BACKGROUND & AIMS: OBJECTIVE:To obtain prevalence estimates of clinical features of obstructive sleep apnoea (OSA) and identify the dimensions of the public health problem requiring further investigation for an Australian population. METHODS:The South Australian Health Omnibus Survey is an annual representative population survey of South Australians aged≥15 years, conducted via interviewer-administered questionnaire. In 2009, 3007 participants were asked the STOP-BANG instrument measure of obstructive sleep apnoea risk, which includes symptoms of loud snoring, frequent tiredness during daytime, observed apnoea, and high blood pressure (STOP), and measured body mass index, age, neck circumference and gender (BANG). Three or more positive response categorises a person at high risk for OSA. RESULTS:Snoring was reported by 49.7% of adults. Tiredness after sleep more than 3 - 4 times per week was reported by 24.8%, and during wake-time by 27.7% of adults, with 8.8% reporting having fallen asleep while driving. Over half of the surveyed men (57.1%, n=566) and 19.3% (n=269) of the women were classified at high-risk of OSA with the STOP-BANG measure. In multivariable models, high risk was associated with less education, lower income, and residence in a regional rather than metropolitan area. CONCLUSION:The high prevalence of adults at risk for OSA suggests that the capacity currently available within the healthcare system to investigate and diagnose OSA is likely to be inadequate, particularly outside urban areas. This highlights an important public health problem that requires further detailed study and trials of new models of care.

背景与目标： 目的：获得阻塞性睡眠呼吸暂停（OSA）临床特征的患病率估计值，并确定需要进一步调查的澳大利亚人群公共卫生问题的范围。
方法：《南澳大利亚健康综合调查》是对年满15岁的南澳大利亚人进行的年度代表性人口调查，通过访调员管理的问卷调查进行。 2009年，有3007名参与者被要求使用STOP-BANG仪器测量阻塞性睡眠呼吸暂停的风险，包括大声打，白天频繁疲倦，观察到的呼吸暂停和高血压（STOP）的症状，以及测得的体重指数，年龄，脖子围和性别（BANG）。三个或更多的积极反应将高OSA风险的人归类。
结果：49.7％的成年人打S。据报告，睡眠后每周疲倦超过3-4次，占24.8％；在唤醒时间，成年人中有27.7％，其中有8.8％的人在开车时睡着了。通过STOP-BANG措施将超过一半的男性（57.1％，n = 566）和19.3％（n = 269）的女性归为OSA高危人群。在多变量模型中，高风险与受教育程度较低，收入较低以及居住在区域而不是大都市地区有关。
结论：高危人群中存在OSA的高患病率表明，医疗系统中目前可用于调查和诊断OSA的能力可能不足，尤其是在城市地区以外。这突出了一个重要的公共卫生问题，需要对新的护理模式进行进一步的详细研究和试验。

BACKGROUND & AIMS: Tumor necrosis factor (TNF) is a well characterized sleep-regulatory substance. To study receptor mechanisms for the sleep-promoting effects of TNF, sleep patterns were determined in control and TNF 55 kDa receptor knock-out (TNFR-KO) mice with a B6 x 129 background after intraperitoneal injections of saline or murine TNFalpha. The TNFR-KO mice had significantly less baseline sleep than the controls. TNFalpha dose-dependently increased non-rapid eye movement sleep (NREMS) in the controls but did not influence sleep in TNFR-KO mice. Although TNFR-KO mice failed to respond to TNFalpha, they had an increase in NREMS and a decrease in rapid eye movement sleep after interleukin-1beta treatment. These results indicate that TNFalpha affects sleep via the 55 kDa receptor and provide further evidence that TNFalpha is involved in physiological sleep regulation. Current results also extend the list of species to mice in which TNFalpha and interleukin-1beta are somnogenic.

背景与目标： 肿瘤坏死因子（TNF）是一种特征良好的睡眠调节物质。为了研究TNF促进睡眠的受体机制，在腹膜内注射盐水或鼠TNFalpha后，在B6 x 129背景的对照组和TNF 55kDa受体敲除（TNFR-KO）小鼠中确定睡眠模式。 TNFR-KO小鼠的基线睡眠明显少于对照组。 TNFalpha剂量依赖性地增加了对照组的非快速眼动睡眠（NREMS），但不影响TNFR-KO小鼠的睡眠。尽管TNFR-KO小鼠对TNFα无效，但在白介素1β治疗后，它们的NREMS升高且眼球快速睡眠减少。这些结果表明TNFα通过55kDa受体影响睡眠，并提供进一步的证据证明TNFα参与生理性睡眠调节。目前的结果也将TNFα和白细胞介素-1β具有催眠作用的小鼠扩大了物种种类。

