Prospective study of the prevalence and co-morbidities of obstructive sleep apnea in active-duty army personnel in the three southernmost provinces of Thailand using questionnaire screening

Background: It is crucial for the army to know the prevalence of obstructive sleep apnea(OSA) syndrome in activeduty army personnel. Little information has been reported on the prevalence of OSA and clinical features in activeduty army personnel. This study was aimed to estimate the prevalence of snoring and risk of developing OSA in activeduty army personnel in Thailand and to identify the co-morbidities of OSA. In total, 1107 participants who were aged20–60 years and were deployed to the three southernmost provinces of Thailand were enrolled. All the participants completed the Phramongkutklao(PMK) Hospital OSA Questionnaire that was modified and validated from the Berlin Questionnaire and underwent physical examination. The participants were 1107 active-duty army personnel in the three southernmost provinces of Thailand, both males and females, aged 20–60 years.Methods: The PMK OSA Questionnaire was used to assess the risk of OSA together with interviewing for snoring,fatigue, falling asleep and day-time sleepiness. Physical examination of the neck, chest and hip circumference,and height was performed. Information concerning physical training, co-morbid diseases, smoking and alcoholic consumption was collected.Results: The prevalence of snoring was 58.5, and 4.8% met the PMK OSA Questionnaire criteria, thus indicating a high risk of OSA. The information obtained indicated that laryngopharyngeal reflux(LPR), current smoking and alcoholic consumption were significantly higher in the high-risk OSA group.Conclusions: Early detection and treatment of OSA in active-duty army personnel are imperative. Physical examination and polysomnography can be used to reveal the high-risk group. High body mess index(BMI), laryngopharyngeal reflux, current smoking and alcoholic consumption are modifiable factors for OSA and are avoidable. A policy to decrease the BMI and risk of LPR, as well as to stop smoking and alcoholic consumption, should be applied.

Reliability and Validity of Simplified Chinese STOP-BANG Questionnaire in Diagnosing and Screening Obstructive Sleep Apnea Hypopnea Syndrome

The main purpose of this study was to assess the reliability and validity of the simplified Chinese STOP-BANG Questionnaire(SBQ)as a diagnosing and screening tool for obstructive sleep apnea hypopnea syndrome(OSAHS).Two hundred and ten patients with suspected OSAHS were recruited in this study.The simplified Chinese SBQ was completed twice before and after polysomnography(PSG)monitoring.SPSS 20.0 was used to analyze the test-retest reliability,discriminant validity,comparative validity and predictive validity of the SBQ.Fourteen patients were excluded on account of fragmentary data,and valid 196 were divided into four groups:non-OSAHS group(n=28,14.29%),mild OSAHS group(n=28,14.29%),moderate OSAHS group(n=31,15.81%)and severe OSAHS group(n=109,55.61%).The test-retest coefficient tor the first four items was 0.810,0.679,0.775,0.963 respectively and the total score of the STOP questionnaire was 0.854.The analysis of discriminant validity revealed that there were significant differences among four groups in the total score of the SBQ and scores of item 1,3,7 and 8,which were also validated between patients with normal blood oxygen saturation and different degrees of hypoxemia.The SBQ evaluation showed low consistency with diagnostic gold standard PSG(k=0.3O3,P<0.05).When taking apnea hypopnea index(AHI)≥5/h,≥15/h and≥30/h as cut-offs to evaluate the SBQ predictive value,the areas under ROC curve were 0.77,0.81 and 0.78,the sensitivity was 90.48%,93.57%and 93.33%,and corresponding negative predictive values were 40.74%,66.67%and 85.19%,respectively.It was suggested that the simplified Chinese version of SBQ had good reliability,and could distinguish the severity of OSAHS.Despite its limited diagnostic accuracy,the SBQ can be considered as an ideal tool for screening OSAHS with superior predictive validity.

