阻塞性睡眠呼吸暂停低通气综合征患者病情与血尿酸水平及颈动脉粥样硬化的关系

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情与血尿酸水平及颈动脉粥样硬化的关系.方法 经多导睡眠图诊断的64例OSAHS患者(OSAHS组),根据呼吸暂停低通气指数(AHI)分组,应用彩色多普勒超声仪检测颈动脉内-中膜厚度(IMT),测定血尿酸的水平,并与20名正常对照者比较.结果 OSAHS轻度亚组20例、中度亚组22例、重度亚组22例,OSAHS患者血尿酸水平显著高于正常对照组,且OSAHS各亚组间差异有统计学意义(均P＜0.01).OSAHS重度亚组颈动脉IMT较正常对照组和OSAHS轻度亚组明显增厚(均P＜0.01).OSAHS患者血尿酸水平与颈动脉IMT、AHI呈正相关(r=0.746,r=0.798),与夜间最低血氧饱和度(SpO2)呈负相关(r=-0.754)(均P＜0.01).结论 OSAHS患者血尿酸水平升高、颈动脉IMT增厚,并影响OSAHS病情.     

季节变化对脑梗死患者睡眠呼吸的影响

目的探讨季节变化对脑梗死患者睡眠呼吸的影响。方法对经头颅CT或MRI证实的病程大于3周小于3个月的脑梗死者及高危人群进行冬春季和夏季多导睡眠(polysomnogram PSG)检查,比较季节变化对受试者睡眠呼吸暂停低通气指数(apnea-hyponea index AHI)、最低血氧饱和度(the lowestoxygen saturation LSaO2)、最长呼吸暂停时间(the longestapnea time)的影响。所有入选者均根据PSG检查结果分为阻塞性睡眠呼吸暂停低通气(obstructive sleep apnea hyponea syndrome,OSAHS)和非OSAHS者。结果 55例完成检查,入选49例,分为两个组,脑梗死组25例,其中OSAHS亚组17例,非OSAHS亚组8例;高危组24例,其中OSAHS亚组17例,非OSAHS亚组7例。脑梗死组中OSAHS亚组冬春季AHI为(14.75±2.55),夏季为(20.44±2.77);非OS-AHS亚组冬春季AHI为(1.81±0.59),夏季为(1.99±0.62)。高危组中OSAHS亚组冬春季AHI为(38.32±5.79),夏季为(45.65±5.27),非OSAHS亚组冬春季AHI为(2.82±0.46),夏季为(2.83±0.40)。两个OSAHS亚组冬春与夏季的AHI比较差异有统计学意义(P0.05),最低血氧饱和度、最长呼吸暂停时间无统计学差异(P0.05)。非OSAHS亚组三项指标均无统计学差异(P0.05)。线性回归分析显示OSAHS亚组的夏季与冬春季AHI的变化与气压的变化呈负相关,气压对脑梗死组的影响大于高危组。结论夏季可加重OSAHS患者睡眠呼吸功能的紊乱,对脑梗死患者的影响更大。气压变化可能是睡眠呼吸紊乱的主要因素。     

UA、TG、LDL水平在脑卒中合并OSAHS 患者中的变化及其临床意义

目的 探讨尿酸(Uric Acid,UA)、甘油三酯(triglyceride,TG)、低密度脂蛋白(Low Density Lipoprotein,LDL)水平在脑卒中合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者中的变化及其临床意义。方法 选取2016年1月-2018年1月在本院神经内科住院部收治的脑卒中患者354例作为研究对象,按照是否合并OSAHS将患者分为OSAHS组(n=85)与非OSAHS组(n=269); 按照多导睡眠(Polysomnography,PSG)监测的暂停低通气指数(Apnea Hypopnea Index,AHI)不同将OSAHS组患者分为轻中度OSAHS亚组(AHI<50次/h,n=37),重度OSAHS亚组(AHI≥50次/h,n=48); 根据PSG监测的夜间最低血氧饱和度(lowest oxygen saturation,L-SaO₂)不同将OSAHS组患者分为轻中度低氧亚组(L-SaO₂>70%,n=41)与重度低氧亚组(L-SaO₂≤70%,n=44); 采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清UA、TG、LDL水平。结果 OSAHS组UA、TG、LDL水平明显高于非OSAHS组(P<0.05)。轻中度OSAHS亚组UA、TG、LDL水平明显低于重度OSAHS亚组(P<0.05); 轻中度低氧亚组UA、TG、LDL水平明显低于重度低氧亚组(P<0.05)。结论 OSAHS所致的呼吸暂停/低通气频度与低氧血症严重影响脑卒中患者UA与血脂代谢功能,通过监测UA、TG、LDL水平在评价OSAHS严重程度中具有重要意义。     

