经鼻持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征的远期效果

目的探讨经鼻持续气道内正压通气（ＣＰＡＰ）治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的远期效果。方法报告１９８７～１９９５年在家坚持长期应用ＣＰＡＰ治疗的ＯＳＡＳ有完善多导睡眠图（ＰＳＧ）监测记录对比的１８例患者及其临床治疗的效果。结果（１）应用ＣＰＡＰ治疗后，ＯＳＡＳ症状消除。（２）１３例（７２％）患者复查ＰＳＧ参数改善，１８例停用ＣＰＡＰ治疗后ＰＳＧ复查，最长呼吸暂停时间从６６±２１秒缩短至４３±２４秒（Ｐ＜０．０５）；呼吸紊乱指数从６６±１６降低至２８±２０（Ｐ＜０．００１）；最低血氧饱度（ＳａＯ２）从５３％±１９％提高至７５％±１１％（Ｐ＜０．００１）。（３）治疗前、后１８例患者体重、血压改变不明显，１２例合并高血压的患者６例（５０％）血压恢复到正常范围。结论ＣＰＡＰ治疗ＯＳＡＳ有效，长期坚持治疗呼吸暂停引起的低氧血症、最长呼吸暂停时间改善，临床症状减轻或消除。其机制可能与患者呼吸调节功能改善有关     

经鼻持续气道内正压通气与咽手术治疗阻塞性睡眠呼吸暂停综合征对比观察

目的对比观察经鼻持续气道内正压通气（ＣＰＡＰ）与悬雍垂腭咽成形术（ＵＰＰＰ）治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的疗效及对睡眠呼吸参数的影响，评价二者在ＯＳＡＳ治疗中的地位。方法６０例ＯＳＡＳ患者，ＣＰＡＰ治疗组３６例，手术治疗组２４例。治疗前后作整夜多导睡眠图（ＰＳＧ）监测。结果两组呼吸紊乱指数减少，夜间低氧血症改善，ＣＰＡＰ组患者优于手术组（Ｐ＜０．０１）。有效率ＣＰＡＰ组为９７％，手术组为４６％（Ｐ＜０．０１），最长暂停时间ＣＰＡＰ组缩短，手术组改变不显著，１０例延长。结论ＣＰＡＰ疗效肯定，优于ＵＰＰＰ，适应证广，可作为ＯＳＡＳ首选治疗     

口腔矫正器治疗阻塞性睡眠呼吸暂停综合征的临床观察

目的探讨口腔矫正器对３６例阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者的临床疗效。方法制作“下颌前移型”矫正器让３６例ＯＳＡＳ患者在睡眠时配戴,用多导睡眠图监测患者治疗前后呼吸紊乱指数（ＡＨＩ）、夜间最低血氧饱和度（最低ＳａＯ２）与最长呼吸暂停时间（Ｔ）,用ｔ检验进行统计学比较。结果使用口腔矫正器后患者的ＡＨＩ明显降低（Ｐ＜００５）,最低ＳａＯ２亦有明显改善（Ｐ＜００５）,Ｔ明显缩短（Ｐ＜００５）。结论口腔矫正器能使上气道增宽,使下颌稳定于一个前伸位置,舌和软腭前移,增加睡眠时的有效通气量,改善睡眠质量,是治疗ＯＳＡＳ的一个有效的辅助手段。     

阻塞性睡眠呼吸暂停综合征患者肺功能与夜间低氧血症的关系

目的探讨睡眠呼吸暂停综合征（ＳＡＳ）患者体位及肥胖因素引起的肺功能改变与夜间低氧血症的关系。方法选择确诊为ＳＡＳ患者３４例，分别于坐位和仰卧位检查肺功能和血气分析，整夜多导睡眠仪监测。肺功能、血气指标和理想体重％（ＩＢＷ％）分别与呼吸暂停指数（ＡＩ）、＜９０％Ｔ（ＳａＯ２低于９０％时间占总睡眠时间百分比）进行相关分析。结果患者由坐位改为仰卧位，ＰａＯ２、肺活量（ＶＣ％）、补呼气量（ＥＲＶ）、功能残气量（ＦＲＣ％）、残气容积（ＲＶ％）、肺总量（ＴＬＣ％）均出现有统计学意义的降低。ＡＩ与仰卧位ＶＣ％、ＴＬＣ％呈正相关。＜９０％Ｔ与坐位ＰａＯ２、ＥＲＶ呈负相关。ＩＢＷ％与坐、仰卧位ＶＣ％和ＥＲＶ呈负相关，与坐位ＦＲＣ呈负相关。ＩＢＷ％与＜９０％Ｔ呈正相关。结论伴有肥胖的ＯＳＡＳ患者，体位改变及肥胖因素影响患者肺功能，加重呼吸暂停时的低氧血症     

