阻塞性睡眠呼吸暂停综合征患者的认知障碍

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是临床上常见的睡眠障碍,其发病占有关睡眠障碍的1/2～2/3.它的发病率在中年女性中为2%,中年男性为4%,而在65岁以上的老人中可高达42%[1].OSAS时反复发作的低氧血症、高碳酸血症、夜间睡眠结构紊乱除加重或导致呼吸衰竭外,还是心肌梗死、脑血管病、阿尔茨海默病(Alzheimer disease)等疾病的危险因素.它可同时累及多个系统功能,认知障碍是其累及神经系统的一个常见表现.本文拟对该综合征所致的认知障碍及其发病机理、防治研究作一介绍.     

睡眠呼吸暂停综合征与精神病人夜间猝死

睡眠呼吸暂停综合征（sleep apnea syndrome,SAS）的分类包括阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）,中枢性睡眠呼吸暂停综合征（central slee papnea syndrome,CSAS）,睡眠低通气综合征（sleep hyporentilation syndrome）。更为广泛的分类还包括Pickwick综合征及重叠综合征（overlap syndrome）即慢性阻塞性肺病与睡眠呼吸暂停合并存在。也有人认为各型睡眠呼吸暂停可能都有中枢神经系统功能障碍,建议分为阻塞为主型与中枢为主型。     

阻塞性睡眠呼吸暂停综合征的认知改变及精神障碍

阻塞性睡眠呼吸暂停综合征（obstructivesleepapneasyndrome，OSAS）是睡眠疾病之一，以睡眠结构紊乱和反复发作低氧血症为特征，患者常因失眠或日间嗜睡而影响正常社会生活与工作，而且是造成高血压、冠心病、脑卒中的危险因素，因此愈来愈受到研究者及临床医师的重视。睡眠结构紊乱和低氧血症易造成患者的认知改变及精神障碍。本文就此作一简要综述。一、OSAS的病理生理变化1.血气的变化:OSAS患者在夜间睡眠时反复发生呼吸暂停，导致低氧血症和高碳酸血症。动脉血氧饱和度在呼吸暂停发作时可低于50％，而每夜发生呼吸暂停的次数可高…     

阻塞性睡眠呼吸暂停综合征与头痛

晨起头痛是阻塞性睡眠呼吸暂停综合征(OSAS)患者的常见症状之一，但是否仅为晨起头痛?发生机制如何?     

阻塞性睡眠呼吸暂停综合征与血管性认知障碍关系的研究进展

阻塞性睡眠呼吸暂停综合征( Obstructive sleep apnea syndrome,OSAS)是一种慢性睡眠呼吸疾病,主要表现为睡眠期间因部分或完全上呼吸道狭窄或阻塞导致间歇性缺氧、睡眠结构紊乱、日间嗜睡等.该病临床常见,患病率较高,且随着年龄的增加而增加.随着我国老龄化日益严重, OSAS受累人群逐渐增加,...     

阻塞性睡眠呼吸暂停综合征致昏迷2例

<正> 患者1,男,75岁,因昏迷四小时于2003年2月16日入院,于当天晨6时家人发现患者鼾声呼吸较重,呼吸暂停,意识障碍,尿失禁,急送我院。既往高血压病史14年,打鼾史30     

睡眠呼吸暂停综合征与脑卒中

本文综述睡眠呼吸暂停综合征与脑卒中的关系及其防治。近年来国内外大量流行病学研究表明,睡眠呼吸暂停综合征(SAS)可显著增加脑卒中发生和死亡的风险,被认为是脑卒中发生的独立危险因素。由SAS产生的呼吸暂停、低氧血症、高碳酸血症引起的血压改变、脑血流动力学改变、脑自动调节功能减退及血液流变学改变是患者发生脑卒中的主要机制。目前在脑卒中的防治中已越来越关注对SAS的早期诊断和治疗。多道睡眠描记术(Poly- somnography,PSG)是诊断SAS的“金标准”。针对SAS的治疗中,经鼻持续气道正压通气为首选治疗措施。     

