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1.
Introduction Mandibular advancement splints (MAS) allowing self-adjustment may be better tolerated, but the optimum titration protocol
needs systematic study.
Aim The aims of the study are to assess the effectiveness of a titratable MAS device in consecutive patients with body mass index
(BMI) < 35 kg/m2 and obstructive sleep apnoea [OSA, apnoea–hypopnoea index (AHI) 10–40/h] and compare two methods of adjustment [self-adjustment
or adjustment after polysomnographic (PSG) feedback].
Materials and methods Twenty-eight patients (24 M, mean age 49 years, mean BMI 27.6 kg/m2) with symptomatic (Epworth Sleepiness score > 8/24, snoring, choking or poor sleep quality) OSA (mean AHI 25.7/h, range 10–46/h)
had a MAS set at 70% maximal protrusion and were randomised to subjective self-adjustment for 6 weeks (n = 16) or objective adjustment (n = 12; fixed position for 3 weeks, then PSG based feedback at 3 weeks with self-adjustment instructions). Primary outcome
variable (AHI) and OSA symptoms were compared by t tests and chi-squared tests at baseline and after 6 weeks. Resolution of apnoea was defined as AHI < 5/h; improvement was
defined as AHI decreased by >50% but still >5/h.
Results The groups had similar baseline demographics, OSA severity and occlusal type. MAS therapy improved or resolved OSA in 20 out
of 28 (71%) and was reportedly used nightly by 91% of the objective group and 63% of the subjective group (p = 0.04). MAS were used all night by 75% of the objective group and 69% of the subjective group (p > 0.05). MAS adjustment following PSG feedback did not lower AHI further from 3 weeks (baseline 26.5 ± 12.0/h, 3 weeks 15.3 ± 13.5/h
p = 0.01, 6 weeks 11.7 ± 10.0/h, p = 0.11). The overall improvement was similar to that achieved with subjective adjustment (baseline AHI 25.4 ± 7.4/h, 6 weeks
14.3 ± 10.7/h, p = 0.0002). Symptomatic benefit was reported by both groups.
Conclusion In selected patients, titratable MAS improved or resolved OSA in the majority of patients and was well tolerated. PSG-based
feedback at 3 weeks allowed objective confirmation of efficacy and increased device use but did not result in greater improvement
in AHI or symptoms. Neither titration method was significantly superior for us to provide firm endorsement. However, we recommend
a follow-up sleep study to confirm MAS efficacy. 相似文献
2.
C-reactive protein (CRP) and interleukin-6 (IL-6) are pro-inflammatory proteins and important risk factors for atherosclerosis.
Plasma CRP levels in snoring children may or may not be elevated. Since obesity is prevalent among snoring children and is
associated with elevated CRP levels, we aimed to investigate the relative contributions of sleep-disordered breathing (SDB)
and obesity to the inflammatory processes in snoring children in this prospective study. Two hundred forty-four children (mean
age 8.9 ± 3.4 years) underwent polysomnographic evaluation. CRP was measured the following morning, and plasma IL-6 levels
from 111 randomly selected children were also examined. Plasma CRP and IL-6 levels were elevated in children with SDB. Log
plasma CRP levels were higher in the moderate-severe SDB group (apnea/hypopnea index, AHI ≥ 5) compared to the mild SDB group
(AHI ≥ 1 and <5; p < 0.0001) or the control group (AHI < 1; p = 0.0001). Log plasma CRP levels correlated with AHI, arousal index, relative BMI, and SpO2 nadir (r = 0.30, p < 0.0001; r = 0.21, p = 0.002; r = 0.39, p < 0.0001, r = −0.36, p < 0.0001, respectively). Log plasma CRP levels were lower in children with SpO2 nadir ≥90 (p < 0.0001). Sub-analysis of the 116 non-obese children in the cohort revealed similar findings. Log plasma IL-6 levels were
increased in children with moderate–severe SDB compared to controls (p = 0.03) and correlated with AHI (r = 0.28, p = 0.003) and SpO2 nadir (r = −0.24, p = 0.02). Children with SDB display significant severity-dependent increases in plasma CRP and IL-6 levels independent of
obesity. 相似文献
3.
