手术治疗对阻塞性睡眠呼吸暂停综合征儿童生长激素、胰岛素样生长因子-1的影响

目的探讨手术(扁桃体、腺样体切除术)治疗前后儿童阻塞性睡眠呼吸暂停综征(OSAS)生长激素(GH)及胰岛素样生长因子-1(IGF-1)的变化情况。方法 200例确诊为OSAS的患儿在清晨采静脉血测定GH及IGF-1,行扁桃体、腺样体切除术后2个月,200例患儿复查GH、IGF-1,并和正常儿童测定的GH、IGF-1进行比较分析。结果 OSAS患儿术前GH、IGF-1值明显低于正常儿童,经手术治疗后,GH、IGF-1值术后较术前明显上升,与正常儿童无明显差异。结论 OSAS患儿由于睡眠缺氧,GH、IGF-1处于正常低值。手术解决上呼吸道梗阻后,GH、IGF-1水平升至正常高值。

阻塞性睡眠呼吸暂停低通气综合征538例综合治疗分析

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)用手术、低温等离子、CO2激光综合治疗的疗效。方法:对538例OSAHS采用手术、低温等离子、CO2激光等综合治疗,并对患者口咽腔测量,治疗前后进行疗效分析。结果:本组538例中鼻息肉,鼻中隔偏曲,腺样体肥大常规手术治疗126例;扁条桃摘除术245例;鼻甲肥大,鼻瓣区黏膜肥厚采用CO2激光治疗303例;悬雍垂粗壮、过长,软腭下垂,腭咽弓增宽,咽壁软组织肥厚、塌陷等采用低温等离子治疗419例。结论:手术、CO2激光、低温等离子综合治疗OSAHS疗效较好。对OSAHS患者行鼻腔通气重建术,悬雍垂腭咽成型术是治疗上气道阻塞的最佳组合措施。

重叠综合征的临床分析及护理

目的:对慢性阻塞性肺疾病,并发阻塞性睡眠呼吸暂停低通气综合征患者进行临床观察和护理。方法:20例均经详细询问病史等检查,观察病情变化及采取相应的护理措施。结果:20例均有明确夜间低氧血症和严重的睡眠结构紊乱,其中16例经无创机械通气治疗和响应的护理,夜间低氧血症和呼吸紊乱明显改善。结论:慢性阻塞性肺疾病与阻塞性睡眠呼吸暂停低通气综合征并存时,肺动脉高压,心功能不全的危险性增高,而且两者相互促进病情的进展,因此早期诊断和有效的观察和护理是提高治愈率的前提之一。

基于定位尺寸板口腔矫正器的制作及临床应用

目的介绍一种基于定位尺寸板口腔矫正器的制作方法并探讨其在临床中的应用。方法采用定位尺寸板进行下颌定位，制作口腔矫正器，矫正器主要由托槽、上颌垫、定位垫片、定位尺寸板和填充塑料组成。38例阻塞性睡眠呼吸暂停综合征患者，其中男性28例，女性10例，年龄36～54岁，轻度13例，中度25例；用定位尺寸板口腔矫正器观察其对患者的疗效。结果矫正器治疗阻塞性睡眠呼吸暂停综合征效果满意，使AHI值降低，最低SaO2值升高，氧减指数降低，与治疗前比较，差异均有统计学意义（P〈0．01）。结论基于定位尺寸板口腔矫正器为下颌的精确定位提供了依据，并可有效改善患者的临床症状。

Investigation on Risk Factors of Cerebrocardiac Vascular Thrombotic Diseases in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Objective: To observe the risk factors of thrombosis in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods: From February 2001 to April 2003, 24 patients with moderate and severe OSAHS (OSAHS group) and 19 healthy adults (control group) were recruited. Their blood samples were drawn at 6∶00 and 16∶00 respectively for testing hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (Fng) and endothelin (ET).Results: There was a significantly higher hemocrit, WBV, Fng and ET as well as a significant shortening of PT and APTT at 6∶00 than that at 16∶00 in OSAHS group. However, there was no significant difference in all testing items between 6∶00 and 16∶00 in control group. The hemocrit, WBV, PAG, plasma Fng and ET were significantly higher, and PT and APTT were obviously shorter at 6∶00 in OSAHS group than those at 6∶00 in control group. A higher hemocrit, PAG, plasma Fng and ET, a longer PT and APTT were observed at 16∶00 in OSAHS group, compared with those at 16∶00 in control group.Conclusion: In OSAHS patients there were striking risk factors of thrombosis, which is more remarkable in the early morning than in the afternoon.

