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.

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.

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.

Relationship between brain—derived neurotrophic factor and cognitive function of obstructive sleep apnea/hypopnea syndrome patients

Objective:To determine the relationship between the blood serum brain-derived neurotrophic factor（BDNF） level and cognitive function deterioration in patients with obstructive sleep apnea/ hypopnea syndrome（OSAHS）,and to explore the possible mechanism of cognitive impairment. Methods:Twenty-eight male OSAHS patients and 14 normal males（as controls） were enrolled in the study.Polysomnography and the Montreal cognitive assessment（MoCA） were conducted. The blood serum BDNF levels were measured using ELISA.Results:The OSAHS group had significantly decreased blood serum BDNF levels compared with the control group（t=-10.912, P=0.000）.The blood serum BDNF level of the subjects was significantly positively associated with the MoCA score（r=0.544,P=0.000）,significantly negatively associated with the apneahypopnea index（AHI） and shallow sleep（S1+S2）（AHI:r=-0.607,P=0.000;S1+S2:r =-0.768,P= 0.000）,and significantly positively associated with the lowest SaO2（LSO）,slow wave sleep（S3+S4）, and rapid eye movement sleep（REM）（LSO:r=0.566,P = 0.000;S3+S4:r=0.778,P=0.000;REM: r=0.575,P=0.000）.Conclusions:OSAHS patients have significantly decreased blood serum BDNF levels compared with the control.Nocturnal hypoxia as well as the deprivation of slow wave sleep and REM may lead to the decreased serum BDNF level of OSAHS patients.This decreased blood serum BDNF level may contribute to the cognitive impairment in OSAHS.

Association between Serum Homocysteine and Oxidative Stress in Elderly Patients with Obstructive Sleep Apnea/hypopnea Syndrome

Objective Elderly patients with obstructive sleep apnea/hypopnea syndrome （OSAHS） has a higher risk of cardiovascular and cerebrovascular disease. However, changes of homocysteine （Hey） as markers of cardiovascular and eerebrovascular disease associated with OSAHS and their mechanism have not been elucidated so far. This study aims to investigate the changes of both serum Hcy and oxidative stress and their possible links with OSAHS in elderly patients. Methods Based on polysomnogram （PSG） and age, 83 patients with OSAHS were recruited and divided into elderly-OSAHS （n=32） and non-elderly OSAHS groups （n=51）. Fifty two subjects without OSAHS were divided into elderly control （n=29） and non-elderly control groups （n-23）. A total of 135 subjects were included in the present study. All subjects were recorded for PSG variables and the contents of homocysteine （Hcy）, malonaldehyde （MDA）, and glutathione （GSH） which were detected after sleep. Serum homocysteine was measured by cyclophorase. MDA and GSH were measured by speetrophotometer. Results （1） The serum levels of Hcy showed significant difference among the four groups （P〈0.05）. The concentrations of Hcy in elderly OSAHS patients were higher than in other groups, while those in the elderly control group were higher than in the non-elderly control; the concentrations in the non-elderly OSAHS group were higher than in the non-elderly control. （2） The concentrations of MDA and GSH changed at an equal pace with Hcy in the four groups. （3） Multielement linearity regression analysis indicated a statistically significant relationship between Hcy concentration and age, MDA, GSH, and apnea hypopnea index （AHI）. Conclusions （1） The concentrations of Hcy and oxidative stress have increased with advancing age. （2） The concentrations of Hcy and oxidative stress have further increased in the elderly patients with OSAHS. （3） Oxidative stress might cause high-level serum Hcy in the elderly patients with OSAHS.

Evaluation of Airway Obstruction at Soft Palate Level in Male Patients with Obstructive Sleep Apnea/Hypopnea Syndrome:Dynamic 3-Dimensional CT Imaging of Upper Airway

