低温等离子消融技术治疗中重度阻塞性睡眠呼吸暂停低通气综合征67例

我科对67例经多导睡眠监测（polysomnogram,PSG）确诊为中重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的患者,采用低温等离子射频消融术进行治疗,现报告如下。     

OSA-18量表评价儿童睡眠呼吸紊乱程度160例

目的探讨OSA-18量表评价儿童睡眠呼吸紊乱严重程度的价值。方法我科收治的疑似阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)儿童患者160例,均行多道睡眠描记术(polysomnography,PSG)监测。采用OSA-18评估患儿的生活质量。分析确诊为OSAHS患儿的呼吸暂停低通气指数(apnea hypopnea index,AHI)和最低血氧饱和度(lowest oxygen saturation,LSaO2)与OSA-18评分的相关性。结果确诊OSAHS患者123例,单纯鼾症37例。OSAHS患者的OSA-18评分与AHI及LSaO2的相关系数分别为0.615和-0.496,P<0.05。单纯鼾症及轻中度OSAHS患者各组间OSA-18中位数差异有统计学意义(P<0.05);重度OSAHS患者OSA-18中位数为91.0,高于单纯鼾症及轻、中度OSAHS患者(OSA-18评分依次为64.0、76.0和87.0,P<0.05)。以LSaO2为依据对OSAHS患者进行分组,发现无低氧血症组及轻、中度低氧血症患者各组间OSA-18中位数差异有统计学意义(P<0.05),重度低氧血症患者OSA-18中位数为93.0,高于无低氧血症组及轻、中度低氧血症患者(OSA-18评分依次为69.0、81.0和89.0,P<0.05)。结论 OSA-18评分与PSG存在相关关系,在不同程度睡眠呼吸紊乱中有差异,可作为临床诊断儿童OSAHS的评价指标。     

儿童阻塞性睡眠呼吸暂停低通气综合征的诊断和治疗

目的明确儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的临床诊断标准,探讨采用扁桃体低温消融术、腺样体刮除术对治疗儿童OSAHS的疗效.方法通过临床表现、常规检查、纤维鼻咽镜检查和多导睡眠图监测,对儿童OSAHS进行诊断.30例儿童OSAHS均在插管全身麻醉下,采用美国低温等离子体射频手术系统对双扁桃体进行低温消融术,腺样体行常规刮除术.结果30例患儿均符合儿童OSAHS诊断标准.经手术治疗除1例效果不佳外,21例临床症状完全缓解,8例明显好转,无一例出现手术并发症.结论通过临床表现、常规检查、纤维鼻咽镜检查可初步诊断儿童OSAHS;根据多导睡眠图监测,以呼吸暂停低通气指数(apnea-hypopneaindex,AHI)≥5次/h,伴最低血氧饱和度＜92%确诊儿童OSAHS.扁桃体消融、腺样体刮除术能有效扩大鼻咽、口咽部通气截面积,解除上气道阻塞因素,是治疗儿童OSAHS新的有效方法.     

阻塞性睡眠呼吸暂停低通气综合征对青光眼患者眼压波动的影响

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对青光眼患者24 h眼压波动的影响,评估辅助持续正压通气(CPAP)治疗对患者眼压的控制效果.方法 对可疑青光眼患者166例行24 h眼压监测,对确诊的青光眼患者行7 h睡眠监测.根据呼吸暂停低通气指数(AHI)将患者分成OSAHS+青光眼组与非OSAHS+青光眼组...     

阻塞性睡眠呼吸暂停低通气综合征与青光眼关系的研究进展

青光眼是一种病理性眼压升高,伴有视野损害,具有青光眼性视神经损害进而严重影响视功能的相关疾病。阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是指睡眠过程中上呼吸道部分或完全阻塞使呼吸气流减少(低通气)或中断(呼吸暂停),随后通过短暂觉醒恢复上呼吸道通气,从而引起反复发作的夜间低氧和高碳酸血症,可导致高血压、冠心病、糖尿病和脑血管疾病等并发症,甚至出现夜间猝死的睡眠呼吸疾病。OSAHS除了是心脑血管的独立危险因素外,目前许多的研究表明其亦与青光眼具有一定关联,但尚缺少对两者关系的系统性分析,本研究拟对其进行综述分析。     

鼻内糖皮质激素治疗儿童阻塞性睡眠呼吸暂停低通气综合征研究进展

儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与上气道及全身炎症反应相关,鼻内糖皮质激素作用于扁桃体、腺样体上的糖皮质激素受体,抑制炎症反应,可以降低儿童OSAHS患者的呼吸暂停低通气指数。     

上气道神经肌肉调控在阻塞性睡眠呼吸暂停低通气综合征发病机制中的作用

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的发病机制涉及多方面,其中上气道神经肌肉的调控可能发挥着重要作用.本文对正常人和OSAHS患者在清醒和睡眠状态下的神经肌肉活动进行综述,以阐释上气道神经肌肉调控参与OSAHS发病的可能机制.     

