Short sleep duration at night in 2.5-year-old children is associated with childhood obesity at age 5.5 years: The Japanese children cohort study

BackgroundObesity in children contributes to higher risks of various chronic diseases in adulthood and the prevalence has increased worldwide including Japan.ObjectivesThis study aims to examine the association between sleep duration at night in children aged 2.5 years and the subsequent risk of obesity at age 5.5 years.MethodsThis study is embedded in the Longitudinal Survey on Babies Born in the 21st Century, which recruited families who had a child born in Japan in 2001. The multivariable logistic regression models were applied to calculate odds ratios (OR) and 95 % confidence intervals (CI) of childhood obesity at 5.5 years, defined as percentage of overweight (POW) ≥ 20 % and body mass index (BMI) ≥ 95th percentile of this study population according to sleep duration at night collected at 2.5 years child age.ResultsAmong 25,378 children, 2.6 % and 3.7 % were obese at age 5.5 years defined by POW and BMI respectively. Compared with night sleep duration > 11 h/d, shorter sleep durations in 2.5 years-old children were associated with higher risk of obesity at 5.5 years; the multivariable ORs (95 %CI) were 1.05 (0.81–1.35), 1.23 (0.93–1.62) and 1.54 (1.04–2.31) for sleep duration 10, 9 and ≤ 8 h/d, respectively; p-trend = 0.03. The observed association differed according to the children (child’s sex, napping habits, and children frequently play at park), and family characteristics (mother’s age at delivery and mother’s level of education).ConclusionShort night sleep duration among girls aged 2.5 years was associated with risk of obesity at age 5.5 years, suggesting the importance of sufficient sleep duration at night for the prevention of obesity.     

阻塞性呼吸睡眠暂停综合征与中枢呼吸驱动

目的阐明不同浓度的CO     

藿香正气片增强镇静催眠药的镇静与催眠作用的研究

目的研究藿香正气片增强镇静催眠药对小鼠的镇静催眠作用.为临床增添了一个中西药结合的镇静催眠合剂提供药理依据.方法应用抖笼换能器法观察藿香正气片对小鼠的自发活动的影响.由此观察藿香正气片与镇静催眠药的协同作用.测定藿香正气片与镇静催眠药对小鼠的入睡时间及睡眠持续时间的作用.两个实验均分成四组,生理水组、藿香正气片组、安定组、安定+藿香正气片组.结果1.对小鼠自发活动的影响.(1)藿香正气片组与生理盐水组比较,具有极显著性差异(P＜0.01).(2)安定组与安定+藿香正气片组比较具有显著性差异(P＜0.05).2.藿香正气片增强镇静催眠药对小鼠的睡眠作用.(1)藿香正气片组与生理盐水组比较具有显著性差异(P＜0.05).(2)藿香正气片+安定组与安定组比较具有极显著性差异(P＜0.01).结论藿香正气片与安定合用对镇静及催眠确有协同作用.     

遗传因素在普通型偏头痛发生中的作用

目的探讨遗传因素在普通型偏头痛发生中的作用及该病的遗传方式.方法以27例普通型偏头痛患者为先证者,收集其一级和二级亲属的患病资料,采用零截尾泊松分布模型判断该病有无家庭聚集性,应用Penrose法和Li-Mantel-Gart法判断该病的遗传方式,应用PPAP软件估算该病的遗传度.结果先证者一级亲属该病的患病率＞二级亲属＞一般人群,符合多基因遗传病的特点;Penrose法的结果也显示该病为多基因遗传病,其一级亲属的遗传度为0.935±0.098,二级亲属的遗传度为0.439±0.284,遗传度的加权平均值为0824±0.093.结论普通型偏头痛是一种多基因遗传病.     

应用适形睡眠垫自然睡眠防治慢性病的临床观察

目的通过睡眠中脊柱保护防治颈椎病、腰椎病及与其相关的慢性病。方法观察３０例颈椎病和（或）腰椎病及可 能与之相关的慢性病患者应用脊柱适形睡眠垫保持自然体位睡眠后的效果。结果平均睡眠 １０７．２７ ｄ后,综合显效率 ９７．６９％。其中７例原发性高血压患者中,４例血压明显降低。结论应用脊柱适形睡眠垫自然睡眠可保护脊柱整体,进 而防治慢性病。     

Evaluation of the effect of shift working and sleep quality on semen parameters in men attending infertility clinic

We aimed to evaluate the effect of shift work on semen parameters together with the effect of sleep quality in men attending infertility clinic. The participants were divided into two groups as follows: 104 shift worker men (Group 1) and 116 nonshift worker men (Group 2). Groups were compared in terms of semen parameters, Depression Anxiety Stress Scale-21 (DASS-21), and Pittsburg Sleep Quality Index (PSQI) scores. A higher rate of oligozoospermia and poor sleep quality and a lower mean normal morphology percentage was observed in shift workers than nonshift workers (p = .006, .039 and .036 respectively). In addition, a positive correlation was seen between sleep duration and sperm concentration, while a negative correlation was found between sleep latency and total sperm count. Shift working together with high PSQI score was also a significant association with oligozoospermia when controlling for the other variables of age, total testosterone, DASS-21 stress score, smoking and varicocele (OR = 2.11, 95% CI 1.03–4.34 and OR = 1.18, 95% CI 1.01–1.39 respectively). In this study, infertile shift workers had a lower percentage of normal morphology and higher rates of oligozoospermia and poor sleep quality. Considering that shift workers have lower sleep quality, it seems that shift working negatively affects the circadian rhythm.     

