睡眠呼吸暂停 sleep apnea - PubMed 文献(第 3 页)
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[Do patients with obstructive sleep apnea syndrome treated with nCPAP therapy lose weight?]. [接受nCPAP治疗的阻塞性睡眠呼吸暂停综合征患者是否会体重减轻？]
A simple therapy for obstructive sleep apnoea syndrome is weight reduction, which we always recommend before initiating and maintaining nCPAP-therapy. We documented the body weight of 123 patients (9 women, 114 men; age 53.8 +/- 10 years, initial apnoea-hypopnoea-index 40.7 +/- 22.6/hour) before and after 582 +/- 391 days nCPAP-therapy. Absolute and relative (Broca Index: weight [kg]/[height [cm] -100] x 100) body weight was 97.8 +/- 19.4 kg resp. 128.3 +/- 24.3 units before and 97.3 +/- 18.2 kg resp. 127.8 +/- 23.5 units during therapy (not significant). Body weight changes ranged from +22 to -26 kg. Only a subgroup of patients with a Broca index between 100-119 exhibited a significant weight change from 86.8 +/- 10.4 to 88.5 +/- 10.4 kg. We conclude that our recommendations to lose weight were unsuccessful in patients with obstructive sleep apnoea, although nCPAP-therapy generally improved well-being.
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A sleep apnoea questionnaire predicts organ damage in hypertensive patients. 睡眠呼吸暂停问卷可预测高血压患者的靶器官损害
Arterial hypertension is associated with obstructive sleep apnoea, poor quality and duration of sleep, which might contribute to hypertension-mediated organ damage. We investigated the presence of insomnia, restless legs syndrome, and obstructive sleep apnoea using validated questionnaires (Insomnia Severity Index, Restless Legs Syndrome Rating Scale, and STOP-Bang), and their relationship with hypertension-mediated organ damage, in hypertensive patients. In 159 consecutive consenting hypertensive patients [age 47(11) years, median and (interquartile range), body mass index 25.5(5.9) kg/m, office systolic and diastolic blood pressure 144(23)/92(12) mmHg], the STOP-Bang, but not the other scores, predicted cardiac remodelling: compared to patients with a STOP-Bang score < 3, those at high risk of obstructive sleep apnoea showed higher left ventricular mass index [49.8(11.9) vs. 43.3(11.9) g/m, p < 0.0001], left atrium volume [25.7(2.5) vs. 25.0(2.8) ml/m, p = 0.003], and aortic root diameter [33.6(3.0) vs. 33.0(3.7) mm, p < 0.0001]. They did not differ for microalbuminuria and estimated glomerular filtration rate. At multivariate analysis, after adjustment for office systolic blood pressure values, the STOP-Bang score remained a predictor of left ventricular mass index; while the Insomnia Severity Index and restless legs syndrome risk score had no predictive value. However, a significant interaction between STOP-Bang and Restless Legs Syndrome Rating Scale scores in determining left ventricular remodelling was found. In consecutive hypertensive stage I patients the STOP-Bang questionnaire allowed identification of a high-risk cohort featuring a more prominent cardiac damage. Hence, this inexpensive tool can be useful for risk stratification purposes in municipalities with limited access to health care resources.
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[Spectral analysis of long-term blood pressure measurements in patients with sleep-related respiratory disorders]. [睡眠相关呼吸障碍患者长期血压测量的频谱分析]
Spectral analysis of long-term recordings of blood pressure is a convenient method to recognise and reveal the amplitude and periodicity of changes in blood pressure during sleep. The increased variability of nocturnal blood pressure in patients with sleep apnoea is mainly determined by two types of oscillating variations in blood pressure: 1. Oscillations in a low frequency range of 0.0-0.06 Hz associated with breathing disorders and consecutive arousals. 2. Oscillations in a higher frequency range of 0.2-0.5 Hz associated with three different patterns of breathing. Normal undisturbed breathing, regular snoring and ineffective breathing efforts during obstruction of the upper airways. Furthermore, the interaction between breathing or breathing disorder and arterial blood pressure is determined by the influence of the sleep stages.
