The authors are grateful to Philipp Grundtner for his help with the statistical analyses.

该协议遵循弗里德里希 - 亚历山大大学埃尔兰根 - 纽伦堡（FAU）的当地伦理委员会的指导方针。 1. DISE-TCI-双谱分析程序<ol><li>执行静脉穿刺，并放置一个输液导管在患者左后卫的手或肘正中静脉，获得静脉通道来管理镇静剂。 </li><li>开展在室温（22℃）的调查。 </li><li>使清醒病人进入手术室。放置在患者中的手术台上仰卧位。 </li><li>在此之后，有麻醉师连接的生命体征监控系统。监测由外围脉搏血氧饱和度，3-导联ECG和非侵入性血压测量在3分钟的间隔在整个过程中的患者。 </li><li>确保两个麻醉师，麻醉设备是在患者的左侧。 </li><li>有麻醉师地点和固定T他一次性使用的传感器双谱分析。 <ol><li>要做到这一点，擦拭皮肤消毒剂，让它干燥。 </li><li>位置传感器（4相互联系和贴附电极）斜着患者前额:前额处中心一个电极（1号），电极2和3的正上方眉电极4眼睛和发际之间的拐角处寺庙。 </li><li>通过接口电缆连接传感器的双谱分析的显示器。按电极牢固，确保自动感应测试通过。 </li></ol></li><li>有麻醉师输入异丙酚患者的个体的性别，年龄，身高，体重和血浆靶浓度到数据管理器与沼泽17的预编程药物代谢动力学模型。 注:根据这个模型，TCI-数据管理器计算异丙酚的输注速率和操作连接的TCI-输液泵建立并自动保持设定的目标血浆浓度。</li><li>暗淡在手术室的光。 </li><li>异丙酚静脉滴注用的2.0微克/毫升初始目标血浆水平的TCI-输液泵诱导睡眠只。 </li><li>下连续监测患者的呼吸，意识和双频分析的值的状态的，直到达到镇静所需深度提高在0.2微克/毫升/ 2分钟的步目标血浆异丙酚水平。 注:镇静的目标深度是一个沉睡的病人（闭眼），在保持自主呼吸和/或开始打鼾和/或通过内窥镜或麻醉师考官观察阻塞性呼吸暂停。 </li><li>记录手动在镇静的目标深度脑电双频分析的平均值。 </li><li>具有与内窥镜检查者站在头部级别上的右侧下给患者。 </li><li>在镇静的目标深度鼻插入柔性光纤内窥镜通过INFerior鼻道。 </li><li>电影内镜检查和数字存储。根据制造商的说明使用的图像采集系统。 注意:在鼻中隔偏差或鼻甲肥大的情况下，下鼻道与较大直径应选择。 </li><li>检查从鼻咽至于下咽癌入口近侧到远侧方向由videoendoscopy上气道。 </li><li>分类阻塞部位（S）（帆，口咽，舌根，会厌）和配置/阻塞模式（前后，侧，同心）和度/严重程度（无障碍物/无震动，部分阻塞/振动，完全性梗阻根据在镇静15的目标深度投票系统/折叠）。 </li><li>在孤立的睡眠内窥镜检查的情况下，通过完成内镜检查后停止异丙酚终止病人的镇静。 </li><li>在T他的睡眠内窥镜的情况下，作为计划的手术过程的一部分，让麻醉师通过启动阿片类药物的输液进行静脉麻醉（ 例如 ，使用瑞芬太尼靶控模式）和增加丙泊酚（ 如 ，设置TCI水平的输液到4微克/毫升），直到失去知觉。注射肌肉松弛剂（如罗库溴铵）和插管病人。 </li></ol>

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The authors have no funding, financial relationships, or conflicts of interest to disclose.