This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome（OSAHS） by using dynamic 3-Dimensional（3-D） CT imaging.A total of 41 male patients who presented with 2 of the following symptoms,i.e.,daytime sleepiness and fatigue,frequent snoring,and apnea with witness,were diagnosed as having OSAHS.They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller＇s maneuver.The soft palate length（SPL）,the minimal cross-sectional area of the retropalatal region（mXSA-RP）,and the vertical distance from the hard palate to the upper posterior part of the hyoid（hhL） were compared between the two breathing states.These parameters,together with hard palate length（HPL）,were also compared between mild/moderate and severe OSAHS groups.Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index（AHI） and the lowest saturation of blood oxygen（LSaO2）] was examined.The results showed that 31 patients had severe OSAHS,and 10 mild/moderate OSAHS.All the patients had airway obstruction at soft palate level.mXSA-RP was significantly decreased and SPL remarkably increased during Muller＇s maneuver as compared with the quiet breathing state.There were no significant differences in these airway parameters（except the position of the hyoid bone） between severe and mild/moderate OSAHS groups.And no significant correlation between these airway parameters and the severity of OSAHS was found.The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group.The patients in group with body mass index（BMI）≥26 had higher collapse ratio of mXSA-RP,greater neck circumference and smaller mXSA-RP in the Muller＇s maneuver than those in group with BMI26（P0.05 for all）.It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients.All the OSAHS patients had airway obstruction of various degrees at soft palate level.But no correlation was observed between the airway change at soft palate level and the severity of OSAHS.The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI26.

Detection of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome using mismatch negativity

In this experiment, 97 patients with obstructive sleep apnea hypopnea syndrome were divided into three groups （mild, moderate, severe） according to minimum oxygen saturation, and 35 healthy subjects were examined as controls. Cognitive function was determined using the mismatch negativity paradigm and the Montreal Cognitive Assessment. The results revealed that as the disease worsened, the mismatch negativity latency was gradually extended, and the amplitude gradually declined in patients with obstructive sleep apnea hypopnea syndrome. Importantly, mismatch negativity latency in severe patients with a persistent time of minimum oxygen saturation 〈 60 seconds was significantly shorter than that with a persistent time of minimum oxygen saturation 〉 60 seconds. Correlation analysis revealed a negative correlation between minimum oxygen saturation latency and Montreal Cognitive Assessment scores. These findings indicate that intermittent night-time hypoxemia affects mismatch negativity waveforms and Montrea Cognitive Assessment scores. As indicators for detecting the cognitive functional status of obstructive sleep apnea hypopnea syndrome patients, the sensitivity of mismatch negativity is 82.93%, the specificity is 73.33%, the accuracy rate is 81.52%, the positive predictive value is 85.00%, the negative predictive value is 70.21%, the positive likelihood ratio is 3, and the negative likelihood ratio is 0.23. These results indicate that mismatch negativity can be used as an effective tool for diagnosis of cognitive dysfunction in obstructive sleep apnea hypopnea syndrome patients.

Correlation of obstructive sleep apnea hypopnea syndrome with metabolic syndrome in snorers

Though obstructive sleep apnea hypopnea syndrome（OSAHS） and metabolic syndrome（MS） are correlated;the contributing factors for the occurrence of MS in Chinese snorers remain largely undefined.We aimed to investigate the associated pathogenesis of coexistence of OSAHS and MS in Chinese snorers.A total of 144 Chinese habitual snorers were divided into 3 groups,the control group（simple snorers）（n = 36）,the mild OSAHS group（n= 52）and the moderate-to-severe OSAHS group（n = 56）.The incidence of MS in the moderate-to-severe OSAHS group（26.8%） was significantly higher than that in the control group（8.3%）,the mild OSAHS group（11.1%） and all the OSAHS patients（19.45%）（all P 〈 0.05）.Homeostatic model assessment（HOMA） index and proinsulin（PI） were negatively correlated with nocturnal meanSpO2 and miniSpO2.Meanwhile,nocturnal SpO2 were negatively correlated with body mass index,waist and neck circumferences and diastolic blood pressure,but positively correlated with total cholesterol and high-density lipoprotein cholesterol.The study indicated that in Chinese snorers,moderate-to-severe OSAHS was closely associated with MS via nocturnal hypoxemia.

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.