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[Differential diagnosis of rhonchopathy using the MESAM system]. [使用MESAM系统对打鼾进行鉴别诊断]
A programme for the differential diagnosis of rhonchopathy is reported, based upon the MESAM system developed at the University of Marburg. With this biparametric long-term monitor the snoring noise and the heart beat frequency (a beat-by-beat analysis) were recorded in 94 patients with a history of snoring. Other investigations included tape recordings of the snoring noise, nasoendoscopy, pulsed cineradiography of the pharynx and the recording of the character of the snoring. This programme is much cheaper than a sleep laboratory, but it can distinguish between obstructive sleep apnoea syndrome, habitual rhonchopathy and non-snorers, mainly by means of the characteristic patterns of MESAM recordings. A sleep apnoea syndrome was diagnosed in 19 patients and habitual rhonchopathy in 38 patients, whereas 33 patients were regarded as non-snorers. Ten of our 19 patients with sleep apnoea were re-examined by a sleep laboratory and the diagnosis was proved in all of these cases. In the 38 patients with habitual rhonchopathy auditory analysis of the snoring noise classified 23 patients as velar and 10 as pharyngeal snorers; 5 patients showed a mixed type of rhonchopathy. The questionnaire accompanying the MESAM system, nasal endoscopy and cine films support the individual diagnosis by revealing typical complaints and characteristic organic findings and thus contribute to the differential diagnostic screening. However, the three groups do overlap quite markedly with respect to symptoms und organic findings. In summary, the MESAM system provides an economically viable examination programme that can be used routinely by the otorhinolaryngologist for the differential diagnosis of rhonchopathy.
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Upper airway imaging in sleep apnoea syndrome: clinical applications. 睡眠呼吸暂停综合征的上气道影像学检查：临床应用
Symptoms of habitual snoring and excessive daytime sleepiness are extremely common in the general population, and have poor predictive value in identifying patients with "true" sleep-related disordered breathing. The upper airways are the main anatomical site responsible for snoring and sleep apnoea; therefore, their examination via different means has been quite extensively assessed. Clinical examination may point to severe micrognathia or retrognathia, grossly hypertrophied tonsils, obvious macroglossia, and oedema and inflammation of the uvula and soft palate. A recently proposed model is promising, but has not been validated independently yet. Endoscopic investigations have been performed in awake as well as in sleeping patients, with the pharynx in relaxed or active states; their predictive value remains poor, both for diagnostic purposes and for identifying patients that may benefit from surgery. Radiographic and magnetic resonance imaging techniques have permitted a detailed understanding of the process of narrowing and collapse of the upper airways. Unfortunately, these techniques do not perform any better than the ones previously cited as clinically efficient tools for diagnosis in the population of patients suspected of sleep-related breathing disorders. In conclusion, clinical examination of the upper airways remains part of the clinical evaluation of patients suspected of sleep-related disordered breathing. Other imaging techniques may be used for research purposes, but do not yet seem to be worth including in the routine assessment of this population.
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Craniofacial abnormalities in obstructive sleep apnoea: implications for treatment. 阻塞性睡眠呼吸暂停的颅面异常：对治疗的启示
Obstructive sleep apnoea (OSA) is a common disorder, and is characterized by repetitive closure of the upper airway during sleep. Upper airway narrowing and sleep-induced loss of muscle tone are important factors in the development of OSA. Over the last decade there has been a growing recognition that craniofacial abnormalities occur commonly in OSA patients. The more commonly identified abnormalities include mandibular deficiency, an inferiorly placed hyoid bone relative to the mandibular plane, a narrowed posterior air space, a greater flexion of the cranial base, and elongation of the soft palate. It is thought that these abnormalities result in upper airway narrowing, thereby predisposing to OSA. When the well established role of obesity in the development of OSA is taken into account, a model of OSA emerges in which the degree of craniofacial abnormalities determines the extent of obesity required to produce OSA in a given individual. The recognition of the role of craniofacial abnormalities in the development of OSA has led to a number of treatment strategies aimed at correcting or improving craniofacial structure, thereby preventing upper airway collapse during sleep. These treatments include dental appliances, and various maxillofacial surgical procedures. An improved understanding of the evolution of OSA from childhood to adulthood, in relation to facial development, may lead to a preventative strategy for this disorder.
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Residual effect of nCPAP applied for part of the night in patients with obstructive sleep apnoea. 部分夜间使用nCPAP对阻塞性睡眠呼吸暂停患者的残留效应
The aim of the present study was to assess whether nasal continuous positive airway pressure (nCPAP) treatment, applied for only a few hours at the beginning of the night, has any residual effect on sleep and breathing during the ensuing hours of unassisted sleep in patients with obstructive sleep apnoea syndrome (OSAS). In 27 patients with newly-diagnosed OSAS, effective nCPAP was applied during the first part of the night and then withdrawn. Polysomnographic parameters after nCPAP withdrawal were compared with those of the corresponding part of the diagnostic polysomnography performed a few days or weeks before and with those of the first part of night on nCPAP. After 255+/-63 (mean+/-SD) min of sleep with normalization of sleep and breathing parameters under nCPAP, there was partial improvement of OSAS severity during the remaining 124+/-56 min of nocturnal sleep without treatment; mean oxygen saturation, desaturation index (equivalent to the apnoea/hypopnoea index) and movement arousal index all improved significantly with respect to the diagnostic night (p=0.001). This improvement was not accounted for by a change in sleep architecture. We conclude that there is an improvement in severity of obstructive sleep apnoea syndrome after only 4 h of nasal continuous positive airway pressure. This carryover effect could explain why a number of patients with obstructive sleep apnoea syndrome apply nasal continuous positive airway pressure for only part of the night or not every night.
