Updates on the relation of weight excess and reproductive function in men： sleep apnea as a new area of interest

Obesity has a negative effect on male reproductive function. It is associated with low testosterone levels and alteration in gonadotropin secretion. Male obesity has been linked to reduced male fertility. Data regarding the relation of obesity to sperm parameters are conflicting in terms of the nature and magnitude of the effect. New areas of interest are emerging that can help explain the variation in study results, such as genetic polymorphism and sleep apnea. Sleep disorders have been linked to altered testosterone production and hypogonadism in men. It was also correlated to erectile dysfunction. The relation of sleep disorders to male fertility and sperm parameters remains to be investigated. Men with hypogonadism and infertility should be screened for sleep apnea. Treatment of obesity and sleep apnea improves testosterone levels and erectile function.

Relationship between brain—derived neurotrophic factor and cognitive function of obstructive sleep apnea/hypopnea syndrome patients

Objective:To determine the relationship between the blood serum brain-derived neurotrophic factor（BDNF） level and cognitive function deterioration in patients with obstructive sleep apnea/ hypopnea syndrome（OSAHS）,and to explore the possible mechanism of cognitive impairment. Methods:Twenty-eight male OSAHS patients and 14 normal males（as controls） were enrolled in the study.Polysomnography and the Montreal cognitive assessment（MoCA） were conducted. The blood serum BDNF levels were measured using ELISA.Results:The OSAHS group had significantly decreased blood serum BDNF levels compared with the control group（t=-10.912, P=0.000）.The blood serum BDNF level of the subjects was significantly positively associated with the MoCA score（r=0.544,P=0.000）,significantly negatively associated with the apneahypopnea index（AHI） and shallow sleep（S1+S2）（AHI:r=-0.607,P=0.000;S1+S2:r =-0.768,P= 0.000）,and significantly positively associated with the lowest SaO2（LSO）,slow wave sleep（S3+S4）, and rapid eye movement sleep（REM）（LSO:r=0.566,P = 0.000;S3+S4:r=0.778,P=0.000;REM: r=0.575,P=0.000）.Conclusions:OSAHS patients have significantly decreased blood serum BDNF levels compared with the control.Nocturnal hypoxia as well as the deprivation of slow wave sleep and REM may lead to the decreased serum BDNF level of OSAHS patients.This decreased blood serum BDNF level may contribute to the cognitive impairment in OSAHS.

Neuropsychological Functioning after Adenotonsillectomy in Children with Obstructive Sleep Apnea:A Meta-analysis

The present study aimed to investigate the efficacy of adenotonsillectomy(AT) for children with obstructive sleep apnea syndrome(OSAS) and the improvement of their cognitive function. Studies on cognitive performance of OSAS children treated with or without AT were identified by searching the Pubmed, EMBASE and Cochrane library. A meta-analysis was conducted to analyze the literature. The random-effects model was used to evaluate 11 eligible studies using an inverse-variance method. The neuropsychological test results of 4 cognitive domains(general intelligence, memory, attention-executive function and verbal ability) were obtained and analyzed. By comparison of cognitive function between OSAS children and healthy controls, the effect sizes of each domain were achieved as follows: general intelligence, –0.5(P<0.0001); memory, –0.18(P=0.02); attention-executive function, –0.21(P=0.002); and verbal ability, –0.48(P=0.0006). The effect sizes of general intelligence, memory, attention-executive function, and verbal ability after AT compared to baseline level were –0.37(P=0.008), –0.36(P=0.0005), –0.02(P=0.88), and –0.45(P=0.009), respectively. Comparing the cognitive ability between OSAS children after AT and healthy controls showed that the effect sizes were –0.54(P=0.0009), –0.24(P=0.12), –0.17(P=0.35), and –0.45(P=0.009) in general intelligence, memory, attention-executive function, and verbal ability, respectively. Our results confirmed that OSAS children performed worse than healthy children in terms of the 4 cognitive domains investigated. After 6–12 months of observation, significant improvement in attention-executive function and verbal ability were found in OSAS children treated with AT compared to their baseline level; restoration of attention-executive function and memory were observed in OSAS children after AT in comparison to healthy controls. Further rigorous randomized controlled trials should be conducted to obtain definitive conclusions.