睡眠评价量表对阻塞性睡眠呼吸暂停综合征的临床初筛诊断意义 总被引:16,自引:0,他引:16
目的 探讨睡眠评价量表对阻塞性睡眠呼吸暂停综合征 (OSAS)的临床初筛诊断意义。方法 对 4 2例鼾症、189例OSAS患者 (轻度 5 0例、中度 6 2例、重度 77例 )分别行睡眠评价量表 (ESS)问卷调查并判断嗜睡评分 (EP) ,然后行多导睡眠仪 (PSG)检查。依据PSG检查将嗜睡评分与相关资料做统计学分析。结果 鼾症、各组OSAS患者EP评分、夜间睡眠呼吸紊乱指数 (AHI)指数、睡眠结构有明显差异 ,且EP与AHI呈明显的正相关 (r=0 4 4 ,P <0 0 1)即OSAS病情越重 ,EP评分越高。诊断符合率分别为 :鼾症 83% (35 /42 ) ,轻度OSAS 90 % (45 /5 0 ) ,中度OSAS 79% (49/6 2 ) ,重度OSAS 82 %(6 3/77)。结论 EP评分基本与病情相符 ,诊断符合率较高。可以用睡眠评价量表作为临床OSAS的初筛检查 ,尤其是在基层医院。 相似文献
4.
Obstructive sleep apnea syndrome (OSAS) is characterized by repeated cessations of breathing during sleep. Major symptoms
of this disease are excessive daytime sleepiness, snoring, and witnessed apnea. Most of the patients are treated with CPAP.
In this study, we aimed to evaluate the factors affecting adherence to the CPAP treatment. Seventy-one patients were enrolled
to this study. Patients were divided into three groups according to CPAP usage. Group I consisted of patients who had never
used CPAP, group II consisted of patients who had used CPAP occasionally, and group-III patients had used CPAP treatment regularly.
Group-III patients had higher apnea–hypopnea index (AHI) than groups I and II (respectively, 56.6 ± 27.7, 26.3 ± 7.5, and
32.3 ± 7.06; p < 0.000 for both). Oxygen desaturation index was significantly higher in group-III patients comparing to groups I and II
(44.6 ± 22.3, 15.9 ± 8.3, and 25.6 ± 9.5; p < 0.000 for all). Our findings have shown that only very severe patients use the CPAP device regularly (mean AHI 56.6 ± 27.7).
Compliance to CPAP treatment seemed to be poor in patients with moderate to severe, AHI about 30, OSAS. Considering the well-established
benefits of CPAP treatment in patients with true indications, patients should be encouraged to use CPAP regularly, and complications
of OSAS should be keynoted. 相似文献
5.
Objectives Sleep and sleep disorders are different in several important ways between men and women. We aimed to investigate gender differences
in initial symptoms and associating medical diseases of patients admitting to our sleep clinic.
Methods Ninety-one patients, 20 women (22%) and 71 men (78%), admitting consecutively to the sleep clinic were studied. A detailed
sleep and medical history of the patients was recorded. All patients were questioned for Epworth Sleepiness Scale (ESS) and
underwent an entire night of diagnostic polysomnography. Apnea–hypopnea index (AHI) was identified as the total number of
apnea and hypopnea per hour of sleep. Hypopnea was defined as a decrease of airflow by at least 50% and desaturations were
defined as ≥4% decrease in oxygen saturation.
Results The mean values for age, body mass index, blood pressures and ESS score did not significantly differ between men and women,
but AHI (events/h) was significantly higher in men (29.1 ± 22.7) than women (17.9 ± 17.7, p < 0.05). Snoring was the most common symptom in both men (95%) and women (90%). Among the main presenting complaints, only
morning headache (12 of women 60%, 31 of men 43%, p = 0.04) and dry mouth on awakening (ten of women 50%, 57 of men 80%, p = 0.02) showed a significant difference between the two genders, while among the medical diseases only hypothyroidism (four
of women 20% and three of men 4%, p = 0.03) and depression (nine of women 45% and 16 of men 22%, p = 0.02) were seen as statistically higher in women than in men.
Conclusions Primary care physicians should be aware of obstructive sleep apnea (OSA) in women and the importance of referring women for
sleep studies when they complain of symptoms associated with OSA, even if other non-specific symptoms such as morning headaches
are reported. Also, hypothyroidism and depression are accompanied with sleep disorders especially in women. 相似文献
6.
