Mandibular advancement devices in the treatment of obstructive sleep apnea and snoring in community dental care: A pilot study on self-reported sleep quality

Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are proven to be efficient in treating mild to moderate sleep apnea and snoring. We examined patients who had been treated in Community Dental Care with a titrable Herbst-type MAD. The aim of the study was to evaluate the quality of sleep based on self report. Methods: A questionnaire was mailed to patients (n = 184) who had received treatment for OSA or snoring between 2007 and2010 inthe Helsinki Health Centre Oral Care Unit. The patients were referred to the clinic for primary treatment, or because another treatment modality had failed. Results: Of the respondents (n = 142, 78.4%), OSA had been diagnosed in 74%, while the MAD was applied for snoring to the remaining. Among all respondents, 78.4% had worn the MAD at least three nights per week. With the MAD in situ, sleep was felt significantly less disrupted (p < 0.001) and more restorative (p < 0.001), and snoring was markedly reduced (p < 0.001). Daytime tiredness was also markedly less frequent (p < 0.001). Conclusions: Treatment with a MAD improved perceived sleep quality and awoke alertness in mild and moderate OSA patients and in snorers. This study supports such treatment to be initiated and monitored in community dental care.

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.

Risk factors and management countermeasures for obstructive sleep apnea hypoventilation syndrome in children

BACKGROUND Obstructive sleep apnea hypoventilation syndrome(OSAHS)in children is a sleep respiratory disorder characterized by a series of pathophysiologic changes.Statistics in recent years have demonstrated an increasing yearly incidence.AIM To investigate the risk factors for OSAHS in children and propose appropriate management measures.METHODS This study had a case–control study design.Altogether,85 children with OSAHS comprised the case group,and healthy children of the same age and sex were matched at 1:1 as the control group.Basic information,including age,sex,height,weight and family history,and medical history data of all study participants were collected.Polysomnography was used to detect at least 8 h of nocturnal sleep.All participants were clinically examined for the presence of adenoids,enlarged tonsils,sinusitis,and rhinitis.RESULTS The analysis of variance revealed that the case group had a higher proportion of factors such as adenoid grading,tonsil indexing,sinusitis,and rhinitis than the control group.CONCLUSION A regression model was established,and glandular pattern grading,tonsil indexing,sinusitis,and pharyngitis were identified as independent risk factors affecting OSAHS development.

Burdened breaths:The influence of depression on obstructive sleep apnea

Depression and metabolic syndrome could exacerbate the risks of the other,leading to a series of severe coexisting conditions.One notable comorbidity that must be mentioned is obstructive sleep apnea(OSA).Current studies suggested that depression increases susceptibility to OSA.As the prevalence of depression rises,it becomes critical to prevent and manage its complications or comorbidities,including OSA.Predictive models,non-invasive electroencephalogram moni-toring,genetic research,and other promising technologies are being applied to the prevention,diagnosis,and personalized treatment of depression and OSA.

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.

Relationship between obstructive sleep apnea hypopnea syndrome and cardiovascular disorders in adult snorers

Objective：To investigate the relationship between sleep apnea hypopnea syndrome（OSAHS） and some cardiovascular disorders in adult habitual snorers as well as the effectiveness of nasal continuous positive airway pressure（NCPAP） on those with OSAHS. Methods： With the use of polysomnography, 262 adult habitual snorers were examined and divided into the OSAHS group and the Non-OSAHS group （control）. Using ambulatory electrocardiogram and blood pressure measurement, daily nocturnal rhythm of blood pressure, hypertension, heart rate variability, some arrythmias and angina pectoris of coronary heart disease were monitored and compared between the two groups, before and after 14 days of treatment with NCPAP in the OSAHS group. Results.This study indicated a higher incidence （39.6%） of OSAHS in adult snorers and demonstrated that there was a significantly higher incidence of hypertension, disappearance of the daily nocturnal rhythm of blood pressure, poor effectiveness of nitrate on angina pectoris of coronary heart disease, decreased heart rate variability during sleep, increased arrythmias and lower SpO2 levels in the OSAHS group than in the Non-OSAHS group. After NCPAP treatment during sleep, snoring control, significantly higher SpO2 and lower apnea hypopnea indices were achieved in the OSAHS group; heart rate variability and daily nocturnal rhythm of blood pressure returned to normal levels. Conclusion：The results of this research suggested that there was a close relationship between the development of OSAHS and some cardiovascular disorders. Furthermore, NCPAP treatment was effective not only on OSAHS but also on coexisting cardiovascular disorders.

