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      睡眠呼吸暫停綜合癥或與癌癥有關(guān)

       東那個(gè)東 2012-11-21

      Sleep Apnea Tied to Increased Cancer Risk

      健康

      睡眠呼吸暫停綜合癥或與癌癥有關(guān)

      Two new studies have found that people with sleep apnea, a common disorder that causes snoring, fatigue and dangerous pauses in breathing at night, have a higher risk of cancer. The new research marks the first time that sleep apnea has been linked to cancer in humans.

      睡眠呼吸暫停綜合癥是一種常見病,可能導(dǎo)致打鼾、疲勞和危險(xiǎn)的夜間呼吸暫停。兩項(xiàng)最新研究發(fā)現(xiàn),患有此種疾病的人罹患癌癥的風(fēng)險(xiǎn)更高。這是睡眠呼吸暫停綜合癥首次與人類癌癥風(fēng)險(xiǎn)聯(lián)系在一起。

      About 28 million Americans have some form of sleep apnea, though many cases go undiagnosed. For sleep doctors, the condition is a top concern because it deprives the body of oxygen at night and often coincides with cardiovascular disease, obesity and diabetes.

      約有2800萬美國人患有不同程度的睡眠呼吸暫停綜合癥,然而許多病人并未得到診斷。對(duì)于睡眠科醫(yī)生,這一狀況被視為頭號(hào)大敵,因?yàn)樗鼤?huì)導(dǎo)致身體在夜間缺氧,而且經(jīng)常伴隨著心血管疾病、肥胖癥和糖尿病。

      "This is really big news," said Dr. Joseph Golish, a professor of sleep medicine with the MetroHealth System in Cleveland who was not involved in the research. "It's the first time this has been shown, and it looks like a very solid association," he said.

      “這可不是件小事,”克利夫蘭市健康服務(wù)體系(Metro Health System)的睡眠醫(yī)學(xué)教授約瑟夫·戈里什(Joseph Golish)醫(yī)生指出。他本人并未參與此項(xiàng)研究?!斑@是研究者首次發(fā)現(xiàn)此種聯(lián)系,而且這種聯(lián)系的存在似乎證據(jù)確鑿?!?/p>

      Dr. Golish, the former chief of sleep medicine at the Cleveland Clinic, said that the cancer link may not prove to be as strong as the well-documented relationship between sleep apnea and cardiovascular disease, "but until disproven, it would be one more reason to get your apnea treated or to get it diagnosed if you think you might have it."

      戈里什醫(yī)生是克利夫蘭醫(yī)學(xué)院的睡眠醫(yī)學(xué)系前負(fù)責(zé)人。他表示,睡眠呼吸暫停綜合癥與癌癥之間的聯(lián)系或許沒有其與心血管病之間的聯(lián)系那么強(qiáng)。關(guān)于后者,已有大量研究文獻(xiàn)證明其相關(guān)性?!暗诹碛凶C據(jù)推翻這一結(jié)論之前,如果你覺得自己可能患有睡眠呼吸暫停綜合癥,那么你又多了個(gè)理由,要盡快治療或確診?!?/p>

      In one of the new studies, researchers in Spain followed thousands of patients at sleep clinics and found that those with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind. The second study, of about 1,500 government workers in Wisconsin, showed that those with the most breathing abnormalities at night had five times the rate of dying from cancer as people without the sleep disorder. Both research teams only looked at cancer diagnoses and outcomes in general, without focusing on any specific type of cancer.

      在一項(xiàng)最新研究中,西班牙研究人員跟蹤記錄了數(shù)千名在睡眠診所接受治療的病人,發(fā)現(xiàn)那些睡眠呼吸暫停綜合癥病況最嚴(yán)重的人患上各類癌癥的風(fēng)險(xiǎn)要高出65%。針對(duì)威斯康辛州1500余名政府工作人員的第二項(xiàng)研究顯示,最常經(jīng)歷夜間呼吸異常狀況的人死于癌癥的風(fēng)險(xiǎn)是那些沒有睡眠障礙問題的人的5倍。兩個(gè)研究團(tuán)隊(duì)都僅關(guān)注癌癥的診出和總體預(yù)后狀況,并未具體分析特定癌癥。

      In both studies, being presented in San Francisco this week at an international conference organized by the American Thoracic Society, the researchers ruled out the possibility that the usual risk factors for cancer, like age, smoking, alcohol use, physical activity and weight, could have played a role. The association between cancer and disordered breathing at night remained even after they adjusted these and other variables.

