阻塞性睡眠呼吸暂停低通气综合征患者血清热休克蛋白70及氧化应激指标检测

目的了解阻塞性睡眠呼吸暂低通气停综合征(OSAHS)患者血清热休克蛋白70(HSP70)的水平以及氧化应激反应对其的影响,探讨HSP70在OSASH疾病过程中的作用。方法对7 9例OSAHS患者实施等离子辅助下悬雍垂腭咽成形术,于术前及术后6个月检测血清中HSP7 0、超氧物歧化酶(SOD)、丙二醛(MDA)水平,分析手术前后HSP70水平变化以及与AHI、MDA、SOD之间的关系。同期选取20例单纯打鼾患者作为对照组。结果 OSAHS患者血清中HSP70、MDA水平较正常对照组显著增高(P<0.01),HSP70与AHI、MDA呈正相关(r=0.95,P<0.01;r=0.61,P<0.01);血清SOD活性降低,与HSP70无关联;术后有效者HSP70水平降低恢复正常水平,无效者手术前后差异无统计学意义(P>0.05)。结论 OSAHS患者存在热休克反应,血清HSP70水平增高,此表达与OSAHS病情及体内的氧化反应程度有关,HSP70在OSASH的病理过程中可能发挥保护性作用。

睡眠呼吸暂停综合征与血小板粘附分子

睡眠呼吸暂停综合征已成为不稳定型心绞痛、心肌梗死、脑卒中等心、脑血管疾病的独立危险因素。血小板及其粘附分子在动脉血栓形成中起了重要作用,监测血小板及其粘附分子,有助于减少睡眠呼吸暂停练合征的心、脑血管并发症。

睡眠呼吸暂仃综合征脉搏血氧计与多导睡眠仪监测对比研究

本文报告30例睡眠呼吸暂仃综合征患者夜间监测结果。仪器使用脉搏血氧计(V×4)与多导睡眠仪(PSG)将监测结果进行比较分析。结果表明这两个仪器在血氧饱和度与睡眠呼吸暂仃次数呈高度相关(P<0.001),尤其在中度和重度睡眠呼吸暂仃患者中,V×4测定有较好的敏感性与特异性(>80％)。V×4与PGS在睡眠呼吸暂仃指数的中度和重度分组比较中有统计学意义,各组之间均有差异(P<0.05)。(V×4)呼吸暂仃指数与嗜睡症状程度相关性较好(P<0.01)。

悬雍垂腭咽成型术对阻塞性睡眠呼吸暂停低通气综合征患者血浆同型半胱氨酸的影响

目的探讨悬雍垂腭咽成型术(uvulopalatopharyngoplasty,UPPP)对阻塞性睡眠呼吸暂低通气停综合征(obstrutive sleep apneda hypopnea syndrome,OSAHS)患者血浆同型半胱氨酸(homocysteine,Hcy)的影响。方法对20例OSAHS患者和19例正常对照者,测定治疗前Hcy的水平及UPPP手术后3个月Hcy水平的变化。结果 OSAHS组血Hcy水平明显高于对照组,OSAHS患者行UPPP手术治疗后血Hcy水平较治疗前降低(P<0.05)。结论通过UPPP可改善OSAHS患者血Hcy水平,降低OSAHS患者发生心脑血管并发症的危险性。

长期自动调节压力持续正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的临床观察

目的观察经过2年自动调节压力持续正压通气（AUTO-CPAP）治疗中、重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的患者体质量指数（BMI）的变化，停机后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSPO2）、微觉醒指数（MAI）、Ⅰ～Ⅱ期及Ⅲ～Ⅳ期睡眠时间占总睡眠时间百分比（Ⅰ～Ⅱ％，Ⅲ～Ⅳ％）的变化，探讨长期AUTO-CPAP呼吸机治疗对患者BMI的影响以及治疗后停机对患者的影响。方法选取42例中、重度OSAHS患者，经AUTO—CPAP治疗2年、治疗时间≥5h／d，治疗结束后对患者停机，并对患者行多导睡眠呼吸监测，观察治疗前后患者BMI、AHI、LSPO2、MAI、Ⅰ～Ⅱ％、Ⅲ～Ⅳ％的变化。结果长期AUTO—CPAP治疗前后患者BMI无明显变化（P〉0．05），当治疗停止时，AHI从（43．6±12，6）次／h减少到（36．7±11．2）次／h，减少了（6．8±3．2）次／h（P〈0．01），LSP02从（69．3±10．2）％上升到（76．4±8．1）％，升高了（7．1±2．6）％（P〈0．01），MAI从（38．1±12．2）次／h上升到（44．2±13．1）次／h，上升了（2．1±3．2）次／h（P〈0．01）。Ⅰ～Ⅱ％，Ⅲ～Ⅳ％无明显变化（P〉0．05）。结论长期AUTO—CPAP治疗OSAHS对患者BMI无明显影响；有利于降低患者原有AHI、提高LSPO2；停机后对患者的影响主要表现在MAI的增加，而与Ⅰ～Ⅱ％、Ⅲ～Ⅳ％无关。