自发睡眠时采用灵活的光纤rhinopharyngolaryngoscopy检测阻塞的部位最初的实验被描述为早在20世纪70年代22。然而，这种调查技术的根源最初纯粹是描述性的病理生理性的。在建立手术技术来治疗OSA，诸如悬雍垂腭咽成形（UPPP）由藤田，有人，然而，示出了操作的成功显然依赖于患者23术前仔细选择。在1991年引入药物诱导睡眠内镜（DISE）由普林格尔克罗夫特导致患者选择的第一次客观的方法和OSA患者7所产生的个体化治疗的概念。在随后的几年，DISE的世界广泛的知名度提高和众多的睡眠内窥镜检查协议的公布。由于担心病人的历年来了无数争议的讨论选举中，镇静的选择，梗阻，有效性，可靠性分类，结果自然睡眠等的适用性，它已经不可能建立一个标准协议的程序。一个小小的里程碑是在欧洲立场文件DISE，这应该作为第一方法，这种检查技术11标准化的2014年出版。 在这项研究中所描述的DISE过程进一步在标准化过程，因为它结合了TCI和双频分析两个standardizable技术。该患者个体化药物代谢动力学和镇静剂（异丙酚）的动态监测作为TCI的一部分，使得与双频监控的帮助下可以实现镇静所需的深度。我们的双频分析（60±10.4）的平均结果对应于50已经描述的目标走廊- 70 11。标准化ŧ是基于为异丙酚的群体药物动力学模型的CI协议，还可以使特定于患者的体重，身高，性别和年龄的镇静作用。这是为了结果是可再生，因此具有不同的中心，将来的调查可比性的根本要求。 可替换地到双频指数的监测时，可以进行脑电图分析来控制镇静深度。然而，原始脑电数据是间和个体内的变化难以解释，容易发生偏差。脑电双频指数的优势是，它是0和100以及独立于任何审查员的解释之间的无量纲数。此外，通过像中位数或频谱边缘频率的EEG功率谱分析得到的处理参数，是使用和术中设置评价少得多相比，脑电双频指数的监控。因此，双谱分析是目前最好的临床评估和容易获得的参数来镇静法官深度，并允许研究结果的可比性。 作为替代血浆异丙酚TCI模式中，可使用效应部位（脑）TCI。但是，使用这种模式，并且在同一预定目标浓度，患者将最有可能被更多的负面副作用，如低血压，无意深度镇静和呼吸暂停面对。这是由于过高的过冲和异丙酚血浆水平的药代动力学实施方案，快速达到设定效应室浓度的结果。为了避免睡眠内窥镜在关键缺氧，鼻氧气导管可以放置在对侧鼻孔和氧气流（3 - 5升/分钟）可以进行调整，以维持足够的外周氧饱和度。可以以这种方式可以防止与患者的重新氧合的检查不必要的中断。 preopera的值它被广泛作为经典的软腭操作进行 - - 也即多级手术性睡眠内镜检查可从UPPP的成功率来间接地测量。在目前的文献中，平均报道在非选择患者UPPP的成功率是33％和50％5之间。在独家软腭水平与临床怀疑梗阻所选择的组，报道的成功率52.3％5。在我们的调查中，跨OSA严重程度的各个层面，我们观察到49.1％（57分之28）在软腭水平障碍物或口咽或两者兼而有之。这将确认在文献中的UPPP应答率，无论是在&lt;50％选择的和未选择的患者群。 在侵入性的，多级手术而言，手术的成功率（根据舍尔）在德国S2E的准则描述是约53.8％5,6-。这个元分析的结果是基于总Ô˚F66回顾性研究，并与平均AHI 40.17前瞻性病例系列。最有趣的事实是一个睡眠内窥镜仅在三个66研究（4.5％）的执行。在剩余的研究中，只有技术检测阻塞的部位是在唤醒刚性光学或柔性rhinopharyngolaryngoscopy有时就座患者虽然也可以在不同的研究，在唤醒患者调查低估了阻塞模式，特别是在水平显示的舌根，会厌及喉咽部24，25。运用我们与德国S2E的准则多层次的手术治疗的患者的研究结果，在会厌至少一个阻塞部位应在重症患者OSA 52％的预期。因此，多层次的手术53.8％的应答率差可能表明潜在的阻塞部位"会厌"有时会被漏诊和连续undertreated。一世ñ的结论，这是赞成，前期介入的睡眠内窥镜另一种说法，尤其是重症患者OSA。 表决分类的限制因素，但是，是一个事实，即它不主（会厌独立地塌陷）或仲之间（会厌是通过用连续的气道阻塞舌根向后推由于会厌吸现象）区分会厌崩溃。在我们的人口，我们可以找到小学和中学会厌崩溃的轻度增加患病率（0％; 7.7％），中度（5.3％; 10.5％）和重度OSA（12％; 40.0％）。 如果我们的调查结果与1249睡眠内镜比利时的研究相比，很明显，尽管我们比较小的群体，无论是分配和梗阻部位的频率出现可重现（腭/盖膜:81％Vroegop 等人 与59.6％;舌根:46.6％Vroegop 等。 与 43.9％;下咽癌/会厌:38.7％Vroegop 等。 与 29.8％，多级:68.2％Vroegop 等。 对 61.4％）26。然而，结果的可转让性仍然存在问题，因为在比利时学习镇静咪达唑仑（一种肌肉松弛苯并二氮呼吸抑制作用）和丙泊酚来实现的。此外，镇静深度没有客观测量 - 这进一步限制了结果的可比性。这是另一个原因倡导睡眠内镜检查进一步规范。此外，它仍然有要显示，与睡眠内镜及其对治疗的决定影响获得的结果，最终也导致手术效果的改善。我们的协议的一个限制因素是事实，不存在数据的DISE比较梗阻图案与阻塞模式在自然睡眠。这应受到将来的调查，例如通过在自然睡眠磁共振成像过程中与阻塞模式DISE期间比较梗阻型态的装置。 该多级障碍物存在于重度OSA的病例的80％，与事实以上的表示会厌参与的情况下（52％）的一半，示出了用于前计划上呼吸道手术睡眠内窥镜的需要。这也是真实的改善术后效果而言。该DISE-TCI-双频谱分析过程是对睡眠内窥镜的需要可重复的协议的一个步骤 - 能够标准化。然而现在还不知道这些观察阻塞模式是否还对应于自然睡眠调查结果。