Effects of sleep deprivation on cognitive functions

Sleep deprivation （SD） is a common condition that afflicts many people in modem life. Deficits in daytime perfor- mance due to SD are experienced universally. Recent evidence indicates that SD causes impairments in cognitive functions. However, the mechanisms that SD impairs cognitive functions are not clear. This review will focus on the behavioral and neural effects of SD with the aim to elucidate the possible mechanisms of SD-induced deterioration in cognitive functions and to identify directions for future research.

Investigation of the usefulness of zaleplon at two doses to induce afternoon-sleep under noise interference and its effects on psychomotor performance and vestibular function

Background:Military operation personnel often suffer from sleep difficulty because of their work requirements.In this study,we investigated the efficacy of zaleplon at two doses to induce afternoon-sleep under noise interference and its effects on psychomotor performance and vestibular function; we subsequently established the optimal dosage regimen for military operation personnel.Methods:Twenty-two healthy young male volunteers were recruited for the study.Eight subjects took 10 mg or 15 mg of zaleplon and placebo alternately and then were exposed to noise.Changes in polysomnography(PSG) indices,including sleep latency(SL),sleep efficiency(SE) and sleep structure,were recorded after drug administration.After awakening,the volunteers' subjective judgments of sleep quality and sleepiness were measured.Eight volunteers underwent 3 psychomotor performance tests at a one-week interval,and the psychomotor performance tests were conducted before and after taking zaleplon and placebo.Six volunteers participated in the vestibular function test session,and parameters,including optokinetic nystagmus(OKN),vestibular ocular reflex(VOR),visualvestibular ocular reflex(VVOR) and vestibular ocular reflex fixation suppression(VOR-Fix),were detected by the same experimental design as described above.The data of sleep observations were subjected to one-way variance analysis.Results:Compared with the placebo group,SL was shortened significantly,and the scores of subjective sleep quality and sleep depth were clearly increased in the zaleplon 10 mg group(P<0.05).Moreover,the SE and the percent of REM(rapid eye movement) sleep were increased remarkably in the zaleplon 15 mg group(P<0.01).Furthermore,the SE,percent of REM sleep and scores of subjective sleep depth in the zaleplon 15 mg group were significantly higher than in the zaleplon 10 mg group(P<0.05).The psychomotor performance did not change significantly after ingestion of 10 mg or 15 mg of zaleplon,whereas the OKN and VOR gains were lower in the two dose groups of zaleplon(P<0.05) and restored to normal 3h after drug ingestion.Conclusion:Zaleplon is an ideal hypnotic for military personnel,and its hypnotic efficiency is dose-related under noise interference; a 15 mg dose of zaleplon could provide significantly better sleep than a 10 mg dose of zaleplon.

Effects of sleep bruxism on functional and occlusal parameters:a prospective controlled investigation

This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigation was to analyze the relationship between sleep bruxism and several functional and occlusal parameters. The null hypothesis of this study was that there would be no differences among sleep bruxism subjects and non-sleep bruxism controls regarding several functional and occlusal parameters. Fifty-eight sleep bruxism subjects and 31 controls participated in this study. The diagnosis sleep bruxism was based on clinical criteria of the American Academy of Sleep Medicine. Sixteen functional and occlusal parameters were recorded clinically or from dental study casts. Similar to the recently published retrospective pilot study, with a mean slide of 0.77 mm （s.d., 0.69 mm） in the sleep bruxism group and a mean slide of 0.4 mm （s.d., 0.57 mm） in the control group, the evaluation of the mean comparison between the two groups demonstrated a larger slide from centric occlusion to maximum intercuspation in sleep bruxism subjects （Mann-Whitney U-test; P=O.O08）. However, following Bonferroni adjustment, none of the 16 occlusal and functional variables differed significantly between the sleep bruxism subjects and the non-sleep bruxism controls. The present study shows that the occlusal and functional parameters evaluated do not differ between sleep bruxism subjects and non-sleep bruxism subjects. However, as the literature reveals a possible association between bruxism and certain subgroups of temporomandibular disorders, it appears advisable to incorporate the individual adaptive caoacitv of the stomatognathic svstem into future investigations.

