Clinical efficacy and mechanism study of mid-frequency anti-snoring device in treating moderate obstructive sleep apnea-hypopnea syndrome

BACKGROUND Obstructive sleep apnea-hypopnea syndrome(OSAHS)is primarily caused by airway obstruction due to narrowing and blockage in the nasal and nasopha-ryngeal,oropharyngeal,soft palate,and tongue base areas.The mid-frequency anti-snoring device is a new technology based on sublingual nerve stimulation.Its principle is to improve the degree of oropharyngeal airway stenosis in OSAHS patients under mid-frequency wave stimulation.Nevertheless,there is a lack of clinical application and imaging evidence.METHODS We selected 50 patients diagnosed with moderate OSAHS in our hospital between July 2022 and August 2023.They underwent a 4-wk treatment regimen involving the mid-frequency anti-snoring device during nighttime sleep.Following the treatment,we monitored and assessed the sleep apnea quality of life index and Epworth Sleepiness Scale scores.Additionally,we performed computed tomo-graphy scans of the oropharynx in the awake state,during snoring,and while using the mid-frequency anti-snoring device.Cross-sectional area measurements in different states were taken at the narrowest airway point in the soft palate posterior and retrolingual areas.RESULTS Compared to pretreatment measurements,patients exhibited a significant reduction in the apnea-hypopnea index,the percentage of time with oxygen saturation below 90%,snoring frequency,and the duration of the most prolonged apnea event.The lowest oxygen saturation showed a notable increase,and both sleep apnea quality of life index and Epworth Sleepiness Scale scores improved.Oropharyngeal computed tomography scans revealed that in OSAHS patients cross-sectional areas of the oropharyngeal airway in the soft palate posterior area and retrolingual area decreased during snoring compared to the awake state.Conversely,during mid-frequency anti-snoring device treatment,these areas increased compared to snoring.CONCLUSION The mid-frequency anti-snoring device demonstrates the potential to enhance various sleep parameters in patients with moderate OSAHS,thereby improving their quality of life and reducing daytime sleepiness.These therapeutic effects are attributed to the device’s ability to ameliorate the narrowing of the oropharynx in OSAHS patients.

Obstructive sleep apnea-hypopnea syndrome immunological relationship

Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a complex disorder cha-racterized by symptoms resulting from intermittent hypoxia and hypopnea,with research indicating a crucial role of immune system dysregulation and genetic variations in its pathogenesis.A recent Zhao et al study utilizes Mendelian ran-domization analysis to explore the causal relationship between immune cell characteristics and OSAHS.The study identifies specific lymphocyte subsets as-sociated with OSAHS,providing valuable insights into the disease's pathophy-siology and potential targets for therapeutic intervention.The findings underscore the significance of genetic and immunological factors in sleep disorders,offering a fresh perspective on OSAHS's complexities.Compared to existing literature,Zhao et al's study stands out for its focus on genetic markers and specific immune responses associated with OSAHS,expanding upon previous research primarily centered on systemic inflammation.In conclusion,the study represents a signi-ficant advancement in the field,shedding light on the causal role of immune cells in OSAHS and paving the way for future research and targeted treatments.

Intermittent hypoxia is involved in gut microbial dysbiosis in type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome

BACKGROUND Obstructive sleep apnea(OSA)-hypopnea syndrome(OSAHS)has been recognized as a comorbidity of type 2 diabetes mellitus(T2DM);more than half of T2DM patients suffer from OSAHS.Intermittent hypoxia(IH)plays an important role in metabolic diseases,such as obesity and OSAHS,through various mechanisms,including altering the gut microecological composition and function.Therefore,it is important to study the role of gut microbiota in T2DM patients with OSAHS,which has a high incidence and is prone to several complications.AIM To assess whether IH is involved in altering the fecal microbiome in T2DM patients with OSAHS.METHODS Seventy-eight participants were enrolled from Henan Province People’s Hospital and divided into healthy control(HC,n=26),T2DM(n=25),and T2DM+OSA(n=27)groups based on their conditions.The fecal bacterial DNA of the research participants was extracted and subjected to 16S ribosomal RNA sequencing.The clinical indices,such as insulin resistance index,homocysteine(HCY)concentration,and the concentrations of inflammatory factors in the peripheral blood,were assessed and recorded.RESULTS Group T2DM+OSA had the highest apnea-hypopnea index(AHI)(2.3 vs 3.7 vs 13.7),oxygen desaturation index(0.65 vs 2.2 vs 9.1),HCY concentration(9.6μmol/L vs 10.3μmol/L vs 13.81μmol/L)and C-reactive protein(CRP)concentrations(0.3 mg/L vs 1.43 mg/L vs 2.11 mg/L),and lowest mean oxygen saturation(97.05%vs 96.6%vs 94.7%)among the three groups.Twelve and fifteen key differences in amplicon sequence variants were identified when comparing group T2DM+OSA with groups T2DM and HC,respectively.We found progressively decreased levels of Faecalibacterium,Eubacterium,and Lachnospiraceae,and an increase in the level of Actinomyces,which strongly correlated with the HCY,CRP,fasting plasma glucose,and hemoglobin A1c concentrations,AHI,mean oxygen saturation,and insulin resistance index in group T2DM+OSA(P<0.05).CONCLUSION For T2DM patients with OSAHS,IH may be involved in selective alterations of the gut microbiota,which may affect the pathophysiological development of T2DM and DM-related complications.

Effect of motivational interviewing on postoperative weight control in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND Obesity is an important factor to cause the obstructive sleep apnea-hypopnea syndrome(OSAHS).Higher body mass index(BMI)often results in more severe OSAHS.Currently,the common measures for controlling the weight mainly include diet control,increase exercise and so on.Motivational interviewing(MI)could explore the patient’s internal state and make the patient realize his/her ambivalence,resulting in the change in his/her behavior.This process emphasizes respecting the patient’s autonomy.AIM To evaluate the effect of MI on the weight control of patients with OSAHS.METHODS A randomized controlled study was conducted in 100 obese OSAHS patients undergoing surgical treatment at Shengjing Hospital of China Medical University.The patients were divided into an intervention group and a control group,with 50 cases each.The control group was given routine health education after the operation;in addition to the regular health education,the intervention group was given MI according to a predetermined plan.Obesity-related indicators,postoperative complications,and the sleep status of both groups were evaluated before and 6 mo after the intervention.RESULTS Patients in the intervention group had significantly improved body weight,BMI,and waist and neck circumferences compared with patients in the control group(P<0.05).Regarding complications at 6 mo after operation,the incidence of cough and reflux in patients in the intervention group was significantly lower than that in the control group(P<0.05).In addition,the Epworth Sleepiness Scale and Self-Rating Scale of Sleep scores of patients in the intervention group were significantly lower than those in the control group,and the sleep status of patients in the intervention group was improved(P<0.05).CONCLUSION MI intervention has a significant advantage over postoperative routine health education.It can greatly change the lifestyle,further control the postoperative weight,reduce the occurrence of complications,improve the quality of sleep,and improve long-term postoperative efficacy in OSAHS patients.

Obstructive Sleep Apnea-Hypopnea Ssyndrome and Hearing in Children

Objective To explore the relationship between hypoxemia and hearing in children with obstructive sleep apnea-hypopnea syndrome. Methods Auditory brainstem responses (ABRs) were recorded in 68 ears and distortion product otoacoustic emissions (DPOAEs) in 60 ears in children with OSAHS and type "A" tym-panograms, and in 30 ears in normal children. Results ABR latencies of waves I, III and V, and I-III, III-V and I-V intervals were not statistically different between OSAHS and normal children. Wave I latency was delayed in children with OSAHS compared to normal children3 (P < 0.05). DPOAE amplitudes in children with mild OSAHS were lower than normal children at 8 kHz (P < 0.05). DPOAEs were lower at 6 kHz and 8 kHz in children with moderate/severe OSAHS than normal children (P < 0.05). Conclusion Cochlear function was affected when AHI was at or greater than 10/hour. ABR and DPOAE can be used to detect early changes in auditory function in children with OSAHS.

