阻塞性睡眠呼吸暂停低通气综合症肿瘤坏死因子-α血清水平的研究

目的探讨肿瘤坏死因子-α（TNF-α）与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的关系。方法比较OSAHS组与正常对照组以及OSAHS患者经鼻持续气道正压通气（nCPAP）治疗前后血清TNF-α水平的差异。结果OSAHS组患者血清TNF-α较正常对照组升高,差异有统计学意义;OSAHS患者进行nCPAP治疗1个月后TNF-α水平较治疗前减低,差异有统计学意义。结论血清肿瘤坏死因子-α水平在OSAHS患者中明显升高,经nCPAP治疗后下降。     

阻塞性睡眠呼吸暂停低通气综合征患者血清肿瘤坏死因子-α、白细胞介素-6水平的检测及临床意义

目的初步探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平的变化及临床意义,并揭示其与OSAHS相关心脑血管病可能存在的相关性。方法 （1）收集单纯鼾症30例、OSAHS患者轻度45例、中度65例、重度68例,采用酶联免疫吸附法（ELISA）检测血清TNF-αI、L-6水平,行相关分析,并计算各组心脑血管病患病率。（2）对接受/未接受经鼻持续气道正压通气（nC-PAP）治疗的中重度OSAHS者随访2月,观察有效nCPAP治疗后TNF-αI、L-6水平的变化。结果 （1）血清TNF-αI、L-6水平随OSAHS病情加重而升高,以重度OSAHS组最高。血清TNF-αI、L-6水平与AHI、tSpO2〈90%呈正相关,与MeanSpO2、MinSpO2呈负相关。随OSAHS病情加重,心脑血管病患病率逐渐增加。（2）中重度OS-AHS患者接受有效nCPAP治疗2月后血清TNF-α及IL-6水平下降;而未接受nCPAP治疗者未发现类似变化。结论 OSAHS患者血清TNF-αI、L-6水平以及心脑血管病患病率均明显升高,提示TNF-αI、L-6水平可能与OSAHS相关心脑血管病发生有关;有效nCPAP治疗可使TNF-αI、L-6水平下降,可能最终减少相关心脑血管病的发生。     

睡眠呼吸暂停综合征患者外周血白细胞介素-6和肿瘤坏死因子-α水平的变化

目的:探讨阻塞型睡眠呼吸暂停综合征(OSAS)患者外周血白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平的变化在发病机制中的作用。方法:①采用放射免疫法检测24例OSAS患者及20例正常人血浆IL-6、TNF-α水平,比较其组间差异,并分析OSAS患者血浆IL-6、TNF-α水平与睡眠呼吸紊乱指数(AHI)和最低血氧饱和度(SaO2)的相关性;②OSAS组患者进行持续气道正压通气(CPAP)治疗,3个月后复查上述各项指标,比较治疗前后血浆中IL-6、TNF-α水平的变化。结果:①OSAS组血浆IL-6和TNF-α水平较对照组升高〔(25.92±4.48)pg/ml vs(13.21±1.97)pg/ml,(11.27±2.60)pg/ml vs(5.83±0.99)pg/ml,P均<0.05〕。OSAS患者血浆IL-6和TNF-α水平与AHI呈正相关(r分别为0.456、0.464,P均<0.05),与其最低SaO2呈负相关(r分别为-0.495、-0.483,P均<0.05);②OSAS患者用CPAP治疗后,血浆IL-6、TNF-α水平较治疗前减低〔(25.92±4.48)pg/ml vs(15.37±1.78)pg/ml,(11.27±2.60)pg/ml vs(6.79±0.87)pg/ml,P均<0.05〕。结论:OSAS患者外周血IL-6、TNF-α水平升高与其低氧血症有关;CPAP可改善OSAS患者缺氧状态,降低外周血IL-6、TNF-α水平。     

