Objective To investigate the correlation between serum level of visfatin and obesity in patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods Forty-seven patients with OSAHS and 20 healthy controls were recruited in this study. Polysomnography was performed in all subjects to detect apnea-hypopnea index ( AHI) . The serumlevels of cisfatin, C-reactive protein ( CRP) , TNF-α, and IL-6 were measured by enzyme linked immunosorbent assay. The body mass inex ( BMI) was calculated.The level of cisfatin was compared between the OSAHS patients with different severity and the controls, and its relationship with the levels of AHI, BMI, CRP, TNF-α, and IL-6 was analyzed. Results The serumlevel of visfatin in the OSAHS patients was higher significantly than that in the controls ( P lt;0. 01) and increased by the severity of OSAHS. There were positive correlations between the serum level of visfatin and AHI,BMI, CRP, TNF-α, IL-6 in the OSAHS patients ( P lt;0. 05) . Conclusion The expression of visfatin may play an important role in the pathogenesis of OSAHS.
ObjectiveTo Affiliated systematically review the efficacy of continuous positive airway pressure (CPAP) for resistant hypertension (RH) patients with obstructive sleep apnea (OSA). MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 10, 2015), CBM, CNKI and WanFang Data from inception to March 2016, to collect randomized controlled trials (RCTs) about CPAP for RH patients with OSA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 395 patients were included. The results of meta-analysis showed that: After 3 months of follow-up, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy could significantly reduce the 24 h diastolic blood pressure (DBP), day DBP, night DBP, 24 h diastolic blood pressure (SBP) and night SBP of RH patients with OSA (MD=-4.79, 95%CI -7.39 to -2.18, P=0.000 3; MD=-2.94, 95%CI -4.99 to -0.89, P=0.005; MD=-3.19, 95%CI -5.84 to -0.55, P=0.02; MD=-4.36, 95%CI -7.38 to -1.33, P=0.005; MD=-4.90, 95%CI -8.72, -1.08, P=0.01), but there was no significant difference between the two groups in day SBP. After 6 months of follow-up, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy could significantly reduce the 24 h DBP, day DBP of RH patients with OSA (MD=-4.89, 95%CI -6.76 to -3.02, P<0.000 01; MD=-5.01, 95%CI -9.58 to -0.45, P=0.03), but there were no significant differences between the two groups in night DBP, 24 h SBP, day SBP, and night SBP. ConclusionCurrent evidence suggests that CPAP on the basis of antihypertensive drug therapy could effectively reduce the DBP and SBP of RH patients with OSA at short-term follow-up, but the long-term effect on SBP is not obvious. Due to limited quality and quantity of the included studies, the above conclusions need to be verified by more high quality studies.
Objective To study the relationships among health-related quality of life( HRQL) ,social support, excessive daytime sleepiness ( EDS) and PSG parameters in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Eighty-five patients were recruited who were diagnosed as OSAHS by overnight polysomnography from August 2007 through November 2007 in West China Hospital.The Calgary sleep apnea quality of life index ( SAQLI) was used for HRQL, social support rating scale ( SSRS) was used for social support, and Epworth sleepiness scale( ESS) was used for EDS. The Pearson linear correlation and stepwise multiple regression analysis were used to analyze the correlation among SAQLI, SSRS, ESS, and PSG. Results The SAQLI was correlated with SSRS score ( r =0. 402, P lt;0. 01) ;ESS score ( r = - 0. 505, P lt;0. 01) ; apnea-hypopnea index ( AHI) ( r = - 0. 269, P lt; 0. 05) and lowest artery oxygen saturation ( LSaO2) ( r = 0. 226, P lt; 0. 05) . Stepwise multiple regression analysis determined two variables, the SSRS and ESS score, as independent factors for predicting the total score of SAQLI which accounted for 37. 3% of the total variance in the total score on SAQLI ( R2 = 0. 373, P lt; 0.001) .Conclusions The HRQL of patients with OSAHS was correlated with the SSRS score, ESS score and PSG parameters. The former two were the more important factors to affect the HRQL of patients with OSAHS.