BACKGROUND & AIMS: BACKGROUND:The hormone melatonin plays a key role in the proper functioning of the circadian timing system (CTS). Exogenous melatonin has been shown to be beneficial in cases of CTS dysfunction and sleep disturbances. The aim of our study was to relate 24-h melatonin excretion to objective sleep measures. METHODS:A total of 67 individuals were included in the study: 29 healthy subjects (16 women, 13 men; mean age 62.4 y, range 24-86) and 38 outpatients with neuropsychiatric sleep-related disturbances (25 women, 13 men; mean age 46.5 y, range 21-69). Over two consecutive nights in the sleep laboratory, polysomnographic (PSG) recordings were made and urine samples were collected at predefined intervals. RESULTS:Our data failed to show any age-controlled partial correlation between 6-sulphatoxymelatonin (aMT6s) parameters and PSG parameters in either of the two groups. CONCLUSION:Measuring endogenous melatonin does not seem to be an adequate way to evaluate sleep quality. This could be due to the fact that the size of the pineal gland and the amount of melatonin produced vary 20-fold between individuals.

背景与目标： 背景：褪黑激素在昼夜节律计时系统（CTS）的正常运转中起着关键作用。外源性褪黑素已被证明对CTS功能障碍和睡眠障碍有益。我们研究的目的是将24小时褪黑激素排泄与客观睡眠指标联系起来。
方法：研究共纳入67位个体：29位健康受试者（16位女性，13位男性；平均年龄62.4岁，范围24-86）和38位神经精神病患者与睡眠相关的门诊患者（25位女性，13位男性；平均年龄46.5岁，范围21-69）。在睡眠实验室连续两个晚上，进行了多导睡眠图（PSG）记录，并以预定的时间间隔收集了尿液样本。
结果：我们的数据未能显示两组中的6-硫代氧黑素（aMT6s）参数和PSG参数之间存在任何年龄控制的部分相关性。
结论：测量内源性褪黑激素似乎并不是评估睡眠质量的适当方法。这可能是由于松果体的大小和褪黑激素的产生量在个体之间变化了20倍。

BACKGROUND & AIMS: The present study examined the differences of self-ratings of 4 h sleep in three statesL-WE, where the percentage of waking time and urinary epinephrine are low (< 20% waking time); H-W, where the percentage of waking time and epinephrine levels increase along the basal regression line as determined by a previous study (20-100% waking time and < 7 ng/min); H-E, where epinephrine levels increase more than expected from the basal regression line for the two parameters (> 7 ng/min). Eight healthy male subjects participated twice in a 4 h polysomnograph experiment with four types of sleep onset (total of 64 observations). In group L-WE (52 observations for eight subjects), there were no excessively negative feelings on sleep latency, sleep depth, and feelings of sleep compared with usual sleep according to the questionnaire. Subjective sleep diagrams in group L-WE were similar to polysomnographic findings. Thus, group L-WE was thought objectively and subjectively to have a good sleep state. Groups H-W (eight observations for four subjects) and H-E (four observations for two subjects) had negative feelings regarding sleep depth and feelings of sleep compared with usual sleep. Approximately half the group H-W underrated their sleep compared with objective diagrams, while all cases in group H-E remarkably underrated their sleep in the subjective diagrams. The state of remarkable adrenal medullary secretory activity seen in group H-E and that of the slightly increased activity shown in group H-W were included in poor sleep states objectively and subjectively.

背景与目标： 本研究研究了三个州L-WE的4小时睡眠自我评价的差异，其中L-WE的醒来时间和尿肾上腺素的百分比较低（醒来时间<20％）； H-W，如先前研究确定的那样，苏醒时间和肾上腺素水平的百分比沿基础回归线增加（苏醒时间为20-100％，<7 ng / min）； H-E，其中两个参数（> 7 ng / min）的肾上腺素水平增加超过基线回归线的预期。八名健康男性受试者两次参加了4小时多导睡眠图实验，其中有四种类型的睡眠发作（总共64次观察）。根据问卷调查，在L-WE组（对八个受试者的52项观察）中，与通常的睡眠相比，在睡眠潜伏期，睡眠深度和睡眠感觉上没有过度的负面感觉。 L-WE组的主观睡眠图与多导睡眠图检查结果相似。因此，客观地和主观地认为L-WE组具有良好的睡眠状态。与常规睡眠相比，H-W组（四个受试者的八个观察结果）和H-E组（两个受试者的四个观察结果）对睡眠深度和睡眠感觉有负面感觉。与客观图表相比，H-W组大约一半的人低估了他们的睡眠，而在客观图表中，H-E组的所有病例均明显低估了他们的睡眠。 H-E组所见的肾上腺髓质分泌活动显着状态和H-W组所显示的肾上腺髓质分泌活动略有增加的状态被客观地和主观地纳入了不良睡眠状态。

