Objective To assess the clinical effectiveness and safety of uvulopalatopharyngoplasty （UPPP） in the treatment of snoring and obstructive sleep aponea syndrome （OSAS ）. Methods MEDLINE （1966 -2005 ）, EMBASE （1984 - 2005 ）, The Cochrane Library （Issue 1, 2005 ）, CBM （1979 - 2005 ）, CNKI （1994 - 2005 ）, VIP （ 1989 - 2005 ）, CMCC （1994-2005） ,Wanfang Database and Internet were searched in English and Chinese versions. Randomized controlled trials（ RC,Ts）, quasi-randomized controlled trials and prospective cohort studies were included. Study quality was evaluated by two researchers independently. RevMan4.2.7 was used for meta-analysis.Results Twelve studies were included, of which 5 were RCTs, 7 were prospective cohort studies. Compared with dental appliance（DA）, PSG （polysomnography） changes of DA group were larger than UPPP group, but patients of UPPP group had better quality of life and compliance. Comparing UPPP with LAUP （laser-assisted uvulopalatpharyngoplasty ） and RFTVR （radiofrequency tissue volume reduction）, the postoperative pain of the latter two was less than UPPP. About complications, UPPP and LAUP had no difference except for nasal reflux at 1 week after operation, there was no statistical difference between UPPP and RFTVR. There was no study to compare the PSG change among the three groups. Comparing UPPP with CPAP （continuous positive airway pressure）, PSG changes were larger in CPAP. Conclusions At present, there is no evidence to assure that UPPP is better than other treatments for snoring and OSAS or to suggest which type of surgery is most effective.The literature search is restricted to the publications of English and Chinese language, which may have resulted in missing some studies; the evidence is still weak due to the poor quality and a small number of included studies. There is an urgent need for high quality RCTs to be carried out.
Objective To evaluate the effects of selective serotonin reuptake inhibitors ( SSRIs) on sleep apneas in Sprague-Dawley ( SD) rats. Methods Thirty adultmale SD rats were randomly divided into two groups ( 15 rats in each group) . The treatment group and the control group were injected intraperitoneally with paroxetine ( 10 mg· kg- 1 · d - 1 ) and sterile distilled water ( 2 mL· kg- 1 · d - 1) for 7 days respectively. Parameters about sleep apnea and sleep structure were measured before and after the treatment. Results In the treatment group, there was a significant reduction of apnea index ( AI) from ( 12. 4 ±3. 7)times /hour to ( 7. 4 ±2. 2) times/ hour ( P = 0. 000) . Both post sigh apnea index ( PSAI) and spontaneous apnea index ( SPAI) were decreased significantly ( P = 0. 000 and 0. 021 respectively) in non-rapid eye movement ( NREM) sleep, but not in REM sleep. REM sleep was reduced from 8. 6% to 8. 0% ( P =0. 013) and its latency was increased from ( 54. 1 ±48. 4) min to ( 110. 9 ±43. 4) min ( P = 0. 001) in the treatment group, as well as the sleep-onset latency [ from ( 20. 7 ±9. 1) min to ( 30. 0 ±15. 7) min, P =0. 038] . Conclusion Paroxetine can reduce sleep apneas in SD rats during NREMsleep. Its effects on sleep structure include reducing REM time, increasing REM latency and sleep-onset latency.
