睡眠呼吸暂停 sleep apnea - PubMed 文献(第 4 页)
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Melanocortin 4 receptor signalling in sleep-disordered breathing. 睡眠呼吸障碍中的黑素皮质激素4受体信号传导
The melanocortin 4 receptor (MC4R) is a key component of the leptin-melanocortin system. Recent studies have started to expand our understanding of the role of MC4R beyond energy balance and sexual behaviour, exploring its potential influence on respiratory function, particularly in the context of obesity hypoventilation syndrome and obstructive sleep apnoea. The MC4R pathway is implicated in respiratory control. MC4R is expressed on the CO-sensing neurons of the retrotrapezoid nucleus, and activation of the MC4R neurons in the retrotrapezoid nucleus augments the hypercapnic ventilatory response. MC4R is present at other sites of the neural respiratory network, where this receptor might also be involved in ventilatory control. The US Food and Drug Administration approved the MC4R agonist setmelanotide, which has been used effectively for the treatment of obesity involving the leptin-melanocortin pathway. Setmelanotide is also a promising treatment option for obesity hypoventilation syndrome and obstructive sleep apnoea, particularly in people with obesity caused by specific genetic disorders, including POMC, LEPR, MC4R and other associated gene mutations.
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Obstructive sleep apnoea among professional taxi drivers: a pilot study. 职业出租车司机中的阻塞性睡眠呼吸暂停：一项初步研究
This study aimed to describe the distribution of risk factors for obstructive sleep apnoea syndrome (OSAS) among taxi drivers, and to investigate differences by ethnicity in OSAS symptoms among drivers. A two-page postal questionnaire was completed by 241 professional taxi drivers from Wellington, New Zealand. Obstructive sleep apnoea syndrome was defined as having an estimated 15 or more respiratory disturbances, per hour of sleep (Respiratory Disturbance Index (RDI)> or =15) and self-reported daytime sleepiness. Pacific and Māori taxi drivers were more likely to have symptoms and risk factors for OSAS, compared to non-Māori non-Pacific drivers. In particular, Pacific drivers had a significantly increased pre-test probability of having moderate-severe OSA (RDI> or =15). Some professional taxi drivers are at increased risk for moderate-severe OSAS, especially Pacific and Māori taxi drivers. Untreated OSAS increases motor vehicle crash risk, so these findings have implications for the health and safety of drivers and their passengers. They suggest a need for more comprehensive research to guide policy on medical examinations required for licensing professional drivers as fit to drive.
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Sleep apnea. 睡眠呼吸暂停
To study clinical presentation of sleep disordered breathing (SDB) in children, their causative factors and response to treatment. A retrospective study of clinical data nd results of overnight polysomnography done at baseline and after therapy were reviewed in 56 patients under 18 years of age. Of the 56 patients included in the study 23(41%) cases were positive for SDB. 12 (52.1 %) patients had craniofacial abnormalities, 4 (17.3%) had neuromuscular and skeletal disorders, 2 (8.6%) had adenotonsillar hypertrophy, 1(4.3%) had bilateral vocal cord palsy and 3 (13%) had sleep apnoea associated with multisystemic disorders. Post-operative data showed improvement in all 6 cases of craniofacial abnormalities and both cases of adenotonsillar hypertrophy. Positive airway pressure treatment was useful in cases with obstructive sleep apnea (OSA) due to vocal cord palsy, thoracic scoliosis, systemic disorders and central hypoventilation. 41% of suspected cases were detected to have SDB. Craniofacial abnormality was the leading cause of OSA in the present study. Surgical correction improved symptoms apnea-hypopnea index (AHI) and desaturation in cases of craniofacial disorders and adenotonsillar hypertrophy. Vocal cord palsy, thoracic scoliosis, hypoventilation and systemic disorders associated OSA responded to positive airway pressure ventilation.
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Sex differences in sleep and sleep-disordered breathing. 睡眠及睡眠呼吸障碍的性别差异
There is increasing evidence for relevant sex differences in pathophysiology, symptom presentation and outcomes in obstructive sleep apnoea (OSA). However, research on sex differences and sex-specific phenotypes in sleep-disordered breathing (SDB) is still in its infancy and data on sex differences in other SDB is still very scarce. While OSA is more common in men than in premenopausal women, the prevalence of OSA doubles postmenopausally and becomes comparable to that of men. Women have a lower collapsibility of the upper airway and a lower arousal threshold. In addition, the rapid eye movement (REM)-apnoea-hypopnoea index (AHI) is typically higher in women than in men, but the non-REM-AHI and thus the total AHI is often lower. Women are often symptomatic at lower AHI and present more frequently with symptoms of sleep fragmentation and poor sleep quality. Both certain forms of OSA (e.g. REM-OSA) and certain phenotypes (e.g. COMISA) are more common in women. Men have a higher risk of high loop gain central sleep apnoea. For a better understanding of sex-typical phenotypes with the aim of a more targeted treatment approach of SDB, adequately powered studies on sex differences in SDB should be conducted.