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

BACKGROUND Epidemiological studies have revealed an association between obstructive sleep apnea(OSA)and hypertension in the general population,while the association in military personnel was rarely investigated.AIM To examine the association between high risk for OSA and hypertension by phenotypes in military young adults.METHODS A total of 746 military personnel,aged 27.9 years,were included in the cardiorespiratory fitness and health in armed forces(CHIEF)-sleep study in Taiwan in 2020.Antihypertensive medications were not used by the subjects.High risk for OSA was assessed using the Berlin Questionnaire.Hypertension was defined using the 7th Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure(JNC 7)and the 2017 American College of Cardiology(ACC)/American Heart Association(AHA)guidelines.The cutoff levels of systolic and diastolic blood pressure(SBP and DBP)for the 2017 ACC/AHA-and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg,respectively.Hypertension phenotypes included isolated systolic and diastolic hypertension(ISH,high SBP only and IDH,high DBP only)and combined hypertension(both high SBP and DBP).Multivariable logistic regression analysis with adjustment for demographics,lifestyle and metabolic biomarkers.RESULTS The prevalence of high risk for OSA,JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%,5.2%and 22.0%,respectively.Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension(odds ratios(ORs))and 95%confidence intervals:2.82(1.07-7.42)and 7.54(1.10-51.54),although the probabilities of ISH and IDH were unaffected by a high risk for OSA(ORs:1.96 and 2.35,respectively,both P>0.05).In contrast,no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.CONCLUSION A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

理查兹-坎贝尔睡眠量表的护患一致性评估研究

目的:调查重症监护室病人自我报告的睡眠质量情况及每日评估睡眠的可行性,探究病人与护士分别使用理查兹-坎贝尔睡眠量表(Richards-Campbell Sleep Questionnaire,RCSQ)评估病人夜间睡眠质量的一致性。方法:选取2022年10月—2023年7月在我院重症监护室(ICU)住院的140例重症监护病人,采用RCSQ分别由护士对病人和病人对自身完成夜间睡眠质量评价,采用配对t检验、组内相关系数(ICC)、Bland-Altman图比较护患评价的一致性。结果:最终共收集到101例病人的727份睡眠报告,总睡眠平均分为52.28分,93例(92.1%)病人至少完成了1次报告,80例(79.2%)病人提供2次及以上的报告。101例病人共完成299次护患配对评估,ICC为0.31~0.59,相关性介于一般到中等,在睡眠深度、睡眠觉醒、重回睡眠、总分上,护士得分高于病人,差异有统计学意义(P<0.05)。结论:采用RCSQ评估睡眠可行性高。睡眠报告表明重症监护室病人睡眠质量低,护士倾向高估病人感知的睡眠质量。

伴中央颞区棘波自限性癫痫患儿睡眠状况及影响因素分析

目的分析伴中央颞区棘波的自限性癫痫(SeLECTS)患儿的主观睡眠状况及影响因素。方法选择2022年1月至2023年1月新乡医学院第一附属医院收治的67例SeLECTS患儿为病例组,选择同期来本院健康体检的151例健康儿童为对照组。应用儿童睡眠习惯问卷(CSHQ)评估2组儿童的睡眠质量,比较2组儿童睡眠质量不良发生率。根据CSHQ总分将病例组患儿分为睡眠质量良好组和睡眠质量不良组,比较2组儿童的性别、年龄、是否为首次发作、是否经过药物治疗、发作频率、非快速动眼(NREM)期放电指数,应用多因素logistic回归分析SeLECTS患儿睡眠质量不良的影响因素。结果病例组患儿CSHQ总分显著高于对照组(P<0.05)。病例组患儿就寝习惯不良、睡眠焦虑、异态睡眠评分显著高于对照组(P<0.05);病例组与对照组儿童睡眠持续时间不规律、睡眠呼吸障碍、白天嗜睡、夜醒、入睡潜伏期延长评分比较差异无统计学意义(P>0.05)。对照组和病例组儿童睡眠质量不良比例分别为53.0%(80/151)、80.6%(54/67);病例组睡眠质量不良比例显著高于对照组(χ^(2)=14.944,P<0.05)。睡眠质量良好组与睡眠质量不良组患儿的年龄和放电指数比较差异有统计学意义(P<0.05);睡眠质量良好组与睡眠质量不良组患儿的性别、是否服用抗癫痫药物、是否为首次发作、发作频率方面比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,NREM期放电指数增加是SeLECTS患儿出现睡眠质量不良的风险因素(比值比=25.297,95%置信区间4.583~139.634,P<0.05)。结论SeLECTS患儿较同年龄段儿童更容易存在睡眠问题,主要表现在睡眠焦虑、就寝习惯不良、异态睡眠3个层面。NREM期放电指数的增加是SeLECTS患儿出现睡眠质量不良的风险因素,NREM期放电指数越高的患儿越容易出睡眠质量不良。

