Long-Term Effects of Dynamic Atrial Overdrive Pacing on Sleep-Related Breathing Disorders in Pacemaker or Cardioverter Defibrillator Recipients

Introduction: Sleep-related breathing disorders occur in 20–30% of Europeans and North Americans, including 10% of sleep apnea syndrome (SAS). A preliminary study suggested that atrial overdrive pacing with a fixed heart rate might alleviate SAS. However, it is not known whether dynamic atrial overdrive pacing alleviates SAS.
Methods: Patients with indications for a dual chamber pacemaker or implantable cardioverter-defibrillator (ICD) were screened for SAS using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. If PSQI was >5, cardio-respiratory polygraphy was performed before and 4 and 7 months after device implantation. Patients were randomized to algorithm ON–OFF (group A) or OFF–ON (group B) and the apnea-hypopnea index (AHI) was measured.
Results: Out of 105 consecutive patients, 46 (44%) had a positive PSQI. This analysis included 12 patients (mean age = 61 ± 10 years, body mass index 28.9 ± 6.5 kg/m², left ventricular ejection fraction = 38.3 ± 13.6%; 10 men). All patients suffered from obstructive or mixed SAS. There were no significant differences in PSQI or AHI between baseline and follow-up or between the two study groups. Therefore, the study was terminated ahead of schedule.
Conclusions: The prevalence of obstructive or mixed SAS was high in pacemaker or ICD recipients and reduced left ventricular ejection fraction. In these patients, long-term dynamic atrial overdrive pacing using did not improve PSQI or SAS. Therefore, patients with relevant obstructive or mixed SAS should not be offered atrial pacing therapy.     

儿童阻塞性睡眠呼吸暂停低通气综合征的诊治

【目的】探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床特点和早期诊断及治疗的方法。【方法】分析经鼻咽侧位X线摄片、纤维鼻咽镜检查及多道睡眠监测(polysomnography,PSG)确诊为OSAHS的86例患儿的临床症状和体征的特点,并对其中72例扁桃体、腺样体肥大的患儿进行了手术治疗。【结果】OS AHS患儿的主要症状是睡眠时有打鼾、呼吸不畅、呼吸暂停、听力下降。术后69例患儿临床症状明显缓解,占95.8%。术后2~4个月内,对60例患儿复查PSG,发现睡眠呼吸低通气指数、夜间血氧饱和度低于0.90的时间所占睡眠时间的百分比、最长呼吸暂停时间较术前均明显改善,且差异有显著性(P<0.05)。【结论】扁桃体和腺样体是儿童OSAHS的主要病因,PSG是诊断的依据,手术切除是其主要的治疗手段。     

Sleep Apnea:

In the general adult population, prevalence of sleep apnea syndrome reaches 4% in men and 2% in women. Continuous positive airway pressure is the most efficient treatment. At the present time, although severe atrial bradycardias could occur during sleep apnea episodes, cardiac pacing has not been demonstrated as an efficient treatment for those bradycardias. Treating sleep apnea generally reduces the number of bradyarrhythmias. However, recent studies reported a beneficial effect of atrial pacing on the sleep apnea burden. The mechanisms rely on two phenomena: first to counteract nocturnal hypervagotonia, and second to treat heart failure. By increasing the heart rate, cardiac output improves, which mitigates pulmonary subedema. Consequently, stimulation of the pulmonary afferent vagal fibers is diminished, which reduces central sleep apnea incidence. During nocturnal hypervagotonia, snoring and obstructive apnea episodes are increased, mainly due to an excessive muscular relaxation of the upper airway area inducing cyclical substantial decreases in the airway caliper. In patients with a low heart rate, atrial pacing can counteract hypervagotonia by enhancing the sympathetic tone and modifying the degree of vigilance. Accordingly, in the near future, sleep apnea treatment might potentially rely on atrial pacing in bradycardic patients with hypervagotonia (with or without heart failure). The role of the physician would then be not only to diagnose sleep apnea, but also to identify potential responders to cardiac pacing.     