右美托咪啶用于阻塞性睡眠呼吸低通气暂停综合征患者手术的麻醉效果

目的:探讨右美托咪啶在阻塞性睡眠呼吸低通气暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAS)患者手术中的应用效果。方法:共入组OSAS患者21例。术前给予患者右美托咪啶1μg/kg,15 min内静脉推注完毕,推注一半时用1%丁卡因行环甲膜穿刺以达到咽喉、气管表面麻醉,并用3%麻黄碱1 mL收缩鼻腔黏膜,在通畅一侧鼻腔置入鼻咽通气管。待右旋托咪啶静脉推注完毕后,行口咽部表面麻醉。如患者反应剧烈则给予0.5～1 mg咪达唑仑和50μg芬太尼,术中予右美托咪啶持续泵注[0.5～1.5μg/(kg.h)]。结果:全部OSAS患者均气管插管成功,其中经鼻盲插入15例,经口喉镜辅助插管3例;纤维支气管镜引导插管3例;患者的氧饱和度均在92%以上。手术结束后18例顺利清醒拔管,带鼻咽通气管回病房,无烦躁、体动等;3例因切除扁桃体时止血不完全而带管回重症监护室(intensive care unit,ICU),观察12～24 h,完全苏醒后拔管。结论:麻醉诱导期应用右旋美托咪啶为OSAS患者提供了有利的插管条件,术中泵注右旋美托咪啶可使患者术中生命体征更加平稳,并能有效减轻患者术后躁动。

8-异前列腺F2a、KL-6、SP—D、瘦素在睡眠呼吸暂低通气综合征疾病中的研究进展

8-异前列腺F2a在体内生成结构稳定，不受食物脂质含量的影响，特异性强，能灵敏地反映体内氧化应激水平并与疾病严重程度相关，是评价氧化应激和脂质过氧化反应的理想生物指标。Ⅱ型肺泡细胞表面抗原6（KL-6）、肺表面活性蛋白D（SP—D）主要由肺泡Ⅱ型上皮细胞分泌，夜间慢性间断缺氧及再氧合损伤肺泡屏障、致肺泡部位内皮细胞氧化应激损伤、导致上皮细胞渗透性增高，使KL-6、SP—D浓度升高。肥胖是导致0SAHS的重要危险因素，瘦素是一种由脂肪细胞分泌的重要的抗肥胖激素。现对细胞因子8-异前列腺F2a、KL-6、SP—D、瘦素等生物标记物在OSAHS中的关系做一综述。

正压通气治疗对OSAHS患者EBC和血清中去甲肾上腺素水平的影响

目的探讨auto-CPAP治疗对OSAHS患者交感神经兴奋性的影响。方法根据PSG确诊的42例OSAHS患者,随机分为治疗组和对照组,对治疗组进行auto-CPAP治疗,对所有患者采取常规治疗,测定治疗组及对照组治疗前后EBC和血清中的NE。结果 (1)治疗组患者EBC和血清中NE治疗前高于治疗后(P<0.01);(2)对照组患者EBC和血清中NE治疗前后无统计学意义(P>0.05);(3)OSAHS患者EBC和血清中NE水平与AHI呈正相关关系,与LPSO2、MPSO2呈负相关关系(P<0.01)。结论 OSAHS患者常伴有交感神经兴奋性的增强,并且可以通过auto-CPAP治疗得以改善。

Investigation on Risk Factors of Cerebrocardiac Vascular Thrombotic Diseases in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Objective: To observe the risk factors of thrombosis in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods: From February 2001 to April 2003, 24 patients with moderate and severe OSAHS (OSAHS group) and 19 healthy adults (control group) were recruited. Their blood samples were drawn at 6∶00 and 16∶00 respectively for testing hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (Fng) and endothelin (ET).Results: There was a significantly higher hemocrit, WBV, Fng and ET as well as a significant shortening of PT and APTT at 6∶00 than that at 16∶00 in OSAHS group. However, there was no significant difference in all testing items between 6∶00 and 16∶00 in control group. The hemocrit, WBV, PAG, plasma Fng and ET were significantly higher, and PT and APTT were obviously shorter at 6∶00 in OSAHS group than those at 6∶00 in control group. A higher hemocrit, PAG, plasma Fng and ET, a longer PT and APTT were observed at 16∶00 in OSAHS group, compared with those at 16∶00 in control group.Conclusion: In OSAHS patients there were striking risk factors of thrombosis, which is more remarkable in the early morning than in the afternoon.