社区居民新型冠状病毒感染与睡眠问题的关系

目的:了解新型冠状病毒感染(COVID-19)爆发期间居民的睡眠问题发生情况,分析睡眠问题发生是否与新型冠状病毒感染有直接关联。方法:选取4810名社区居民,包括1116例新型冠状病毒核酸检测阳性者(核酸检测阳性组)和3694例新型冠状病毒核酸检测阴性者(核酸检测阴性组),采用睡眠自评量表(SRSS,总分≥23阳性)、广泛性焦虑量表(GAD-7,总分≥5阳性)和病人健康问卷(PHQ-9,总分≥5阳性)进行评测。结果:SRSS量表、GAD-7量表和PHQ-9量表筛查阳性率分别为30.5%、33.7%和27.2%。Logistic回归分析显示,控制性别、年龄段、GAD筛查阳性、PHQ筛查阳性等因素后,核酸检测阳性与SRSS筛查阳性呈正向关联(OR=1.73,95%CI:1.48~2.03)。结论:核酸检测阳性组睡眠问题发生率高于核酸检测阴性组,睡眠问题发生与新型冠状病毒感染可能有关联。

高血压患者服药依从性、神经衰弱与睡眠质量的相关性分析

目的:分析高血压患者服药依从性、神经衰弱与睡眠质量的相关性。方法:选取2023年1月至2023年6月福清市海口镇中心卫生院内科高血压患者62例,分别采用匹兹堡睡眠质量指数(PSQI)、Morisky服药依从性评估量表(MMAS)、衰弱筛查量表(FRAIL)分别评估睡眠质量、服药依从性、神经衰弱情况,分析高血压患者Morisky评分、FRAIL评分与PSQI评分的相关性。结果:高血压患者Morisky评分、FRAIL评分与PSQI总分分别为(63.03±4.13)分、(2.13±1.22)分、(12.78±3.30)分。经Pearson分析,Morisky评分与PSQI各维度评分及总分呈负相关(P<0.05),FRAIL评分与PSQI各维度评分及总分呈正相关(P<0.05)。结论:高血压患者普遍服药依从性较低,且存在神经衰弱和睡眠问题,并且高血压患者的服药依从性、神经衰弱与睡眠质量密切相关,对此需提高患者的服药依从性,改善神经衰弱和睡眠质量。

右美托咪定对膝关节置换术患者麻醉疗效及短期睡眠的效果观察

目的:为提升膝关节置换术患者麻醉效果,降低麻醉影响,就右美托咪定麻醉药物的效果进行评价和分析。方法:选取2019年8月至2022年8月福建省三明市尤溪县中医医院收治的行膝关节置换术患者300例作为研究对象,按照随机数字表法分为对照组和观察组,每组150例。对照组采用利多卡因麻醉药物,观察组采用右美托咪定+利多卡因麻醉方案,比较2组的麻醉效果、睡眠质量、并发症等。结果:观察组麻醉后15 min、手术切皮后、术毕时镇静效果评分高于对照组,差异有统计学意义(P<0.05)。观察组患者匹兹堡睡眠质量指数低于对照组[(14.03±2.16)分],差异有统计学意义(P<0.05)。观察组麻醉后15 min、手术开始30 min、术毕时心率和平均动脉压低于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:右美托咪定能够提升膝关节置换术麻醉效果,可以保证短期睡眠质量,对血流动力学影响小,有较好的推广性。

