This article introduces the experience of Academician SHI Xuemin in treatment of stroke combined with obstructive sleep apnea hypopnea syndrome. It is believed that this disease is the syndrome of "stroke of lung qi exhaustion". It is rooted at the deficiency of primary qi, and lung qi declining; and characterized by phlegm stagnation, qi reversion and mind blockage. This disease is manifested as somnolence-like symptoms, snoring-like breathing and sawing-like expectorating. The therapeutic regimen focuses on "governing qihai (sea of qi ), regulating the spirit and adjusting the orifice closure". The main acupoints include Neiguan (PC6), Shuigou (GV26) and Sanyinjiao (SP6) to regain the consciousness and open the orifices. Besides, Renying (ST9) is added to regulate the respiration, Baihui (GV20) and Sishencong (EX-HN1) to harmonize the spirit, and Fengchi (GB20), Wangu (GB12) and Yifeng (TE17) to open the orifice for the treatment of symptoms. It provides a new idea for the clinical diagnosis and treatment of stroke with accompanying symptoms.
Humans ; Sleep Apnea, Obstructive/complications* ; Acupuncture Therapy ; Stroke/physiopathology* ; Male ; Acupuncture Points ; Female ; Middle Aged ; Qi ; Aged ; Lung/physiopathology* ; Snoring/physiopathology* ; Adult ; Drugs, Chinese Herbal/administration & dosage*

Objective:The variability of the apnea-hypopnea index（AHI） measured in the first and second halves of the night is significant in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. This variation may be related to fluid redistribution caused by the supine position during sleep. Methods:Eighty-nine adult subjects were enrolled. Circumferences（neck, chest, waist, and calf） were measured before sleep onset and upon awakening. Polysomnography（PSG） was performed, and the night was divided into two halves based on the midpoint of total sleep time to calculate AHI for each half. The correlation between changes in AHI and changes in circumferences was analyzed. Results:Twenty simple snorers and sixty-nine OSAHS patients were included, with a median AHI of 22.6（11.8, 47.3） events/hour. Compared to pre-sleep measurements, there was no significant change in neck circumference upon awakening in the control group（P=0.073）, while reductions were observed in the other three measurements（P=0.006, P=0.038, P<0.001）. In the OSAHS group, neck circumference increased（P<0.001）, and reductions were noted in the other three measurements（P<0.001 for all）, with the most significant change observed in calf circumference 40.0（37.1, 42.0） cm to 38.0（35.8, 40.5） cm. Compared to the first half of the night, total AHI, supine AHI, and NREM AHI significantly decreased in the second half（P=0.010, P=0.031, P=0.001）, while no significant changes were observed in lateral AHI and REM AHI（P=0.988, P=0.530）. Further analysis revealed a significant relationship between increased chest circumference and decreases in NREM AHI, supine AHI, and supine NREM AHI（P=0.036, P=0.072, P=0.034）, as well as between decreased lateral position AHI and increased waist circumference（P=0.048）. Additionally, this study found a negative correlation between changes in calf circumference and changes in AHI（R=-0.24, P=0.048）, while neck circumference changes positively correlated with changes in AHI（R=0.26, P=0.03）. Conclusion:In OSAHS patients during the second half of sleep compared to before sleeping, chest circumference, waist circumference, and calf circumference decrease while neck circumference increases; total AHI, supine position AHI, and NREM period AHI decrease; increases in chest circumference are associated with decreases in NREM period AHI, supine position AHI, supine position NREM period AHI. There is nocturnal variability in AHI among OSAHS patients that may be associated with fluid shifts during sleep.
Humans ; Sleep Apnea, Obstructive/physiopathology* ; Male ; Female ; Polysomnography ; Fluid Shifts/physiology* ; Adult ; Middle Aged ; Neck ; Severity of Illness Index ; Sleep/physiology* ; Snoring/physiopathology*

OBJECTIVETo determine the clinical value of portable sleep testing by Watch-PAT (PAT) in children with obstructive sleep apnea syndrome (OSAS).

