慢性阻塞性睡眠呼吸暂停低通气综合征心肌损伤肾功能不全与病情严重程度的关系

目的:探讨慢性阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopneasyndrome,OSAHS)患者心肌损伤、肾功能不全患病率其及与OSAHS病情严重程度的关系。方法:回顾性收集98例OSAHS患者的临床资料,并设立正常健康对照组40例,根据患者呼吸暂停低通气指数(apnea-hypopnea index,AHI)、最低血氧饱和度(SaO2m in)的水平将OSAHS患者分成轻度、中度、重度组。计算各组心肌损伤、肾功能不全患病率,探讨血清脂蛋白Lp(a)、心肌肌钙蛋白I(CTnI)及肌酐(Cr)水平的变化及与OSAHS病情严重程度的相关性。结果:OSAHS与对照组相比,Lp(a)、CTnI和Cr水平明显增高,差异有统计学意义(P<0.01);随着OSAHS病情严重程度分级的升高,血清脂蛋白(a)、心肌肌钙蛋白I及Cr浓度在升高,且三组间有统计学差别(P<0.01);OSAHS心肌损伤、肾功能不全的患病率分别为51.02%、24.48%,并且随着OSAHS病情严重程度分级的升高,心肌损伤、肾功能不全患病率也在升高。结论:随着OSAHS病情严重程度分级的升高,Lp(a)、CTnI和Cr水平在升高,心肌损伤、肾功能不全患病率也在升高,提示OSAHS患者中心肌损伤、肾功能不全较常见,Lp(a)、CTnI和Cr可以作为OSAHS病情严重程度的评价指标之一。     

昼夜节律与睡眠质量的链式中介模型:焦虑特质和睡眠信念态度的作用

目的：探究在大学生群体中昼夜节律类型与睡眠质量之间的关系,并明确焦虑特质和睡眠信念态度在其中所起的中介作用。方法：对某医学院大学生进行线上调查,使用清晨型与夜晚型量表-5项（MEQ-5）特质焦虑量表（STAI-T）、简易睡眠信念和态度量表（DBAS- 16）、匹兹堡睡眠量表指数（PSQI）分别评估大学生的昼夜节律类型、焦虑特质水平、睡眠信念态度以及睡眠质量。采用Pearson相关分析和中介效应分析昼夜节律类型、焦虑特质水平、睡眠信念态度以及睡眠质量之间的关系。结果：共回收问卷238份,有效问卷233份,有效率97.90%。Pearson相关分析指出昼夜节律类型、焦虑特质水平、睡眠信念态度以及睡眠质量四个变量得分两两之间呈显著相关（P<0.01）。以昼夜节律类型为自变量,睡眠质量为因变量,焦虑特质水平、睡眠信念态度为中介变量进行中介效应分析。焦虑特质水平的中介效应量（MEQ → STAI-T → PSQI）占总效应的 30.48%（r=-0.128,95% CI：-0.211至-0.066）,睡眠信念态度得分的中介效应量（MEQ → DBAS → PSQI）占总效应的12.62%（r=-0.053,95% CI：-0.106 至-0.014）;2个中介变量的链式中介效应量（MEQ → STAI → DBAS → PSQI）占总效应的11.19%（r = -0.047,95% CI：-0.085 至-0.022）。结论：大学生的昼夜节律类型能够负向预测其睡眠质量,并且焦虑特质水平与睡眠信念态度在其中起链式中介作用。     

胃肠耐受性监测对急性脑血管病患者治疗转归的影响

目的探讨胃肠耐受性监测对急性脑血管病患者治疗转归的影响。方法将170例急性脑血管病患者随机分为观察组(90例)及对照组(80例),两组均常规予控制颅内压、营养神经、调整血糖血压、改善脑循环、防治并发症治疗,按急性脑血管病常规护理,密切监测生命体征、意识、瞳孔,观察组增加胃肠耐受性监测。观察比较两组并发症的发生率及住院时间。结果观察组并发症的发生率为18%,显著低于对照组42%(P<0.05);观察组住院时间(23.99±6.15)d比对照组(27.25±6.54)d明显缩短(t=3.35,P<0.05)。结论急性脑血管病患者,在常规护理同时,还应进行胃肠耐受性监测,及早改善胃肠功能,降低并发症的发生率,使患者获得更好的治疗转归,缩短住院时间。     

The Glymphatic System: A Review of the Challenges in Visualizing its Structure and Function with MR Imaging