The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus

The aim of this study was to determine the relationship between sleep condition and autonomic nervous function of women in their 70s with type 2 diabetes mellitus by analyzing the activity counts (AC) on actigraphs and heart rate variability (HRV). Ten healthy women in their 30s to 40s as control and four women patients with type 2 diabetes in their 70s wore the electrocardiograph and an actigraph for 24 hours while keeping a diary of activities, including their sleep and food intake. The Pittsburgh Sleep Quality Index was used to assess subjective sleep conditions. The subjective sleeping results were significantly correlated with those measured by the AC and HRV. However, AC and HRV correlation pattern showed different activity in the patients with type 2 diabetes mellitus. The quality of sleep of those with chronic diabetes was not good even if their HbA1c was well controlled. Furthermore, their automatic nervous function was different from the control group. The sleeping hours of patients with type 2 diabetes were shorter or longer than those of healthy women. Ultimately, this study maintains that it is important to examine automatic nervous functions using objective examination index during the early stage of diabetes mellitus.

Immune function in Japanese schoolchildren with sleep-disordered breathing: a preliminary study with analyses of salivary markers

The aim of this study was to assess the prevalence of sleep-disordered breathing (SDB) symptoms among primary schoolchildren, and to objectively determine the influence of SDB on the intra-oral environment through the analysis of saliva. A questionnaire survey was conducted among approximately 400 children from a primary school in Hiroshima. Parents were asked to complete the questionnaire and provide their contact information if they allowed the collection of saliva samples from their children. Thirty-eight chil- dren agreed to participate in the saliva study. Habit- ual snoring and cessation of breathing during sleep were found in approximately 8% and 1% of children, respectively. The present results showed significant correlations between snoring and mouth breathing. A significant association between excessive daytime sle- epiness (EDS) and learning problems was found. Fur- thermore, among children between the ages of 7 and 12 years, those with EDS and learning problems tended to be older. SDB symptom scores were statisti- cally significant only in relation to EDS. The present study also demonstrated significantly higher levels of salivary IgA and cortisol in children with sleep-re- lated disorders. The present study determined the pre- valence and characteristics of SDB among Japanese primary schoolchildren and their effects on the oral environment. Approximately 8% of primary school- children with habitual snoring might need to be care- fully monitored for SDB symptoms and immune sta- tus to ensure proper psychological and physical deve- lopment.

Sleep,immunity and inflammation in gastrointestinal disorders

Sleep disorders have become a global issue,and discovering their causes and consequences are the focus of many research endeavors.An estimated 70 million Americans suffer from some form of sleep disorder.Certain sleep disorders have been shown to cause neurocognitive impairment such as decreased cognitive ability,slower response times and performance detriments.Recent research suggests that individuals with sleep abnormalities are also at greater risk of serious adverse health,economic consequences,and most importantly increased all-cause mortality.Several research studies support the associations among sleep,immune function and inflammation.Here,we review the current research linking sleep,immune function,and gastrointestinal diseases and discuss the interdependent relationship between sleep and these gastrointestinal disorders.Different physiologic processes including immune system and inflammatory cytokines help regulate the sleep.The inflammatory cytokines such as tumor necrosis factor,interleukin-1(IL-1),and IL-6 have been shown to be a significant contributor of sleep disturbances.On the other hand,sleep disturbances such as sleep deprivation have been shown to up regulate these inflammatory cytokines.Alterations in these cytokine levels have been demonstrated in certain gastrointestinal diseases such as inflammatory bowel disease,gastro-esophageal reflux,liver disorders and colorectal cancer.In turn,abnormal sleep brought on by these diseases is shown to contribute to the severity of these same gastrointestinal diseases.Knowledge of these relationships will allow gastroenterologists a great opportunity to enhance the care of their patients.

