An Assessment of the Surgical Results of the Site-Directed Surgical Treatment in Obstructive Sleep Apnoea Syndrome

Background: Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. Aims and objectives: To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment. Methodology: Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. Result: 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved surgical success with a total success rate of 8/9 (89%). While only two patients achieved surgical cure (23%) among children. Conclusion: The outcome of site-directed surgical treatment is that it is a satisfactory way of treatment of OSAS with an overall success rate of 76%.

Pathophysiology and Treatment Options in Obstructive Sleep Apnoea: A Review of the Literature

Obstructive sleep apnoea, OSA, is formally defined as an apnoeahypopnoea index (AHI) of at least 5 episodes/hour (mild). Obesity, alcohol, smoking and sedatives may contribute to the development of OSA, as well as tonsilar hypertrophy and maxillary and/or mandibular retrognathia. Endocrine conditions such as hypothyroidism and acromegaly have also been reported associated with OSA. Except for excessive daytime sleepiness, headaches and irritability, OSA may lead to hypertension, heart failure, MI and stroke. Management involves reduction of predisposing factors such as obesity and alcohol. Treatment with continuous positive airway pressure (CPAP) is currently most common and best documented. Also uvulopalatopharyngeal surgery and so called phase II surgery, which means advancement of the jaw(s) with orthognatic surgical methods are used. Treatment with dental appliances is getting increasingly popular but the long term outcome remains debatable.

Prevalence of Symptoms of Obstructive Sleep Apnoea in Children Undergoing Routine Adenotonsillectomy

Introduction: Obstructive sleep apnoea (OSA) is a condition characterized by episodic partial or complete obstruction of the upper airway during sleep leading to apnoea or cessation of breathing. Obstruction of the upper airway during sleep may result in the generation of noise (snoring), reduction (hypopnoea) or cessation (apnoea) of airflow at the nostrils and mouth. There are multiple indications for undertaking a patient for adenoidectomy and/or tonsillectomy with obstructive sleep apnoea (OSA) being one among many. Objective: The aim of the present study was to find the prevalence of OSA symptoms in children undergoing adenotonsillectomy for indications other than that of obstructive sleep apnoea. Material & Methods: The study was conducted in the Department of ENT and Head & Neck surgery, Gauhati Medical College & Hospital, Guwahati for a period of one year. Twenty six patients who underwent adenoidectomy and/or tonsillectomy during this period were selected for the study. The parents of the patients were administered the Paediatric Sleep Questionnaire pre-operatively and the patients were evaluated for any symptoms of OSA. A score of 8 or more was suggestive of presence of breathing related sleep disorder. All statistical analyses were performed using statistical software SPSS 16.0 version. To test for the difference in the proportion between different variables, chisquare/fisher exact test where appropriate were employed. All statistical tests were two tailed with 0.05 as the threshold level of significance. Results: 11 children (42.3%) had a score of 8 or more out of the 26 children in Paediatric sleep questionnaire. The chi square for this was 4.696 with a p value of 0.096. The snoring subscale was found to be positive in 19 children (73.1%). All children with score of 8 or more were positive for the snoring scale. The sleepiness subscale was found to be positive in 14 children (53.8%). 10 of the 11 children were positive for sleepiness scale among the children who had a score of 8 or more in the questionnaire. These were found to be statistically significant. Conclusion: A significant population of the children undergoing routine adenotonsillectomy also has symptoms of obstructive sleep apnoea. The pathophysiology of obstructive sleep apnoea should be borne in mind in all children having adenotonsillar hypertrophy and a prompt and early intervention into these children should be aimed for both the infective etiology and the possible outcomes of their compromise to the airway column for a better quality of life.

Analysis of Referrals for Mandibular Advancement Appliances for Sleep Apnoea

Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be improved with an intra-oral mandibular advancement appliance. Methods: Data from referrals to a Prosthodontic Unit from 01-01-2019 to 18-8-2022 were analysed. Results: A total of 240 consecutive referrals to an NHS hospital where a patient was fitted with a mandibular advancement appliance (MAA) were analysed and 160 (67%) were male and 80 (33%) were female. The mean age in years was 52 (2019), 50 (2020), 52 (2021) and 51 (2022). Mean age of male referrals was 51 and female referrals was 53. Conclusion: There are a large number of patients with OSA seeking a dental device and practitioners should be aware of this treatment modality to help the medical team manage OSA. Clinical relevance: Dentists may need to have a greater understanding of OSA and be able to provide MAAs.