阻塞性睡眠呼吸暂停低通气综合征与左心室肥厚相关性研究

【目的】探讨阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep Apnea Hypopnea Syndrome，OSAHS）与左心室肥厚（Left Ventricular Hypertrophy，LVH）的相关性。【方法】随机抽取我院心血管内科住院病人63例，进行夜间多导睡眠监测（Polysomnography，PSG）及心脏彩超检查，并根据PSG结果分成正常组、轻度组及中重度组。【结果】轻度及中重度组的室间隔厚度（interventricular septum thickness in diastole，IVSd）及左心室后壁厚度（left ventricular posterior Wall thickness in diastole，LVPWd）高于正常组且与睡眠呼吸暂停低通气指数（apnea hypoventilation index，AHI）存在正相关。AHI与IVSd、LVPWd的回归系数分别为0．061（P（0．05）及0．071（P〈0．05），即在其它条件不变的情况下AHI每增加10，IVSd可增加0．61mm，LVPWd可增加0．71mm。【结论】OSAHS与LVH存在正相关。OSAHS可能是引起LVH的原因之一。     

阻塞性睡眠呼吸暂停综合征对犬心血管功能的影响

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)对犬心血管功能的影响。方法:建立OSAS犬模型,人为干预使犬出现类似OSAS患者症状,干预时间为3个月。干预前和干预后,取血用ELISA法检测犬血中白介素-6(IL-6)浓度;用超声心动图检测犬的心功能相关指标:左室射血分数(LVEF)、左室内径缩短率(FS)、每搏输出量(SV)、心率(HR)、舒张早期充盈峰值流速和舒张晚期充盈峰值流速的比值(E/A)。结果:与干预前相比较,3月后犬血中IL-6值明显升高(P<0.01);LVEF、FS、SV、HR、E/A值均降低(P<0.05)。结论:OSAS可能是一个慢性炎性过程,不仅对血管内皮功能造成影响,而且其慢性长期缺氧对心脏收缩和舒张功能也会造成影响。     

阻塞性睡眠呼吸暂停对犬左室收缩功能的慢性影响

目的:观察阻塞性睡眠呼吸暂停(OSA)对犬左室收缩功能的慢性影响及其系统性氧化应激反应和心肌组织ATP酶活性的变化,探讨OSA与心血管疾病的相关性及影响机制。方法:在全麻下对气管切开后的犬进行人为的反复的气道阻塞,3个月后做心脏彩超检查,并测定血清SOD活性、MDA含量以及心肌组织ATP酶活性。结果:实验组前后自身对照,左室射血分数下降,伴随LVESV明显增加(P<0.05),但LVEDV的增加并不明显。与正常组相比,模型组犬心肌组织两种ATP酶(Na+-K+ATP酶和Ca2+-ATP酶)活性均明显降低(均为P<0.01),血清MDA水平较正常组升高(P<0.05),SOD水平较正常组下降(P<0.05)。结论:阻塞性呼吸暂停能导致左心室收缩功能下降,心肌ATP酶活性下降以及氧化应激作用可能参与了心血管疾病发生发展的过程。     

阻塞性睡眠呼吸暂停低通气综合征与左心室肥厚相关性研究

[目的]探讨阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)与左心室肥厚(Left Ventricular Hypertrophy,LVH)的相关性。[方法]随机抽取我院心血管内科住院病人63例,进行夜间多导睡眠监测(Polysomnography,PSG)及心脏彩超检查,并根据PSG结果分成正常组、轻度组及中重度组。[结果]轻度及中重度组的室间隔厚度(interventricular septum thickness in diastole,IVSd)及左心室后壁厚度(left ventrieular posterior wall thickness in diastole,LVPWd)高于正常组且与睡眠呼吸暂停低通气指数(apnea hypoventilation index,AHI)存在正相关。AHI与IVSd、LVPWd的回归系数分别为0.061(P<0.05)及0.071(P<0.05),即在其它条件不变的情况下AHI每增加10,IVSd可增加0.61 mm,LVPWd可增加0.71 mm。[结论]OSAHS与LVH存在正相关。OSAHS可能是引起LVH的原因之一。     

