Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(...Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms,advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users.However,residual insomnia symptoms persisted,indicating that PAP therapy provides only limited treatment.RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes,and their potential impact on posttraumatic stress symptoms.Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.展开更多
目的:研究不同健康状态及亚健康各证型的脉象图参数,探求评价亚健康状态的特征性脉象图指标。方法:运用"健康状态评价问卷H20.V2009"对1275例无明确急慢性疾病者进行健康状态评估,并分为健康组和亚健康组,依据"亚健康状...目的:研究不同健康状态及亚健康各证型的脉象图参数,探求评价亚健康状态的特征性脉象图指标。方法:运用"健康状态评价问卷H20.V2009"对1275例无明确急慢性疾病者进行健康状态评估,并分为健康组和亚健康组,依据"亚健康状态辨证依据V2010",对亚健康者进行辨证分型。另设明确诊断的患有心血管疾病的患者121例作为对照。用YJJ-101亚健康脉象监测系统采集脉象,分析主波幅度(amplitude of main wave,h1),重搏波前波幅度(amplitude of front wave,h3),重搏波幅度(amplitude of repeat wave,h5),主波上1/3处宽度(1/3width of main wave,w1),主波上1/5处宽度(1/5width of main wave,w2),左心室快速射血期时值(time of rapid ejection phase,t1),脉动周期(period of pulse,t),脉象图总面积(square of pulse diagram,S)、收缩期面积(area in systole,As)、舒张期面积(area in diastole,Ad),采脉压力(pulse pressure,Pp)和h3/h1、h5/h1、w1/t、w2/t、h1/t1比值等。结果:健康组、亚健康组与疾病组3组比较:与健康组相比,亚健康组w1/t、w2/t增高,Pp、h1、h5、h5/h1、S、As、Ad降低;与疾病组相比,亚健康组Pp、h5/h1增高,h1、w2/t、S、As降低。健康组、实证组与虚证组3组比较:与健康组相比,实证组与虚证组均表现为h3/h1、w1、w1/t、w2/t增高,h1、h5、h1/t1、h5/h1降低。健康组与各证候组比较:各证候组间比较,脉象图参数h1、h5在肝郁组、阴虚组、气虚组、实热组依次降低,脉象图参数h3/h1、w1/t在肝郁组、实热组、阴虚组、气虚组依次升高,肾虚组脉象图指标h1显著高于健康组及其他证候组。结论:不同健康状态、亚健康不同类别及各证型的脉象图参数存在较明显差异,脉象图特征指标可作为客观评价不同健康状态、亚健康分类量化诊断、辨证分型研究的实验依据之一。展开更多
基金small private donations to the Sleep&Human Health Institute.
文摘Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms,advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users.However,residual insomnia symptoms persisted,indicating that PAP therapy provides only limited treatment.RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes,and their potential impact on posttraumatic stress symptoms.Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.
文摘目的:研究不同健康状态及亚健康各证型的脉象图参数,探求评价亚健康状态的特征性脉象图指标。方法:运用"健康状态评价问卷H20.V2009"对1275例无明确急慢性疾病者进行健康状态评估,并分为健康组和亚健康组,依据"亚健康状态辨证依据V2010",对亚健康者进行辨证分型。另设明确诊断的患有心血管疾病的患者121例作为对照。用YJJ-101亚健康脉象监测系统采集脉象,分析主波幅度(amplitude of main wave,h1),重搏波前波幅度(amplitude of front wave,h3),重搏波幅度(amplitude of repeat wave,h5),主波上1/3处宽度(1/3width of main wave,w1),主波上1/5处宽度(1/5width of main wave,w2),左心室快速射血期时值(time of rapid ejection phase,t1),脉动周期(period of pulse,t),脉象图总面积(square of pulse diagram,S)、收缩期面积(area in systole,As)、舒张期面积(area in diastole,Ad),采脉压力(pulse pressure,Pp)和h3/h1、h5/h1、w1/t、w2/t、h1/t1比值等。结果:健康组、亚健康组与疾病组3组比较:与健康组相比,亚健康组w1/t、w2/t增高,Pp、h1、h5、h5/h1、S、As、Ad降低;与疾病组相比,亚健康组Pp、h5/h1增高,h1、w2/t、S、As降低。健康组、实证组与虚证组3组比较:与健康组相比,实证组与虚证组均表现为h3/h1、w1、w1/t、w2/t增高,h1、h5、h1/t1、h5/h1降低。健康组与各证候组比较:各证候组间比较,脉象图参数h1、h5在肝郁组、阴虚组、气虚组、实热组依次降低,脉象图参数h3/h1、w1/t在肝郁组、实热组、阴虚组、气虚组依次升高,肾虚组脉象图指标h1显著高于健康组及其他证候组。结论:不同健康状态、亚健康不同类别及各证型的脉象图参数存在较明显差异,脉象图特征指标可作为客观评价不同健康状态、亚健康分类量化诊断、辨证分型研究的实验依据之一。