Changes in Brachial and Central Blood Pressure after Short Term Continuous Positive Airway Pressure Treatment of Patients with Moderate-to-Severe Obstructive Sleep Apnoea and Impaired Renal Function

Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth Sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.

Sleep Disorders among Professional Oil Tanker Drivers in Ouagadougou Burkina Faso

Introduction: Sleep disorders among professional drivers are a major road safety problem. They cause fatigue and drowsiness at the wheel, which can lead to road traffic accidents and even accidents at work. The aim of this study was to assess sleep disorders among professional drivers of oil tankers in Ouagadougou, Burkina Faso. Methods: This was a descriptive and analytical cross-sectional study carried out from 11 April 2020 to 11 September 2020 in the national hydrocarbon company’s fuel depot. All the drivers present at the time were included and accomplished a questionnaire incorporating the commonly scales using to assess sleep disorders, sleep quality and sleep apnoea. Data analysis using R 3.6.1 software enabled to perform univariate and multivariate analyses to identify associated factors. Adjusted odd ratios were used to measure the strength of association. The significance level chosen was p ≤ 0.05. Results: All the 339 respondents were male. A proportion of 33.6% suffered from insomnia, including 12.7% with moderate to severe insomnia, and 18.58% were at risk of sleep apnoea. On the Epworth scale, 26.6% of drivers showed sleep debt and 4.1% excessive daytime sleepiness. The risk factors associated with insomnia were the use of psychostimulants. A history of diabetes and insomnia were risk factors associated with sleep apnoea syndrome. Conclusion: The prevalence of sleep disturbance and insomnia among the respondents were 52.2% and 33.6% respectively. Use of psychostimulants was the identified risk factor. The prevalence of SAS was 4.72%, with diabetes and insomnia as associated factors.

阻塞性睡眠呼吸暂停对男性生殖功能的影响

男性不育与环境因素、不良生活习惯、肥胖、代谢综合征以及染色体异常等密切相关,阻塞性睡眠呼吸暂停(OSA)是其中一个重要的独立危险因素。研究发现,OSA的发病率逐年上升,OSA作为男性不育的一种可逆因素,应当及时诊断并尽早进行治疗。本文就OSA与睾酮水平、勃起功能障碍(ED)、精液质量、男性不育等方面的研究进展进行综述,总结其对男性生殖功能的影响及其潜在机制。