BACKGROUND & AIMS: :The central nervous system undergoes several dynamic changes during sleep, which are coordinated by the pons, basal forebrain areas, and other subcortical structures and are mediated by three major neurotransmitters-norepinephrine, serotonin, and acetylcholine. The neuronal populations that produce these neuromodulators constitute the central representation of the sympathetic and parasympathetic subdivisions of the autonomic nervous system. The locus coeruleus (noradrenergic) and the raphe nucleus (serotoninergic) are most active during waking and become progressively less active in the transition from non-rapid eye movement (non-REM) to rapid eye movement (REM) sleep. On the other hand, the cholinergic neurons in the dorsolateral tegmental and pedunculopontine nuclei area are active both during waking and REM sleep. Over the past decade, a number of studies have provided interesting new evidence supporting the role of sleep in sleep-dependent memory processing. These studies have been directed specifically towards the role of sleep in memory encoding, memory consolidation, brain plasticity and memory reconsolidation, and have confirmed the hypothesis that sleep contributes importantly to processes of memory and brain plasticity. It has been shown in humans that sleep triggers overnight learning on a motor-sequence memory task, while equivalent waking periods produce no such improvement. These findings have important implications for acquiring real-life skills and in clinical rehabilitation following brain trauma and stroke.

背景与目标： ：中枢神经系统在睡眠过程中会经历一些动态变化，这些变化由脑桥，基底前脑区域和其他皮质下结构协调，并由三种主要的神经递质-去甲肾上腺素，5-羟色胺和乙酰胆碱介导。产生这些神经调节剂的神经元群体构成了自主神经系统交感神经和副交感神经细分的主要代表。醒来时，蓝斑（去甲肾上腺素能）和核中核（5-羟色胺能）最活跃，并且在从非快速眼动（non-REM）到快速眼动（REM）睡眠的过渡过程中，逐渐变弱。另一方面，在清醒和快速眼动睡眠期间，背外侧被盖区和足桥骨核区域的胆碱能神经元均活跃。在过去的十年中，许多研究提供了有趣的新证据来支持睡眠在依赖于睡眠的记忆处理中的作用。这些研究专门针对睡眠在记忆编码，记忆巩固，脑可塑性和记忆重建中的作用，并证实了以下假设：睡眠在记忆和脑可塑性过程中起重要作用。在人类中已经证明，睡眠触发了对运动序列记忆任务的通宵学习，而等效的醒着时间则没有这种改善。这些发现对于获得现实生活的技能以及脑外伤和中风后的临床康复具有重要意义。

BACKGROUND & AIMS: :Sleep-disordered breathing often presents as a cardiac or psychiatric problem. Such presentation may lead to suboptimal diagnostic and therapeutic decisions. The authors present a case in which a patient's condition improved only after the primary disorder was diagnosed and properly managed.

背景与目标： ：睡眠呼吸障碍通常表现为心脏或精神疾病。这样的表现可能导致次优的诊断和治疗决策。作者介绍了一种情况，只有在诊断出原发性疾病并妥善处理后，患者的病情才会改善。

BACKGROUND & AIMS: OBJECTIVES:To examine associations between sleep duration and health outcomes among distinct groups of sexual minority adults. METHODS:Using data from the 2014 Behavioral Risk Factor Surveillance System, we compared sleep duration (very short: ≤ 5 hr; short: 6 hr; normal: 7-8 hr; and long: ≥ 9 hr per day) between cisgender straight adults and distinct groups of sexual minorities. We further examined associations between sleep duration and 10 chronic health conditions among sexual minorities. RESULTS:Of 146,893 respondents, 142,507 (96.2%) were cisgender straight, and 4,386 (3.8%) were lesbian, gay, bisexual, transgender (LGBT). Overall, 17.3% of LGBT respondents reported very short sleep per day, compared with 12.2% for cisgender straight respondents (p < 0.0001). Among LGBT populations, the prevalence of very short sleep varied significantly among distinct groups, ranging from 13.2% among transgender female to male adults to 35.5% among transgender gender nonconforming adults. Very short sleep was further associated with increased odds of having stroke (aOR = 4.1, 95% CI [2.2-7.6]), heart attack (aOR = 3.0, CI [1.6-5.8]), coronary heart disease (aOR = 3.1, 95% CI [1.5-6.2]), asthma (aOR = 1.7, 95% CI [1.1-2.4]), chronic obstructive pulmonary disease (aOR = 2.5, CI [1.5-4.0]), arthritis (aOR = 2.1, CI [1.4-3.0]), and cancer (aOR = 1.8, 95% CI [1.0-3.2]) among sexual minorities. Disparities in the prevalence of stroke, heart attack, coronary health disease, COPD, diabetes, obesity, arthritis, and cancer were found among LGBT populations. CONCLUSIONS:Sexual minorities have a higher prevalence of sleep deprivation as compared with their straight counterparts. Sleep deprivation varies by sexual identity and gender. Very short sleep duration is associated with some chronic health conditions among LGBT populations. Promotion of sleep health education and routine medical assessment of sleep disorders are critically needed for sexual minority adults.