Relation between Obstructive Sleep Apnea-Hypopnea Syndrome and Glaucoma in a Sub-Saharan African Population

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a frequent pathology worldwide whose main mechanism is a complete or partial obstruction of the upper airway. One of the pathophysiological mechanisms described in primary open-angle glaucoma is that hypoxia in the optic nerve progressively destroys the retinal cells leading to the onset and/or aggravation of glaucoma. The aim of the study was to evaluate the risk of OSA in patients with primary open-angle glaucoma. Methodology: An analytical study was conducted from January to May 2020 at the UHC. After obtaining ethical clearance, 112 patients including 50 glaucoma patients (44.64%) and 62 in the control group were enrolled. Sociodemographic and clinical data were collected from the medical records of the participants, with or without glaucoma, and a questionnaire was administered and a clinical examination performed. The STOP BANG score was used to determine the risk level of OSAHS. Statistical analyses were performed using Epi Info version 7.2. Results: A female predominance was found (60%) in the glaucoma group with a mean age of 55 ± 17 years against 49 ± 18 years in the control group. The high risk of OSAHS was more associated with glaucoma patients. In glaucoma patients, an association was found between high risk of OSAHS and snoring (OR = [1.43 - 849.53];p = 0.029) as well as insomnia (OR = [1.36 - 482.86];p = 0.030). Conclusion: High risk of OSAHS was found in participants with chronic open-angle glaucoma. Signs of OSAHS should be sought in chronic open-angle glaucoma as it may be a factor in its progression.

Serum Sex Hormone Levels in Different Severity of Male Adult Obstructive Sleep Apnea-hypopnea Syndrome in East Asians

Summary： Obstructive sleep apnea-hypopnea syndrome （OSAHS） is a serious health issue, which can impact the hormone secretion. The aim of this study is to analyze the relationship between serum sex hormone concentrations and different severity degree of OSAHS, and to evaluate the influence of OSAHS on sex hormone levels. We enrolled 116 subjects who were subjected to polysomnography （PSG）. They were divided into three groups： control group （n=10） [apnea hypopnea index （AHI） 〈5/h], mild-moderate OSAHS group ,（n=15） （5〈AHI〈30/h）, and severe OSAHS group （n=91） （AHI〉30/h）. The patients in OSAHS group were subdivided into obesity and non-obesity subgroups. The parameters such as AHI, body mass index （BMI）, lowest oxygen saturation （LSaO2）, and mean oxygen saturation （MSaO2） were recorded. Serum levels of testosterone, polactin, estradiol, follicle stimulating hormone （FSH） and luteinizing hormone （LH） were determined in the morning immediately after waking up. Mean levels of hormones were compared among groups. The correlation between hormone levels and sleep-breathing parameters was analyzed. No significant differences in serum sex hormone levels were found among control, mild-moderate OSAHS, and severe OSAHS groups （P〉0.05）. There was no cor- relation between AHI and sex hormone levels （P〉0.05）. Testosterone was significantly negatively cor- related with BMI （P〈0.05）. These results suggested that BMI might have a direct effect on testosterone level, and it might be an important factor affecting testosterone level in male OSAHS patients, and there may be no correlation between severity of OSAHS and sex hormones levels.