慢性失眠共病OSAHS患者血清NLRP3炎症小体、IL-1β、IL-18水平与睡眠质量、认知功能的相关性研究

目的探讨慢性失眠共病阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠质量和认知功能的临床特征及其与血清核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体、白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)水平的相关性。方法选取2021年1月—2022年5月内蒙古科技大学包头医学院第一附属医院114例慢性失眠患者为研究对象,依据多导睡眠监测(PSG)结果将患者分为慢性失眠组58例,慢性失眠共病OSAHS组56例,并选取同期该院健康体检者52例作为对照组。采用匹兹堡睡眠质量指数(PSQI)和PSG评估受试者的睡眠质量,采用蒙特利尔认知评估量表(MoCA)评估总体认知功能,采用酶联免疫吸附试验(ELISA)检测受试者血清NLRP3炎症小体、IL-1β及IL-18水平。Pearson法分析慢性失眠共病OSAHS患者血清NLRP3炎症小体、IL-1β、IL-18水平与睡眠质量、认知功能的相关性。多元线性回归分析慢性失眠共病OSAHS患者睡眠质量和认知功能的影响因素。结果与慢性失眠组比较,慢性失眠共病OSAHS组患者入睡潜伏期、阻塞性呼吸暂停最长持续时间延长(P<0.05),呼吸暂停低通气指数(AHI)升高(P<0.05),鼾声事件次数增加(P<0.05),非快速眼球运动睡眠1期所占睡眠总时间的百分比(N1%)、快速眼球运动期睡眠所占睡眠总时间的百分比(REM%)、血氧饱和度<90%时间占监测总时间的百分比(TS90%)升高(P<0.05),非快速眼球运动睡眠2期所占睡眠总时间的百分比(N2%)、平均氧饱和度(SpO2)及最低SpO2降低(P<0.05);与对照组比较,慢性失眠共病OSAHS组患者总睡眠时间缩短(P<0.05),入睡潜伏期、睡后觉醒总时间和阻塞性呼吸暂停最长持续时间延长(P<0.05),觉醒次数、AHI及鼾声事件次数增加(P<0.05),PSQI评分、N1%、TS90%升高(P<0.05),睡眠效率、N2%、N3%、平均SpO2及最低SpO2降低(P<0.05)。与慢性失眠组比较,慢性失眠共病OSAHS组患者注意力、视空间与执行能力、定向力和MoCA总分降低(P<0.05);与对照组比较,慢性失眠共病OSAHS组患者注意力、视空间与执行能力、延迟回忆能力、定向力和MoCA总分降低(P<0.05)。慢性失眠共病OSAHS组、慢性失眠组及对照组血清NLRP3炎症小体、IL-1β、IL-18水平分别依次下降(P<0.05)。慢性失眠共病OSAHS组患者Pearson相关性分析结果显示:血清NLRP3炎症小体、IL-1β、IL-18水平与PSQI评分、睡后觉醒总时间、N1%o及AHI呈正相关(P<0.05),与总睡眠时间、TS90%、视空间与执行能力、延迟回忆能力及MoCA总分呈负相关(P<0.05);IL-1β、IL-18水平与N3%呈负相关(P<0.05);NLRP3炎症小体、IL-18水平与注意力呈负相关(P<0.05)。多元线性回归分析结果显示:血清NLRP3炎症小体水平影响PSQI评分、N1%、N3%、AHI、TS90%及注意力,IL-1β水平影响PSQI评分、N1%、N3%、TS90%、注意力及延迟回忆能力,IL-18水平影响AHI、TS90%及延迟回忆能力(P<0.05)。结论慢性失眠共病OSAHS患者的血清NLRP3炎症小体、IL-1β及IL-18水平较慢性失眠患者和正常人高,并且升高的血清NLRP3炎症小体、IL-1β及IL-18与睡眠质量下降、认知功能受损相关。

广东省新生儿窒息发病率调查及危险因素分析

目的了解广东省新生儿窒息的发病率及其流行特征,分析有关危险因素。方法以整群抽样的方式收集资料,用多因素Logistic回归分析筛选危险因素。结果广东地区新生儿窒息发病率为9.85%。产妇心脏病、贫血、流产次数、胎位及先露因素、催产素、胎头吸引、第二产程延长、剖宫产次数为新生儿窒息发病的危险因素,怀孕次数、接近分娩的最后一次产检以及较高等级的产检医院及分娩医院、产检次数为新生儿窒息发病的保护因素。羊水不正常、早产、脐带绕颈为新生儿窒息发病的胎儿危险因素,正常合适的羊水量为新生儿窒息发病的保护因素。结论避免危险因素,关注保护因素,以减少和预防新生儿窒息的发病。

Hypno PTT监测仪对阻塞性睡眠呼吸暂停低通气综合征的诊断价值

目的研究和评价HypnoPTT睡眠呼吸监测仪对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断价值。方法选择147例打鼾患者,对其行整夜多导睡眠监测(PSG),以PSG的呼吸暂停低通气指数(AHI)为诊断OSAHS的金标准,同时对同一患者作HypnoPTT监测获得其监测结果PTTAHI。绘制受试者工作特征曲线(ROC曲线),获得PTTAHI的最佳诊断点,对PTTAHI作分层检测,得出各层的阳性似然比。结果PTTAHI与金标准PSGAHI的结果有较好的直线相关关系。以PSGAHI≥5作为目前国内诊断OSAHS的金标准,绘制ROC曲线,得出的PTTAHI对OSAHS的最佳诊断值为PTTAHI≥8。对该诊断点作卡方检验,其灵敏度为97.5%,特异度为90.5%。结论PTT监测仪对OSAHS的诊断准确性较高,临床应用价值较大。

