睡眠呼吸暂停 sleep apnea - PubMed 文献
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关于 睡眠呼吸暂停
睡眠呼吸暂停（sleep apnea）是一种以睡眠期间反复出现呼吸暂停或低通气为特征的睡眠呼吸障碍，属于呼吸病学、睡眠医学与耳鼻咽喉科学交叉领域。其核心机制为上气道塌陷或呼吸中枢调控异常，导致间歇性低氧、高碳酸血症及睡眠片段化。临床上分为阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）、中枢性睡眠呼吸暂停（central sleep apnea, CSA）及混合性。中文常称“睡眠呼吸暂停综合征”，近义词包括“睡眠呼吸障碍”“打鼾伴呼吸暂停”“阻塞性睡眠呼吸暂停低通气综合征”。该术语在PubMed中对应主题词Sleep Apnea Syndromes及其下位词。
该方向的研究热点涵盖上气道解剖与神经调控机制、间歇性低氧对心脑血管及代谢系统的远期影响、持续气道正压通气（CPAP）依从性、口腔矫治器与上气道手术疗效比较、以及儿童与老年人群的特殊表现。经典议题包括与高血压、心房颤动、2型糖尿病及认知功能障碍的关联。代表性期刊有Sleep、Journal of Clinical Sleep Medicine、Chest、American Journal of Respiratory and Critical Care Medicine等，学者如Douglas Bradley、Allan Pack等在心血管与流行病学方向有长期贡献。
PubMed增强版可为睡眠呼吸暂停主题的读者提供多项实用功能：中英文摘要对照翻译，帮助快速理解非母语文献；显示期刊影响因子与分区，辅助评估文献学术分量；提供PDF全文下载链接，减少跨库检索步骤；AI阅读功能可提炼研究设计、样本特征与核心结论，提升文献筛选效率。这些功能共同服务于临床医生、科研人员与医学生对该领域证据的获取与整合。
睡眠呼吸暂停 的 PubMed 搜索结果
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A machine learning-based test for adult sleep apnoea screening at home using oximetry and airflow. 基于机器学习的成人睡眠呼吸暂停居家筛查测试：使用血氧测定法和气流监测
The most appropriate physiological signals to develop simplified as well as accurate screening tests for obstructive sleep apnoea (OSA) remain unknown. This study aimed at assessing whether joint analysis of at-home oximetry and airflow recordings by means of machine-learning algorithms leads to a significant diagnostic performance increase compared to single-channel approaches. Consecutive patients showing moderate-to-high clinical suspicion of OSA were involved. The apnoea-hypopnoea index (AHI) from unsupervised polysomnography was the gold standard. Oximetry and airflow from at-home polysomnography were parameterised by means of 38 time, frequency, and non-linear variables. Complementarity between both signals was exhaustively inspected via automated feature selection. Regression support vector machines were used to estimate the AHI from single-channel and dual-channel approaches. A total of 239 patients successfully completed at-home polysomnography. The optimum joint model reached 0.93 (95%CI 0.90-0.95) intra-class correlation coefficient between estimated and actual AHI. Overall performance of the dual-channel approach (kappa: 0.71; 4-class accuracy: 81.3%) significantly outperformed individual oximetry (kappa: 0.61; 4-class accuracy: 75.0%) and airflow (kappa: 0.42; 4-class accuracy: 61.5%). According to our findings, oximetry alone was able to reach notably high accuracy, particularly to confirm severe cases of the disease. Nevertheless, oximetry and airflow showed high complementarity leading to a remarkable performance increase compared to single-channel approaches. Consequently, their joint analysis via machine learning enables accurate abbreviated screening of OSA at home.
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Arousal in patients with gastro-oesophageal reflux and sleep apnoea. 胃食管反流与睡眠呼吸暂停患者的觉醒反应
Nocturnal gastro-oesophageal reflux has been observed in patients with obstructive sleep apnoea (OSA). Negative intrathoracic pressure during apnoeas and arousal have been suggested as the underlying mechanisms. In order to evaluate this hypothesis, the coincidence and sequence in time of arousal, apnoea and reflux events were analysed. Fifteen patients with OSA or heavy snoring were studied by means of standard polysomnograpy with parallel recording of 24-h oesophageal pH. Reflux events during the day were present in all patients, five of whom had symptoms of reflux. In three of these and in five other patients, a total of 69 nocturnal reflux events were found. In 68 events, arousal was found with the reflux event. Only one reflux without arousal was found (sleep stage 2). Seventeen events occurred during wakefulness after sleep onset. The percentage of time with a pH of <4 during wakefulness after sleep onset was significantly higher than the percentage of time with a pH of <4 during total sleep time (p<0.05). In 37 of the 52 reflux events which occurred during sleep, either an apnoea or a hypopnoea was found prior to the event. The investigation of sequence in time did not prove a causal relation between respiratory events and reflux events. The results indicate that gastro-oesophageal reflux and obstructive sleep apnoea are two separate disorders, which both have a high prevalence in obese patients.