阻塞性睡眠呼吸暂停（OSA）的特征在于完整（呼吸暂停）或者上呼吸道在睡眠时的部分（低通气）崩溃的重复阶段。这些阶段往往是动脉氧饱和度下降而造成睡眠觉醒的碎片有关。 OSA用在一般人群中伴随白天症状发病率为3 -男性7％和2 -在妇女1 5％。中至重度OSA治疗中度的金标准是经鼻持续气道正压通气（nCPAP），其合规性是国际上报道的约40 - 60％2。该处理用于通过29 - OSA患者的83％，定期为小于4小时3。关于双方CPAP使用的长期合规正面和负面的预测都很好时下4闻名。此外，情感和临床副作用往往大大降低合规性。替代治疗方案，例如上呼吸道手术日erefore发挥OSA治疗中起重要作用。然而，事实上，手术（响应速度）的成功率比较低与通气治疗的比较是有问题的5,6。 人们希望，在1991年引进的睡眠内窥镜用克罗夫特和普林格尔不仅能够进一步深入了解OSA的病理生理机制也可能通过提高个体化手术治疗7响应速度。早在2011年，德维托等人的研究。展示了使用基于靶控输注（TCI）并相对于安全性，稳定性和精度8双频分析调查技术的优点。在此期间，睡眠内镜检查的有效性和可靠性已经建立，自从2014年欧洲立场文件，它是走向规范化9-11上。本研究的目的是建立用于睡眠endoscop的标准化协议ý由镇静异丙酚靶控输注，具有镇静的使用双频分析深度的实时监测相结合，以便根据OSA-严重性分化障碍图案。 病例报告: 学习规划: 回顾性研究是在耳鼻咽喉 - 弗里德里希 - 亚历山大大学埃尔兰根 - 纽伦堡头颈外科部2012年9月和2014年11月间进行，之后由当地伦理委员会的批准。所有参赛57例，年龄20〜73岁，被耳鼻咽喉，头颈外科部招聘。 52例患者男5女。除了标准化的采访中，他们被一个耳鼻喉科检查，并接受了胃镜检查清醒评估上呼吸道。然后心肺多导睡眠图是在该部进行的睡眠实验室，使他们的睡眠呼吸障碍的准确分类。该OSA的严重程度分为轻度（AHI 5 - 15 /小时），中度（AHI&gt; 15 &lt;30 /小时）或重度（AHI&gt; 30 /小时），根据睡眠医学任务的美国学院的标准部队12 。成立于上呼吸道（主要指示）的一个计划手术干预的情况下，或在应用nCPAP违约（仲或佐剂指示）的情况下，为睡眠内窥镜的指示。 这项研究的入选标准是男性和女性年龄在18 - 75岁被诊断为多导睡眠监测轻度，中度或重度OSA。排除标准是麻醉医师的美国社会分类（ASA）IV / V，中枢性呼吸暂停，镇静剂，酒精或毒品上瘾，过敏异丙酚，孕妇误用积极的历史。 诊断，评估和计划: 汽车diorespiratory多导睡眠图（PSG）: 多导睡眠图用一个33通道心肺诊断系统进行的。对于多导睡眠监测诊断技术的过程中使用脑电图标准化技术遵循睡眠医学的美国学院（AASM）的建议（EEG; F4-M1，C4-M1，O2-M1），左右眼电图，颏和胫肌，鼻压力插管，胸腹呼吸努力传感器（感应体积描记器），体位传感器，脉搏血氧饱和度，打鼾麦克风的肌电，一个通道ECG和一个红外录像13。评价是根据AASM标准进行（2.0版，2012）和由德国睡眠学会（DGSM）13，14的认可的医疗睡眠专家进行。多导睡眠图证实OSA后，所有57例患者接受了标准化的异丙酚基于药物引起的石勒EP内窥镜（DISE）与TCI和双频谱分析（DISE-TCI-双频谱分析）。 术前准备: 由于肌肉松弛作用，与苯二氮没有在术前用药仅用于诊断目的而进行的睡眠内镜检查的情况下，被赋予。如果有计划外科手术过程中进行睡眠内窥镜，用可乐定为前用药为苯并二氮类的替代，考虑相应的禁忌考虑。 梗阻的分类: 投票系统用于分类目的15。梗阻以下站点被认为是:帆，口咽（横向口咽墙，扁桃体），舌根和会厌。梗阻严重程度分为三个档次（无阻碍;部分和完全性肠梗阻）。梗阻的配置被分为前，后erior，横向和同心。 靶控输注（TCI）: 靶控输注（TCI）描述了使用Microchip控制输液泵来实现血液中的目标浓度药物输液。该方法的目的是迅速实现和根据指定的（定义）的血浆水平，或在效应部位的TCI的情况下的效果的水平有一定的效果（ 例如，镇静）的维护。血浆水平或效应部位水平的计算是基于药物动力学3-隔室模型（根据沼泽或Schnider）使用在志愿者人口16-18所确定的药理半衰期值和分配系数。快速达到并保持在等离子体异丙酚指定的目标水平所需的输注率然后自动计算并通过输液泵来控制。本研究使用由输注泵的系统和一个数据马nager与沼泽的预编程的药代动力学模型在一起。镇静的目标深度同时被双谱分析监测。 双频分析: 双频分析/索引与大脑中的电活动密切相关。的双频分析记录在监视器额叶EEG信号，并与各种专有算法的帮助下，分析了脑电功率谱的分布。的脑电双频指数是0和100 19之间的无量纲数。在一般情况下，大约90的值反映了高频的β-波的优势，并表明病人清醒。低于10双频分析值表示脑电图抑制20，21的。因此，这种规模提供了镇静剂的对大脑的效果的间接测量。为了维持麻醉的足够深度，避免患者的不希望的术地区分清醒，一个BISP推荐的&lt;60 ectral指数。另一方面，应该避免的&lt;40的双频指数的值，以防止不必要的深度麻醉。 所有的睡眠内窥镜检查是由两名经验丰富的耳鼻咽喉科的顾问，在睡眠医学附加资格（TM 59.6％（57分之34），AF 40.4％（57分之23）进行。