Serum Level of Vascular Endothelial Growth Factor in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

To explore the relationship between the serum vascular endothelial growth factor （VEGF） level and the severity of obstructive sleep apnea hypopnea syndrome （OSAHS）, the concentrations of serum VEGF in 40 OSAHS patients and 9 healthy controls were measured by using ELISA method. Meanwhile the correlation between the concentration of VEGF and parameters of polysomnography （PSG） was examined. Our results showed that the concentrations of VEGF were significantly higher in OSAHS patients with severe hypoxia （536.8±334.7 pg/mL） than in those with mild hypoxia （329.2±174.7 pg/mL） and healthy controls （272. 8±211.0 pg/mL） （P〈0.05 for both）. The concentrations of VEGF were also significantly higher in OSAHS patients with hypertension （484.5±261.4 pg/mL） than in those without hypertension （311.0±158.4 pg/mL） and healthy controls （272. 8±211.0 pg/mL） （P〈0.05 for both）. There was a positive correlation between the concentration of VEGF and the apnea hypopnea index （AHI） （r=0.34, P〈0.05）. It is concluded that the concentration of the serum VEGF is positively related to the severity of OSAHS. The elevated serum VEGF level may be involved in the pathogenesis of the complications of obstructive sleep apnea hypopnea syndrome.

Relationship between obstructive sleep apnea hypopnea syndrome and cardiovascular disorders in adult snorers

Objective：To investigate the relationship between sleep apnea hypopnea syndrome（OSAHS） and some cardiovascular disorders in adult habitual snorers as well as the effectiveness of nasal continuous positive airway pressure（NCPAP） on those with OSAHS. Methods： With the use of polysomnography, 262 adult habitual snorers were examined and divided into the OSAHS group and the Non-OSAHS group （control）. Using ambulatory electrocardiogram and blood pressure measurement, daily nocturnal rhythm of blood pressure, hypertension, heart rate variability, some arrythmias and angina pectoris of coronary heart disease were monitored and compared between the two groups, before and after 14 days of treatment with NCPAP in the OSAHS group. Results.This study indicated a higher incidence （39.6%） of OSAHS in adult snorers and demonstrated that there was a significantly higher incidence of hypertension, disappearance of the daily nocturnal rhythm of blood pressure, poor effectiveness of nitrate on angina pectoris of coronary heart disease, decreased heart rate variability during sleep, increased arrythmias and lower SpO2 levels in the OSAHS group than in the Non-OSAHS group. After NCPAP treatment during sleep, snoring control, significantly higher SpO2 and lower apnea hypopnea indices were achieved in the OSAHS group; heart rate variability and daily nocturnal rhythm of blood pressure returned to normal levels. Conclusion：The results of this research suggested that there was a close relationship between the development of OSAHS and some cardiovascular disorders. Furthermore, NCPAP treatment was effective not only on OSAHS but also on coexisting cardiovascular disorders.

The Clinical effect of the Acupuncture treatment on the Patients with Obstructive sleep apnea hypopnea syndrome combined with Hypertension

Objective:To research the effect of conventional treatment(Gingko biloba extract(GBE)+continuous positive airway pressure(CPAP)ventilation)combined with acupuncture on the changes of blood pressure,respiratory efficiency,oxidative index,and clinical effect in patients with OSAHS combined with hypertension.Method Selecting 80 patients with OSAHS combined with hypertension,then they were randomly divided into observation group(n=40)and control group(n=40).The patients in the control group were given conventional drug therapy(GBE)and rehabilitation and CPAP,and the observation group were given acupuncture on this basic,they were treated 14 days.The primary endpoints were the changes from baseline to day 14 in blood pressure;the secondary endpoints were changes from baseline to day 14 in the respiratory efficiency(PSG);the tertiary endpoints were changes from baseline to day 14 in the oxidative related substances(SOD,GSH-Px,ROS,and MDA).Results After 14-day treatment,the respiratory efficiency index were better than pretherapy(p<0.05),and the observation group were better than control group(p<0.05);the blood pressure were lower than pretherapy(p<0.05),and the observation group were lower than control group(p<0.05);the ROS and MDA were lower than pretherapy(p<0.05),and the observation group were lower than control group(p<0.05);the SOD,GSH-Px were higher than pretherapy(p<0.05),and the observation group were higher than control group(p<0.05);the clinical effect of hypotensive in the observation group were better control group(p<0.05).Conclusion 14-day treatment of conventional treatment combined with acupuncture can improve the imbalance of oxidation and antioxidation and blood pressure.