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In-person versus video instruction of patients with sleep apnoea in the use of continuous positive airway pressure (CPAP). 面对面指导与视频指导睡眠呼吸暂停患者使用持续气道正压通气（CPAP）的比较
Instructing newly diagnosed sleep apnoea patients in the use of continuous positive airway pressure (CPAP) machines is time consuming for healthcare workers and patients alike. Our aim was to test the feasibility of video instruction as an alternative to physical attendance in the clinic. In this randomised controlled trial, we enrolled 120 patients who were randomised to either classic instruction by a nurse or video instruction at home. Both patients and doctors answered questionnaires at the time of inclusion. Follow-up was 1-3 months. No significant difference was recorded between the two groups on any measured parameter. Video instruction is feasible and should be considered as an alternative to physical attendance for the CPAP start-up. none. clinicaltrials.gov (NCT number 15022020).
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Mechanisms underlying end-organ injury in sleep apnoea. 睡眠呼吸暂停中终末器官损伤的机制
Obstructive sleep apnoea is a prevalent chronic condition characterised by repetitive upper airway collapse that promotes the occurrence of gas exchange abnormalities reflected as intermittent hypoxia along with heightened risk for the occurrence of end-organ morbidity. Here, we examine the molecular and cellular mechanisms driving obstructive sleep apnoea-induced morbidity. We describe the maladaptive responses to chronic intermittent hypoxia, including stress programmes, primarily driven by bursts of reactive oxygen species that overwhelm antioxidant defences and trigger robust, NF-κB-mediated inflammatory cascades ( tumour necrosis factor-α, interleukin-6). These responses, strikingly different from the adaptive responses to sustained hypoxia, lead to systemic consequences, including endothelial dysfunction, hypertension and profound metabolic dysfunction with insulin resistance. Understanding this pathophysiology is complicated by marked cellular and tissue heterogeneity, with different cell populations ( endothelium, adipose tissue or different brain regions) exhibiting divergent, context-dependent responses to intermittent hypoxia ( inflammation repair). Traditional bulk-tissue analyses and clinical metrics, such as the apnoea-hypopnoea index and hypoxic burden, fail to capture in their entirety this cellular and tissue heterogeneity or the critical kinetics of intermittent hypoxia, particularly during reoxygenation. Critical knowledge gaps remain, including the need to standardise intermittent hypoxia exposure metrics (capturing cycle frequency, hypoxic depth and reoxygenation kinetics), integrate circadian context and other obstructive sleep apnoea-related stressors ( episodic hypercapnia, fragmented sleep), account for key biological modifiers (sex, age, genetic background, comorbidities) and determine the potential reversibility of intermittent hypoxia-induced injury. Addressing these gaps will be essential to advance obstructive sleep apnoea diagnostic and therapeutic approaches. Integrating multi-omics profiling and physiological modelling within standardised intermittent hypoxia paradigms offers a pathway towards patient-tailored interventions.
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Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. 阻塞性睡眠呼吸暂停对健康的影响及持续气道正压通气治疗的有效性：研究证据的系统综述
To examine the research evidence for the health consequences of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure. A systematic review of published research, studies being identified by searching Medline (1966-96), Embase (1974-96), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1982-95); scanning citations; and consulting experts. Studies in all languages were considered which either investigated the association between obstructive sleep apnoea in adults and key health outcomes or evaluated the effectiveness of treatment of obstructive sleep apnoea with continuous positive airways pressure in adults. Mortality, systematic hypertension, cardiac arrhythmias, ischaemic heart disease, left ventricular hypertrophy, pulmonary hypertension, stroke, vehicle accidents, measures of daytime sleepiness, and quality of life. 54 epidemiological studies examined the association between sleep apnoea and health related outcomes. Most were poorly designed and only weak or contradictory evidence was found of an association with cardiac arrhythmias, ischaemic heart disease, cardiac failure, systemic or pulmonary hypertension, and stroke. Evidence of a link with sleepiness and road traffic accidents was stronger but inconclusive. Only one small randomised controlled trial evaluated continuous positive airways pressure. Five non-randomised controlled trials and 38 uncontrolled trials were identified. Small changes in objectively measured daytime sleepiness were consistently found, but improvements in morbidity, mortality, and quality of life indicators were not adequately assessed. The relevance of sleep apnoea to public health has been exaggerated. The effectiveness of continuous positive airways pressure in improving health outcomes has been poorly evaluated. There is enough evidence suggesting benefit in reducing daytime sleepiness in some patients to warrant large randomised placebo controlled trials of continuous positive airways pressure versus an effective weight reduction programme and other interventions.