阻塞性睡眠呼吸暂停综合征患者认知障碍的临床分析

目的 通过TCD、脑电图记忆量表研究阻塞性睡眠呼吸暂停患者的认知状况及认知障碍产生的可能机制.方法 入组受试者分为阻塞性睡眠呼吸暂停患者组(n=30)及正常对照组(n=15),均进行睡觉多导仪、TCD、脑电图、临床记忆量表检查及神经系统查体.结果 采用t检验和spearman等级相关分析.结果 阻塞性睡眠呼吸暂停患者组记忆商(MQ)为(90±12);对照组MQ为104±16,研究组大脑中动脉[左(63.81±13.12)Cm/s,右(60.61±10.23)cm/s],基底动脉[(42.67±8.02)cm/s]的平均血流速度及脉动指数与对照组比较显著差异(t=6.8～11.3,P＜0.05或0.01).结论 阻塞性睡眠呼吸暂停患者有认知功能损害,夜间低氧血症可能起重要作用.     

睡眠呼吸暂停综合征病人的记忆和情绪障碍

目的为探讨睡眠呼吸暂停综合征病人的记忆和情绪改变及其与血气和睡眠结构之间的关系。方法应用中国科学院心理研究所编制的（临床记忆量表）及抑郁、焦虑量表检测25例睡眠呼吸暂停综合征患者的记忆功能和情绪变化。结果睡眠呼吸暂停综合征病人的记忆功能显著差于鼾症病人组，并且存在着明显的情绪障碍。患者的记忆功能与血氧饱和度（SaO2）呈正相关，与睡眠呼吸紊乱指数（AHI）呈负相关；而抑郁症状与快速眼动睡眠（REM）时间里负相关。结论提示睡眠呼吸暂停综合征病人的低氧血症和睡眠结构紊乱是引起记忆功能和情绪障碍的主要原因。     

伴有惊恐障碍的阻塞性睡眠呼吸暂停低通气综合征睡眠结构特征

目的 分析阻塞性睡眠呼吸暂停低通气综合征合并惊恐障碍(obstructive sleep apnea syndrome com?bined with panic disorder,OCP)患者的睡眠结构特征,探讨OCP睡眠结构变化在临床上的意义.方法 纳入25例OCP患者、29例阻塞性睡眠呼吸暂停低通气综合征(obst...     

Methadone and sleep apnea syndrome]

BACKGROUND: Sleep apnea syndrome occurs when, during sleep, breathing stops for 10 seconds or longer, with an index of 5 times or more an hour. It is clinically characterized by loud snoring at night, continuous or interrupted by pauses followed by loud breathing. Sleep is fitful, broken by arousals, and yields little rest. There is daytime excessive sleepiness with repeated involuntary falling asleep, often unknown by the subject. CLINICAL DESCRIPTION: In this article, we describe an observation of central sleep apnea syndrome in a female patient receiving an opiate replacement therapy. METHOD: An analysis of the before and after methadone withdrawal polysomnograhic tracing was done for this patient. RESULTS: This diagnosis etiology and physiopathology are critically approached. Clinicians should be careful in treating induced sleep disorders in such patients. Conclusion: Prescribing benzodiazepines during an opiate withdrawal of the methadone type is not recommended when central apnea occurs.     

颅内肿瘤和睡眠呼吸暂停低通气综合征

目的 评估颅内肿瘤病人呼吸暂停低通气的类型以及肿瘤切除术在改善呼吸紊乱方面起的作用.方法 对30例颅内肿瘤病人(22例幕上,8例幕下)术前、术后进行睡眠呼吸检测.结果 术前平均呼吸暂停低通气指数为23.3,18例病人存在阻塞性呼吸暂停,3例病人存在阻塞性和中枢性呼吸暂停.术后平均呼吸暂停低通气指数降为9.6(P＜0.0...     

Therapy of obstructive sleep apnea syndrome

Symptomatology and sequelae, as well as diagnosis and therapy of the obstructive sleep apnea syndrome are discussed. The Esmarch prosthesis, which we developed for the prosthetic treatment of obstructive sleep apnea syndrome, was tested in 7 patients. Patients were polysomnographically recorded during two sequential nights with and without Esmarch prosthesis. All apnea parameters improved significantly (apnea time by 78%, apnea index by 67% of baseline values). The mean duration of the remaining apnea phases diminished by 31%. Improvement of O2 saturation of haemoglobin and O2 partial pressure in the tissue paralleled that of the apnea parameters. The severely disturbed sleep profile of the patients showed a clear tendency towards normalization. The Esmarch prosthesis is an efficient method for the treatment of the obstructive sleep apnea syndrome.     

