A Very Severe Obstructive Sleep Apnea Syndrome: In a Cause of Resistant Hypertension with One Sample Case

When blood pressure values remain above the target in a hypertensive patient treated concomitantly with three anti-hypertensive drugs including a diuretic, maximum well-tolerated doses, this is a resistant arterial hypertension. In this case, it is advisable to look for a secondary cause such as a drug intake that influencing the blood pressure or the presence of obstructive sleeping syndrome (OSAS). We report a clinical case of a patient with a high cardiovascular risk at the age of 50, hypertensive and diabetic, with dyslipidemia and obesity. He was on anti-hypertensive triple therapy at an optimal dose. Her diabetes was balanced with 6.4% glycated hemoglobin. Dyslipidemia has being treated. Despite healthy diet including a low sodium diet and weight loss, blood pres- sure target was not reached. With self-measurement, the mean arterial pressure was 180/110 mmHg and on ABPM it was 167/113 mmHg. The ventilatory polygraphy finds a severe OSA with an IAH = 56.6. Treatment with PCP (Con- tinuous positive pressure) allowed this patient to control blood pressure. The search for OSA should be systematic in face of resistant hypertension, in par- ticular in overweight or obese patients.

Obstructive Sleep Apnea Syndrome Phenotyping by Cluster Analysis: Typical Sleepy, Obese Middle-aged Men with Desaturating Events are A Minority of Patients in A Multi-ethnic Cohort of 33% Women

Objective Several clinical obstructive sleep apnea syndrome(OSAS)phenotypes associated with heterogeneous cardiovascular risk profiles have been recently identified.The purpose of this study was to identify clusters amongst these profiles that allow for the differentiation of patients.Methods This retrospective study included all moderate-to-severe OSAS patients referred to the sleep unit over a 5-year period.Demographic,symptom,comorbidity,polysomnographic,and continuous positive airway pressure(CPAP)adherence data were collected.Statistical analyses were performed to identify clusters of patients.Results A total of 567 patients were included(67%men,54±13 years,body mass index:32±7 kg/m2,65%Caucasian,32%European African).Five clusters were identified:less severe OSAS(n=172);healthier severe OSAS(n=160);poorly sleeping OSAS patients with cardiometabolic comorbidities(n=87);younger obese men with sleepiness at the wheel(n=94);sleepy obese men with very severe desaturating OSAS and cardiometabolic comorbidities(n=54).Patients in clusters 3 and 5 were older than those in clusters 2 and 4(P=0.034).Patients in clusters 4 and 5 were significantly more obese than those in the other clusters(P=0.04).No significant differences were detected in terms of symptoms and comorbidities.Polysomnographic profiles were very discriminating between clusters.CPAP adherence was similar in all clusters but,among adherent patients,daily usage was more important in cluster 1(less severe patients)than in cluster 5.Conclusion This study highlights that the typical sleepy obese middle-aged men with desaturating events represent only a minority of patients in our multi-ethnic moderate-to-severe OSAS cohort of 33%females.

Meta-analysis of randomized controlled trials of traditional Chinese medicine in the treatment of obstructive sleep apnea syndrome

Objective:Though Chinese medicine(CM)has showed its clinical efficacy for the treatment of obstructive sleep apnea(OSA)in China,no systematic reviews or meta-analyses provide evidences for its therapeutic effects on OSA and the long-term safety.The aim of the present study is to evaluate the effectiveness and safety of CM on OSA using meta-analysis.Methods:We used search items of"Chinese Medicine"AND"obstructive sleep apnea"to retrieve the randomized control trials(RCTs)of CM treatments for OSA in PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI),VIP database,and Wanfang database from their respective inception dates to December 2019.Only RCTs of CM therapy versus no treatment which could be quantitatively synthesized were included.Finally,20 studies representing 1,297 participants were included after extraction.Two investigators independently extracted and analyzed the data using RevMan5.3 software.Results:The treatment group using CM decoctions or CM granules presented significantly ameliorative effects on apnoea-hypopnoea index(AHI)compared with the control group(MD:-2.58,95%CI:-3.59 to-1.56,P<0.00001 and MD:-5.47,95%CI:-6.75 to-4.19,P<0.00001,respectively)in the sensitivity analysis.However,there were non significant differences in the duration of treatment between subgroups,indicating that the duration of treatment has no impacts on the therapeutic effects on AHI.CM granules also showed significantly ameliorative effects on the lowest nocturnal oxygen saturation(LSaO2)(MD:2.76,95%CI:1.85 to 3.68,P<0.00001).CM decoctions exhibited significantly improved Epworth Sleepiness Scale(ESS)scores compared with the control group in a sensitivity analysis(MD:-1.50,95%CI:-2.13 to-0.88,P<0.00001).CM granules showed a better improvement of ESS than the control group(MD:-1.35,95%CI:-1.92 to-0.78,P<0.00001).Mild adverse reactions occurred only in five patients and disappeared without special treatment.Conclusion:This study showed favorable therapeutic efficacy of CM on OSA.However,in consideration of the low methodological quality of the included RCTs,more rigorous designed,large sample size RCTs are recommended for providing more high-quality evidences.