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Sleep disordered breathing in adults living with a Fontan circulation and CPAP titration protocol. 成人Fontan循环患者的睡眠呼吸障碍及CPAP滴定方案
Fontan-type single ventricle physiology has exquisite respiratory dependence. Obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) are likely to have deleterious haemodynamic consequences. Asymptomatic and symptomatic Fontan-adults underwent diagnostic polysomnography; The overnight CPAP titration employed echocardiography and peripheral venous pressure (PVP) measurements to determine the upper limit of pressure prior to haemodynamic deterioration (> 20% rise in PVP or 20% fall in stroke volume). In asymptomatic adults (n = 7), mean age was 32 ± 9 years and awake oxygen saturations were 92 ± 3%. There was no significant OSA with Apnoea Hypopnoea Index (AHI) of 0.6 ± 1.1 events/h and mild nocturnal hypoxaemia (nadir 89 ± 4%). In sleepy patients (n = 7, age 36 ± 7 years, awake saturations 84 ± 5%, NYHA Class III ± I), sleep efficiency was 81 ±10% with mild OSA on average (AHI 7.9 ± 10.1) events/h) and marked desaturation (nadir of 76 ± 6%); Most episodes were obstructive in nature. BMI correlated with AHI (n = 14, R = 0.7, p = .005). Two of 7 (29%) had moderate OSA characterised by an early fall in PVP, 3 ± 1 mmHg and a 2 ± 1 mmHg increase at event termination. CPAP was successfully applied through in-laboratory titration (stroke volume fall was the end-point determinant in both). Our cohort of asymptomatic adults did not have significant SDB but SDB was common in sleepy patients. Fontan-adults with symptoms suggestive of SDB should be offered polysomnography and can be safely treated with CPAP employing echocardiographic titration.
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Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure. 卡托普利和氧气对轻中度充血性心力衰竭患者睡眠呼吸暂停的影响
To determine the effects of captopril and oxygen on sleep quality in patients with mild to moderate cardiac failure. An open observational study. 12 patients with New York Heart Association class II-III heart failure were studied at baseline. 9 of these patients were then examined at the end of 1 month of treatment with captopril; 9 of the patients were separately assessed during a single night of supplementary oxygen. Sleep patterns by polysomnography, overnight oximetry, and subjective sleep assessment using visual analogue scores. Abnormal sleep was present in all baseline studies. Complete polysomnograms after treatment with captopril were obtained in 8 patients. Light sleep (stages 1 and 2) was reduced (mean (SEM) 61%(8)% to 48%(6)% actual sleep time, P < 0.05) but slow wave (stages 3 and 4) and REM (rapid eye movement) sleep increased (25%(6)% to 31%(5)%, 14%(2)% to 21%(5)% actual sleep time, P < 0.05). Apnoeic episodes (242(59) to 118(30), P < 0.05), desaturation events (171(60) to 73(37), P < 0.05), and arousals (33(5) to 18(3) P < 0.01) were reduced. Visual analogue scores of sleep quality increased 49(5) to 69(5), P < 0.01). Complete polysomnograms were obtained in 7 patients treated with oxygen. Light sleep duration was reduced (55% (7)% to 42%(5)% actual sleep time, P < 0.05) and slow wave sleep increased (30%(5)% to 38%(6)% actual sleep time, P < 0.05). REM sleep duration was not significantly different. Total arousals (33(6)% to 20(2) P < 0.05), desaturation events (140(33) to 38(10), P < 0.01), and apnoeic episodes (212(53) to 157(33), P < 0.05) were reduced. Visual analogue scores of sleep quality were unchanged. Captopril and oxygen may improve sleep quality and reduce nocturnal desaturation in patients with mild to moderate cardiac failure. Improved sleep quality could explain the reduction in daytime symptoms seen after treatment in patients with chronic heart failure.