舒适护理对乳腺癌化疗患者睡眠质量及生命质量的影响

目的:探讨乳腺癌化疗患者应用舒适干预对睡眠质量及生命质量的影响。方法:选取2021年6月至2023年6月厦门大学附属第一医院收治的乳腺癌患者74例作为研究对象,按照随机数字表法分为对照组和观察组,每组37例。对照组接受常规护理,观察组应用舒适干预。从睡眠质量、失眠严重指数以及生命质量方面观察2组患者。结果:在舒适干预的应用下,观察组匹兹堡睡眠质量指数(PSQI)评分以及世界卫生组织生命质量测定简表(WHOQOL-BREF)评分均优于对照组,差异有统计学意义(P<0.05)。在舒适干预的应用下,观察组失眠严重指数评分低于对照组,差异有统计学意义(P<0.05)。结论:舒适干预能提高乳腺癌化疗患者睡眠质量,有利于患者预后,提高患者生命质量。

Sleep breathing disorders in female population of Dubai, UAE

PURPOSE: United Arab Emirates (UAE) is part of the GCC countries and ranks 18 on 2007 WHO list of the fattest countries with 68.3% of its citizens with an unhealthy weight. The WHO data in 2008 state that the prevalence of overweight in UAE is 71%, while it is 61% in the UK, 54% in Germany, and 45% in France. The increasing overweight and obesity in the UAE are closely related to high social-economic development. Accordingly, the medical authority has observed that the rates of hypertension and diabetes mellitus type 2 appear to be one of the highest rates worldwide. We presume that the increase prevalence of obesity in the UAE would be linked to the increase in prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in women followed up in the primary health care (PHC) setting in Dubai and the relationship between obesity and sleep apnea in females in the UAE. DESIGN: Prospective observational community-based survey. SETTING: 20 primary health centers in Dubai. PARTICI-PANTS: Consecutive female patients who were older than 14 years, regardless of the reason of their visit. METHODS: In this prospective survey, trained medical nurse administered the Berlin Questionnaire (which includes questions about self-reported snoring, witnessed apneas, daytime sleepiness, hypertension, and obesity) to a consecutive random sample of female patients in the age group older than 14 years, attending the PHC center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire, individuals were classified into high-risk and low-risk groups for OSAS. RESULTS: Based on the responses and measurement of the Berlin Questionnaire of 704 female subjects studied, 137 respondents met the criteria for the high-risk scoring. This gives a prevalence rate of 19.5% while the remainders of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 ± 11.73 years. The highest prevalence was noticed between age group 51 to 60 years. 70% of the high risk group patients had Body Mass Index (BMI) ≥30 kg/m2 and nearly 75% of the low risk group had BMI 2 and the Mean BMI was 33.59 ± 6.44 kg/m2. CONCLUSIONS: One in five women in Dubai, UAE is at high risk of having OSAS. Awareness by the primary care medical community about this disorder in females should be increased so that the patients would benefit from proper evaluation and treatment of OSAS.

The COVID-19 Pandemic’s Consequences on Medical Students’ Sleep Patterns and Technology Addiction

Introduction: Sleep disorders are an important public health problem. In the case of young people, and especially students, due to both academic demands and social life, many situations can lead to sleep disturbances. Aim: To evaluate the quality of sleep in medical students and its relationships with technology addiction. Background: Current research indicates that the technology usage by the university students determined an impaired sleep quality and a shortened sleep duration. Method: One hundred eleven second-year students attending medical education were included in the study. Its dependent variable was low sleep quality and independent variables were behavioral factors, smartphone addiction, computer usage, watching TV and other questioned features. A sleep questionnaire to assess the sleep quality in medical students was provided to medical students. This study was conducted in the University of Medicine and Pharmacy of Iasi, Romania. Results: The majority of medical students had shorter, irregular sleep duration and consumed energizing and stimulating drinks. Conclusions: In COVID-19 pandemic, the students’ tech addiction associated with the behavioral factors was found as risk factors for poor sleep quality.

