The sleep breathing disorders (SDB) include obstructive sleep apnea (OSA), central sleep apnea disorders, sleep related hypoventilation disorders, and sleep related hypoxemia disorder in international classification of sleep diseases 3rd edition (ICSD-3). Latest diagnosis criteria are introduced. Treatments, which target to Individual contributors, should be applied. Thus identification of the phenotype in patients with OSA is important. The methods of evaluation patients' arousal thresholds, loop gain as well as neuromyopathy in clinical setting are reported. Several new treatment strategies are developed and applied for OSA. Long term follow up and more data are needed for evaluation the outcomes of hypoglossal nerve stimulation, bariatric surgery as well as medicine as treatments for OSA.
Humans ; Sleep Apnea Syndromes ; diagnosis ; therapy ; Sleep Apnea, Central ; Sleep Apnea, Obstructive

OBJECTIVE To evaluate the vali-dity and reliability of the outoral surface electrodes. METHODS The outoral surface electrodes were used to record the EMG activity of mandible muscles in 10 male OSAHS patients. The changes of EMG activity were observed among different sleep stages,during the apnea events,and which were compared with that recorded with intraoral surface electrodes from other researchers in our sleep center. The EMG activity was recorded again 7 days later with outoral surface electrodes in those 10 patients. RESULTS The characteristics of mandible muscular electrical activity in OSAHS patients by outoral surface electrodes were consistent to the characteristics of genioglossal electrical activity by intraoral surface electrodes. EMG activity was consistent between the 2 times recording results. CONCLUSION It is valid and reliable in measuring the EMG activity of mandible muscles by using outoral surface electrodes.

Humans ; Laryngopharyngeal Reflux ; Sleep Apnea, Obstructive

[ABSTRACT]OBJECTIVETo assess the upper airway and related structures in different patterns of the upper airway obstruction on cine magnetic resonance (CMR) imaging in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).METHODSCMR images of upper airway were obtained in 30 male patients with severe OSAHS during waking state and natural sleep. The midsagittal plane images were obtained. Patients were classified into 3 groups based on the upper airway obstruction patterns at apnea events and the reference data of the upper airway were measured.RESULTSDuring natural sleep, the diameter of retropalatal region, retroglossal region, retroepiglottic region and the length of suprahyoid muscles were significantly shorter than those during waking state (P<0.01). The maximum angle between the suprahyoid muscles and the apex of the tongue during natural sleep was significantly larger than that during waking state (P<0.01). During wakefulness, there was a significantly difference in the diameter of retropalatal region among 3 obstruction patterns (P<0.01). During natural sleep, there were statistical difference in the diameter of retropalatal region and the upper tongue, the angle between the hard palate and soft palate, the maximum angle between the suprahyoid muscles and the apex of the tongue, and their change values among 3 obstruction patterns (P<0.05). CONCLUSIONThe measurements of the upper airway and related structures on CMR imaging in OSAHS patients could provide useful information in assessing upper airway.

Objective To investigate the characteristics of upper airway collapse in patients with obstructive slcep apnea hypopnea syndrome (OSAHS) when muscle is fully relaxed.Methods Thirty male ASA Ⅱ or Ⅲ patients with OSAHS aged 20-59 yr with body mass index 21-36 kg/m2 and apnea-hypopnea index (AHI) of 28-102times/h were studied.The patients were sedated with iv midazolam 1 mg and sufentanil 5 μg.Nasotracheal intubation was then performed under topical anesthesia with 1％ dicaine.After confirmation of correct position of nasotracheal tube,anesthesia was induced with propofol 0.5 mg/kg and vecuronium 0.08 mg/kg and maintained with target-controlled infusion of propofol and remifentanil.BIS was maintained at 40-60.Fiberopticnasopharyngoscope and pressure transducer were inserted via contralateral nasal cavity and connected with imaging workstation.The site and length of the obstruction were measured and calibrated.Positive pressure was applied to the pharyngeal cavity and gradually increased in increments of 1 cm H2O until 20 cm H2O.The change in cross-section area and critical opening pressure at different planes in pharyngeal cavity were recorded.Results Complete obstruction occurred at the plane of hard palate in one patient (3％).The soft palate and uvula completely collapsed in all 30 patients (100 ％).The collapse occurred at tongue level in 23 patients (77 ％).Every 1 cm H2O increase in pressure produced increase in cross-section area by (10 ± 4)mm2 at the level of hard palate and by(28 ± 18) mm2 at the level of soft palate and uvula.The critical opening pressure ranged from 3 to 18 cm H2O and was≤ 15 cm H2O in 90％ patients.Conclusion Soft palate and uvula collapse in all patients with OSAHS when muscle is fully relaxed.The critical opening pressure is ≤ 15 cm H2O in 90％ patients.