The central nervous system (CNS) was previously thought to be the only organ system lacking lymphatic vessels to remove waste products from the interstitial space. Recently, based on the results from animal experiments, the glymphatic system was hypothesized. In this hypothesis, cerebrospinal fluid (CSF) enters the periarterial spaces, enters the interstitial space of the brain parenchyma via aquaporin-4 (AQP4) channels in the astrocyte end feet, and then exits through the perivenous space, thereby clearing waste products. From the perivenous space, the interstitial fluid drains into the subarachnoid space and meningeal lymphatics of the parasagittal dura. It has been reported that the glymphatic system is particularly active during sleep. Impairment of glymphatic system function might be a cause of various neurodegenerative diseases such as Alzheimer’s disease, normal pressure hydrocephalus, glaucoma, and others. Meningeal lymphatics regulate immunity in the CNS. Many researchers have attempted to visualize the function and structure of the glymphatic system and meningeal lymphatics in vivo using MR imaging. In this review, we aim to summarize these in vivo MR imaging studies and discuss the significance, current limitations, and future directions. We also discuss the significance of the perivenous cyst formation along the superior sagittal sinus, which is recently discovered in the downstream of the glymphatic system.     

非致残性缺血性脑血管事件患者早期淡漠与情感认知障碍的相关性研究

目的 探究非致残性缺血性脑血管事件（NICE）患者早期淡漠与情感认知障碍的关系。方法 收集2021年6月至2022年12月在上海长海医院收治的NICE患者244例,其中男性156例,女性88例,平均年龄为63.1±9.7岁。根据入院时淡漠评估量表-临床医师版（AES-C）评分分为情感淡漠（≥33分,n=64） 组和非淡漠（＜33分,n=180）组。收集患者的人口学资料、血检验结果以及影像学资料,于发病2周内完善匹兹堡睡眠质量指数量表(PSQI)、蒙特利尔认知评估量表（MoCA）、听觉语词学习测验（AVLT）、数字广度实验（DST）、数字符号转换测验（DSST）、数字连线测验（TMT）、汉密尔顿焦虑、抑郁量表（HAMD、HAMA）等评估。利用t检验或非参数检验比较两组之间资料的差异,多因素Logistic回归分析影响淡漠的因素。结果 NICE后早期淡漠的发生率为26.2%,与非淡漠组相比,淡漠组患者的年龄较高而 BMI和受教育年限较低（所有P<0.05）;两组患者的性别、吸烟、饮酒以及高血压病史无显著性差异（所有P>0.05）。入院时首次血检验结果提示两组患者甲状腺激素水平均无显著性差异（P>0.05）,同时TOAST病因分型未发现两组患者的病因存在差异（P>0.05）。使用Fazekas白质评分对白质损伤进行量化结果提示,淡漠组患者的脑白质损伤明显高于非淡漠组（P=0.004）。认知功能检测结果提示,与非淡漠组相比,淡漠组患者认知障碍发生率（MoCA＜26）明显更高（46% vs 59%, P＜0.05）。淡漠组患者的言语流畅性抽象能力、延迟回忆和定向能力均明显减退（所有P<0.05）,两组之间视空间、执行功能以及命名能力无显著差异（所有P>0.05）。此外,淡漠组PSQI、HAMA、HAMD得分均高于非淡漠组,且睡眠障碍、焦虑和抑郁的发生率显著增加（P<0.05）。Logistic回归分析发现HAMD得分、年龄以及TMT-A用时为卒中后淡漠的危险因素（P<0.05）。结论 早期淡漠的NICE患者认知功能障碍发生率更高,且更易出现睡眠障碍以及焦虑和抑郁状态。HAMD得分、年龄以及TMT-A用时为卒中后淡漠的危险因素。     

Sleep architecture based on sleep depth and propensity: patterns in different demographics and sleep disorders and association with health outcomes

Study ObjectivesConventional metrics of sleep quantity/depth have serious shortcomings. Odds-Ratio-Product (ORP) is a continuous metric of sleep depth ranging from 0 (very deep sleep) to 2.5 (full-wakefulness). We describe an ORP-based approach that provides information on sleep disorders not apparent from traditional metrics.MethodsWe analyzed records from the Sleep-Heart-Health-Study and a study of performance deficit following sleep deprivation. ORP of all 30-second epochs in each PSG and percent of epochs in each decile of ORPs range were calculated. Percentage of epochs in deep sleep (ORP < 0.50) and in full-wakefulness (ORP > 2.25) were each assigned a rank, 1–3, representing first and second digits, respectively, of nine distinct types (“1,1”, “1,2” … ”3,3”). Prevalence of each type in clinical groups and their associations with demographics, sleepiness (Epworth-Sleepiness-Scale, ESS) and quality of life (QOL; Short-Form-Health-Survey-36) were determined.ResultsThree types (“1,1”, “1,2”, “1,3”) were prevalent in OSA and were associated with reduced QOL. Two (“1,3” and “2,3”) were prevalent in insomnia with short-sleep-duration (insomnia-SSD), but only “1,3” was associated with poor sleep depth and reduced QOL, suggesting two phenotypes in insomnia-SSD. ESS was high in types “1,1” and “1,2”, and low in “1,3” and “2,3”. Prevalence of some types increased with age while in others it decreased. Other types were either rare (“1,1” and “3,3”) or high (“2,2”) at all ages.ConclusionsThe proposed ORP histogram offers specific and unique information on the underlying neurophysiological characteristics of sleep disorders not captured by routine metrics, with potential of advancing diagnosis and management of these disorders.     