Patients presenting for colonoscopy: A great opportunity to screen for sleep apnea

AIM To discover the prevalence and the feasibility of screening for obstructive sleep apnea(OSA) in patients presenting for routine colonoscopy.METHODS Adult patients having a colonoscopy for routine indications at our outpatient endoscopy center were eligible if they did not carry a diagnosis of OSA or had not had a prior sleep study.All patients were administered the Berlin questionnaire prior to the procedure.Mallampati,neck circumference,height,weight,and BMI were obtained for each patient.Patients were observed for any drops in oxygen saturation < 92% or the presence of snoring for > 10 s.Patients were determined to be high-risk if they met at least 2 of the 3 symptom categories for the Berlin questionnaire.RESULTS A total of 60 patients were enrolled and completed the study; mean age was 56 years(range 23-72 year).Twenty-six patients had a positive Berlin questionnaire(43.3%),31 patients had a negative Berlin questionnaire(51.6%) and 3 patients had an equivocal result(5.0%).Patients with a positive Berlin questionnaire were more likely to be of increased weight(mean 210.5 lbs vs mean 169.8 lbs,P = 0.003),increased BMI(33.0 kg/m2 vs 26.8 kg/m2,P = 0.0016),and have an increased neck circumference(38.4 cm vs 35.5 cm,P = 0.012).Patients with a positive Berlin questionnaire were more likely to have a drop in oxygen saturation < 92%(76.9% vs 36.4%,P = 0.01).Patients with snoring were more likely to have a positive Berlin questionnaire(8/9 patients vs 1/31 patients with negative Berlin questionnaire; P = 0.0045).CONCLUSION Risk for OSA is extremely common in a population presenting for a routine colonoscopy,and screening at the time of a colonoscopy offers an excellent opportunity to identify these patients.

吉林省婴幼儿睡眠现状及睡眠问题影响因素的横断面研究

目的 了解吉林省婴幼儿睡眠状况及睡眠问题发生的危险因素。方法 选取吉林省8个地级市和1个自治州的1 080例0~3岁的健康婴幼儿作为研究对象。采用自制调查问卷收集研究对象的一般资料,采用简明婴幼儿睡眠问卷了解婴幼儿睡眠情况,并应用多因素logistic回归分析探讨睡眠问题发生的危险因素。结果 婴幼儿睡眠问题的总检出率为38.24%(413/1 080)。4~11月龄、12~24月龄、25~36月龄组睡眠总时长均高于推荐睡眠总时长(P<0.05)。多因素logistic回归分析显示,足月出生、主要监护人文化程度较高、白天活动强度较大是婴幼儿睡眠问题的保护因素(P<0.05),而服用维生素D频次较低、夜间喂养频繁和母亲打鼾是睡眠问题发生的危险因素(P<0.05)。结论 吉林省4月龄以上婴幼儿睡眠总时长均高于推荐睡眠总时长,但睡眠问题发生率较高。睡眠问题的发生与多种因素有关;加强对早产儿的随访,对主要监护人进行婴幼儿睡眠知识宣教,坚持规律地补充维生素D,有利于减少婴幼儿睡眠问题的发生。

