痰湿证OSAHS患者CPAP压力水平初探
|
摘要
目的
通过对痰湿证睡眠呼吸暂停患者运用持续正压通气治疗后,得到呼吸机压力水平,用相关的原始数据得出压力值计算公式,方便临床应用。
方法
将2007年3月至2008年3月广安门医院睡眠门诊的患者通过痰湿证诊断和PSG的筛查,得到的54例痰湿型睡眠呼吸暂停低通气患者,于次夜行呼吸机压力滴定,将得到的数据采用SPSS13.0软件进行统计分析,得出与平均压力相关的多元线性回归方程,及和平均压力有关的95%有效压力值(即实际最大压力),用于临床压力值调定,同时与目前临床上较有争议的Hoffstein公式进行对比,发现所测的平均压力值与之较为接近。
结果
1.在54例痰湿证患者中,重度OSAHS患者占68.51%,重度低氧血症患者占75.93%,重度肥胖占51.85%。最低血氧、鼾声指数和AHI显著相关(P<0.01),年龄和AHI相关(p<0.05).
2.CPAP治疗前后AHI指数有显著差异(P<0.01),CPAP治疗前后鼾声指数有显著差异。CPAP治疗疗效显著。
3.最高压力、最低压力、95%有效压力值和Hoffestein方程压力值差异显著(P<0.01),平均压力值和Hoffstein公式压力值无明显差异(P>0.05)。
4.BMI、颈围、最低血氧、AHI、鼾声指数均和平均压力直线相关( P<0.01)
5.根据多元线性逐步回归,得出颈围、AHI、鼾声指数均有统计学意义,回归方程为平均压力=0.220×颈围+0.036×AHI+0.001×鼾声指数—3.746
6.根据直线回归,得出95%有效压力值运算公式95%有效压力值=5.393+0.690×平均压力
结论
1.本次研究筛选了54例痰湿证睡眠呼吸暂停低通气患者,发现睡眠呼吸暂停低通气者以重度肥胖的中青年男性患者居多,多为重度睡眠呼吸暂停低通气综合征及重度夜间低氧血症。
2.呼吸暂停低通气指数和最低血氧、年龄、鼾声指数相关。提示患者对平时的鼾声要引起足够重视。尤其是肥胖的中青年打鼾患者更易患此病。
3.呼吸机对OSAHS患者疗效显著,压力滴定前后患者的呼吸暂停低通气指数和鼾声指数明显下降,提示呼吸机治疗后疗效理想,患者病情明显好转。
4. BMI、颈围、最低血氧、AHI、鼾声指数均与CPAP平均压力显著相关,在知道患者颈围,AHI指数,鼾声指数的前提下,可通过回归方程计算得出所需平均压力,并根据此压力值推出95%有效压力(实际最大压力)。
5.OSAHS治疗前景广阔,除呼吸机治疗外,可加入中药治疗,以提高患者的依从性,使对OSAHS患者有新的选则。
The research on Phlegm damp OSAHS patients’proper Pressure level with continuous positive airway pressure
Object: Treat the Phlegm damp OSAHS patients with continuous positive airway pressure.
Get a related calculation formula from these data, which can be used in the clinic practice.
Method:To get 54 cases of Phlegm damp OSAHS patients from the sleep-department of Guang’anmen hospital from March, 2007 to March, 2008. The patients were diagnosed with PSG and Phlegm damp criteria. Then in the second night, we treated the patients with continuous positive airway pressure, and form a multivariate linear regression equation which can be used to calculate the pressure level( average pressure) with related data. Compare all kinds of pressure levels to the Hoffstein pressure level, and found that there is no significant difference between average pressure in our study and Hoffstein pressure level. All the statistics are analyzed by software SPSS13.0.
Result:1. In 54 phlegm-damped OSAHS cases, severe OSAHS patients are about 68.51%, and severe nocturnal hypoxemia are 75.93%, severe obesity are 51.85%. Lowest oxygen, snore index are significantly correlated with AHI(p<0.01), and age are correlated with AHI(p<0.05).
2. There is significant difference between the AHI before and after the treatment of continuous airway pressure (p<0.01), and the snore index is also differ greatly before and after the treatment of CPAP. The effect of this treatment is significant.
3. The highest pressure, lowest pressure, and 95% effective pressure differ significantly to the pressure calculated by Hoffstein equation (p<0.01), however, there is no greatly difference between average pressure and Hoffstein pressure (p>0.05).