Significant Association of Nightly Nasal Continuous Positive Airway Pressure Using Time with Weight Change in Japanese Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Background: Obstructive sleep apnea syndrome (OSAS) is one of the representative sleep disorders believed to be associated with metabolic syndrome. Nasal continuous positive airway pressure (nCPAP) ventilation is the first choice therapy for OSAS, which has been reported to cause an improvement in body fat mass, hepatocellular damage and hypertension. Study Objectives: We evaluated whether the changes in the body weight observed in patients with OSAS may have potential associations with the sleep time during which the patients are under nCPAP. Method: A total of 194 patients (148 obese and 46 non-obese) in whom nCPAP use was present for more than 70% of the nights were enrolled in this study. Using the electronic records of the night use time for CPAP devices, we examined whether the habitual sleep time during nCPAP is associated with changes in body weight. Results: In the non-obese OSAS group, the patients with night time use of nCPAP devices for 6 to 7 hours showed the greatest and the most sustained decrease in body weight. In the obese patients with OSAS, on the other hand, a U-shaped relationship has been demonstrated between a percent weight gain over 9 years and a minimal weight gain in patients with habitual sleep for 5 to 6 hours. Conclusions: These results suggest that changes in body weight in patients with OSAS are associated with habitual sleep time.

Forced Inspiratory Flow Volume Curve in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Objective: Obstructive sleep apnea-hypopnea syndrome (OSA) is a disease of obstructive apnea or hypopnea caused by a repeated partial or complete collapse of the upper airway during sleep. The inspiratory part of the flow-volume curve (F-V curve) can be used as an auxiliary means to evaluate upper airway obstruction in adults. This study is to evaluate the ability of the F-V curve to predict the OSA and explore inspiratory indicators related to airway obstruction during sleep. Methods: There were 332 patients included in this cross-sectional study, who were accompanied by snoring, daytime sleepiness and other symptoms, with suspicion of OSA. According to the nocturnal polysomnography, the subjects were distributed into mild to moderate OSA group, severe OSA group and non-OSA group. A pulmonary function test was used to collect the subjects’ spirometry and F-V curves. Results: There was no significant difference in a variety of indices derived from the F-V curve between OSA and normal subjects, including 25% inspiratory flow rate, middle inspiratory flow rate, 75% inspiratory flow rate, peak flow rate, and forced inspiratory flow rate in the first second. The pulmonary function parameters were significantly correlated with the weight, age and sex of the subjects. Conclusion: These findings suggest that the inspiratory curve of pulmonary function cannot evaluate the upper airway abnormalities in patients with obstructive apnea-hypopnea syndrome.

Character of diaphragm compound muscle action potential and phrenic nerve conduction time in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND： Both hypoxia and.carbon dioxide retention can damage phrenic nerve and muscle conduction, as well as diaphragm function. Diaphragm compound muscle action potential and phrenic nerve conduction time are reliable indicators for measuring phrenic nerve and diaphragm function. OBJECTIVES： To verify the hypothesis that changes of phrenic nerve conduction time （PNCT） and diaphragm compound muscle action potential （CMAP） in obstructive sleep apnea-hypopnea syndrome （OSAHS） patients might contribute to the decline of phrenic nerve and diaphragm function. PNCT and CMAP were measured with multipair esophageal electrodes combined with unilateral magnetic stimulation. DESIGN, TIME AND SETTING： Case controlled study. The experiment was carried out in Guangzhou Institute of Respiratory Disease, Guangzhou MediCal College, from June 2005 to April 2006. PARTICIPANTS： Twenty seven OSAHS patients and eight primary snoring subjects from Guangzhou Institute of Respiratory Disease, Guangzhou Medical College were recruited and all subjects were diagnosed by polysomnography （PSG）. Sixteen healthy, non-snoring subjects in the hospital for medical examination during the same time period were selected as the control group. METHODS： Esophageal electrodes, made by Guangzhou Institute of Respiratory Disease, combined with unilateral magnetic stimulation, were used to measure PNCT and CMAP of all subjects. PNCT was defined as the time from stimulation artifact to the onset of CMAP and diaphragm CMAP amplitude was measured from peak to peak. Oxygen desaturation index and apnea-hypopnea index were measured using PSG, and their relevance to PNCT and CMAP were analyzed. PNCT and CMAP in five OSAHS patients were repeatedly measured after effective nasal continuous positive airway pressure treatment for more than 2 months. MAIN OUTCOME MEASURES： （1） PNCT and diaphragm CMAP of subjects in each group. （2） Relevance of oxygen desaturation index and apnea-hypopnea index to PNCT and CMAP. （3） Changes of PNCT and CMAP of OSAHS patients before and after treatment. RESULTS： All subjects were included in the analyzed results. （1） PNCT of the OSAHS group was significantly longer compared to that of the control and primary snore groups, while CMAP of the OSAHS group was significantly lower （P 〈 0.05）. （2） PNCT and CMAP recorded from both sides correlated significantly with oxygen desaturation index and with apnea-hypopnea index （P 〈 0.01 ）. （3） PNCT shortened significantly after effective nasal continuous positive airway pressure treatment for more than 2 months （ P 〈 0.05）. CONCLUSION： Prolongation of PNCT and decrease of CMAP might contribute to the decline of phrenic nerve and diaphragm function caused by repeated nocturnal hypoxia and carbon dioxide retention. The impairment of the phrenic nerve might also decrease diaphragm function.

