帕金森病患者白天过度嗜睡的研究进展

帕金森病(PD是中老年人常见的神经变性病,以运动障碍为主要表现,近年来其非运动症状也逐渐受到重视,其中白天过度嗜睡(excessive daytime sleepiness,EDS)和睡眠发作是影响患者生活质量的重要因素.EDS在PD患者中较常见,某些可以表现为睡眠发作,即在白天清醒期突然发生不可抗拒的睡眠,常无明显先兆,或先兆时间极短,往往来不及采取保护性措施,类似于发作性睡病的表现.根据其是否伴有EDS,可分为在EDS基础上出现的睡眠发作和无EDS而突然出现的睡眠发作.     

e-ping,WANG Qi-zhi

帕金森病(Parkinson's disense,PD)除出现运动减少、震颤和肌强直等症状外,还常常出现睡眠障碍等伴随症状。PD睡眠障碍常见形式有失眠、白天过多思睡、睡眠发作和异态睡眠等,严重影响患者的生活质量[1,2]。以下简要叙述PD睡眠障碍的临床表现、可能机制和治疗。这些观点同样适用     

帕金森病的睡眠障碍

帕金森病（Parkinson’s disense，PD）除出现运动减少、震颤和肌强直等症状外，还常常出现睡眠障碍等伴随症状。PD睡眠障碍常见形式有失眠、白天过多思睡、睡眠发作和异态睡眠等．严重影响患者的生活质量。以下简要叙述PD睡眠障碍的临床表现、可能机制和治疗。这些观点同样适用于帕金森综合征患者。     

93例帕金森病患者睡眠障碍的临床特征分析

目的评价帕金森病（PD）患者睡眠质量,探讨PD患者睡眠障碍的临床特征. 方法采用匹兹堡睡眠质量指数（PQSI）、爱泼沃斯思睡量表（ESS）对93例PD患者和96例年龄、性别相匹配对照者的睡眠状况及临床特点进行评估. 结果 60例（64.5%）PD患者总体睡眠质量差,睡眠障碍的主要类型有入睡困难（49.5%）和片断睡眠（72.0%）、睡眠行为障碍[梦魇（50.5%）、尖叫（30.1%）和肢体反击性动作（22.6%）]、不宁腿综合征（RLS）（12.9%）以及日间过度思睡（EDS）（40.9%）;而对照组有28例（29.2%）睡眠质量差,主要表现为入睡困难（22.9%）和片断睡眠（50.0%）以及EDS（14.6%）,两组差异有统计学意义（P＜0.01）. 结论 PD患者总体睡眠质量差,伴发睡眠障碍较对照组常见,其临床主要表现为入睡困难和片断睡眠、睡眠行为障碍、EDS及RLS.提示了解PD患者睡眠障碍有利于PD的防治,提高患者的生活质量.     

帕金森病睡眠量表:评估帕金森病睡眠和夜间障碍的新工具

帕金森病(PD)伴睡眠障碍的发生率高达96％,严重影响了患者的生存质量。然而,当前广泛应用于临床的EPworth睡眠评分法(ESS)和匹兹堡睡眠质量指数(PSQI)均未系统地对PD)睡眠障碍的不同方面进行阐述和量化;改良的ESS(MESS)对预测驾驶中突然的睡眠发作缺乏灵敏性;统一的PD评定量表(UPDRS)和PD生存质量量表(PDQ39 )仅包含几条与睡眠相关的问题。因此,作者设计了一种包含15个项目(分别代表PD伴睡眠障碍常见睡眠问题)     

美国内科医师学院关于阻塞性睡眠呼吸暂停低通气综合征诊疗指南解读

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种临床常见的具有潜在危险的疾病.其由于睡眠时反复发作的上呼吸道塌陷,引起呼吸暂停或低通气,伴有间歇性夜间低氧血症.主要表现为睡眠中出现打鼾、憋气、频繁觉醒、睡眠片段,导致白天嗜睡或注意力不集中,增加交通事故和其它意外的发生率,严重影响患者的生活质量.近年来的研究表明,OSAHS与高血压、糖尿病、心脏病、认知受损、脑血管病等多种疾病密切相关.随着对OSAHS认识的深入,其诊断和治疗也越来越受到人们的重视.     

帕金森病相关性睡眠障碍研究进展

帕金森病(PD)是一种中老年人常见的神经系统变性疾病.过去人们主要关注其运动迟缓、静止性震颤、肌肉强直以及姿势平衡障碍等运动功能障碍的表现,而非运动方面的症状却很少述及.目前认为,精神障碍、认知功能障碍和睡眠障碍是PD最常见的导致其失去生活能力的非运动方面的三大并发症,且睡眠障碍则尤为明显[1-2].近年来,临床上越来越多地发现PD患者常合并睡眠障碍,至少存在于60%的PD患者中[3],甚至有时可作为疾病的首发症状出现,严重影响患者的生活质量和认知功能[4].因此,识别临床前期症状对超早期PD的诊断和治疗十分重要.     

帕金森病相关性睡眠障碍研究进展

帕金森病(PD)是一种中老年人常见的神经系统变性疾病.过去人们主要关注其运动迟缓、静止性震颤、肌肉强直以及姿势平衡障碍等运动功能障碍的表现,而非运动方面的症状却很少述及.目前认为,精神障碍、认知功能障碍和睡眠障碍是PD最常见的导致其失去生活能力的非运动方面的三大并发症,且睡眠障碍则尤为明显[1-2].近年来,临床上越来越多地发现PD患者常合并睡眠障碍,至少存在于60%的PD患者中[3],甚至有时可作为疾病的首发症状出现,严重影响患者的生活质量和认知功能[4].因此,识别临床前期症状对超早期PD的诊断和治疗十分重要.     