Therapeutic effect of melatonin on pediatric functional dyspepsia: A pilot study

AIM: To study the effectiveness of melatonin vs placebo in children with functional dyspepsia(FD).METHODS: The study was conducted as a double blind, randomized, placebo controlled crossover trial. Subjects were aged 8-17 years and diagnosed with FD based on Rome Ⅲ criteria. All subjects had failed to respond to 4 wk of acid suppression. Subjects receive a continuous two weeks of placebo and a continuous two weeks of melatonin in an order blinded to the participant and the study team. A Global Clinical Score was obtained to assess changes in abdominal pain. Pain was self-reported to be worse(grade 1), no change(grade 2), moderate improvement(grade 3), good(grade 4; minimal pain and not interfering with daily activities), or excellent(grade 5; no pain), respectively. A positive clinical response was defined as a grade 3 or greater response. Subjects wore an actigraph to assess sleep during a one week baseline period and during each treatment period. Subjects' sleep latency and total sleep time were recorded throughout the duration of the study. RESULTS: Fourteen subjects were enrolled and 12 completed the study. One withdrew prior to starting both melatonin and placebo and the other before starting melatonin. A positive clinical response(grade 3-5) was achieved in 42% of subjects on melatonin vs 50% of subjects on placebo(NS). Effect size was calculated and revealed a Cohen's D of 0.343 which demonstrates a medium effect favoring placebo. A grade 4 or grade 5 response was seen in 4 patients on melatonin and 5 patients on placebo. Baseline sleep parameters were in the healthy range with the longest sleep latency being just over 20 min(mean 7.46 ± 8.53 min) and the shortest sleep duration just over 7 h(mean 10.09 ± 2.72 h). The mean latency did not differ between periods of treatment with melatonin as compared to placebo(4.48 ± 6.45 min vs 3.58 ± 4.24 min; NS). The mean sleep duration did not differ between periods of treatment with melatonin as compared to placebo(9.90 ± 3.53 h vs 9.41 ± 2.70 h; NS).CONCLUSION: Melatonin does not appear to have efficacy in relieving pain in unselected pediatric FD. Future studies should consider FD subtypes, pathophysiologic mechanisms, and baseline sleep disturbances.

维生素D联合右佐匹克隆治疗老年慢阻肺合并睡眠障碍疗效及对认知功能的保护作用研究

目的探讨维生素D联合右佐匹克隆治疗老年慢阻肺合并睡眠障碍疗效及对认知功能的保护作用。方法收集140例老年慢阻肺合并睡眠障碍患者作为研究对象,随机分为对照组和研究组,每组70例。对照组给予右佐匹克隆治疗,研究组给予维生素D联合右佐匹克隆治疗。采用匹茨堡睡眠质量指数(PSQI)评估睡眠质量。采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估认知功能。比较两组睡眠障碍临床疗效、睡眠监测指标、PSQI评分、认知功能和神经营养因子水平。结果研究组睡眠障碍治疗总有效率高于对照组(92.8%vs 80.0%,P<0.05)。睡眠监测指标显示,研究组治疗后总睡眠时间长于对照组[(371.77±27.22)min vs(334.71±28.80 min)],觉醒时间和觉醒次数少于对照组[(32.51±3.89)min vs(46.88±7.32)min,(1.36±0.51)次vs(3.11±0.77)次,P<0.05]。治疗前、治疗后1月和治疗后3月时,不同时间点PSQI评分差异有统计学意义(P<0.05),研究组与对照组PSQI评分变化趋势差异有统计学意义,研究组降低更明显[(15.78±2.02)分vs(15.67±2.05)分,(9.31±2.01)分vs(11.60±2.04)分,(7.60±0.95)分vs(9.40±1.21)分,P<0.05]。研究组治疗后MMSE评分和MoCA评分高于对照组[(28.24±0.92)分vs(26.24±1.53)分,(27.88±1.23)分vs(25.21±1.02)分],脑源性神经生长因子(BDNF)和神经生长因子(NGF)水平高于对照组[(672.29±66.60)pg/mL vs(626.89±55.46)pg/mL,(31.49±5.62)pg/mL vs(23.75±5.18)pg/mL,P<0.05]。结论维生素D联合右佐匹克隆治疗老年慢阻肺合并睡眠障碍疗效良好,而且对认知功能具有一定程度的保护作用。