脑卒中患者发生睡眠呼吸暂停低通气综合征状况及其与体质量的关系

目的探讨脑卒中患者发生睡眠呼吸暂停低通气综合征(SAHS)的状况及其与体质量的关系。方法应用便携式睡眠呼吸监测仪对68例脑卒中并有睡眠打鼾的患者进行监测,记录患者睡眠中血氧饱和度<90%占整个记录时间的百分比(TS90%)、呼吸暂停低通气指数(AHI)和氧减饱和指数(ODI);并对各指标与患者的体质量指数(BMI)进行相关性分析。结果本组患者中,睡眠呼吸正常15例(22.1%);SAHS者53例(77.9%),其中轻度30例(44.1%),中度7例(10.3%),重度16例(23.5%)。AHI与ODI、睡眠呼吸暂停程度及BMI呈正相关(r=0.907,r=0.944,r=0.315;均P<0.01);TS90%与AHI、ODI和BMI及呼吸暂停程度呈正相关(r=0.685,r=0.769,r=0.383,r=0.673;均P<0.01);睡眠呼吸暂停程度与BMI呈正相关(r=0.317,P=0.008)。结论伴有睡眠打鼾的脑卒中患者SAHS的发生率较高,导致夜间出现低氧饱和度;其睡眠呼吸暂停程度与体质量有明显关系。     

阻塞性睡眠呼吸暂停与觉醒型卒中的关系分析

目的讨论阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)与觉醒型卒中(wake-up stroke,WUS)的关系。方法回顾性分析伴阻塞性睡眠呼吸暂停低通气综合征的急性缺血性卒中患者资料,患者均接受夜间睡眠监测检查,分为WUS组和非WUS组,比较两组间一般临床资料、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分及睡眠呼吸参数等指标的差异。结果共入组96例患者,其中WUS组22例,非WUS组74例,WUS组的体质指数(body mass index,BMI)(P=0.030)、呼吸暂停低通气指数(apnea-hypopnea index,AHI)(P=0.001)、血氧饱和度下降指数(oxygen desaturation index,ODI)(P=0.001)均显著高于非WUS组,平均血氧饱和度(P=0.002)显著低于非WUS组;Logistic回归分析显示,AHI增高[比值比(odds ratio,OR)1.162,95%可信区间(confidence interval,CI)1.007~1.341]是WUS的独立危险因素。结论 BMI、AHI、ODI和平均血氧饱和度与阻塞性睡眠呼吸暂停低通气综合征患者发生WUS有关,其中AHI是WUS的独立危险因素。     

老年人阻塞性睡眠呼吸暂停综合征与脑白质疏松的关系

目的 探讨老年人阻塞性睡眠呼吸暂停综合征(OSAHS)与脑白质疏松(LA)之间的关系.方法 对应用多导睡眠呼吸监测诊断的169例OSAHS患者进行头颅磁共振检查,评估LA的发生率及其程度,探讨睡眠呼吸参数与LA程度的关系.结果 169例OSAHS患者中无LA24例(14.20%);LA 145例(85.80%),其中轻度LA 27例(15.98%),中度LA 65例(38.46%),重度LA53例(31.36%).对不同程度LA患者年龄、体重指数及睡眠呼吸参数进行比较发现,年龄、睡眠呼吸紊乱指数(AHI)、平均血氧饱和度(MSaO2)、SaO2＜90%时间及氧减指数各组间差异有统计学意义(P＜0.05).经Logistic回归分析,年龄及氧减指数与LA密切相关.结论 随着年龄的增加,氧减指数逐渐增大,LA发生率逐渐增加,程度逐步加重.对OSAHS患者采取适当的干预措施有利于改善LA引起的认知功能障碍等症状.     

脑梗死伴阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构及认知功能分析

目的 探讨脑梗死伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠结构的特点及与认知功能的相关性.方法 选择2009年12月至2011年3月在天津医科大学总医院神经内科及呼吸睡眠监测室就诊的打鼾患者,行多导睡眠监测,筛选出60例患者,分为合并组(脑梗死合并OSAHS)20例,OSAHS组(单纯OSAHS)20例及对照组(无脑梗死及OSAHS)20例,均完善相关检查及进行认知功能的评分[ MMSE和蒙特利尔认知评估量表(MoCA)].结果 睡眠结构比较:合并组及OSAHS组与对照组比较,患者醒觉时间、非快速眼球运动(NREM)期、NREM 1+2期延长,NREM3+4期及快速眼球运动(REM)期缩短.合并组与OSAHS组比较,NREM期及NREM 1期延长,NREM 3+4及REM期缩短.认知功能与呼吸紊乱及低氧相关指数相关性分析:OSAHS组患者MMSE和MoCA评分与呼吸暂停低通气指数(AHI)、氧减指数(ODI)呈线性负相关(MMSE r=-0.450、-0.671,MoCA r=-0.486、-0.494,均P＜0.05),与夜间平均血氧及夜间最低血氧呈线性正相关(MMSE r=0.477、0.485,MoCA r=0.507、0.482,均P＜0.05).合并组患者MoCA评分与ODI、微觉醒指数呈线性负相关(r=-0.463、-0.480,均P＜0.05),MMSE评分与呼吸紊乱及低氧相关指数相关无统计学意义.认知功能与睡眠分期相关性分析:OSAHS组患者MMSE及MoCA评分均与NREM 3 +4期呈线性正相关(r=0.521、0.474,均P＜0.05),MMSE评分与NREM 1+2期呈线性负相关(r=-0.458,P＜0.05).合并组患者MoCA评分与REM期呈线性正相关(r=0.472,P＜0.05),MMSE评分与睡眠分期相关无统计学意义.结论 OSAHS患者睡眠结构紊乱,特点为觉醒时间与浅睡眠延长,深睡眠与REM期缩短,脑梗死伴OSAHS睡眠结构紊乱更严重,合并脑梗死使OSAHS浅睡眠1期延长更明显.OSAHS患者夜间血氧越低,呼吸紊乱指数越高,微觉醒次数越多,浅睡眠时间越长,深睡眠及REM期睡眠越短,认知功能受损越严重,但认知功能损害与低氧的相关性比睡眠结构紊乱的相关性明显.脑梗死伴OSAHS患者MoCA评分与缺氧程度及睡眠结构的一些指标相关性明显,MoCA在轻中度血管性认知功能障碍筛选中的敏感性高于MMSE.     