<table><tbody><tr><td>&lt;strong&gt;Cardiorespiratory polysomnography&amp;nbsp;&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>&lt;em&gt;SOMNOscreen&amp;nbsp;&lt;/em&gt;</td><td>SOMNOmedics, Randersacker, Germany</td><td>SBT202</td><td></td></tr><tr><td>&lt;strong&gt;Sedation&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>&lt;em&gt;Propofol-Lipuro&lt;/em&gt; 20 mg/ml; 2,6-diisopropylphenol</td><td>B. Braun Melsungen AG, Melsungen, Germany</td><td></td><td></td></tr><tr><td>&lt;strong&gt;Target-controlled infusion (TCI)&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Infusion pump &lt;em&gt;Orchestra Module DPS Visio&lt;/em&gt;</td><td>Fresenius Kabi, Germany GmbH&amp;nbsp;</td><td>Z082420</td><td></td></tr><tr><td>Data manager &lt;em&gt;Orchestra Base Primea&lt;/em&gt;</td><td>Fresenius Kabi Germany GmbH</td><td>Z081320</td><td></td></tr><tr><td>&lt;strong&gt;Bispectral analysis (BIS)&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>BIS single-use electrode &lt;em&gt;BIS Quatro Sensor&lt;/em&gt;</td><td>Covidien, Neustadt/Donau, Germany GmbH</td><td>186-0106</td><td></td></tr><tr><td>BIS monitor&lt;em&gt; BIS VISTA&lt;/em&gt;</td><td>Covidien, Neustadt/Donau, Germany GmbH</td><td>186-0210</td><td></td></tr><tr><td>&lt;strong&gt;Endoscope&amp;nbsp;&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Laryngo fiberscope, length 30 cm, diameter 3.5 mm</td><td>KARL STORZ GmbH &amp;amp; Co. KG, Tuttlingen, Germany</td><td>11101RP</td><td></td></tr><tr><td>&lt;strong&gt;Picture Archiving&amp;nbsp; System&amp;nbsp;&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>AIDA</td><td>Karl STORZ GmbH &amp;amp; Co. KG, Tuttlingen, Germany</td><td>WD 200-XX</td><td></td></tr><tr><td>&lt;strong&gt;Premedication&amp;nbsp;&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>&lt;em&gt;Catapresan;&lt;/em&gt; Clonidin-HCl 0.075 mg/0.15 mg/0.3 mg</td><td>Boehringer Ingelheim Pharma, GmbH &amp;amp; Co. KG, Ingelheim am Rhein, Germany</td><td></td><td></td></tr></tbody></table>

drug-induced sleep endoscopy (dise) with target controlled infusion (tci) and bispectral analysis in obstructive sleep apnea