乳腺癌化疗患者睡眠障碍变化规律及预测指标研究

目的 识别乳腺癌患者化疗期间睡眠障碍的纵向变化趋势及不同轨迹类别,并分析人口学及疾病相关因素对轨迹类别的预测作用.方法 采用一般资料调查表、乳腺癌患者报告结局测量系统-化疗期间睡眠障碍量表收集219例乳腺癌患者首次化疗开始前、第1疗程用药结束后第7天(化疗早期)、第2～4疗程用药结束后第7天(化疗中期)及最后1个疗程用药结束后第7天(化疗末期)的睡眠障碍情况.使用重复测量方差分析比较不同时间点测评结果的差异,应用潜类别增长模型探讨轨迹类别,并采用x2检验和Logistic回归分析探索轨迹类别的预测指标.结果 乳腺癌化疗患者4个时间点睡眠障碍得分分别为47.50±8.82、51.38±10.83、50.66±9.90、50.46±9.99,差异有统计学意义(P＜0.01).识别出乳腺癌化疗患者睡眠障碍4条不同的潜在轨迹,命名为无睡眠障碍组(19.2％)、轻度睡眠障碍组(25.1％)、中度睡眠障碍组(50.7％)及重度睡眠障碍组(5.0％).区域淋巴结转移(OR=1.475,P=0.042)、使用靶向药物(OR =2.135,P=0.011)及参与临床试验(OR=1.899,P=0.040)对乳腺癌化疗患者的睡眠障碍轨迹类别具有预测作用.结论 乳腺癌化疗患者的睡眠障碍随着化疗的推进而动态变化,且其发展轨迹有显著的群体异质性,淋巴结转移、使用靶向药物及参与临床试验对患者的睡眠障碍轨迹类别具有预测作用.医护人员可根据睡眠障碍的变化规律及预测指标早期识别睡眠障碍中、高危人群,并为患者提供全程管理与精准照护.     

Update on ENT anaesthesia in children

This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing proportion are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea (OSA), so judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities, and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including recent advances in ENT surgery that have an impact on the anaesthetist.     

A capnography and transcutaneous CO2 profile of bariatric patients during early postoperative period after opioid-sparing anesthesia

BackgroundNoninvasive monitoring of partial pressure of carbon dioxide can be accomplished indirectly with capnography (P_ETCO₂) or with transcutaneous carbon dioxide monitoring (P_TCCO₂). The use of capnography has been shown to offer an advantage over pulse oximetry alone in the early detection of adverse respiratory events when supplemental oxygen is administered. Furthermore, capnography allows for the monitoring of various respiratory measures, including end-tidal carbon dioxide, respiratory rate, tidal volume, and changes in breathing patterns. Transcutaneous CO₂ also closely approximates arterial CO₂ values, but is not as easy to monitor for prolonged periods. The purpose of this study was to examine the usefulness of capnography and of transcutaneous carbon dioxide monitoring in patients recovering from obesity surgery at high risk of developing postoperative obstructive sleep apnea.MethodsIn a prospective observational study, 64 bariatric surgery patients at risk of developing obstructive sleep apnea were monitored in the postanesthesia care unit (PACU) with either capnography alone (31 patients) or capnography plus transcutaneous carbon dioxide monitoring (33 additional patients) every 3–5 minutes for the duration of their recovery. Primary endpoints included end-tidal and transcutaneous carbon dioxide, peripheral oxygen saturation, respiratory rate, pain scores, and incidence of adverse respiratory events.ResultsAlthough no adverse pulmonary events were observed, capnography detected several patients who experienced short periods of respiratory apnea while maintaining pulse oximetry readings within normal limits. Transcutaneous values were slow to change and averaged 4.5 ± 5.5 mm Hg (P < .05) higher than corresponding end-tidal measurements.ConclusionsThese results indicate the capabilities of both these noninvasive techniques for postoperative monitoring. Capnography acutely monitors changes in respiration, whereas transcutaneous monitoring more accurately reflects arterial CO₂ levels.     

Obstructive sleep apnea remission following bariatric surgery: a national registry cohort study

BackgroundObstructive sleep apnea (OSA) is strongly associated with metabolic syndrome. Bariatric surgery is an effective available treatment for OSA; however, limited research predicts which patients undergoing bariatric surgery will undergo OSA resolution.ObjectivesTo determine perioperative predictors for OSA resolution following bariatric surgery using a national database.SettingUnited Kingdom national bariatric surgery database.MethodsThe UK National Bariatric Surgery Registry (NBSR) was interrogated to identify all patients with OSA that underwent primary bariatric surgery between January 2009 and June 2017. Those with at least 1 follow-up recording postoperative OSA status were selected for further analysis. Demographic, pre- and postoperative outcomes were collected and analyzed. Poisson multivariate regression was conducted to identify predictors of OSA remission.ResultsA total of 4015 bariatric cases were eligible for inclusion: 2482 (61.8%) patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), 1196 (29.8%) sleeve gastrectomy (LSG), and 337 (8.4%) adjustable gastric banding (LAGB). Overall, the mean excess weight loss (EWL) % for the whole group was 61.2 (SD ± 27.2). OSA resolution was recorded in 2377 (59.2%) patients. Following Poisson regression, LRYGB (risk ratio [RR], 1.49 confidence interval [CI] 1.25–1.78) and LSG (RR, 1.46 [CI 1.22–1.75] were associated with approximately 50% increased likelihood of OSA remission compared with LAGB. Greater weight loss following intervention was associated with greater likelihood of OSA remission, while both greater age and greater preoperative body mass index (BMI) were associated with reduced likelihood of OSA remission (P < .001).ConclusionThis study demonstrated that metabolic surgery results in OSA remission in the majority of patients with obesity. Younger age, lower BMI preprocedure, greater %EWL and the use of LSG or LRYGB positively predicted OSA remission.