阻塞性睡眠呼吸暂停综合征与高血压病：附240例监测报告

对２４０例患者行整夜多导睡眠图监测及睡前、醒后肘部血压测定，呼吸紊乱指数（ＡＨＩ）＞５的１００例为阻塞性睡眠呼吸暂停综合征组（ＯＳＡＳ组），１４０例ＡＨＩ≤５的为对照组，发现ＯＳＡＳ组由睡前血压１７．６±３．０／１１．８±１．９ｋＰａ（１３２．３±２２．５／８８．２±１４．６ｍｍＨｇ）至醒后血压１９．７±３１／１３．１±２．２ｋＰａ（１４７．８±２３．４／９８．６±１６．２ｍｍＨｇ）明显增高（Ｐ＜０．００１），较对照组睡前血压１５．５±１．５／１０．５±１．０ｋＰａ（１１６．２±１１．６／７８．４±７．６ｍｍＨｇ），醒后血压１５．０±１．５／１０．５±１．３ｋＰａ（１１２．４±１１．２／７８．６±１０．０ｍｍＨｇ）明显升高（Ｐ＜０．００１），ＯＳＡＳ组最低血氧饱和度６０．６±１８．２％较对照组８６．２±５．０％明显降低（Ｐ＜０．００１），ＯＳＡＳ组６８％确诊为高血压病，且ＯＳＡＳ经有效治疗后血压也下降接近正常或部分下降，提示ＯＳＡＳ患者夜间反复呼吸暂停引起的低氧血症可能是部分高血压病原因之一。     

老年人睡眠呼吸暂停综合征与夜间心绞痛的关系

目的研究睡眠呼吸暂停综合征（ＳＡＳ）与夜间心绞痛的关系。方法对伴有或不伴有ＳＡＳ的老年冠心病患者９２例进行睡眠呼吸暂停和动态心电监测以及夜间心绞痛、无症状心肌缺血的观察。结果ＳＡＳ组夜间心绞痛１６例（３４８％），心肌缺血２７例（５８７％），心律失常４１例（８９１％），均较无ＳＡＳ组的４例（８７％）、８例（１７４％）和１６例（３４８％）明显增加（均为Ｐ＜００１）。夜间心绞痛和无症状心肌缺血发作次数与呼吸暂停次数、持续时间呈显著正相关（ｒ＝０４７５～０６１３，Ｐ＜００１），与血氧饱和度呈显著负相关（ｒ＝－０５２６，Ｐ＜００１）。ＳＡＳ患者经治疗夜间心绞痛和无症状心肌缺血显著改善（Ｐ＜００１）。结论老年人ＳＡＳ与夜间心绞痛有关。     

阻塞性睡眠呼吸暂停综合征患者睡眠状态下呼吸中枢控制功 …

目的 探讨阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者上气道阻塞与睡眠状态下呼吸中枢控制功能的低下是否有关，方法 通过经鼻气管插管建立鼻咽通气道测定了１６例重度ＯＳＡＳ患者在清楚状态，非快动眼（ＮＲＥＭ）Ｉ＋Ⅱ睡眠期，Ⅲ＋Ⅳ睡眠期，快速眼（ＲＥＭ）睡眠期的口腔阻断压（Ｐ０．１）低氧反应指标（△Ｐ０．１／△ＳａＯ２，△ＶＥ／△ＳａＯ２）及高二氧化碳反应指标（△Ｐ０．１／△ＳａＯ２，△ＶＥ／△ＳａＯ２）。     