体重指数对患者耐受呼吸暂停安全时限的影响

目的:探讨全麻诱导插管期间,体重指数对患者呼吸暂停安全时限的影响。方法:选择年龄21～63岁,ASAⅠ-Ⅱ级择期手术的全麻病人80例。根据其体重指数(Body mass index,BMI)分为Ⅰ组(正常体重组)20例、Ⅱ组(超重组)20例、Ⅲ组(1°肥胖组)20例和Ⅳ组(2°肥胖组)20例。常规静脉麻醉诱导,诱导期间以10L/min的氧流量充分吸氧去氮4min,诱导结束行气管插管,插管完毕后继续脱氧观察,待脉搏氧饱和度(SpO2)降至90%时,接入麻醉机呼吸回路行控制呼吸。记录麻醉诱导末到SpO2下降至90%时的呼吸暂停时限,采集入室初、吸氧去氮后和SpO2降至90%时3个时间点的动脉血作血气分析。结果:各组患者呼吸暂停安全时限明显不同,其时限分别为(542.47±48.24)s(Ⅰ组)、(465.77±32.20)s(Ⅱ组)、(355.13±44.36)s(Ⅲ组)、(227.53±34.23)s(Ⅳ组),组间比较具有显著性差异(P<0.05)。结论:体重指数不同,患者耐受呼吸暂停时限明显不同,随着体重指数的增加,患者耐受呼吸暂停的时限逐渐缩短。

不同体位新生儿呼吸暂停QT间期和QT离散度的测定

目的:评价QT间期和QT离散度对新生儿呼吸暂停的临床意义。方法:采用上海华泰软件工程有限公司Cardio ExCN100电脑心电图系统12导联同步测定心电图对22例新生儿呼吸暂停患儿的QT间期和QT离散度进行检测,并采用仰卧位和俯卧位两种体位进行测定,并与22例同期正常婴儿进行对照分析。结果:新生儿呼吸暂停组QTc间期和QTc离散度与正常新生儿组相比有显著性差异,但新生儿呼吸暂停组和正常组的仰卧位、俯卧位的QTc间期和QTc离散度相比无显著性差异。结论:新生儿呼吸暂停组由于多种因素的存在导致有不同程度的增加室性心律失常可能,心电图表现为室性复极化的延长;但是从仰卧位到俯卧位改变体位后,室性复极化没有发生改变,因此,新生儿呼吸暂停改变体位增加发生猝死的原因是不能用姿势改变导致室性复极化改变来解释的。

全麻诱导期呼气末正压通气对老年患者无通气期的影响

目的观察全麻诱导呼气末正压通气（PEEP）能否延长老年患者无通气期。方法选择ASAⅠ～Ⅱ级、年龄大于65岁全麻老年患者30例，随机分为PEEP组和对照组（C组），每组15例。所有患者自主呼吸存在时行面罩吸100％O2 5min。全麻诱导后，C组行控制呼吸（FiO2 100％，RR12次／分，VT 10ml／kg）5min，PEEP组应用C组相同的控制呼吸条件加PEEP6cm H2O 5min。无通气期为SpO2降至90％。记录无通气期时间，分别于入室后（T1）、面罩吸100％O2 5min时（T2）、控制呼吸5min时（T3）和SpO2降至90％时（T4）抽血样本行血气分析。结果PEEP组无通气期时间为（396±121）S，显著长于C组（305±107）S（P〈0．05）。动脉血气分析显示，两组患者T1、T2和T4时的PaO2和PaCO2相似，但T3时PEEP组的PaO2明显高于C组（P〈0．05），而PaCO2显著低于C组（P〈0．05）。结论全麻诱导应用PEEP，可增加氧储备，延长老年患者无通气期。