呼吸气流平台指数与气道阻力的关系

目的研究从鼻导管得到的呼吸气流-时间曲线的平台指数,反映气道阻力的可靠性.方法行整夜多导睡眠监测(polysomnography,PSG)时用鼻导管观察呼吸气流,并用分析软件对气流-时间曲线进行量化、统计后得到平台指数.比较重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hyponeasyndrome,PSAHS)组、中度OSAHS驵、轻度OSAHS组、单纯鼾症组、疑上气道阻力综合征组(upper airway resistancesyndronme UARS?)及对照组(无鼾组)的平均平台指数.结果发现各级OSAHS组和UARS?组的各级平台指数明显高于单纯鼾症组和无鼾组.结论从鼻导管得到的呼吸气流-时间曲线的平台指数是反映气道阻力的较敏感参数.     

多导睡眠监测评估儿童阻塞性睡眠呼吸暂停低通气综合征手术疗效78例

我科采用扁桃体切除术、鼻内镜下腺样体刮除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）,术前、术后应用多导睡眠监测（polysomnogram,PSG）确定诊断和评价手术效果,现报告如下。     

阻塞性睡眠呼吸暂停低通气综合征患儿血氧指标与呼吸紊乱指标相关性研究

目的 通过研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿血氧指标与呼吸紊乱指标之间的相关性,为临床诊断提供参考.方法 128例经整夜多导睡眠监测（PSG）确诊为重度OSAHS的患儿,着重统计分析最低血氧饱和度（LSpO2）、血氧饱和度低于0.90占监测总时间的百分比（TS90％）与睡眠呼吸暂停低通气指数（AHI）、阻塞性睡眠呼吸暂停指数（OAI）之间的相关性.结果 当AHI＞ 20次/h时：①LSpO2与AHI、OAI呈负相关,Pearson相关系数分别为-0.545、0.380;②TS90％与AHI、OAI呈正相关,Pearson相关系数分别为0.779、0.645.当OAI＞ 10次/h时：①LSpO2与AHI、OAI呈负相关,Pearson相关系数分别为-0.583、-0.418;②TS90％与AHI、OAI呈正相关,Pearson相关系数分别为0.785、0.672.以上均有统计学意义（P＜0.01）.结论 重度OSAHS患儿中,TS90％与AHI、OAI的相关性较LSpO2与之更强,要提高对TS90％在评估儿童缺氧程度中的关注.使用OAI指标判断疾病程度时,血氧指标与AHI及OAI相关性更强,提示儿童睡眠疾病严重程度判断中不能忽视OAI指标.     

阻塞性睡眠呼吸暂停低通气综合征与糖尿病视网膜病变的关系

阻塞性睡眠呼吸暂停低通气综合征（ obstructive sleep apnea hypopnea syndrome,OSAHS）是一种以上气道塌陷反复发作为特征的,最终导致夜间间歇性低氧血症的一类疾病。近年来OSAHS与糖尿病视网膜病变的关系已有报道,我们就两者的临床联系、相关检查及其可能的作用机制进行综述。     

阻塞性睡眠呼吸暂停低通气综合征患者主观评估与客观检查的相关性研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者主观评估和客观检查的相关性.方法 分别采用视觉模拟量表(visual analogue scale, VAS)、Epworth嗜睡量表(Epworth sleepiness scale, ESS)和Calgary睡眠呼吸暂停生活质量指数量表(sleep apnea quality of life index, SAQLI)评估200例OSAHS患者的打鼾、嗜睡症状和生活质量,分析它们与多导睡眠仪(polysomno-graphy,PSG)检查间的相关性.结果 VAS、ESS与PSG间有一定的相关性,但不同呼吸暂停低通气指数(apnea hypopnea index, AHI)和最低血氧饱和度(lowest oxygen saturation, LSaO2)组间只有重度组VAS和ESS值与其他各组间差异有统计学意义.SAQLI同PSG间没有良好的相关性,而且不同AHI和LSaO2组间只有重度低血氧组的症状维度分值与其他各组间差异有统计学意义.结论 评估OSAHS患者须结合主观评估和客观检查.VAS和ESS在评估病情严重程度上的价值不大.(中国眼耳鼻喉科杂志,2009,9:145-147)     

