睡眠呼吸暂停 sleep apnea - PubMed 文献(第 2 页)
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[Transcranial motor stimulation of patients with obstructive sleep apnea]. [阻塞性睡眠呼吸暂停患者的经颅运动刺激]
In a total of 7 patients suffering from sleep apnoea syndrome measurement of conduction was effected by means of transcranial motor stimulation to investigate whether the period of latency is prolonged compared to a group of healthy persons. The conduction period between motor cortex and musculus adductor digit minimi right and left. The latency period was 23.6 +/- 1.4 ms for the sleep apnoea patients whereas the standard value is 19.9 +/- 2.4 ms. Due to the small number of cases investigated it is not possible to allocate these data to the degree of severity of the sleep apnoea syndrome.
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Cross-correlation of EEG frequency bands and heart rate variability for sleep apnoea classification. 脑电频段与心率变异性的互相关分析用于睡眠呼吸暂停分类
Sleep apnoea is a sleep breathing disorder which causes changes in cardiac and neuronal activity and discontinuities in sleep pattern when observed via electrocardiogram (ECG) and electroencephalogram (EEG). Using both statistical analysis and Gaussian discriminative modelling approaches, this paper presents a pilot study of assessing the cross-correlation between EEG frequency bands and heart rate variability (HRV) in normal and sleep apnoea clinical patients. For the study we used EEG (delta, theta, alpha, sigma and beta) and HRV (LF(nu), HF(nu) and LF/HF) features from the spectral analysis. The statistical analysis in different sleep stages highlighted that in sleep apnoea patients, the EEG delta, sigma and beta bands exhibited a strong correlation with HRV features. Then the correlation between EEG frequency bands and HRV features were examined for sleep apnoea classification using univariate and multivariate Gaussian models (UGs and MGs). The MG outperformed the UG in the classification. When EEG and HRV features were combined and modelled with MG, we achieved 64% correct classification accuracy, which is 2 or 8% improvement with respect to using only EEG or ECG features. When delta and acceleration coefficients of the EEG features were incorporated, then the overall accuracy improved to 71%.
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Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. 睡眠呼吸暂停综合征中心率的周期性变化：机制及24小时心电图作为筛查技术的实用性
400 sleep-apnoeic patients with an intact autonomic nervous system underwent twenty-four-hour electrocardiography with simultaneous polygraphy recording at night. At onset of sleep apnoea all showed progressive bradycardia, followed by abrupt tachycardia on resumption of breathing. The electrocardiographic pattern, which is identifiable by computer analysis, can be used as a screening tool for sleep apnoea; it was not seen in controls without sleep apnoea syndrome. A subgroup of patients with sleep apnoea and impairment of autonomic nervous control of the heart (heart transplants, autonomic neuropathy, Shy-Drager syndrome) did not show the cyclical heart rate pattern. In obstructive sleep apnoeic patients with normal autonomic nervous function, atropine sulphate blocked the pattern by eliminating the bradycardia component, while 100% oxygen, even at high rates of administration, caused only moderate blunting of the heart rate variation. The electrocardiographic changes observed in sleep apnoea syndrome are therefore mediated by the autonomic nervous system; hypoxia is not the only factor involved.
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Sleep apnoea syndrome in pregnancy: a case report. 妊娠期睡眠呼吸暂停综合征：一例病例报告
A case of sleep apnoea syndrome in a pregnant patient is reported here. For obstetric reasons, and because of the possibility that a metabolic and respiratory acidosis associated with the apnoea syndrome might have developed, we decided to do a caesarian section. Orotracheal intubation was particularly difficult because of the patient's abnormal mandibular, palatal and retropharyngeal shape, which was probably the underlying cause of the apnoeic syndrome.