Maya Ramagopal Steven M. Scharf Darryl W. Roberts Carol J. Blaisdell 《Sleep & breathing》2008,12(4):381-392
Asthma has been identified as a possible risk factor for Obstructive Sleep Apnea (OSA) in children. It is not known whether
parent-reported asthma increases the likelihood of the diagnosis of OSA in snoring children. We hypothesized that snoring
children with asthma are more likely to have OSA than snoring children without asthma. This study is a 1-year retrospective
review of polysomnogram and questionnaire data collected on 236 patients referred to the University of Maryland Pediatric
Sleep laboratory for evaluation of snoring. Of the 236 patients, 58% (137/236) were boys, and 79% (173/219 reporting race)
were African-American (AA). The age at referral was 7.2 ± 3.7 years (mean ± S.D.). Mean body mass index (BMI) percentile was
73.4 ± 32.3%, with 43.2% (54/125) >95th percentile. A history of asthma was reported by 31.4% (74/236); no subject was symptomatic
on the night of the study. We found no increased risk for polysomnographically diagnosed OSA for asthmatics. To the contrary,
by logistic regression analysis, a parent/guardian report of asthma decreased the odds of having OSA by 34% (p = 0.027), controlling for individual and socioeconomic factors and assessment results. Polysomnographic (PSG) differences
between asthmatic and non-asthmatic children were found in only the arousal index (11.0 vs.9.3 ± 6.5/h, p = 0.099) and total
sleep time (337.1 ± 64.3 vs. 347 ± 65.2 min, p = 0.1) In a referral-based group of predominantly AA inner-city snoring children, asymptomatic asthma decreased the likelihood
of OSA. 相似文献
7.
Micha T. Maeder Peter Ammann Hans Rickli Otto D. Schoch Wolfgang Korte Christoph Hürny Jonathan Myers Thomas Münzer 《Sleep & breathing》2008,12(1):7-16
The obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular abnormalities including left ventricular hypertrophy,
left ventricular diastolic dysfunction, and endothelial dysfunction. The present study evaluated whether N-terminal pro-B-type
natriuretic peptide (NT-proBNP) and peak oxygen consumption (peak VO2), both integral markers of cardiovascular function, are related to OSAS severity. In addition, we tested whether NT-proBNP
levels depend on body composition in OSAS patients, similar to what has been reported in patients without OSAS. Eighty-nine
patients with untreated OSAS underwent NT-proBNP measurement, dual X-ray absorptiometry, and cardiopulmonary exercise testing.
In a representative subgroup (n = 32), transthoracic echocardiography was performed. The severity of OSAS was classified based on apnea–hypopnea index (AHI)
values as mild (AHI 5–15 h−1), moderate (AHI 15–30 h−1), and severe (AHI >30 h−1). OSAS was mild in 19 (21%), moderate in 21 (24%), and severe in 49 (55%) patients. NT-proBNP levels did not differ among
patients with mild [30 (10–57)], moderate [37 (14–55)], and severe [24 (13–49) pg/ml; p = 0.8] OSAS and were not related to body mass index (r = 0.07; p = 0.5), percent lean body mass (r = −0.17; p = 0.1), and percent fat mass (r = 0.18; p = 0.1). Percent predicted peak VO2 was on average normal and did not differ among patients with mild (115 ± 26), moderate (112 ± 23), and severe OSAS (106 ± 29%;
p = 0.4). Body weight-indexed peak VO2 did not differ among patients with mild (31.9 ± 10.3), moderate (32.1 ± 7.9), and severe OSAS (30.0 ± 9.9 ml kg−1 min−1; p = 0.6) either. Lower NT-proBNP (β = −0.2; p = 0.02) was independently but weakly associated with higher body weight-indexed peak VO2. In the echocardiography subgroup, NT-proBNP was not significantly related to left ventricular mass index (r = 0.26; p = 0.2). In conclusion, NT-proBNP and peak VO2 are not related to OSAS severity, and NT-proBNP poorly reflects left ventricular hypertrophy in OSAS. The lack of a relationship
between NT-proBNP and OSAS severity is not due to a significant influence of body composition on NT-proBNP. There is an association
between higher NT-proBNP and lower peak VO2, indicating that NT-proBNP is a marker of cardiorespiratory fitness in patients with OSAS. However, the association is too
weak to be clinically useful. 相似文献
8.
Reese GE Nanidis T Borysiewicz C Yamamoto T Orchard T Tekkis PP 《International journal of colorectal disease》2008,23(12):1213-1221
Objective The aim of the study was to quantify the risk of disease recurrence associated with cigarette smoking for individuals with
Crohn’s disease after disease-modifying surgery.
Design Meta-analysis of observational studies.
Data sources Medline, Embase, Ovid and the Cochrane database.
Materials and methods A literature search was performed to identify studies published between 1966 and 2007 comparing outcomes of smokers, ex-smokers
and non-smokers with Crohn’s disease. Random-effect meta-analytical techniques were employed to assess the risk of medical
or surgical recurrence.
Results Sixteen studies encompassing 2,962 patients including 1,425 non-smokers (48.1%), 1,393 smokers (47.0%) and 137 ex-smokers
(4.6%) were included. Smokers had significantly higher clinical post-operative recurrence than non-smokers (odds ratio [OR] = 2.15;
95%CI = 1.42, 3.27; p < 0.001). Smokers were also more likely to experience surgical recurrence by 5 (OR = 1.06; 95%CI = 0.32; 3.53, p = 0.04) and 10 years of follow-up (OR = 2.56; 95%CI = 1.79, 3.67; p < 0.001) compared to non-smokers, although the crude re-operation rate was not statistically significant. When matched for
operation and disease site, smokers had significantly higher re-operation rates to non-smokers (OR = 2.3; 95%CI = 1.29, 4.08;
p = 0.005). There was no significant difference between ex-smokers and non-smokers in re-operation rate at 10 years (OR = 0.30;
95%CI = 0.09, 1.07; p = 0.10) or in post-operative acute relapses (OR = 1.54; 95%CI = 0.78, 3.02; p = 0.21).
Conclusions Patients with Crohn’s disease who smoke have a 2.5-fold increased risk of surgical recurrence and a twofold risk of clinical
recurrence compared to non-smokers. Patients with Crohn’s disease should be encouraged to stop smoking since the risk of disease
relapse is minimised upon its cessation.
George E. Reese and Theodore Nanidis with equal contribution. 相似文献
9.
Seockhoon Chung In-Young Yoon Yoon-Kyung Shin Chul Hee Lee Jeong-Whun Kim Hee Jeong Ahn 《Sleep & breathing》2009,13(1):11-17
Introduction Obstructive sleep apnea syndrome (OSAS) is considered to be associated with cardiovascular complications, and atherosclerosis
could mediate this relationship. Cardiovascular risk factors of OSAS still need to be elucidated in elderly patients, since
studies about the association between OSAS and cardiovascular diseases have been done mainly in middle-aged adults. To investigate
whether endothelial dysfunction, as an early marker of atherosclerosis, and inflammatory responses in OSAS were affected by
age, we studied flow-mediated dilatation (FMD) and C-reactive protein (CRP) in elderly and middle-aged patients with OSAS.
Materials and methods This study enrolled 161 male subjects of 117 middle-aged (35–59 years old) and 44 elderly (≥60 years old) patients with OSAS.
After they finished nocturnal polysomnography (NPSG), FMD was measured on the brachial artery and blood samples were obtained
to determine serum CRP levels.
Results and discussion FMD was significantly lower in the elderly patients (p = 0.04), but no difference was observed between two age groups in body mass index (BMI), neck circumference, waist-to-hip
ratio, apnea hypopnea index (AHI), serum CRP level, or NPSG findings related with nocturnal hypoxemia such as average O2 saturation, percentage of time below 90% O2 saturation, and oxygen desaturation index (ODI). From the results of stepwise multiple linear regression analysis, the lowest
oxygen saturation was a significant determinant of FMD (β = 0.25, p < 0.01, adjusted R
2 = 6%), and BMI (β = 0.22, p < 0.05) and waist-to-hip ratio (β = 0.21, p < 0.05) were significant variables to explain CRP (adjusted R
2 = 11%, p < 0.01) in the middle aged patients. In the elderly patients, no variable was significant for predicting FMD, but AHI was
significant determinant of CRP (β = 0.46, p < 0.01, adjusted R
2 = 19%, p < 0.01). In predicting cardiovascular risks of OSAS, both hypoxia and obesity should be considered in the middle-aged group,
whereas nocturnal respiratory disturbances are important in the elderly group. 相似文献
10.
Objective The objective of this study was to assess the reliability and validity of a Norwegian version of the self-administered Epworth
sleepiness scale (ESS).
Materials and methods Two samples responded to the ESS: (1) 226 patients previously evaluated for obstructive sleep apnea, of whom 51 also responded
to a retest 2 weeks later, and (2) 37 ambulant patients complaining of excessive daytime sleepiness, who were referred to
multiple sleep latency testing (MSLT). We assessed internal consistency reliability with Cronbach’s alpha and test–retest
reliability with weighted kappa (Kw) or an intraclass correlation coefficient (ICC). The validity of the Norwegian ESS was
assessed by correlating ESS item and total scores with the number of times a patient fell asleep and the mean latency found
on the MSLT.
Results Internal consistency reliability, as assessed with Cronbach’s alpha, was 0.84 (n = 154). Test–retest reliability for the eight ESS items ranged from Kw of 0.61 to 0.80 (n = 50) and for the total score. ICC was 0.81.There was only fair to moderate correlation of ESS item and total scores with
MSLT variables, mainly in a subset of patients with total ESS score >10.
Conclusions The Norwegian version of the ESS had acceptable internal consistency and test–retest reliability. The association of the ESS
items and total score with the MSLT was only fair to moderate, in line with previous studies. 相似文献
11.
Athanasios G. Kaditis Emmanouel I. Alexopoulos Fotini Hatzi Ioanna Karadonta Konstantinos Chaidas Konstantinos Gourgoulianis Elias Zintzaras George A. Syrogiannopoulos 《Sleep & breathing》2008,12(1):25-31
Correlation between obesity and obstructive sleep apnea has been documented in both adults and children. This investigation
evaluated importance of body mass index (BMI) in relation to age as predictor of severity of obstructive sleep-disordered
breathing (SDB). Children with habitual snoring referred for polysomnography were recruited. BMI Z score (≥1.036 vs <1.036,
i.e. at risk for overweight or overweight vs normal) was assessed as predictor of severity of SDB (apnea-hypopnea index [AHI]
>five vs ≤five episodes per hour) at different ages (≤6 vs >6 years). Two hundered eighty-four participants were recruited:
75 young children (4.6 ± 1 years) with high BMI (1.9 ± 0.7); 95 young subjects (4.5 ± 1.1 years) with low BMI (−0.2 ± 1.3);
55 older children (9.2 ± 1.8 years) with high BMI (1.8 ± 0.5); and 59 older participants (9.7 ± 2.2 years) with low BMI (−0.2 ± 1.1).
Odds ratios for AHI >5 in young/high BMI children, young/low BMI subjects, and older/high BMI subjects relative to older/low
BMI participants were: 6.5 (95% confidence interval 2.1–19.9), 7.3 (2.4–22) and 2 (0.6–7.3), respectively. Large tonsil size
was associated with young age (odds ratio 1.97; 1.2–3.3). Among children with habitual snoring, adiposity does not predict
severity of obstructive SDB in early childhood probably due to the prominent role of adenotonsillar hypertrophy. However,
it may have a more important contribution to severity of SDB in older children.
Presented at the European Respiratory Society Meeting, Munich, September 4, 2006. 相似文献
12.
Tomasz J. Kuzniar Snigdha Pusalavidyasagar Peter C. Gay Timothy I. Morgenthaler 《Sleep & breathing》2008,12(2):135-139
Patients with complex sleep apnea syndrome (CompSAS) have obstructive sleep apnea but develop troublesome central sleep apnea
activity or Cheyne–Stokes breathing when provided continuous positive airway pressure (CPAP) therapy. We examined whether
CompSAS activity persists with long-term CPAP treatment. We retrospectively identified all patients with CompSAS who underwent
two therapeutic polysomnograms (PSGs) separated by at least 1 month during 2003–2005. We compared PSG findings between the
initial and follow-up study and noted clinical responses to therapy. We identified 13 CompSAS patients meeting criteria. Most
follow-up PSGs were ordered after an abnormal overnight oximetry on CPAP or because of CPAP intolerance after 195 (49–562)
days. The residual apnea–hypopnea index (AHI) on CPAP decreased from 26 (23–40) on the first PSG to 7 (3–21.5) on the follow-up
PSG. Only seven patients reached AHI < 10 and 6 had AHI ≥ 10 (“CPAP nonresponders”) at follow-up. “CPAP nonresponders” were
sleepier (Epworth Sleepiness Score 13 [12.5–14] vs 9 [6–9.5], p = 0.03) and trended toward lower body mass index (29.7 [28.6–31.6] vs 34.3 [32.5–35.1], p = 0.06). Both groups were equally compliant with CPAP therapy. Although the AHI tends to improve over time in CompSAS patients
treated with CPAP, in this retrospective study nearly half-maintained a persistently elevated AHI. A prospective trial is
merited to determine the optimal treatment for these patients. 相似文献
13.
Marco Antonio Cardoso Machado Ligia Juliano Marcel Taga Luciane Bizari Coin de Carvalho Lucila Bizari Fernandes do Prado Gilmar Fernandes do Prado 《Sleep & breathing》2007,11(4):225-231
Mandibular repositioning appliances (tMRAs) designed with a titratable mechanism are effective to treat obstructive sleep
apnea syndrome (OSAS) but are not widely used, although many studies have proven their value. The aim of the present study
was to evaluate the efficacy of tMRAs in the treatment of OSAS on the criteria of the American Academy of Sleep Medicine (AASM;
apnea/hypopnea index [AHI] < 5). Three hundred consecutive patients with a polysomnographic diagnosis of OSAS were referred
for treatment with tMRAs between 2000 and 2003. Thirty-eight patients were excluded, and 262 concluded the titration protocol
with tMRA that lasted 4 months. After titration, the patients were referred for a medical reassessment, and 83 patients (70
men) participated in the new polysomnographic exam with tMRA in place to access tMRA’s efficacy. The mean pre- and post-treatment
AHI were 26 ± 17.7 and 4.8 ± 5.3 events per hour, respectively (p < 0.00005). Fifty-three (62.6%) of the 83 patients were treated successfully (AHI < 5). Twenty-three patients had severe
OSAS, and 12 of them (52.1%) were treated successfully (AHI < 5). Forty patients had moderate OSAS, and 26 of them (65%) were
treated successfully. Twenty patients had mild OSAS, and 15 (75%) were successfully treated. Even when applying more rigid
criteria such as those of the AASM, the expressive success rate obtained with the treatment of different degrees of OSAS indicates
that tMRAs are an additional valuable option even for cases of severe apnea in which the patient does not tolerate continuous
positive airway pressure or cannot afford this treatment, a fact quite common in Brazil and other developing countries. 相似文献
14.
Overcoming Poor Attendance to First Scheduled Colonoscopy: A Randomized Trial of Peer Coach or Brochure Support
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Turner BJ Weiner M Berry SD Lillie K Fosnocht K Hollenbeak CS 《Journal of general internal medicine》2008,23(1):58-63
OBJECTIVES Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure
support and compared these with concurrent patients who did not receive support.
METHODS From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visits to 4 primary care practices
and scheduled for a first colonoscopy from February 1, 2005 to August 31, 2006. Using block randomization, we assigned consenting
patients to a phone call by a peer coach trained to address barriers to attendance or to a mailed colonoscopy brochure. Study
data came from electronic medical records. Odds ratios of colonoscopy attendance were adjusted for demographic, clinical,
and health care factors.
RESULTS Colonoscopy attendance by the peer coach group (N = 70) and brochure group (N = 66) differed by 11% (68.6% vs 57.6%, respectively). Compared with the brochure group, the peer coach group had over twofold
greater adjusted odds ratio (AOR) of attendance (2.14, 95% confidence interval [CI] = 0.99–4.63) as did 49 patients who met
the prespecified criteria for needing no support (2.68, 95%CI = 1.05–6.82) but the AORs did not differ significantly for 41
patients who declined support (0.61, 95%CI = 0.25–1.45) and 49 patients who could not be contacted (0.85, 95%CI = 0.36–2.02).
Attendance was less likely for black versus white race (AOR = 0.37, 95%CI = 0.19–0.72) but more likely for patients with high
versus low primary care visit adherence (AOR = 2.30, 95%CI = 1.04–5.07).
CONCLUSION For patients who often fail to keep appointments, peer coach support appears to promote colonoscopy attendance more than an
educational brochure.
Presented at the 30th Annual Meeting of the Society of General Internal Medicine, Toronto, Ontario, April 26, 2007. 相似文献
15.
目的 调查分析机关工作人员打鼾人群中阻塞性睡眠呼吸暂停综合征(OSAS)与代谢综合征的关系.方法 采用整群抽样法,于2007年10月至2009年4月将江苏省老年医院体检中心接受健康体检的机关干部中的546名打鼾者纳入研究.先行现场抽样问卷调查,按嗜睡量表(ESS)评分将546人分为Ⅰ组(ESS评分<9)、Ⅱ组(ESS评分≥9).全部进行口服葡萄糖耐量试验及血液生化检测,并对前期连续入选的175人进行多导睡眠仪监测.统计学分析采用直线回归分析及多元回归分析等.结果 (1)该组打鼾者ESS评分为0~20,中位分值为5.546人中Ⅰ组398人(72.9%);Ⅱ组148人(27.1%).(2)直线回归分析显示,代谢综合征构成比=0.1433+0.0337×ESS评分(r2=0.7414,P<0.01),ESS评分每增加1分,代谢综合征构成比增加3.37%.两组间代谢综合征构成比比较,差异具有统计学意义(x2=4.605,P<0.05).(3)经多导睡眠仪检查175人,呼吸暂停低通气指数(AHI)为0.3~90.0次/h,中位值34.20.确诊OSAS(AHI>5次/h+ESS评分≥9)50例;高危OSAS(AHI>5次/h+ESS评分<9)118例;排除(AHI<5次/h)OSAS共7人.Pearson相关分析显示ESS评分与AHI呈直线相关(r=0.721,P<0.01).AHI与HOMA法胰岛素抵抗指数(HOMA-IR)的相关分析显示,OSAS组的HOMA-IR平均值高于高危OSAS组和非OSAS组(P<0.01、P<0.05).OSAS患者罹患代谢综合征的风险较对照组高1.6倍(OR=1.647,95%CI为0.795~3.414).(4)多元回归分析显示影响代谢综合征的主要因素是体重指数(OR=2.303,P<0.01)、呼吸紊乱指数(OR=1.083,P<0.01)、平均最低脉氧饱和度(OR=0.443,P<0.05).结论 机关工作人员的打鼾人群中OSAS患者具有更多代谢综合征的危险因素和显著的胰岛素抵抗,需要对其中高危人群进行早期干预. 相似文献
16.
This cross-sectional study was conducted to estimate the caregiver time and calculate the cost of informal care for AD, and
to explore the potential predictors of caregiver time. Seventy-one community-dwelling AD patient-caregiver dyads completed
the assessment and questionnaire. AD patients were assessed with Mini-mental status examination (MMSE), activities of daily
living (ADL), and Neuropsychiatric Inventory (NPI). Caregiver time was recorded using the Resource Utilization in Dementia
(RUD). According to the MMSE score, subjects were classified as mild (n = 18), moderate (n = 43), and severe (n = 10) groups. The PADL care time was significantly different among three groups, with highest in severe group (172.5 ± 208.0 h/month),
and least in mild group (24.9 ± 70.5 h/month) (F = 5.215, df = 2, P = 0.008). The supervision time was higher in severe group compared to mild group (F = 3.330, df = 2, P = 0.042), while there were no differences between mild and moderate groups, and between moderate and severe groups. There
was no difference in IADL caregiver time among three groups. The estimated annual cost of PADL care ranged from 903 USD (mild)
to 6,259 USD (severe), IADL care from 4042USD to 7645USD, and supervision from 871 USD to 6,172 USD. Stepwise logistic regression
analysis showed that MMSE score was significant predictor of PADL care time. For every one unit increase in MMSE, the odds
of PADL care time decrease by a factor of 0.791 (χ2 = 13.628, P = 0.000). Spouse caregivers significantly predict greater IADL care time (OR = 4.469, 95%CI = 1.248–15.999, P = 0.021), and male caregiver was a protector for IADL care time (OR = 0.157, 95%CI = 0.040–0.609, P = 0.007). The ADL score was a significant predictor of supervision time. For every one unit increase in ADL, the odds of
supervision time increase by a factor of 1.132 (95%CI = 1.055–1.215, P = 0.001). Higher educational level of the patient predicted decrease in supervision time (OR = 0.888, 95%CI = 0.794–0.994,
P = 0.038). Caregiver time and cost of home care for AD was substantial in China. Care time of PADL increased with the progression
of cognitive decline. The IADL care time was strongly influenced by the biographical characteristics of caregivers. Supervision
was mostly predicted by the functional status of the patient. 相似文献
17.
Stijn L. Verhulst Sarah Jacobs Liselotte Aerts Nancy Schrauwen Dominique Haentjens Raoul P. Rooman Luc Van Gaal Wilfried A. De Backer Kristine N. Desager 《Sleep & breathing》2009,13(2):207-210
Introduction The aim of this retrospective study was to investigate if sleep-disordered breathing (SDB) was an independent predictor of
suspected fatty liver disease in a clinical sample of overweight children and adolescents.
Materials and methods Consecutive overweight and obese children attending a pediatric obesity clinic underwent polysomnography, fasting blood sample,
and abdominal ultrasound.
Results and discussion The respiratory disturbance index, percentage of total sleep time with SO2 < 90%, and SaO2nadir were associated with higher
alanine amino-transferases (ALT) independent of abdominal obesity. Multiple logistic regression selected waist circumference
(odds ratio = 1.05; p = 0.05) and SaO2nadir (odds ratio = 0.87; p = 0.03) as predictors of suggestive fatty liver disease, defined as ALT > 40 U/L and/or hyperechoic liver on abdominal ultrasound.
This study supports the association between the severity of SDB and suspected fatty liver disease in a clinical sample of
overweight children and adolescents. We recommend more research on the influence of SDB on the development of fatty liver
disease and on the effect of treating sleep apnea on liver function parameters. 相似文献
18.
Yan Luo Bing Xia Chun Li Zhitao Chen Liuqing Ge Ting Jiang Feng Zhou Yan Zhao 《International journal of colorectal disease》2009,24(5):489-493
Background and aim Cytotoxic T lymphocyte antigen-4 (CTLA-4) plays a role in the downregulation of T cell activation. The present study aimed
to examine an association between the CTLA-4 gene polymorphisms and ulcerative colitis (UC) in the Han Chinese in central
China.
Materials and methods One hundred seventeen patients with UC and 246 healthy controls were genotyped for CTLA-4 gene −658CT in the promoter and
CT61 at the 3′ untranslated region using a method of polymerase chain reaction-based restriction fragment length polymorphism
and single-strand conformation polymorphism, respectively. The distributions of the genotypes and the allele frequencies of
the CTLA-4 gene in UC patients and healthy controls were compared by chi-square test.
Results The frequency of the T/T+C/T genotype at the CTLA-4 gene −658CT in the promoter was significantly higher in UC patients than
in healthy controls (26.5% vs 15.4%, χ
2 = 6.287, P = 0.015, OR = 1.973, 95%CI = 1.153–3.375). The frequency of the T allele at the CTLA-4 −658CT was also significantly higher
in UC patients than in the controls (13.2% vs 8.1%, χ
2 = 4.707, P = 0.033, OR = 1.726, 95%CI = 1.049–2.838). The frequency of the T/T genotype at the −658 locus was highly associated with
extensive colitis in UC patients (P = 0.037, OR = 3.955, 95%CI = 1.068–14.647). The frequency of the T allele at the −658 locus was highly associated with extensive
colitis in UC patients (P = 0.0067, OR = 3.05, 95%CI = 1.320–7.048).
Conclusion The T allele of CTLA-4 −658 polymorphism in the promoter of CTLA-4 gene was highly associated with UC in the Han Chinese in
central China. 相似文献
19.
Negar Ahmadi Gilla K. Shapiro Sharon A. Chung Colin M. Shapiro 《Sleep & breathing》2009,13(3):221-226
Purpose The purpose of this study was to investigate apnea–hypopnea index (AHI) across two polysomnographies (PSGs) to examine AHI
variability and impact on clinical diagnosis.
Materials and methods Two-night PSGs of 193 sleep clinic patients were reviewed, and the AHI variability was analyzed. Anonymized records from five
patients with significant night-to-night AHI variability were used in this study: the two-night PSGs from two patients were
represented as four individual PSGs; the two-night PSG for two others were represented as being obtained from two different
sleep clinics; the last patient’s PSG was shown as a two-night study. Twenty-two sleep experts attending the Associated Professional
Sleep Societies meeting were recruited to make diagnoses based on the PSGs. They were told that the PSGs were from seven patients:
four with single-night PSG; two with two PSGs, each one from a different clinic; and one patient with a two-night PSG.
Results Twenty-one percent of the 193 sleep clinic patients had a nightly PSG AHI variability of greater than 5. Forty-eight percent
of all patients had a significantly higher AHI on the first night, and 41% had a significantly higher AHI on the second night.
Using an AHI > 15 diagnostic criteria, sleep apnea would have been undetected in 20% (n = 39) of patients due to low AHI on one night. Furthermore, 13% of all patients had a more severe sleep apnea classification
based on the second night of PSG. For the seven cases, 27–36% of sleep experts failed to identify sleep apnea especially when
presented with the PSG containing the lower AHI. Incidences of missed sleep apnea diagnoses were reduced to 15–18% when information
from two PSGs was presented to the sleep experts.
Conclusions Utilizing a large patient population, this study supports the significant night-to-night variability in PSG respiratory variables.
Identification of sleep apnea in some patients is reduced when sleep experts are provided with only one PSG recording. The
clinical implication is that about 13% of sleep clinic patients might benefit from a second night of PSG.
Disclosure statement: This study did not receive external funding. 相似文献
20.
Ferdinand Zizi Girardin Jean-Louis Sonalis Fernandez Hans von Gizycki Jason M. Lazar Joao Nunes Clinton D. Brown 《Sleep & breathing》2008,12(4):317-322
Obstructive sleep apnea (OSA) is a prevalent sleep disorder that disproportionately affects blacks. While clinical and epidemiologic
data indicate intraethnic differences in several medical diseases, little is known about whether OSA symptoms differ within
the black ethnic group. We estimated the rate of OSA symptoms in a community-based sample of Caribbean-born black men and
women. We also ascertained which sociodemographic and/or medical factors were associated with OSA risk. A total of 554 patients
(mean age = 48.17 ± 16.75 years) participated in the study; 55% were women. Data were collected in four primary-care clinics
in Brooklyn, NY. A health educator explained the purpose of the study to interested patients and assisted consenting participants
in completing questionnaires, which required 15 min to complete. Participants reporting habitual snoring, excessive daytime
sleepiness, and sleep fragmentation were considered at high OSA risk. The rate of OSA symptoms was: snoring (45%), excessive
daytime sleepiness (33%), and difficulty maintaining sleep (34%). Many reported falling asleep while watching television (47%)
or while driving (14%). Based on logistic regression analysis, a history of heart disease was the most important predictor
of the likelihood of expressing OSA symptoms, with a corresponding multivariate-adjusted odds ratio of 11 (95% confidence
interval = 3.03–40.63). Findings suggest the need to investigate whether Caribbean-born blacks are at greater risk for developing
OSA than African Americans and whites. Caribbean-born blacks with a history of heart disease should be a prime target for
interventions that promote adequate screening and timely OSA diagnosis. 相似文献