阻塞性睡眠呼吸暂停综合征的治疗进展

<正>阻塞性睡眠呼吸暂停综合征(obstractive sleep apnea-hypopnea syndrome,OSAHS)是指在睡眠期间反复发生上气道阻塞并引起呼吸间歇性暂停的疾病。具体指在每晚7h睡眠中,胸腹呼吸运动存在的情况下,呼吸暂停反复发作30次以上或呼吸紊乱指数(apnea hypopnea index,AHI)即平均睡眠呼吸暂停或低通气次数超过5次/h以上[1],其中睡眠呼吸暂停是指睡眠过程中口鼻呼吸气流均停     

96例阻塞性睡眠呼吸暂停综合征临床分析

目的探讨阻塞性睡眠呼吸暂停综合征(OSAHS)患者的临床表现、多导睡眠监测及治疗。方法回顾性分析96例睡眠呼吸暂停综合征患者的临床资料。结果多导睡眠监测轻度16例,中度42例,重度38例,其中OSAHS 87例,混合性睡眠呼吸暂停综合征(MSAHS)9例,中枢性睡眠呼吸暂停综合征(CSAHS)0例。结论阻塞性睡眠呼吸暂停综合征是一种具有潜在危险的睡眠呼吸疾病,应该早期确诊,合理治疗,并积极预防并发症发生。     

阻塞性睡眠呼吸暂停低通气综合征与心脑血管疾病的关系

<正>阻塞性睡眠呼吸暂停低通气综合征(OSAHS)已为比较常见的疾病,研究显示OSAHS是多种全身疾病的独立危险因素,是对人类健康有影响的疾病之一,是心脑血管疾病的独立危险因子。     

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诊治指南(草案)

成人睡眠呼吸暂停综合征包括阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、中枢性睡眠呼吸暂停综合征、睡眠低通气综合征等。临床上以OSAHS最为常见，故本指南重点介绍OSAHS。OSAHS主要表现为睡眠时打鼾并伴有呼吸暂停和呼吸表浅，夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱，导致白天嗜睡、心脑肺血管并发症乃至多脏器损     

中晚期妊娠阻塞性睡眠呼吸暂停低通气综合征对母儿结局影响

［摘要］　目的　探讨中晚期妊娠阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对母儿结局影响。方法　对2020年3月至2021年3月广西医科大学附属柳州市工人医院收治的156例孕妇进行呼吸睡眠障碍筛查，42例孕妇患OSAHS为OSAHS组，114例孕妇未患OSAHS为非OSAHS组。比较两组孕妇临床特征及母儿结局。结果　两组中有高血压病史、糖尿病病史、甲状腺功能减退、OSAHS家族史的人数比例差异均无统计学意义（P>0.05）。孕妇不同预产期年龄组（<25岁、25～34岁、≥35岁）中OSAHS患病率分别为16.7%、23.7%、38.9%，呈上升趋势。在孕中期和孕晚期OSAHS患病率随BMI的增长亦呈上升趋势。OSAHS组中妊娠期高血压疾病、妊娠期糖尿病发生率（分别为47.6%、47.6%）显著高于非OSAHS组（分别为8.8%、29.8%）（P<0.05）。两组胎儿生长受限、羊水过少、死产或死胎、早产、剖宫产、产后出血发生率比较差异无统计学意义（P>0.05）。OSAHS组低出生体重儿发生率（28.6%）高于非OSAHS组（8.8%）（P<0.05）。两组新生儿窒息发生率比较差异无统计学意义（P>0.05）。结论　妊娠期OSAHS患病率随孕妇BMI水平增加而上升。妊娠期OSAHS与妊娠期高血压疾病、妊娠期糖尿病、低出生体重儿的发生密切相关。应加强孕期OSAHS知识的宣教以及筛查，指导患者改变生活方式，必要时给予医疗干预以改善孕期OSAHS情况。     

阻塞性睡眠呼吸暂停综合征的研究进展——阻塞性睡眠呼吸暂停综合征的研究概述

睡眠呼吸障碍是与睡眠相关的呼吸道疾患,以睡眠中发生异常呼吸事件为特征,包括上气道阻力综合征、鼾症、阻塞性睡眠呼吸暂停综合征（OSAHS）、中枢性睡眠呼吸暂停低通气综合征、睡眠低通气综合征及陈一施呼吸等,临床上以OSAHS最常见。OSAHS是以睡眠时反复呼吸暂停、间歇性低氧、睡眠结构紊乱和反复微觉醒为特征,伴或不伴低通气的临床综合征。近年来,随着对人群患病率的流行病学调查,该病患病率之高、并发症之严重越来越引起人们的关注。     