Should nonalcoholic fatty liver disease be regarded as a hepatic illness only?

The highly increasing prevalence of obesity and type 2 diabetes mellitus in the general population makes nonalcoholic fatty liver disease the most common diagnosis in every-day practices. Lifestyle changes （mainly exercise withdrawal and weight gain） have probably heightened the prevalence of nonalcoholic fatty liver disease. Mortality in patients with Nonalcoholic Fatty Liver Disease is significantly higher when compared with that of the same age-gender general population. Hepatologists claim to bear a new burden, being Nonalcoholic Fatty Liver Disease strongly linked to systemic diseases.

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI 5≥5-30, n=27, 'severe' (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensinaldosterone system

Background Obstructive sleep apnea （OSA） is the most common cause of resistant hypertension, which has been proposed to result from activation of the renin-angiotensin-aldosterone system （RAAS）. We meta-analyzed the effects of OSA on plasma levels of RAAS components. Methods Full-text studies published on MEDL1NE and EMBASE analyzing fasting plasma levels of at least one RAAS component in adults with OSA with or without hypertension. OSA was diagnosed as an apnea-hypopnea index or respiratory disturbance index 〉 5. Study quality was evaluated using the Newcastle-Ottawa Scale, and heterogeneity was assessed using the 12 statistic. Results from individual studies were synthesized using inverse variance and pooled using a random-effects model. Subgroup analysis, sensitivity analysis, and meta-regression were performed, and risk of publication bias was assessed. Results The meta-analysis included 13 studies, of which 10 reported results on renin （n = 470 cases and controls）, 7 on angiotensin II （AnglI, n = 384）, and 9 on aldosterone （n = 439）. AnglI levels were significantly higher in OSA than in controls [mean differences = 3.39 ng/L, 95% CI： 2.00-4.79, P 〈 0.00001], while aldosterone levels were significantly higher in OSA with hypertension than OSA but not with hypertension （mean differences = 1.32 ng/dL, 95% CI： 0.58-2.07, P = 0.0005）. Meta-analysis of all studies suggested no significant differences in aldosterone between OSA and controls, but a significant pooled mean difference of 1.35 ng/mL （95% CI： 0.88-1.82, P 〈 0.00001） emerged after excluding one small-sample study. No significant risk of publication bias was detected among all included studies. Conelusions OSA is associated with higher AnglI and aldosterone levels, espe- cially in hypertensive patients. OSA may cause hypertension, at least in part, by stimulating RAAS activity.

Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.

Adiponectin Ameliorated Pancreatic Islet Injury Induced by Chronic Intermittent Hypoxia through Inhibiting the Imbalance in Mitochondrial Fusion and Division

Objective This study aimed to assess the protective value of adiponectin(APN)in pancreatic islet injury induced by chronic intermittent hypoxia(CIH).Methods Sixty rats were randomly divided into three groups:normal control(NC)group,CIH group,and CIH with APN supplement(CIH+APN)group.After 5 weeks of CIH exposure,we conducted oral glucose tolerance tests(OGTT)and insulin released test(IRT),examined and compared the adenosine triphosphate(ATP)levels,mitochondrial membrane potential(MMP)levels,reactive oxygen species(ROS)levels,enzymes gene expression levels of Ant1,Cs,Hmox1,and Cox4 i1 which represented mitochondrial tricarboxylic acid cycle function,the protein and gene expression levels of DRP1,FIS1,MFN1,and OPA1 which represented mitochondrial fusion and division,and the protein expression levels of BAX,BCL-2,cleaved Caspase-3,and cleaved PARP which represented mitochondrial associated apoptosis pathway of pancreatic islet.Results OGTT and IRT showed blood glucose and insulin levels had no differences among the NC,CIH and CIH+APN groups(both P>0.05)at 0 min,20 min,30 min,60 min,120 min.However,we found that compared to NC group,CIH increased the ROS level,reduced ATP level and MMP level.The islets of CIH exposed rats showed reduced gene expression levels of Ant1,Cs,Hmox1,and Cox4 i1,decreased protein and gene expression levels of MFN1 and OPA1,increased protein and gene expression levels of DRP1 and FIS1,increased protein expression levels of cleaved Caspase-3 and cleaved PARP,with lower ratio of BCL-2/BAX at protein expression level.All the differences among three groups were statistically significant.APN treated CIH rats showed mitigated changes in the above measurements associated with islet injuries.Conclusion APN may ameliorate the pancreatic islet injury induced by CIH via inhibiting the imbalance in mitochondrial fusion and division.

Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux?

In a recent issue ot World Journal of Gastroenterology, Demeter et al., reported that in patients having both gastro-esophageal reflux disease （GERD） and obstructive sleep apnea （OSA）, there was a positive correlation between endoscopic findings of GERD and the number of apneas and hypopneas per hour, namely apnea hypopnea index. They proposed that the severity of OSA and GERD are parallel to each other. The study of Demeter and colleagues is very important, not only for assessing reflux-induced esophageal damage in OSA,

USE OF PULSE TRANSIT TIME AS A MEASURE OF AUTONOMIC AROUSALS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Objective To evaluate the feasibility of pulse transit time (PTT) arousals as an index of sleep fragmentation in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Individuals referred for evaluation of possible OSAHS underwent overnight polysomnography (PSG). Three conventional indices of sleep fragmentation [electroencephalography (EEG) arousals, apnea/hypopnea index (AHI), oxygen desaturation index (ODI)], PTT arousals, and Epworth sleepiness scale (ESS) were compared. Results PTT arousals were positively correlated with EEG arousals (r= 0.746, P<0.001), AHI (r= 0.786, P<0.001), and ODI (r= 0.665, P<0.001), respectively. But, both PTT arousals and EEG arousals had no correlation with ESS (r= 0.432, P=0.201; r= 0.196, P=0.591, respectively). Conclusion PTT arousals are correlated well with other standard measures estimating severity of OSAHS and potentially a non-invasive marker with which to measure the sleep fragmentation in patients with OSAHS.

Effects of Obstructive Sleep Apneas on Endothelial Function and Autonomic Modulation in Adult Man

Objective To study the effects of obstructive sleep apneas on endothelial function and autonomic modulation. Methods From June 2009 to June 2011, male patients with obstructive sleep apnea hypopnea syndrome (OSAHS) were consecutively enrolled in this study. Patients with an apnea/hypopnea index (AHI) of greater than 15 and without previous treatment for OSAHS were included as Group OSAHS and obese subjects with an AHI of less than 5 were included as non-OSAHS controls (Group Control). Electrocardiography and beat-to-beat blood pressure were continuously recorded from the radial artery by applanation tonometry which was synchronized with polysomnography recording. Endothelial function was measured by arterial augmentation index (AAI). Spectral analysis of heart rate variability (HRV) and blood pressure variability (BPV) were computed for cardiac parasympathetic modulation (high frequency power, HF); sympathetic modulation (low frequency power, LF), sympathovagal balance (LF/HF power of R-R variability, LF/HF) and BPV sympathetic modulation (BPV LF) in normalized units [total power of the components/(total power-very LF power)×100]. Results Finally, 27 moderate-severe OSAHS patients and 22 non-OSAHS obese controls were recruited in the Group OSAHS and Group Control, respectively. In Group OSAHS, the age was 43.3±9.3 year-old, body mass index (BMI) was 36.8±8.7 kg/m 2 ; in Group Control, the age was 42.9±8.6 year-old, BMI was 34.4±7.9 kg/m 2 ; there were no significant differences in age and BMI between the Group OSAHS and Group Control (all P>0.05). The baseline AAI (12.5%±2.2% vs. 8.2%±2.1%) and BPV LF (68.3%±13.5% vs. 61.1%±11.7%) of the Group OSAHS were significantly higher than those of the Group Control (all P<0.05). And after overnight sleep, systolic BP (143.7±14.2 vs. 132.8±13.3 mm Hg), diastolic BP (87.7±7.7 vs. 78.6±5.5 mm Hg), HRV LF (69.7%±14.4% vs. 64.3%±12.1%), HRV LF/HF (3.7±2.0 vs. 2.3±1.3) and BPV LF (77.8%±15.6% vs. 68.3%±13.5%) of the Group OSAHS were significantly increased (all P<0.001), while HRV HF was significantly decreased (21.1%±9.3% vs. 27.5%±10.3%, P<0.05) from baseline.Conclusions The baseline endothelial function and autonomic modulation are impaired in OSAHS patients, which happened prior to hypertension and other cardiovascular complications. And the load effects of overnight obstructive breathing events could induce blood pressure and sympathetic activity increasing in the morning in OSAHS patients without acute aggravation in endothelial dysfunction.