4. BMI, neck circumference, the lowest oxygen, AHI and snore index are correlated to average pressure (p <0.01).
5. According to multivariate linear regression equation, we found that neck circumference, AHI, snore index are statistical significant.
multivariate linear regression equation is as follows:average pressure of CPAP=0.220*neck circumference +0.036*AHI+0.001*snore index-3.746 95%effective pressure of CPAP= 5.393+0.690*average pressure
Conclusion: 1.This research selected 54 phlegm-damped OSAHS patients, and it is found out that the severe obesity of middle aged male take the major part, and most of them are severe OSAHS and severe nocturnal hypoxemia syndrome.
2. AHI are significant correlated with the lowest oxygen, age, snore index, which indicated that we shall pay more attention to the snore. And the overweight middle aged men may have OSAHS easily than others.
3. CPAP is effective to OSAHS patients, AHI and snore index decreased dramatically with the treatment of the CPAP.
4. BMI, neck circumference, the lowest oxygen, and snore index significant correlate to average pressure, we can get the average pressure level by the multivariate linear regression equation.
5. The treatments of OSAHS may vary from CPAP to traditional medicine, and the use of TCM might increase patients’compliance, and become the new choice for patients.
通过对痰湿证睡眠呼吸暂停患者运用持续正压通气治疗后,得到呼吸机压力水平,用相关的原始数据得出压力值计算公式,方便临床应用。
方法
将2007年3月至2008年3月广安门医院睡眠门诊的患者通过痰湿证诊断和PSG的筛查,得到的54例痰湿型睡眠呼吸暂停低通气患者,于次夜行呼吸机压力滴定,将得到的数据采用SPSS13.0软件进行统计分析,得出与平均压力相关的多元线性回归方程,及和平均压力有关的95%有效压力值(即实际最大压力),用于临床压力值调定,同时与目前临床上较有争议的Hoffstein公式进行对比,发现所测的平均压力值与之较为接近。
结果
1.在54例痰湿证患者中,重度OSAHS患者占68.51%,重度低氧血症患者占75.93%,重度肥胖占51.85%。最低血氧、鼾声指数和AHI显著相关(P<0.01),年龄和AHI相关(p<0.05).
2.CPAP治疗前后AHI指数有显著差异(P<0.01),CPAP治疗前后鼾声指数有显著差异。CPAP治疗疗效显著。
3.最高压力、最低压力、95%有效压力值和Hoffestein方程压力值差异显著(P<0.01),平均压力值和Hoffstein公式压力值无明显差异(P>0.05)。
4.BMI、颈围、最低血氧、AHI、鼾声指数均和平均压力直线相关( P<0.01)
5.根据多元线性逐步回归,得出颈围、AHI、鼾声指数均有统计学意义,回归方程为平均压力=0.220×颈围+0.036×AHI+0.001×鼾声指数—3.746
6.根据直线回归,得出95%有效压力值运算公式95%有效压力值=5.393+0.690×平均压力
结论
1.本次研究筛选了54例痰湿证睡眠呼吸暂停低通气患者,发现睡眠呼吸暂停低通气者以重度肥胖的中青年男性患者居多,多为重度睡眠呼吸暂停低通气综合征及重度夜间低氧血症。
2.呼吸暂停低通气指数和最低血氧、年龄、鼾声指数相关。提示患者对平时的鼾声要引起足够重视。尤其是肥胖的中青年打鼾患者更易患此病。
3.呼吸机对OSAHS患者疗效显著,压力滴定前后患者的呼吸暂停低通气指数和鼾声指数明显下降,提示呼吸机治疗后疗效理想,患者病情明显好转。
4. BMI、颈围、最低血氧、AHI、鼾声指数均与CPAP平均压力显著相关,在知道患者颈围,AHI指数,鼾声指数的前提下,可通过回归方程计算得出所需平均压力,并根据此压力值推出95%有效压力(实际最大压力)。
5.OSAHS治疗前景广阔,除呼吸机治疗外,可加入中药治疗,以提高患者的依从性,使对OSAHS患者有新的选则。
The research on Phlegm damp OSAHS patients’proper Pressure level with continuous positive airway pressure
Object: Treat the Phlegm damp OSAHS patients with continuous positive airway pressure.
Get a related calculation formula from these data, which can be used in the clinic practice.
Method:To get 54 cases of Phlegm damp OSAHS patients from the sleep-department of Guang’anmen hospital from March, 2007 to March, 2008. The patients were diagnosed with PSG and Phlegm damp criteria. Then in the second night, we treated the patients with continuous positive airway pressure, and form a multivariate linear regression equation which can be used to calculate the pressure level( average pressure) with related data. Compare all kinds of pressure levels to the Hoffstein pressure level, and found that there is no significant difference between average pressure in our study and Hoffstein pressure level. All the statistics are analyzed by software SPSS13.0.