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Reduction in sympathetic activity after long-term CPAP treatment in sleep apnoea: cardiovascular implications. 睡眠呼吸暂停患者长期CPAP治疗后交感神经活动的降低：心血管意义
Twelve patients with severe obstructive sleep apnoea were included in an open, long-term, prospective, follow-up study addressing the effects of nasal continuous positive airway pressure (CPAP) on sympathetic activity, cardiac structure and blood pressure. Plasma norepinephrine (P-NE) (daytime at rest), daytime and night-time urinary excretion of NE (U-NE), vanylmandelic acid and metanephrines, together with 24 h noninvasive blood pressure (BP) recording and Doppler-echocardiography, were assessed before and after a mean of 20.5 (range 14-26) months of CPAP. Average self-reported use of CPAP was 89% (range 65-100%) of time spent in bed. Resting daytime P-NE ranged 0.35-0.83 ng.ml-1, which is elevated compared to healthy controls. Only night-time U-NE, mean daytime BP and average 24 h BP were related to severity of OSA. Night-time metanephrine was related to daytime and night-time diastolic, as well as night-time systolic, BP. Left ventricular mass index (LVMI) at baseline was correlated to daytime systolic BP and P-NE. Long-term CPAP treatment reduced biochemical markers of sympathetic activity. P-NE decreased by approximately 50%, and daytime and night-time vanylmandelic acid and metanephrine by 32-54%. In contrast, there were no overall reductions in BP or LVMI. It is concluded that obstructive sleep apnoea is associated with high sympathetic activity both during sleep and waking periods. Urinary metanephrine excretion seemed to reflect blood pressure, but neither daytime nor night-time catecholamine excretion was directly related to disease severity in patients with severe obstructive sleep apnoea.(ABSTRACT TRUNCATED AT 250 WORDS)
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An evidence-based approach to the 12-min consultation for a child with Down's syndrome. 唐氏综合征儿童12分钟问诊的循证方法
Down's syndrome is the commonest genetic condition. ENT problems are common in these children and can affect their development and quality of life. English literature review and experience of the senior author in managing ENT problems in children and adults with Down's syndrome. We carried out a Medline search on 31/03/2012 of English language publications using the following keywords: Down/Down's syndrome, hearing loss, ear infections, sleep apnoea, thyroid. The prevalence, presenting features and management of many common ENT conditions are significantly different in children who have Down's syndrome. This is particularly true of otitis media with effusion and sleep-disordered breathing. The outpatient consultation for a child with Down's syndrome should assess a range of specific ENT problems affecting this patient group including hearing issues, sleep-disordered breathing, recurrent upper respiratory tract infections, as well as other health conditions like hypothyroidism, atlantoaxial instability and cardiac issues, which can potentially affect the management of the patient.
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Predictive value of clinical features for the obstructive sleep apnoea syndrome. 临床特征对阻塞性睡眠呼吸暂停综合征的预测价值
The advantage of being a National Referral Centre for patients with suspected obstructive sleep apnoea (OSA) was used to seek clinical factors predictive of OSA, and thus determine if the number of polysomnography tests required could be reduced. Patients were mainly primary referrals, from an island population of 3.5 million. Two hundred and fifty consecutive patients underwent clinical assessment, full polysomnography, and a detailed self-administered questionnaire. This represents one of the largest European studies, so far, utilizing full polysomnography. Fifty four percent (n = 134) had polysomnographic evidence of OSA (apnoea/hypopnoea index (AHI) > or = 15 events.h-1 sleep). Patients with OSA were more likely to be male, and had a significantly greater prevalence of habitual snoring, sleeping supine, wakening with heartburn, and dozing whilst driving. Alcohol intake, age and body mass index (BMI) were significant independent correlates of AHI. After controlling for BMI and age, waist circumference correlated more closely with AHI than neck circumference among males, while the opposite was true among females. No single factor was usefully predictive of obstructive sleep apnoea. However, combining clinical features and oximetry data, where appropriate, approximately one third of patients could be confidently designated as having obstructive sleep apnoea or not. The remaining two thirds of patients would still require more detailed sleep studies, such as full polysomnography, to reach a confident diagnosis.