METHODFifty cases of snoring children aged 3-11 years were randomly selected to undergo the polysomnography (PSG) and PAT simultaneously at the same night. The consistency of sleep parameters in OSAS and non - OSAS children were compared with PSG as reference standard, and ROC curve analysis was performed to assess the sensitivity and specificity in the diagnosis of OSAS with PAT portable sleep monitor.

RESULTFourteen cases were diagnosed as OSAS in 6-11 years group by PAT and PSG. But in 3-5 years group, only six children were diagnosed as OSAS, there was significant difference between PAT and PSG (P < 0.05). Among those 6-11 years old children, compared with non-OSAS, PAT study showed that III+IV stage sleep ((30.5 ± 2.4)% vs. (38.2 ± 2.3)%, χ(2)=4.31, P<0.05), REM sleep duration ((8.9 ± 2.5)% vs. (18.3 ± 2.1)%, χ² =4.31, P<0.05), TST ((458 ± 78) min vs. (522 ± 56) min, t=4.85, P<0.05) and sleep efficiency ((83.5 ± 3.1)% vs. (93.5 ± 3.5)%, t=3.75, P<0.05) decreased, I+II stage sleep ((61.5 ± 4.4)% vs. (44.1 ± 3.5)%, χ² =6.07, P<0.05), arousal index ((29.5 ± 8.2)/h vs. (10.6 ± 5.6)/h, t=3.70, P<0.05), AHI ((7.6 ± 5.3)/h vs. (2.1 ± 2.0)/h, t=2.40, P<0.05), RDI((18.2 ± 5.1)/h vs. (6.5 ± 3.9)/h, t=3.85, P<0.05) increased in OSAS children. Furthermore, the total sleep time (TST) ((458 ± 78) min vs. (430 ± 76) min, t=2.90, P<0.05) and sleep efficiency ((83.5 ± 3.1) % vs. (81.9 ± 4.3) %, t=2.45, P<0.05) were higher by PAT than scored by PSG. ROC curve analysis showed the best threshold selection of AHI 5.0, the sensitivity was 0.952, the specificity was 0.858. AHI 7.0, the sensitivity was 0.968, the specificity was 0.985. AHI 10, the sensitivity was 0.985 and the specificity was 0.99, but AHI 1.0, the sensitivity was 0.852 and the specificity was 0.785.

CONCLUSIONPAT can be used at home in school age children due to the high consistency with PSG and the high compliance.

Child ; Child, Preschool ; Humans ; Polysomnography ; methods ; ROC Curve ; Sensitivity and Specificity ; Sleep ; Sleep Apnea, Obstructive ; diagnosis ; Sleep Stages ; Snoring ; physiopathology

OBJECTIVE: to investigate the origin characters of snore in simple snorers and provide the basis for its treatment. METHOD: Thirty-two simple snorers diagnosed by polysomnography were induced to sleep by propofol and dexmedetomidine, then we observed the vibration sites, pattern and concomitant collapse of soft tissue in pharyngeal cavity by nasendoscopy. RESULT: Thirteen cases showed palatal fluttering only, and 1 case showed vibration of epiglottis only. Six cases showed palatal fluttering with vibration of epiglottis, and 2 cases showed palatal fluttering with vibration of epiglottis and tongue base. Five cases showed palatal fluttering with vibration of pharyngeal lateral wall, and 5 cases showed palatal fluttering with vibration of lateral wall, epiglottis and tongue base together. Palate and pharyngeal lateral wall vibrated strongly and always collapsed with vibrating, but epiglottis and tongue base usually vibrated slightly and seldom collapsed. CONCLUSION The palatal fluttering is the main source of snoring sounds for most simple snorers, then followed by vibration of palatal and pharyngeal lateral wall together. The site of collapse in pharyngeal cavity is consistent with the main site of vibration.
Endoscopy ; Epiglottis ; physiopathology ; Humans ; Palate ; physiopathology ; Pharynx ; physiopathology ; Polysomnography ; Propofol ; Sleep ; Sleep Apnea, Obstructive ; Snoring ; diagnosis ; Tongue ; physiopathology