Result:1. In 54 phlegm-damped OSAHS cases, severe OSAHS patients are about 68.51%, and severe nocturnal hypoxemia are 75.93%, severe obesity are 51.85%. Lowest oxygen, snore index are significantly correlated with AHI(p<0.01), and age are correlated with AHI(p<0.05).
2. There is significant difference between the AHI before and after the treatment of continuous airway pressure (p<0.01), and the snore index is also differ greatly before and after the treatment of CPAP. The effect of this treatment is significant.
3. The highest pressure, lowest pressure, and 95% effective pressure differ significantly to the pressure calculated by Hoffstein equation (p<0.01), however, there is no greatly difference between average pressure and Hoffstein pressure (p>0.05).
4. BMI, neck circumference, the lowest oxygen, AHI and snore index are correlated to average pressure (p <0.01).
5. According to multivariate linear regression equation, we found that neck circumference, AHI, snore index are statistical significant.
multivariate linear regression equation is as follows:average pressure of CPAP=0.220*neck circumference +0.036*AHI+0.001*snore index-3.746 95%effective pressure of CPAP= 5.393+0.690*average pressure
Conclusion: 1.This research selected 54 phlegm-damped OSAHS patients, and it is found out that the severe obesity of middle aged male take the major part, and most of them are severe OSAHS and severe nocturnal hypoxemia syndrome.
2. AHI are significant correlated with the lowest oxygen, age, snore index, which indicated that we shall pay more attention to the snore. And the overweight middle aged men may have OSAHS easily than others.
3. CPAP is effective to OSAHS patients, AHI and snore index decreased dramatically with the treatment of the CPAP.
4. BMI, neck circumference, the lowest oxygen, and snore index significant correlate to average pressure, we can get the average pressure level by the multivariate linear regression equation.
5. The treatments of OSAHS may vary from CPAP to traditional medicine, and the use of TCM might increase patients’compliance, and become the new choice for patients.
引文
[1]Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. The New England journal of medicine. 1993;328(17):1230-1235.
[2]Kripke OF ,Ancoli I ,Klauber MR ,et al . Prevalence of sleep2disordered breathing in ages 40～64 years :a population2based survey. Sleep ,1997 , 20 :65
[3]Ip M, Lam B , Lauder IJ , et al . A community study of sleep2disordered breathing in middle2aged Chinese men in Hong Kong. Chest , 2001 , 119 : 62269.
[4]郭兮恒 睡眠呼吸暂停低通气综合征的流行病学、病因与发病机制。 《中国医刊》2003 ,38 (1):8-9
[5]刘艳骄.高容林.主编. 中医睡眠医学. 北京: 人民卫生出版社; 2003:142-143.
[6]上海市医学会呼吸病学分会睡眠呼吸疾病学组 上海是 30 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查 中华结核和呼吸杂志 2003,26(5):268-269
[7]李明娴 王莹 华树成 长春市 20 岁以上人群OSAHS流行病学现况调查。国家自然科学基金资助项目(V30270502)
[8]张庆 何权瀛 杜秋艳 承德市区居民睡眠呼吸暂停低通气综合征患病率入户调查 中华结核和呼吸杂志 2003 ,26 (5):273-274
[9]杨玉萍 化痰祛瘀法治疗睡眠呼吸暂停综合征 10 例 江西中医药 2005 ,12(36):32-33
[10]赵秀敏 张耐茹 刘建茹 穴位注射与针刺治疗巨声鼾症 中国实用医药 2007,2(22):23-24
[11]夏瑢.陈继忠.邵国民.等. 中医痰湿体质与阻塞性睡眠呼吸暂停低通气综合征病变机制探要. 中华中医药杂志. 2006;29(8):465-468.
[12] 付桂玲.闫雪.刘艳骄.等. 睡眠呼吸暂停综合征与中医体质关系的初步研究. 中国中医基础杂志. 2006;21(12):567-569.
[13]Young T,Finn L,Palta M,etr al.Chronic nasal congestion at bight is a risk factor for snoring in a population-base cohort study, Arch Ibter Med, 2001,161(12):1514-1519
[14]Schwab RJ, Gupta KB,Gefter WB, et al. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing significance of the lateral pharyngeal walls. Am J Respir Crit Care Med, 1995,152(5pt 1):1673-1689
[15]Forgel RB, Malhotra A, White DP, pathophysiology of obstructive sleep apnea/hypopnea syndrome. Thorax,2004,59(2):159-163.
[16]Fogel RB, Malhotra A, White DP. Pathophysiology syndrome. Thorax, 2004,59(2):159-163.
