REM sleep behavior disorder and vocal cord paralysis in Machado-Joseph disease.

We evaluated the occurrence of REM sleep behaviour disorder (RBD) and vocal cord abductor paralysis (VCAP) in a group of 9 Machado-Joseph disease (MJD) patients. RBD was diagnosed by clinical history plus audiovisual polysomnography in 4 men and 1 woman (55%). While dreaming, 4 fell out of the bed and the other injured his arms. Laryngoscopy detected bilateral VCAP in 1 patient with stridor who required emergency tracheotomy, and partial vocal cord abductor restriction in 2. RBD and VCAP are two potentially injurious conditions that should be considered part of the clinical spectrum of MJD.     

阻塞性睡眠呼吸暂停患者临床表现与上气道阻塞部位关系的探讨

目的 观察一组AHI接近的阻塞性睡眠呼吸暂停综合征（OSAS）患者中上气道阻塞部位对多导睡眠监测（PSG）图及临床表现的影响。方法选取36例AHI为30—40的成年男性OSAS患者行再次整夜PSG，加同步上气道及食道压力监测确定上气道最低阻塞部位。比较上气道最低阻塞部位在软腭水平、舌根水平和下咽水平的不同患者中PSG相关参数：平均SaO2、最低SaO2、最长阻塞性呼吸暂停事件时间、呼吸暂停事件中SaO2下降率（dSaO2／dt）、微觉醒指数；以及部分临床表现参数：白日嗜睡程度、入睡前收缩压／清晨收缩压、入睡前舒张压／清晨舒张压以及高血压发生率。结果平均SaO2、最长阻塞性呼吸暂停事件时间和入睡前收缩压／清晨收缩压比值在3种不同上气道最低阻塞部位患者中差异无显著性（P〉0．05），但与软腭水平相比，舌根水平和下咽水平的最低Sa02降低（P〉0．05），dSaO2／dt（％／s）比值增高（P〈0．05），微觉醒指数及白日嗜睡评分增高（P〈0．01），入睡前舒张压／清晨舒张压比值降低（P〈0．05），最低SaO2〈80％的发生率增高（P〈0．01）以及高血压的发生率增高（P〈0．01）。结论AHI接近的OSAS患者上气道阻塞部位在舌根水平以下者与软腭以上水平者相比，阻塞性呼吸暂停事件的致缺氧效率和程度提高，OSAS的临床表现加重。     

Oxidative stress and sleep apnoea in clinically healthy infants in the first year of life

Summary Question of the study   Respiratory instability as well as tissue damage by free radicals (oxidative stress) have been hypothesized to play a role in cases of sudden and unexpected infant death in the first year of life. The ratio of the oxidized/reduced form of redox compounds in the circulation could be used as a marker of oxidative stress. Therefore, the sleep apnoea rate and redox status of coenzyme Q10 (CoQ10) (percentage of the oxidized form in total CoQ10) were measured in a population of clinically healthy infants in their first year of life in order to study whether a physiological parameter of respiratory instability is related to a biochemical parameter of oxidative stress. Patients and methods   Between May and December 1999, 323 infants in the first year of life were referred to a paediatric sleep laboratory. Sleep apnoea rate, periodic breathing and parameters of oxygenation (SaO₂ and TcPO₂) were calculated based on polysomnographic recordings. The CoQ10 redox status was calculated based on high-pressure liquid chromatographic (HPLC) analysis. Results   Statistical analysis showed an age-dependent decrease in apnoea rate ( r = – 0.38) and CoQ10 redox status ( r = – 0.40). An increased CoQ10 redox status (median: 16.6 %; range: 7.3 – 29.7 %) was found in infants with high apnoea rates above the 90^th percentile of a reference group in comparison with infants with apnoea rates below the 90^th percentile of a reference group (median: 10.4 %; range: 5.1 – 20.4 %; P = 0.031). Conclusions   These findings may indicate that high apnoea rates are accompanied by increased formation of free radicals in clinically healthy infants in the first year of life.     