OBJECTIVE: To discuss the main influence factors of sound pressure level parameters in patients with simple snoring (SS) and obstructive sleep apnea hypopnea syndrom (OSAHS). METHOD: Eighty-four cases with snoring disease underwent polysomnography and simultaneously snoring sound pressure level recording. The correlations between AHI, age, BMI, abdomen circumference, neck circumference, the lowest oxygen saturation total apnea time and sound pressure level parameters: equivalent continuous sound level(LAeq)and maximum sound pressure level(L10) were analyzed. RESULT: LAeq was significantly correlated to AHI (P= 0. 000) and BMI (P= 0. 007), and the odd ratios of AHI and BMI were 5. 74,2. 09 respectively, but it was unrelated to age, abdomen circumference, neck circumference, the lowest oxygen saturation and total apnea time. A significantly association also existed between L10 and AHI(P=0. 000), BMI(P=0. 032), and the odd ratios were 4. 11 and 2. 33 respectively. Other factors had nothing to do with L10. CONCLUSION The main factors which affect the snoring sound pressure level parameters LAeq and L10 are AHI and BMI.
Humans ; Polysomnography ; Pressure ; Sleep Apnea, Obstructive ; physiopathology ; Snoring ; physiopathology ; Sound

There are little information on prevalence of obstructive sleep apnea syndrome (OSAS) and clinical features in the young military population. The purpose of this study was to estimate the prevalence of snoring and high risk of OSAS in young male soldiers in Korea and to identify the risk factors of OSAS. A total of 665 participants (aged 20-23 yr) who visited the Armed Forces Ildong Hospital for regular physical examination were enrolled. All participants completed the Berlin Questionnaire and underwent a physical examination. The participants with high risk for OSAS completed portable sleep monitoring. The prevalence of snoring and high risk of OSAS in young male soldiers in Korea was 13.5% and 8.1%, respectively. The prevalence of high arched palate, tongue indentation, long uvula, large tonsil and retrognathia was significantly higher in the high risk OSAS group. High arched palate, long uvula or low lying soft palate, tonsil size III or IV, Epworth Sleepiness Scale score > 10 and obesity (BMI > 27 kg/m2) were found to independently predict OSAS. For early identification and treatment of young soldiers with OSAS in a military environment, a precise screening by questionnaire and physical examination is needed.
Asian Continental Ancestry Group ; Body Mass Index ; Humans ; Logistic Models ; Male ; *Military Personnel ; Odds Ratio ; Palate/anatomy & histology ; Palatine Tonsil/anatomy & histology ; Polysomnography ; Prevalence ; Questionnaires ; Republic of Korea ; Retrognathia/physiopathology ; Risk Factors ; Sleep Apnea, Obstructive/*epidemiology ; Snoring/epidemiology ; Uvula/anatomy & histology ; Young Adult

OBJECTIVE: To build up a steady and credible animal model on obstructive sleep apnea-hypopnea syndrome (OSAHS) with New Zealand rabbit. METHOD: Ten New Zealand rabbit were divided into two groups (A and B, 5 for each). Group A was treated by injecting Dimethiconum from exterior. Group B was blank. EEG, snoring and oxygen-saturation were recorded by PSG after operation. Examination was repeated two weeks later and one month later. CT was done in the operation and two weeks later. Animals were sacrificed three months later and the Dimethiconum in the body was used for examination with light microscopy. RESULT: Group A showed apnea or hypopnea and decreasing SaO2 after operation. The changes in group A were more obvious at two weeks and one month. CONCLUSION A steady and credible animal model of OSAHS has been built. The model provides a tool to study the pathogenesy and pathophysiology of OSAHS.
Animals ; Apnea ; chemically induced ; physiopathology ; Disease Models, Animal ; Oxygen ; metabolism ; Rabbits ; Sleep Apnea, Obstructive ; chemically induced ; physiopathology ; Snoring ; physiopathology