Objective To investigate publication of papers by nursing staff in a TCM hospital and to find out the problems as well as countermeasures.Method A retrospective analysis about authors,education,academictitle,length of service and age was done to investigate the classes of published papers from 2008 to 2012.Results The academic publication by the nurses from 2008 to 2012 was increased.Among these articles,the TCM nursing techniques took up the largest ratio,which accounted for 29.12%. There were significant differences in ages,length of service and educational background in authors(P<0.05).Conclusions Nurses’ awareness and capabilities of publishing academic papers needs enhancement as well as training.It may be significant to strengthen their incentives in scientific research by enforcing encouraging policies.

20/h. In the regression equationthat AHI was as the dependent, only volumetric change rate of velopharynx had statistic significance. CONCLUSION Middle-age and old women with OSAHS have obvious anatomy abnormalities which are the morphological foundation of the OSAHS. Higher compliance of upper airway plays an important role in the OSAHS pathogenesis in middle-age and old women.

OBJECTIVE: To study the efficacy of treatment with microsurgery in combination with local injection of type A botulinum toxin for vocal process granuloma. METHOD: 28 patients with vocal process granuloma received endotracheal intubation under general anesthesia. The lesion was removed with micro-scissor and CO2 laster under a self-retaining laryngoscope and microscope. The incision and mucous membrane surrounding the wound was closed with 8-0 absorbable suture. 4-point injection of botulinum toxin type A 8-15 u was then performed along the thyroarytenoid muscle and arytenoid muscle of the same side. Postoperative medication was administered based on disease causes. RESULT: All patients experienced vocal cord dyskinesia of the injected side 2-3 days after surgery. At 1 month after the surgery, wound healing was good in all the 28 patients, and the vocal cord movement was limited at the injected side. At 3 months, movement of the bilateral vocal cords was normal, and the vocal cord process mucosa was smooth. Patients were followed up for more than a year, and only one patient had recurrence in 2 months after surgery. The cure rate was 96. 4%. CONCLUSION Combination of laryngeal microsurgery and type A botulinum toxin local injection can shorten the treatment course of vocal process granuloma.
Anesthesia, General ; Botulinum Toxins ; administration & dosage ; Granuloma ; drug therapy ; surgery ; Humans ; Injections ; Intubation, Intratracheal ; Laryngeal Mucosa ; Laryngeal Muscles ; Laryngeal Neoplasms ; drug therapy ; surgery ; Laryngoscopes ; Larynx ; Microsurgery ; Postoperative Period ; Recurrence ; Vocal Cords ; Wound Healing

OBJECTIVE To investigate the effects of obstructive sleep apnea hypopnea syndrome on the quality of life of the patients. METHODS The quality of life was assessed with the Medical Outcomes Study SF-36 Health Survey in 145 patients with OSAHS and 17 snorers without OSAHS. Excessive Daytime Sleepiness was assessed with Epworth Sleepiness Scale. Pearson linear correlation and stepwise multiple regression analysis were used to study the association between each domain score of SF-36 and patients information,PSG parameters,EDS scores. RESULTS Three domains of SF-36 correlated negatively with Body Mass Index. Four domains correlated negatively with EDS. Three domains and total score correlated significantly with the lowest oxygen saturation. Two domains correlated negatively with the longest time of apnea. AHI and the lowest oxygen saturation have a mild side effect on the quality of life. BMI and EDS score have significantly side effect on the quality of the life. CONCLUSION Comparing to the mild OSAHS patients and snorers without OSAHS,the severe OSAHS patients have worse quality of life. EDS score and BMI have a significantly side effect on the severe OSAHS patients. OSAHS has a side effect on the quality of life of the patients.

OBJECTIVE To investigate the effects of continuous positive airway pressure (CPAP) on patients with severe obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent the revised uvulopalatopharyngoplasty (UPPP). METHODS 18 cases of severe OSAHS patients (therapy group) were selected for CPAP treatment in the 2nd week of postoperation. The average time of CPAP treatment was 34.3 days. The other 20 cases (control group) onlyunderwent operation. All patients were monitored with PSG before operation and in the 6 months postoperatively. RESULTS Compared with the result of pre-operative PSG, apnea hypopnea index (AHI) and Lowest SaO2 (LSaO_2) was improved (P＜0.001) in two groups. Compared with control group, LSaO_2 of the therapy group in the sixth month postoperatively was improved (P＜0.001), but the decreasing of AHI was not significant (P＞0.05). Contrast to the control group, the length of stage 1 and 2 decreased and that of REM increased. (P＜0.05). CONCLUSION For severe OSAHS patients who underwent uvulopalatopharyngo plasty, CPAP treatment for one month postoperatively could improve the hypoxia of patients, and prolong REM stage, shorten the stage 1 and 2 sleep. CPAP treatment in short time would be helpful for the severe OSAHS patients with revised UPPP.