持续气道正压通气治疗睡眠呼吸暂停综合征

[目的]观察持续气道正压通气（CPAP）对睡眠呼吸暂停综合征（SAS）的治疗效果。[方法]应用CPAP治疗30例SAS患者,观察治疗前及治疗后30-60 d后未脱机复查患者的临床症状及多导睡眠图（PSG）的各项指标。[结果]SAS患者的症状得到有效的控制,呼吸紊乱指数、最长呼吸暂停时间、最低血氧饱和度等多项指标均有显著改善（P〈0.01）。[结论]CPAP治疗SAS患者疗效确切,操作简单,副作用少,患者依从性好,值得基层医院推广。     

阿尔茨海默病与睡眠呼吸障碍的相关研究

[目的]研究阿尔茨海默病(AD)患者合并睡眠呼吸暂停综合征(SAS)对睡眠结构及认知功能的影响.[方法]随机选择AD患者29例作为研究组,健康老年人24例为对照组.两组分别进行多导睡眠图检查,比较两组睡眠状况.[结果]在研究组中,合并SAS的AD患者与没有合并SAS的相比,其睡眠时间减少,S1期占睡眠时间(SPT)百分...     

阻塞性睡眠呼吸暂停综合征的口腔矫治器治疗

目的:探讨口腔矫治器对阻塞性睡眠呼吸暂停综合征(OSAS)的治疗效果。方法:11例经多导睡眠图监测确诊OSAS的患者,用德国EBKODENT器材制作可调节型的软塑料口腔矫治器(OA),患者佩戴2～3个月后复查,了解患者的自觉症状,并再次进行多导睡眠图监测,比较治疗前后患者的睡眠结构以及呼吸情况的各项指标。结果:11例患者均感到夜间睡眠质量明显提高。患者的呼吸暂停时间和低通气时间在睡眠时间中所占的比例有明显下降,呼吸暂停指数和低通气指数也显著降低;而最低血氧饱和度和平均血氧饱和度则显著增高。患者的睡眠结构以及呼吸情况的各项指标有了明显的改善。结论:OA对于轻中度的OSAS具有明显的治疗效果。     

儿童阻塞性睡眠呼吸暂停的手术方式及疗效分析

【目的】分析不同手术方式治疗儿童阻塞性睡眠呼吸暂停的疗效。【方法】对扁桃体肥大及腺样体肥大所致阻塞性睡眠呼吸暂停的儿童,采用传统腺样体刮除＋单侧扁桃体切除（A组）及鼻内镜引导下腺样体切割＋双扁桃体切除术（B组）,术后随访并分析疗效。【结果】A组治疗28例：治愈15例,好转8例,无效5例,有效率82．1％;B组治疗65例：治愈52例,好转13例,有效率100％。【结论】儿童阻塞性睡眠呼吸暂停主要是解除鼻咽及口咽气道的阻塞,才能保证气道通畅,鼻内镜引导下腺样体切割＋双扁桃体切除能很好地解决鼻咽,口咽气道阻塞,疗效最好。     

阻塞性睡眠呼吸暂停综合征与代谢综合征的相关研究

【目的】探讨阻塞性睡眠呼吸暂停综合征（OSAHS）与代谢综合征（MS）的关系。【方法】选择本院综合科住院患者98例进行多导睡眠监测,其中72例OSAHS患者（19例轻度、21例中度和32例重度）和26例非OSAHS患者,比较不同0SAHS组的血压（BP）、体重指数（BMI）、空腹血糖（FBG）、血脂指标及各组MS的患病率,分析OSAHS的严重程度与MS的相关性。【结果】①各组间MS患病率比较有显著性差异（P〈0．05）;②轻、中度与重度OSAHS组肥胖、高血压、高血糖、高甘油三酯（TG）、低高密度脂蛋白胆固醇（HDL-C）与对照组存在显著差异（P〈0．05）;③趋势检验显示随着OSAHS程度的加重MS有升高趋势（P〈0．05）。【结论】阻塞性睡眠呼吸暂停患者较正常者更易发生代谢紊乱,导致MS的发生,重度OSAHS患者发生代谢紊乱的程度更为严重。     