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Value of beat-to-beat blood pressure changes, detected by pulse transit time, in the management of the obstructive sleep apnoea/hypopnoea syndrome. 脉搏传导时间检测的逐搏血压变化在阻塞性睡眠呼吸暂停/低通气综合征管理中的价值
Two important aspects of a respiratory sleep study are a measure of inspiratory effort and an estimate of the number of arousals. These can be derived from an indirect estimate of beat-to-beat blood pressure (BP), pulse transit time (PTT). This study investigated the reproducibility of inspiratory BP falls (reflecting inspiratory effort), and BP arousals derived from PTT, and the contribution they could make to the management of the obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Overnight PTT was recorded at home in 40 patients being investigated for OSAHS, and a second PTT recording was made in the sleep laboratory with full polysomnography. Patients were divided into three groups according to the severity of their sleep disorder, and a third PTT recording was made at home in 13 patients subsequently established on nasal continuous positive airway pressure (CPAP). The reproducibility between the home and laboratory studies was reasonable (r=0.87 for inspiratory BP falls, r=0.81 for BP arousals). Both derivatives showed a clear progression through the three patient groups, which returned to normal on treatment. The differences between the groups were significant (p<0.001 for inspiratory BP falls, p=0.0014 for BP arousals). Receiver operator characteristic curves, used to compare polysomnography variables and PTT variables, confirmed that the PTT variables were as good as apnoea-hypopnoea index (AHI), >4% arterial oxygen saturation dip rate and electroencephalography micro-arousals at dividing patients into two groups, either requiring nasal CPAP or not requiring CPAP. Pulse transit time can provide a noninvasive estimate of inspiratory effort and a measure of arousals that together document disease severity and response to treatment and may be useful in managing obstructive sleep apnoea/hypopnoea syndrome.
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Management of Sleep-Disordered Breathing in Children With Craniofacial Abnormalities and Skeletal Dysplasia. 颅面畸形和骨骼发育不良儿童睡眠呼吸障碍的管理
Anatomic malformations associated with craniofacial abnormalities (CFAs) and skeletal dysplasias (SDs) contribute to airway obstruction during sleep in children, which may be treated surgically, with positive airway pressure (PAP) therapy, or with dental appliances. This study examines the management of OSA in children with CFAs and/or SDs, including the prevalence of residual OSA postsurgery and PAP therapy compliance. This was a retrospective cohort study of children with CFAs and/or SD. Children were included if they underwent polysomnography (PSG) at the Queensland Children's Hospital between December 2014 and April 2022. In this cohort of 150 children, 69% had a CFA, 25% had SD, and 5% had both a CFA and SD. The most common reason for referral to sleep clinic was snoring (61%). Half (n=75) received surgical intervention as first-line treatment (with adenotonsillectomy as the most common surgery), and of these children, 47 (77%) had no residual OSA, while 16 (23%) required further PAP therapy (as determined by PSG). PSG results were statistically similar between surgical and nonsurgical groups, but these data were skewed to more severe disease in the non-surgical group. PAP therapy adherence was 63% and was not age or sex dependent. Surgical intervention was the most common first-line treatment offered to children with CFAs and/or SD. The rate of residual OSA following surgery was similar to previous reports, and CPAP was the most common form of PAP offered to children. Overall, PAP compliance in this cohort of children was also similar to previous reports.
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Automated recognition of patients with obstructive sleep apnoea using wavelet-based features of electrocardiogram recordings. 利用心电图记录的小波特征自动识别阻塞性睡眠呼吸暂停患者
Patients with obstructive sleep apnoea syndrome (OSAS) are at increased risk of developing hypertension and other cardiovascular diseases. This paper explores the use of support vector machines (SVMs) for automated recognition of patients with OSAS types (+/-) using features extracted from nocturnal ECG recordings, and compares its performance with other classifiers. Features extracted from wavelet decomposition of heart rate variability (HRV) and ECG-derived respiration (EDR) signals of whole records (30 learning sets from physionet) are presented as inputs to train the SVM classifier to recognize OSAS+/- subjects. The optimal SVM parameter set is then determined by using a leave-one-out procedure. Independent test results have shown that an SVM using a subset of a selected combination of HRV and EDR features correctly recognized 30/30 of physionet test sets. In comparison, classification performance of K-nearest neighbour, probabilistic neural network, and linear discriminant classifiers on test data was lower. These results, therefore, demonstrate considerable potential in applying SVM in ECG-based screening and can aid sleep specialists in the initial assessment of patients with suspected OSAS.