      這兩項(xiàng)研究結(jié)果提交發(fā)布于本周在舊金山召開的一場由美國胸科協(xié)會(huì)主辦的國際會(huì)議上。在研究中,研究者均排除了可能影響結(jié)果的其他常見癌癥風(fēng)險(xiǎn)因素,如年齡、煙草和酒精攝入、運(yùn)動(dòng)狀況和體重等。即便在根據(jù)這些因素和其他變量加以調(diào)整之后,癌癥與夜間呼吸障礙之間的聯(lián)系依然顯著。

      Dr. Mitesh Borad, a cancer researcher and assistant professor of medicine at the Mayo Clinic who was not involved with the studies, called the findings "provocative" but said more research was needed to confirm the association. The studies were observational, and other, unknown factors may account for the correlation between sleep apnea and cancer.

      梅奧醫(yī)學(xué)中心(Mayo Clinic)的癌癥研究人員、醫(yī)學(xué)助理教授米捷什·博拉德(Mitesh Borad)醫(yī)生并未參與這兩項(xiàng)研究。他認(rèn)為這些發(fā)現(xiàn)“令人深省”,但表示仍需更多研究來驗(yàn)證該種聯(lián)系確實(shí)存在。這兩項(xiàng)研究都是觀察性研究(與有對(duì)照組的干預(yù)研究相對(duì)——譯注),其他未知因素或許會(huì)影響到睡眠呼吸暫停綜合癥與癌癥之間的相關(guān)性。

      Recent animal studies have suggested that sleep apnea might play a role in cancer. When mice with tumors were placed in low-oxygen environments that simulate the effects of sleep apnea, their cancers progressed more rapidly. Scientist speculate that depriving mice of oxygen may cause their bodies to develop more blood vessels to compensate, an effect that could act as a kind of fertilizer for cancer tissue and cause tumors to grow and spread more quickly.

      最近的幾項(xiàng)動(dòng)物研究表明,睡眠呼吸暫停綜合癥或許會(huì)導(dǎo)致癌癥。將長有腫瘤的小鼠置于氧氣濃度低的環(huán)境中,以達(dá)到睡眠呼吸暫停綜合癥的效果,這些小鼠的癌癥惡化速度要快得多??茖W(xué)家推測,令小鼠處于缺氧狀態(tài)或許會(huì)促使它們的身體用增生血管的方式加以補(bǔ)償,這相當(dāng)于為癌變組織提供“肥料”,讓腫瘤生長和擴(kuò)散得格外迅速。

      The researchers wondered whether a similar relationship might exist in people with sleep apnea, in whom throat muscles collapse during sleep, choking off the airway and causing gasping and snoring as the body fights for air. Severe sleep apnea can produce hundreds of such episodes each night, depleting the body of oxygen.

      研究人員想要知道,類似的關(guān)系是否也存在于患有睡眠呼吸暫停綜合癥的人中。病人入睡期間喉部肌肉松弛塌陷,阻塞氣道,當(dāng)身體拼命獲取氧氣時(shí),便導(dǎo)致憋氣或打鼾。嚴(yán)重的睡眠呼吸暫停綜合癥患者一晚上可以經(jīng)歷上百次類似的發(fā)作,令身體缺氧。

      In one study, a team at the University of Wisconsin School of Medicine and Public Health examined data on state workers taking part in the long-running Wisconsin Sleep Cohort, who since 1989 have undergone extensive overnight sleep studies and other measures of health about every four years. The landmark project was one of the first to reveal the widespread occurrence of sleep apnea in the general population.

      威斯康辛大學(xué)(University of Wisconsin)醫(yī)學(xué)與公共衛(wèi)生學(xué)院的研究小組在一項(xiàng)研究中,對(duì)參與“威斯康辛睡眠隊(duì)列研究”的州政府工作人員的數(shù)據(jù)加以分析。這些研究對(duì)象自1989年起,每四年時(shí)間便要接受詳盡的整晚睡眠研究及其他健康狀況檢查。這一具有歷史意義的項(xiàng)目最早揭示出睡眠呼吸暫停綜合癥在一般人群中的普遍存在。

      The researchers found that the more severe a person's breathing problems at night, the greater the likelihood of dying from cancer. People with moderate apnea were found to die of cancer at a rate double that of people without disordered breathing at night, while those in the severe category died at a rate 4.8 times that of those without the sleep disorder.

      研究人員發(fā)現(xiàn),一個(gè)人夜間呼吸問題越嚴(yán)重,其未來死于癌癥的可能性就越高。患有中度睡眠呼吸暫停綜合癥的人死于癌癥的風(fēng)險(xiǎn)是沒有夜間呼吸障礙問題的人的兩倍,而那些睡眠呼吸暫停綜合癥重癥患者的風(fēng)險(xiǎn)更高達(dá)不存在睡眠障礙者的4.8倍。

      "That is really striking," said Dr. F. Javier Nieto, one of the study's authors and chairman of the department of population health sciences at the University of Wisconsin. "It could be something else, but it's hard to imagine that something we didn't control for is causing this."