[17]Mezzanotte WS, Tangel DJ, White DP, et al. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal contral. Am J Respir Crit Care Med, 1996,153(6):1880-1887.
[18]Bottini P, Tauntucci C. Sleep apnea syndrome in endocrine diseases. Respiration,2003,70(3):320-327.
[19]Dexter DD, Dovre EJ. Obstructive sleep apnea due to endogenous testosterone production in a woman, Mayo Clin Proc,1998,73(3):246-248.
[20]Young T, Finn L, Austin D, et al.Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med,2003,167(9):1181-1185.
[21]Odonnell CP, Schaub CD, Haines AS. Leptin prevents respiratory depression in obesity.Am 就 Respir crit Care Med, 1999,159(5 Pt1):1477-1484。
[22]朱奕豪, 瘦素、肥胖和呼吸功能关系的研究进展。国外医学呼吸系统分册,2004,24 (4):216-218。
[23]Malhotra A, Huang Y, Forgel RB, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med, 2002,166(10):1388-1395.
[24]肖毅,谢海雁 OSAHS发病机制的新进展 2005 北戴河国际睡眠呼吸障碍疾病大会:21-22
[25]Hatipoglu U, Rubinstein I. Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis Respiration,2003,70(6):665-671.
[26]Tauman R, Sivan Y. obstructive sleep apnea in children-pathophysiology update. Hare fuah,2002,141(2):189-195,221.
[27]姚亮,杨佩兰,宋文宝 睡眠呼吸暂停综合征中医分型初探 河南中医 2004,24(2):32-33
[28]俞新中 苏子将气汤治疗睡眠呼吸暂停 浙江中医杂志 2007,42(2):68-69。
[29]古立新 黄美杏 酸枣仁汤加味合生脉胶囊治疗阻塞性睡眠呼吸暂停低通气综合征34 例。广西中医药 2005,28(5):14-15
[30]关风岭 运用自拟桔梗愈鼾汤治疗睡眠呼吸暂停综合征 20 例临床研究 四川中医 2005,23(12):49-50
[31] BrooksD, Horent R L, Kozar I, F, et al. Obsteuctive sleep apnea as a cause of systemic hypertension. J Clin Invest, 1997, 99: 106.
[32]李莉,吴海英,刘力生. 睡眠呼吸暂停综合症与高血压治疗. 中华心血管病杂志, 2004, 32 (1) : 32.
[33]李莉,黄建风,谢晋湘,等. 睡眠呼吸暂停综合症. 中华心血管病杂志, 2001, 9: 524 - 526.
[34]郭莲香,乔冬梅,李小永,等. 呼吸睡眠暂停低通气综合征 29 例临床分析. 临床肺科杂志, 2004, 9 (1) : 72.
[35]李永霞,海冰,钟红. 阻塞性睡眠呼吸暂停低通气征与高血压. 临床肺科杂志, 2004, 9 (6) : 638.等,
[36]Sullivan C E , Berthon2Jones M , Issa F O , et al . Reversal obstructive sleep apnea by continuous positive airway pressure applied through the nose[J ] . Lancet ,1981 ,1 (4) :862
[37]高雪梅 口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征 2005 北戴河国际睡眠呼吸障碍疾病大会:31-33
[38]殷敏, 程雷,温控射频技术在阻塞性睡眠呼吸暂停综合征外科治疗中的应用。临床耳鼻喉科杂志,2005,19(2):95-96。
[39]Ogasa T, Ray AD, Michilin CP . Systemic administration of serotonin 2A/2B agonist improves upper airway stability in Zucker rates. Am J Respir Crit Care Med,2004,170(7):804-810.
[40]Bpaoshaw DA, Ruff GA, Murphy DP.An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest,2006,130(5):1369-1376。
[41]Wesensten NJ,Effects of modafinil on cognitive performance and alertness during sleep deprivation. Curr Pharm Des,2006,12(20):2457-2471
[42]Black JE, Hirshkowitz M。 Modafinil for treatment of residual excessive sleepiness in nasal continuous positive airway pressure-treated obstructive sleep apnea/hypopnea syndrome, Sleep, 2005,28(4):464-471
[43]Keating GM,Raffin MJ,Modafinil: a review of its use in excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome and shift work sleep disorder. CNS Drugs,2005,19(9):785-803,
[44]Veasey SC. Serotonin agonists and antagonists in obstructive sleep apnea: therapeutic potential. Am J Respir Med,2003,2(1):21-29
[45]Ogasa T, Ray AD, Michilin CP . Systemic administration of serotonin 2A/2B agonist improves upper airway stability in Zucker rates. Am J Respir Crit Care Med,2004,170(7):804-810.