Detection of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome using mismatch negativity

In this experiment, 97 patients with obstructive sleep apnea hypopnea syndrome were divided into three groups （mild, moderate, severe） according to minimum oxygen saturation, and 35 healthy subjects were examined as controls. Cognitive function was determined using the mismatch negativity paradigm and the Montreal Cognitive Assessment. The results revealed that as the disease worsened, the mismatch negativity latency was gradually extended, and the amplitude gradually declined in patients with obstructive sleep apnea hypopnea syndrome. Importantly, mismatch negativity latency in severe patients with a persistent time of minimum oxygen saturation 〈 60 seconds was significantly shorter than that with a persistent time of minimum oxygen saturation 〉 60 seconds. Correlation analysis revealed a negative correlation between minimum oxygen saturation latency and Montreal Cognitive Assessment scores. These findings indicate that intermittent night-time hypoxemia affects mismatch negativity waveforms and Montrea Cognitive Assessment scores. As indicators for detecting the cognitive functional status of obstructive sleep apnea hypopnea syndrome patients, the sensitivity of mismatch negativity is 82.93%, the specificity is 73.33%, the accuracy rate is 81.52%, the positive predictive value is 85.00%, the negative predictive value is 70.21%, the positive likelihood ratio is 3, and the negative likelihood ratio is 0.23. These results indicate that mismatch negativity can be used as an effective tool for diagnosis of cognitive dysfunction in obstructive sleep apnea hypopnea syndrome patients.

聚焦解决模式护理对COPD患者呼吸功能、睡眠质量及症状改善的影响

目的研究聚焦解决模式护理对慢性阻塞性肺疾病(COPD)患者呼吸功能、睡眠质量及症状改善的影响。方法选取2020年1月至2022年5月收入的COPD患者90例,按随机数字表法均分2组,对照组接受常规护理,观察组接受聚焦解决模式护理,比较2组的临床干预效果。结果干预后,观察组各症状改善时间包括喘憋[(2.51±0.87)d]、咳嗽[(4.11±1.02)d]及肺部啰音时间[(4.65±1.32)d]均短于对照组,差异有统计学意义(P<0.05)。出院6个月显示观察组治疗依从性各项得分包括运动锻炼[(82.33±2.31)分]、改变生活方式[(85.18±2.24)分]、饮食[(88.25±2.42)分]、服药[(90.59±2.74)分]均高于对照组,差异有统计学意义(P<0.05)。2组干预前R5与R20值比较,差异无统计学意义(P>0.05);干预后,观察组R5[(0.39±0.06)kPa·L^(-1)·s^(-1)]与R20[(0.23±0.03)kPa·L^(-1)·s^(-1)]测定值均低于对照组,差异有统计学意义(P<0.05)。2组干预前PSQI量表评分比较,差异无统计学意义(P>0.05);干预后,观察组该项评分[(9.31±1.05)分]低于对照组,差异有统计学意义(P<0.05)。结论聚焦解决模式护理能够更好地控制COPD患者的临床症状,改善其呼吸功能及睡眠质量,值得临床推广借鉴。

首发老年抑郁症病人睡眠纺缍波与抑郁、焦虑和认知功能的关系

目的 分析首发老年抑郁症病人睡眠纺缍波(sleep spindle, SS)与抑郁、焦虑和认知功能的关系。方法 回顾性选取本院2021年1月至2022年1月接诊的40例首发老年抑郁症病人为老年组,40例青中年抑郁症病人为青中年组,40例老年健康体检者为健康组,比较3组SS缺失率、异常率、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)-17评分、MoCA评分的差异。分析不同性别、不同认知功能亚组SS缺失率、异常率。结果 老年组SS缺失率(57.50%)、异常率(62.50%)均高于青中年组(32.50%、2.50%)和健康组(35.00%、2.50%)(P<0.05)。老年组HAMA评分、HAMD-17评分与青中年组比较差异无统计学意义(P>0.05);老年组、青中年组HAMA评分、HAMD-17评分均高于健康组(P<0.05)。老年组MoCA评分均低于青中年组和健康组(P<0.05),青中年组MoCA评分低于健康组(P<0.05)。老年组不同性别病人SS缺失率比较差异无统计学意义(P>0.05);青中年组女性病人SS缺失率显著低于中青年男性和老年女性病人(P<0.05)。老年组中认知功能障碍亚组SS缺失率、异常率高于无认知功能障碍亚组(P<0.05)。结论 首发老年抑郁症病人SS缺失率、异常率相对较高,SS与认知功能存在一定的关系。