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Sleep-disordered breathing in heart failure and the effect of cardiac resynchronization therapy. 心力衰竭中的睡眠呼吸障碍及心脏再同步化治疗的效果
Respiratory disturbances during sleep are common in patients with heart failure (HF) and can trigger the occurrence of sleep apnoea or deteriorate pre-existing breathing disorder. This in turn may lead to worsening of the HF itself. Optimal treatment for HF has been found to reduce respiratory disturbances during sleep significantly, whereas cardiac resynchronization therapy (CRT), achieved by biventricular pacing, appears to cause a further reduction in episodes of central type apnoea, although it may also have an effect on episodes of obstructive type. The beneficial effect of CRT is due to the patients' haemodynamic improvement and in the HF amelioration, and not due to some other effect resulting from the electrical stimulation of the heart. However, this therapeutic intervention by itself is insufficient for the effective treatment of respiratory disturbances during sleep and should be considered as an adjunctive treatment in addition to other established therapies.
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Prevalence and characteristics of treatments for sleep disordered breathing in people receiving dialysis: a scoping review. 接受透析治疗人群中睡眠呼吸障碍治疗的患病率及特征：范围综述
Individuals with kidney failure experience elevated cardiovascular risk, potentially worsened by the presence of sleep disordered breathing. Despite this association, prevalence of sleep apnoea, and evidence for effective treatments are poorly understood in people with kidney failure. This review examines sleep apnoea prevalence, types of sleep apnoea, and treatment interventions in people with kidney failure receiving dialysis. Guidelines for scoping reviews were followed and the following databases were searched for both peer reviewed and grey literature: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Web of Sciences Core Collection, OpenGrey, ETHos and ProQuest. All databases were searched from inception to 18th October, 2024. Random-effects proportional meta-analysis was used to estimate prevalence. A narrative synthesis of the interventions from the included studies for sleep apnoea was reported. There were 36 included studies. Pooled data from 19 studies indicated that sleep apnoea prevalence was 59% (95% CI 47%, 70%). Pooled data estimated mild apnoea prevalence at 21% (95% CI 16%, 26%) (11 included studies), with moderate and severe prevalence being 44% (95% CI 30%, 60%) (14 included studies). The majority of sleep apnoea was obstructive (75% (95% CI 53%, 89%)) with the remaining being central (15% (95% CI 8%, 28%)) and mixed (15% (95% CI 3%, 49%)) in nature. The prevalence of sleep apnoea is high in people receiving dialysis. Currently there is insufficient evidence for the effective treatment of sleep apnoea in this population.
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Causal effects of life-course obesity on sleep apnoea: a Mendelian randomization study. 生命历程肥胖对睡眠呼吸暂停的因果效应：孟德尔随机化研究
Sleep apnoea (SA) is a common condition associated with obesity, conferring significant cardiovascular and metabolic risks. This study investigates the causal effects of obesity phenotypes throughout the life course, from birth weight to adult obesity, on SA risk using Mendelian randomization (MR). A two-sample MR approach was utilized, employing genome-wide association study (GWAS) data from individuals of European ancestry. Exposures included birth weight, childhood obesity, adult obesity classifications (overweight and obesity classes 1-3), and fat distribution characteristics (waist/hip circumference and MRI-derived abdominal adipose tissue volumes). Outcome data were sourced from the FinnGen database. Analyses were conducted using inverse variance weighting (IVW), MR-Egger regression, and sensitivity analyses. A replication analysis using another GWAS dataset on SA was also performed. The analysis demonstrated a positive causal relationship between birth weight and SA risk (OR = 1.142, P < 0.001). Features of childhood obesity, including BMI (OR = 1.218, P < 0.001) and early life body size (OR = 1.533, P < 0.001), were associated with increased SA risk. In adulthood, BMI was strongly associated with SA risk (OR = 2.419, P < 0.001). Fat distribution measures, notably MRI-derived subcutaneous adipose tissue volume (OR = 1.119, P = 0.003) and waist circumference (OR = 1.953, P < 0.001), were also predictors of SA risk. Sensitivity analyses affirmed these findings, suggesting minimal horizontal pleiotropy. The replication analysis confirmed a positive correlation between obesity indicators and SA. This study supports the causal relationship of life-course obesity, including birth weight and obesity, in childhood and adulthood, on SA risk, highlighting the importance of fat distribution metrics in understanding SA determinants.