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Accuracy of automatic analysis of ambulatory recordings of nocturnal breathing disorders is significantly instrumentation dependent. 动态夜间呼吸障碍记录自动分析的准确性显著依赖于所使用的仪器
Obstructive sleep apnoea (OSA) is generally diagnosed with ambulatory recordings. Although reliability of automated analysis has been investigated, suitability of one single analysis software for use with different devices is unclear. Here, validity of automatic analysis of recordings with two ambulatory devices and reliability of automatic analysis in detection of mixed and central apnoeas are investigated through 100 and 167 recordings with Venla and Embletta devices, respectively. Recordings were analysed automatically with Somnologica 3.2 and compared to manual analysis. Significant differences were seen between devices in classification of the severity of OSA when automatic analysis was applied. 65.4% and 11.4% of patients with mild obstructive sleep apnoea received false negative diagnosis with Venla and Embletta, respectively. Further, as automatic analysis was seen to have major difficulty in detection and classification of central and mixed apnoeas, manual analysis is suggested when these forms of disease are suspected.
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Prevalence of comorbid Insomnia and sleep apnoea (COMISA) in patients with obesity hypoventilation syndrome. 肥胖低通气综合征患者中共病失眠与睡眠呼吸暂停（COMISA）的患病率
BACKGROUND: Obesity hypoventilation syndrome (OHS) frequently coexists with obstructive sleep apnoea (OSA), but the prevalence of comorbid insomnia and sleep apnoea (COMISA) in patients with OHS is uncertain. We aimed to determine COMISA prevalence in OHS and to describe the associated clinical and polysomnographic features. METHODS: Adults with OSA ± OHS were included. Demographics, comorbidities, daytime arterial blood gases, polysomnography variables, structured sleep-questionnaire responses, and the Epworth Sleepiness Scale (ESS) score were noted. RESULTS: We analysed 3,215 patients (516 with OHS, 2,699 with pure OSA; age:50.3 ± 12.0 years; female/male: 1,030/2,185). The prevalence of COMISA was higher in OHS than in pure OSA (32.0% vs. 22.6% p < 0.001). Within the OHS group, COMISA was associated with a higher apnoea–hypopnoea index, oxygen desaturation index, arousal index, and ESS score (all p < 0.001), as well as a higher prevalence of hypertension, diabetes mellitus, and heart failure (p < 0.001, p = 0.002, and p = 0.005, respectively). OHS patients with COMISA also had more severe OSA than COMISA patients alone did (p < 0.001). COMISA in OHS patients was independently associated with higher daytime arterial partial pressure of carbon dioxide (PaCO₂) (adjusted OR [aOR] 1.299; 95% CI 1.198–1.409; p < 0.001), more severe OSA (aOR 2.419; 95% CI 1.288–4.543; p = 0.006), higher ESS score (aOR 1.104; 95% CI 1.047–1.163; p < 0.001). CONCLUSIONS: Compared with pure OSA group, COMISA is more common in OHS. High daytime PaCO₂ was independently associated with COMISA in OHS. OHS patients with COMISA also had more fragmented sleep, greater OSA severity, a higher ESS score and a higher prevalence of comorbidities.