A simplified two-piece mandibular advancement appliance for obstructive sleep apnea

Nowadays mandibular advancement appliances (MA- As) are available and distributed widely in the field of dentistry for the treatment of snoring and ob- structtive sleep apnea (OSA). However, a few stud- ies discussed temporomandibular joint (TMJ) discom- fort and masticatory muscle stiffness during wearing MAAs are found. A new appliance that we introduced in this pilot study has shown significant jaw move- ment and could diminish TMJ and masticatory side effects.

Relation between Obstructive Sleep Apnea-Hypopnea Syndrome and Glaucoma in a Sub-Saharan African Population

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a frequent pathology worldwide whose main mechanism is a complete or partial obstruction of the upper airway. One of the pathophysiological mechanisms described in primary open-angle glaucoma is that hypoxia in the optic nerve progressively destroys the retinal cells leading to the onset and/or aggravation of glaucoma. The aim of the study was to evaluate the risk of OSA in patients with primary open-angle glaucoma. Methodology: An analytical study was conducted from January to May 2020 at the UHC. After obtaining ethical clearance, 112 patients including 50 glaucoma patients (44.64%) and 62 in the control group were enrolled. Sociodemographic and clinical data were collected from the medical records of the participants, with or without glaucoma, and a questionnaire was administered and a clinical examination performed. The STOP BANG score was used to determine the risk level of OSAHS. Statistical analyses were performed using Epi Info version 7.2. Results: A female predominance was found (60%) in the glaucoma group with a mean age of 55 ± 17 years against 49 ± 18 years in the control group. The high risk of OSAHS was more associated with glaucoma patients. In glaucoma patients, an association was found between high risk of OSAHS and snoring (OR = [1.43 - 849.53];p = 0.029) as well as insomnia (OR = [1.36 - 482.86];p = 0.030). Conclusion: High risk of OSAHS was found in participants with chronic open-angle glaucoma. Signs of OSAHS should be sought in chronic open-angle glaucoma as it may be a factor in its progression.

Severe obstructive sleep apnea and long distance truck driving: A case report

Introduction: Untreated sleep disorders can increase driver crash risk by up to 7 fold, and truck drivers have a variety of risk factors for sleep disorders. Measures currently used to identify drivers at risk depend predominantly on the ability of the driver to identify and report themselves as sleepy. Methods: This case report presents a 54 year old long distance truck driver who participated in a case-control study, underwent at home breathing monitoring and was followed up with an in-depth interview. Results: Self-reported measures did not identify this driver as at risk of sleepiness or sleep apnea;yet he was subsequently diagnosed with severe sleep apnea using an at home monitor and polysomnography. Conclusions: Self-assessment of risk factors is insufficient as a screen for sleep apnea. General practitioners are in an ideal position to identify potential sleep apnea sufferers and can initiate the enquiry process that leads to diagnostic testing.

A Nomogram for Predicting the Likelihood of Obstructive Sleep Apnea to Reduce the Unnecessary Polysomnography Examinations

Background：The currently available polysomnography （PSG） equipments and operating personnel are facing increasing pressure,such situation may result in the problem that a large number of obstructive sleep apnea （OSA） patients cannot receive timely diagnosis and treatment,we sought to develop a nomogram quantifying the risk of OSA for a better decision of using PSG,based on the clinical syndromes and the demographic and anthropometric characteristics.Methods：The nomogram was constructed through an ordinal logistic regression procedure.Predictive accuracy and performance characteristics were assessed with the area under the curve （AUC） of the receiver operating characteristics and calibration plots,respectively.Decision curve analyses were applied to assess the net benefit of the nomogram.Results：Among the 401 patients,73 （18.2%） were diagnosed and grouped as the none OSA （apnea-hypopnea index [AHI] 〈5）,67 （16.7%） the mild OSA （5 ≤ AHI 〈 15）,82 （20.4%） the moderate OSA （15 ≤ AHI 〈 30）,and 179 （44.6%） the severe OSA （AHI ≥ 30）.The multivariable analysis suggested the significant factors were duration of disease,smoking status,difficulty of falling asleep,lack of energy,and waist circumference.A nomogram was created for the prediction of OSA using these clinical parameters and was internally validated using bootstrapping method.The discrimination accuracies of the nomogram for any OSA,moderate-severe OSA,and severe OSA were 83.8%,79.9%,and 80.5%,respectively,which indicated good calibration.Decision curve analysis showed that using nomogram could reduce the unnecessary polysomnography （PSG） by 10% without increasing the false negatives.Conclusions：The established clinical nomogram provides high accuracy in predicting the individual risk of OSA.This tool may help physicians better make decisions on PSG arrangement for the patients referred to sleep centers.