[46]Simth I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea in adults. Cochrane Database Syst Rev,2006,19(2):CD003002。
[47]Horner RI。 Motor control of the pharyngeal musculature and implications for the pathogenesis of obstructive sleep apnea. Sleep,1996,19(10):827-853.
[48]Horner RL. Impact of brainstem mechanisms on pharyngeal motor control. Respir Physiol,2000,119(2-3):113-121.
[49]Horner RL. The neuropharmacology of upper airway motor control in the awake and asleep states: implication for obstructive sleep apnea. Respir Res,2001,2(5):286-294.
[50]胡良冈等,经皮电刺激治疗阻塞性睡眠呼吸暂停综合征的研究。 中国生物医学工程学报,2005,24(3):370-373。
[51]中华医学会耳鼻咽喉科学分会, 中华耳鼻咽喉科杂志编委会 阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准 暨悬雍垂愕咽成型术适应证(杭州)中华耳鼻咽喉科杂志,2002,37(6):403-404。
[52]师秀珍, 张宝泉, 张连山, 等 腭咽成型术治疗阻塞型睡眠呼吸暂停综合征 中华耳鼻咽喉科杂志,1994,29(3):173-174。
[53]孙济治 有关鼾症及阻塞性睡眠呼吸暂停综合征疗效评定的意见 临床耳鼻咽喉科杂志 1997,11(6):287。
[54]FUJITA S , Uppp for sleep apnea and snoring. Ear Nose Throat J,1984,63(5):224-235.
[55]李树华, 石洪金, 邹连贵, 等 中国阻塞性睡眠呼吸暂停低通气综合征治疗回顾 中国耳鼻咽喉头颈外科杂志,2006,13(1):54-57
[56]赵颖, 曾祥龙, 傅民魁, 等 阻鼾器对阻塞性睡眠呼吸暂停综合征患者治疗效果的研究。口腔正畸学 2001,8(1):13-16
[57]肖伟东, 徐星, 苏荣江 口腔矫治器治疗阻塞性睡眠呼吸暂停综合征效果观察 广东医学院学报,2006,24(2):163-164。
[58] Doherty LS ,Kiely JL. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome[J ] . Chest ,2005 ,127 (6) :2076 - 2084
[59]Duchna HW,Orth M. Long-term effects of nasal continuous positive airway pressure on vasodilatory endothelial function in obstructive sleep apnea syndrome[J ] . Sleep Breath ,2005 ,9 (3) :97 - 103
[60] Teschler H , Farhat A A , Exner V , et al . AutoSet nasal CPAP titration : constancy of pressure ,compliance and effectiveness at 8month follow up[J ] . Eur Respir J ,1997 ,10 (9) :2073.
[61] Hosselet J J . Auto2CPAP in the titration and treatment of obstructive respiratory sleep disorders[J ] . Rev Mal Respir ,1999 , 16 (5) :799.
[62] 谢嵩英 谢维新 CPAP 呼吸治疗机临床应用进展及探讨 全国第六届中西医结合呼吸病学术研讨会论文汇编
[63]Sériés F. Accuracy of an unattended home CPAP titration in the treatment of obstructive sleep apnea . Am J Resp ir Crit CareMed, 2000, 162 (1) : 94 - 97.
[64]Meurice JC, Marc I, Series F. Efficacy of auto2CPAP in the treatment of obstructive sleep apnea /hypopnea syndrome . Am J Resp ir Crit Care Med, 1996, 153 (2) : 794 - 798.
[65] Ficker J H, Wiest G H, Lehnert G, et al. Evaluation of an autoCPAP device for treatment of obstructive sleep apnoea. Thorax, 1998, 53 (8) : 643 - 648.
[66]Baltzan MA, Kassissia I, Elkholi O, et al. Prevalence of persistent sleep apnea in patientswith continuous positive airway p ressure. Sleep, 2006, 29 (4) : 557 - 563.
[67]Kessler R, Weitzenblum E, ChaouatA, et al. Evaluation of unattended automated titration to determine therapeutic continuous positive airway p ressure in patients with obstructive sleep apnea . Chest. 2003, 123 (3) : 704 - 710.
[68]Masa JF, J iménez A, Durán J, et al. Alternative methods of titrating continuous positive airway pressure A large multicenter study. Am JResp ir Crit CareMed, 2004, 170 (11) : 1218 - 1224.
[69]Gay PC, Herold DL, Olson EJ. A randomized, double blind clinical trial comparing continuous positive airway p ressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome. Sleep, 2003, 26 (7) : 864 - 869.