原发性遗尿症儿童情绪和行为异常的相关因素分析

目的分析原发性遗尿症(PNE)儿童情绪和行为异常的相关影响因素。方法收集2020年1月至2022年12月于郑州大学第一附属医院和新乡医学院第一附属医院儿童遗尿门诊就诊的251名PNE儿童的相关信息,包括一般资料、长处和困难问卷(SDQ)及儿童睡眠调查表。依SDQ得分分为得分异常组(ASG)(≥20分)和得分正常组(NSG)(<20分)。结果PNE患儿情绪和行为异常发生率为43.4%(109/251)。ASG女性和青春期(13~16岁)占比高于NSG(P<0.05)。两组患儿家庭照顾者受教育程度、学习成绩及睡眠呼吸紊乱得分比较差异有统计学意义(P<0.05)。ASG患儿大便异常、具有家族遗传史、严重遗尿症及膀胱功能障碍占比高于NSG(P<0.05)。ASG患儿情绪症状、品行问题、多动症状、同伴交往得分高于NSG(P<0.05)。多因素回归分析显示,性别、年龄、照顾者受教育程度、学习成绩、大便异常、家族史、儿童睡眠量表总分为PNE患儿情绪和行为异常的影响因素(P<0.05)。结论PNE患儿情绪和行为异常的发生率较高,女性、青春期、照顾者受教育程度、学习成绩和睡眠差、家族史和便秘等是其影响因素。

Effect of Mindfulness-based Cognitive Training on Sleep Quality and Mindfulness Cognitive Level of College Students

Objective:To study the effect of mindfulness-based cognitive training on sleep quality and mindfulness cognitive level of college students who score below the critical value of sleep disorders.Methods:The subjects were freshmen of a university in Shanghai who had scored below the critical value of sleep disorders.They were divided into the control group and experimental group by a random number table method,with 35 students in each group.No intervention was provided in the control group,and the mindfulness-based cognitive training(1 hour per day,5 days per week for 8 consecutive weeks)was performed in the intervention group.Eight weeks later,the Pittsburgh Sleep Quality Index(PSQI)and Five Facet Mindfulness Questionnaire(FFMQ)scores were compared between the two groups before and after the intervention for changes in the sleep quality and mindfulness cognitive level.Results:The sleep quality and daytime dysfunction were significantly improved,the sleep latency was shortened,the sleep duration was prolonged(P<0.05),and the mindfulness level of the subjects was significantly improved(P<0.05)in the intervention group compared with the control group.Conclusion:Mindfulness-based cognitive training can significantly improve the sleep quality of college students who scored below the critical value of sleep disorders.Furthermore,its psychological mechanism may be associated with the improvement of the mindfulness level of college students.

围绝经期女性睡眠及相关影响因素分析

目的调查北京市大兴区围绝经期患者睡眠及相关影响因素分析。方法对178例围绝经期女性进行更年期问卷调查,调查内容包括人口学特征、改良Kupperman评分、焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数量表(PSQI),采用Spearman相关性分析各因素对围绝经期女性睡眠的影响。结果178例患者年龄40~60岁,平均49岁。改良Kupperman评分:轻度37.1%(66/178),中度52.8%(94/178),重度10.1%(18/178)。SAS评分:无症状82.6%(147/178),轻度14.6%(26/178),中度2.8%(5/178),重度0(0/178)。SDS评分:无症状82.0%(146/178),轻度14.0%(25/178),中度3.4%(6/178),重度0.6%(1/178)。PSQI评分:无睡眠障碍52.8%(94/178),睡眠障碍47.2%(84/178),睡眠质量及睡眠时间所占比例更高,分别为74.7%(133/178)及70.8%(126/178)。以PSQI评分为因变量,改良Kupperman评分分级、SAS评分、SDS评分、是否为肥胖苦恼、压力程度为自变量,经Spearman相关性分析显示,改良Kupperman评分分级、SAS评分、SDS评分、为肥胖苦恼、压力与PSQI评分均呈正相关(r=0.450、0.340、0.336、0.161、0.250,P<0.05)。改良Kupperman评分分级与PSQI各因子(除睡眠药物外)评分呈正相关(P<0.05);SAS评分、SDS评分与PSQI各因子(除睡眠药物及睡眠效率外)评分呈正相关(P<0.05)。年龄40~50岁及51~60岁患者的PSQI评分比较差异无统计学意义(P>0.05);是否绝经与PSQI评分比较差异无统计学意义(P>0.05)。结论围绝经期睡眠问题与围绝经期症状、焦虑、抑郁、为肥胖而苦恼及压力程度呈正相关,改善睡眠问题质量从改善围绝经期症状、心理疏导、适当运动等方面着手,尽早干预,提升其睡眠质量,从而预防因长期睡眠问题而引起的身心疾病。

