Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease

Background：Obstructive sleep apnea/hypopnea syndrome （OSAHS） and laryngopharyngeal reflux （LPR） disease have a high comorbidity rate,but the potential causal relation between the two diseases remains unclear.Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions.Methods：Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography.High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility.Results：There were 13 OSAHS patients （36.1%） without LPR （OSAHS group） and 23 （63.9%） with both OSAHS and LPR （OSAHS and LPR group）.Significant differences were found in the onset velocity of liquid swallows （OVL,P =0.029） and the percent relaxation of the lower esophageal sphincter （LES） during viscous swallows （P =0.049） between the OSAHS and control groups.The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time （P =0.016,R =-0.507）,and OVL was found to be negatively correlated with recumbent distal acid percent time （P =0.006,R =-0.557） in the OSAHS and LPR group.Conclusions：OSAHS patients experience esophageal functional changes,and linear correlations were found between the changed esophageal functional parameters and reflux indicators,which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.

Retinal Vascular Morphological Changes in Patients with Extremely Severe Obstructive Sleep Apnea Syndrome

Background：Obstructive sleep apnea syndrome （OSAS） has been shown to generate hypertension and endothelial dysfunction.Retinal vessel is the only vessel that can be observed directly and noninvasively;retinal vascular abnormalities can serve as a predictive marker for the occurrence,clinical course,and prognosis of cardiovascular and cerebrovascular diseases.The objective of this study was to identify the effect of OSAS severity on the morphological changes of retinal vessels.Methods：Adult patients complained of snoring were included in this study.The patients＆#39; general information,polysomnography,and fundus photography parameters including central retinal artery equivalent （CRAE）,central retinal vein equivalent （CRVE）,and arteriole-to-venule ratio （AVR） were collected.Patients were divided into four groups according to their apnea-hypopnea index （AHI） results：Group Ⅰ,AHI ≤5/h;Group ll,5/h 〈 AHI ≤30/h;Group Ⅲll,30/h 〈 AHI ≤60/h;and Group Ⅳ,AHI 〉60/h.Results：A total of 133 patients were included in this study with 111 males （83.5%） and 22 females （16.5%）.Mean age was 41.6 ± 9.9 years,and the mean body mass index was 28.1 ± 4.0 kg/m2.AHI ranged between 0 and 130.8/h with a mean of 39.l ± 30.7/h.There were 24,34,35,and 40 patients in Group Ⅰ,Group Ⅱ,Group Ⅲ,and Group Ⅳ,respectively.Significant differences were found for AHI （F =388.368,P 〈 0.001）,minimal pulse oxygen saturation （F-91.902,P 〈 0.001）,and arousal index （F =31.014,P 〈 0.001） among four groups;no significant differences were found for CRAE （F=0.460,P =0.599） and CRVE （F =0.404,P =0.586） among groups;there were significant differences for AVR between Group l and Group Ⅳ （63.6 ± 5.1% vs.67.2 ± 5.5%,P =0.010） Group Ⅱ and Group Ⅳ （64.5 ± 6.0% vs.67.2 ± 5.5%,P =0.030）,and Group ll and Group Ⅳ （64.7 ± 4.1% vs.67.2 ± 5.5%,P=0.043）.A main group-by-AHI effect was found on the AVR：patients with higher AHI showed higher AVR results （r =0.225,P =0.009）.Multivariate logistic regression analysis was used for multi-variable factors.A group-by-age effect was found on the AVR：younger patients showed higher AVR results （β =-0.001,P =0.020）.Conclusions：This study indicated that increased AVR of retinal vessel can be observed in extremely severe OSAS patients.For patients with OSAS,retinal vascular abnormalities may become an early indication for further cardiovascular abnormalities.

Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea

Background： Obstructive sleep apnea （OSA） is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway. The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest. In this study, we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional （3D） reconstruction of cone-beam computed tomography （CT）. Methods： Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study. All patients were diagnosed with OSA using polysomnography （PSG） in multi sleep health centers associated with Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 3 I, 2011 to December 14, 2013. The effect of nasal surgery was evaluated by the examination of PSG, subjective complains, and 3D reconstructed CT scan. Cross-sectional area was measured in eleven coronal levels, and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in oral pharynx region was also measured. Results： Five out of the 12 patients were successfully treated by nasal surgery, with more than 50% drop of apnea-hypopnea index. All the 12 patients showed significant increase of cross-sectional area and volume postoperatively. The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively, which decreased from 19.14 ± 2.40 cm2 and 6.11± 1.76 cm2 to 17.13 ±1.91 cm2 and 5.22 ± 1.20 cm2. Conclusions： Nasal surgery improved OSA severity as measured by PSG, subjective complaints, and 3D reconstructed CT scan. 3D assessment of upper airway can play an important role in the evaluation of treatment outcome.