为环境因素,再次为心理社会因素,最后为其他因素。认为肺结核患者睡眠质量的改善,需要从以上因素着手并有针对性地开展相关的护理措施。     

北京市房山区某农村社区睡眠环境及常见睡眠异常现象考察

正睡眠障碍除了不良的睡眠感受,还伴随各种不适症状影响生活。睡眠环境(房屋、床铺、被褥、枕头等)也影响睡眠,适宜的睡眠环境是良好睡眠的重要条件,不良的睡眠环境可以导致或者加重睡眠障碍。笔者通过在北京房山区农村调查睡眠环境(房屋、床铺、被褥、枕头等)与睡眠及睡眠障碍的关系,以及常见症状与睡眠障碍的关系进行调查,以期探讨农村睡眠环境与睡眠及睡眠障碍的关系及症状特点。     

肺癌患者化疗期间睡眠障碍的影响因素与护理对策

目的:探讨肺癌患者化疗期间睡眠障碍的影响因素及护理对策。方法:采用一般情况调查表、匹兹堡睡眠质量指数(PSQI)对2013年12月~2014年8月我院100例接受化疗的肺癌患者进行调查。结果:89.00%的接受化疗治疗肺癌患者睡眠质量低下,且年龄、文化程度、付费方式、病情严重程度等是肺癌患者化疗期间睡眠障碍的主要影响因素。结论:肺癌患者化疗期间普遍存在睡眠障碍,分析其影响因素并针对性地给患者提供护理干预能改善患者的睡眠质量。     

抑郁症患者睡眠障碍与康复的关系研究

目的探讨抑郁症患者睡眠障碍与疾病康复的关系。方法采用自编调查表及汉密顿抑郁量表(HAMD)对入组患者进行检测并分组,经同样治疗后比较存在严重睡眠障碍患者和睡眠障碍不明显患者的康复情况。结果存在严重睡眠障碍患者的康复明显滞后于睡眠障碍不明显患者,睡眠障碍和患者的病情轻重及发病有密切的关系。结论抑郁症的睡眠障碍直接影响其康复和预后,在抑郁症的治疗过程中应加强对睡眠障碍的原因分析和治疗。     

腹膜透析患者睡眠障碍状况调查

目的了解腹膜透析患者睡眠障碍状况,分析其影响因素。方法采用肾透析与移植病友专用健康调查表（KDQOL）中的睡眠分量表测评84例腹膜透析患者的睡眠状况,同时收集患者疲乏状况、体力活动状况及抑郁情况等。结果本组患者的睡眠得分为15．0—97．5分,平均（53．12±19．33）分,48．8％的患者存在睡眠问题。单因素及多因素Logistic回归分析发现低体力活动水平（OR=2．172）、医疗费是否自费（OR=1．793）、抑郁（OR=1．367）是睡眠障碍的相关因素,差异具有统计学意义（P〈0．05）。结论应当关注腹膜透析患者的睡眠状况,鼓励患者增加身体活动,采取药物或非药物方法改善睡眠质量,改善患者的心理状态,可减少腹膜透析患者睡眠障碍的出现。     

Central sleep apnea syndrome and Cheyne-Stokes respiration

This overview discusses pathogenesis, clinical presentation, prognostic implications and therapy of central sleep apnea with special reference to Cheyne-Stokes-Respiration or periodic breathing. In contrast to obstructive sleep apnea due to upper airway collapse during sleep, central sleep apnea (CSA) is mainly due to an instability of the breathing control system. Causes of central sleep apnea include alveolar hypoventilation disorders, heart failure, neurologic and autonomic disorders and idiopathic forms of CSA. Patients with idiopathic CSA often complain of insomnia and awakening during sleep but may also suffer from daytime sleepiness. Cheyne-Stokes-Respiration or peridic breathing is often associated with heart failure and neurological disorders especially those involving the brainstem. In heart failure periodic breathing has enormous prognostic implications. Treatment options for central sleep apnea are oxygen supplementation, medical therapy (i.e. acetazolamide) and CPAP. For patients with central sleep apnoea associated with alveolar hypoventilation nasal ventilation is treatment of choice. Newer nasal ventilation techniques (BiPAP, AutoSetCS) are under investigation for heart failure patients with Cheyne-Stokes-Respiration.     

The metabolic headaches

This review discusses headaches secondary to disorders of homeostasis, formerly known as “headaches associated with metabolic or systemic diseases.” They include the headaches attributed to 1) hypoxia and/or hypercapnia (high altitude, diving, sleep apnea); 2) dialysis; 3) arterial hypertension; 4) hypothyroidism; 5) fasting; and 6) cardiac cephalalgia. For each headache type, we discuss the clinical features and diagnosis, as well as therapeutic strategies.     

Definitions and clinical classifications of sleep disorders

Sleep disorders are defined as disorders which symptoms or pathophysiology are related with sleep regardless of comorbid physical and/or mental disorders. Sleep disorders are classified into 6 major categories: sleep related breathing disorders which exhibit abnormal breathing during sleep, sleep related movement disorders which show involuntary movements and/or abnormal sensations during sleep and/or nighttime, hypersomnia of central origin not due to other sleep disorders, circadian rhythm sleep disorders due to desynchronization between sleep-wake pattern and required social schedule, parasomnia which exhibit abnormal behavior during sleep and/or around sleep, and insomnia not due to other sleep disorders.     