Objective To investigate whether the sleep-induced hypoxemia ( SIH) at different time and different level have different effects on pulmonary emphysema and coagulation systemfunction in the rats with pulmonary emphysema. Methods Thirty Wistar rats were randomly divided into three groups( n = 10 in each group) . All rats were exposed to cigarette smoke twice a day ( 30 min each time) . From29th day on, the rats in Group A ( pulmonary emphysema with short SIH) were also exposed to mixed gas of 12. 5% oxygen for 1. 5 hours during sleeping time every day ( the expose time was divided into 4 periods, 22. 5 min each) . The rats in Group B ( pulmonary emphysema with mild SIH) were also exposed to mixed gas of 15% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods, 45 min each) . The rats in Group C( pulmonary emphysema with standard SIH) were also exposed to mixed gas of 12. 5% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods,45 min each) . After continuous exposure for 56 days, the rats were sacrificed. Semi-quantitative image analytic method was employed for histopathological analysis including pathological score of lungs, mean linear intercept ( MLI) and mean alveolus number( MAN) . ATⅢ, FIB, vWF, FⅧ were measured. Results All animals in three groups manifested the histopathological features of emphysema. Pathological scores of lungs and MLI of every group were significantly different from each other( F = 21. 907, F = 18. 415, all P lt; 0. 05) , Group A [ ( 61. 90 ±4. 25) % , ( 92. 45 ±1. 78) μm] and Group B[ ( 64. 60 ±3. 95) % , ( 92. 80 ±3. 65) μm] were significantly lower than Group C[ ( 73. 30 ±3. 86) % , ( 99. 32 ±2. 81) μm, q= 8. 96, q =6. 84, q = 12. 64, q =9. 65, all P lt; 0. 05] . Levels of FIB were significantly different among three groups ( F = 20. 592, P lt; 0. 05) while FIB in Group A[ ( 189. 98 ±5. 29) mg/ dL] and Group B[ ( 182. 70 ±2. 78) mg /dL] were significantly lower than that in Group C[ ( 198. 40 ±7. 37) mg/ dL, q = 4. 86, q= 9. 07, all P lt; 0. 05] , and FIB in Group A was significantly higher than that in Group B( q = 4. 20, P lt; 0. 05) . Levels of FⅧ were significantly different from each other( F = 33. 652, P lt;0. 05) while FⅧ in Group A[ ( 232. 26 ±4. 17) % ]and Group B[ ( 242. 53 ±14. 50) % ] were significantly lower than that in Group C[ ( 303. 25 ±32. 93) % ,q= 10. 73, q = 9. 18, all P lt; 0. 05] . Conclusions Pulmonary emphysema and hypercoagulable states increases with time and severity of SIH in rats with pulmonary emphysema. The elevated activity of blood coagulation factor may be a critical role in the hypercoagulable states.
Objective To reveal the worldwide research status and hot topics of sleep apnea syndrome ( SAS) . Methods Articles were searched from Web of Science ( SCI) , Essential Science Indicator ( 2000 to 2010) database using sleep apnea syndrome or apnea as keywords. Retrieved documents were analyzed using the database with its own statistical functions and histcite software ( version 8.12. 16) .Results Since 1992 the international scientific papers on the SAS study showed a gradual upward trend.The United States is a world leader in this field. Recent research has focused on vascular endothelial barrier function and repair, oxidative stress, inflammation, cognitive function, special populations such as the elderlyor children patients with SAS. Conclusion Clinical researchers have paid more attention to SAS than before, but there are still many important issues unresolved.
Objective To evaluate the effectiveness ofradiofrequency volumetric tissue reduction （RFVTR） in the treatment of sleep disordered breathing （SDB ）. Methods We searched The Cochrane Central Register of Controlled Trials （Issue 1, 2005）, MEDLINE （1966 to Apr. 2005）, EMBASE （1989 to Apr. 2005）, CINAHL （1982 to Dec. 2000）, VIP （1989 to Dec. 2004） , CJFD （1979 to 2005）, WANFANG DATA （1977 to 2004） , and CBMdisc （1978 to 2005）. The bibliographies of all papers retrieved in full text form and relevant narrative reviews were searched for additional publications. All randomized controlled clinical trials （RCT） or quasi-randomized controlled trials （quasi-RCT） or prospective cohort studies of RFVTR alone or in combination with other treatments compared with placebo or other treatments were included. Data were extracted independently from the trial reports by the two authors. Meta-analysis was performed using RevMan software. Results There were 11 studies including 540 patients met the inclusion criteria for this review, among which five were RCTs, six were prospective cohort studies, and all trials were of lower methodological quality. RFVTR showed benefit over placebo in apnea index （AI）, but this benefit was not seen in other polysorrmography （PSG） parameters, symptom and quality of life, psychomotor vigilance pain, swallowing difficulty and adverse events. Compared with continuous positive airway pressure （CPAP）, uvulopalatopharyngoplasty （UPPP） and laser assisted uvulopalatoplasty （LAUP） , RFVTR was more effective in psychomotor vigilance pain and swallowing difficulty, but this effect was not seen in PSG parameters, symptom and quality of life. Conclusions RFVTR is more effective than placebo in AI improvement and other treatments in decreasing postoperative pain and other adverse events ; but this benefit was not seen in improving quality of sleeping and life. More well-designed randomized trials need to be conducted to identify the effectiveness and the influence on effectiveness of severity and frequency of treatment.
