阻塞性睡眠呼吸暂停患者血清对氧磷酶-1活性变化的研究

目的:检测阻塞性睡眠呼吸暂停综合征(OSAS)患者血清时氧磷酶-1(PON1)活性的变化,探讨OSAS患者并发心血管疾病的可能机制.方法:选取经多导睡眠仪监测诊断的80例OSAS患者,分为轻度组(n=22)、中度SK(n=23)、重度组(n=35).选取20例健康者为正常对照组.检测各组间血脂水平及PON1活性并进行相关性分析.结果:轻、中及重度OSAS组血清PON1活性均低于正常对照组(P<0.05).不同程度的OSAS患者组间PON1活性差异有显著性(P<0.05),且PON1活性随OSAS程度加重而降低.20例重度OSAS患者经3个月经鼻持续气道正压通气(nCPAP)治疗后TG下降(P<0.05),HDL升高(P<0.05),血清PONI活性较前升高(P<0.01).结论:OSAS患者血清PON1活性明显降低,可能是OSAS患者易惠心血管疾病的原因之一.nCPAP治疗可能有助于降低OSAS患者并发心血管疾病的危险性.     

浅析阻塞性睡眠呼吸暂停综合征与心血管疾病发病的关系

目的：浅析阻塞性睡眠呼吸暂停综合征（OSAS）与心血管疾病发病的关系，初步探讨其发病机制。方法：经多导睡眠图（PSG）94、时监测，确诊OSAS患者160例，随机选取其中100例重度OSAS患者，另取正常受试者100例，分别观察其血压、血脂、内皮素（ET）等指标。对其心血管疾病患病情况进行随访观察2年。结果：OSAS组患心血管疾病患者明显高于正常受试组。结论：OSAS患者与其并发心血管疾病有密切关系，防治OSAS对于心血管疾病的防治具有重要意义。     

浅析阻塞性睡眠呼吸暂停综合征与心血管疾病发病的关系

目的：浅析阻塞性睡眠呼吸暂停综合征(OSAS)与心血管疾病发病的关系。初步探讨其发病机制。方法：经多导睡眠图(PSG)9小时监测。确诊GSAS患者160例，随机选取其中100例重度GSAS患者，另取正常受试者100例，分别观察其血压、血脂、内皮素(ET)等指标。对其心血管疾病患病情况进行随访观察2年。结果：OSAS组患心血管疾病患者明显高于正常受试组。结论：OSAS患者与其并发心血管疾病有密切关系，防治OSAS对于心血管疾病的防治具有重要意义。     

超声心动图在阻塞性睡眠呼吸暂停综合征相关心脏结构功能改变方面的应用

阻塞性睡眠呼吸暂停综合征(OSAS)是一种严重威胁人类健康的睡眠呼吸障碍疾病,与心血管疾病密切相关。超声心动图是评价心功能的主要工具。本文就超声心动图在OSAS导致的心血管疾病中近年的应用进展进行综述。     

整体护理在阻塞性睡眠呼吸暂停综合征患者中的应用

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）是指睡眠中口鼻气流终止超过10s以上，并伴有血氧饱和度下降。近年来，随着生活水平提高，各种测试方法不断进展，对OSAS进行深入地综合研究，发现本病的复杂多变普遍存在，影响生活质量。因此，对OSAS不能一般视为社交生活中影响他人休息的厌烦声响，而是需要进行仔细检查诊治的一种临床疾病，它可以引起儿童发育不良，老年心血管疾病等许多严重的并发症，因此手术是目前治疗本病最有力的措施。我科自1999年至今已实行手术50例，运用整体护理程序使患者取得良好效果，现将护理体会报告如下。     

持续气道正压通气对中重度阻塞性睡眠呼吸暂停综合征患者血液流变学的影响

目的：探讨持续气道正压通气（CPAP）治疗对中重度阻塞性睡眠呼吸暂停综合征（OSAS）患者血液流变学的影响。方法：选择经多导睡眠监测确诊的中重度OSAS患者96例，于CPAP治疗前行全血粘度及红细胞比容检测，然后进行CPAP治疗3个月，治疗后再次行睡眠呼吸监测，全血粘度及红细胞比容检测，判断CPAP治疗对中重度OSAS患者的血液流变学有无影响。结果：OSAS患者经CPAP治疗后睡眠呼吸暂停指数显著降低，睡眠时平均及最低血氧饱和度显著增高（P〈0．01）。OSAS患者经CPAP治疗后全血粘度及红细胞比容较治疗前显著降低（P〈0．01）。结论：CPAP治疗可能通过改善OSAS患者的血液流变学异常，因而可降低OSAS患者发生心脑血管疾病的危险性。     

nCPAP治疗对中重度OSAS患者血液流变学影响的研究

目的探讨nCPAP(经鼻持续正压通气)治疗对中重度阻塞型睡眠呼吸暂停综合征(OSAS)患者血液流变学的影响。方法选择经多导睡眠图确诊的中重度OSAS患者80例,于CPAP治疗前行全血粘度及红细胞压积检测,然后进行CPAP治疗三个月,治疗后再次行睡眠呼吸监测,全血粘度及红细胞压积检测。结果 (1)OSAS患者经nCPAP治疗后睡眠呼吸暂停指数(AHI)显著降低,睡眠时平均及最低血氧饱和度(SPO2)显著增高(P<0．01)。(2)OSAS患者经nCPAP治疗后全血粘度及红细胞压积较治疗前显著降低(P<0．01)。结论 nCPAP治疗可能通过改善OSAS患者的血液流变学异常,降低OSAS患者发生心脑血管疾病的危险性。     

阻塞性睡眠呼吸暂停综合征患者悬雍垂腭咽成形术后并发症的观察及护理

阻塞性睡眠呼吸暂停综合征(OSAS)是由于睡眠时上气道阻塞,引起阻塞性呼吸暂停反复发作而出现的低氧血症及高碳酸血症[1].是心、脑、肺血管疾病的高危因素.悬雍垂腭咽成形术(UPPP)是治疗OSAS的有效方法,我科2005年2月-2006年5月共行UPPP治疗OSAS患者43例,术后患者无死亡发生,治疗效果满意,现报道如下.     

阻塞性睡眠呼吸暂停综合征与血脂的相关性分析

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAS）与血脂代谢的相关性。方法：依据呼吸暂停低通气指数（AHI）结果，将患者分为轻、中、重度，与健康对照组血脂结果比较。结果：OSAS组总胆NN（TC）、甘油三酯（TG）、载脂蛋白B（apoBⅠ）、脂蛋白（a）[Lp（a）]高于对照组，两者比较差异有显著性（P〈0．01）。结论：OSAS可引起脂代谢紊乱，积极治疗OSAS是防治心血管疾病的重要环节。     

阻塞性睡眠呼吸暂停综合征与高敏C反应蛋白、内皮素-1、一氧化氮的关系

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)与心血管危险因素高敏C反应蛋白(CRP)、内皮素-1(ET-1)、一氧化氮(NO)之间的关系.方法:选取经多导睡眠监测系统(PSG)确诊且未经治疗并排除其他疾病的OSAS患者96例为OSAS组,52例PSG监测正常者且排除其他疾病为对照组,分别测定血清高敏CRP(hs-CRP)、ET-1、NO水平.两组的结果进行统计学分析.结果:OSAS组与对照组比较显示hs-CRP、ET-1水平升高,NO水平降低(P<0.05),且OSAS越严重,血清hs-CRP、ET-1升高越明显,NO降低越明显(P<0.05).结论:OSAS患者心血管危险因素hs-CRP、ET-1水平升高时,NO水平降低,且血清hs-CRP、ET-1、NO水平与OSAS严重程度相关.     

Sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is strongly associated with cardiovascular disease which means these patients could suffer sudden death from these cardiovascular diseases, but it is a rare case that common OSAS itself causes sudden death directly. On the other hand, we never wrongly diagnose serious sleep-related breathing disorders (SBDs) such as sleep hypoventilation syndrome, OSAS patients with cardiovascular disease (i.e. ischemic heart disease, cardiac arrhythmia and cardiac failure) and bilateral vocal cord paralysis caused by multiple system atrophy as common OSAS. This section describes how to distinguish these SBDs from common OSAS.     

The effect of surgical treatment of obstructive sleep apnea syndrome on the plasma TNF-alpha levels

Obstructive sleep apnea syndrome (OSAS) is defined as intermittent complete or partial upper airway obstruction during sleep, causing mental and physical effects. Both the local and systemic inflammation observed in OSAS induce certain potent pro-inflammatory mediators, which may contribute to the development of cardiovascular consequences. The present study was designed to evaluate the plasma levels of TNF-alpha, which is one of the known pro-inflammatory cytokines, in patients with OSAS and to assess the effect of surgical treatment on the levels of TNF-alpha levels. Twenty seven patients diagnosed to have OSAS, 7 non-apneic patients with chronic tonsillitis (non-OSAS patients), and 4 healthy subjects were enrolled in this study. Blood samples were collected one week preoperatively and postoperatively, and the plasma TNF-alpha levels were measured using high-sensitivity ELISA. The plasma TNF-alpha levels in patients with OSAS were significantly elevated in comparison to normal healthy subjects. In contrast, there was no difference between the patients with non-OSAS and healthy subjects. Moreover, the surgical treatment to enlarge the upper airway in patients with OSAS significantly decreased the levels of TNF-alpha levels. Surgical treatment of patients with OSAS reduces the plasma TNF-alpha levels, thereby ameliorating the systemic inflammation and preventing the development of cardiovascular consequences.     

Improvement of factor VII clotting activity following long-term NCPAP treatment in obstructive sleep apnoea syndrome

Obstructive sleep apnoea syndrome (OSAS) is a very common disorder. Patients with OSAS are at an increased risk for cardiovascular events. It has also been reported that a 25% rise in factor VII clotting activity (FVIIc) is associated with a 55% increase in ischaemic heart disease death during the first 5 years. We examined the effects of nasal continuous positive airway pressure (NCPAP) treatment on FVIIc in patients with OSAS. FVIIc was investigated prospectively in 15 patients with OSAS before (mean +/- SEM apnoea and hypopnoea index (AHI) 61.5 +/- 4.2 and after (AHI 3.0 +/- 0.9) NCPAP treatment for immediate relief, at 1 month after treatment and at over 6 months. FVIIc levels gradually decreased after NCPAP treatment. After 6 months of NCPAP treatment, FVIIc levels had decreased significantly (before 141.1 +/- 11.7% vs. after 6 months 110.7 +/- 6.2%; p < 0.01). Six of the seven patients whose FVIIc levels were over 140% before the NCPAP treatment had FVIIc levels below 130% after 6 months or 1 year of NCPAP treatment. This decrease in FVIIc after long-term NCPAP treatment could improve mortality in OSAS patients. If patients, especially obese ones, present with high FVIIc of unknown origin, it would be prudent to check for OSAS.     

阻塞性睡眠呼吸暂停综合征与心血管疾病的关系探讨

目的：探讨阻塞性睡眠呼吸暂停综合征对睡眠中心血管的影响。方法：应用多导睡眠监测仪研究66例患者夜间血压、心律的动态变化。结果：经统计学处理，其早搏发生的次数和血压较对照组明显增高，病情越重，发生早搏的次数更加频繁，血压升高更明显。结论：阻塞性睡眠呼吸暂停综合征可导致心血管系统的异常，两者具有显著差异。     

Sleep apnea syndrome

The association between gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS) has recently been suggested. Patients with OSAS have a high frequency of nocturnal GER, and patients with GERD have various sleep-related symptom such as snoring and apnea. However, the causal relation between OSAS and GERD has not been sufficiently elucidated. The treatment of OSAS with nasal continuous positive airway pressure significantly reduces GERD symptom and nocturnal GER in both patients with and without OSAS. On the other hand, treatment of GERD in patients with OSAS improves the number of arousal during sleep, but one study showed a significant decline of apnea index. It is necessary to make further studies evaluating the association and treatment of OSAS and GERD.     

Effectiveness of nasal CPAP-treatment (continuous positive airway pressure)

Nasal continuous positive airway pressure (n-CPAP) is an effective treatment for the obstructive sleep apnea syndrome (OSAS). It is currently regarded as the first line therapy for OSAS. The principal indication for n-CPAP treatment is daytime sleepiness. Nasal-CPAP improves daytime sleepiness dramatically in severe cases and the effect is objectively measurable with the multiple sleep latency test (MSLT). It is noteworthy that n-CPAP also improves symptoms, subjective daytime sleepiness, cognitive function, IQ, mood, quality of life and driving ability already in patients with mild sleep apnea with an apnea/hypopneaindex (AHI) between 5 and 15 per hour of sleep during overnight polysomnography. Although not yet 100% robust, there is clear evidence that patients with OSAS have an increased frequency of systemic hypertension. Some early and imperfect studies suggest that CPAP reduces cardiovascular and cerebrovascular outcomes; however unequivocal evidence that n-CPAP reduces mortality is still awaited. There is now good evidence that treatment with n-CPAP reduces the two- to sevenfold increased risk of road accidents of untreated patients with OSAS. In summary, there exists abundant evidence today that n-CPAP is an efficient therapy for symptomatic patients with the obstructive sleep apnea syndrome. A trial with n-CPAP is therefore justified in all symptomatic patients. Based on the large number of randomized controlled trials of n-CPAP a therapeutic trial is indicated even in only mildly symptomatic patients with OSAS. Nasal-CPAP use and outcomes of therapy can be improved by provision of an intensive CPAP-education and support program.     