这项研究的目的是要建立药物诱导睡眠内镜（DISE）的标准化协议来区分阻塞性睡眠呼吸暂停（OSA）阻塞模式。镇静异丙酚靶控输注（TCI）与镇静使用双频分析深度的实时监测相结合。 在一项观察性研究57例患者（平均年龄44.8年，±SD 10.5;平均呼吸暂停低通气指数（AHI）30.8 /小时，±SD 21.6，平均BMI28.2千克/米2，±SD 5.3）进行心肺多导睡眠监测，然后用DISE TCI和双频分析。睡眠通过用一个TCI-泵异丙酚的静脉滴注单独诱导，用2.0微克/毫升的初始目标血浆水平。根据连续监测病人的呼吸，意识和双频分析的价值状态，目标血浆丙泊酚水平在0.2微克/毫升/ 2分钟的步上升，直到德镇静sired深度为止。在镇静的目标深度脑电双频分析的平均值确定和DISE-TCI-双频谱分析过程中受阻的模式，然后根据投票系统分类。随后对结果进行按多导睡眠监测和人体测量数据进行分析。在所有学位OSA的严重阻碍多部位发生澄清了之前的上呼吸道手术睡眠内窥镜的需要。 该技术的优点是协议即使对于患者异质群体的再现性。此外，与双频指数的实时控制异丙酚的血浆水平的逐渐受控，标准化增加导致镇静的精确控制的深度。该DISE-TCI-双频谱分析过程是对睡眠内窥镜的需要可重复的协议的一个步骤 - 能够标准化。但它是尚未公知的瓦特论是这些观察到的阻塞模式也对应于自然睡眠的调查结果。

<html>患者特性示于表1中 。在镇静的期望深度的双频分析的平均值为60（±SD 10.4，范围35 - 80; 95％置信区间42.0 - 47.6）。阻塞的单个或多个组合的各网站上OSA严重程度的各个层面被发现。梗阻确定的地点，频率递减的顺序，分别为:内膜59.6％（五十七分之三十四），舌根43.9％（57分之25），口咽42.1％（57分之24），或在会厌29.8％的水平（57分之17）。软腭或口咽障碍物，在每种情况下分离或组合，被认为在患者49.1％（五十七分之二十八）。所有OSA患者的38.6％（57分之22）显示阻塞和61.4％（35/57）的至少两个位点的单个位点。阻塞点的配置取决于OSA严重程度（ 图1）不同。 轻度OSA "FO:保持-together.within页="1"&gt;患者特性示于表1之中患者轻度OSA，超过一半（53.8％（7/13））显示完全阻塞在一个单一的现场（ 图2）。两个或两个以上梗阻部位存在于46.2％（6/13）。 中度OSA 患者特性示于表1中 。在中度OSA患者一半（52.6％（10/19））有一个孤独的完全性梗阻（ 图3），与47.4％（9/19），显示在两个或多个部位阻塞。 重度OSA 患者特性示于表1中 。的患者严重OSA只有20.0％（5/25）显示阻塞在单一站点（ 图4 </st荣&gt;）和鲜明的对比有轻度或中度的OSA的基团，在两个或多个位点的障碍物存在于患者的严重OSA组中80.0％（20/25）。软腭和/或口咽部阻塞的组合中的重度OSAS患者的40％（10/25）被发现。在44％（11/25），软腭阻碍是与其他障碍物网站（扁桃体，舌根，会厌）相结合。的严重OSAS患者的48％（12/25）显示阻塞在舌根的水平，这阻碍了与在其中的91.7％（11/12）另一个站点相结合。同样，口咽梗阻与在另一个位置梗阻的情况下为91.7％（11/12）的结合。会厌是至少有一个阻塞的部位病例的52％（13/25）。的患者严重OSA 40％（10/25）也表明共存障碍物在舌根的水平。试析完全阻塞帆图谱表明前后的显着下降，从轻微的崩溃和中等（90％）到重度OSA（50％）。与此相反，同心障碍物大幅度增加从轻微（0％）出现中度（10％）到重度OSA（36％），而部分和完全软腭梗阻的比率似乎是独立的OSA严重性（轻度OSA:60 ％/ 40％;中等OSA:60％/ 40％;重度OSA:57％/ 43％）（ 图5）。 <img alt="图1" src="/files/ftp_upload/54739/54739fig1.jpg" /> 图1:阻塞模式（X轴）的患病率（单位:％）根据OSA严重程度。由于这样的事实，每一个阻塞部位可以多级崩溃内发生多次，超过100％，可累计根据OSA的每个等级获得。 <a href="https://ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54739/54739fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2"SRC ="/文件/ ftp_upload / 54739 / 54739fig2.jpg"/&gt; 图2:轻度OSA。维恩图表示上气道阻塞网站（患病率％和上气道阻塞的网站比）的所有可能的关系。 <a href="https://ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54739/54739fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图3" src="/files/ftp_upload/54739/54739fig3.jpg" /> 图3:中度OSA。维恩图表示上气道阻塞网站（患病率％和上气道阻塞的网站比）的所有可能的关系。 <a href="https://ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54739/54739fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图4" src="/files/ftp_upload/54739/54739fig4.jpg" /> 图4:严重OSA。维恩图表示上气道阻塞网站（患病率％和上气道阻塞的网站比）的所有可能的关系。 <a href="https://ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54739/54739fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图5" src="/files/ftp_upload/54739/54739fig5.jpg" /> 软腭梗阻模式（x轴）根据OSA严重性的流行率（单位:％）:图5。 <a href="https://ecsource-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54739/54739fig5large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="表格1" src="/files/ftp_upload/54739/54739table1.jpg" /> 表1:患者特征。 SD =标准差，BMI =体重指数（公斤/米2），AHI = Apne一个低通气指数（/小时）。