阻塞性睡眠呼吸暂停合并血糖异常患者血清脂联素水平分析

目的探讨阻塞性睡眠呼吸暂停(OSA)合并血糖异常患者的血清脂联素水平变化。方法选取2010年6月—2013年6月在山西大同大学附属医院呼吸科接受多导睡眠呼吸监测的男性OSA患者129例(OSA组),其中1年内新诊断糖尿病41例(DM组),葡萄糖调节受损29例(IGR组),血糖正常59例(NG组);同时选取30例健康男性作为对照(NC组)。所有受试者采用ELISA法测定血清脂联素,并比较各组的血清脂联素水平及分析低脂联素血症的危险因素。结果各组间年龄、体质指数(BMI)比较,差异无统计学意义(P>0.05)。NG组、IGR组和DM组的空腹血糖和胰岛素抵抗指数均高于NC组,差异均有统计学意义(P<0.05);DM组的空腹血糖高于IGR组,差异有统计学意义;DM组的高密度脂蛋白低于NC组,差异有统计学意义(P<0.05)。IGR组和DM组的三酰甘油均高于NC组,差异均有统计学意义(P<0.05);DM组和IGR组的空腹血糖、胰岛素抵抗指数、三酰甘油、呼吸暂停低通气指数及血氧饱和度低于90%的时间占总睡眠时间的百分比高于NG组,最低血氧饱和度、血清脂联素低于NG组,差异均有统计学意义(P<0.05);NG组、IGR组和DM组的血清脂联素均低于NC组,差异均有统计学意义(P<0.05)。OSA组的相关分析显示,BMI(r=-0.248,P=0.005)、腰臀比(r=-0.476,P<0.001)、空腹血糖(r=-0.374,P<0.001)、胰岛素抵抗指数(r=-0.546,P<0.001)、胆固醇(r=-0.253,P=0.004)、三酰甘油(r=-0.287,P=0.001)、呼吸暂停低通气指数(r=-0.710,P<0.001)、夜间血氧饱和度低于90%时间占总睡眠时间百分比(r=-0.521,P<0.001)与血清脂联素呈负相关;高密度脂蛋白、夜间最低血氧饱和度与血清脂联素正相关(r=0.294,P<0.001;r=0.651,P<0.001)。多元逐步回归分析显示,呼吸暂停低通气指数是男性OSA患者发生低血清脂联素血症的独立危险因素(P<0.05)。结论 OSA合并血糖异常患者血清脂联素水平降低,检测血清脂联素,有利于早期发现男性OSA患者的2型糖尿病风险。

阻塞性睡眠呼吸暂停及快动眼睡眠期行为障碍对帕金森病患者认知功能的影响

目的观察伴阻塞性睡眠呼吸暂停(OSA)及快动眼睡眠期行为障碍(RBD)对帕金森病(PD)患者认知功能的影响。方法收集101例PD患者的临床资料,采用MMSE、蒙特利尔认知评估量表(MoCA)北京版评定患者认知功能,并对患者进行整夜多导睡眠监测(PSG)并对相关结果进行比较。结果根据PSG监测结果,将患者分为对照组34例、OSA组18例、RBD组34例及OSA+RBD组15例。与对照组比较,RBD组及OSA+RBD组MoCA评分显著降低(均P<0.05)。与OSA+RBD组比较,RBD组体质量指数及PD组Epworth嗜睡量表评分显著降低,RBD组慢波睡眠比例显著升高(均P<0.05)。与OSA组及OSA+RBD组比较,对照组及RBD组呼吸暂停低通气指数及氧减指数显著降低,最低脉搏氧饱和度显著升高(均P<0.05);OSA组的觉醒次数较其他三组显著升高(均P<0.05)。在相关分析中,PD患者的MoCA评分与RBD(r=0.324,P=0.001)、总睡眠时间(r=0.212,P=0.035)、睡眠效率(r=0.272,P=0.006)、非快速眼动睡眠2期时间(r=0.257,P=0.010)呈正相关。结论认知功能障碍在伴RBD的PD患者中很常见。PD患者认知功能与睡眠效率、总睡眠时间、非快速眼动睡眠2期时间及RBD显著相关。

