etal-甘肃省睡眠研究会.ppt

* Prospective study of elective cardioversion for AF (151) vs 312 without AF referred to cardiology practice. OSA diagnosed by Berlin questionnaire. 49% of AF patients vs 32% of general patients. 心衰患者出现CSA比OSA多 * CSA存活率低 * * * 24 patients with stable CHF and OSA randomized to a month of CPAP treatment or medical treatment.No changes in the control group but significant reductions in BP, heart rate, LVESD and increased LVEF (25 vs 33) * n = 64 * * CPAP有收益但并无不同 必须有效控制CSA才可以 * 对比不同方式治疗CSA效果 CS2最有效 * * ASV提高了 CPAP下降 * * * * 皮质性激素导致儿茶酚胺增加 活性氧导致衰老 白介素6增加细胞坏死的几率 瘦素：来自胰岛，会感觉饥饿，岁饭量的摄入，瘦素迅速下降?脂肪因子上升?饱腹感 缺氧本身导致胰岛损伤；化学刺激?抵抗 * * 胰岛素敏感性越高越好 Insulin resistance is when more insulin than normal is required to get the same response in lowering blood glucose. Insulin resistance is a pre-diabetic state. When pancreas can’t produce enough insulin to get normal response, blood glucose then rises and you have type 2 diabetes. 胰岛素抵抗就是要到达相同的降低血糖水平效果需要更多的胰岛素，是糖尿病之前的阶段。当胰腺不能生成足够的胰岛素来获得正常的效果时，血糖升高，II糖尿病产生。 West et al 2010 showed retinopathy significantly worse in diabetics with OSA and that OSA was an independent significant predictor of retinopathy. * Patient Demographics and Clinical Characteristics患者的人口学和临床特征 n 5605 Age ?years? 年龄 67 ± 11 BMI ?kg/m2? 28.5 ± 5.1 Male gender 男性(%) 4416 (78.8) LVEF 左室射血分数 ?%? 33.4 ± 8.1 NYHA 纽约心脏病分级 ≥ III (%) 3852 (68.7) Atrial fibrillation 房颤 (%) 1382 (24.9) Ischemic etiology 缺血性心衰 (%) 2893 (51.6) AHI ?1/h? 18.0 ± 15.8 ODI ?1/h? 16.5 ± 23.2 Mean SpO2 ?%? 92.5 ± 5.1 Min SpO2 ?%? 81.3 ± 7.5 Demographic and Clinical Characteristics患者的人口学和临床特征 AHI 15/h AHI ≥15/h N (%) 2977 (53) 2628 (47) Age ?years?年龄 65 ± 12 68 ± 10 * BMI ?kg/m2? 28.1 ± 4.9 29.0 ± 5.2 * Male gender (%)男性 2231 (75) 2185 (83) * LVEF ?%?左心室射血分数 33.7 ± 8.0 33.0 ± 8.2 * NYHA ≥ III (%)纽约心脏病分级 1977 (66) 1875 (71) * Atrial fibrillation (%)房颤 616 (21) 766 (29) * Ischemic etiology (%)缺血性心衰 1513 (51) 1380 (53) AHI ?1/h? 6.5 ± 4.0 31.1 ± 13.8 * ODI ?1/h? 8.4 ± 19.7 25.7 ± 23.5 * Mean SpO2 ?%