背景与目标： 目的：研究不同性别的成年少数群体的睡眠时间与健康结局之间的关联。
方法：使用2014年行为危险因素监测系统的数据，我们比较了直食成年成年直觉成年成年人的睡眠时间（非常短：≤5小时;短：6小时;正常：7-8小时;每天：≥9小时）以及不同性别的少数群体。我们进一步研究了性少数群体的睡眠时间与10种慢性健康状况之间的关联。
结果：在146,893名受访者中，有142,507名（96.2％）为顺性别，而有4,386名（3.8％）为女同性恋，男同性恋，双性恋和变性者（LGBT）。总体而言，LGBT受访者中有17.3％的人每天睡眠时间很短，而顺性别的受访者中有12.2％的人每天睡眠时间短（p <0.0001）。在LGBT人群中，不同组别的极短睡眠发生率差异显着，从跨性别女性到男性成年人中的13.2％，到跨性别性别不合格成年人中的35.5％。睡眠时间短还与中风（aOR = 4.1，95％CI [2.2-7.6]），心脏病发作（aOR = 3.0，CI [1.6-5.8]），冠心病（aOR = 3.1， 95％CI [1.5-6.2]），哮喘（aOR = 1.7、95％CI [1.1-2.4]），慢性阻塞性肺疾病（aOR = 2.5，CI [1.5-4.0]），关节炎（aOR = 2.1，CI [1.4-3.0]）和性少数人群中的癌症（aOR = 1.8，95％CI [1.0-3.2]）。在LGBT人群中发现中风，心脏病发作，冠心病，COPD，糖尿病，肥胖症，关节炎和癌症的患病率存在​​差异。
结论：与异性恋人群相比，性少数人群的睡眠剥夺患病率更高。睡眠剥夺因性别和性别而异。极短的睡眠时间与LGBT人群中的某些慢性健康状况有关。性少数成年人迫切需要促进睡眠健康教育和睡眠障碍的常规医学评估。

BACKGROUND & AIMS: :Chronic sleep restriction is a common experience; and while it has negative physiological effects, little is known about how it affects human behavior. To date, no study has investigated whether chronic sleep restriction can influence implicit attitudes (e.g., towards a race). Here, in a randomized, counterbalanced crossover design, we subjected participants to 3 weeks of chronic sleep restriction in the lab (i.e., 3 weekly cycles of 5 nights of 4 hours of sleep per night followed by 2 nights of 8 hours of sleep) and found evidence for an increased negative implicit bias towards Arab Muslims. No indicators of an implicit bias were found in these same individuals when they were rested (during a counterbalanced 3-week period of 8 hours time in bed per night). These findings suggest that chronic sleep restriction may "unmask" implicit racial or ethnic biases that are otherwise inhibited when in a rested state. Because chronic sleep restriction is prevalent among many occupations that routinely interact with ethnic minorities in potentially high-conflict situations (e.g., police officers), it is critical to consider the role that restricted sleep may play in exacerbating negative implicit attitudes and their potential for provoking unintentional and potentially harmful behavioral consequences.

背景与目标： ：长期睡眠受限是一种常见的经历；尽管它具有负面的生理作用，但对其如何影响人类行为知之甚少。迄今为止，尚无研究调查慢性睡眠限制是否会影响内在态度（例如，对种族的态度）。在这里，在随机，平衡的分频设计中，我们在实验室中对参与者进行了3周的慢性睡眠限制（即每周3个周期，即每晚4个小时的5夜睡眠，然后是2个小时的8个小时的夜睡眠）。发现证据表明，对阿拉伯穆斯林的负面内在偏见有所增加。在这些人休息时（在平衡的3周内，每晚卧床时间为8小时），没有发现隐性偏见的迹象。这些发现表明，长期睡眠限制可能会“掩盖”内在的种族或种族偏见，而这些偏见在休息状态下会受到抑制。由于慢性睡眠限制在许多潜在的高冲突情况下通常与少数族裔互动的职业中很普遍（例如，警务人员），因此必须考虑限制睡眠可能在加剧负面的内隐态度和挑衅中扮演的角色。意外和潜在有害的行为后果。