阻塞性睡眠呼吸暂停综合征

随着传感、计算机及医学生理工程学技术应用于临床,对睡眠生理、病理生理的了解日益增多,在发达国家睡眠疾患诊疗中心如雨后春笋般地建立起来,一门新兴的边缘横断学科——睡眠医学(sleep medicine)已成为现代医学的一个重要组成部分正在建立和发展起来。我国由中国协和医科大学黄席     

阻塞性肺疾病并睡眠呼吸暂停综合征的相关因素分析

探讨肺心病并睡眠呼吸暂停综合征的相互影响,方法：对２４例肺心病并睡眠呼吸暂下患者的临床资料进行回顾分析,并与２１例肺心病组对比观察。结果：两组１ｓ用力呼出气量,用力呼气峰流量均有统计学意义的降低,血气分析比较ＰａＯ２降低,ＰａＣＯ２升高,有显著性差异,ＰＨ降低无显著性差异。     

Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease

Background:

Obstructive sleep apnea/hypopnea syndrome (OSAHS) and laryngopharyngeal reflux (LPR) disease have a high comorbidity rate, but the potential causal relation between the two diseases remains unclear. Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions.

Methods:

Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography. High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility.

Results:

There were 13 OSAHS patients (36.1%) without LPR (OSAHS group) and 23 (63.9%) with both OSAHS and LPR (OSAHS and LPR group). Significant differences were found in the onset velocity of liquid swallows (OVL, P = 0.029) and the percent relaxation of the lower esophageal sphincter (LES) during viscous swallows (P = 0.049) between the OSAHS and control groups. The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time (P = 0.016, R = −0.507), and OVL was found to be negatively correlated with recumbent distal acid percent time (P = 0.006, R = −0.557) in the OSAHS and LPR group.

Conclusions:

OSAHS patients experience esophageal functional changes, and linear correlations were found between the changed esophageal functional parameters and reflux indicators, which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.     

低温等离子射频腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效观察

目的:对局麻下低温等离子射频治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效进行观察,为该手术的选择提供理论依据。方法:选用低温等离子射频于局麻下分别对138例OSAHS患者进行腭咽成形术治疗,术后随访6个月和12个月。根据手术前后PSG监测结果,得出治疗有效率,并比较睡眠呼吸暂停低通气指数(AHI)及最低血氧饱和度(LSaO2)改善情况。结果:术后6个月、12个月总有效率分别为85.7%和79.7%,平均AHI分别降低56.2%(P<0.01)及50.5%(P<0.05),平均LSaO2分别升高15.5%(P<0.05)及14.0%(P<0.05)。术后12个月与6个月比较,疗效差异无统计学意义,P>0.05。所有病例无术后呼吸道梗阻、无大出血等严重并发症。结论:局麻下低温等离子射频治疗OSAHS疗效确切,手术安全。在病例选择合适时,用局麻下行低温等离子射频腭咽成形术方法可达到全麻下行UPPP手术效果,在病例选择合适时用局麻方法可达到全麻手术效果。该术式可以成为OSAHS患者手术治疗的选择之一。     

阻塞性呼吸睡眠暂停综合征与心血管疾病关系的可视化知识图谱分析

在Web of Science核心合集中检索阻塞性呼吸睡眠暂停综合征（Obstructive Sleep Apnea Syndrome,OSAS）和心血管疾病关系的文献,从作者、发文量、国家/机构分布、引文和关键词等方面进行分析,使用CiteSpace软件绘制知识图谱,探讨该领域研究热点和前沿,以期为相关研究提供参考。     

Asthma and Obstructive Sleep Apnea

Objective:

To get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology, pathophysiology, and clinical manifestation and then summarizing the latest progress on diagnosis and treatment.

Data Sources:

Articles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms “OSA” and “asthma” as the main keywords. Highly regarded older publications were also included.

Study Selection:

Information about the features of the two diseases in common, the pathophysiologic association between them and their current treatments from the literature search were identified, retrieved, and summarized.