Obstructive Sleep Apnea Syndrome Phenotyping by Cluster Analysis: Typical Sleepy, Obese Middle-aged Men with Desaturating Events are A Minority of Patients in A Multi-ethnic Cohort of 33% Women

Objective Several clinical obstructive sleep apnea syndrome(OSAS)phenotypes associated with heterogeneous cardiovascular risk profiles have been recently identified.The purpose of this study was to identify clusters amongst these profiles that allow for the differentiation of patients.Methods This retrospective study included all moderate-to-severe OSAS patients referred to the sleep unit over a 5-year period.Demographic,symptom,comorbidity,polysomnographic,and continuous positive airway pressure(CPAP)adherence data were collected.Statistical analyses were performed to identify clusters of patients.Results A total of 567 patients were included(67%men,54±13 years,body mass index:32±7 kg/m2,65%Caucasian,32%European African).Five clusters were identified:less severe OSAS(n=172);healthier severe OSAS(n=160);poorly sleeping OSAS patients with cardiometabolic comorbidities(n=87);younger obese men with sleepiness at the wheel(n=94);sleepy obese men with very severe desaturating OSAS and cardiometabolic comorbidities(n=54).Patients in clusters 3 and 5 were older than those in clusters 2 and 4(P=0.034).Patients in clusters 4 and 5 were significantly more obese than those in the other clusters(P=0.04).No significant differences were detected in terms of symptoms and comorbidities.Polysomnographic profiles were very discriminating between clusters.CPAP adherence was similar in all clusters but,among adherent patients,daily usage was more important in cluster 1(less severe patients)than in cluster 5.Conclusion This study highlights that the typical sleepy obese middle-aged men with desaturating events represent only a minority of patients in our multi-ethnic moderate-to-severe OSAS cohort of 33%females.

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.

低龄阻塞性睡眠呼吸暂停患儿围手术期危险因素分析

目的探讨低龄阻塞性睡眠呼吸暂停(OSA)患儿围手术期的危险因素。方法将2020年1月~2022年12月昆明医科大学附属儿童医院耳鼻咽喉头颈外科收治的86例低龄OSA患儿,按术后治疗情况分为普通病房组与重症监护(ICU)病房组,比较分析两组患儿的临床资料。结果ICU病房组患儿的病程、手术时间长于普通病房组,阻塞性呼吸暂停低通气指数(OAHI)、氧减指数(ODI)、术中出血量大于或多于普通病房组,平均血氧饱和度(mean oxygen saturation,MSaO_(2))、最低血氧饱和度(lowest oxygen saturation,LSaO_(2))低于普通病房组,扁桃体大小分级、手术方式,以上参数两组差异比较有统计学意义(P<0.05);而性别、年龄、体重、身高、体重指数(BMI)、腺样体大小分级比较,差异比较无统计学意义(P>0.05)。两组患儿的OAHI值与MSaO_(2)、LSaO_(2)呈显著负相关(r=-0.676、-0.724),与扁桃体大小分级、ODI、手术时间、术中出血量呈显著正相关(r=0.242、0.967、0.321、0.446,P<0.05),而与病程无显著相关性(r=0.172,P>0.05)。多元线性回归分析显示LSaO_(2)、ODI是患儿病情严重程度的独立危险因素(P<0.05)。结论低龄OSA患儿的病情严重程度决定围手术期的风险,并受手术方式的影响。LSaO_(2)、ODI作为独立危险因素应得到临床医师的广泛重视。

张忠德运用平调五脏法辨治阻塞性睡眠呼吸暂停低通气综合征的经验

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见的睡眠呼吸障碍性疾患,易引起多器官、多系统损害;可归属中医学的“鼾证”。全国名中医张忠德教授以平调五脏法辨治阻塞性睡眠呼吸暂停低通气综合征,强调五脏“失衡”的发病机理;认为肺气失于宣降是OSAHS的发病之基础;“脾胃失于运化,痰湿内生”是OSAHS的关键致病因素,“心肾之阳虚,肝血之不足”是OSAHS的发病之根本。发病过程中五脏之间阴阳气血此消彼长,从而导致疾病的发展。辨证治疗以“平”为度,通过“平调”的思维,以“健脾、宣肺、温心肾、养肝血”为治则,五脏同调,从而达到各脏器间的动态平衡,起到治疗疾病的目的。

Clinical assessment and polysomnographic study of sleep apnea in a Chinese population of snorers