Sleep apnea causes cardiac arrest, sleep rhythm disorders, nocturnal hypoxia and abnormal blood pressure fluctuations in patients, which eventually lead to nocturnal target organ damage in hypertensive patients. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) is extremely high, which seriously affects the physical and mental health of patients. This study attempts to extract features associated with OSAHS from 24-hour ambulatory blood pressure data and identify OSAHS by machine learning models for the differential diagnosis of this disease. The study data were obtained from ambulatory blood pressure examination data of 339 patients collected in outpatient clinics of the Chinese PLA General Hospital from December 2018 to December 2019, including 115 patients with OSAHS diagnosed by polysomnography (PSG) and 224 patients with non-OSAHS. Based on the characteristics of clinical changes of blood pressure in OSAHS patients, feature extraction rules were defined and algorithms were developed to extract features, while logistic regression and lightGBM models were then used to classify and predict the disease. The results showed that the identification accuracy of the lightGBM model trained in this study was 80.0%, precision was 82.9%, recall was 72.5%, and the area under the working characteristic curve (AUC) of the subjects was 0.906. The defined ambulatory blood pressure features could be effectively used for identifying OSAHS. This study provides a new idea and method for OSAHS screening.
Objective To investigate the implication of oxidation protein product ( advanced oxidation protein product, AOPP) , an index of oxidative stress in obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods 47 patients with OSAHS and 48 normal controls were enrolled. The concentration of AOPP was measured by spextrophotometry after ameliorated, while superoxide ( SOD) , malonaldehyde ( MDA) , glutathione peroxidase ( GSH-PX) in morning blood samples were detected by Xanthine oxidase test. Results ( 1) Plasma AOPP and MDA were significantly elevated in OSAHS compared with those in control group ( both P lt;0. 01) . Plasma SOD and GSH-PX were significantly lower in OSAHS compared with those in control group ( both P lt;0. 01) . There were significant differences in the plasma AOPP, MDA, SODand GSH-PX among different severity of OSAHS ( all P lt; 0. 01) . Plasma AOPP and MDA were increased and SOD and GSH-PX were gradually decreased with the progression of OSAHS. ( 2) Plasma AOPP correlated well with MDA, SOD and GSH-PX, moreover, AOPP was positively correlated with apnea hyponea index or lowest oxygen saturation. Conclusion AOPP is an alternative index reflecting both oxidative streess and tissue injury in patients with OSAHS.
ObjectiveTo systematically review the risk factors leading to postoperative persistence of children diagnosed with obstructive sleep apnea (OSA) after adenoidectomy and tonsillectomy. MethodsPubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, VIP, WanFang Data and SinoMed databases were electronically searched to collect case-control studies and cohort studies related to risk factors for postoperative persistence of OSA in children from inception to July 2019. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 12 cohort studies involving 1 659 OSA patients were included. Meta-analysis results showed that the risk of postoperative persistence of OSA in children with preoperative obesity was 3.47 times higher than that in non-obese children (RR=3.47, 95%CI 2.04 to 5.92, P<0.000 01). Compared with normal-weight children, obese children had 4.11 times higher risk of postoperative residual OSA (RR=4.11, 95%CI 1.68 to 10.07, P<0.000 01).ConclusionsPreoperative obesity is a risk factor for postoperative persistence of OSA in children. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verity the above conclusions.
Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, Plt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97). Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.
Objective To investigate the changes and significance of serum inflammatory factors in coronary heart disease ( CHD) patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) , and the treatment effects of continuous positive airway pressure( CPAP) . Methods A total of 76 CHD patients in Renmin Hospital of Wuhan University from October 2007 to October 2008 were enrolled. Polysomnography ( PSG) was performed in these CHD patients to identify if they were complicated by OSAHS. The levels of inflammatory factors including TNF-α, IL-6, high sensitive C-reactive protein ( hs-CRP) in serum were determined in the CHD patients and 23 normal subjects. The CHD patients with moderate-severe OSAHS ( AHI≥15 episodes/hour) were treated by Auto-CPAP for 3 months and all parameters above were measured again. Results There were 41 /76 ( 53. 9% ) of CHD patients had moderate-severe OSAHS and were treated with CPAP. The levels of TNF-α, IL-6 and hs-CRP were significantly higher in the CHD patients than those in the normal controls ( all P lt; 0. 01) , and were significantly higher in moderate-severe OSAHS patients than those in the non-OSAHS CHD patients. Auto-CPAP ventilation significantly decreased the levels of inflammatory factors in the CHD patients with moderate-severe OSAHS. Conclusions An obvious proinflammatory state is detected in CHD patients, and is aggravated with OSAHS. CPAP is a useful treatment for CHD patients with mediate to severe OSAHS.