阻塞性睡眠呼吸暂停综合征腭咽成形术前后多导睡眠图的变化

为评价悬雍垂腭咽成形成术 (UPPP)在治疗阻塞性睡眠呼吸暂停综合征 (OSAS)中的意义 ,我们通过多导睡眠图记录仪观察了 13例OSAS患者在接受UPPP前后多导睡眠图的变化。结果显示 :13例患者中 9例有效 ,有效率为 6 9%。提示并非所有接受UPPP的OSAS患者均有效 ,UPPP仅能作为OSAS治疗的方法     

Predictive value of specific risk factors, symptoms and signs, in diagnosing obstructive sleep apnoea and its severity

SUMMARY  A positive diagnosis of obstructive sleep apnoea (OSA) is based on a combination of characteristic symptoms and polysomnographic findings. The present study evaluated the specificity and sensitivity of several risk factors, signs and symptoms in predicting an Apnoea Index in 86 patients referred to the sleep laboratory with suspected OSA. All 86 subjects completed a detailed questionnaire, were interviewed, underwent a brief physical examination, and then a whole-night polysomnographic study. Stepwise multiple regression analysis revealed that self reporting on apnoeas, neck circumference index (NCI), age, and a tendency to fall asleep unintentionally, were all significant positive predictors of apnoea index (AI), explaining 41.8% of the variability. The sensitivity of the model for predicting OSA (taking OSA as AI>10) was 92.2%, specificity was 18.2% and the positive predictive value was 76.6%. Raising the cut-off AI values resulted in decreased sensitivity and increased specificity. Applying the predicting equation of AI to another group of 50 patients referred to the sleep laboratory with suspected OSA revealed similar results. However, running the equation on 105 offspring of OSA patients who did not complain of OSA-associated symptoms resulted in 32% sensitivity and 94% specificity in predicting OSA. It is concluded that questionnaires, interviews and physical examination, can only vaguely predict AI, and cannot replace polysomnographic recordings. However, the low rates of false negative in predicting AI > 10, and the low rates of false positive in predicting AI > 50, can be used for specific purposes.     

Nocturnal sleep spindle activity in blind subjects

To determine spindle activity during sleep in congenitally blind subjects, electroencephalogram sleep recordings were done on two or three consecutive nights in five subjects aged in their 20s and 30s. The number per minute and the duration of sleep spindles, scored visually, were compared with the data of sighted persons of comparable ages. The results indicated that the total number of sleep spindles a night was ranged from 117 to 585, and the number per minute ranged 0.52 to 2.06 during stage 2. Both values were much less than the values of sighted persons.     

无抽搐电休克治疗对男性抑郁症病人多导睡眠图的影响

目的:探讨无抽搐电休克(MECT)治疗对抑郁症病人睡眠脑电活动的影响。方法:应用多导睡眠图(PSG)对12例男性首发抑郁症病人在MECT治疗前后进行整夜PSG记录,观察MECT治疗前后PSG的变化。结果:与正常对照组比较,病人组睡眠总时间减少、睡眠潜伏期延迟、觉醒增加、快动眼睡眠(REM)时间增多、REM潜伏期缩短、S1和S2增加以及慢波睡眠减少。病人组经过MECT治疗后PSG显示睡眠总时间增加[治疗前:(342±s51)min,治疗后:(437±25)min,t值11.840,P<0.01],睡眠潜伏期缩短[治疗前:(68±12)min,治疗后:(56±7)min,t值4.249,P<0.01],觉醒时间减少[治疗前:(163±43)min,治疗后:(30±7)min,t值10.409,P<0.01],REM睡眠时间减少[治疗前:(164±19)min,治疗后:(120±5)min,t值9.333,P<0.01],S1减少[治疗前:(46±15)min,治疗后:(39±11)min,t值5.071,P<0.01],慢波睡眠增加[治疗前:(34±19)min,治疗后:(99±7)min,t值-13.146,P<0.01]。REM潜伏期和S2未见明显变化(P>0.05)。结论:MECT有改善睡眠的作用。这可能是MECT起到治疗抑郁症的重要机制之一。     