老年阻塞性睡眠呼吸暂停低通气综合征临床及睡眠监测特点分析

目的探讨老年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床及睡眠监测特点。方法 237例确诊为OSAHS的患者分为老年组(105例)和中青年组(132例),将两组临床及睡眠监测资料进行对比,应用SPSS17.0软件进行统计学分析。结果两组体重、BMI、颈围、饮酒率、睡眠呼吸总暂停时间、Ⅰ期睡眠时间占总睡眠时间百分比、Ⅲ期睡眠时间占总睡眠时间百分比、觉醒指数、氧减指数、冠心病发病率比较差异均有统计学意义(P均<0.05)。结论老年OSAHS临床症状不典型,肥胖发生率低,容易并发冠心病;睡眠结构紊乱,Ⅰ期睡眠时间延长,Ⅲ期睡眠时间缩短;总睡眠呼吸暂停时间、微觉醒指数、氧减指数均低于中青年OSAHS患者。     

阻塞型睡眠呼吸暂停低通气综合征的中西医临床治疗现状

阻塞型睡眠呼吸暂停低通气综合征（OSAHS）是一种常见的睡眠呼吸疾患,其患病率高、并发症多、危害性大,成为多种全身性疾病的独立危险因素。本文总结国内近几年来阻塞性睡眠呼吸暂停低通气综合征（obstructive Sleep Apnea Hypopnea Syndrome,OSAHS）的研究进展,并探讨存在问题。     

物联网在睡眠呼吸疾病诊治中的应用专家共识

一、前言睡眠呼吸疾病较为常见且具有潜在风险,其中以阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)最为常见。OSAHS主要表现为睡眠时打鼾并伴有呼吸暂停和呼吸表浅,夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱,常引起白天嗜睡、心脑血管并发症等多器官损害,严重影响患者的生活质量和寿命。OSAHS的成人患病率,国外为2%～4%,国内为3%～5%[1]。2009年美国睡眠医学会发表了"成人OSAHS的评估、管理和长期护理的临床指南",强调了OSAHS患者长期治疗白春学     

Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome

Purpose

Both obstructive sleep apnea syndrome (OSAS) and sleep bruxism (SB) are commonly related to arousal events. In this study, we examined the effect of SB on the sleep architecture and investigated the relationship between SB and sleep respiratory events in patients with OSAS.

Methods

Patients with OSAS (n?=?67) in whom apnea/hypopnea occurred five or more times per hour were recruited to this study. Healthy volunteers (n?=?16) were recruited as controls. None of the healthy volunteers had any sleep disorders or medical disorders, nor had they taken any medication or alcohol. Data were collected by standard polysomnography during overnight sleep tests in a dark, quiet room.

Results

The frequency of SB was higher in the OSAS than in the control group. The risk of SB was significantly higher in the OSAS than in the control group (odds ratio, 3.96; 95 % confidence interval, 1.03–15.20; P?OSAS than in the control group.

Conclusions

We found that patients with OSAS have a high risk of SB. In particular, this is the first report relating phasic-type SB to obstructive apnea events. This relationship suggests that improvement in OSAS might prevent exacerbations of SB.     

Do patients with sleep apnea die in their sleep?

Patients with sleep apnea syndrome (SAS) show cardiac dysrhythmias in association with cyclical nocturnal hypoxemia; are they at risk of dying during sleep? To assess this claim, we reviewed the clinical course of 91 patients with polysomnographically documented SAS between July 1978 and June 1986. A control group was comprised of 35 patients who were referred with symptoms suggestive of SAS but had negative sleep studies. Follow-up was obtained by survey questionnaire. Nine of 91 SAS and four of 35 control patients had died by completion of the study. There were no statistically significant differences in mortality between the two groups. None of the SAS patients died in their sleep, but they reported a higher incidence of disability and vehicular mishaps than did control subjects. The findings in this study do not support the hypothesis that SAS patients are at increased risk of dying in their sleep.     

Optogenetically induced sleep spindle rhythms alter sleep architectures in mice

Sleep spindles are rhythmic patterns of neuronal activity generated within the thalamocortical circuit. Although spindles have been hypothesized to protect sleep by reducing the influence of external stimuli, it remains to be confirmed experimentally whether there is a direct relationship between sleep spindles and the stability of sleep. We have addressed this issue by using in vivo photostimulation of the thalamic reticular nucleus of mice to generate spindle oscillations that are structurally and functionally similar to spontaneous sleep spindles. Such optogenetic generation of sleep spindles increased the duration of non-rapid eye movement (NREM) sleep. Furthermore, the density of sleep spindles was correlated with the amount of NREM sleep. These findings establish a causal relationship between sleep spindles and the stability of NREM sleep, strongly supporting a role for the thalamocortical circuit in sleep regulation.     

The impact of sleep duration in obstructive sleep apnea patients

Purpose

Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease. Strong associations have been reported among sleep duration, hypertension, obesity, and cardiovascular mortality. The authors hypothesize that sleep duration may play a role in OSA severity. The aim of this study is to analyze sleep duration in OSA patients.

