,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,睡眠与睡眠呼吸障碍,唐向东,四川大学华西医院,美国睡眠医学会从,1979,年成立后颁发的睡眠专科医师执照,睡眠医学中心控制室（美国的检查房间数是每,1,万人口,1,个）,华西医院睡眠医学中心项目：整夜睡眠呼吸监测；,CPAP,压力滴定；日间多次睡眠潜伏期测量；便携式睡眠呼吸监测,睡眠医学中心科门诊,各国,PSG,收费,睡眠医学发展史,1930,年代,-,慢波睡眠的发现,1956,年,-,快速眼球运动期睡眠的发现,1970,年代,-,阻塞性睡眠呼吸暂停的发现,All the major elements of sleep brain wave patterns were described by Harvey,Hobart,Davis,and others at Harvard University in a series of extraordinary papers published in 1937,1938,and 1939.,核心假说：睡眠是被动的过程,Passive State,慢波睡眠（,1936,年）,REM,期睡眠（,1956,）,Kleitman,正常的整夜睡眠分期示意图,REM,期睡眠活动异常有关的疾病,REM,期睡眠行为异常（,RBD,）：,REM,期肌肉和记忆的机制，一个首先在动物实验中发现的疾病，,1965,年,In experiments reported in 1965,bilateral lesions of pontine regions adjacent to the locus coeruleus in cats caused absence of the expected atonia associated with REM sleep,allowing the cats to demonstrate prominent motor activities during REM sleep(oneiric behavior).,In the 1970s,scattered reports of dream-enacting behavior involving humans appeared;,阻塞性睡眠呼吸暂停的核心病理学损害,正常人和重症,OSA,病人整夜血氧饱和度变化,与异常呼吸事件相关的微觉醒,睡眠呼吸暂停的日间嗜睡,特点,重度日间嗜睡患者在成功治疗后可自述，已经完全忘记了完全觉醒的体验,重,度日间嗜睡的患者往往有很高的主观（,ESS,）和客观日间（,MSLT,）嗜睡测量的分离现象（不一致）,日,间觉醒状态高的个体在急性夜间睡眠限制（,Sleep Restriction,）后，常常有最一致的主观和客观测量（,MSLT,和,Theta,活动）结果,Alpha,Eye Movements,Steering&,Lane Position,睡眠呼吸暂停与失眠和精神 疾病,OSAS&Psychiatric illnesses:,Sharing symptoms&consequences,OSAS,，,失眠与情緒障碍,:,共同症狀,Psychiatric,illness,Insomnia,OSAS,Daytime sleepiness,Fatigue,Attention,concentration and memory impairment,Sleep disturbances,Accidents,Impaired quality of life,Medical consequences,Absenteeism,Health care utilization,Hypno-sedatives:Contribute to OSAS?,镇静安眠药会导致,OSAS,吗,?,Traditional belief of worsening of OSAS by hypno-sedatives:,传统的观念,-,镇静安眠药会导致,OSAS,恶化,Upper airway muscle tone,上呼吸道肌张力下降,Ventilatory response to hypoxia,减少对缺氧的通气反应,Increase arousal threshold,提高微觉醒,水平,Prevalence of insomnia in OSAS population,失眠在,OSAS,病人,当,中,的患病率,OSAS,在打鼾与失眠为主诉病人,的患病率,（打鼾,N=2355,；失眠,N=1221,）,男性,女性,OSAS,在打鼾与失眠为主诉病人中性别、,年龄与,患病率,打鼾主诉,失眠主诉,睡眠呼吸暂停与躯体 疾病,2,周的间歇性缺氧使血管中膜的新生胶原量增加,NORM,IH,CIH,*,心血管病人的,SAS,发病率,Sjostrom,et al,.,Thorax,2003,Logan,et al,.,J.Hypertension,2001,Javaheri,et al,.,Circulation,1999,Schafer,et al,.,Cardiology,1999,Sanner,et al,.,Clin Cardiology,2001,Somers,et al,.,Circulation,2004,睡眠呼吸暂停与夜间心绞痛,-CPAP,的疗效,Franklin KA,et al,Lancet 2005;345:1085-7,p0.05,p0.01,未治疗,OSA,病人的房颤复发率增加,OSAS,治疗后的心血管事件生存率,Milleron et al,Eur Heart J 2004,内分泌疾病,肢端肥大症：,多伴有,SAHS,阻塞性和中枢性兼有。可见口咽部肌肉组织和舌体肥大。,甲状腺功能减退症：,造成,舌体肥大,悬雍垂、软腭和舌根松弛,口咽部狭窄、上气道塌陷气道阻塞。,糖尿病：,糖尿病患者中,SAHS,发病率是普通人群,3,4,倍。可能与糖尿病的血管神经病变损害呼吸中枢及呼吸肌有关。,柯兴综合征：,常伴有睡眠呼吸障碍，伴睡眠呼吸障碍患者白天嗜睡更明显。,Prevalence of sleep apnea in acromegaly in two cohorts in Sydney,Australia.In hospital 1,which has a sleep laboratory,almost all patients with acromegaly,肢端肥大症,have sleep apnea.In hospital 2,a regional endocrine center without sleep investigation facilities,60%of patients have sleep apnea,CPAP,治疗改善,OSAS,患者的,胰岛素敏感性,Harsch AJRCCM 2004,I,nsulin sensitivity index(ISI)at baseline,2 days,and 3 months after onset of continuous positive airway pressure(CPAP)treatment in 31 patients,.,多谢！,