Objective To study the changes of receptor activator of nuclear factor-κB ligand (RANKL, an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG, the decoy receptor for RANKL), oxidative stress and bone turnover markers in obstructive sleep apnea-hypopnea syndrome (OSAHS), in order to understand the potential mechanisms underlying bone loss in OSAHS patients. Methods Ninety-eight male patients with OSAHS, confirmed by polysomnography (PSG) study, were enrolled. The patients were divided into mild-moderate groups and severe groups. Forty-two male subjects who were confirmed as not having OSAHS served as the controls. The subjects’ bone mineral density (BMD) and T-score were assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry. Blood samples were collected from all subjects for measurement of RANKL, OPG, the bone formation marker bone-specific alkaline phosphatase (BAP), the bone resorption marker tartrate-resistant acid phosphatase-5b (TRAP-5b), total antioxidant capacity (TAOC). Twenty-eight severe OSAHS patients accepted continuous positive airway pressure (CPAP) treatment voluntarily. After 6 months, PSG was conducted, and serum RANKL, OPG, TAOC, TRAP-5b, BAP was measured after six months treatment. Results The BMD, T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group. The level of BAP was significantly decreased in the OSAHS group as compared to the control group, and there was no significant difference in TRAP-5b level between two groups. As compared with the control group, levels of OPG, TAOC and the OPG/RANKL ratio decreased significantly. None of these parameters (BMD, T-score, RANKL, OPG, TRAP-5b, BAP) showed significant difference between patients with mild-moderate and severe OSAHS group. Correlation analysis showed that the apnea hypopnea index and oxygen desaturation index were correlated with TAOC. BAP level was positively correlated with TAOC and lowest pulse oxygen saturation. The serum level of TAOC was lower in the OSAHS group after CPAP therapy, but the levels of RANKL, OPG, TRAP-5b, BAP were not different. As compared with the OSAHS group before CPAP therapy, the BMD of the femoral neck and the lumbar spine were not significant difference. Conclusions In patients with OSAHS, the oxidative stress response is enhanced, and imbalance of OPG/RANKL is shifted, which participates in the occurrence of osteoporosis. The oxidative stress injury of severe OSAHS patients was relieved after non-invasive ventilation treatment, but the effect of oxidative stress response on bone metabolism still needs further evaluation.
ObjectiveTo analyze the causal relationship between obstructive sleep apnea (OSA) with its typical symptoms (daytime sleepiness and snoring) and cardiovascular diseases (hypertension, coronary heart disease, myocardial infarction, heart failure) by using Mendelian randomization. MethodsWe used the instrumental variables (IV) in the FINNGen database and the UK Biobank to perform two-sample Mendelian randomization (TSMR) analysis. The results of random-effects inverse variance weighting method (IVW) were the main results. MR-Egger method was used for pleiotropic analysis and sensitivity analysis was performed by the leave-one-out method to verify the reliability of the data. ResultsOSA could lead to hypertension (IVW β=0.043, 95%CI 0.012 to 0.074, P=0.006) and heart failure (IVW β=0.234, 95%CI 0.015 to 0.452, P=0.036). Daytime sleepiness also had a pathogenic effect on heart failure (IVW β=1.139, 95%CI 0.271 to 2.006, P=0.010). There was no causal association between OSA and CHD or MI, snoring and the four CVDs. There was no causal association between daytime sleepiness and hypertension, CHD or MI.ConclusionOSA and daytime sleepiness have pathogenic effects on hypertension and heart failure, with heart failure being the most affected.