下颌前伸式阻鼾器的改良及对轻中度OSA的临床疗效评价

目的:对临床常用的胶联一体下颌前伸式阻鼾器进行改良,评价其对轻、中度阻塞型睡眠呼吸暂停综合征(OSA)的临床疗效。方法:40例经多导睡眠呼吸监测(PSG)确诊为轻、中度OSA(5<AHI<30)的患者,随机将其均分为实验组及对照组,分别佩戴改良一体式阻鼾器和软压膜一体式阻鼾器,佩戴前及3月后行个人问卷调查及PSG监测,分别记录患者主观症状及睡眠参数变化,比较两组治疗前、后情况差异。结果:与治疗前比较,实验组18例的AHI下降了50%以上,客观有效率为90%,高于对照组55%;实验组治疗后N1%显著减少、N2%和N3%显著增加(P<0.05),对照组治疗前、后睡眠结构没有明显改善。实验组主观症状改善率高于对照组,无睡眠中阻鼾器脱落现象发生。结论:改良一体式阻鼾器对于轻、中度OSA有更好的治疗效果,在OSA的治疗中有广阔的临床应用价值。

阻塞性睡眠呼吸暂停相关高血压和氧化应激

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnoea/hypopnoea syndrome,OSAHS)被认为是一个严重影响公众健康的疾病。OSAHS引起的主要病理生理过程为反复发生的低氧血症、高碳酸血症和睡眠结构紊乱,从而引起系统性氧化应激及神经反射异常等,并很大程度上增加高血压的风险以及首发、再发中风的死亡率。文章主要就OSAHS氧化应激与高血压的关系作一综述。

头高15°倾斜位吸氧去氮对肥胖患者耐受呼吸暂停安全时限的影响

目的;探讨全麻诱导插管期间,头高15°倾斜位与平卧位吸氧去氮两种给氧方式对肥胖患者耐受呼吸暂停安全时限的影响。方法：选择年龄21-63岁,BMI〉28 kg/m2,ASAI-II级择期手术的全麻插管病人62例。将其随机分为平卧位（30例）和头高15°倾斜位（32例）两组,常规静脉麻醉诱导,诱导期以10L/min的氧流量充分吸氧去氮4min,诱导结束行气管插管,插管完毕后继续脱氧观察,待脉搏氧饱和度（SpO2）降至90%时,接入麻醉机呼吸回路行控制呼吸。记录麻醉诱导末至SpO2下降到90%时刻的呼吸暂停时限,采集入室初、吸氧去氮后和SpO2降至90%时3个时间点的动脉血作血气分析。结果：肥胖患者头高15°倾斜位与平卧位吸氧去氮耐受呼吸暂停安全时限比较,头高15°倾斜位可明显延长患者耐受时限约70秒,两组有显著性差异（P〈0.05）。结论;肥胖患者头高15°倾斜位吸氧去氮较平卧位能明显延长呼吸暂停安全时限,降低麻醉风险。

PTT与PSG同步监测鼾症患者的临床研究

目的评估脉搏传导时间检测仪(PTT)与多导睡眠仪(PSG)同步监测鼾症患者的一致性。方法33例鼾症患者同步使用PSG和PTT监测,对所记录数据进行统计学分析。结果PSG与PTT所记录心率、血氧饱和度、呼吸事件次数、事件发生时间及事件持续时间均可一一对应。两组阻塞性呼吸暂停指数(O-AI)间差异有显著性意义(P=0·000);两组低通气指数(HI)间差异无显著性意义(P=0·549);两组中枢性呼吸暂停指数(C-AI)间差异有显著性意义(P=0·033);两组混合性呼吸暂停指数(MIX-AI)间差异有显著性意义(P=0·002);对两组呼吸紊乱指数(RDI)进行相关分析,r=0·995,表明PSG与PTT监测所得RDI有高度相关性。结论PTT用于OSAHS临床诊断与PSG具有一致性,用于呼吸努力程度的判断较PSG更准确。

睡眠呼吸暂停综合征与代谢综合征的回顾性研究

目的:研究阻塞性睡眠呼吸暂停综合征(OSAS)与代谢综合征(MS)的相关性。方法:回顾分析323例OSAS患者MS的发病率,并对非肥胖OSAS患者与健康人群MS发病率进行对照研究。结果:323例OSAS患者MS患病率为42.1%,轻、中、重度患者患病率分别为13.5%、37.8%和60.2%。非肥胖OSAS患者中高血压、血脂异常、高血糖的发生率均明显高于健康对照组(P<0.01)。结论:MS的发生率与OSAS显著相关,且这种关系可能并不依赖于肥胖。