[70]李庆云 万欢英 李敏 CPAP 治疗 OSAHS 压力滴定方式选择-A、B 还是 C? 临床肺科杂志 2007,12(6):597-599
[71]张中伟,徐利浩,叶辛幸 CPAP 呼吸机固定压力与自调压力在同组 OSAHS 患者治疗中的初步比较 中国血液流变学杂志 2003;13(4):414-415
[72]JH Ficker ,GH Wiest ,GLehnert , et al. Evaluation of an autoCPAP device for treatment of obstructive sleep apnosea [J ] . Thorax ,1998 ,53 :643～6481
[73]刘广南 苏红 钟小宁等 不同自动调节持续气道内正压通气系统压力滴定的研究 临床荟萃 2002,17(21):1254-1255
[74] 聂舟山 韩志海 段蕴轴等 持续气道正压呼吸机在治疗睡眠呼吸暂停综合征时的调压观察 武警医学 2004,9(15)
[75] 骆斌,王琦,痰湿体质论析 安徽中医学院学报 1999,18(5):10-11。
[2]Kripke OF ,Ancoli I ,Klauber MR ,et al . Prevalence of sleep2disordered breathing in ages 40～64 years :a population2based survey. Sleep ,1997 , 20 :65
[3]Ip M, Lam B , Lauder IJ , et al . A community study of sleep2disordered breathing in middle2aged Chinese men in Hong Kong. Chest , 2001 , 119 : 62269.
[4]郭兮恒 睡眠呼吸暂停低通气综合征的流行病学、病因与发病机制。 《中国医刊》2003 ,38 (1):8-9
[5]刘艳骄.高容林.主编. 中医睡眠医学. 北京: 人民卫生出版社; 2003:142-143.
[6]上海市医学会呼吸病学分会睡眠呼吸疾病学组 上海是 30 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查 中华结核和呼吸杂志 2003,26(5):268-269
[7]李明娴 王莹 华树成 长春市 20 岁以上人群OSAHS流行病学现况调查。国家自然科学基金资助项目(V30270502)
[8]张庆 何权瀛 杜秋艳 承德市区居民睡眠呼吸暂停低通气综合征患病率入户调查 中华结核和呼吸杂志 2003 ,26 (5):273-274
[9]杨玉萍 化痰祛瘀法治疗睡眠呼吸暂停综合征 10 例 江西中医药 2005 ,12(36):32-33
[10]赵秀敏 张耐茹 刘建茹 穴位注射与针刺治疗巨声鼾症 中国实用医药 2007,2(22):23-24
[11]夏瑢.陈继忠.邵国民.等. 中医痰湿体质与阻塞性睡眠呼吸暂停低通气综合征病变机制探要. 中华中医药杂志. 2006;29(8):465-468.
[12] 付桂玲.闫雪.刘艳骄.等. 睡眠呼吸暂停综合征与中医体质关系的初步研究. 中国中医基础杂志. 2006;21(12):567-569.
[13]Young T,Finn L,Palta M,etr al.Chronic nasal congestion at bight is a risk factor for snoring in a population-base cohort study, Arch Ibter Med, 2001,161(12):1514-1519
[14]Schwab RJ, Gupta KB,Gefter WB, et al. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing significance of the lateral pharyngeal walls. Am J Respir Crit Care Med, 1995,152(5pt 1):1673-1689
[15]Forgel RB, Malhotra A, White DP, pathophysiology of obstructive sleep apnea/hypopnea syndrome. Thorax,2004,59(2):159-163.
[16]Fogel RB, Malhotra A, White DP. Pathophysiology syndrome. Thorax, 2004,59(2):159-163.
[17]Mezzanotte WS, Tangel DJ, White DP, et al. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal contral. Am J Respir Crit Care Med, 1996,153(6):1880-1887.
[18]Bottini P, Tauntucci C. Sleep apnea syndrome in endocrine diseases. Respiration,2003,70(3):320-327.
[19]Dexter DD, Dovre EJ. Obstructive sleep apnea due to endogenous testosterone production in a woman, Mayo Clin Proc,1998,73(3):246-248.
[20]Young T, Finn L, Austin D, et al.Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med,2003,167(9):1181-1185.
[21]Odonnell CP, Schaub CD, Haines AS. Leptin prevents respiratory depression in obesity.Am 就 Respir crit Care Med, 1999,159(5 Pt1):1477-1484。
[22]朱奕豪, 瘦素、肥胖和呼吸功能关系的研究进展。国外医学呼吸系统分册,2004,24 (4):216-218。
[23]Malhotra A, Huang Y, Forgel RB, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med, 2002,166(10):1388-1395.