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Sleep-disordered breathing in children and adults with intellectual disability: mind the gap! 智力障碍儿童和成人的睡眠呼吸障碍：关注差距！
In adults and children with intellectual disability (ID), sleep -disordered breathing (SDB) is thought to be common. However, large epidemiological studies are lacking, and there are few studies on optimal methods of investigation and even fewer randomised, controlled intervention trials of treatment. Peer-reviewed publications from various databases were examined in line with search terms relevant to ID and SDB spanning the years 200-2024. Findings suggest that, due to comorbid conditions, children and adults with ID may experience both an increased risk of SDB, as well as lower frequency of diagnosis. SDB can compromise the emotional, physical and mental health of individuals with ID. Appropriate treatment when tolerated leads to an improvement in health and well-being and several studies emphasized the importance of consistent follow-up of people with ID - something that is not universally occurring during childhood, in the transition to adulthood and during adulthood itself. As the most frequently occurring form of ID worldwide, we use Down syndrome as a specific example of how diagnosing and treating SDB can lead to improved outcomes. This review highlights the importance of identifying SDB in this heterogenous population, recognising the multi-faceted, deleterious consequences of untreated SDB in people with ID, and presents some strategies that can be harnessed to improve diagnosis and management. Until further ID-specific research is available, we urge flexibility in the approach to people with ID and SDB based in guidelines and standard practice developed for the typically developing population.
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[A young man with adynamia, subepicardial ischemia and sleep apnea]. [一例表现为乏力、心外膜下缺血和睡眠呼吸暂停的年轻男性]
A 44-year-old manager presented himself for the assessment of nocturnal apnoea. He reported increasing lack of drive and nightly angina pectoris. Polysomnography indicated obstructive apnoea and hypopnoea with a respiratory disturbance index of 29.1, while the ECG showed T wave inversion in all leads. There was severe hypothyroidism with atrophic thyroid tissue. The patient had an obstructive sleep apnoea syndrome (OSAS), hypothyroidism with myxoedema, hypopnoea and myocardial ischaemia. He was treated with negative peak airway pressure (nCPAP) ventilation, administration of L-thyroxine and initiation of anti-anginal medication, which relieved his symptoms. The severe hypothyroidism was thought to be the most important cause of his respiratory disorder and angina. This case illustrates the connection between hypothyroidism and OSAS. Hypothyroidism must be excluded in patients with OSAS, regardless of the patient's age.
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Sleep apnoea related hypoxia is associated with cognitive disturbances in patients with tetraplegia. 睡眠呼吸暂停相关缺氧与四肢瘫痪患者的认知障碍相关
Sleep disordered breathing is common in patients with tetraplegia. Nocturnal arterial hypoxemia and sleep fragmentation due to sleep apnoea may be associated with cognitive dysfunction. We therefore studied the influence of sleep disordered breathing on neuropsychological function in 37 representative tetraplegic patients (mean age 34 +/- 9.7 years). Thirty percent (11 of 37 patients) had clinically significant sleep disordered breathing, defined as apnoea plus hypopnoea index (AHI) greater than 15 per hour of sleep. Most apnoeas were obstructive in type. Seven patients (19%) desaturated to < 80% during the night. Neuropsychological variables were significantly correlated with measures of sleep hypoxia, but not with the AHI and the frequency of sleep arousals. The neuropsychological functions most affected by nocturnal desaturation were: verbal attention and concentration, immediate and short-term memory, cognitive flexibility, internal scanning and working memory. There appeared to be a weak association between the presence of severe sleep hypoxia and visual perception, attention and concentration but no association was found between sleep variables and depression scores. We concluded that sleep disordered breathing is common in patients with tetraplegia and may be accompanied with significant oxygen desaturation. The latter impairs daytime cognitive function in these patients, particularly attention, concentration, memory and learning skills. Cognitive disturbances resulting from sleep apnoea might adversely affect rehabilitation in patients with tetraplegia.
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Sleep apnoea in infancy. 婴儿期睡眠呼吸暂停
Serial polygraphic sleep studies were carried out in 86 index infants (33 'symptomatic', 24 siblings of infants with the sudden infant death syndrome (SIDS), 29 'near-miss' for SIDS) and 11 healthy controls. Brief (greater than or equal to 3 less than 6 sec) or prolonged (greater than or equal to 6 sec) obstructive apnoea was observed only in index caes, and coincided with symptoms due to associated illnesses (usually respiratory). Their prevalence was comparable in 'symptomatic' and 'near-miss' groups--39% and 35% respectively. Prolonged (greater than or equal to 20 sec) central apnoea was seen only in pre-term 'near-miss' infants. Dips in transcutaneous oxygen tension greater than or equal to 15 mmHg occurred during sleep in 17% of 'symptomatic' infants and 19% of 'near-miss' cases, usually in association with obstructive or central apnoea. Diminution or disappearance of these abnormalities following clinical recovery from 'minor' illnesses suggested that they were the result of such illnesses.