BACKGROUND & AIMS: STUDY OBJECTIVES:Population-based studies have demonstrated associations between sleep-disordered breathing (SDB), hypertension, and cardiovascular disease; few large-scale studies have examined associations of SDB with objective measures of cerebrovascular disease. This study tested the significance of associations of SDB with evidence of brain injury or ischemia determined by cerebral magnetic resonance imaging (MRI) studies. DESIGN:Cross-sectional and longitudinal analyses in a nested sample of Cardiovascular Health Study participants in the Sleep Heart Health Study. PARTICIPANTS:The 843 individuals (mean age 77, SD 4.3 years, 58% women) who had MRI studies as part of the Cardiovascular Health Study before and after polysomnography obtained as part of the Sleep Heart Health Study. MEASUREMENTS:A 12-channel polysomnogram was used to derive indexes of sleep-disordered breathing. Repeated MRI measurements provided indexes of infarct (presence and size) and white matter disease. Logistic regression analyses were used to model MRI changes of infarct-like lesions and white matter disease as a function of age, baseline white matter grade, and indexes of central and obstructive sleep-disordered breathing. RESULTS:Individuals who showed progression in white matter disease compared to those who did not were significantly more likely to show a Cheyne-Stokes respiration pattern and to have an increased number of central but not obstructive apneas. CONCLUSIONS:An association between change in white matter grade and measures of central sleep apnea was demonstrated that was consistent with a causal pathway in which central sleep apnea contributes to the progression of white matter disease; alternatively, central sleep apnea may be a marker of subclinical cerebrovascular or cardiovascular disease.

背景与目标： 研究目的：基于人口的研究表明睡眠呼吸障碍（SDB），高血压和心血管疾病之间存在关联。很少有大规模研究检查了SDB与脑血管疾病客观指标的关联。这项研究测试了SDB与通过脑磁共振成像（MRI）研究确定的脑损伤或局部缺血的证据之间的相关性。
设计：在睡眠心脏健康研究中的心血管健康研究参与者的嵌套样本中进行横断面和纵向分析。
参与者：843名个体（平均年龄77岁，标准年龄4.3岁，女性占58％）在多导睡眠监测仪前后进行了MRI研究，作为心血管健康研究的一部分，该研究是睡眠心脏健康研究的一部分。
测量：使用12通道多导睡眠图来得出睡眠呼吸障碍的指标。重复进行MRI测量可提供梗塞（存在和大小）和白质疾病的指数。使用Logistic回归分析来模拟梗塞样病变和白质疾病的MRI变化与年龄，基线白质等级以及中枢性和阻塞性睡眠呼吸障碍指数的关系。
结果：与未出现白质病进展的患者相比，未出现白质病进展的患者更可能显示Cheyne-Stokes呼吸模式，中枢性呼吸暂停但无阻塞性呼吸暂停的次数增加。
结论：白质分级的变化与中枢性睡眠呼吸暂停的措施之间存在关联，这与中枢性睡眠呼吸暂停导致白质疾病进展的因果关系一致；或者，中枢性睡眠呼吸暂停可能是亚临床脑血管或心血管疾病的标志。

BACKGROUND & AIMS: STUDY OBJECTIVES:To determine the total number of active sleep laboratories in the United States and the number of polysomnograms conducted on a yearly basis in these laboratories. METHODS:All members of the AASM and all AASM accredited sleep laboratory directors received a questionnaire addressing their laboratory and its volume. In three states, multiple telephone calls to AASM members were used to correctly identify the absolute number of labs and their PSG volume in those states. Extrapolating from the number of labs studies identified per questionnaire relative to the correct number (per calls) in those states and, then applying this ratio to the entire US, the total number of labs and studies was determined. RESULTS:Our data suggests that there are, in the year 2001, 1,292 sleep laboratories conducting 1,165,135 polysomnograms per year. This comes to 427 PSG's/year per 100,000 population in the United States. CONCLUSIONS:These data suggest that there are a relatively large number of sleep laboratories in the US conducting a substantial number of PSG's. However, there was considerable variability in this volume between states that did not relate to known markers of healthcare utilization. These numbers have likely increased since 2001.