A sleep disordered breathing as the lifestyle-related diseases

Lifestyle related disease is a generic term for diseases such as cardiovascular diseases, diabetes mellitus and cancer caused by life style or life habit, and one of its fundamental causes is obesity. The reason why most people put on weight after their middle age is mainly because of the increase of visceral fat by the decrease in basal metabolism and the amount of momentum despite of unchanging appetite. Due to this sequence of weight gain, after middle age upper respiratory tract becomes narrower, and it worsens obstructive sleep apnea syndrome (OSAS). Since mastication is to provoke and maintain arousal, OSAS patients, who especially feel strong sleepiness, tend to encourage them to be obesity by frequent mastication that leads them to the tendency to overeat. Two main symptoms of OSAS are snoring and sleepiness; however, the essence of sleepiness is the worse quality of sleep due to apnea. In addition, a vicious circle is eventually generated because sleep deprivation and sleep disorders affects hypertension and glucose intolerance, and those worsen lifestyle disease. In order to break this off, it is necessary to review life style and habit, and improve not only on diet and exercise therapy but also on sleep.     

Sleep apnea syndrome (SAS) and ischemic heart disease (IHD)

Several epidemiological studies have suggested that sleep-disordered breathing is a risk factor for cardiovascular disease, particularly hypertension, stroke and IHD. The relative risk for IHD among obstructive SAS(OSAS) patients is 1.2 to 6.9 higher compared with the general population. The prevalence of SAS with an apnea-hypopnea index(AHI) of 10 and over was 35 to 40% in IHD, while 23.8% of SAS patients had IHD. These evidence suggests that IHD is an important prognostic factor in SAS patients. Characteristic pathophysiological conditions such as sleep apnea-induced hypoxemia and sympathetic activation may play an important role in the genesis of nocturnal angina pectoris. Most patients with OSAS are obese, and the complication of non-insulin dependent diabetes mellitus is quite a few. Insulin resistance is also attracting great attention as a cause of the cardiovascular complication of SAS.     

Depression and the heart: a systematic overview of definition, measurement, consequences and treatment of depression in cardiovascular disease.

Depression is an independent risk factor in the pathogenesis of cardiovascular disease and it is a prevalent disorder after cardiovascular disease associated with negative outcome in terms of mortality and morbidity. It is a dangerous condition requiring adequate screening and treatment, however, it often remains undiagnosed and thus untreated. Non-psychiatric healthcare workers, like nurses, general practitioners, physiotherapists and cardiologists are the health providers most closely involved in the management of patients with cardiovascular disease. They can play an important role in screening cardiovascular patients for depressive symptoms and in referring them for treatment. The purpose of this article therefore is to provide an evidence-based framework, aiming to educate non-psychiatric healthcare providers on depressive disorder in the context of chronic cardiovascular disease. In this paper, an overview of the definition, prevalence and consequences of depression will be discussed. Moreover, an overview of measurement methods and treatment modalities for depression will be provided. In addition, a step-by-step guide is provided in order to help non-psychiatric healthcare providers in dealing with depressed patients.     

OSAS 老年患者及合并冠心病患者血管内皮功能的变化

【目的】分析阻塞性睡眠呼吸暂停综合征（OSAS）老年患者及合并冠心病（CHD）患者血管内皮功能的变化。【方法】选取2014年2月至2015年8月本院收治的OSAS患者32例（OSAS组）,另选取同时期我院收治的OSAS合并冠心病患者35例（OSAS合并CHD组）,对两组患者的睡眠呼吸暂停指数（AHI）和氧减饱和指数（ODI）进行监测分析,并测定对比两组患者血管内皮功能相关指标血浆内皮素（ET ）、一氧化氮（NO ）及 ET／NO比值。【结果】与OSAS合并CHD组患者对比,OSAS组患者的ODI、AHI、最低SpO2及平均SpO2均显著降低,差异均具有统计学意义（均 P ＜00．5）;与OSAS合并CHD组对比,OSAS组患者的 ET 及 NO／ET 显著降低, NO水平显著升高,差异有统计学意义（均 P ＜00．5）。【结论】 OSAS合并CHD老年患者存在明显的血管内皮功能障碍,对OSAS老年及合并CHD患者应关注血管内皮功能障碍的影响。