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Objective:To construct a perioperative activity program for patients with minimally invasive esophageal cancer under enhanced recovery after surgery (ERAS) concept through literature review and Delphi method.Methods:This was a single-center and interview study. Databases and websites including PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Medive and other databases and websites were searched systematically for articles related to esophageal cancer and upper digestive tract cancer patients′ activities from January 1, 2002 to January 31, 2022. In this single-center and interview study, literature review and group discussion were conducted to form a preliminary activity program, and then Delphi method was used to further demonstrate the practicability and feasibility of the activity program.Results:The overall program and specific intervention methods of perioperative activity program for minimally invasive esophageal cancer patients under ERAS concept were constructed, including 3 first-level indicators, 9 second-level indicators and 35 third-level indicators.Conclusions:Perioperative activity program of patients with minimally invasive esophageal cancer is scientific and reasonable, which can provide reference for medical staff and patients.
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Objective To investigate the characteristics of the objective sleep disturbances in Parkinson' s disease (PD) and the factors related to it.Methods One hundred and one PD patients and 90 age- and sex- matched controls underwent a video-polysomnography.The sleep parameters and its related factors in two groups were analyzed.Results Sleep latency was not statistically different in comparing two groups.PD patients had a higher percentage of non-rapid eye movement( non-REM ) sleep stage 1 and a lower percentage of non-REM sleep stage 2 compared with controls ( 27.9 ± 1 7.8 vs 21.2 ± 11.7,t =3.034,P =0.003 ;47.8 ± 17.4 vs 54.7 + 12.9,t =- 3.043,P =0.003 ).Reduced sleep efficiency,decreased the proportion of slow wave sleep and REM sleep,increased awake time and longer REM sleep latency occurred in PD patients.There were no significant differences of these above parameters.Some sleep parameters in PD patients were correlated with advancing age,the severity of PD,and the degree of depression.The index of periodic leg movements in sleep (PLMSI) of 41 PD patients (40.6％ ) was more than 15.These PD patients didn' t complain corresponding symptoms about their legs.The PLMSI in PD patients were significantly higher than the controls.PLMSI increased with aging in the PD group( r =0.261,P ＜0.01 ).PD patients didn' t suffer significantly lower apnea- hypopnea index and oxygen desaturation index.The lowest SPO2 ( L-SPO2 ) increased in the PD group.REM sleep without atonia occurred in 83 patients (82.2％) with PD.Thirty-eight patients (37.6％) were diagnosed with REM sleep behavior disorder (RBD).The incidences of REM without atonia and RBD in the PD group were significantly higher than in the control s(0 and 8 patients (8.9％),x2 =42.271,102.480; both P ＜ 0.01 ).Conclusions The sleep parameters in PD patients are changed.For PD patients,there is no difficulty in falling asleep.The PD patients also have sleep structure disorder and difficulty in maintaining sleep.The sleep parameters are correlated with advancing age,the severity of PD,and the degree of depression in PD.PLMS don' t lead to sleep disturbances in PD patients.The blood oxygen saturation don' t decrease severely when PD patients suffer apnea or hypopnea.RBD occur more frequently in PD patients.
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Objective To analyze the characteristics and influencing factors of sleep disorders and nocturnal hypoxemia of patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Four hundred and twenty-five patients with snoring were scored by Epworth Sleepiness Scale ( ESS), and monitored by polysomnography (PSG). The possible correlations between sleep structure, hypoxia parameters, ESS and clinical features were analyzed and compared in those patients. Results Four hundred and twenty-five patients were divided into 4 groups according to the apnea-hypopnea index (AHI). There were 65 primary snoring patients (15.3%) and 360 OSAHS patients (84. 7% ) including 187 patients (44. 0% ) in severe OSAHS group. ESS was increased as aggravation of OSAHS. There were significant statistical differences in ESS among each group. Compared with primary snoring group, sleep efficiency, NREM1 + 2, oxygen desaturation index ( ODI), time with pulse oxygen saturation below 90% (T(SpO2 <90% ) ) were significantly higher in the OSAHS groups, and NREM3 +4, lowest pulse oxygen saturation level ( LSpO2 ) were lower. ESS was correlated positively with AHI (r= 0. 474,P <0. 01 ). They were both correlated positively with ODI, T (SpO2 <90% ) and NREM1 + 2( ESSr =0. 392, 0. 356,0. 194;AHI r = 0. 714, O. 682, 0. 365, all P < 0. 01 ), and correlated negatively with LSpO2, NREM3 + 4 ( ESS r = - 0. 414, - 0. 196; AHI r = - 0. 740, - 0. 385, both P < 0. 01 ). LSpO2, ODI and T (SpO2 < 90% ) were the primary influencing factors. Common clinical presentations and subjective symptoms were presented including daytime sleepiness, impaired memory, fatigue, dry mouth, oppressive wake and morning headache, etc. Percentage of individuals with daytime sleepiness in the severe OSAHS group was 73. 3% (137/187). These had serious impact on the patients' quality of life, leading to difficulty concentrating, poor memory and cognitive impairment. Conclusions Sleep disorders are found in the patients with different degrees of OSAHS. The excessive daytime sleepiness interrelated partly with the structure of sleep, and totally with hypoxia parameters. The more severity the patients have, the more nocturnal hypoxia, sleep disorders and higher ESS are found.