背景与目标： 研究目的：确定美国活跃睡眠实验室的总数以及这些实验室每年进行的多导睡眠图的数量。
方法：所有AASM成员和所有AASM认可的睡眠实验室主任均收到了一份有关其实验室及其数量的问卷。在三个州中，使用多次致电AASM成员的电话来正确标识实验室的绝对数量及其在这些州中的PSG量。从每个调查表中确定的实验室研究数量相对于这些州的正确数量（每次呼叫）进行推断，然后将该比率应用于整个美国，即可确定实验室和研究的总数。
结果：我们的数据表明，在2001年，有1,292个睡眠实验室每年进行1,165,135项睡眠监测。在美国，每10万人中有427个PSG /年。
结论：这些数据表明，美国有相对大量的睡眠实验室在进行大量的PSG。但是，与已知的医疗保健利用指标无关，各州之间的容积存在很大差异。自2001年以来，这些数字可能有所增加。

BACKGROUND & AIMS: :We report a patient with severe obstructive sleep apnea syndrome, diabetes mellitus, and hypertension, with postoperative complications following tracheostomy. His stormy postoperative course is presented with emphasis on glycemic control and hypertension. We present a cautionary tale of a significant reduction in medications to control blood pressure and hyperglycemia following tracheostomy for severe OSA. The severe reduction in blood pressure and hypoglycemia could mimic sepsis and clinicans need to be vigilant to these dramatic effects following tracheostomy and appropriately adjust baseline medications.

背景与目标： ：我们报告了一名患有严重阻塞性睡眠呼吸暂停综合症，糖尿病和高血压的患者，其气管切开术后出现并发症。介绍了他风雨如磐的术后课程，重点是血糖控制和高血压。我们提出一个警告性的故事，指出严重OSA气管切开术后控制血压和高血糖的药物显着减少。血压和低血糖的严重降低可以模仿败血症，临床医生需要警惕气管切开术后的这些巨大影响，并适当调整基线药物。

BACKGROUND & AIMS: :Hypocretin/orexin signalling varies among sleep-wake behaviours, impacts upon cardiovascular autonomic control and is impaired in patients with narcolepsy with cataplexy (NC). However, evidence concerning disturbed cardiovascular autonomic control in NC patients is contrasting, and limited mainly to waking behaviour. We thus investigated whether control of cardiovascular variability is altered in NC patients during wakefulness preceding sleep, light (1-2) and deep (3-4) stages of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Polysomnographic recordings and finger blood pressure measurements were performed on nine drug-free male NC patients and nine matched healthy control subjects during spontaneous sleep-wake behaviour in a standardized laboratory environment. Indices of autonomic function were computed based on spontaneous fluctuations of systolic blood pressure (SBP) and heart period (HP). During wakefulness before sleep, NC patients showed significant decreases in indices of vagal HP modulation, cardiac baroreflex sensitivity and amplitude of central autonomic (feed-forward) cardiac control compared with control subjects. During NREM sleep, the negative correlation between HP and subsequent SBP values was greater in NC patients than in control subjects, suggesting a greater contribution of central autonomic commands to cardiac control. Collectively, these results provide preliminary evidence that autonomic control of cardiac variability by baroreflex and central autonomic (feed-forward) mechanisms is altered in NC patients during spontaneous sleep-wake behaviour, and particularly during wakefulness before sleep.

背景与目标： ：促胰泌素/促尿素信号转导在睡眠-觉醒行为之间变化，影响心血管自主控制，并且在发作性发作性猝死（NC）患者中受损。然而，有关NC患者心血管自主神经控制紊乱的证据却相反，并且主要限于苏醒行为。因此，我们调查了在睡眠前觉醒，非快速眼动（NREM）睡眠的浅（1-2）和深度（3-4）阶段以及快速眼动（REM）睡眠的NC患者中是否改变了心血管患者的心血管变异控制。在标准实验室环境中，在自发性睡眠-觉醒行为期间，对9名无毒品的男性NC患者和9名匹配的健康对照受试者进行了多导睡眠图记录和手指血压测量。根据收缩压（SBP）和心脏周期（HP）的自发波动计算自主神经功能的指标。在睡眠前的清醒过程中，与对照组相比，NC患者的迷走神经HP调节指数，心脏压力反射敏感性和中枢自主神经（前馈）心脏控制幅度明显降低。在NREM睡眠期间，NC患者的HP与随后的SBP值之间的负相关性大于对照组，这表明中枢自主神经命令对心脏控制的贡献更大。总的来说，这些结果提供了初步的证据，即在自发性觉醒行为期间，特别是在睡前觉醒期间，通过压力反射和中枢自主神经（前馈）机制对心脏变异的自主控制发生了改变。