Causal role of immune cells in obstructive sleep apnea hypopnea syndrome:Mendelian randomization study

BACKGROUND Despite being one of the most prevalent sleep disorders,obstructive sleep apnea hypoventilation syndrome(OSAHS)has limited information on its immunologic foundation.The immunological underpinnings of certain major psychiatric diseases have been uncovered in recent years thanks to the extensive use of genome-wide association studies(GWAS)and genotyping techniques using highdensity genetic markers(e.g.,SNP or CNVs).But this tactic hasn't yet been applied to OSAHS.Using a Mendelian randomization analysis,we analyzed the causal link between immune cells and the illness in order to comprehend the immunological bases of OSAHS.AIM To investigate the immune cells'association with OSAHS via genetic methods,guiding future clinical research.METHODS A comprehensive two-sample mendelian randomization study was conducted to investigate the causal relationship between immune cell characteristics and OSAHS.Summary statistics for each immune cell feature were obtained from the GWAS catalog.Information on 731 immune cell properties,such as morphologic parameters,median fluorescence intensity,absolute cellular,and relative cellular,was compiled using publicly available genetic databases.The results'robustness,heterogeneity,and horizontal pleiotropy were confirmed using extensive sensitivity examination.RESULTS Following false discovery rate(FDR)correction,no statistically significant effect of OSAHS on immunophenotypes was observed.However,two lymphocyte subsets were found to have a significant association with the risk of OSAHS:Basophil%CD33dim HLA DR-CD66b-(OR=1.03,95%CI=1.01-1.03,P<0.001);CD38 on IgD+CD24-B cell(OR=1.04,95%CI=1.02-1.04,P=0.019).CONCLUSION This study shows a strong link between immune cells and OSAHS through a gene approach,thus offering direction for potential future medical research.

Epidemiological and Clinical Profile of Hypertensive Patients with Obstructive Sleep Apnea at CHU-B

Objectives: To detect obstructive sleep apnea syndrome (OSAS) in a population of hypertensive patients, using the Berlin questionnaire and to establish the epidemiological and clinical profile of patients. Patients and Method: This was a cross-sectional and analytical study, carried out from March to August 2019 at the CHU Brazzaville. Included are hypertensive patients followed as outpatients. The diagnosis of the OSAS was based on the answers to the Berlin questionnaire. Results: A total of 315 patients were included, including 210 women (64.9%). Prevalence of OSAS was 75.8% (n = 239). The average age of patients with sleep apnea was 58.5 ± 12.4 years with female predominance (64.9%). In the mixed analysis, the factors associated with (OSAS) were: occupation OR (2.56) 95% CI (1.15 - 5.69), obesity OR 7.50 (1.60 - 35.1) and abdominal obesity OR 2.36 CI 95% (1.36 - 4.08). Living standards were high in 59 cases (18.7 per cent). The medical history of previous hospitalization was present in 209 cases (66.3%), diabetes 95 (30.2%), and heart failure 57 cases (18.1%). Lifestyle patterns were: sedentary (n = 181;57.5%) alcohol consumption (n = 97;30.8%). On physical examination, overweight was noted in 96 cases (30.5%) and obesity in 91 cases (28.8%). The anomalies in the Berlin questionnaire were: snoring (n = 197;62.5%), waking fatigue (n = 127;40.3%), fatigue during the day (n = 97;30.8%). Conclusion: The prevalence of obstructive sleep apnea syndrome is high during arterial hypertension in our setting. Hence the need for sleep exploration through polysomnography, and prevention through the fight against the associated risk factors.

Clinical observation of soft palate-pharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome in children

BACKGROUND Childhood obstructive sleep apnea hypopnea syndrome(OSAHS)is a common clinical disease that can cause serious complications if not treated in time.The preferred treatment for OSAHS in children is surgery.AIM To observe the effects of soft palate-pharyngoplasty on postoperative outcome,pharyngeal formation,and possible complications.METHODS A total of 150 children with snoring,hernia,and mouth breathing were selected.A polysomnography test was performed to confirm the diagnosis of OSAHS.The children were randomly divided into experimental and control groups.The experimental group underwent adenoidectomy,tonsillectomy,and soft palatepharyngoplasty.The control group underwent adenoidectomy and tonsillectomy.The t-test and chi-square test were used to compare conditions such as postoperative fever,postoperative hemorrhage,and pharyngeal reflux.Postoperative efficacy and complications were interrogated and observed in the form of outpatient follow-up and telephone follow-up at 6 mo and 1 year after surgery.The curative effects were divided into two groups:Cure(snoring,snoring symptoms disappeared)and non-cure.RESULTS The effective rate of the experimental group was significantly higher than that of the control group,but the difference was not statistically significant(P>0.05).The incidence of postoperative bleeding was lower in the experimental group.There was no postoperative pharyngeal reflux in either group.In the experimental group,the incidence of hyperthermia(body temperature exceeded 38.5°C)was lower than that in the control group.The difference in postoperative swallowing pain scores between the experimental and control groups was significant.CONCLUSION Soft palate-pharyngoplasty can more effectively enlarge the anteroposterior diameter and transverse diameter of the isthmus faucium.Compared with surgery alone,it can better treat OSAHS in children,improve the curative effect,reduce the risk of perioperative bleeding,close the surgical cavity,reduce the risk of postoperative infection,reduce the proportion of postoperative fever,and accelerate healing.Although this process takes more time,it is simple,safe,and effective.

Clinical analysis of obstructive sleep apnea hypopnea syndrome in children

A case of obstructive sleep apnea hypopnea syndrome(OSAHS)in the Department of Otolaryngology of the Third Affiliated Hospital of Inner Mongolia Medical School was collected.The incidence of this disease is high,which seriously threatens the physical and mental health of children,but it has not been paid enough attention by medical workers and parents.We hope we can make early discovery and treatment,relieve upper airway obstruction factors,prevent and treat complications for children with OSAHS through the case analysis,so as to improve their quality of life.

Management of non-alcoholic fatty liver disease patients with sleep apnea syndrome

Nonalcoholic fatty liver disease(NAFLD)is strongly associated with sleep apnea syndrome(SAS).Many NAFLD patients have SAS,and obstructive sleep apnea hypopnea syndrome is also considered to be an independent risk factor for NAFLD,as it contributes to the progression of NAFLD via oxidative stress,lipid peroxidation,inflammation,and insulin resistance.This review aims to provide some recommendations for the management of NAFLD patients with SAS,including diet,exercise,weight loss,and continuous positive airway pressure.This review also highlights the importance of effective strategies in NAFLD prevention and treatment.

Evaluation of the Role of Palatal Tonsil Hypertrophy in Sleep Apnea Patients: Cephalometric Analysis

The purpose of this research was to elucidate the relationship between tonsillar hypertrophy and Obstructive Sleep Apnea Syndrome (OSAS) in terms of cephalometric analysis, as well as to determine factors that affect OSAS severity. 25 patients were enrolled in this study. Lateral cephalograms of the subjects were taken. Disease severity was evaluated by the Apnea Hypopnea Index (AHI). Cephalometric measurements (angle between line S-N and line N-A (SNA), angle between line S-N and line N-B (SNB), distance between the Mandibular Plane and the Hyoid (MPH), posterior airway space, the width of the airway behind the base of tongue along the B-Go line (PAS), upper airway space, the distance parallel to long axis of the airway, between a horizontal plane tangent to the superior aspect of the hyoid and a horizontal plane tangent to the posterior palate (UAL), multiplication of PAS and UAL (PAS × UAL)) were analyzed and compared between the groups with and without tonsillar hypertrophy. PAS and PAS × UAL were lower in the no hypertrophy group. SNB was significantly lower in the severe apnea group than mild to moderate group in no hypertrophy group (p = 0.035). In conclusion, patients with tonsillar hypertrophy had severe obstruction, but they had a relatively larger pharyngeal space on cephalometric analysis. After exclusion of the tonsillar hypertrophy group, cephalometric analysis could be more effective for analyzing OSAS severity.

Factors influencing glucose metabolism in young obese subjects with obstructive sleep apnea hypopnea syndrome

Objective To explore the factors influencing glucose metabolism in young obese subjects with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 106 young obese subjects[18-44 years old,body mass index(BMI)≥30 kg/m^2]were enrolled and divided into two groups based on full-night polysomnography(PSG),OSAHS group[apnea hypopnea index(AHI)

Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

针刺对轻度至中度阻塞性睡眠呼吸暂停综合征患者的疗效:一项随机对照临床试验方案

Introduction:Obstructive sleep apnea syndrome(OSAS) is considered a major public health issue due to its high prevalence and severe consequences.Several published studies have revealed that electroacupuncture may relieve OSAS symptoms.However,the mechanism of electro-acupuncture in the treatment of patients with OSAS remains unclear.Methods and analysis:We evaluated the efficacy and mechanism of electro-acupuncture in the treatment of patients with OSAS.This was a two-group parallel randomized controlled trial.Sixty patients with OSAS will be randomly divided into an electro-acupuncture or shallow acupuncture group in a proportion of 1:1,and the patients will be administered 36 sessions of electro/shallow acupuncture treatment(three times a week for 12 weeks,20 min for each session).The Epworth Sleepiness Scale(ESS) will be used as the primary outcome.Secondary outcomes will include polysomnography(PSG),sleep quality,emotional state,and cognitive function.In addition,patients will receive neuroimaging scanning before and after the entire acupuncture treatment to evaluate neuroplasticity changes,including gray matter density,white matter integrity,and functional connections.Expected outcomes:We believe that the use of electro-acupuncture will be more effective in patients with mild to moderate OSAS and that the cognitive and emotional status of patients will improve after acupuncture treatment.In addition,we aim to clarify which brain areas can be altered by acupuncture in patients with OSAS.Discussion:This randomized clinical trial aims to explore the curative effect and central mechanism of acupuncture treatment for OSAS.We will explore gray matter density,white matter integrity,and functional connections of the brain using fMRI technology.The results of this study will be significant to the guidelines for clinical OSAS treatment.