Watch this Scientific Journal Video about Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea at JoVE.com

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

这项研究的目的是要建立睡眠内窥镜来区分阻塞性睡眠呼吸暂停（OSA）阻塞模式的标准化协议。镇静的靶控输注（TCI）与镇静使用双频分析深度的实时监测相结合。

药物引起的与靶控输注（TCI）和双频分析阻塞性睡眠呼吸暂停睡眠内窥镜（DISE）

The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in ...

drug-induced-sleep-endoscopy-dise-with-target-controlled-infusion-tci

Nanyang Technological University

Research

JoVE Journal

Medicine

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

19.5K 次观看.  Friedrich-Alexander University Erlangen-Nürnberg (FAU). 这项研究的目的是要建立睡眠内窥镜来区分阻塞性睡眠呼吸暂停（OSA）阻塞模式的标准化协议。镇静的靶控输注（TCI）与镇静使用双频分析深度的实时监测相结合。 

视频: Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

Noninvasive, High-throughput Determination of Sleep Duration in Rodents

Traditionally, sleep is monitored by an electroencephalogram (EEG). EEG studies in rodents require surgical implantation of the electrodes followed by a long recovery period. To perform an EEG recording, the animal is connected to a receiver, creating an unnatural tether to the head-mount. EEG monitoring is time consuming, carries risk to the animal, and is not a completely natural setting for the measurement of sleep. Alternative methods to detect sleep, particularly in a high-throughput fashion, would greatly advance the field of sleep research. Here, we describe a validated method for detecting sleep via activity-based home-cage monitoring. Previous studies have shown that sleep assessed via this method has a high degree of agreement with sleep defined by traditional EEG-based measures. Whereas this method is validated for total sleep time, it is important to note that sleep bout duration should be assessed by an EEG which has better temporal resolution. The EEG can also differentiate rapid eye movement (REM) and non-REM sleep, giving more detail about the exact nature of sleep. Nevertheless, activity-based sleep determination can be used to analyze multiple days of undisturbed sleep and to assess sleep as a response to an acute event (like stress). Here, we show the power of this system to detect the response of mice to daily intraperitoneal injections.

We describe a high-throughput method of measuring sleep by means of activity-based home-cage monitoring. This method offers advantages over traditional EEG-based methods. It is well validated for the determination of total sleep duration and can be a powerful tool to monitor sleep in rodent models of human disease.

无创高通量测定啮齿类动物睡眠时间

Traditionally, sleep is monitored by an electroencephalogram (EEG). EEG studies in rodents require surgical implantation of the electrodes followed by a ...

科研

行为学

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can jeopardize their spontaneous breathing, topical anesthesia of the airway is a popular technique. The spray-as-you-go technique represents one of the simplest opportunities to anesthetize the airway mucosa. The application of local anesthetic through the working channel of the flexible endoscope is a widespread practice for anesthetists as well as pulmonologists. There is neither need for additional devices nor special training as a pre-requisite to perform this technique. However, a known clinical problem is the coughing and gagging reflex that may occur when the liquid anesthetic strikes the airway mucosa and other sensitive structures like the vocal cords. This can be avoided by the use of oxygen applied through the working channel with the aim of fogging the local anesthetic into finer particles. Furthermore, the oxygen flow provides a higher oxygen supply and contributes to a better view, dispersing mucus secretions and blood away from the lens. Using an atomizer with a high oxygen flow of 10 L/min we maximized these benefits, caused less coughing and had more satisfied and therefore cooperative patients. Possible, but very rare complications of using oxygen flow including gastric insufflation, organ rupture or barotrauma did not arise. We attribute the complication-free use of high oxygen flow to the design of the set, which permits flow and pressure release.

The topical anesthetic lidocaine was atomized using a high oxygen flow through the working channel of a flexible intubating endoscope to achieve topical airway anesthesia for awake endotracheal intubation. We prefer this modified spray-as-you-go technique for endoscopic intubation to classical bolus application because of higher patient satisfaction and better compliance.