OSAHS患者血中NLR水平与认知功能的关系

目的探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者血中性粒细胞/淋巴细胞比值(NLR)水平与认知功能的关系。方法将66例OSAHS患者分为轻度组(n=16)、中度组(n=15)和重度组(n=35),选择25例健康者作对照组。用多导睡眠监测仪(PSG)监测患者夜间睡眠呼吸暂停低通气指数(AHI)和最低血氧饱和度(LSaO2),采用MMSE和MoCA量表评判患者认知功能,检测4组NLR水平。分析认知功能量表评分、AHI、LSaO2与NLR之间相关性。结果与对照组比较,中、重度组MMSE、MoCA评分降低;与轻度组比较,重度组MMSE、MoCA评分降低(P0.05);OSAHS患者MMSE、MoCA评分与AHI呈负相关(r=-0.472和-0.768,P0.05),与LSaO2呈正相关(r=0.672和0.741,P0.05)。与对照组、轻度组比较,重度组NLR水平升高(P0.05)。OSAHS患者NLR水平与AHI呈正相关(r=0.2594,P0.05),与LSaO2呈负相关(r=-0.2423,P0.05);OSAHS患者MMSE、MoCA评分与NLR呈负相关(r=-0.3225和-0.3299,P0.05)。结论 OSAHS患者NLR水平随着AHI增加和缺氧程度加重而升高,NLR升高与认知功能下降具有相关性,早期对OSAHS患者NLR进行筛查,对病情评估具有一定参考价值。     

伴有阻塞性睡眠呼吸暂停低通气综合征的缺血性脑血管病患者血同型半胱氨酸的变化

目的 探讨伴有阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)的缺血性脑血管病患者(ischemie cerebrovascular disease,ICVD)血同型半胱氨酸(homocysteine,Hey)水平.方法 从南京脑卒中注册系统中筛选76例ICVD患者,行多导睡眠图(PSG)监测,并检测纤维蛋白原(FBG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、血浆Hcy.结果 76例患者中有57例存在呼吸暂停现象,其中53例(69.7%)诊断为OSAHS;排除4例中枢性呼吸暂停患者,将72例ICVD患者根据呼吸暂停加低通气指数(AHI)值分为4组:无呼吸暂停组19例,AHI值2.38±0.96,Hcy值(8.78±2.01)μmol/L;轻度OSAHS 21例,AHI值14.14±4.37,Hcy值(12.91±3.00)μmoL/L;中度OSAHS24例,AHI值29.62±5.81,Hcy值(14.85±4.15)μmoL/L;重度OSAHS 8例,AHI值46.75±2.82,Hey值(19.30±4.82)μmoL/L.4组间Hcy值差异有统计学意义(F=40.32,P<0.01).Hey与AHI存在显著相关性(r=0.598,P<0.01).结论 在ICVD患者中,OSAHS患病率较高,且以轻中度为主;Hcy在ICVD合并OSAHS患者时具有升高趋势,且随着阻塞程度的进展而加重.     

阻塞性睡眠呼吸暂停低通气综合征患者脑白质结构损害与认知功能障碍的相关性分析

目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑白质结构损害与认知功能障碍的相关性。方法选取2014年11月至2015年10月因打鼾于我院就诊的91例患者,根据呼吸暂停低通气指数(AHI)将患者分为单纯鼾症18例,轻度OSAHS组24例,中度OSAHS组21例,重度OSAHS组28例。比较四组研究对象的睡眠呼吸参数、侧脑室周围高信号灶(PVH)评分、简易智能状态量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分,分析PVH评分和其他参数的相关性。结果重度OSAHS组的AHI及呼吸睡眠参数ODI、RI、TS90%、LSaO_2、MSaO_2与单纯鼾症组、轻度OSAHS组、中度OSAHS组相比较有显著性差异(P0.05)。重度OSAHS组的PVH评分、MMSE评分、MoCA评分与其他三组相比较,差异具有统计学意义(P0.05)。PVH评分和MoCA评分、MMSE评分、LSaO_2、MSaO_2呈负相关(P0.05),和AHI、ODI、RI参数呈正相关(P0.05)。结论 OSAHS患者的脑白质结构受损和认知功能障碍存在着密切的关联性。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -