Impaired objective daytime vigilance in obesity-hypoventilation syndrome: impact of noninvasive ventilation

BACKGROUND: Obesity-hypoventilation syndrome (OHS) is efficiently treated by noninvasive ventilation (NIV). Sleep respiratory disturbances, reduced ventilatory drive, and excessive daytime sleepiness (EDS) are commonly reported, but their relationships remain unclear. OBJECTIVES: To characterize sleep breathing disorders encountered in patients with OHS, to compare low and normal CO(2) responders in terms of sleep abnormalities, subjective and objective measures of EDS, and to measure the changes induced by NIV on these parameters. METHODS: At baseline and after 5 nights of NIV, 15 consecutive patients (mean [+/- SD] age, 55 +/- 9 years; mean body mass index, 38.7 +/- 6.1 kg/m(2); Paco(2), 47.3 +/- 2.3 mm Hg) prospectively underwent polysomnography, CO(2) ventilatory response testing, Epworth sleepiness scale scoring, and the Oxford Sleep Resistance (OSLER) test, which is an objective vigilance test. RESULTS: OHS patients exhibited obstructive sleep apnea syndrome (mean apnea-hypopnea index, 62 +/- 32 events per hour) and rapid eye movement (REM) sleep hypoventilation (mean REM sleep time, 35 +/- 33%). Baseline CO(2) sensitivity was significantly related to the proportion of hypoventilation during REM sleep (r = 0.54; p = 0.037). Six patients showed abnormal sleep latencies during the OSLER test (71% of the low CO(2) responders vs 14% of the normal CO(2) responders). Low CO(2) responders exhibited significantly shorter sleep latencies during the OSLER test (23 +/- 14 vs 37 +/- 8 min, respectively; p = 0.05). Using NIV, diurnal blood gas levels were improved and REM sleep hypoventilation were suppressed. Objective sleepiness was improved in low CO(2) responders (p = 0.04). CONCLUSION: In OHS patients, the lower the daytime CO(2) response, the higher the proportion of REM sleep hypoventilation and daytime sleepiness. Short-term therapy with NIV improves all of these parameters.     

Predictors of decreased spontaneous baroreflex sensitivity in obstructive sleep apnea syndrome

BACKGROUND: The impact of obstructive sleep apnea syndrome (OSAS) on the arterial baroreflex, and its significance, is still under debate. We investigated the baroreflex sensitivity (BRS) during sleep in well-selected OSAS patient and control subject cohorts METHODS: We performed a prospective study of 10 non-OSAS subjects, 14 subjects with mild-to-moderate OSAS, and 14 male subjects with severe OSAS subjects. Groups were matched for age, body mass index, and other relevant variables. Subjects had no other disease and were not receiving regular medication. BP was monitored beat-by-beat (Portapres; Finapres Medical Systems; Amsterdam, the Netherlands) at night during polysomnography. Spontaneous BRS was assessed by the sequence technique. Heart-rate correction was also applied to calculate BRS at a heart rate (HR) of 60 beats/min (BRS-60) to account for intersubject variability in baseline HR. Eight suitable patients were treated with continuous positive airway pressure (CPAP), and BRS measurements were repeated 6 weeks later. RESULTS: BRS and BRS-60 were significantly lower in patients with severe OSAS than in patients with mild-to-moderate OSAS and in non-OSAS subjects, and a separate sleep-stage analysis revealed this difference to be evident in stage 2 non-rapid eye movement sleep and during nocturnal wakefulness. There was no difference in BRS and BRS-60 between non-OSAS subjects and patients with mild-to-moderate OSAS. In multivariate analysis, the desaturation index was the only independent predictor of depressed BRS. CPAP therapy significantly improved the BRS measures. CONCLUSION: Patients with severe OSAS demonstrate depressed BRS during sleep, which may contribute to the cardiovascular pathophysiology in OSAS patients.     

Sleep-related hypoventilation/hypoxemic syndromes

The latest edition of The International Classification of Sleep Disorders: Diagnostic and Coding Manual subsumes a broad range of disorders under the heading "Sleep Related Hypoventilation/Hypoxemic Syndromes." Some are quite common, such as COPD with worsening gas exchange during sleep; while some are exceedingly rare, such as congenital central hypoventilation syndrome. All share the attribute of abnormal gas exchange that worsens, or may only be present, during sleep. The sleep state, the sleeping posture, and the circadian rhythm driving sleep all may affect respiration by altering control of breathing and/or pulmonary mechanics. These changes are largely inconsequential in the normal individual but interact with respiratory, neurologic, or neuromuscular disease to manifest as the sleep-related hypoventilation/hypoxemic syndromes. In addition to optimal treatment of the underlying disorder (when known and when possible), treatment usually involves nocturnal ventilatory support that is now most commonly provided by noninvasive positive pressure ventilation.     

七氟醚在阻塞性睡眠呼吸暂停综合征患者麻醉中的应用

目的:比较观察七氟醚和异氟醚与在阻塞性睡眠呼吸暂箨综合征(OSAS)患者麻醉中的应用,探讨其临床效果和安全性.方法:择期OSAS手术患者44例,随机分为瑞芬+异氟醚组、瑞芬+七氟醚组,麻酵维持首先根据BIS监测来调节七氟醚和异氟醚的吸入浓度,使BIS维持在45～55之,然后根据血压和心率调节瑞芬太尼的输注速率,手术结束前10分钟停止吸入麻醉药.观察两组的苏醒拔管时间、定向力恢复时间等苏醒指标和术后并发瘟的发生.结集:七氟醚麻醇后睁跟时间、自主呼吸恢复对间、呼吸满意时间、拔管时间、离开手术室时间、定向力恢复时间等情况均优卡予异氟醚组(均(P<0.05)),记忆恢复时间明显优于异氟醚组(P<0.01).术后并发症的发生率无统计学差异(P>0.05).结论:七氟醚和异氟醚均适合予OSAS患者的麻醇,七氟醚麻醉苏醒质量更高.     

Platinum concentration in sentinel lymph nodes after preoperative intra-arterial cisplatin chemotherapy targeting primary tongue cancer

Abstract Conclusion: We conclude that intra-arterially injected cisplatin passed via lymph flow into sentinel nodes (SNs) as the platinum concentration in the SNs was higher than that in the non-sentinel nodes (NSNs). It is possible that preoperative intra-arterial chemotherapy targeting primary cancer also has a therapeutic effect on subclinical metastatic SNs. Objectives: Intra-arterial chemoradiotherapy has been reported to be effective against not only primary tumors but also nodal metastases. We considered the hypothesis that intra-arterially injected cisplatin passed via lymph flow into regional nodes. This study aimed to investigate intra-arterially injected cisplatin distribution to regional nodes by comparing platinum concentrations in SNs and NSNs. Methods: Five patients with T1-2 N0 tongue cancer were treated with preoperative intra-arterial chemotherapy (cisplatin, 100 mg/m(2)) targeting primary cancer. Partial glossectomy together with SN biopsy and elective neck dissection were performed 2 weeks after intra-arterial chemotherapy. Platinum concentrations in the lymph nodes were measured using a Zeeman atomic absorption spectrometer. Results: Thirteen SNs were harvested together with eight NSNs from the areas adjacent to the SNs. Platinum concentrations were then measured, revealing a significant difference in platinum concentration between the SNs and the NSNs (mean ± SD, 0.682 ± 0.246 μg/g vs 0.506 ± 0.274 μg/g; p = 0.049).     

阻塞性睡眠呼吸暂停综合征合并高血压的临床研究

目的观察阻塞性睡眠呼吸暂停综合征(OSAS)合并高血压患者行舌根、软腭消融术后的血压变化。方法采用睡眠呼吸监测确诊OSAS的高血压患者45例行低温等离子消融术,术后1个月、2年复查血压变化。结果45例OSAS合并高血压患者在术后1个月血压下降,2年后平均血压下降10mmHg。结果考虑引起部分高血压的因素与OSAS有某种关系,改善睡眠时呼吸通畅,是治疗高血压的一种手段。     

Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial

IntroductionObesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the “gold standard” treatment for obstructive sleep apnea syndrome.Objectivewe aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity.MethodsEighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I – continuous positive air pressure with a steady pressure of 4 cm H₂O; group II – ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4≥ hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out.Results39 patients completed the study. The mean age was 52 ± 11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p < 0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%–75% was significantly enhanced (p < 0.05) in group II.ConclusionContinuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.     

脉冲振荡系统对32例打鼾患者的测定及其意义探讨

目的 初步探讨脉冲振荡法在测定单纯打鼾及阻塞性睡眠呼吸暂停综合症（OSAS）呼吸阻抗中的诊断价值。方法 应用脉冲振荡法（IOS）和流量-容积曲线检测19例健康人、11例单纯打鼾而无睡眠呼吸暂停综合症患者及21例打鼾而且伴有阻塞性睡眠呼吸暂停综合症患者。结果 在粘性阻力（R35）方面,从健康组→单纯打鼾组→OSAS组阻力逐步增高,3组之间两两比较差异均存在显著性（P〈0.05或P〈0.01）;阻抗容积图分析表明单纯打鼾组存在毛刺状图形的比率为27.27%,而OSAS组的比率为61.90%,两者比较差异存在显著性（P〈0.01）。流量-容积曲线图形分析表明单纯打鼾组呼气及吸气曲线存在锯齿波的比率为18.18%,而OSAS组的比率为52.38%,两者比较差异存在显著性（P〈0.01）。结论 脉冲振荡系统可以作为单纯打鼾及阻塞性睡眠呼吸暂停综合症初筛的客观指标之一。     

阻塞性呼吸暂停综合征的围手术期护理

<正>阻塞性睡眠呼吸暂停综合征(OSAS),也称酣症,表现为夜间睡眠打酣,睡眠后憋醒,白天嗜睡、乏力,注意力不集中,记忆力减退,头痛、头晕、血压升高。常合并有冠心病、肺心病、心律失常,重者可致睡眠中猝死。临床可通过多导睡眠监     

阻塞性睡眠呼吸暂停综合征对男性患者血清中脂联素和脂蛋白水平的影响

目的 :探讨男性阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）患者脂联素（adiponectin,ADPN）水平和高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）的变化情况。方法 :选择单纯打鼾患者和OSAS患者共计103例,受试者均为男性。按照睡眠呼吸暂停低通气指数（apnea hypopnea index,AHI,次/h）将所有受试者分为4组,即对照组（n=21,AHI≤5次/h）,轻度OSAS组（n=25,5次/hOSAS组（n=42,20次/hOSAS组（n=15,AHI>40次/h）。监测整晚的AHI和血氧饱和度（SpO₂）,并测定血清中ADPN、HDL-C和LDL-C浓度。结果 :与对照组相比,各个OSAS组受试者间年龄无显著性差异（P>0.05）,各OSAS组受试者的AHI均明显高于对照组（P<0.01）;最低SpO₂和ADPN水平明显低于对照组（P<0.05,P<0.01）。轻度OSAS组血清中HDL-C和LDL-C水平与对照组相比差异不明显（P>0.05）;中度和重度OSAS患者HDL-C明显降低,LDL-C显著升高（P<0.05,P<0.01）。OSAS患者AHI与血清中ADPN（r=-0.521,P<0.01）和HDL-C（r=-0.344,P<0.05）的浓度呈负相关,与LDL-C呈正相关（r=0.326,P<0.05）;而最低SpO₂与ADPN（r=0.519,P<0.01）和HDL-C（r=0.337,P<0.05）呈正相关,与LDL-C呈负相关（r=-0.309,P<0.05）。结论 :OSAS可以降低男性患者血清中ADPN和HDL-C的浓度,升高LDL-C的水平,该作用与OSAS患者AHI的升高和最低SpO₂的降低密切相关。