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

医学

Recording Brain Electromagnetic Activity During the Administration of the Gaseous Anesthetic Agents Xenon and Nitrous Oxide in Healthy Volunteers

Anesthesia arguably provides one of the only systematic ways to study the neural correlates of global consciousness/unconsciousness. However to date most neuroimaging or neurophysiological investigations in humans have been confined to the study of &#947;-Amino-Butyric-Acid-(GABA)-receptor-agonist-based anesthetics, while the effects of dissociative N-Methyl-D-Aspartate-(NMDA)-receptor-antagonist-based anesthetics ketamine, nitrous oxide (N2O) and xenon (Xe) are largely unknown. This paper describes the methods underlying the simultaneous recording of magnetoencephalography (MEG) and electroencephalography (EEG) from healthy males during inhalation of the gaseous anesthetic agents N2O and Xe. Combining MEG and EEG data enables the assessment of electromagnetic brain activity during anesthesia at high temporal, and moderate spatial, resolution. Here we describe a detailed protocol, refined over multiple recording sessions, that includes subject recruitment, anesthesia equipment setup in the MEG scanner room, data collection and basic data analysis. In this protocol each participant is exposed to varying levels of Xe and N2O in a repeated measures cross-over design. Following relevant baseline recordings participants are exposed to step-wise increasing inspired concentrations of Xe and N2O of 8, 16, 24 and 42%, and 16, 32 and 47% respectively, during which their level of responsiveness is tracked with an auditory continuous performance task (aCPT). Results are presented for a number of recordings to highlight the sensor-level properties of the raw data, the spectral topography, the minimization of head movements, and the unequivocal level dependent effects on the auditory evoked responses. This paradigm describes a general approach to the recording of electromagnetic signals associated with the action of different kinds of gaseous anesthetics, which can be readily adapted to be used with volatile and intravenous anesthetic agents. It is expected that the method outlined can contribute to the understanding of the macro-scale mechanisms of anesthesia by enabling methodological extensions involving source space imaging and functional network analysis.

Simultaneous magnetoencephalography and electroencephalography provides a useful tool to search for common and distinct macro-scale mechanisms of reductions in consciousness induced by different anesthetics. This paper illustrates the empirical methods underlying the recording of such data from healthy humans during N-Methyl-D-Aspartate-(NMDA)-receptor-antagonist-based anesthesia during inhalation of nitrous oxide and xenon.

在健康志愿者的气体麻醉剂氙和一氧化二氮的管理中记录大脑电磁活动

Anesthesia arguably provides one of the only systematic ways to study the neural correlates of global consciousness/unconsciousness. However to date most ...

神经科学

Computer-based Multitaper Spectrogram Program for Electroencephalographic Data

Current web resources provide limited, user friendly tools to compute spectrograms for visualizing and quantifying electroencephalographic (EEG) data. This paper describes a Windows-based, open source code for creating EEG multitaper spectrograms. The compiled program is accessible to Windows users without software licensing. For Macintosh users, the program is limited to those with a MATLAB software license. The program is illustrated via EEG spectrograms that vary as a function of states of sleep and wakefulness, and opiate-induced alterations in those states. The EEGs of C57BL/6J mice were wirelessly recorded for 4 h after intraperitoneal injection of saline (vehicle control) and antinociceptive doses of morphine, buprenorphine, and fentanyl. Spectrograms showed that buprenorphine and morphine caused similar changes in EEG power at 1&#8722;3 Hz and 8&#8722;9 Hz. Spectrograms after administration of fentanyl revealed maximal average power bands at 3 Hz and 7 Hz. The spectrograms unmasked differential opiate effects on EEG frequency and power. These computer-based methods are generalizable across drug classes and can be readily modified to quantify and display a wide range of rhythmic biological signals.

This protocol provides an open source, compiled MATLAB program that generates multitaper spectrograms for electroencephalographic data.

基于计算机的多星仪电谱仪程脑电图数据

Current web resources provide limited, user friendly tools to compute spectrograms for visualizing and quantifying electroencephalographic (EEG) data. ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

老年人多式家庭睡眠监测

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Multi-system Monitoring for Identification of Seizures, Arrhythmias and Apnea in Conscious Restrained Rabbits

Patients with ion channelopathies are at a high risk of developing seizures and fatal cardiac arrhythmias. There is a higher prevalence of heart disease and arrhythmias in people with epilepsy (i.e., epileptic heart.) Additionally, cardiac and autonomic disturbances have been reported surrounding seizures. 1:1,000 epilepsy patients/year die of sudden unexpected death in epilepsy (SUDEP). The mechanisms for SUDEP remain incompletely understood. Electroencephalograms (EEG) and electrocardiograms (ECG) are two techniques routinely used in the clinical setting to detect and study the substrates/triggers for seizures and arrhythmias. While many studies and descriptions of this methodology are in rodents, their cardiac electrical activity differs significantly from humans. This article provides a description of a non-invasive method for recording simultaneous video-EEG-ECG-oximetry-capnography in conscious rabbits. As cardiac electrical function is similar in rabbits and humans, rabbits provide an excellent model of translational diagnostic and therapeutic studies. In addition to outlining the methodology for data acquisition, we discuss the analytical approaches for examining neuro-cardiac electrical function and pathology in rabbits. This includes arrhythmia detection, spectral analysis of EEG and a seizure scale developed for restrained rabbits.