Background and objectives： While an increasing number of people who snore are seeking medical con- sultations, the clinical characteristics of snorers are rarely reported. The aim of this study is to characterize the clinical and polysomnographic features in a population of snorers. Methods： A total of 490 subjects were examined retro- spectively. The clinical history, Epworth Sleepiness Scale （ESS） scores, physical examination, and full-night poly- somnography （PSG） data were obtained for all the subjects. The correlations between the neck circumference, waist circumference, ESS scores, body mass index （BMI）, and apnea-hypopnea index （AHI） of obstructive sleep apnea （OSA） patients were explored. The gender and age differences in OSA patients were analyzed. Results： OSA was diagnosed in 84.7% of the sample, with 21.2% of the patients having a mild form, 15.4% having a moderate form, and 63.4% having a severe form of OSA. The ESS scores, neck circumference, waist circumference, and BMI were posi- tively correlated with AHI in OSA patients. The ESS scores and BMI were negatively correlated with nadir oxygen saturation （SaO2）. A greater number of men than women exhibited moderate to severe forms of the disease. OSA affects the work of males more commonly compared with females. Nocturia was a more common complaint in elderly OSA patients. Heart diseases coexisted more frequently with OSA in elderly patients. Conclusions： In a population of snorers, OSA is the most common condition identified. The ESS scores and BMI were well correlated with the severity of the disease. Men had a more severe form of OSA than women. Nocturia frequently occurred in elderly OSA patients, as did the coexistence of heart disease.

阻塞性睡眠呼吸暂停综合征患者糖代谢情况分析

目的分析男性阻塞性睡眠呼吸暂停综合征(OSAS)患者糖代谢情况,探究OSAS患者糖代谢异常的影响因素。方法连续选取2020年4—12月就诊于新疆维吾尔自治区人民医院高血压诊疗研究中心的男性患者224例,纳入人群均完成多导睡眠呼吸监测、糖耐量-胰岛素释放试验。根据呼吸暂停低通气指数(AHI)分为无OSAS组(59例)、轻度OSAS组(55例)、中度OSAS组(54例)、重度OSAS组(56例)。结果筛查出OSAS患者165例,OSAS组患者血糖异常患病率高于无OSAS组患者,差异有统计学意义(P<0.05)。四组间糖化血红蛋白及各时段血糖水平差异均有统计学意义(P<0.05);重度OSAS组患者糖化血红蛋白水平高于其余各组,差异有统计学意义(P<0.05),重度OSAS组患者空腹、0.5 h、1 h、2 h、3 h血糖水平高于无OSAS组患者,差异有统计学意义(P<0.05),重度OSAS组患者3 h血糖高于轻度OSAS组、2 h血糖高于中度OSAS组,差异有统计学意义(P<0.05)。无、轻度OSAS患者Matsuda指数高于中、重度OSAS患者,HOMA-IR低于中、重度OSAS患者,差异均有统计学意义(P<0.05);无OSAS患者葡萄糖处置指数高于其他各组患者,差异均有统计学意义(P<0.05)。logistic回归发现在校正相关因素后AHI、年龄、颈围和腹围为OSAS患者糖代谢异常的危险因素(P<0.05)。结论本研究结果显示男性OSAS患者合并糖代谢异常的患病率及血糖水平相关参数明显升高,这可能与AHI、年龄、颈围及腹围等危险因素有关。

2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征的列线图预测模型构建

目的 构建2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的列线图预测模型。方法 选取2018年9月至2020年4月自贡市第四人民医院完成多导睡眠监测的526例T2DM患者为研究对象,并按照7∶3的比例随机分为训练组和验证组。通过对T2DM患者进行单变量和多变量的logistic回归分析,本研究确定了OSAHS的风险因素,并据此构建了一个预测模型。模型的有效性通过计算受试者工作特征曲线下的面积(AUC)、使用校正曲线和决策曲线(DCA)进行评估。结果 多因素logistic分析结果显示,体重指数(OR=1.09,95%CI:1.01~1.17)、高血压病史(OR=3.80,95%CI:3.43~4.26)、血清低密度脂蛋白(OR=1.35,95%CI:1.03~1.56)及25(OH)维生素D(OR=0.94,95%CI:0.91~0.96)水平是T2DM合并OSAHS发生的独立预测因素(P <0.05)。根据上述变量建立列线图预测模型,并在训练组和验证组中预测T2DM合并OSAHS发生的AUC分别为0.742和0.789。Hosmer-Lemeshow拟合优度检验显示模型具有较好的拟合度(P> 0.05)。DCA显示预测模型能够获得净收益的风险阈值大于0.9。结论 本研究成功建立并验证了一种性能良好的列线图预测模型,有助于提高T2DM患者合并OSAHS的早期识别和筛选能力。