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI 5≥5-30, n=27, 'severe' (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

Adiponectin Ameliorated Pancreatic Islet Injury Induced by Chronic Intermittent Hypoxia through Inhibiting the Imbalance in Mitochondrial Fusion and Division

Objective This study aimed to assess the protective value of adiponectin(APN)in pancreatic islet injury induced by chronic intermittent hypoxia(CIH).Methods Sixty rats were randomly divided into three groups:normal control(NC)group,CIH group,and CIH with APN supplement(CIH+APN)group.After 5 weeks of CIH exposure,we conducted oral glucose tolerance tests(OGTT)and insulin released test(IRT),examined and compared the adenosine triphosphate(ATP)levels,mitochondrial membrane potential(MMP)levels,reactive oxygen species(ROS)levels,enzymes gene expression levels of Ant1,Cs,Hmox1,and Cox4 i1 which represented mitochondrial tricarboxylic acid cycle function,the protein and gene expression levels of DRP1,FIS1,MFN1,and OPA1 which represented mitochondrial fusion and division,and the protein expression levels of BAX,BCL-2,cleaved Caspase-3,and cleaved PARP which represented mitochondrial associated apoptosis pathway of pancreatic islet.Results OGTT and IRT showed blood glucose and insulin levels had no differences among the NC,CIH and CIH+APN groups(both P>0.05)at 0 min,20 min,30 min,60 min,120 min.However,we found that compared to NC group,CIH increased the ROS level,reduced ATP level and MMP level.The islets of CIH exposed rats showed reduced gene expression levels of Ant1,Cs,Hmox1,and Cox4 i1,decreased protein and gene expression levels of MFN1 and OPA1,increased protein and gene expression levels of DRP1 and FIS1,increased protein expression levels of cleaved Caspase-3 and cleaved PARP,with lower ratio of BCL-2/BAX at protein expression level.All the differences among three groups were statistically significant.APN treated CIH rats showed mitigated changes in the above measurements associated with islet injuries.Conclusion APN may ameliorate the pancreatic islet injury induced by CIH via inhibiting the imbalance in mitochondrial fusion and division.

Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux?

In a recent issue ot World Journal of Gastroenterology, Demeter et al., reported that in patients having both gastro-esophageal reflux disease （GERD） and obstructive sleep apnea （OSA）, there was a positive correlation between endoscopic findings of GERD and the number of apneas and hypopneas per hour, namely apnea hypopnea index. They proposed that the severity of OSA and GERD are parallel to each other. The study of Demeter and colleagues is very important, not only for assessing reflux-induced esophageal damage in OSA,

USE OF PULSE TRANSIT TIME AS A MEASURE OF AUTONOMIC AROUSALS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Objective To evaluate the feasibility of pulse transit time (PTT) arousals as an index of sleep fragmentation in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Individuals referred for evaluation of possible OSAHS underwent overnight polysomnography (PSG). Three conventional indices of sleep fragmentation [electroencephalography (EEG) arousals, apnea/hypopnea index (AHI), oxygen desaturation index (ODI)], PTT arousals, and Epworth sleepiness scale (ESS) were compared. Results PTT arousals were positively correlated with EEG arousals (r= 0.746, P<0.001), AHI (r= 0.786, P<0.001), and ODI (r= 0.665, P<0.001), respectively. But, both PTT arousals and EEG arousals had no correlation with ESS (r= 0.432, P=0.201; r= 0.196, P=0.591, respectively). Conclusion PTT arousals are correlated well with other standard measures estimating severity of OSAHS and potentially a non-invasive marker with which to measure the sleep fragmentation in patients with OSAHS.

