nCPAP治疗对阻塞性睡眠呼吸暂停综合征患者动态血压的影响

目的:探讨经鼻持续气道正压通气(nCPAP)治疗,对阻塞性睡眠呼吸暂停综合征(OSAS)合并高血压患者动态血压的影响。方法:22例男性患者行多导睡眠图(PSG)监测及动态血压检查确诊为OSAS合并高血压的患者,观察nCPAP治疗前后患者动态血压、多导睡眠图等多项指标变化。结果:nCPAP治疗后患者PSG参数明显改善:睡眠时最低SaO_2从(71.0±12.3)％上升到(91.7±7.3)％(P<0.01);RDI显著降低;同时24小时血压明显下降,治疗前血压(16.5±1.6/11.6±2.3Kpa),治疗后血压(13.7±1.5/9.3±1.4Kpa)(P<0.01)。结论:经鼻持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征,不但可以纠正患者的呼吸暂停,改善临床症状,而且可能降低患者的血压。     

鼻塞对阻塞性睡眠呼吸暂停综合征发病影响的研究

目的:探讨鼻塞对阻塞性睡眠呼吸暂停综合征(OSAS)发病的影响。方法:对18例诊断为鼻塞和腭咽平面阻塞的OSAS患者,单纯行鼻腔手术改善通气,6个月后复诊。结果:12例睡眠阻塞症状缓解,其中4例效果明显;6例无效。睡眠呼吸紊乱指数(AHI)由术前的29.9±2.1降至22.8±2.7;夜间最低血氧饱和度由(75.0±2.9)％升至(83.4±2.3)％;而体重指数无明显差异。无效组与有效组的术前AHI值差异有显著性意义。结论:鼻塞是OSAS的重要致病因素,早期治疗解除鼻塞是预防OSAS发病的重要措施之一;长期鼻塞引发的OS-AS患者,早期通过鼻腔手术解除鼻塞是治疗OSAS的有效方法之一。     

The genetics of sleep apnea

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a complex chronic condition that is undoubtedly influenced by multiple factors. Accumulating data suggest that there are strong genetic underpinnings for this condition. It has been estimated that approximately 40% of the variance in the apnea hypopnea index (AHI) may be explained by familial factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAHS phenotype. Although the role of specific genes that influence the development of OSAHS have not yet been identified, current research in rodents suggests that several genetic systems may be important. In this chapter, we shall first define the OSAHS phenotype, and then review the evidence that suggests an underlying genetic basis of OSAHS, the risk factors for OSAHS that may be inherited, and potential candidate genes.     

睡眠呼吸监测技术的研究进展

睡眠呼吸监测技术对于睡眠呼吸暂停综合征的预防、发现及治疗起着重要作用.简要介绍用于睡眠呼吸暂停综合征的监测设备分级及应用趋势,分析睡眠呼吸监测技术的特点,对睡眠呼吸监测技术的研究方向和发展现状进行了综述.     

手术治疗对阻塞性睡眠呼吸暂停低通气综合征患者夜间微觉醒与心率变异的影响

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者微觉醒与心率变异(HRV)的关系及手术后的变化。方法:对54例重度OSAHS患者行手术前后PSG。分析1 h内每个呼吸紊乱相关微觉醒开始前10 s的平均心率(HR)和微觉醒开始后10 s的最高HR比较。同时计算1 h内呼吸紊乱相关微觉醒指数(B-Arl)和脉率升高指数(PRRI)并作相关分析。比较不伴微觉醒事件和伴有微觉醒事件的心率差(△HR)及手术后的影响。结果:微觉醒开始后10 s的最高HR显著高于微觉醒开始前的平均HR,且B-Arl与PRRI呈显著正相关,伴有微觉醒的呼吸事件终止前后△HR显著高于不伴微觉醒的呼吸事件的△HR,手术后患者△HR显著低于术前。结论:B-Arl与夜间HRV相关,提示微觉醒可影响心血管调节功能,频繁的微觉醒是导致心血管疾病的重要原因之一。手术可通过减少微觉醒来减轻患者的心血管损害。     

冠心病伴阻塞性睡眠呼吸暂停综合征ICAM-1基因多态性研究

目的:观察ICAM-1基因多态性与冠心病(CHD)伴阻塞性睡眠呼吸暂停综合征(OSAS)的相关性,并观察ICAM-1的不同基因型与其血清中ICAM-1含量之间的关系。方法:选择CHD患者(A组)56例、CHD伴OSAS患者(B组)58例、OSAS患者(C组)54例和健康者(对照组)53例。以聚合酶链式反应-限制性酶切长度多态性(RFLP-PCR)对基因组DNA中ICAM-1基因多态性进行分析。结果:①4组间的ICAM-1469C/T3种基因型的分布比例差异有统计学意义,A、B、C组的TT TC型基因型分布频率分别是86.44%、89.67%、90.74%均高于对照组的47.16%(P<0.01)。而对照组的CC基因型分布频率高于其他3组(P<0.01)。②T等位基因在A、B、C3组的分布频率分别是74.11%、71.55%、72.22%,明显高于对照组的35.85%(P<0.01),而A、B、C3组间分布频率差异无统计学意义(P>0.05)。③所有组中TT TC基因型的ICAM-1含量均高于CC基因型的含量(P<0.01),B组的黏附分子含量明显高于其他3组。结论:①ICAM-1469C/T的基因多态性与CHD有关联,C-T的等位基因突变可能是CHD的一种遗传易感因素;②OSAS患者存在与CHD患者相同的基因型分布,这种相同的基因多态性分布可能是OSAS与CHD的一种易感的遗传因素;③ICAM-1469C/T的基因多态性与血清中的ICAM-1含量有着明显的相关性,OSAS可能是通过改变血清ICAM-1含量来加重CHD的发展进程。     