The causal relationships between obstructive sleep apnea and elevated CRP and TNF-α protein levels

BackgroundObstructive sleep apnea (OSA) and inflammation are closely related. This study aimed to evaluate the associations and causal effect between C-reactive protein (CRP) and tumour necrosis factor-alpha (TNF-α) levels and OSA.MethodsPooled analysis was conducted to compare the expression differences of CRP and TNF-α between OSA patients with different severity and controls, and between continuous positive airway pressure (CPAP) and non-CPAP interventions for OSA patients. Using published GWAS summary statistics, we conducted a bidirectional two-sample Mendelian Randomization (MR) to estimate the causal relationships between CRP and TNF-α levels and OSA risk. Effect estimates were evaluated using inverse-variance weighted (IVW) as primary method, and several other MR methods as sensitivity analysis.ResultsBoth TNF-α (WMD [95%CI] = 5.86 [4.80–6.93] pg/ml, p < .00001) and CRP (WMD [95%CI] = 2.66 [2.15–3.17] mg/L, p < .00001), showed a significant increase in OSA patients compared with controls and this increasing trend was associated with OSA severity. Besides, compared to blank control (non-CPAP), CPAP treatment can reduce high TNF-α (WMD [95%CI]= −4.44 [−4.81, −4.07]pg/ml, p < .00001) and CRP (WMD [95%CI]= −0.91 [−1.65, −0.17] mg/l, p = .02) in OSA. Moreover, the primary MR analysis by IVW showed that OSA was the genetically predicted cause of elevated CRP (estimate: 0.095; 95% CI, [0.010–0.179]; p = .029) using six SNPs as the instrument variable, which were repeated by weighted median (estimate: 0.053; 95% CI, [0.007, 0.100]; p =.024) and MR RAPS (estimate: 0.109; 95% CI, [0.079, 0.140]; p = 1.98x10⁻¹²). Besides, the causal effect from elevated CRP on increased OSA risk was almost significant by IVW (OR:1.053; 95% CI, [1.000, 1.111]; p = .053). However, there were no causal associations between TNF-α and OSA from both directions.ConclusionsIncreased CRP and TNF-α were associated with OSA severity and sensible to CPAP treatment. Also, OSA had a suggestive causal effect on elevated CRP.     

嗓音病患者的遵医行为与治疗时间的相关性分析

目的探讨嗓音病患者遵医行为与疾病恢复时间的相关性。方法将需遵医行为内容细化,制定量表,对同意参加本研究的42例门诊就诊的嗓音病患者进行填表指导,要求患者自行记录治疗期间的违反遵医行为的项次,治疗结束时,统计违反项次得分与疾病治愈时间相关性。结果42例患者违反遵医行为得分与治愈时间的相关系数为r=0．762（P＜0.001）,说明不遵医行为与疾病治愈时间呈正相关。结论嗓音病患者遵医行为越差,疾病治愈越长;反之,遵医行为越好,疾病治愈时间越短,提示对门诊嗓音病患者的遵医行为应寻求有效的监督方式,促进其早日康复。     

Sleep-Specific Processing of Auditory Stimuli Is Reflected by Alpha and Sigma Oscillations

Recent research revealed a surprisingly large range of cognitive operations to be preserved during sleep in humans. The new challenge is therefore to understand functions and mechanisms of processes, which so far have been mainly investigated in awake subjects. The current study focuses on dynamic changes of brain oscillations and connectivity patterns in response to environmental stimulation during non-REM sleep. Our results indicate that aurally presented names were processed and neuronally differentiated across the wake-sleep spectrum. Simultaneously recorded EEG and MEG signals revealed two distinct clusters of oscillatory power increase in response to the stimuli: (1) vigilance state-independent θ synchronization occurring immediately after stimulus onset, followed by (2) sleep-specific α/σ synchronization peaking after stimulus offset. We discuss the possible role of θ, α, and σ oscillations during non-REM sleep, and work toward a unified theory of brain rhythms and their functions during sleep.SIGNIFICANCE STATEMENT Previous research has revealed (residual) capacity of the sleeping human brain to interact with the environment. How sensory processing is realized by the neural assemblies in different stages of sleep is however unclear. To tackle this question, we examined simultaneously recorded MEG and EEG data. We discuss the possible role of θ, α, and σ oscillations during non-REM sleep. In contrast to versatile θ band response that reflected early stimulus processing step, succeeding α and σ band activity was sensitive to the saliency of the incoming information, and contingent on the sleep stage. Our findings suggest that the specific reorganization of mechanisms involved in later stages of sensory processing takes place upon falling asleep.