Association of adiponectin genotype polymorphisms at positions 45 and 276 with obstructive sleep apnea hypopnea syndrome

Objective： To investigate the relationship between adiponectin genotype polymorphisms and obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods： Using the TaqMan polymerase chain reaction（PCR） method, the single nucleotide polymorphisms（SNP） at positions 45 and 276 in the adiponectin gene were determined in Chinese of the Han nationality in the Nanjing district. The OSAHS group consisted of 78 patients, and the control group contained 40 subjects. The association of adiponectin genotype polymorphisms at positions 45 and 276 with obstructive sleep apnea hypopnea syndrome was analyzed. Results： No evidence of a direct association was found between OSAHS and adiponectin genotype SNP at positions 45 and 276（P〉 0.05）. However, compared with those OSAHS patients having G/T＋T/T genotype at position 276, the OSAHS patients with the G/G genotype showed a greater neck circumference（NC）, a prolonged duration of the longest apnea event, and elevated levels of blood cholesterol and low-density lipoprotein cholesterol（P 〈 0.05）. Conclusion： No direct association was detected between OSAHS and adiponectin genotype distribution at positions 45 and 276 in Chinese of Han nationality in the Nanjing district. However, OSAHS patients with the adiponectin G/G genotype at position 276 had a larger NC and the longest apnea event compared to those having the adiponectin SNP276 G/T ＋T/T genotype. This may have an indirect influence on the development of OSAHS,

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.

低温等离子消融技术与电刀凝切技术在OSAHS中的应用效果对比

目的 分析比较低温等离子消融技术与电刀凝切技术在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的应用效果。方法 回顾性分析我院92例行手术治疗的OSAHS患者临床资料,其中48例行低温等离子消融术联合悬雍垂腭咽成形术(UPPP)治疗(观察组),44例行电刀凝切UPPP治疗(对照组)。记录两组围术期指标、术后疼痛程度[视觉模拟评分法(VAS)]、术后并发症及临床疗效,比较两组术前、术后6个月多导睡眠图(PSG)参数[睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO_(2))]变化情况。结果 两组术后创面假膜开始脱落时间及假膜彻底脱落时间、术后并发症发生率比较,差异无统计学意义(P>0.05);观察组手术时间、术中出血量均低于对照组(P<0.05)。两组术后VAS评分均逐渐降低(P<0.05),观察组术后VAS评分均低于对照组(P<0.05)。观察组、对照组分别有42、39例患者具有术后12个月的检查数据,分别有16例、11例患者具有术后24个月的检查数据;观察组术后6个月、术后12个月、术后24个月临床疗效均显著高于对照组(P<0.05)。术后6个月时,两组AHI均较术前降低(P<0.05),且观察组术后低于对照组(P<0.05);LSaO_(2)较术前升高(P<0.05),且观察组术后高于对照组(P<0.05)。结论 低温等离子消融技术术中可联合舌根部消融治疗,对中重度OSAHS近远期疗效均较好,术区损伤小,临床应用价值高。

基于多中心的老年OSAHS合并冠心病患者不良预后的Nomogram预测模型构建

目的基于多中心分析老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并冠心病患者不良预后的影响因素并构建Nomogram预测模型。方法于2020年3月至2022年3月选取江苏省中医院共357例老年OSAHS合并冠心病患者,按照7∶3比例将纳入患者分为建模组(n=250)及验证组(n=107)。对患者进行为期1年的随访,根据患者预后将建模组分为预后良好组(n=215)和预后不良组(n=35)。单因素及多因素Logistic回归分析影响老年OSAHS合并冠心病患者不良预后的因素,并根据此结果构建Nomogram预测模型,再以H-L拟合度曲线评估模型的有效性,以受试者工作特征(ROC)曲线评估模型的区分度。结果单因素分析结果显示,体重指数、睡眠呼吸暂停低通气指数(AHI)、睡眠平均氧饱和度(SaO_(2))、超敏C反应蛋白(hs-CRP)及白细胞介素-6(IL-6)为老年OSAHS合并冠心病患者不良预后的影响因素(P<0.05)。多因素Logistic回归分析显示,体重指数较高、AHI水平较高、hs-CRP水平较高、低水平的睡眠平均SaO_(2)为老年OSAHS合并冠心病患者不良预后的影响因素(P<0.05)。验证模型显示,建模组χ^(2)=6.125,P=0.421,ROC曲线下面积AUC为0.958(95%CI:0.926~0.980),敏感度及特异度分别为82.86%、96.28%;验证组χ^(2)=5.754,P=0.311,AUC为0.932(95%CI:0.893~0.960),敏感度及特异度分别为85.70%、88.40%。结论体重指数较高、AHI水平较高、hs-CRP水平较高、低水平的睡眠平均SaO_(2)为老年OSAHS合并冠心病患者不良预后的影响因素,以此构建的Nomogram预测模型具有较好的区分度及有效性,可帮助临床预测患者不良预后的发生风险,具有较高的临床价值。