自动持续正压系统对睡眠呼吸障碍的诊治

目的探索简便、临床易于推广应用的睡眠呼吸障碍疾患的诊治手段。方法对１１例睡眠呼吸障碍患者同步进行经典的多导睡眠图监测和自动持续正压系统监测，将监测结果进行比较；对２３例已确诊的阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者使用自动持续正压系统治疗，并对治疗效果进行评价。各监测指标比较采用ｔ检验。结果（１）自动持续正压系统与多导睡眠图相比较，自动持续正压系统虽无睡眠及心电记录，但可记录鼾声及上气道阻力；最高及最低血氧饱和度、最长呼吸暂停时间、呼吸暂停低通气（ＡＨＩ）指数等监测结果，两者相比，差异无显著性（Ｐ＞０．０５）；自动持续正压系统诊断ＯＳＡＳ的敏感性为７０％，特异性为１００％。（２）ＯＳＡＳ患者使用自动持续正压系统治疗后症状改善；ＡＨＩ显著减低，最低血氧饱和度显著升高（Ｐ＜０．００１）；此外，平均和最高压力与９５％可信压力比较差异有显著性。结论自动持续正压系统使用简便，并减轻了技术员监测时的劳动强度；在持续正压通气（ＣＰＡＰ）治疗时可采用９５％可信限所需的压力     

阻塞性睡眠呼吸暂停患者持续正压通气治疗前后自主神经系统功能的研究

目的研究阻塞性睡眠呼吸暂停（ＯＳＡ）患者夜间睡眠时自主神经功能的状态，以及有效的持续正压通气治疗对自主神经张力的影响。方法对５６例重度ＯＳＡ患者持续正压通气（ＣＰＡＰ）治疗前和治疗中进行夜间７小时多导睡眠图（ＰＳＧ）及动态心电图监测，另择３０名正常受试者作为对照。采用心率功率谱分析法（ＨＲＰＳＡ）定量分析ＯＳＡ患者治疗前后夜间自主神经功能的变化。结果ＯＳＡ组夜间睡眠时伴随着反复的呼吸暂停和低氧血症，低频（ＬＦ）及高频（ＨＦ）值逐渐增高，与对照组比较差异有显著性（ＬＦ为１３８３±３０５∶１２５±６４，Ｐ＜０．００１；ＨＦ为６６２±１９０∶１６３±７８，Ｐ＜０．００１），表明交感神经和副交感神经张力均明显增高。夜间平均ＬＦ／ＨＦ比率在较高水平（２１１±１０１），与对照组（０８７±０６４）比较差异有显著性（Ｐ＜０．０５），说明以交感神经张力增加更为显著。经过有效的ＣＰＡＰ治疗，ＯＳＡ患者ＬＦ（２２１±８１）、ＨＦ（２２１±１０８）明显降低（Ｐ＜０．００１）。结论ＯＳＡ患者夜间有自主神经功能紊乱。针对ＯＳＡ的有效治疗可以改善自主神经的异常活动     

睡眠呼吸紊乱患者的警觉性测定

目的检测几种临床常见的睡眠呼吸紊乱患者的警觉性是否受损。方法前瞻性地对因疑诊而接受全晚睡眠监测的患者,在监测前（傍晚）和监测后（早上）,利用电脑模拟开车试验,以碰撞障碍物的百分率,衡量其警觉性。以等级方差分析检验各组间早晚平均碰撞率（％Ｈｍ）的差异,并将％Ｈｍ与睡眠监测有关参数作等级相关分析。结果正常人和按诊断分组后患者的％Ｈｍ［以中位数（范围）表示］为：正常人（１１名）０．６（０～２．５）;睡眠鼾症（７例）１．１（０．２～２．０）;阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ,２２例）２．２（０．２～７．７）;中枢性睡眠呼吸暂停综合征（ＣＳＡＳ,６例）２．７（０．９～５．４）。除睡眠鼾症组外,各组患者％Ｈｍ均高于正常人（Ｐ＜０．０５）。正常、睡眠鼾症及ＯＳＡＳ三组合并分析表明：％Ｈｍ与睡眠累计低血氧饱和度时间％有相关性（ｒ＝０．４１,Ｐ＜０．０５）而与呼吸停顿／低呼吸指数和觉醒指数无明显相关（ｒ分别为０．２２和０．１０,Ｐ＞０．０５）。结论ＯＳＡＳ和ＣＳＡＳ患者的警觉性下降,睡眠鼾症患者的警觉性大致正常。警觉性受损可能与睡眠时缺氧有关     

Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea

We examined the effects of percutaneous electrical stimulation of the genioglossus in six patients with obstructive sleep apnea syndrome (OSAS) during sleep and investigated the possible applicability of this procedure as a treatment of OSAS. Six patients with OSAS were polysomnographically studied in the supine position during all-night sessions with and without electrical stimulation of the genioglossus. Using an apnea demand-type stimulator that we developed, electrical pulses of 0.5 ms (repetition rate, 50 Hz) and 15 to 40 V were delivered through bipolar electrodes (10 mm in diameter) attached to the skin of the submental region when apnea lasted more than 5 s, and was stopped immediately after breathing resumed or after 10 s at the longest. With submental stimulation, the apnea index, apnea time/total sleep time, longest apnea duration, and the number of times per hour that oxygen saturation dropped below 85% decreased significantly compared with those on control nights. The lowest arterial oxygen saturation and the duration of sleep stages III and IV increased significantly. The stimulation employed did not cause arousal, and it did not affect blood pressure or heart rate significantly. These findings show that submental stimulation decreases the incidence of apnea episodes and promotes deeper sleep without accompanying serious side effects, suggesting that the apnea demand-type stimulator may be a noninvasive and effective treatment for OSAS.     

The effects of posture on obstructive sleep apnea

To determine whether the adoption of a more upright sleep posture would improve breathing and gas exchange in patients with obstructive sleep apnea syndrome (OSAS), 13 male patients with OSAS were studied during an all-night polysomnographic study while lying supine or sitting at a 60-degree angle. In the upright posture, the frequency of obstructive apnea was decreased (lying, 48.9 +/- 5.4/h; sitting, 19.6 +/- 6.9/h; p less than 0.0005) and arterial oxyhemoglobulin saturation (Sao2) was increased (nREM; mean lying, 90.6 +/- 0.8%; mean sitting, 92.1 +/- 0.5%, p less than 0.005; minimum lying, 64.8 +/- 3.2%, minimum sitting, 80.8 +/- 2.1%, p less than 0.005). In approximately half the patients studied, obstructive sleep apnea was essentially abolished by the postural intervention. These patients were more obese and had lower Pao2 and higher Paco2 values awake than the remaining patients in whom the response was either incomplete or absent. Arousal from sleep was less frequent in the upright posture, but sleep efficiency and overall sleep architecture were unchanged. This simple maneuver may be useful for treating some patients with OSAS.     

Genioglossus activity during sleep in normal control subjects and children with obstructive sleep apnea

Children with obstructive sleep apnea syndrome (OSAS) have more collapsible airways compared with normal subjects, yet sustain stable breathing during wakefulness and part of sleep. This indicates successful neuromuscular compensation. Using a custom intraoral surface electrode to record pharyngeal dilator muscle activity (the genioglossus [EMGgg] normalized to the wakeful baseline), we performed overnight polysomnograms in three groups of children: (1) patients with OSAS without continuous positive airway pressure (CPAP) (n = 13); (2) patients with OSAS with CPAP (n = 5); and (3) control subjects without CPAP (n = 13). Our objective was to evaluate the EMGgg as a function of sleep state and during disordered breathing, compared with stable sleep and wakefulness. In control subjects, the EMGgg decreased from wakefulness to Stage 2 (mean +/- SD, 65 +/- 6%), and further during REM (51 +/- 9%) (p < 0.05). In patients with OSAS, the EMGgg for apneic breaths during REM (37 +/- 9%) was lower than during stable breathing (83 +/- 17%) (p < 0.05) and wakefulness (p < 0.05). CPAP lowered the EMGgg in patients with OSAS during all sleep states. These data indicate that (1) EMGgg compensatory mechanisms remain active during sleep in patients with severe OSAS; (2) EMGgg reductions are temporally associated with sleep apnea events; and (3) REM sleep is associated with the lowest and most variable EMGgg.     

The effects of transcutaneous electrical stimulation during wakefulness and sleep in patients with obstructive sleep apnea.

Upper airway (UA) collapse in obstructive sleep apnea (OSA) is considered in part to result from the decrease in UA dilator muscle tone that occurs during sleep. We hypothesized that augmentation of UA muscle function by transcutaneous electrical stimulation (TES) might function to enlarge UA size during wakefulness and/or prevent UA collapse during sleep in patients with OSA. Eight male patients with OSA were studied both awake and asleep, with TES administered to the submental region in two patients and to both the submental and subhyoid regions in six patients. Fast-CT scans obtained at FRC and end-inspiration (VTei) demonstrated increased UA size with tidal breathing, p less than or equal to 0.05. The active generation of -10 cm H2O pressure at FRC substantially decreased UA size, p less than or equal to 0.001. However, no changes in UA size were detected at either FRC or VTei with TES applied at 50 and 100% of the maximal tolerated intensity. The collapsibility of the UA in response to the generation of -10 cm H2O pressure was also unchanged by TES. In contrast to the lack of effect of TES on UA size, voluntary protrusion of the tongue increased cross-sectional area (CSA) of the orohypopharyngeal (OHP) segment of the UA, p less than 0.05, and to a lesser extent the CSA of the distal velopharyngeal segment, p = 0.06. When applied during sleep, TES failed to prevent or improve either sleep-disordered breathing or sleep architecture.(ABSTRACT TRUNCATED AT 250 WORDS)     