阻塞性睡眠呼吸暂停低通气综合征的临床流行病学调查及相关因素分析

【目的】了解人群中阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的患病率,探讨该病的临床防治策略。【方法】采用随机整群抽样的方法对株洲市芦凇区部分常住居民4035人进行入户问卷调查。对其中打鼾≥2级的730人和ESS≥9分的504人由医务人员再上门进行确认,筛选出打鼾≥2级同时日间Epworth嗜睡量表(ESS)评分≥9分的431例行整夜多导睡眠监测,推算人群OSAHS的患病率。【结果】实际完成调查人数3616人,有效应答率89.62%。确诊为OSAHS患者146人,患病率为4.04%。男性高于女性;40～59岁是患病的高峰年龄;司机为易患OSAHS的高危人群;心血管疾病、肥胖等基础疾病与OSAHS关系密切。【结论】OSAHS在人群中的患病率为4.04%,是严重危害公众健康的疾病之一,应予以足够的重视。     

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。     

阻塞性睡眠呼吸暂停综合征相关危险因素探讨

目的探讨阻塞性睡眠呼吸暂停综合征（0sAs）的相关危险因素，并据此提出相应的护理干预措施，降低该疾病的发生率，为改善防治措施提供依据。方法选择2007年4—7月间接受整夜多导睡眠图监测（PSG）的患者60例，采用二分类逐步Logistic回归分析OSAS的相关危险因素。结果体质量指数、家族史以及高血压史是OSAS的危险因素，OR值分别是1．502、8．511、5．497：结论患者的体质量指数、家族史以及高血压史是OSAS的主要危险因素，建议通过减肥、控制体质量和饮食、适当运动、积极控制血压、改变不良生活习惯、戒烟戒酒等护理干预方式降低OSAS的发病率，减轻患者疾病相关症状，提高患者生活质量。     

Relationship Between Selected Overdrive Parameters and the Therapeutic Outcome and Tolerance of Atrial Overdrive Pacing

ATTUEL, P., et al. : Relationship Between Selected Overdrive Parameters and the Therapeutic Outcome and Tolerance of Atrial Overdrive Pacing. There is a paucity of information on the influence of selected overdrive parameters on the clinical efficacy and tolerance of atrial overdrive algorithms to suppress atrial tachyarrhythmias. Data from a completed clinical trial investigating a new DDD+ overdrive algorithm implemented in a permanent pacemaker were analyzed. One-hundred patients with standard pacing indications and atrial tachyarrhythmias were enrolled and followed for 6 months in DDD and 6 months in DDD+ mode in a randomized, crossover fashion. The overdrive step size was programmed at the discretion of the investigators between 4 and 12 beats/min, overdrive plateau length between 10 and 32 beats, and maximum overdrive rate between 100 and 160 beats/min. The effects of DDD+ versus DDD mode on burden and incidence of atrial tachyarrhythmias stored in the mode switch memory were examined as a function of the programmed overdrive parameters. An overdrive step size between 7 and 12 beats/min, and higher a maximum overdrive rate between 121 and 160 beats/min were slightly more effective than lower programmed values, though >500 randomized, crossover observations would have been necessary to verify statistical significance. Overdrive pacing related symptoms mandated early manual deactivation of overdrive pacing in 4.7% of 85 evaluated patients. Overdrive was disabled without testing tolerability of less aggressive overdrive values. There was no link between patient symptoms and programmed overdrive step size or overdrive plateau length values. (PACE 2003; 26[Pt. II]:257–263)     