BACKGROUND & AIMS: OBJECTIVE(S):Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder which affects from 1 to 3 % of people during development. OSAS treatment may be pharmacological, surgical or based on application of intraoral devices to increase nasal respiratory spaces. The purpose of this study was to determine the efficacy of the Rapid Maxillary Expander in OSAS young patients by measuring cardio-respiratory monitoring parameters (AHI, the average value of complete and incomplete obstructed respiration per hour of sleep, and SAO2, the percentage of oxygen saturation). STUDY DESIGN:The study was conducted on 11 OSAS young subjects (mean age 6.9±1.04 years), all treated with rapid maxillary expansion (RME). Cardio-respiratory monitoring (8-channel Polymesam) was performed at the beginning (diagnostic, T0) and after 12 months of treatment. RESULTS:The mean values of cardio-respiratory parameters at TO were: AHI=6.09±3.47; SAO2=93.09%±1.60. After 12 months of treatment, the mean values of the same polysomnographic parameters were: AHI=2.36 ± 2.24;SAO2=96.81% ±1.60. These changes were associated with an improvement in clinical symptoms, such as reduction of snoring and sleep apnea. CONCLUSION(S):This study confirms the therapeutic efficacy of RME in OSAS young patients. This orthopedic-orthodontic treatment may represent a good option in young patients affected by this syndrome.

背景与目标： 目的：阻塞性睡眠呼吸暂停综合症（OSAS）是一种呼吸系统疾病，在发育过程中会影响1-3％的人。 OSAS的治疗可以是药物治疗，外科手术或基于口腔内器械的应用以增加鼻腔呼吸空间。这项研究的目的是通过测量心脏呼吸监测参数（AHI，每小时完全和不完全阻塞性呼吸的平均值，每小时SAO2，氧气百分比）来确定快速上颌骨扩张器在OSAS年轻患者中的疗效。饱和）。
研究设计：该研究针对11名OSAS年轻受试者（平均年龄6.9±1.04岁）进行，所有受试者均接受快速上颌骨扩张（RME）治疗。在治疗开始（诊断为T0）和治疗12个月后进行心脏呼吸监测（8通道Polymesam）。
结果：在TO时，心脏呼吸参数的平均值为：AHI = 6.09±3.47； SAO 2 ＝ 93.09％±1.60。治疗12个月后，相同的多导睡眠图参数的平均值为：AHI = 2.36±2.24； SAO2 = 96.81％±1.60。这些变化与临床症状的改善有关，例如打呼and和睡眠呼吸暂停的减少。
结论：该研究证实了RME在OSAS年轻患者中的治疗功效。这种骨科正畸治疗可能是受此综合征影响的年轻患者的一个不错的选择。

BACKGROUND & AIMS: :Context • Obstructive sleep apnea/hypopnea syndrome (OSAHS) is among the most prevalent of sleep-related breathing disorders. No long-term follow-up studies have documented the continued success of lifestyle changes in treatment; oral appliances have an approximate 50% success rate; compliance with continuous positive airway pressure is poor, ranging from 50% to 89%; and the success rate of upper-airway surgery is only 66.4%. Therefore, some OSAHS patients seek alternative treatments. Objectives • The study intended to examine the efficacy of traditional Chinese therapeutic massage (tui na) for patients with OSAHS. Design • The research team designed a prospective study. Setting • The study took place at the outpatient clinic of the sleep center at the Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan), an academic tertiary medical center. Participants • Participants were 31 patients with moderate to severe OSAHS. Intervention • Each participant received a tui na treatment at multiple acupoints 2 ×/wk for 10 wk for approximately 15 min/session. Outcome Measures • At baseline and 3 mo after treatment, participants completed subjective measures, including (1) quality of life using a 36-item, short-form health survey (SF-36); (2) subjective snoring intensity indicated by bed-partners using a 0-10 visual analog scale (VAS); and (3) excessive daytime sleepiness (EDS) status, using a Chinese version of the Epworth Sleepiness Scale (CESS). The research team completed objective measures, including (1) polysomnography, (2) body mass index, and (3) neck circumference. Results • Twenty patients completed the full course of treatment. The apnea/hypopnea index per hour decreased from 43.8 ± 26.9 to 37.8 ± 31.7 after the treatments, with P = .049 (paired t test). The arousal index and rapid eye movement stage of sleep improved significantly. Statistically significant improvements were observed for the SF-36 on the score for the physical component summary, for its subscale for general health, for the mental component summary, and for 2 of its subscales: vitality and mental health. The VAS and the CESS showed that snoring intensity and EDS decreased significantly, respectively. No major complications occurred. Conclusions • Tui na is a feasible and safe treatment for patients with OSAHS. It can improve the quality of life, sleep architecture, snoring intensity, and EDS in patients with moderate-to-severe OSAHS. In the future, a controlled study should be considered to further investigate the effects of tui na for OSAHS.