腺样体联合扁桃体切除术对OSAHS患儿睡眠质量的影响

目的:探讨腺样体联合扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿睡眠质量的影响。方法:选取郑州儿童医院2021年1月至2022年7月收治的98例OSAHS患儿,随机分为对照组和观察组,各49例。对照组采用单纯腺样体切除术,观察组采用腺样体联合扁桃体切除术。比较两组患儿治疗后临床疗效、手术前后呼吸暂停通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、最低血氧饱和度(LSaO_(2))水平变化、睡眠质量及OSAHS对生活质量的影响程度,并统计6个月内并发症情况。结果:治疗后观察组患儿临床总有效率高于对照组,差异具有统计学意义(P<0.05)。与术前比较,出院时两组患儿AHI及OAI水平均降低,且观察组患儿AHI及OAI水平均低于对照组,差异具有统计学意义(P<0.05);出院时两组患儿LSaO_(2)水平均明显高于术前,差异具有统计学意义(P<0.05),但组间LSaO_(2)水平比较,差异无统计学意义(P>0.05)。与术前比较,出院时两组患儿匹茨堡睡眠质量指数量表(PSQI)评分、Epworth嗜睡量表(ESS)评分及儿童OSAHS疾病特异性生活质量调查量表(OSA-18)评分均降低,且观察组患儿PSQI、ESS及OSA-18评分均低于对照组,差异具有统计学意义(P<0.05)。术后6个月内,观察组患儿并发症发生率低于对照组,差异具有统计学意义(P<0.05)。结论:腺样体联合扁桃体切除术可更有效地降低OSAHS患儿AHI、OAI水平,改善其睡眠、生活质量,降低术后扁桃体再度增生及扁桃体反复发炎风险,整体临床疗效优于单纯腺样体切除术,对于腺样体和扁桃体肥大的患儿,建议同时切除腺样体和扁桃体。

超声测量应用于OSAHS病人困难喉镜暴露评估

目的:探讨通过超声测量皮肤到舌骨的距离、皮肤到会厌的距离及皮肤到声带前联合的距离来预测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病人困难喉镜暴露的可行性。方法:选取择期在气管插管全麻下行悬雍垂腭咽成形术(UPPP)的OSAHS病人150例,ASA分级Ⅰ~Ⅲ级。麻醉前进行常规气道评估(Mallampati分级)及应用超声测量皮肤到舌骨的距离、皮肤到会厌的距离及皮肤到声带前联合的距离。麻醉诱导后采用直接喉镜气管插管,记录喉镜暴露分级,将Cormack-LehaneⅢ~Ⅳ级定为喉镜暴露困难。依据喉镜暴露分级的结果将病人分为非困难喉镜暴露组和困难喉镜暴露组,比较两组间Mallampati分级及超声测量值的差异。计算各指标的受试者工作特征曲线(ROC)下面积及超声测量的最佳截点,分析各评估方法对困难喉镜暴露的预测效果。结果:困难喉镜暴露组Mallampati气道分级>Ⅱ级的病例数的比例明显多于非困难喉镜暴露组(P<0.05)。困难喉镜暴露组皮肤到舌骨的距离及皮肤到会厌的距离均明显长于非困难喉镜暴露组(P<0.05),皮肤到舌骨的距离及皮肤到会厌的距离最佳截点分别为1.12 cm及2.23 cm。皮肤到声带前联合的距离两组差异无统计学意义。结论:超声测量皮肤到舌骨,皮肤到会厌的距离对OSAHS病人困难喉镜暴露具有良好的预测作用。

耳鸣与OSAHS相关性研究进展

耳鸣的发生机制还不清楚,除了耳部疾病可诱发耳鸣外,身体各系统也共同参与了耳鸣的发病机制。阻塞性睡眠呼吸暂停低通气综合征(OSAHS)可能与耳鸣发生有关,近年来,这一观点逐渐受到关注。本文就OSAHS与耳鸣发生的关系及可能机制的最新研究进展进行综述,以期给耳鸣的治疗带来新的思考。