手术治疗儿童阻塞性睡眠呼吸暂停综合征60例报告

目的：探讨儿童阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome，OSAS)发病因素和治疗方法。方法：60例OSAS患儿中，45例行双侧扁桃体切除术，12例行扁桃体加腺样体切除术，3例行鼻腔息肉摘除术。结果：60例OSAS患儿中，呼吸暂停改善的总有效率为93．33％(56／60)，打鼾改善的总有效率为80％(48／60)。结论：扁桃体肥大在儿童OSAS的发病中起主要作用，扁桃体切除术是治疗儿童OSAS的有效方法之一。     

阻塞性睡眠呼吸暂停综合征的病理生理及病因研究

阻塞性睡眠呼吸暂停综合征在古代就有描述 ,它的发生与睡眠和清醒状态交界时及睡眠的各个阶段相互转换时呼吸控制中枢的作用有关 ,并与头颈部的生理异常相关。     

睡眠呼吸暂停综合征的护理研究进展

介绍睡眠呼吸暂停综合征患的常见症状．主要病理生理改变．对身体的影响以及相关的因素和护理研究进展。     

UPPP手术对阻塞性睡眠呼吸暂停低通气综合征患者胰岛素敏感性的影响

【目的】探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者悬雍垂腭咽成形术（UPPP）手术前后胰岛素敏感性的变化。【方法】选择伴血糖紊乱的OSAHS患者20例行多导睡眠监测（PSG）检查及UPPP手术,并于术前及术后6个月进行PSG检查及空腹血糖、糖化血红蛋白、空腹胰岛素水平检测,计算胰岛素敏感指数（ISI）分析其变化关系。【结果】经过UPPP手术治疗后,患者的呼吸暂停低通气指数（AHI）及最低血氧饱和度（LSaO2）明显改善（P〈0．05）,空腹血糖、糖化血红蛋白水平较术前降低,胰岛素敏感性较术前升高（P〈0．05）。【结论】UPPP手术治疗能改善伴糖代谢紊乱的OSAHS患者低血氧的情况,增加其胰岛素的敏感性。     

阻塞性睡眠呼吸暂停综合征围术期的监护进展

综述阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome，OSAS)患术前、术中、术后的监测和护理特点。对OSAS患术前要进行呼吸道和循环系统的监测；术中要注意血氧饱和度、血压、心功能情况；术后1-2d内应严密监测病情变化。护理要点包括：保持呼吸道通畅、观察生命体征变化、适当饮食及及时补液等。     

动态心电图在阻塞性睡眠呼吸暂停综合征中的应用研究

目的:研究动态心电图在阻塞性睡眠呼吸暂停综合征中的应用效果.方法:选取2018年1 月至2019年5 月山东省威海市立医院电生理科收治的阻塞性睡眠呼吸暂停综合征患者58例作为观察组,再选择同时期58例至本院体检的健康人群作为对照组,比较2组动态心电图各项指标.结果:本次研究成果显示,观察组各项心电图指标和对照组比较,差异有统计学意义(P<0.05).结论:通过本次研究成果可以得出,通过观察患者的HRV、24 hRMSSD以及夜间RMSSD指标可以有效诊断阻塞性睡眠呼吸暂停综合征,为临床提供治疗依据,值得在临床上大力推广.     

心房按需起搏或房室顺序起搏治疗慢快综合征疗效比较

目的：评估用心房按需起搏器（AAI）或房室顺序起搏器（DDD）治疗慢快综合征患者的疗效。方法：1997年1月—2005年12月34例慢快综合征患者接受心脏起搏器治疗,其中用AAI16例,用DDD18例,术后长期随访心功能,持续性心房颤动发生率。结果：经过平均6.8±2.5年随访发现,左室射血分数（LVEF）AAI组术前（57.1±6.4）%,术后（61.2±8.1）%;DDD组术前（57.3±4.3）%,术后（58.7±6.5）%,差异无统计学意义（P〉0.05）。持续性心房颤动发生率,AAI组12.5%（2例）,DDD组33.3%（6例）,差异有统计学意义（P〈0.05）。结论：用AAI与DDD起搏治疗慢快综合征同样有效,初步观察发现AAI组持续性心房颤动发生率低于DDD组。