术前睡眠质量对腹腔镜下胆囊切除术结局影响

目的 探讨术前病人睡眠质量与腹腔镜下胆囊切除术结局之间的关联,为改善该类病人术后结局提供相关指导意见。方法 采用随机数字表法,选取2021年6月至2022年1月在安徽医科大学附属巢湖医院就医的需腹腔镜下胆囊切除术病人,收集病人基线信息,此外术前住院期间对该部分病人采用匹兹堡睡眠质量指数评价表进行睡眠质量评估,依据量表评估准则,将最终得分≥7纳入到低睡眠质量组(n=23),得分<7分纳入高睡眠质量组(n=41)。同时对两组病人术后结局进行评估,包括术后镇痛泵的使用、术后并发症、术后高血压评分及术后首次下床时间,综合评判确定睡眠质量与术后结局之间的关联。结果两组病人基线资料,年龄、性别、文化程度、家庭住址等均差异无统计学意义,两组病人均衡可比。结局指标结果显示高质量睡眠组术后未发生呕吐38人高于低质量睡眠组17人,高质量睡眠组术后首次活动时间(22.91±17.38)h低于低质量睡眠组术后首次活动时间(34.61±20.03)h(P<0.05),logistic回归分析调整了性别、年龄、文化程度、家庭住址、术前血压分级等多项指标后,低睡眠质量组与高睡眠质量组相比,术后更容易发生呕吐症状且恢复时间更长[OR=33.37,95%CI:(1.46,762.65);β=0.19,95%CI:(0.02,0.36)];在此基础上,针对手术时长、气腹时间以及术前镇静剂使用情况等混杂因素进行调整,结果仍然与之前保持一致。结论 胆囊切除术病人术前良好的睡眠质量可以有效地缓解腹腔镜下手术对病人带来的负面影响,包括病人术后病人的恢复情况以及并发症。因此临床上针对病人睡眠问题采取合理有效措施,改善病人的睡眠质量,可以对手术结局产生良好的影响。

重度阻塞性睡眠呼吸暂停风险预测模型的建立与评价

目的本研究通过列线图构建普通人群罹患重度阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)风险的预测模型,探究重度OSA的独立危险因素,指导临床早期诊断和治疗。方法回顾性纳入1656名患者,并按7∶3将其随机分为训练集与验证集。根据呼吸暂停低通气指数>30次/h将患者分为重度OSA与非重度OSA组。用最小绝对收缩、选择算子(the least absolute shrinkage and selection operator,Lasso)和逻辑回归(logistic regression,LR)对所有备选预测因子进行进一步筛选,基于LR建立重度OSA患者的预测模型,在验证集中对列线图模型进行验证,使用C指数、校准曲线和决策曲线分析(Decision Curve Analysis,DCA)评价列线图的区分能力、校准性和临床有效性。此外,我们将该模型与临床上广泛使用的问卷,包括STOP-Bang、柏林问卷通过受试者工作曲线进行了比较。结果通过单因素及多因素Logistic回归分析和Lasso Logistic回归确定吸烟、憋气病史、BMI、腰围、打鼾病史、Epworth嗜睡量表(Epworth sleepiness scale,ESS)作为纳入列线图的预测因子。该模型曲线下面积(area under the curve,AUC)=0.795(95%CI:0.769~0.820),Hosmer-Lemeshow检验提示模型校准良好(χ2=3.942,P=0.862)。DCA曲线显示,该模型对患者是有益的,当阈值概率>18%时,该模型对患者的净获益优于柏林问卷或STOP-Bang量表。临床影响曲线(Clinical Impact Curve,CIC)分析显示了该预测模型的临床有效率,当阈值概率大于82%预测评分概率值时,预测模型判定为重度OSA高风险人群与实际罹患重度OSA人群高度匹配,证实该预测模型临床有效率较高。结论相较于临床常用量表,本研究建立的模型在预测重度OSA方面具有更好的识别能力,可应用于普通人群的OSA早期筛查,有助于及早识别重度OSA,保护患者免受OSA的严重后果,减轻社会负担。