白天过度嗜睡可增加阻塞性睡眠呼吸暂停患者的高血压风险

正阻塞性睡眠呼吸暂停(OSA)是高血压的独立危险因素,而白天过度嗜睡(EDS)是OSA的常见表现,也是诊断和治疗OSA的重要标准。很多研究表明,伴有白天过度嗜睡与无白天过度嗜睡的OSA患者相比,高血压发病率明显增加,说明OSA患者高血压与白天过度嗜睡之间存在相关性。但是,既往研究中白天过度嗜睡的评估基本都是基于Epworth嗜睡量表(ESS),这是一种自我评估白天嗜睡程度的问卷调查表,反映的是患者主观的白天过度嗜睡情况。     

睡眠增多

1　发作性睡病1.1　临床表现　发作性睡病 (narcolepsy)的病因未明 ,可见过度的白天睡眠 ,常伴有猝倒发作、睡眠麻痹和入睡前幻觉。患病率 0 0 3 %～ 0 16%。幼儿期到老年期 ( 3～ 72岁 )均可发病 ,15～ 2 5岁为发病高峰。1.1.1　白天睡眠过度　反复发作的多次打盹、小睡。病人突然出现无法预计和不可抗拒的睡眠发作 ,常出现于不适宜的场合 ,尤其是环境刺激减少时 ,如阅读、看电视、骑自行车、驾驶车辆或听课、会议或考试 ,甚至见于相互间的商务谈判、吃饭、行走、或主动性交谈时。睡眠发作偶可被强刺激所阻止。病人如积极努力 ,也可忍受…     

青少年高血压的研究进展

随着人们生活和行为方式的改变,高血压发病明显呈年轻化趋势。在青少年时期识别高血压病高危人群有助于早期进行有效干预和治疗,降低未来高血压的发生率及其严重性。现试从青少年高血压的诊断、发病因素、特点、治疗策略等方面的研究进展作一综述。     

Morbidity in cardiovascular diseases in immigrants in Sweden

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.     

Pulmonary sporotrichosis in Oklahoma in susceptibilities in vitro

Six cases of pulmonary sporotichosis were observed in 2 institutions in Oklahoma City, Okla. Three of the patients were treated with iodides with or without surgery. Although one patient required a second course of iodides, the patients have remained well after at least 34 months of follow-up. Three patients treated with amphotericin B, single course as well as multiple courses, and other antifungal agents (hydroxystilbamidine and miconazole) have all relapsed. These cases and a reviewed of more than 40 cases of pulmonary sporotrichosis susceptibilities of Sporothrix schenckii that we observed in vitro suggest that amphotericin B is not an effective agent for the treatment of pulmonary sporotrichosis. It is our opinion that the treatment of choice for pulmonary sporotrichosis is a supersaturated solution of potassium iodide. If the patient is allergic to the medication or fails to respond, then a combination of amphotericin B plus flucytosine may be tried.     

C·肉毒杀鼠素(冻干剂)应用研究

目的为研究C·肉毒杀鼠索对杀灭达乌尔黄鼠(简称黄鼠)的大面积应用情况和对家畜、家禽的毒害作用,进行了C·肉毒杀鼠素的应用研究.方法大面积投毒采用ES-2药饵撒播机[1],间隔约80m进行条投.羊、鸡采用直接灌胃.结果大面积应用的灭鼠率为83.72%.对羊、鸡最高剂量分别为500万MLD、150万MLD,均未出现中毒现象.结论 C·肉毒杀鼠素是较为理想的草原大面积杀灭黄鼠的理想、首选药物.     

Differences in outcome in primary angioplasty in women.

BACKGROUND: In acute myocardial infarction (AMI), primary percutaneous transluminal coronary angioplasty (PTCA) has proved to be the best therapeutic approach. Several factors have been associated with worse outcome in AMI in females. Are there differences in outcome in women undergoing PTCA for AMI? AIM: To evaluate gender influence on clinical outcome and in-hospital mortality in patients with AMI who undergo primary percutaneous interventions. METHODS: We studied 245 consecutive patients (72 women, 29.4 %), who underwent primary PTCA between January 2000 and December 2001. The following parameters were analyzed: risk factors for coronary artery disease including hypertension, diabetes, smoking, hypercholesterolemia and family history, previous AMI, PTCA or angina, pain-to-balloon time, extent of coronary disease and outcome. RESULTS: Female patients were older (67.9+/-11.6 vs. 59.6+/-13; p < 0.001) with a higher prevalence of hypertension (65.3 % vs. 47.4 %; p < 0.05) and angina (29.0 % vs. 16.0 %; p < 0.05) and lower prevalence of smoking (27.8 % vs. 54.3 %; p < 0.001). Pain-to-balloon time was longer in women (6.8+/-4.1 vs. 5.4+/-3.7 hours; p < 0.05). Extent of coronary disease was similar in both groups. Glycoprotein IIb/IIIa inhibitors were used in 84.7 % of women and 90.8 % of men. The frequency of hemorrhagic complications (5.6 % vs. 5.2 %) and arrhythmias (15.3 % vs. 10.4%) and in-hospital mortality (9.7 6.4 %) were higher in females, although without statistical significance (p = NS). Hospitalization time was similar in both groups. CONCLUSIONS: Despite the growing awareness of a gender bias in therapeutic approaches to AMI, there are still some differences in outcome, with a trend towards higher mortality rates in women. Older age and longer pain-to-balloon time could account for this.