由于高血压的高患病率与高致残致死率, 已经成为我国重点防治的心血管疾病和社会普遍关注的重大公共卫生问题之一。大量流行病学、临床和基础研究已证实睡眠呼吸暂停低通气综合征( sleep apnea-hypopnea syndrome, SAHS) 与高血压发病和疗效关系密切[ 1-8 ] , 是高血压发生的主要病因之一, 由此“睡眠呼吸暂停相关性高血压”一词便应运而生[ 9-1 0] , 它是指由SAHS 引发和加重的高血压。本期刊载的“阻塞性睡眠呼吸暂停相关性高血压临床诊断和治疗专家共识”( 以下简称共识) , 为睡眠呼吸暂停相关性高血压的诊治提供了规范性的指导意见, 对推动我国该领域的防治水平有重要作用。我们期望“共识”能为读者认识和防治睡眠呼吸暂停相关性高血压提供必要的指导和帮助, 使我国为数众多的睡眠呼吸暂停相关性高血压患者得到规范的诊治。
高血压是我国重点防治的心血管疾病, 血压的控制率备受关注。在一些血压控制不良的患者中睡眠呼吸暂停是导致顽固性高血压的重要原因。以睡眠过程中反复、频繁出现呼吸暂停和低通气为特点的睡眠呼吸暂停低通气综合征( sleep apneahypopnea syndrome, SAHS) 自20 世纪80 年代以来也受到广泛关注, 临床和基础研究取得了迅速发展。目前, 多项临床、流行病学和基础研究证实SAHS可以导致和/ 或加重高血压, 与高血压的发生发展密切相关。
Objective To analyze the causes of missed diagnosis of sleep apnea hypopnea syndrome ( SAHS) . Methods 42 missed diagnosed cases with SAHS from May 2009 to May 2011 were retrospectively analyzed and related literatures were reviewed. Results The SAHS patients often visited the doctors for complications of SAHS such as hypertension, diabetes mellitus, metabolic syndrome, etc. Clinical misdiagnosis rate was very high. Lack of specific symptoms during the day, complicated morbidities, and insufficient knowledge of SAHS led to the high misdiagnosis rate and the poor treatment effect of patients with SAHS. Conclusion Strengthening the educational propaganda of SAHS, detail medical history collection, and polysomnography monitoring ( PSG) as early as possible can help diagnose SAHS more accurately and reduce missed diagnosis.
ObjectiveTo explore the influence of 3D printing assisting educational intervention on the anxiety and sleep outcomes in the patients with trauma. MethodA total of 40 patients were selected between October 2014 and June 2015. The patients were randomly divided into the intervention group and control group with 20 patients in each. The outcomes from admitted to the 7th day after the surgery were evaluated, including visual analogue scale (VAS) scores, state-trait anxiety inventory (STAI) score, Likert score, and the condition of anxiety, pain, and sleep outcomes. ResultsThe differences in VAS scores, STAI scores, and Likert scores between the two groups were significant (P<0.05). Conclusions3D printing assisting educational intervention is a useful intervention that can improve post-operative outcomes for the patients with trauma.
ObjectiveTo assess the polysomnographic characteristics of insomnia patients with comorbid obstructive sleep apnea-hypopnea syndrome (OSAHS). MethodsWe performed a comparative analysis on the polysomnographic features among patients with pure insomnia (n=80), patients with pure OSAHS (n=80), and patients with insomnia and OSAHS (n=50) between August and December 2013. ResultsCompared with OSAHS group, patients with insomnia and comorbid OSAHS had a higher percentage of female, older age, lower body mass index, shorter total sleep time during the night, longer sleep latent period and wake after sleep onset (WASO), lower sleep efficacy, lower arousal index and apnea hypoventilation index (AHI), higher average and the lowest oxygen saturation of blood, lower Epworth Sleepiness Scale scores and sleep perception (P < 0.05). Compared with the insomnia group, patients with insomnia and comorbid OSAHS had a lower percentage of female, shorter total sleep time, lower sleep efficacy, longer WASO and higher AHI (P < 0.05). ConclusionPatients with insomnia and comorbid OSAHS have all the characteristics of insomnia and OSAHS patients:nocturnal hypoxia, sleep fragmentation, broken sleep continuity, decreased sleep efficiency, damaged perception of sleep time and sleep perception.