鼾症对儿童睡眠结构及生长发育的影响

目的探讨原发性鼾症(PS)及阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对儿童睡眠效率(SE)、睡眠结构、呼吸事件及生长发育的影响。方法选择2007年12月-2009年7月因打鼾、张口呼吸、呼吸困难等来本院呼吸科及耳鼻喉科就诊的患儿122例,经多导睡眠监测分为PS组(58例)和OSAHS组(64例),对2组患儿的SE、睡眠结构、睡眠事件及生长发育情况进行统计学分析。结果OSAHS组患儿SE低于PS组(P<0.01);OSAHS组Ⅰ期、Ⅱ期睡眠百分比高于PS组,Ⅲ+Ⅳ期及快速动眼睡眠(REM)期睡眠百分比低于PS组(Pa<0.01);OSAHS组呼吸暂停总次数高于PS组(P<0.01);最长呼吸暂停时间OSAHS组明显延长(P<0.01)。二组低通气总次数比较差异有统计学意义(P<0.01),OSAHS组较多;二组最长低通气时间比较差异亦有统计学意义(P<0.01),OSAHS组较长;呼吸紊乱指数、氧减指数二组比较差异均有统计学意义(Pa<0.01),OSAHS组较高。二组患儿身高、体质量、体质量指数、颈围比较差异均无统计学意义(Pa>0.05),OSAHS组腺样体面容发生率较PS组显著增高(P<0.05)。结...     

阻塞性睡眠呼吸暂停综合征多导睡眠图分析及短期疗效观察

目的 探讨阻塞性睡眠呼吸暂停综合征的多导睡眠图特征并观察双水平正压通气治疗OSAS的短期疗效。方法 经多导睡眠图检查确诊OSAS患者46例，对照组（单纯鼾症组）12例，分析比较两组睡眠参数。对34例中重度OSAS患者进行睡眠时BiPAP辅助通气并比较治疗前后PSG参数变化。结果 与对照组相比，OSAS患者夜间睡眠结构紊乱，主要为深睡眠减少、浅睡眠相对增加、快速动眼相（REM）睡眠减少、睡眠潜伏期缩短、呼吸暂停或低通气次数增加、夜间平均及最低动脉血氧饱和度下降（P〈0．05）。34例中重度OSAS患者经BiPAP辅助通气后，临床症状显著改善，AHI、夜间平均及最低动脉血氧饱和度、最长呼吸暂停时间较治疗前有显著改善（P〈0．05）。结论 OSAS患者存在睡眠结构紊乱，BiPAP可改善患者的临床症状及睡眠结构，是治疗OSAS的有效手段。     

阻塞性睡眠呼吸暂停综合征合并高血压患者动态血压的相关研究

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压患者动态血压的变化。方法：对120例高血压伴鼾症患者同步进行24h动态血压监测（ABPM）及多导睡眠监测（PSG），根据睡眠呼吸暂停低通气指数（AHI）分为轻、中、重度OSAS合并高血压组共3组，观察并比较3组基线资料、睡眠监测指标、动态血压监测各指标，根据不同的血压昼夜节律状况分组（杓型组、非杓型组），比较睡眠监测指标、动态血压监测各指标。结果：（1）重度OSAS合并高血压患者白昼平均舒张压（dDBP）、夜间平均舒张压（nDBP）高于轻、中度组（P〈0．05），偶测收缩压（cSBP）高于轻度组（P〈0．05）。（2）最低血氧饱和度（minSaO2）同24h平均收缩压（24hSBP）、白昼平均收缩压（dSBP）呈负相关。AHI与偶侧舒张压（cDBP）呈正相关。（3）根据血压昼夜节律状况进行分组，非杓型组占全部患者的68．3％，随着OSAS病情的加重，血压昼夜节律消失者比例增多（P〈0．05）。杓型组minSaO2、夜间平均收缩压（nSBP）及nDBP明显低于非杓型组患者（P〈0．05）。结论：频繁缺氧在OSAS患者舒张压升高中的作用更为显著；OSAS病情的严重程度与血压昼夜节律异常密切相关。