背景与目标： ：背景•阻塞性睡眠呼吸暂停/呼吸不足综合征（OSAHS）是与睡眠有关的呼吸系统疾病中最普遍的一种。没有长期的随访研究证明治疗改变生活方式的持续成功。口腔用具的成功率约为50％；持续的气道正压顺应性差，范围从50％到89％；上呼吸道手术的成功率仅为66.4％。因此，一些OSAHS患者寻求替代治疗。目的•这项研究旨在检查传统中式按摩（推拿）对OSAHS患者的疗效。设计•研究团队设计了一项前瞻性研究。设置•研究在大学高等医学中心高雄长庚纪念医院（台湾高雄）睡眠中心的门诊进行。参与者•参与者为31例中度至重度OSAHS患者。干预•每位参与者在2次/周的多个穴位上接受推拿治疗，持续10周，每次疗程约15分钟。成果指标•在基线和治疗后3个月，参与者完成了主观指标，包括（1）使用36项简短健康调查（SF-36）的生活质量； （2）卧床伴侣使用0-10视觉模拟量表（VAS）表示的主观打强度； （3）使用中文版的Epworth嗜睡量表（CESS）过度白天嗜睡（EDS）。研究小组完成了客观测量，包括（1）多导睡眠监测，（2）体重指数和（3）颈围。结果•20名患者完成了整个疗程。治疗后每小时呼吸暂停/呼吸不足指数从43.8±26.9降至37.8±31.7，P = .049（配对t检验）。睡眠的觉醒指数和快速眼动阶段显着改善。在SF-36的身体成分摘要，总体健康次级量表，心理成分摘要以及其中的两个量表：活力和精神健康方面，在统计上均观察到了显着改善。 VAS和CESS显示打强度和EDS分别显着降低。无重大并发症发生。结论•推拿对于OSAHS患者是一种可行且安全的治疗方法。它可以改善中度至重度OSAHS患者的生活质量，睡眠结构，打呼intensity强度和EDS。将来，应考虑进行一项对照研究，以进一步研究推拿对OSAHS的影响。

BACKGROUND & AIMS: :Oxygen therapy can be life-saving for patients with chronic obstructive pulmonary disease (COPD) and is the backbone of any acute COPD treatment strategy. Although largely considered to be a benign drug, many publications have highlighted the need to accurately adjust oxygen delivery to avoid both hypoxemia and the problem of hyperoxia-induced hypercapnia. Recent clinical data have shown that the deleterious effects of excess oxygen treatment can not only alter carbon dioxide levels (which has been known for more than 60 years) but can also lead to an increase in mortality. Nevertheless, despite the extensive literature, the risks associated with hyperoxia are often overlooked and published clinical recommendations are largely ignored. This failure in knowledge translation has become increasingly important not only because of the desire to reduce medical error, but in a society with limited health care resources, the economic burden of COPD is such that it cannot afford to make preventable medical mistakes. Recently, novel devices have been developed to automatically adjust oxygen flow rates to maintain stable oxygen saturations. These closed-loop oxygen delivery systems have the potential to reduce medical error, improve morbidity and mortality, and reduce health care costs. Preliminary data in this field are promising and will require a significant amount of research in the coming years to determine the precise indications for these systems. The importance of appropriate oxygen dosing and the current literature regarding novel oxygen delivery systems are reviewed.

背景与目标： ：氧气疗法可挽救慢性阻塞性肺疾病（COPD）患者的生命，并且是任何急性COPD治疗策略的骨干。尽管在很大程度上被认为是一种良性药物，但许多出版物都强调了准确调整氧气输送量的必要性，以避免低氧血症和高氧血症引起的高碳酸血症的问题。最近的临床数据表明，过量氧气处理的有害作用不仅会改变二氧化碳水平（已知水平已超过60年），而且还会导致死亡率增加。尽管如此，尽管有大量文献报道，但与高氧有关的风险常常被忽视，已发表的临床建议在很大程度上被忽略。知识翻译的这种失败变得越来越重要，这不仅是因为希望减少医疗错误，而且在医疗资源有限的社会中，COPD的经济负担使得它无法承担可预防的医疗错误。最近，已开发出新颖的装置来自动调节氧气流速以维持稳定的氧气饱和度。这些闭环氧气输送系统具有减少医疗错误，改善发病率和死亡率以及降低医疗保健成本的潜力。该领域的初步数据是有希望的，并且在未来几年中需要大量研究才能确定这些系统的确切适应症。适当的氧气剂量的重要性和有关新型氧气输送系统的当前文献进行了审查。