Characteristics of glucolipid metabolism as well as atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome combined with cerebral infarction

Objective:To evaluate the characteristics of glucolipid metabolism as well as atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) combined with cerebral infarction.Methods:Patients who were treated in the hospital due to acute cerebral infarction between March 2015 and February 2018 were selected, and according to the combination of OSAHS, the 300 patients with cerebral infarction were divided into the cerebral infarction group A who were combined with OSAHS and the cerebral infarction group B who were not combined with OSAHS;the 100 cases of healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The contents of glucolipid metabolism indexes, cytokines and plaque hydrolysis molecules in serum were determined.Results: Serum F-Ins, TC, LDL-C, VE-cadherin, YKL-40, FKN, M-CSF, MCP-1, MMP9, Caspase-3, ICTP and VCAM-1 levels of cerebral infarction group A and cerebral infarction group B were significantly higher than those of control group whereas HDL-C levels were significantly lower than that of control group;serum F-Ins, TC, LDL-C, VE-cadherin, YKL-40, FKN, M-CSF, MCP-1, MMP9, Caspase-3, ICTP and VCAM-1 levels of cerebral infarction group A were significantly higher than those of cerebral infarction group B whereas HDL-C level was significantly lower than that of cerebral infarction group B.Conclusion: There are more significant glucolipid metabolism disorder and worse plaque stability in patients with OSAHS combined with cerebral infarction.

Altered Cortical Information Interaction During Respiratory Events in Children with Obstructive Sleep Apnea-Hypopnea Syndrome

tObstructive sleep apnea-hypopnea syndrome(OSAHS)significantly impairs children's growth and cognition.This study aims to elucidate the pathophysiological mechanisms underlying OSAHS in children,with a particular focus on the alterations in cortical information interaction during respiratory events.We analyzed sleep electroencephalography before,during,and after events,utilizing Symbolic Transfer Entropy(STE)for brain network construction and information flow assessment.The results showed a significant increase in STE after events in specific frequency bands during N2 and rapid eye movement(REM)stages,along with increased STE during N3 stage events.Moreover,a noteworthy rise in the information flow imbalance within and between hemispheres was found after events,displaying unique patterns in central sleep apnea and hypopnea.Importantly,some of these alterations were correlated with symptom severity.These findings highlight significant changes in brain region coordination and communication during respiratory events,offering novel insights into OSAHS pathophysiology in children.

Regulation of sleep by astrocytes in the hypothalamic ventrolateral preoptic nucleus

Astrocytes are functionally dynamic cells that support neurons in multiple ways throughout an organism’s lifespan.The astrocytic regulation of neuronal activity has been increasingly recognized in recent years.Astrocytes are now recognized as playing a more complex role than mere bystanders in the central nervous system.However,their role in regulating the sleep neurocircuitry is not well understood.From this perspective,we highlight the role of astrocytes in sleep modulation,with a particular focus on regulatory mechanisms related to the ventrolateral preoptic nucleus(VLPO)of the hypothalamus.We briefly discuss recent literature reporting the role of VLPO astrocytes in regulating sleep-associated behaviors.

Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances:a 3-month longitudinal study

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 infections.Previous studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019(COVID-19).However,neuroimaging studies on sleep disturbances caused by COVID-19 are scarce,and existing studies have primarily focused on the long-term effects of the virus,with minimal acute phase data.As a result,little is known about the pathophysiology of sleep disturbances in the acute phase of COVID-19.To address this issue,we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection,and verified the results using 3-month follow-up data.A total of 26 COVID-19 patients with sleep disturbances(aged 51.5±13.57 years,8 women and 18 men),27 COVID-19 patients without sleep disturbances(aged 47.33±15.98 years,9 women and 18 men),and 31 age-and gender-matched healthy controls(aged 49.19±17.51 years,9 women and 22 men)were included in this study.Eleven COVID-19 patients with sleep disturbances were included in a longitudinal analysis.We found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain lobes.The cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index scores.Additionally,we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy controls.The 3-month follow-up data revealed indices of altered cerebral structure(cortical thickness,cortical grey matter volume,and cortical surface area)in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep disturbances.Our findings indicate that the sleep disturbances patients had altered morphology in the cortical and hippocampal structures during the acute phase of infection and persistent changes in cortical regions at 3 months post-infection.These data improve our understanding of the pathophysiology of sleep disturbances caused by COVID-19.

Decoding the nexus:branched-chain amino acids and their connection with sleep,circadian rhythms,and cardiometabolic health

The sleep-wake cycle stands as an integrative process essential for sustaining optimal brain function and,either directly or indirectly,overall body health,encompassing metabolic and cardiovascular well-being.Given the heightened metabolic activity of the brain,there exists a considerable demand for nutrients in comparison to other organs.Among these,the branched-chain amino acids,comprising leucine,isoleucine,and valine,display distinctive significance,from their contribution to protein structure to their involvement in overall metabolism,especially in cerebral processes.Among the first amino acids that are released into circulation post-food intake,branched-chain amino acids assume a pivotal role in the regulation of protein synthesis,modulating insulin secretion and the amino acid sensing pathway of target of rapamycin.Branched-chain amino acids are key players in influencing the brain's uptake of monoamine precursors,competing for a shared transporter.Beyond their involvement in protein synthesis,these amino acids contribute to the metabolic cycles ofγ-aminobutyric acid and glutamate,as well as energy metabolism.Notably,they impact GABAergic neurons and the excitation/inhibition balance.The rhythmicity of branchedchain amino acids in plasma concentrations,observed over a 24-hour cycle and conserved in rodent models,is under circadian clock control.The mechanisms underlying those rhythms and the physiological consequences of their disruption are not fully understood.Disturbed sleep,obesity,diabetes,and cardiovascular diseases can elevate branched-chain amino acid concentrations or modify their oscillatory dynamics.The mechanisms driving these effects are currently the focal point of ongoing research efforts,since normalizing branched-chain amino acid levels has the ability to alleviate the severity of these pathologies.In this context,the Drosophila model,though underutilized,holds promise in shedding new light on these mechanisms.Initial findings indicate its potential to introduce novel concepts,particularly in elucidating the intricate connections between the circadian clock,sleep/wake,and metabolism.Consequently,the use and transport of branched-chain amino acids emerge as critical components and orchestrators in the web of interactions across multiple organs throughout the sleep/wake cycle.They could represent one of the so far elusive mechanisms connecting sleep patterns to metabolic and cardiovascular health,paving the way for potential therapeutic interventions.

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background： For patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） and type 2 diabetes mellitus （T2DM）, the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure （CPAP） therapy in patients with OSAHS and T2DM. Methods： Continuous glucose monitoring system （CGMS） was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin （HbAlc） were measured and compared to the pretreatment data. Results： After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose （MBG） and the night time MBG were significantly reduced （P 〈 0.05 and P = 0.03, respectively）. The mean ambulatory glucose excursions （MAGEs） and the mean of daily differences were also significantly reduced （P 〈 0.05 and P = 0.002, respectively） compared to pretreatment levels. During the night, MAGE also significantly decreased （P = 0.049）. The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment （P 〈 0.05 and P = 0.024, respectively）. The 24 h and night time durations of high blood glucose （〉7.8 mmol/L and 〉 11.1 mmol/L） decreased （P 〈 0.05 and P 〈 0.05, respectively） after the treatment. In addition, HbA 1 c levels were also lower than those before treatment （P 〈 0.05）, and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment （P = 0.034）. Conclusions： CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.