The eye in sleep apnea syndrome

Sleep apnea syndrome (SAS) is a disease characterized by recurrent complete or partial upper airway obstructions during sleep. The majority of patients with SAS demonstrate this obstruction either at the nasopharynx or the oropharynx. Risk factors for SAS include obesity, male gender, upper airway abnormalities, alcohol use, snoring, and neck girth of more than 17 in. in men or 16 in. in women. Reported ophthalmic findings in patients with SAS include floppy eyelid syndrome (FES), glaucoma, and non-arteritic anterior ischemic optic neuropathy (NAION).     

Baroreflex modulation during sleep and in obstructive sleep apnea syndrome

This review focuses on the complex integration between cardiovascular reflexes and central autonomic influences controlling physiological sleep-dependent changes in arterial blood pressure and heart rate. A brief introduction on the anatomic and functional organization of the arterial baroreflex and the methods available to assess its function in humans is followed by an analysis of the functional interaction between autonomic nervous system and sleep mechanisms at the highest levels of brain organization. An insight into these interactions is important to shed light on the physiopathology of the most frequent complications of obstructive sleep apnea syndrome, such as sustained arterial hypertension, and excessive daytime sleepiness.     

Plasma norepinephrine in sleep apnea syndrome

In 8 male patients suffering from sleep apnea syndrome, plasma norepinephrine (NE) levels were examined. At 22.00 and at 6.30 blood samples were obtained. In 3 cases, plasma NE levels displayed little changes between 22.00 and 6.30. In 2 cases, plasma NE levels at 6.30 increased 20% compared with those at 22.00. In 3 cases, plasma NE levels at 6.30 increased more than 40%. No significant correlation between apnea index and plasma NE levels was observed. Total time under 90% arterial oxygen saturation (SaO2) significantly correlated with the ratio of plasma NE levels at 6.30 to those at 22.00. In 2 cases of the 8 patients blood samples were drawn hourly (22.00-6.00) and at 6.30. In these 2 cases, when SaO2 decreased, plasma NE levels tended to increase. It is concluded that in sleep apnea syndrome plasma NE levels increased during sleep and did not correlate with apnea index but with oxygen desaturation.     

Supine sleep and obstructive sleep apnea syndrome in Parkinson's disease

ObjectiveSupine sleep is associated with increased obstructive sleep apnea. People with Parkinson's disease (PD) complain about difficulties turning around in bed. The relationship between supine sleep and sleep-disordered breathing has never been explored in people with Parkinson's disease.MethodsFifteen consecutive people with PD with severe Obstructive Sleep Apnea Syndrome (OSAS) were compared to: (1) 15 age-matched, gender-matched, body mass index-matched and Unified Parkinson's Disease Rating Scale-III score-matched people with PD without sleep-disordered breathing; (2) 11 age-matched and gender-matched people with severe obstructive sleep apnea syndrome (OSAS) alone; and (3) 11 age-matched and gender-matched healthy controls. Outcomes were: number of position changes during the night and per hour of sleep, and the percentage of sleep time spent in supine.ResultsPeople with PD and severe OSAS spent most of their sleep time in the supine position (93 ± 11%); while people with PD without OSAS (61 ± 24%, p <0.001), people with isolated, severe OSAS (50 ± 28%, p <0.001), and the controls (40 ± 21, p <0.001) spent significantly less time on their back. People with PD and severe OSAS changed their position in bed per hour of sleep (0.4 ± 0.5) less frequently than those with PD without OSAS (1.1 ± 0.8, p = 0.002), those with isolated OSAS (1.2 ± 1.0, p = 0.006) and the controls (1.5 ± 0.5, p <0.001).ConclusionPD and severe OSAS are associated with a major reduction in the number of position changes and an increased supine sleep position during the night. For people with PD, alleviating the difficulties of turning around in bed might reduce the supine sleep position and improve sleep-disordered breathing.