Cognitive and Emotional Factors Related to Obstructive Sleep Apnea Diagnoses: A Brief Review

Sleep apnea is a clinical condition characterized by cessation of breathing in the sleeper due to pharyngeal airway closure. The reduction in air exchange results in decreased cerebral blood circulation with consequential behavioral deficits cognitively and emotionally. Untreated sleep apnea is associated with chronic illnesses of depression, cardiovascular disorder, obesity and diabetes mellitus. Measured cognitive behavior before and following CPAP treatment demonstrates the cognitive deficit as the effectiveness of CPAP treatment. Emotional factors related to sleep apnea diagnosis and adherence to treatment are facilitated in patients with cognitive behavior therapy (CBT) interventions by sleep specialists. This is a brief review paper that presents findings about cognition and emotional factors related to sleep apnea. This is a brief review paper.

Forced Inspiratory Flow Volume Curve in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Objective: Obstructive sleep apnea-hypopnea syndrome (OSA) is a disease of obstructive apnea or hypopnea caused by a repeated partial or complete collapse of the upper airway during sleep. The inspiratory part of the flow-volume curve (F-V curve) can be used as an auxiliary means to evaluate upper airway obstruction in adults. This study is to evaluate the ability of the F-V curve to predict the OSA and explore inspiratory indicators related to airway obstruction during sleep. Methods: There were 332 patients included in this cross-sectional study, who were accompanied by snoring, daytime sleepiness and other symptoms, with suspicion of OSA. According to the nocturnal polysomnography, the subjects were distributed into mild to moderate OSA group, severe OSA group and non-OSA group. A pulmonary function test was used to collect the subjects’ spirometry and F-V curves. Results: There was no significant difference in a variety of indices derived from the F-V curve between OSA and normal subjects, including 25% inspiratory flow rate, middle inspiratory flow rate, 75% inspiratory flow rate, peak flow rate, and forced inspiratory flow rate in the first second. The pulmonary function parameters were significantly correlated with the weight, age and sex of the subjects. Conclusion: These findings suggest that the inspiratory curve of pulmonary function cannot evaluate the upper airway abnormalities in patients with obstructive apnea-hypopnea syndrome.

Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder

The purpose of this case study was to examine the changes before and after improvements of the subjective sleep status of Mr A, a 40-year-old man diagnosed with pre-diabetes and a sleep disorder. Data were collected using a Holter monitor for 24 hours a day for 3 days to assess autonomic nervous activity by recording bed-time and waking time activity (activity counts: ACs). Mr. A kept a diary of activities and completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The study revealed that subjective sleeping hours correlated almost precisely with those measured by the actigraph and as described in the diary. Both the parasympathetic and sympathetic nervous system activities were imbalanced. However, no correlation was observed between the ACs and autonomic nervous activity. Subjective sleep state according to the PSQI score improved remarkably by dietary and exercise therapy from 13 to 3 points, after six months, with corresponding high level sleep satisfaction level. Significant correlations were observed between ACs and high-frequency spectral power of R-R intervals, and between ACs and the low-frequency/high frequency ratio of spectral power of R-R intervals. Although Mr. A’s sleep satisfaction level has improved, the autonomic nervous system activity remained different from that of healthy people.