[24]肖毅,谢海雁 OSAHS发病机制的新进展 2005 北戴河国际睡眠呼吸障碍疾病大会:21-22
[25]Hatipoglu U, Rubinstein I. Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis Respiration,2003,70(6):665-671.
[26]Tauman R, Sivan Y. obstructive sleep apnea in children-pathophysiology update. Hare fuah,2002,141(2):189-195,221.
[27]姚亮,杨佩兰,宋文宝 睡眠呼吸暂停综合征中医分型初探 河南中医 2004,24(2):32-33
[28]俞新中 苏子将气汤治疗睡眠呼吸暂停 浙江中医杂志 2007,42(2):68-69。
[29]古立新 黄美杏 酸枣仁汤加味合生脉胶囊治疗阻塞性睡眠呼吸暂停低通气综合征34 例。广西中医药 2005,28(5):14-15
[30]关风岭 运用自拟桔梗愈鼾汤治疗睡眠呼吸暂停综合征 20 例临床研究 四川中医 2005,23(12):49-50
[31] BrooksD, Horent R L, Kozar I, F, et al. Obsteuctive sleep apnea as a cause of systemic hypertension. J Clin Invest, 1997, 99: 106.
[32]李莉,吴海英,刘力生. 睡眠呼吸暂停综合症与高血压治疗. 中华心血管病杂志, 2004, 32 (1) : 32.
[33]李莉,黄建风,谢晋湘,等. 睡眠呼吸暂停综合症. 中华心血管病杂志, 2001, 9: 524 - 526.
[34]郭莲香,乔冬梅,李小永,等. 呼吸睡眠暂停低通气综合征 29 例临床分析. 临床肺科杂志, 2004, 9 (1) : 72.
[35]李永霞,海冰,钟红. 阻塞性睡眠呼吸暂停低通气征与高血压. 临床肺科杂志, 2004, 9 (6) : 638.等,
[36]Sullivan C E , Berthon2Jones M , Issa F O , et al . Reversal obstructive sleep apnea by continuous positive airway pressure applied through the nose[J ] . Lancet ,1981 ,1 (4) :862
[37]高雪梅 口腔矫治器治疗阻塞性睡眠呼吸暂停低通气综合征 2005 北戴河国际睡眠呼吸障碍疾病大会:31-33
[38]殷敏, 程雷,温控射频技术在阻塞性睡眠呼吸暂停综合征外科治疗中的应用。临床耳鼻喉科杂志,2005,19(2):95-96。
[39]Ogasa T, Ray AD, Michilin CP . Systemic administration of serotonin 2A/2B agonist improves upper airway stability in Zucker rates. Am J Respir Crit Care Med,2004,170(7):804-810.
[40]Bpaoshaw DA, Ruff GA, Murphy DP.An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest,2006,130(5):1369-1376。
[41]Wesensten NJ,Effects of modafinil on cognitive performance and alertness during sleep deprivation. Curr Pharm Des,2006,12(20):2457-2471
[42]Black JE, Hirshkowitz M。 Modafinil for treatment of residual excessive sleepiness in nasal continuous positive airway pressure-treated obstructive sleep apnea/hypopnea syndrome, Sleep, 2005,28(4):464-471
[43]Keating GM,Raffin MJ,Modafinil: a review of its use in excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome and shift work sleep disorder. CNS Drugs,2005,19(9):785-803,
[44]Veasey SC. Serotonin agonists and antagonists in obstructive sleep apnea: therapeutic potential. Am J Respir Med,2003,2(1):21-29
[45]Ogasa T, Ray AD, Michilin CP . Systemic administration of serotonin 2A/2B agonist improves upper airway stability in Zucker rates. Am J Respir Crit Care Med,2004,170(7):804-810.
[46]Simth I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea in adults. Cochrane Database Syst Rev,2006,19(2):CD003002。
[47]Horner RI。 Motor control of the pharyngeal musculature and implications for the pathogenesis of obstructive sleep apnea. Sleep,1996,19(10):827-853.
[48]Horner RL. Impact of brainstem mechanisms on pharyngeal motor control. Respir Physiol,2000,119(2-3):113-121.
[49]Horner RL. The neuropharmacology of upper airway motor control in the awake and asleep states: implication for obstructive sleep apnea. Respir Res,2001,2(5):286-294.
