OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with sl...OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with slowing of the heart rate during apnea and tachycardia with subsequent arousal. Patients with permanent pacemakers may have reduced episodes of sleep apnea when their pacemaker rate is set faster than their spontaneous nocturnal heart rate. METHODS: We conducted a prospective, randomized, single-blind crossover trial of temporary atrial pacing in obstructive sleep apnea to reduce the apnea hypopnea index(AHI). Fifteen patients(age 60± 13 years, 12 men) with moderate to severe obstructive sleep apnea(AHI 34± 14) underwent insertion of an externalized atrial permanent pacing system via the left subclavian vein. Patients underwent overnight respiratory sleep studies in hospital, during atrial pacing at 75 beats/min, and with pacing turned off. The order of pacing mode was randomized, with crossover the subsequent night to the other mode. Patients were blinded to pacing mode, and the analysis of sleep recordings was blind to pacing mode. RESULTS: Pacing was tolerated without complications in all patients. Overnight physiologic pacing did not affect the AHI(pacing 39± 21/h vs. control 42± 21/h, p=0.23, 95% confidence interval- 9.3 to 2.5 for difference), desaturation time(pacing 3.8± 6.0% vs. control 3.5± 4.3% , p=0.70), or the minimum SaO2(pacing 75± 10% vs. control 77± 11% , p=0.38). There was a borderline significant reduction in circulatory time with pacing(pacing 23.4± 3.2 s vs. control 25.5± 4.4 s, p=0.09). CONCLUSIONS: Temporary atrial pacing does not appear to improve respiratory manifestations of obstructive sleep apnea. Permanent atrial pacing in this patient population does not appear to be justified.展开更多
多效复方固定制剂(Polypill)可用于心血管疾病风险的一级预防,但其降低胆固醇和血压的疗效尚未确定。本研究入选年龄≥50岁,无心血管疾病的参与者,进行一项随机、双盲、安慰剂对照的交叉试验,探讨Polypill降低胆固醇和血压的疗效,并与...多效复方固定制剂(Polypill)可用于心血管疾病风险的一级预防,但其降低胆固醇和血压的疗效尚未确定。本研究入选年龄≥50岁,无心血管疾病的参与者,进行一项随机、双盲、安慰剂对照的交叉试验,探讨Polypill降低胆固醇和血压的疗效,并与已发表的单一组分药物的疗效进行比较。参与者每天傍晚上按随机顺序服用Polypill(氨氯地平2.5mg,氯沙坦25.0mg,氢氯噻嗪12.5mg和辛伐他汀40.0mg)12周或安慰剂12周。每12周结束之后,观察参与者血压和低密度脂蛋白胆固醇水平的变化。86名参与者中的84名完成了试验。服用Polypill参与者的平均收缩压降低了17.9mm Hg(95% CI 15.7～20.1),平均舒张压降低9.8mm Hg(95% CI 8.1～11.5),低密度脂蛋白胆固醇降低1.4mmol/L(95% CI 1.2～1.6),降低的百分比分别12%、11%、39%。这与以往已发表的结果一致(分别降低18.4、9.7mm Hg和1.4mmol/L)。总之,Polypill能够降低低密度脂蛋白胆固醇和血压至预期水平,对预防心脏病和脑卒中发生发展有重要作用。展开更多
Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary o...Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary open angle glaucoma or ocular hypertension were included.Each patient received 0.5% timoloi and 0.5% betaxolol twice daily for four weeks in two phases. Between two courses of treatment there was four weeks wash out period. At the end of study the effect of these two drugs on intraocular pressure, mean arterial blood pressure,pulse rate,basic tear secretion and ocular symptoms were evaluated and statistically analyzed,using wilcoxon and chi-squar test.RESULTS:The study was performed on fourteen patients with baseline IOP of 26.7 ±1.5 mmHg.After four weeks treatmem,timoiol and betax-olol reduced IOP by 7.8±1.2mmHg or 29% and 6.1±1.3mmHg or 23%, respectively (P<0.001). The difference between two groups was significant(P<0.001). Mean arterial blood pressure was reduced with betaxolol and展开更多