阻塞性睡眠呼吸暂停综合征的睡眠结构改变

目的研究阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）病情严重程度及持续气道内正压（ＣＰＡＰ）治疗对睡眠结构的影响。方法通过分析多导睡眠图，分析了３１例非ＯＳＡＳ者和１４７例ＯＳＡＳ患者的睡眠结构及ＣＰＡＰ治疗对１１例ＯＳＡＳ患者睡眠结构的影响。结果与对照组相比ＯＳＡＳ组的睡眠结构存在如下异常：（１）睡眠期转换次数（ＯＳＡＳ组：１２０±７１，对照组：９２±６０，Ｐ＝０．０１０６）、快波睡眠次数（ＯＳＡＳ组：８８±５４，对照组：６５±４５，Ｐ＝０．００７５）、醒觉次数（ＯＳＡＳ组：２７±２８，对照组：１９±１８，Ｐ＝０．０１７）差异有显著性；（２）慢波睡眠次数（ＯＳＡＳ组：５±９，对照组：８±８，Ｐ＝０．００３５）、占总睡眠时间的比例（ＯＳＡＳ组：５％±８％，对照组：８％±９％，Ｐ＝０．００６２）及慢波睡眠的缺乏率（ＯＳＡＳ组：４８％，对照组：２６％，Ｐ＜０．０５）亦明显不同；（３）睡眠呼吸紊乱指数低于２５的ＯＳＡＳ者与对照组比较睡眠各参数相差不大；（４）ＣＰＡＰ治疗能使上述参数得到不同程度的改善。结论ＯＳＡＳ主要引起睡眠的破碎、深睡减少及浅睡增加，且与病情的严重程度有一定关系。ＣＰＡＰ治疗能够改善这些紊乱。     

Sustained effect of continuous positive airway pressure on baroreflex sensitivity in congestive heart failure patients with obstructive sleep apnea

BACKGROUND: Patients with either heart failure or obstructive sleep apnea have a reduced baroreflex sensitivity for heart rate, a sign of poor prognosis. We previously demonstrated that nocturnal application of continuous positive airway pressure to heart failure patients with obstructive sleep apnea increased baroreflex sensitivity acutely, but it is not known whether these effects persist into wakefulness. OBJECTIVE: To determine whether treating obstructive sleep apnea in heart failure patients with continuous positive airway pressure improves baroreflex sensitivity during wakefulness. METHODS: Spontaneous baroreflex sensitivity was assessed during wakefulness in 33 heart failure patients (left ventricular ejection fraction < or = 45%) with obstructive sleep apnea (apnea-hypopnea index > or = 20). Subsequently, baroreflex sensitivity was reassessed 1 month after patients were randomly allocated to nocturnal continuous positive airway pressure treatment or no treatment (control). RESULTS: Compared with the 14 control patients, the 19 continuous positive airway pressure-treated patients experienced a greater increase in baroreflex sensitivity [median, (25%, 75%)] [from 5.4 (2.2, 8.3) to 7.9 (4.4, 9.4) ms/mmHg; P = 0.01] and left ventricular ejection fraction (P < 0.001). In addition, daytime systolic blood pressure and heart rate decreased more in the continuous positive airway pressure group (from 122 +/- 15 to 113 +/- 12 mmHg; P = 0.02, and from 66 +/- 8 to 62 +/- 8 bpm; P < 0.001, respectively) than in the control group. CONCLUSION: Treatment of coexisting obstructive sleep apnea by continuous positive airway pressure in heart failure patients improves baroreflex sensitivity during wakefulness in addition to improving left ventricular ejection fraction and lowering blood pressure and heart rate. These data indicate that the improved autonomic regulation of heart rate in heart failure patients treated for obstructive sleep apnea during sleep persists into wakefulness.     