腺样体扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征患儿 免疫 功能及睡眠结构的影响

目的探讨腺样体扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿免疫功能及睡眠结构的影响。方法选择2020年11月至2022年6月在郑州大学附属儿童医院治疗的94例OSAHS患儿为观察组,另选择同期在本院体检的健康儿童80例作为对照组。观察组患儿均采用双侧扁桃体完整切除术联合鼻内镜下腺样体切除术。采用多导睡眠监测系统检测观察组患儿术前及出院时睡眠结构变化。观察组患儿于术前、术后1个月及术后6个月,对照组于体检日抽取静脉血,采用免疫比浊法测定血清中IgA、IgG和IgM水平,流式细胞仪检测血浆中CD3^(+)、CD4^(+)、CD8^(+)细胞百分比,并计算CD4^(+)/CD8^(+)。结果与术前比较,观察组患儿出院时非快速眼动睡眠(NREM)1期比例、呼吸暂停低通气指数和阻塞性呼吸暂停低通气指数降低,NREM 2期比例、NREM 3期比例、快速眼动睡眠(REM)比例、睡眠效率和最低血氧饱和度增加,REM时间延长(P<0.05)。观察组患儿术前血清IgA、IgG及IgM水平显著高于对照组(P<0.05),观察组患儿术后1个月血清IgA、IgG及IgM水平显著低于对照组(P<0.05),观察组患儿术后6个月血清IgA、IgG及IgM水平与对照组比较差异无统计学意义(P>0.05)。观察组患儿术后1、6个月血清IgA、IgG及IgM水平显著低于术前(P<0.05),术后6个月血清IgA、IgG及IgM水平显著高于术后1个月(P<0.05)。观察组患儿术前CD3^(+)、CD4^(+)细胞比例及CD4^(+)/CD8^(+)显著低于对照组,CD8^(+)细胞比例显著高于对照组(P<0.05);观察组患儿术后1个月CD3^(+)、CD4^(+)细胞比例及CD4^(+)/CD8^(+)显著低于对照组,CD8^(+)细胞比例显著高于对照组(P<0.05);观察组患儿术后6个月CD3^(+)、CD4^(+)、CD8^(+)细胞比例及CD4^(+)/CD8^(+)与对照组比较差异无统计学意义(P>0.05)。观察组患儿术后1个月CD3^(+)、CD4^(+)细胞比例及CD4^(+)/CD8^(+)显著低于术前,CD8^(+)细胞比例显著高于术前(P<0.05);观察组患儿术后6个月CD3^(+)、CD4^(+)细胞比例及CD4^(+)/CD8^(+)显著高于术前,CD8^(+)细胞比例显著低于术前(P<0.05);观察组患儿术后6个月CD3^(+)、CD4^(+)细胞比例及CD4^(+)/CD8^(+)显著高于术后1个月,CD8^(+)细胞比例显著低于术后1个月(P<0.05)。结论腺样体扁桃体切除可有效延长OSAHS患儿REM时间,提高睡眠效率,改善患儿睡眠结构和机体紊乱的免疫调节功能,其机体免疫功能在腺样体扁桃体切除后有短暂的降低,随后可逐渐恢复至正常水平。

阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构、效率与认知功能的相关性研究

目的探讨睡眠结构、效率对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的认知功能的影响。方法回顾性分析自2022年1月至2022年6月于承德医学院附属医院经多导睡眠监测(polysomnography,PSG)诊断为OSAHS共52例的临床资料,并选取同期于该中心行多导睡眠监测后除外OSAHS诊断的30例作为健康对照组。安排OSAHS患者及健康受试者在进行多导睡眠监测前填写蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、Epworth嗜睡量表(Epworth sleepiness scale,ESS)。分析患者年龄、性别、微觉醒指数、睡眠后觉醒时间(Wake-time After Sleep Onset,WASO)、睡眠效率、N3期占总睡眠时间的百分比(N3/TST%)和REM期占总睡眠时间的百分比(REM/TST%)等指标与MoCA量表结果之间的相关性。以MoCA总分为因变量进行多因素逐步回归来分析认知功能下降的预测指标。结果1.OSAHS组患者与健康对照组相比,最低脉氧饱和度水平(LaSpO_(2))减低(Z=-7.290,P<0.001),AHI(Z=-7.394,P<0.001)、ESS评分(Z=-2.558,P<0.05)升高。2.与对照组相比,OSAHS患者在MoCA总分(Z=-4.405,P<0.001)、视空间与执行能力(Z=-2.818,P=0.005)、注意(Z=-2.695,P=0.007)、语言(Z=-2.476,P=0.013)、抽象(Z=-2.328,P=0.020)、延迟回忆能力(Z=-2.978,P=0.003)方面均有所下降,而命名(P=0.182)、定向能力(P=0.181)无统计学意义。3.MoCA总分与LaSpO_(2)(r=0.624,P<0.001)、N3/TST%(r=0.425,P<0.001)、REM/TST%(r=0.541,P<0.001)呈正相关,与AHI(r=-0.714,P<0.001)、微觉醒指数(r=-0.641,P<0.001)、ESS(r=-0.527,P<0.001)呈负相关。受试者的视空间与执行能力与AHI(r=-0.541,P<0.001)、ESS(r=-0.470,P<0.001)呈负相关,与LaSpO_(2)(r=0.403,P<0.001)、REM/TST%(r=0.468,P<0.001)呈正相关;注意能力与AHI(r=-0.459,P<0.001)、微觉醒指数(r=-0.562,P<0.001)呈负相关;抽象能力与REM/TST%(r=0.400,P<0.001)呈正相关;延迟回忆能力与AHI(r=-0.498,P<0.001)、ESS(r=-0.469,P<0.001)、微觉醒指数(r=-0.483,P<0.001)呈负相关,与LaSpO_(2)(r=0.441,P<0.001)呈正相关。4.通过多元逐步回归分析,以MoCA总分为因变量,以BMI、AHI、最长呼吸暂停/低通气时间、LaSpO_(2)、ESS、睡眠效率、微觉醒指数、REM/TST%、N1/TST%、N3/TST%、WASO为自变量进行多因素逐步回归分析,发现AHI(β=-0.482,P<0.001)、REM/TST%(β=0.441,P<0.001)、最长呼吸暂停/低通气时间(β=0.328,P<0.001)、LaSpO_(2)(β=0.235,P=0.033)是认知功能下降的重要预测指标。结论OSAHS患者更容易发生认知功能异常,OSAHS患者的认知功能下降与低氧、REM睡眠期减少及微觉醒次数增加相关。OSAHS患者的睡眠效率下降与认知功能障碍相关。AHI、REM/TST%、最长呼吸暂停/低通气时间、LaSpO_(2)是认知功能下降的重要预测指标。

应用二维斑点追踪技术评估阻塞性睡眠呼吸暂停综合征患者右心室功能

目的 :应用二维斑点追踪技术(2D-STI)技术评价阻塞性睡眠呼吸暂停综合征(OSAS)患者右心室收缩功能的改变。方法:纳入经多导睡眠监测确诊OSAS患者49例为OSA组,根据睡眠呼吸暂停低通气指数(AHI)进行分度,轻度12例,中度9例,重度28例,同期选择年龄、性别相匹配无打鼾史的健康志愿者40例为对照组。应用常规超声心动图和2D-STI技术测量所有受试者的超声心动图参数,比较两组参数的差异。结果:与对照组相比,OSA组右房容积指数(RAVI)显著增大(P=0.04),三尖瓣口舒张晚期血流峰值速度(A-tv)显著升高(P=0.025),三尖瓣口舒张早期血流峰值速度/三尖瓣口舒张晚期血流峰值速度(E/A)减低(P=0.047),组织多普勒(TDI)三尖瓣环舒张早期峰值速度(Ea)显著减低(P=0.014)。OSA组右心室整体纵向应变(RV-GLS)(P=0.036)和右心室游离壁纵向应变(RV-FWLS)(P=0.039)显著减低。轻中度组与重度组比较,重度组RV-GLS(P=0.002)、RV-FWLS(P=0.030)显著减低,重度组RVFW基底段纵向应变(P=0.033)、心尖段纵向应变(P=0.028)显著减低,两组RVFW中间段纵向应变差异无统计学意义(P>0.05)。结论:OSAS患者右心室舒张和收缩功能均出现异常改变,2D-STI可早期发现OSAS患者右心室收缩功能的改变,且随着病情严重程度的增加,收缩功能呈减低趋势,右心室纵向应变可作为临床重要的参数,为临床治疗和预后提供有价值的信息。