[50]胡良冈等,经皮电刺激治疗阻塞性睡眠呼吸暂停综合征的研究。 中国生物医学工程学报,2005,24(3):370-373。
[51]中华医学会耳鼻咽喉科学分会, 中华耳鼻咽喉科杂志编委会 阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准 暨悬雍垂愕咽成型术适应证(杭州)中华耳鼻咽喉科杂志,2002,37(6):403-404。
[52]师秀珍, 张宝泉, 张连山, 等 腭咽成型术治疗阻塞型睡眠呼吸暂停综合征 中华耳鼻咽喉科杂志,1994,29(3):173-174。
[53]孙济治 有关鼾症及阻塞性睡眠呼吸暂停综合征疗效评定的意见 临床耳鼻咽喉科杂志 1997,11(6):287。
[54]FUJITA S , Uppp for sleep apnea and snoring. Ear Nose Throat J,1984,63(5):224-235.
[55]李树华, 石洪金, 邹连贵, 等 中国阻塞性睡眠呼吸暂停低通气综合征治疗回顾 中国耳鼻咽喉头颈外科杂志,2006,13(1):54-57
[56]赵颖, 曾祥龙, 傅民魁, 等 阻鼾器对阻塞性睡眠呼吸暂停综合征患者治疗效果的研究。口腔正畸学 2001,8(1):13-16
[57]肖伟东, 徐星, 苏荣江 口腔矫治器治疗阻塞性睡眠呼吸暂停综合征效果观察 广东医学院学报,2006,24(2):163-164。
[58] Doherty LS ,Kiely JL. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome[J ] . Chest ,2005 ,127 (6) :2076 - 2084
[59]Duchna HW,Orth M. Long-term effects of nasal continuous positive airway pressure on vasodilatory endothelial function in obstructive sleep apnea syndrome[J ] . Sleep Breath ,2005 ,9 (3) :97 - 103
[60] Teschler H , Farhat A A , Exner V , et al . AutoSet nasal CPAP titration : constancy of pressure ,compliance and effectiveness at 8month follow up[J ] . Eur Respir J ,1997 ,10 (9) :2073.
[61] Hosselet J J . Auto2CPAP in the titration and treatment of obstructive respiratory sleep disorders[J ] . Rev Mal Respir ,1999 , 16 (5) :799.
[62] 谢嵩英 谢维新 CPAP 呼吸治疗机临床应用进展及探讨 全国第六届中西医结合呼吸病学术研讨会论文汇编
[63]Sériés F. Accuracy of an unattended home CPAP titration in the treatment of obstructive sleep apnea . Am J Resp ir Crit CareMed, 2000, 162 (1) : 94 - 97.
[64]Meurice JC, Marc I, Series F. Efficacy of auto2CPAP in the treatment of obstructive sleep apnea /hypopnea syndrome . Am J Resp ir Crit Care Med, 1996, 153 (2) : 794 - 798.
[65] Ficker J H, Wiest G H, Lehnert G, et al. Evaluation of an autoCPAP device for treatment of obstructive sleep apnoea. Thorax, 1998, 53 (8) : 643 - 648.
[66]Baltzan MA, Kassissia I, Elkholi O, et al. Prevalence of persistent sleep apnea in patientswith continuous positive airway p ressure. Sleep, 2006, 29 (4) : 557 - 563.
[67]Kessler R, Weitzenblum E, ChaouatA, et al. Evaluation of unattended automated titration to determine therapeutic continuous positive airway p ressure in patients with obstructive sleep apnea . Chest. 2003, 123 (3) : 704 - 710.
[68]Masa JF, J iménez A, Durán J, et al. Alternative methods of titrating continuous positive airway pressure A large multicenter study. Am JResp ir Crit CareMed, 2004, 170 (11) : 1218 - 1224.
[69]Gay PC, Herold DL, Olson EJ. A randomized, double blind clinical trial comparing continuous positive airway p ressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome. Sleep, 2003, 26 (7) : 864 - 869.
[70]李庆云 万欢英 李敏 CPAP 治疗 OSAHS 压力滴定方式选择-A、B 还是 C? 临床肺科杂志 2007,12(6):597-599
[71]张中伟,徐利浩,叶辛幸 CPAP 呼吸机固定压力与自调压力在同组 OSAHS 患者治疗中的初步比较 中国血液流变学杂志 2003;13(4):414-415
[72]JH Ficker ,GH Wiest ,GLehnert , et al. Evaluation of an autoCPAP device for treatment of obstructive sleep apnosea [J ] . Thorax ,1998 ,53 :643～6481
[73]刘广南 苏红 钟小宁等 不同自动调节持续气道内正压通气系统压力滴定的研究 临床荟萃 2002,17(21):1254-1255
[74] 聂舟山 韩志海 段蕴轴等 持续气道正压呼吸机在治疗睡眠呼吸暂停综合征时的调压观察 武警医学 2004,9(15)
[75] 骆斌,王琦,痰湿体质论析 安徽中医学院学报 1999,18(5):10-11。