文摘OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with slowing of the heart rate during apnea and tachycardia with subsequent arousal. Patients with permanent pacemakers may have reduced episodes of sleep apnea when their pacemaker rate is set faster than their spontaneous nocturnal heart rate. METHODS: We conducted a prospective, randomized, single-blind crossover trial of temporary atrial pacing in obstructive sleep apnea to reduce the apnea hypopnea index(AHI). Fifteen patients(age 60± 13 years, 12 men) with moderate to severe obstructive sleep apnea(AHI 34± 14) underwent insertion of an externalized atrial permanent pacing system via the left subclavian vein. Patients underwent overnight respiratory sleep studies in hospital, during atrial pacing at 75 beats/min, and with pacing turned off. The order of pacing mode was randomized, with crossover the subsequent night to the other mode. Patients were blinded to pacing mode, and the analysis of sleep recordings was blind to pacing mode. RESULTS: Pacing was tolerated without complications in all patients. Overnight physiologic pacing did not affect the AHI(pacing 39± 21/h vs. control 42± 21/h, p=0.23, 95% confidence interval- 9.3 to 2.5 for difference), desaturation time(pacing 3.8± 6.0% vs. control 3.5± 4.3% , p=0.70), or the minimum SaO2(pacing 75± 10% vs. control 77± 11% , p=0.38). There was a borderline significant reduction in circulatory time with pacing(pacing 23.4± 3.2 s vs. control 25.5± 4.4 s, p=0.09). CONCLUSIONS: Temporary atrial pacing does not appear to improve respiratory manifestations of obstructive sleep apnea. Permanent atrial pacing in this patient population does not appear to be justified.
文摘多效复方固定制剂(Polypill)可用于心血管疾病风险的一级预防,但其降低胆固醇和血压的疗效尚未确定。本研究入选年龄≥50岁,无心血管疾病的参与者,进行一项随机、双盲、安慰剂对照的交叉试验,探讨Polypill降低胆固醇和血压的疗效,并与已发表的单一组分药物的疗效进行比较。参与者每天傍晚上按随机顺序服用Polypill(氨氯地平2.5mg,氯沙坦25.0mg,氢氯噻嗪12.5mg和辛伐他汀40.0mg)12周或安慰剂12周。每12周结束之后,观察参与者血压和低密度脂蛋白胆固醇水平的变化。86名参与者中的84名完成了试验。服用Polypill参与者的平均收缩压降低了17.9mm Hg(95% CI 15.7～20.1),平均舒张压降低9.8mm Hg(95% CI 8.1～11.5),低密度脂蛋白胆固醇降低1.4mmol/L(95% CI 1.2～1.6),降低的百分比分别12%、11%、39%。这与以往已发表的结果一致(分别降低18.4、9.7mm Hg和1.4mmol/L)。总之,Polypill能够降低低密度脂蛋白胆固醇和血压至预期水平,对预防心脏病和脑卒中发生发展有重要作用。
文摘Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary open angle glaucoma or ocular hypertension were included.Each patient received 0.5% timoloi and 0.5% betaxolol twice daily for four weeks in two phases. Between two courses of treatment there was four weeks wash out period. At the end of study the effect of these two drugs on intraocular pressure, mean arterial blood pressure,pulse rate,basic tear secretion and ocular symptoms were evaluated and statistically analyzed,using wilcoxon and chi-squar test.RESULTS:The study was performed on fourteen patients with baseline IOP of 26.7 ±1.5 mmHg.After four weeks treatmem,timoiol and betax-olol reduced IOP by 7.8±1.2mmHg or 29% and 6.1±1.3mmHg or 23%, respectively (P<0.001). The difference between two groups was significant(P<0.001). Mean arterial blood pressure was reduced with betaxolol and