Methods

Patients who underwent overnight polysomnography were consecutively selected from the Sleep Clinic of Universidade Federal de São Paulo database between March 2009 and December 2010. All subjects were asked to come to the Sleep Clinic at 8:00 a.m. for a clinical evaluation and actigraphy. Anthropometric parameters such as weight, height, hip circumference, abdominal circumference, and neck circumference were also measured.

Results

One hundred thirty-three patients were divided into four groups based on total sleep time, sleep efficiency, sleep latency, and wake after sleep onset: very short sleepers (n?=?11), short sleepers (n?=?21), intermediate sleepers (n?=?56), and sufficient sleepers (n?=?45). Apnea–hypopnea index (AHI) was higher in very short sleepers (50.18?±?30.86 events/h) compared with intermediate sleepers (20.36?±?14.68 events/h; p?=?0.007) and sufficient sleepers (23.21?±?20.45 events/h; p?=?0.02). Minimal and mean arterial oxygen saturation and time spent below 90 % oxygen saturation exhibited worse values in very short sleepers. After adjustment for gender, age, AHI, and body mass index, mean oxygen saturation was significantly associated to total sleep time (p?=?0.01).

Conclusions

In conclusion, the present study suggests that sleep duration may be associated to low mean oxygen saturation in OSA patients.     

The accuracy of subjective sleep time in sleep apnoea recordings

Total sleep time is important in investigations of obstructive sleep apnoea, since the diagnosis is usually based on the average number of apnoeas per hour of sleep. Sleep estimates instead of exact EEG-recorded total sleep time is often used in the clinical setting. However, an overestimated sleep time would underestimate the degree of the disease and vice versa. The purpose of this study was to investigate the accuracy of subjective sleep time and time-in-bed as sleep estimates. One hundred patients undergoing diagnostic polysomnography for suspected obstructive sleep apnoea were asked to estimate their sleep time in a questionnaire. Seventy-five patients were diagnosed as suffering from obstructive sleep apnoea syndrome. The mean difference between self-scored and EEG-recorded total sleep time was 4 +/- 74 min. However, 30% scored with a difference greater than 1 h. The intra-class correlation coefficient was fair (0.58, CI: 0.43-0.70). Fifty-three patients overestimated their sleep time and 47 patients underestimated it. All but four patients underestimated their number of awakenings (P<0.001). The mean difference between time-in-bed and EEG-recorded total sleep time was 110 +/- 63 min. This difference was significantly larger than the difference between subjective sleep time and EEG-recorded total sleep time (P<0.001). The intra-class correlation coefficient was poor (0.38, CI: 0.20-0.54). Mean AHI was 27 +/- 27 using subjective sleep time and did not change significantly compared with the mean AHI of 25 +/- 21 based on EEG-recorded total sleep time. Mean AHI decreased significantly to 20 +/- 17 (P<0.001) when time-in-bed was used. In conclusion, 'time-in-bed' time is a poor predictor of total sleep time and should not be used when calculating the apnoea-hypopnoea index. Subjective sleep time is better as an approximation, but the individual differences are large.     

Regulation of respiration during sleep in congenital central sleep apnea

We report on 2 children aged 13 and 14 months with congenital central alveolar sleep apnea which showed depression of respiratory drive during sleep resulting from dysfunction of central chemoreceptors. Hypoventilation was found to be more severe during NREM sleep (minimum of alveolar ventilation in stages 3/4) than during REM sleep. During NREM sleep arousal responses to hypoxia proved to be an important factor in influencing the level of alveolar ventilation and in preventing fatal asphyxia.     

Actimetry in sleep medicine

Actigraphy is more and more used in the longterm record of sleep of patients with insomnia. The correlation with data from polysomnography is reasonable for parameters like total sleep period (TSP) with r = 0,95-0,97 in healthy controls and r = 0,77-0,91 in patients. However for parameters, which inform about sleep fragmentation like wake after sleep onset (WASO) the correlation is not satisfieing with r = 0,87 in healthy controls and r = 0,49-0,63 in patients with fragmented sleep. The question is therefore, if actigraphs are really more useful in the record of sleep in patients with insomnia and fragmented sleep than sleep calenders.     

Arrhythmias in sleep apnea

A 23-year-old black female was referred to the University Hospital of Oklahoma because of “sleep trouble.” She complained of falling asleep easily during the daytime. A sleep study was performed which showed prolonged apnea, up to 35 seconds, and prolonged asystole, up to seven seconds, with second-degree heart block. A tracheostomy was performed. She had lost some weight and did well until six months later, when she developed severe throbbing headache with visual blurring. She came to the emergency room and an ECG showed sinus bradycardia with prolonged sinus pauses, up to 2.6 seconds, and first- and second-degree AV block. She had no hypoxia and atropine was ineffective. Electrophysiologic studies were performed. Details of the case are described and mechanisms of the arrhythmias are discussed.