Analysis of the characteristics of coronary artery lesions in patients with obstructive sleep apnea-hypopnea syndrome and influencing factors

Objective:The current study involved an analysis of the characteristics of coronary artery lesions of patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and the correspond-ing influencing factors.Methods:One hundred twenty patients were selected by sleep apnea monitoring and coronary angiography.According to the apnea-hypopnea index(AHI),the patients were divided into the following 3 groups:patients with an AHI<10 times/h as the control group(n=25);patients with an AHI=10~15 times/h as the mild OSAHS group(n=32);and patients with an AHI>15 times/h as the moderate-to-severe OSAHS group(n=63).The clinical and laboratory test data of patients in each group were collected.A single-factor ANOVA and multi-factor logistic regression analysis were performed on the study data to analyze the coronary artery lesions in patients with OSAHS and the corresponding influencing factors.Results:(1)With respect to smoking,alcohol consumption,BMI,blood glucose,blood lipids,and blood pressure among the three groups,there were no significant differences between the three groups;however,age did differ among the three groups(P<0.05).(2)The incidence of anterior descending artery,right coronary artery,single-vessel,and coronary artery lesions as determined by coronary angiography was significantly different(P<0.05).The incidence of these vascular lesions in the moderate-to-severe group was higher than the mild group,and the incidence of coro-nary artery lesions in the moderate-to-severe group was higher(P<0.0167).(3)Based on multi-factor logistic regression analysis,alcohol consumption(OR=7.058;95%CI,1.953-25.508),age(OR=1.845;95%CI,1.121-3.038),and the AHI(OR=2.404;95%CI,1.088-5.314)were the major risk factors for coronary artery lesions.Alcohol consumption(OR=12.114;95%CI,3.058-47.979)and the AHI(OR=3.052;95%CI,1.210-7.694)were the risk factors for single-vessel disease.Age(OR=2.812;95%CI,1.236-6.400)was the major risk factor for multi-vessel disease.Conclusion:The probability of coronary artery lesions increased with OSAHS severity.The main manifestation of the increased possibility was single-vessel coronary artery lesions.In single-vessel disease,the anterior descending branch and the right coronary artery were the most vulner-able,which may be related to the anatomic distribution.Alcohol consumption,age,and AHI are the major risk factors for coronary artery lesions.Alcohol consumption and AHI are major risk factors for single-vessel disease.Age is the main risk factor for multi-vessel disease.

Relationship between obstructive sleep apnea-hypopnea syndrome(OSAHS)and liver fibrosis