月龄0~35的300名婴幼儿睡眠状况研究

目的分析0~35月龄婴幼儿的睡眠状况,以了解婴幼儿常见的睡眠问题及可能的影响因素。方法选取2022年6月至2023年5月于昆明市儿童医院儿童保健科门诊进行健康体检的0~35月龄健康婴幼儿为研究对象,由家长完成简明婴幼儿睡眠问卷(brief infant sleep questionnaire,BISQ)。采用单因素及Logistic回归分析婴幼儿的睡眠状况及影响睡眠问题的因素。结果婴幼儿主要睡床方式为与父母同床睡(85.6%),平均睡眠时间白天为(3.51±1.75)h,夜间为(8.84±1.41)h,全天为(12.37±2.07)h。各年龄组白天和全天总睡眠时间随着年龄增加而逐渐减少(P<0.05)。27.7%的婴幼儿可能存在睡眠时长不足;睡眠问题发生率为79%,入睡困难发生率最高为75.3%,其次夜醒(72.2%)和睡眠节律紊乱(19.7%);278例(92.7%)为非自主入睡。单因素分析显示月龄及入睡方式与婴幼儿睡眠问题发生有关(P<0.05);Logistic回归分析提示小月龄及非自主入睡是睡眠问题发生的危险因素。结论婴幼儿睡眠问题发生率高,与月龄小及非自主入睡有关,建议早期培养婴幼儿自主入睡,加强婴幼儿睡眠习惯培养的宣教,减少婴幼儿睡眠问题的发生。

住院医师对阻塞性睡眠呼吸暂停低通气综合征的认知及态度

目的:阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)可引起机体多脏器的损伤,有潜在致死性,对患者身体健康和生活质量产生严重影响。住院医师在OSAHS的筛查中起着重要的作用。本研究旨在评估住院医师对OSAHS的认知和态度水平,为疾病的干预和诊疗提供依据。方法:于2021年12月1日至2022年12月1日对某教学医院的住院医师进行横断面调查。采用阻塞性睡眠呼吸暂停知识及态度问卷(Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire,OSAKA)评估住院医师在处理OSAHS患者方面的知识、态度和信心。结果:在接受问卷的200名住院医师中,183名(91.5%)完成了问卷调查。所有住院医师的OSAKA问卷的知识量表得分为13.12±2.46。内科住院医师知识得分高于其他科住院医师(13.46±2.22 vs 12.33±2.83,P<0.05),有过呼吸科轮转经历的住院医师知识得分高于没有在呼吸科轮转经历的住院医师(13.46±2.35 vs 12.69±2.56,P<0.05)。所有住院医师的OSAKA问卷的态度/信心量表得分为3.64±0.62。60.7%的住院医师认为OSAHS作为一种临床疾病是极其重要的。72.7%的住院医师有信心识别OSAHS患者,但只有50.3%的对管理OSAHS患者有信心,仅42.6%的住院医师有信心管理持续正压通气治疗的患者。知识与态度、信心水平之间呈弱正相关关系。结论:多数住院医师意识到OSAHS的临床重要性,但对OSAHS的诊断和管理知识、信心水平仍存在不足,需要加强对其管理OSAHS患者的培训。