鼻部相关手术对治疗阻塞性睡眠呼吸暂停低通气综合征的有效性

目的：探讨鼻部相关手术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗的有效性。方法：回顾性分析94例OSAHS合并鼻部相关疾病的患者,均经PSG、鼻内镜、鼻咽纤维镜检查确诊,因种种原因只行鼻部相关手术而未行其他任何治疗。鼻部相关手术包括鼻中隔矫正术,双下鼻甲等离子射频消融术,鼻息肉、慢性鼻窦炎患者行功能性鼻内镜手术。术后2个月、1年复查PSG。结果：94例患者鼻部手术后有效19例,术前AHI11．7±5．2,最低SaO287．6±2．7,平均SaO287．8±5．4,术后2个月AHI5．5±5．0,最低SaO292．5±5．3,平均SaO294．5±3．7,术后1年AHI6．1±4．2,最低SaO291．8±4．2,平均SaO292．8±4．1,有效率20．21％（19／94）,均为轻度Ⅰ型患者,占轻度患者的38．00％（19／50）,经PSG随访1年无复发。其余75例无效。结论：伴有鼻部相关疾病的OSAHS患者,单纯鼻部手术仅对部分以鼻部阻塞为主的Ⅰ型患者有效。     

双颌板磁力矫正器治疗阻塞性睡眠呼吸暂停综合征临床观察

目的探讨双颌板磁力矫治器对阻塞性睡眠呼吸暂停综合征(OSAS)治疗效果。方法对确诊为OSAS的患者口腔内配戴双颌磁力矫治器,并在配戴前后用CT扫描观察患者上气道截面积的变化。结果观察组19例上气道截面积均有增大,最小值从0.80cm2增加到1.71cm2;口咽上部平均值由1.05cm2增加到1.92cm2。结论口腔双颌板磁力矫治器是治疗OSAS的有效方法。     

The impact of continuous positive airway pressure on cardiac mechanics: Findings from a meta‐analysis of echocardiographic studies

Current evidence on the effects of continuous positive airway pressure (CPAP) on cardiac mechanics in patients with obstructive sleep apnea (OSA) is based on a few single studies. The authors investigated this topic through a meta‐analysis of speckle tracking echocardiography (STE) studies that provided data on left ventricular (LV) and right ventricular (RV) mechanics as assessed by global longitudinal strain (GLS). The PubMed, OVID‐MEDLINE, and Cochrane library databases were systematically analyzed to search English‐language review papers published from inception to January 31, 2022. Studies were identified by crossing the following terms: “obstructive sleep apnea”, “sleep quality”, “sleep disordered breathing”, “continuous positive airway pressure therapy”, “noninvasive ventilation”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “left ventricular mechanics”, “right ventricular mechanics”, “echocardiography” and “STE echocardiography”. The meta‐analysis, including a total of 337 patients with OSA from nine studies (follow‐up 2–24 months) showed a significant GLS improvement in both LV and RV after CPAP, standard mean difference (SMD) being 0.51±0.08, CI:0.36–0.66, p = .0001 and 0.28±0.07, CI:0.15–0.42, p = .0001), respectively. Corresponding SMD values for LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) were 0.20±0.06, CI:0.08–0.33, p = .001 and 0.08±0.06, CI: ‐0.04/0.20, p = .21. Our meta‐analysis suggests that: I) CPAP treatment exerts beneficial effects on biventricular function in patients with OSA; II) the assessment of cardiac mechanics by STE should be routinely recommended for monitoring cardiac function in this setting, due to limitations of conventional echocardiography in evaluating biventricular performance.     

Effects of Apnea,Obesity, and Statin Therapy on Proprotein Convertase Subtilisin/Kexin 9 Levels in Patients with Obstructive Sleep Apnea

ObjectivesObstructive sleep apnea (OSA) is a common condition closely related to obesity, insulin resistance, dyslipidemia, and cardiovascular disease. The aim of this study was to explore the possible relationship between OSA and proprotein convertase subtilisin/kexin type 9 (PCSK9).MethodsFull-night polysomnography was performed on 150 participants who were divided into three groups: controls, OSA patients on statin therapy, and OSA patients not on statin therapy. Biochemical markers, plasma low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses, and PCSK9 were determined.ResultsPCSK9 was highest in OSA patients on statins compared to the control group and to OSA patients not on statins (p = 0.036 and p = 0.039, respectively), after adjustment for body mass index (BMI). LDL diameter was greater in OSA patients not on statins compared to OSA patients on statins (p = 0.032). PCSK9 was highest in the group of patients with all three risk factors (diagnosed OSA, statins, BMI ≥25 kg/m²) compared to groups with no, one, and two risk factors (p = 0.031, p = 0.001, and p = 0.029, respectively). Presence of OSA, statin therapy, and BMI ≥25 kg/m² when combined were independently associated with higher levels of PCSK9 when adjusted for antihypertensive therapy, small dense LDL, and HDL 3c subclass (odds ratio = 2.849; interquartile range [1.026–7.912], p = 0.044).ConclusionStatin therapy was closely related to PCSK9. OSA along with obesity and statin use induces elevation of PCSK9.