      “這的確引人注目,”該項(xiàng)研究作者之一、威斯康辛大學(xué)群體健康科學(xué)系主任F·哈維爾·涅托(F. Javier Nieto)醫(yī)生表示?!爱?dāng)然也可能存在其他原因,但很難想像我們未加控制的其他因素會(huì)導(dǎo)致這一結(jié)果?!?/p>

      In the second study, researchers with the Spanish Sleep Network took a slightly different approach, looking not at cancer mortality among apnea patients, but at the incidence of cancer. They used a measure called the hypoxemia index, which looks at the amount of time the level of oxygen in a person's blood drops below 90 percent at night.

      在第二項(xiàng)研究中,西班牙睡眠網(wǎng)絡(luò)(Spanish Sleep Network)的研究人員采取了一種略為不同的研究途徑。他們所考察的并非睡眠呼吸暫停綜合癥患者的癌癥死亡率,而是癌癥發(fā)病率。研究者使用低血氧指數(shù)(hypoxemia index)作為評(píng)估標(biāo)準(zhǔn),該指數(shù)考察個(gè)體夜間血氧濃度低于90%的時(shí)長。

      About 5,200 people were followed for seven years, none of whom had a cancer diagnosis when the study began. The researchers found that the greater the extent of hypoxemia, or oxygen depletion, during sleep, the more likely a person would receive a cancer diagnosis during the study period.

      該研究對(duì)5200人進(jìn)行了長達(dá)7年的跟蹤調(diào)查,在起始階段,所有調(diào)查對(duì)象都未被診斷出患有癌癥。研究者發(fā)現(xiàn),睡眠時(shí)低血氧指數(shù)越高,調(diào)查對(duì)象在研究持續(xù)期間被診斷出癌癥的可能性也就越大。

      People whose oxygen levels dropped below 90 percent for up to 12 percent of the total time they were asleep, for example, had a 68 percent greater likelihood of developing cancer than people whose oxygen levels did not plummet at night, said study author Dr. Miguel Angel Martinez-Garcia of La Fe University and Polytechnic Hospital in Spain. As time spent without oxygen increased, so, too, did cancer risk.

      該研究作者、西班牙拉斐大學(xué)理工學(xué)院醫(yī)院的米格爾·安赫爾·馬丁內(nèi)斯-加西亞(Miguel Angel Martinez-Garcia)醫(yī)生指出,例如那些睡眠過程中12%的時(shí)間血氧濃度低于90%的人,患上癌癥的風(fēng)險(xiǎn)就比夜晚血氧濃度不會(huì)驟然下降的人高出68%。處于缺氧狀態(tài)下的時(shí)間越長,癌癥風(fēng)險(xiǎn)也便相應(yīng)增加。

      Although the study did not look for it, Dr. Martinez-Garcia speculated that treatments for sleep apnea like continuous positive airway pressure, or CPAP, which keeps the airways open at night, might reduce the association.

      盡管該項(xiàng)研究并未涉及干預(yù)方法,馬丁內(nèi)斯-加西亞醫(yī)生猜測,用來治療睡眠呼吸暫停綜合癥、保持晚間氣道通暢的連續(xù)氣道正壓通氣療法(continuous positive airway pressure,簡稱CPAP)或許可以減少癌癥風(fēng)險(xiǎn)。

      The Wisconsin study also did not specifically look at the impact of treatment for apnea on survival, either, but when people who were being treated with CPAP were removed from the analysis, the cancer association became stronger, "which is consistent with the hypoxemia theory," Dr. Nieto said.

      威斯康辛大學(xué)的研究也沒有涉及睡眠呼吸暫停綜合癥治療與癌癥存活率之間的關(guān)系。但當(dāng)那些接受了CPAP治療的調(diào)查對(duì)象在數(shù)據(jù)分析時(shí)被排除在外時(shí),睡眠呼吸暫停綜合癥與癌癥之間的相關(guān)性變得更強(qiáng)了,“這與低血氧理論相吻合,”涅托醫(yī)生指出。

      "I would say that this is one more instance that shows that sleep apnea can have profound impacts for people's health," he added. "Not breathing while you're sleeping is a serious problem."

      他補(bǔ)充道,“我想指出,這是表明睡眠呼吸暫停綜合癥顯著影響健康的另一例證。睡覺時(shí)無法呼吸是件非同小可的事?!?/p>

      本文最初發(fā)表于2012年5月20日。

      翻譯:倚櫓

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