Quality of life in nonorganic and organic sleep disorders: I. Comparison with normative data

Subjective health-related quality of life (HRQoL) was investigated in 100 patients with disturbed sleep (39 women aged 52 +/- 13 years and 61 men aged 53 +/- 10 years) referred to the sleep laboratory and compared with HRQoL in 100 normal healthy adults. Measurements included the Quality of Life Index (QLI) (Mezzich and Cohen), and objective (polysomnographic) and subjective (psychometric) quality of sleep and awakening. Statistical analysis (Mann-Whitney U-test) showed HRQoL to be significantly reduced in sleep disorders (SDs), with a more pronounced reduction in nonorganic than in organic SDs. Patients with nonorganic hypersomnia were more disturbed than those with nonorganic insomnia. Within organic SDs, patients with apnea were more disturbed than those with obstructive snoring. Out of ten elementary HRQoL components, seven were disturbed in SDs: physical well-being, psychological well-being, self-care and independent functioning, occupational functioning, interpersonal functioning, personal fulfillment, and overall quality of life. No differences between patients and normal healthy subjects where found in the components social support, community and services support or spiritual fulfillment. Patients suffering from nonorganic SDs had significantly worse scores in physical and psychological well-being and overall quality of life than those with organic SDs. Patients with both SDs and additional diagnoses of affective disorders had more profoundly reduced HRQoL than those with anxiety disorders. Follow-up of 51 patients (31 with nonorganic SDs and 20 with organic SDs) one year after sleep laboratory investigation and subsequent treatment found significantly improved HRQoL compared with pre-treatment. Moreover, patients diagnosed and treated in the sleep laboratory showed lower re-hospitalization rats.     

Sleep apnea in adults with traumatic brain injury: a preliminary investigation

OBJECTIVE: To determine the occurrence and nature of sleep-related breathing disorders in adults with traumatic brain injury (TBI). DESIGN: Prospective, observational, consecutive sample enrollment of subjects admitted for rehabilitation after TBI. SETTING: Inpatient rehabilitation and subacute rehabilitation units of a tertiary care university medical system. PARTICIPANTS: Subjects (n = 28) included adults with TBI and a Rancho Los Amigos Scale level of 3 or greater who were less than 3 months postinjury and admitted for comprehensive inpatient rehabilitation. INTERVENTIONS: Overnight sleep study using portable 6-channel monitoring system. MAIN OUTCOME MEASURE: Respiratory disturbance index (RDI), which is the number of apneic and hypopneic episodes per hour of sleep. RESULTS: Evidence of sleep apnea was found in 10 of 28 (36%) subjects as measured by a RDI level of 5 or greater and in 3 of 28 (11%) subjects as measured by a RDI level of 10 or greater. This rate of sleep apnea is significantly (p =.002) higher than would be predicted based on population norms. No correlation was found between the occurrence of significant sleep apnea and measures of TBI severity or other demographic variables. Sleep-related breathing disorders were primarily central though obstructive apneas were also noted. CONCLUSION: In this preliminary investigation, sleep-related breathing disorders as defined by a respiratory disturbance index of 5 or greater appears to be common in adult subjects with TBI.     

维持性血液透析病人睡眠障碍研究现状

从维持性血液透析睡眠障碍发生状况、影响因素、睡眠障碍对病人及照顾者的不良影响、改善睡眠状况的方法等方面对维持性血液透析病人睡眠障碍研究现状进行了综述.     

Factors associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis.

OBJECTIVE: This study aimed at identifying factors that are associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis (CAPD). STUDY DESIGN: Questionnaire survey. SETTING: Renal dialysis unit of a tertiary-care hospital. PATIENTS: 179 Chinese patients on CAPD. MAIN OUTCOME MEASURES: The quantity and quality of sleep were compared between CAPD patients with and without self-reported sleep disorders. Demographic variables, personality traits, behavioral factors, somatic symptoms, and clinical parameters were correlated with the presence of sleep disorders. RESULTS: The mean age of the patients was 61 +/- 12 years and the male-to-female ratio was 1:1.3. The mean duration of CAPD was 47 +/- 42 months. 110 patients (61%) had self-reported sleep disorders. Among patients with self-reported sleep disorders, difficulty falling asleep was the most frequent complaint (74.5%), followed by frequent awakening (68%) and early morning waking (68%). The mean duration of sleep among these patients was 4.6 +/- 2.2 hours, versus 7.3 +/- 1.4 hours in patients without self- reported sleep disorders. Three personality traits (anxiety, worry, and sadness) and two somatic symptoms (bone pain and arthralgia) were the factors significantly associated with sleep disorders. Patients with sleep disorders also more frequently reported certain symptoms suggestive of sleep apnea. Demographic variables, behavioral factors (e.g., caffeine or alcohol intake), and clinical parameters (e.g., adequacy of dialysis, body mass index, hemoglobin, albumin, parathyroid hormone levels) did not differ between patients with and without sleep disorders. CONCLUSIONS: Sleep disorders are prevalent among Chinese CAPD patients. Personality traits (anxiety, worry, and sadness) and somatic symptoms (bone pain and arthralgia) were the factors significantly associated with sleep disorders in this patient population. Behavioral factors, demographic variables, and clinical parameters did not appear to predict sleep disorders. Further studies evaluating the impact of various psychological factors on sleep disorders among CAPD patients are warranted.