OBJECTIVE: To investigate the acoustic characteristics of snoring sound in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: Thirty-one patients with OSAHS were included in this study. Natural overnight snoring was digitally recorded and polysomnography (PSG) was performed simultaneously. Thirty hundred and ten snores which after obstructive apnea and 310 continuous snores which not after obstructive apnea were extracted and peak frequency, maximal frequency, mean frequency,central frequency and power ratio were analyzed. RESULT: The maximal frequency, peak frequency, mean frequency and central frequency of the snores which after obstructive apnea was higher than that of the continuous snores. But 800 Hz power ratio of the snores which after obstructive apnea was lower than those of the continuous snores. The differences of all parameters were of statistical significance (P<0.01 or 0.05). The patients were divided into mild, moderate and severe groups according to AHI, it were seen that in mild patients group peak frequency, central frequency and 800 Hz power ratio were of statistical difference (P<0.01); and in moderate and severe patients groups,in addition to fc, the rest of the index difference was statistically significance except central frequency (P<0.01 or 0.05). CONCLUSION 800 Hz power ratio is a good index for distinguishing the two kind of snores of OSAHS patients. It indicates that it is feasible to study the OSAHS by way of snore monitoring and analyzing technique employed in this study.
Acoustics ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Sleep Apnea, Obstructive ; physiopathology ; Snoring ; physiopathology

BACKGROUNDA prospective 2-night polysomnographic (PSG) study in Chinese snorers was designed to assess the role of the first night effect (FNE) in PSG parameters and the diagnosis of obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODSSeventy-two snorers from two teaching hospitals underwent overnight PSG on two consecutive nights. The night-to-night variability of PSG parameters were recorded and analyzed.

RESULTSSixty-six patients were analyzed. Among all the PSG parameters, only the total time of stage 2 presented a significant difference between two nights: 219.50 (83.50 - 353.50) vs. 215.25 (59.50 - 342.50) (P = 0.000). Subgroup assessment showed a slight night-to-night difference in about 1 - 2 parameters in the group with the apnea-hypopnea index (AHI) ≥ 20 events per hour as well as the group with AHI < 20 events per hour, but there was no night-to-night difference in the AHI in each group. And slighter FNE was found among patients ≥ 40 years old. There was no significant difference in diagnosis of OSAHS. In the decision of severity, a slight difference was found between the two nights with a Kappa value = 0.531.

CONCLUSIONSOnly mild FNE can be found on two consecutive nights of PSG in adult Chinese snorers, but it has no effect on the diagnosis of OSAHS. A single polysomnographic night may be adequate for the diagnosis of OSAHS.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Prospective Studies ; Sleep Apnea, Obstructive ; physiopathology ; Snoring ; physiopathology ; Young Adult

OBJECTIVETo investigate the relationship between sleep apnea-hypopnea syndrome (SAHS) and preeclampsia and the possible pathogenesis of the latter.

METHODSTwenty-five healthy pregnant women, 43 pregnant women with preeclampsia, and 27 with preeclampsia complicated by SAHS were enrolled in this study. Apnea-hypopnea index (AHI) and the lowest arterial oxygen saturation (LSaO2) were measured through a 7-hour polysomnography (PSG), and the maternal age, gestational age, body mass index and 24-hour urine protein were recorded.

RESULTSAll the indexes except for the maternal age and gestational age showed significant differences between the 3 groups. The two groups of preeclampsia patients showed a significant difference in BMI from the control cases. Significant positive correlations of AHI to BMI, MAP and 24-hour urine protein were noted; LSaO2 was found to inversely correlate to BMI, MAP, and 24-hour urine protein. In spite of the significant correlation of BMI to the other indexes, we found that BMI was less important than AHI and LSaO2.

CONCLUSIONSAHS may induce or aggravate preeclampsia. Greater attention should be given to the presence of SAHS in pregnant women with obesity, but obesity is not the predominant predisposing factor for preeclampsia.

Adult ; Body Mass Index ; Case-Control Studies ; Female ; Humans ; Interleukin-6 ; blood ; Polysomnography ; Pre-Eclampsia ; blood ; etiology ; Pregnancy ; Risk Factors ; Sleep Apnea Syndromes ; blood ; complications ; physiopathology ; Snoring ; physiopathology ; Tumor Necrosis Factor-alpha ; blood