阻塞性睡眠呼吸暂停低通气综合征与眼表疾病的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种在夜间睡眠过程中上呼吸道短暂的、反复发作的、部分或完全阻塞的一组疾病,其可以影响机体血流动力学、内分泌和自主神经调节,进而导致机体氧饱和度降低、慢性缺氧和高碳酸血症。OSAHS除了是心脑血管疾病的独立危险因素外,目前许多研究表明其亦与眼表疾病具有一定关联,如眼睑松弛综合征、干眼、圆锥角膜等,但尚缺少完善的系统性分析。本文拟对OSAHS与相关眼表疾病的关系,包括发病机制、临床表现、治疗进展等进行综述,以期在临床诊疗中减少OSAHS患者眼科并发症,更好地提高患者的生命质量。     

睑板腺形态及功能与阻塞性睡眠呼吸暂停综合征的关系

目的探讨阻塞性睡眠呼吸暂停综合征（OSAHS）患者睑板腺形态结构及其泪膜稳定性的改变。方法描述性研究。选取2013年11月至2014年6月期间于我院呼吸内科确诊为OSAHS的患者63例（126眼）作为OSAHS组,同期体检中心健康体检人群44例（88眼）作为对照组。对全部纳入对象询问个人基本信息及病史,并对眼表疾病指数（OSDI）进行评分后,再进行裂隙灯显微镜、非接触式红外线睑板腺成像仪、泪膜破裂时间（BUT）、睑板腺分泌物性状等眼部检查。结果睑板腺缺失发生率在对照组,轻度、中度、重度OSAHS患者中分别为12/88（14%）、7/18（39%）、14/30（47%）、53/78（68%）,组间差异有统计学意义（χ²=50.62,P＜0.01）;轻度、中度、重度OSAHS患者睑板腺缺失评分分别为2.29±1.25、2.29±0.91、2.64±1.18,差异无统计学意义。对照组,轻度、中度、重度OSAHS患者中睑板腺扭曲发生率分别为8/88（9%）、6/18（33%）、12/30（40%）,49/78（63%）,组间差异有统计学意义（χ²=51.96,P＜0.01）。OSAHS组睑板腺开口堵塞发生率（69%）、分泌物性状改变发生率（72%）较对照组高（分别为36%、39%）,差异均有统计学意义（χ²=22.42、27.26,P＜0.01）。结论与正常人群比较,OSAHS患者泪膜稳定性较低,睑板腺萎缩及腺体的形态异常发生率较高,并且睑板腺的形态改变与OSAHS严重程度有关。     

Obstructive sleep apnea–hypopnea syndrome (OSAHS) and glaucomatous optic neuropathy

Obstructive sleep apnea–hypopnea syndrome (OSAHS) is becoming widely accepted as a risk factor for glaucoma. We discuss the proposed mechanism involved in the pathogenesis of glaucoma in OSAHS, and review the published data on the association between these two conditions, as well as papers regarding functional and structural tests related with glaucomatous damage. There is increasing evidence that the prevalence of glaucoma is higher in OSAHS patients, especially in those with severe disease with apnea-hypopnea index (AHI) >30, and also that sleep disorders may be more frequent in patients with glaucoma, especially in those with normal tension glaucoma (NTG). Several ophthalmic signs and symptoms have been associated with this condition. Raised intraocular pressure (IOP), possibly related to increased body mass index, thinning of retinal nerve fiber layer (RNFL), and alteration of visual field (VF) indices has been demonstrated in many studies, in patients with no history of glaucoma or evidence of glaucomatous changes in the ophthalmic examination. A correlation of AHI with RNFL and VF indices has been described in some studies. Finally, corneal thinning, suspicious glaucomatous disc changes and anomalies in electrophysiological tests such as multifocal visual evoked potential have been described in patients with OSAHS, even in patients with normal findings in the optic nerve and VF, suggesting subclinical optic nerve involvement not detectable in conventional ophthalmic examinations. The pathogenesis of optic nerve involvement has been related to vascular and mechanical factors. Vascular factors include recurrent hypoxia with increased vascular resistance, autonomic deregulation, oxidative stress and inflammation linked to hypoxia and subsequent reperfusion, decreased cerebral perfusion pressure and direct hypoxic damage to the optic nerve. Proposed mechanical factors include increased IOP at night related to supine position and obesity, raised intracranial pressure and elastic fiber depletion in the lamina cribosa and/or trabeculum. In conclusion, ophthalmic evaluation should be recommended in patients with severe OSAHS, and the presence of sleep disorders should be investigated in patients with glaucoma, especially in NTG patients and in those with progressive damage despite controlled IOP, as treatment with continuous positive airway pressure may contribute to stabilizing the progression of glaucomatous damage.     