Using simultaneous video-EEG-ECG-oximetry-capnography, we developed a methodology to evaluate the susceptibility of rabbit models to develop provoked arrhythmias and seizures. This novel recording system establishes a platform to test the efficacy and safety of therapeutics and can capture the complex cascade of multi-system events that culminate in sudden death.

意识约束兔子中癫痫发作、心律失常和呼吸暂停的多系统监测

Patients with ion channelopathies are at a high risk of developing seizures and fatal cardiac arrhythmias. There is a higher prevalence of heart disease ...

Image Acquisition using Portable Sonography for Emergency Airway Management

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of patients, but also to address the potential benefits of employing ultrasound in airway management. The benefits of point of care ultrasound (POCUS) include its portability, the speed at which it can be utilized, and its lack of invasiveness or exposure of the patient to radiation of other imaging modalities.
Two primary indications for airway POCUS include confirmation of endotracheal intubation and identification of the cricothyroid membrane in the event a surgical airway is required. In this article, the technique of using ultrasound to confirm endotracheal intubation and the relevant anatomy is described, along with the associated ultrasonographic images. In addition, identification of the anatomy of the cricothyroid membrane and the ultrasonographic acquisition of appropriate images to perform this procedure are reviewed.
Future advances include utilizing airway POCUS to identify patient characteristics that might indicate difficult airway management. Traditional bedside clinical exams have, at best, fair predictive values. The addition of ultrasonographic airway assessment has the potential to improve this predictive accuracy. This article describes the use of POCUS for airway management, and initial evidence suggests that this has improved the diagnostic accuracy of predicting a difficult airway. Given that one of the limitations of airway POCUS is that it requires a skilled sonographer, and image analysis can be operator dependent, this paper will provide recommendations to standardize the technical aspects of airway ultrasonography and promote further research utilizing sonography in airway management. The goal of this protocol is to educate researchers and medical health professionals and to advance the research in the field of airway POCUS.

Point of care ultrasound (POCUS) is increasingly being utilized in airway management. Presented here are some clinical utilities of POCUS, including differentiating endotracheal and esophageal intubation, identification of the cricothyroid membrane in the event a surgical airway is required, and measuring anterior neck soft tissue to predict difficult airway management.

使用便携式超声采集图像进行紧急气道管理

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of ...

保留自主呼吸的视频辅助胸腔镜手术的非插管方案

Non-Intubated Video-Assisted Thoracoscopic Surgery

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the lung, and lobectomy. However, there is a high incidence of pulmonary complications arising from general anesthesia with tracheal intubation. Non-intubation with the preservation of voluntary breathing is an alternative to anesthesia. Non-intubation procedures minimize the adverse effects of tracheal intubation and general anesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and post-operative nausea and vomiting. However, the steps for non-intubation procedures are not detailed in many studies. Here, we present a concise non-intubated protocol for the performance of video-assisted thoracoscopic surgery with preserved autonomic breathing. This article identifies the conditions necessary to convert from non-intubated to intubated anesthesia and also discusses the advantages and limitations of non-intubated anesthesia. In this work, this intervention was performed on 58 patients. In addition, the results of a retrospective study are presented. Compared with intubated general anesthesia, patients in the non-intubated video-assisted thoracic surgery group had lower rates of post-operative pulmonary complications, shorter operative times, less intraoperative blood loss, shorter PACU stays, a lower number of days to chest drain removal, less post-operative drainage, and shorter hospital stays.

作者聚焦: 一种具有多模式镇痛和七氟烷吸入麻醉的非插管视频辅助胸腔镜手术 

Here, we present a non-intubated protocol for performing video-assisted thoracoscopic surgery with preserved autonomic breathing.

非插管视频辅助胸腔镜手术

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the ...

药物引起的与靶控输注（TCI）和双频分析阻塞性睡眠呼吸暂停睡眠内窥镜（DISE）

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无创高通量测定啮齿类动物睡眠时间

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

在健康志愿者的气体麻醉剂氙和一氧化二氮的管理中记录大脑电磁活动

基于计算机的多星仪电谱仪程脑电图数据

老年人多式家庭睡眠监测

意识约束兔子中癫痫发作、心律失常和呼吸暂停的多系统监测

使用便携式超声采集图像进行紧急气道管理

非插管视频辅助胸腔镜手术

非插管视频辅助胸腔镜手术

非插管视频辅助胸腔镜手术