OSAS患者循环ICAM-1,VCAM-1及L-选择素水平与心血管疾病的研究

目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者循环细胞间黏附分子 - 1(intercellularadhesionmolecule 1,ICAM - 1)、血管细胞黏附分子 - 1(vasculaecelladhesionmolecule 1,VCAM -l)及L -选择素 (L -selection)水平及与心血管疾病的相关性。方法 :选取OSAS患者 12例 (男性 9例 ,女性 3例 ,平均年龄 5 1.6±4 .8岁 )及 12例年龄相匹配的健康对照者。采用ELISA法检测OSAS患者入睡前、睡醒后血浆ICAM - 1、VCAM - 1及L -选择素水平 ,并与正常对照组比较。结果 :OSAS患者入睡前ICAM - 1,VCAM - 1及L -选择素水平较正常对照组升高 (ICAM - 1:4 0 2 .8± 4 8.2vs 2 0 8.4± 5 6 ,P <0 .0 5 ;VCAM - 1:814± 88.9vs 5 82±4 4 .5 ,P <0 .0 5 ;L -选择素 :1390 .4± 76 .8vs 10 4 4 .3± 80 .2 ,P <0 .0 1) ,睡醒后ICAM - 1及L -选择素水平较正常对照组明显升高 (ICAM - 1:395± 4 5vs 2 0 5± 5 0 ,P <0 .0 5 ;L -选择素 :114 3.5± 196 .2vs 10 2 5 .6±5 0 .3,(P <0 .0 5 )。结论 :OSAS所致的低氧血症激活了循环黏附分子 ,参与了心血管疾病的发生与发展。     

阻塞性睡眠呼吸暂停综合征与血液流变学关系探讨

目的：探讨阻塞性睡眠呼吸暂停综合征(OSAS)与血液流变学的关系。方法：对186例观察对象行多导睡眠图监测和血液流变学检查，按睡眠呼吸紊乱指数(AHI)分为3组：轻度组(5＜AHI＜30)，中重度组(AHI＞30)和正常对照组(AHI＜5)。结果：OSAS患者的体重(Wt)和体块指数(BMI)均大于正常对照者(P＜0．01)，其中中重度组患者Wt和BMI大于轻度组(P＜0．01)；中重度组的红细胞比容(HCT)、红细胞聚积指数(RAI)明显高于轻度组和正常对照织(P＜0．05，P＜0．01)。回归分析显示AHI与HCT、RBCI呈正相关(r＝0．437，P＜0．001)；另外还显示BMI与HCT、血浆黏度比呈正相关(r＝0．3l，P＝0.007)。结论；OSAS及肥胖的严重程度与血液黏稠度增高有关。血液黏稠度增加易引起高黏血症，导致血栓性疾病发生。     

阻塞性睡眠呼吸暂停综合征正压通气治疗前后肾功能和电解质的变化

目的：观察阻塞性睡眠呼吸暂停综合征(OSAS)正压通气治疗前后肾功能和电解质的变化情况。方法：通过测定血K^ 、Na^ 、Cl^-；尿K^ 、Na^ 、Cl^-、自由肌酐清除率(Ccr)、β2-微球蛋白(β2-mG)、夜间尿量等分别观察OSAS患者肾小球滤过功能及近、远端肾小管钠水重吸收功能。结果：OSAS治疗组20例治疗前夜尿量、夜尿K^ 、Na^ 、Cl^-均高于正常，与最低血氧饱和度(LsaO2)、最长呼吸暂停时间(LAT)的严重性呈正比关系。治疗组经一整夜正压通气(nCPAP)治疗后仪尿量及尿液中K^ 、Na^ 、Cl^-恢复正常。结沦：严重的OSAS确实累及肾脏，但没有导致肾脏实质性损害。     

阻塞性睡眠呼吸紊乱综合征有效治疗前后的心率变异性分析

目的通过观察OSAS患者经过有效治疗前后HRV的变化,评价患者的心率变异性变化情况。方法对51例OSAS病人在有效治疗前后同步进行PSG检查及动态心电监测,统计其HRV的时阈指标SDNN、rMSSD及频阈指标LF、HF及LF/HF,采用SPSS/PC统计软件中配对样本t检验进行处理。结果SDNN、LF、LF/HF等指标在治疗前后的差异有显著性(p<0·05),rMSSD、HF的变化无显著性差异(p>0·05)。结论有效治疗OSAS可使植物神经系统的功能得到恢复,降低心脏事件发生的危险性。     

射频治疗在阻塞性睡眠呼吸暂停综合征中的应用

射频治疗在临床医学上应用较广，目前在阻塞性睡眠呼吸暂停综合征的治疗中，不失为一种安全有效、简便易行的方法。作者就射频治疗的作用机理、对软腭、舌根及下鼻甲方面的临床与实验研究作一综述。     

正常成人上呼吸道CT测量及其意义

目的：确定正常人的上呼吸道CT扫描下各平面的横截面积、经线长度以及咽壁厚度，为临床服务。方法：无明显睡眠呼吸疾病史的成年人（男115、女110），采用Philips Tomoscan AV Expander E1螺旋CT，对鼻咽顶部到声门之间的区域进行连续扫描，测量软腭后区、悬雍垂后区、舌后区和会厌后区的气道横截面积、失状径、冠状径、咽侧壁和咽后壁软组织厚度，以单侧95％可信区间确定各测量指标的参考值。结果：在上呼吸道各个扫描平面，绝大多数气道的形状均为横椭圆形，冠状径大于失状径，在软腭后区、悬雍垂后区、舌后区和会厌后区中，失状径大于冠状径者分别占总人数的3．11％、10．67％、0．8％和0％。各年龄组间比较，绝大多数测量指标差异不显著，男子组和女子组间比较，除软腭后区外，大多数测量指标差异显著。故分别制定了男、女各测量指标的还范围。结论：成人上呼吸道CT测量以及正常范围的确定为临床判定OSAS患者上呼吸道解剖性狭窄的部位提供了客观依据，男性OSAS发病率明显高于女性有其相关的生理基础。     

莫达非尼联合BiPAP呼吸机治疗慢性阻塞性肺疾病合并睡眠呼吸暂停综合征的临床疗效

目的:评价莫达非尼联合双水平气道正压通气(BiPAP)在治疗慢性阻塞性肺疾病(COPD)合并睡眠呼吸暂停综合征(OSAS)的临床疗效。方法:选取在医院接受治疗的93例COPD合并OSAS患者,根据治疗方案的不同将其分为对照组(41例)和观察组(52例),对照组采用常规药物联合BiPAP治疗;观察组在对照组的基础上口服莫达非尼。记录两组正压通气时间及不良反应情况,比较两组治疗前后血氧分压(PaO₂)、血二氧化碳分压(PaCO₂)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1与FVC的比值(FEV1/FVC)、呼吸暂停指数(AHI)、总睡眠时间、最低氧饱和度和Epworth睡眠量表(ESS)评分的改善情况。结果:对照组和观察组患者治疗后的AHI、总睡眠时间、最低氧饱和度及ESS评分均较治疗前有显著改善,差异有统计学意义(t_对照组=21.187,t=6.155,t=7.648,t=29.947;t_观察组=22.380,t=7.931,t=8.168,t=37.593;P<0.05),观察组患者总睡眠时间及ESS评分均显著低于对照组,差异有统计学意义(t=2.315,t=14.232;P<0.05)。对照组和观察组患者治疗后1周和4周与治疗前相比,PaO₂有显著升高,Pa CO₂则有明显降低,差异有统计学意义(F对照组=29.947,F=36.147;F_观察组=27.533,F=34.580;P<0.05),而两组比较差异无统计学意义。对照组和观察组患者治疗后1周和4周的FVC、FEV1及FEV1/FVC通气指标均较治疗前有显著改善(F对照组=16.506,F=40.570,F=59.220;F_观察组=19.680,F=43.962,F=61.728;P<0.05),而两组比较差异无统计学意义。观察组和对照组不良反应发生率分别为19.2%(10/52)和7.3%(3/41),而两组比较差异无统计学意义。结论:对于COPD合并OSAS患者,呼吸机BiPAP模式可显著改善肺功能及肺通气相关指标,莫达非尼能提升睡眠质量,减轻白天的嗜睡症状,且未出现明显不良反应。     

The use of an ambulatory,automatic sleep recording device (QUISI™ Version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea

The use of an ambulatory, automatic sleep recording device (QUISI? Version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea Electroencephalogram (EEG) evaluation with polysomnography (PSG) according to the Rechtschaffen & Kales (R&K) rules is time and cost consumptive, but ambulatory polygraphy systems do not allow EEG recording routinely. As a consequence, the number of sleep disordered events cannot be calculated exactly. QUISI is a one‐channel, self‐applicable ambulatory EEG recording device. The present study was designed as a prospective, non‐randomized clinical trial. This investigation evaluated the results of 40 patients with primary snoring and obstructive sleep apnoea measured with level 1 PSG and QUISI simultaneously. Fifteen patients (37.5%) were primary snorers with normal sleep profiles, whereas 25 patients (62.5%) suffered from obstructive sleep apnoea (OSA) with a Respiratory Disturbance Index (RDI) of 38.6 ± 23.8. The mean total sleeping time (TST) was underestimated by 4.5%, while Sleep Efficiency Index (SEI) was understimated by 4.6% by the QUISI device compared with PSG. The correlation between the QUISI and the PSG estimates for single sleep stages demonstrated only moderate correlation. The statistical significance for sleep stage 2 was r = 0.42, P = 0.002; for sleep stage 3/4, r = 0.31, P = 0.02; and for WAKE, r = 0.33, P = 0.01. Sleep stage 2 as well as sleep stage 3/4 were underestimated by QUISI substantially (difference: ?5.6% and ?10.3%), while WAKE was overestimated by QUISI to a larger amount (difference: +10.4%). Sensitivity and specificity of QUISI to recognize pathological sleep profiles compared with PSG/R&K were 0.92 and 0.96 respectively. QUISI is able to evaluate normal versus altered sleep profiles in patients with primary snoring and OSA. Comparing the quartile ranges, we found substantial differences between QUISI and PSG/R&K. QUISI gives an impression of sleep architecture and objective verification of a sleep disturbance in an ambulant setting but cannot replace the sleep laboratory‐based PSG.     

Perinatal risk factors for obstructive sleep apnea syndrome in children

ObjectiveThe aim of this study was to determine whether specific perinatal factors are associated with obstructive sleep apnea syndrome (OSAS) in children.MethodsA retrospective case–control study was conducted. All cases of OSAS were obtained from a tertiary pediatric hospital between April 2013 and April 2016. A total of 823 children who had been diagnosed with OSAS were designated as the case group, and 823 children without OSAS were selected with strict criteria to match with the case group by age, gender and body mass index. Logistic regression models were used to determine the perinatal factors associated with childhood OSAS.ResultsPreterm birth (adjusted odds ratio (aOR): 1.87, 95% confidence interval (CI): 1.13–3.08) and cesarean section (aOR: 1.32, 95% CI: 1.03–1.68) were significantly associated with OSAS. Exposure of the mother to smoke (aOR: 2.59, 95% CI: 1.57–4.26) was also associated with an increased risk of childhood OSAS. Mothers aged 35 years and above, performing manual labor, and living in suburban areas significantly increased the risk of childhood OSAS. Multiparous mothers decreased the risk of childhood OSAS (aOR: 0.59, 95% CI: 0.42–0.83). Maternal education, gravidity, prenatal care times, pregnancy-induced hypertension, multiple pregnancies, sex of the child and birth weight were not significantly associated with OSAS in children.ConclusionPerinatal risk factors are important for predicting childhood OSAS. Our findings provide evidence regarding several potentially useful factors for recognizing OSAS in children, which could be important in diagnosis of pediatric OSAS by physicians.