间歇缺氧对幼龄大鼠血清中胰岛素样生长因子水平的影响

目的利用间歇缺氧条件下饲养的幼龄大鼠研究间歇缺氧与生长发育迟滞的关系。方法设计制造自动控制环境低氧装置，实现可控的间歇低氧。选取24只25日龄雌性SD大鼠，随机均分为对照组及轻、重度缺氧组。对照组正常喂养；其他两组饲养于间歇低氧箱内，每天循环间歇缺氧8h，共35d。根据预实验的结果确定间歇低氧的浓度和频度，使轻度组动物每小时发生低氧事件6次，平均最低血氧饱和度降至0．853；重度组动物每小时发生低氧事件24次，平均最低血氧饱和度降至0．776。实验前后均测量体质量及身长，并取静脉血用酶联免疫吸附测定法检测血清胰岛素样生长因子（insulin-likegrowthfactor，IGF）-1及胰岛素样生长因子结合蛋白（insulin-like growth factorbinding protein，IGFBP）-3表达水平。结果3组大鼠实验前后身长和体质量差异均无统计学意义（P值均〉0．05）。实验前各组血清IGF-1和IGFBP-3水平差异无统计学意义（P值均〉0．05），实验35d后，对照组、轻度缺氧组和重度缺氧组血清中IGF-1（元±s，下同）分别为（60．0±18．5）ng／ml、（40．6±9．9）ng／ml和（13．1±8．6）ng／ml，F=25．840，P〈0．01；IGFBP-3分别为（1．93-4-0．23）μg／ml、（1．39±0．30）μg/m1和（0．90-t-O．21）μg/ml，F=33．929，P〈0．01；差异均有统计学意义，且IGF-1及IGFBP-3水平随着缺氧程度加重而降低（P值均〈0．05）。结论模拟儿童睡眠呼吸暂停低通气综合征缺氧程度的间歇缺氧幼龄大鼠模型尚未引起大鼠体格发育迟缓，但造成大鼠血清中IGF-1、IGFBP-3水平下降并随着缺氧程度加重及血氧饱和度降低而降低。

Relationship between sleep apnea hypopnea syndrome and cardiovascular events in elderly Chinese snorers

OBJECTIVE: To investigate the relationship between sleep apnea hypopnea syndrome (SAHS) and some cardiovascular abnormalities in elderly snorers, as well as the effectiveness of nasal continuous positive airway pressure on those with SAHS. METHODS: With the use of polysomnography, 73 elderly snorers (older than 60 years) were examined and placed into either the SAHS group or the control group. Using ambulatory electrocardiogram (ECG) and blood pressure measurement, daily nocturnal rhythm of blood pressure, hypertension, heart rate variability, some arrhythmia and angina pectoris of coronary heart disease (CHD) were monitored and compared between the two groups before and after 5 - 7 days of treatment with nasal continuous positive airway pressure on the SAHS group. RESULTS: This study indicated a higher incidence (47.9%) of sleep apnea syndrome in elderly snorers and demonstrated that there was a significantly higher incidence of hypertension, disappearance in daily nocturnal rhythm of blood pressure, poor effectiveness of nitrate on angina pectoris of coronary heart disease, decreased heart rate variability during sleep, increased arrhythmia and lower pulse oxygen saturation (SpO(2)) levels in the SAHS group than in the control group. After nasal continuous positive airway pressure treatment during sleep, snoring control, significantly higher SpO(2) levels and lower index of apnea/hypopnea were achieved in the SAHS group; heart rate variability (HRV) and blood pressure day nocturnal rhythm were returned to normal levels. CONCLUSION: This research suggests that there is a close relationship between the development of sleep apnea syndrome and some cardiovascular diseases. Continuous positive nasal airway pressure is effective not only on SAHS but also on coexisting cardiovascular disorders.

Analysis of points selection pattern in acupuncture treatment of sleep apnea syndrome based on data mining

To explore the points selection pattern of acupuncture for sleep apnea syndromes by data mining technique. Methods： Clinical literature about acupuncture therapy for sleep apnea syndromes was derived from China National Knowledge Infrastructure （CNKI）, Wanfang Academic Journal Full-text Database （Wanfang）, Chongqing VIP Database （CQVIP）, PubMed and Science Direct between the time that databases were created and March 25th,2017. Relevant excel database was established and descriptive studies and association rules were analyzed. Results： The most frequently used point was Lianquan （CV 23） and the most frequently used meridian was the Stomach Meridian. The analysis of association rules showed that the clinical choice of acupuncture points was highly correlated, among which the combination of the highest degree of confidence and the highest degree of support was Shenmen （HT 7） and Sishencong （EX-HN 1）; Lieque （LU 7）, lianquan （CV 23） and Zhaohai （KI 6）. Conclusion： Acupuncture treatment of sleep apnea syndromes has specific selection rules of points, providing certain references for clinical and scientific research.

Influence of Auricular Plaster Therapy on Sleeping Structure in OSAS Patients

Objective: To evaluate the therapeutic effects of auricular plaster therapy for obstructive sleep apnea syndrome (OSAS) and the influence on sleeping structure. Methods: 45 OSAS patients were randomly divided into a treatment group of 30 cases and a control group of 15 cases for comparison of the changes in parameters of respiration and sleep at night. Results: The auricular plaster therapy significantly improved the hypoventilation index, respiratory disturbance index and other respiratory parameters as well as the sleeping parameters such as the time and rate of sleep at stage Ⅰ and Ⅱ, and the waking time and rate. Conclusion:Auricular plaster therapy may show good therapeutic effects for OSAS, and with the advantages of low cost and less side effects.