Results:

Both OSA and asthma are very prevalent conditions. The incidences of them have kept on rising in recent years. Asthma is often accompanied by snoring and apnea, and OSA often combines with asthma, as well. They have many predisposing and aggravating factors in common. Possible shared direct mechanistic links between them include mechanical effects, intermittent hypoxia, nerve reflex, inflammation, leptin, etc. Indirect mechanistic links include medication, nose diseases, smoking, obesity, and gastroesophageal reflux disease. Since OSA presents many similar features with nocturnal asthma, some scholars termed them as a sole syndrome – “alternative overlap syndrome,” and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure.

Conclusions:

OSA and asthma are closely associated in pathogenesis, symptoms, and therapies. With the growing awareness of the relationship between them, we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients. Further studies are still needed to guide the clinical works.     

阻塞型睡眠呼吸暂停低通气综合征与心血管疾病关系的研究

目的 :探讨阻塞型睡眠呼吸暂停低通气综合症 (OSAHS)与心血管疾病的关系。方法 :对 5 6例鼾症患者进行睡眠呼吸监测 ,同时将 5 6例鼾症患者分为阻塞型睡眠呼吸暂停低通气综合征组与单纯性鼾症组 ,以探讨阻塞型睡眠呼吸暂停低通气综合征、单纯性鼾症与心血管疾病之间的关系。结果 :阻塞型睡眠呼吸暂停低通气综合征组30例 ,其中高血压病 15例占 5 0 % ,冠心病 6例占 2 0 % ,2 6例有不同程度的红细胞、血红蛋白含量增加。单纯性鼾症组 2 6例 ,高血压病 3例占 11% ,冠心病 2例占 7% ,两组比较差异有显著性意义 (P <0 .0 5 )。结论 :阻塞型睡眠呼吸暂停低通气综合征与心血管疾病发病关系密切 ,两者之间呈显著正相关 ,应引起足够的重视。     

双水平正压通气治疗慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停综合征

目的:探讨双水平正压通气(BiPAP)呼吸机治疗中到重度慢性阻塞性肺病(COPD)合并阻塞性睡眠呼吸暂停综合征(OSAS)的疗效。方法:经肺功能和睡眠呼吸监测诊断的中到重度COPD合并OSAS患者共30例,随机分成两组,分别给予氧疗和BiPAP呼吸机治疗3月。结果:中到重度COPD合并OSAS患者使用BiPAP呼吸机治...     

阻塞性睡眠呼吸暂停低通气综合征患者记忆功能的研究

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者记忆功能与OSAHS严重程度的关系,为临床干预提供依据。方法选择我院2010年10月～2013年10月呼吸睡眠门诊经整夜多导睡眠监测（PSG）确诊为OSAHS且其他方面正常的患者150例,应用英国Rivermead康复中心设计的行为记忆测验第二版（RBMFII）对患者进行记忆功能评估。根据呼吸暂停低通气指数（AHI）将患者分为3组：轻度OSAHS（AHI10～20次／h）;中度OSAHS（AHI20-40次／h）;重度OSAHS（AHI≥40次／h）,比较各组患者的记忆功能评分结果。结果不同程度的OSAHS患者记忆障碍的患病率及程度与夜间发生AHI密切相关。重度OSAHS患者的RBMFII初评分与轻、中度OSAHS患者比较,在回忆姓名、回忆被藏物品、脸部再认、路线延迟回忆、定向测试和日期等6项初评分及总标准分方面,差异有统计学意义（P〈0．05）。中度OSAHS患者与轻度OSAHS患者比较,在回忆姓名、回忆被藏物品、回忆预约、脸部再认和日期等5项初评分及总标准分方面,差异有统计学意义（P〈0．05）。轻度OSAHS患者与对照组比较,除回忆姓名评分差异有统计学意义（P〈0．05）,在被藏物品、脸部再认、定向等3项初评分及总标准分方面,差异均无统计学意义（P〉0．05）。结论OSAHS患者记忆功能损害程度与病情分级相关,记忆功能减退在中、重OSAHS患者（AHI≥20次／h）中发生率较高。