Objective:The current study discusses the relationship between sleep apnea-hypopnea syn-drome(OSAHS)and liver fibrosis by determining the level of plasma hyaluronic acid(HA),pro-collagen III(PIII),collagen IV(IVC),and laminin(LN)in OSAHS patients and non-OSAHS patients with obesity and normal body weight.Methods:The patients who underwent polysomnographic(PSG)examinations in the outpatient and inpatient departments of our hospital between December 2010 and June 2013 were selected.The patients were divided into two groups based on the apnea-hypopnea index(AHI;OSAHS and non-OSAHS patients),and both groups were further divided based on obesity and normal body weight based on the body mass index(BMI).Sleep breathing indicators,including BMI,AHI,LSaO_(2),and MSaO_(2),were measured in all patients.All of the patients had their blood drawn on the morning after the day of the PSG examination,and the samples were sent to the biochemical laboratory of our hospital for determination of the levels of HA,PIII,IVC,and LN.Results:Among the obese and normoweight patients,the levels of HA,PIII,IVC,and LN in OSAHS patients were higher than the non-OSAHS patients(P value<0.05).Amongst the OSAHS and non-OSAHS patients,the levels of HA,PIII,IVC,and LN in the obese patients were also higher than the non-obese patients(P value<0.05).The levels of HA,PIII,IVC,and LN in the obese OSAHS patients were higher than the remaining three groups(P value<0.05).The levels of HA,PIII,IVC,and LN had positive correlations with the AHI and BMI(r=0.701,0.523,0.639,and 0.421,respectively,P<0.05;and r=0.565,0.441,0.475,and 0.401,respectively,P<0.05),and nega-tive correlations with the LSaO_(2) and MSaO_(2) in OSAHS patients(r=-0.432,-0.394,-0.403,and-0.267,respectively,P<0.05;and r=-0.591,-0.517,-0.533,and-0.484,respectively,P<0.05).Conclusion:The levels of plasma HA,PIII,IVC,and LN in OSAHS patients were related to OSAHS.OSAHS might lead to liver fibrosis.

Imbalance of osteoprotegerin/receptor activator of nuclear factor-κB ligand and oxidative stress in patients with obstructive sleep apnea-hypopnea syndrome

Background:Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with a higher prevalence of osteoporosis.However,the underlying mechanisms linking OSAHS with bone loss are still unclear.The aim of this study was to investigate 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 metabolism markers in OSAHS,in order to understand the potential mechanisms underlying bone loss in OSAHS patients.Methods:Forty-eight male patients with OSAHS,confirmed by polysomnography (PSG) study,were enrolled.Twenty male subjects who were confirmed as not having OSAHS served as the controls.The subjects’bone mineral density (BMD) was assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA).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),and total antioxidant capacity (TAOC).Results:The BMD and the T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group (P< 0.05).The serum level of BAP was significantly decreased in the OSAHS group (15.62 ± 5.20 μg/L) as compared to the control group (18.83 ± 5.50 μg/L,t= -2.235,P< 0.05),while the levels of TRAP-5b did not differ between the two groups (t= -1.447,P> 0.05).The serum level of OPG and the OPG/RANKL ratio were lower in the OSAHS group compared to the control group (bothP< 0.05).TAOC level was also decreased significantly in the OSAHS group (P< 0.05).Correlation analysis showed that the TAOC level was positively correlated with BAP in the OSAHS group (r= 0.248,P= 0.04),but there were no correlations between TAOC and the BMD or the T-scores.The correlations between the level of OPG (or the OPG/RANKL ratio) and BMD or TAOC did not reach significance.Conclusion:In OSAHS patients,lower levels of TAOC were associated with decreased bone formation,suggesting a role of oxidative stress in bone loss,while the role of OPG/RANKL imbalance in bone metabolism in OSAHS needs further evaluation .

SLEEP-MAD模式护理策略在结直肠癌病人术后护理中的应用

目的:探讨SLEEP-MAD模式护理策略在结直肠癌病人术后护理中的应用价值。方法:2022年5月—2023年5月选取医院收治的86例结直肠癌病人为研究对象,按照随机数字表法将病人分为观察组、对照组各43例,对照组行常规护理,观察组实施SLEEP-MAD模式护理策略,干预前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、视觉模拟疼痛评分表(VAS)、匹兹堡睡眠质量指数量表(PSQI)、癌因性疲乏评分及欧洲癌症研究与治疗组织生命质量量表(EORTC QLQ-C30)评价病人的不良情绪、疼痛感、癌因性疲乏、睡眠质量及生活质量。结果:干预后观察组病人HAMA、HAMD、VAS、PSQI及癌因性疲乏评分低于对照组(P<0.05);干预后观察组病人EORTC QLQ-C30评分高于对照组(P<0.05)。结论:SLEEP-MAD模式护理策略可有效减轻结直肠癌病人焦虑及抑郁情绪,减轻病人术后疼痛感及癌因性疲乏,改善病人睡眠质量及生活质量。