In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome

BACKGROUND: Patients with obstructive sleep apnea syndrome (OSAS) have an increased risk of cardiovascular events including myocardial infarction and stroke. OBJECTIVE: To determine whether in vivo platelet activation and the generation of procoagulant platelet-derived microparticles (PMP) are increased during sleep in patients with OSAS. METHODS: In vivo platelet activation and PMP formation was determined using flow cytometry in 12 patients with untreated OSAS during and after sleep (4 and 7 a.m.). To study the effect of treatment with continuous positive airway pressure (CPAP), the measurements were repeated at the same time points after initiation of CPAP therapy. Healthy volunteers served as controls (n = 6). RESULTS: Patients with OSAS had an increased percentage of platelets positive for the activation-dependent epitopes CD63 and CD62P during sleep (4 a.m.) compared to controls (4.8 +/- 0.8 vs. 1.9 +/- 0.4% for CD63, p < 0.01, and 2.0 +/- 0.5 vs. 1.1 +/- 0.3% for CD62P, p < 0.05). In OSAS patients, the amount of CD63- and CD62P-positive platelets was significantly elevated at 4 compared to 7 a.m. (4.8 +/- 0.8 vs. 2.6 +/- 0.4% for CD63 and 2.0 +/- 0.5 vs. 1.1 +/- 0.2% for CD62P, p < 0.05), but not in the control group. The levels of PMP were similar in patients with OSAS and controls at 4 and 7 a.m. After 1 night of CPAP therapy, there was a trend to reduced levels of CD63- and CD62P-positive platelets at 4 a.m. CONCLUSIONS: Patients with OSAS have increased in vivo platelet activation during sleep, which may contribute to the increased incidence of cardiovascular events in patients with OSAS.     

阻塞性睡眠呼吸暂停患者血清瘦素水平的研究

目的　探讨瘦素在阻塞性睡眠呼吸暂停综合征 (OSAS)患者体内的变化。方法　选择年龄及体重指数 (BMI)差异无显著性的OSAS患者 5 8例和单纯肥胖者 2 1例 ,用多导睡眠呼吸监测仪进行监测 ,用放射免疫法测定所有对象的血清瘦素。结果　 (1)无论男性还是女性 ,OSAS患者瘦素水平 [(6 1± 1 7) μg/L ,(19 5± 9 9) μg/L]平均高于单纯肥胖者 [(4 5± 1 7) μg/L ,(10 5± 2 4) μg/L](P <0 0 1,P <0 0 5 )。 (2 )单纯肥胖者及OSAS患者血清瘦素水平分别与BMI呈显著正相关 (r=0 5 9,P <0 0 1;r=0 6 4,P <0 0 1) ,同时OSAS患者血清瘦素水平分别与呼吸暂停及低通气指数 (AHI) (r=0 47,P <0 0 1)和颈围 (r=0 6 4,P <0 0 1)也有明显的正相关。结论　OSAS患者血清瘦素水平比单纯肥胖者更高 ,除了肥胖、颈围宽外 ,OSAS本身也是引起瘦素水平升高的原因。     

Recent weight gain in patients with newly diagnosed obstructive sleep apnea.

OBJECTIVE: Patients with obstructive sleep apnea are often obese. Obesity may contribute to both sleep apnea itself and to the cardiovascular risk associated with sleep apnea. Weight loss in obese patients with sleep apnea may alleviate symptoms and decrease the severity of sleep apnea. Whether patients with obstructive sleep apnea are indeed predisposed to recent weight gain, as compared with similarly obese subjects without sleep apnea, is not known. PATIENTS AND METHODS: We compared 1-year weight histories in 53 male and female patients newly diagnosed with obstructive sleep apnea, compared with 24 controls matched for gender, age, body mass index, and percent body fat. Sleep apnea patients had never been treated. Control subjects were proven to be free of sleep-disordered breathing by overnight polysomnography. RESULTS: Patients with obstructive sleep apnea (n = 53) had a significant recent weight gain of 7.4 +/- 1.5 kg compared with a weight loss of 0.5 +/- 1.7 kg (P = 0.001) in similarly obese controls (n = 24). Male patients with obstructive sleep apnea (n = 28) had a history of significant weight gain (6.8 +/- 2.3 kg) over the year preceding the study compared with male control subjects (n = 13), in whom average weight fell by 0.58 +/- 2.4 kg (P = 0.03). Female patients (n = 25) with obstructive sleep apnea had an 8.0 +/- 1.9 kg weight gain compared with female controls (n = 11) who had a history of weight loss of 0.46 +/- 2.6 kg (P = 0.02). CONCLUSION: These findings support the concept that patients with obstructive sleep apnea may be susceptible to increasing obesity in the period preceding the diagnosis of obstructive sleep apnea.