手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征312例

目的 探讨手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(obsturctive sleep apnea hypopnea syndrome, OSAHS)的疗效.方法 对312例OSAHS患儿行全身麻醉鼻内镜下腺样体、扁桃体切除联合腭咽成型术,并将本组患儿疗效同175例经传统方法治疗的OSAHS患儿疗效进行比较.结果 术后随访6个月,283例痊愈,7例显效,21例有效,1例无效.与传统方法治疗组比较,痊愈率差异有统计学意义.无一例复发,未见任何局部及全身并发症,无不良反应.149例患儿术后3个月行多道睡眠监测(polysomnography, PSG),结果均较术前明显改善.结论 手术治疗儿童OSAHS可提高其痊愈率,无局部及全身并发症.     

儿童阻塞性睡眠呼吸暂停低通气综合征104例

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的临床诊断标准和采用等离子低温切除扁桃体及鼻内镜下低温消融腺样体治疗儿童OSAHS的疗效.方法 通过临床症状、常规检查、鼻咽镜检查及鼻咽侧位X线片和多导睡眠监测确诊的OSAHS患儿104例.所有患儿均在气管插管全身麻醉下,采用美国低温等离子手术系统切除双侧扁桃体、鼻内镜下消融腺样体,其中手术切除双侧扁桃体22例,消融腺样体28例,切除扁桃体加消融腺样体54例.结果 104例患儿经治疗后,治愈74例,显效22例,有效6例,无效2例.无一例出现手术并发症.结论临床表现、常规检查、鼻咽镜及影像学检查结合多导睡眠监测为诊断儿童OSAHS的依据.通过等离子扁桃体切除、腺样体消融解除上气道阻塞,是目前治疗儿童OSAHS的最佳选择.     

儿童阻塞性睡眠呼吸暂停低通气综合征中耳功能的观察

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对中耳功能的影响.方法 对32例(64耳)OSAHS患儿及26例(52耳)健康儿童行声导抗和纯音测听检查.结果 32例OSAHS患儿中,鼓室导抗图A型16耳,B型24耳,c型18耳,Ad型4耳,As型2耳;正常听阈12耳,轻度聋48耳,中度聋4耳.患儿组各频率气导听阈均值与对照组比较,差异有统计学意义,峰压值与对照组比较差异亦有统计学意义.结论 儿童OSAHS患者异常导抗图增加,镫骨肌反射消失增多,峰压值偏向负压,出现气导听阈的提高.     

Diurnal changes in retinal nerve fiber layer thickness with obstructive sleep apnea/hypopnea syndrome

AIM: To compare the retinal nerve fiber layer (RNFL) thickness in the morning and evening in Thai patients with varying degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: In this cross-sectional study, potential OSAHS patients at Siriraj Hospital underwent polysomnography to determine the severity of OSAHS and an eye examination (including best corrected visual acuity, slit-lamp examination, and Goldmann applanation tonometry). RNFL thickness was recorded once in the morning and once in the evening, using spectral domain optical coherence tomography. Thickness was expressed as an average and given for each quadrant. Patients with ocular or systemic diseases that might affect RNFL thickness were excluded. RESULTS: Forty-one eyes of 41 patients were classified into 4 OSAHS groups. The average and mean RNFL thickness in most of the four quadrants of the severe OSAHS group trended toward being less than those in the comparable quadrants of the other groups in both the morning and evening. In the moderate OSAHS group, the average RNFL thickness and temporal and superior quadrant thickness in the morning were significantly higher than in the evening (P=0.01, P=0.01, and P=0.03, respectively). In the severe OSAHS group, the inferior quadrant thickness in the morning was significantly higher than in the evening (P=0.03). CONCLUSION: The RNFL thickness in the morning was higher than in the evening in moderate OSAHS.