平鼾祛湿汤联合持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征疗效观察

目的观察平鼾祛湿汤联合持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAS)的临床疗效。方法选择2021年1月—2022年3月河北省沧州中西医结合医院诊治的80例OSAS患者为研究对象,随机分为2组各40例,对照组给予CPAP治疗,观察组在对照组基础上加用平鼾祛湿汤治疗,2组均治疗12周。比较2组治疗前后中医证候积分,呼吸睡眠相关指标[Epworth嗜睡量表评分(ESS评分)、睡眠呼吸暂停低通气指数(AHI)、呼吸紊乱时最低氧饱和度(LSaO 2)、压力滴定值]、体质指数(BMI)、红细胞相关指标[红细胞分布宽度(RDW)、红细胞计数(RBC)、血红蛋白(Hb)、促红细胞生成素(EPO)]及临床治疗效果与不良反应发生情况。结果2组治疗12周后的单项中医症状(形体肥胖、胸脘痞闷、呕恶纳呆、嗜睡、倦怠乏力、大便溏滞不爽、身体困重、痰多色白、头晕健忘)积分与总积分均较治疗前显著降低(P均<0.05),且观察组治疗后的上述积分均显著低于对照组(P均<0.05)。2组治疗12周后的ESS评分、AHI、BMI及RDW、RBC、Hb、EPO水平均显著低于治疗前(P均<0.05),压力滴定值、LSaO 2均显著高于治疗前(P均<0.05),且观察组治疗后的上述指标改善情况均显著优于对照组(P均<0.05)。观察组治疗总有效率为92.5%(37/40),明显高于对照组的70.0%(28/40)(P<0.05)。观察组不良反应发生率为7.5%(3/40),明显低于对照组的22.5%(9/40)(P<0.05)。结论在CPAP基础上加用平鼾祛湿汤治疗OSAS可明显改善患者临床症状和呼吸睡眠情况,且不良反应少,其机制可能与改善红细胞相关指标,降低微循环血液黏稠度,从而改善机体缺氧状况有关。

阻塞性睡眠呼吸暂停诱导肠道菌群失调与缺血性脑卒中:机制与研究进展

缺血性脑卒中作为一种高发病率、高死亡率、高致残率、高复发率的脑血管疾病,是导致我国中老年人残疾和死亡的重要原因。因此,识别与缺血性脑卒中相关危险因素并进行有效预防至关重要。有研究表明,阻塞性睡眠呼吸暂停是缺血性脑卒中发生的独立危险因素,但具体机制尚未明确。随着新一代测序技术的发展,研究发现阻塞性睡眠呼吸暂停可引起肠道菌群改变,而肠道菌群可能与缺血性脑卒中密切相关。因此,本文就阻塞性睡眠呼吸暂停诱导肠道菌群失调与缺血性脑卒中的相关机制进行综述,以期为阐明阻塞性睡眠呼吸暂停引起缺血性脑卒中的潜在病理机制提供依据。

基于鼾声分析技术的手机软件在成人阻塞性睡眠呼吸暂停筛查中的应用价值研究

目的评价基于鼾声分析技术的智能手机软件“睡好了么”(Sleepok)在成人阻塞性睡眠呼吸暂停(OSA)筛查中的应用价值,并与常用OSA筛查量表进行比较。方法纳入2022年7月至2023年4月因打鼾就诊于北京大学人民医院呼吸睡眠医学科进行多导睡眠监测(PSG)的成人受试者173例,在行PSG时同步使用Sleepok监测鼾声,受试者于监测当晚在研究者指导下填写纸质问卷(包括基本信息和常用OSA筛查量表)。结果Sleepok与PSG测得呼吸暂停低通气指数(AHI)差异无统计学意义(P>0.05)。Pearson相关分析结果显示,Sleepok_AHI与PSG_AHI具有较好的相关性(r=0.80,P<0.001)。Bland-Altman一致性检验结果显示,Sleepok_AHI与PSG_AHI有较高的一致性(P=0.118),两者之间的平均差异仅为-1.82次/h。ROC曲线分析结果显示,Sleepok_AHI对OSA、中重度OSA和重度OSA均有较好的诊断价值,其最佳截断值分别为16.6次/h、18.9次/h和28.0次/h。单纯鼾症组与OSA组6种量表(No-Apnea、GOAL、NoSAS、STOP、STOP-Bang、CNCQ-OSA)的评分值以及Sleepok_AHI水平比较差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,6种量表均有诊断OSA的应用价值(P<0.05)。结论基于鼾声分析技术的智能手机软件Sleepok能有效识别睡眠中的呼吸事件,对于OSA高风险患者有较好的灵敏度和特异度,可用于OSA筛查。