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Is C-reactive protein elevated in obstructive sleep apnea? a systematic review and meta-analysis. 阻塞性睡眠呼吸暂停中C反应蛋白是否升高？系统综述与荟萃分析
This study examined whether circulating C-reactive protein (CRP) is elevated in obstructive sleep apnoea (OSA) independent of the confounding effects of comorbidities, smoking, body mass index (BMI), age and gender. A systematic review of the literature was performed using PubMed, Embase and Cochrane databases from 1 January 1997 to 1 November 2017 using the key words obstructive sleep apnoea and C-Reactive protein to identify full text English language studies that compared CRP in adult non-smoking OSA participants without comorbidities and adult healthy non-smoking control participants matched for BMI, age and gender. Data from eligible studies were subjected to meta-analysis using RevMan version 5.3. Five studies (219 OSA participants, 116 controls) met the selection criteria. The total standard mean difference for circulating high sensitivity CRP was 0.61 mg/dL higher in OSA participants than in control participants (confidence interval: 0.38 to 0.84, < 0.00001), with low between-studies heterogeneity (df = 7, = 0.16, = 33%) and minimal evidence of publication bias. : CRP levels in non-smoking OSA participants without comorbidities were increased relative to levels in healthy matched non-smoking control participants, suggesting that pharyngeal or systemic inflammatory effects attributable to OSA may elevate CRP.
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A method of studying adaptive changes of the oropharynx to variation in mandibular position in patients with obstructive sleep apnoea. 一种研究阻塞性睡眠呼吸暂停患者口咽部对下颌位置变化适应性改变的方法
The aim of this study was to develop a method of studying the effects of mandibular advancement on oropharyngeal airway dimensions in the sagittal plane in conscious, supine patients. Six white, dentate, male patients with proven obstructive sleep apnoea had sagittal fluoroscopic recordings taken in the resting supine position. Images were recorded at four frames per second as the mandible was advanced with the teeth in contact to maximum protrusion and then opened. Software in the fluoroscopic imaging system permitted measurement of the change in mandibular position together with oropharyngeal airway dimensions expressed as the narrowest dimension observable in the post-palatal and post-lingual sites. Plotting of airway dimensions during mandibular advancement enabled estimation of the degree of protrusion associated with maximal airway benefits. Progressive mandibular advancement produced variable adaptive changes in the post-palatal and post-lingual regions of the oropharynx. The amount of airway opening appeared to be related to the horizontal and vertical relationships of the face and to the dimensions of the soft palate. The changes in post-palatal and post-lingual airway dimensions were not always identical, despite the observation that both tongue and soft palate were seen to move in unison, with close contact being maintained between the two structures. Jaw opening resulted in synchronous posterior movement of both tongue and soft palate, with consequent narrowing of oropharyngeal airspace. Fluoroscopy is a simple method of assessing upper airway changes with mandibular advancement in the conscious patient. The technique should facilitate the selection of subjects for whom mandibular advancement would seem advantageous. The nature of the adaptive response is dependent on individual structural variation. It is suggested that, where artificial mandibular advancement with dental devices is considered beneficial, jaw opening should be kept to a minimum.
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Obstructive sleep apnoea presenting as failure to thrive in infancy. 以婴儿期生长迟缓为主要表现的阻塞性睡眠呼吸暂停
To study the postoperative outcome of infants under the age of 18 months in whom an adenotonsillectomy had been performed, with particular emphasis on the pre- and postoperative weight gain and linear growth velocities, and the resolution of symptoms of obstructive sleep apnoea (OSA). A retrospective study of all infants in whom an adenotonsillectomy had been performed during the 5 year period to January 1990. Details of pre- and postoperative outcome variables were obtained by review of hospital and office records and by telephone calls to the parents. Complete data were available for 29 (76%) of the 38 infants in whom an adenotonsillectomy had been performed. The data from these infants are reported. Pre-operatively, all infants had clinical symptoms of OSA, and 52% of infants also presented with failure to thrive (FTT). Seven infants were dysmorphic: three had Down syndrome, three had a craniofacial anomaly and one infant had Mobius syndrome. Following adenotonsillectomy, 23 infants (79%) had complete resolution of their OSA symptoms. Two infants with Down syndrome required a tracheostomy to relieve persistent upper airway obstruction. Eighty-seven per cent of the infants with pre-operative FTT had a significant increase in weight gain velocity postoperatively (mean 195.1 +/- 80.8 s.d. vs 509.8 +/- 249.1 g/month; P < 0.001), including the infants with mild persistent symptoms of OSA. The weight gain velocity of infants who were not failing to thrive pre-operatively did not change significantly following adenotonsillectomy (328.1 +/- 106.9 vs 333.2 +/- 146.4 g/month; P = 0.82). The linear growth velocity of all infants did not change significantly postoperatively. OSA should be considered in infants with FTT, as adenotonsillectomy is an effective treatment for OSA in infancy, and the weight gain velocity of these infants may increase significantly postoperatively. Overnight oximetry or other physiological studies may be required if the clinical signs and symptoms of OSA are equivocal.