The Change of Interleukin-6 and Tumor Necrosis Factor in Patients with Obstructive Sleep Apnea Syndrome

The levels of lipopolysaccharide (LPS) induced interleukin 6 (IL 6) and tumor necrosis factor α (TNF α) expression in culture of peripheral blood mononuclear cells (PBMC) and the plasma levels of IL 6 and TNF α in the patients with obstructive sleep apnea syndrome (OSAS) were measured and the relationship between OSAS and IL 6 or TNF α expression studied. Both IL 6 and TNF α were detected by using ELISA in 22 patients with OSAS and 16 normal controls. The levels of LPS induced IL 6 (787.82±151.97 pg/ml) and TNF α (4165.45±1501.43 pg/ml) expression in the supernatant of the culture of PBMC and plasma level of IL 6 (50.67±4.70 pg/ml) and TNF α (299.09±43.57 pg/ml) in the patients with OSAS were significantly higher than those in the normal controls (in the supernatant of the culture of PBMC: 562.69±197.54 pg/ml and 1596.25±403.08 pg/ml respectively; in the plasma: 12.69±2.75 pg/ml and 101.88±21.27 pg/ml respectively). There were significantly positive correlation between the levels of IL 6 and TNF α and the percentage of time of apnea and hyponea, as well as the percentage of time spending at SaO 2 below 90 % in the total sleep time. It was concluded that LPS induced IL 6 and TNF α levels as well as plasma IL 6 and TNF α levels in the patients with OSAS were up regulated, which may be associated with the pathogenesis of OSAS.

Sleep quality in elderly patients with obstructive sleep apnea syndrome

AIM:To investigate the sleep quality in elderly patients with obstructive sleep apnea syndrome (OSAS). METHODS:54 cases of elderly patients with OSAS were evaluated by the pittsburgh sleep quality index (PSQI) questionnaire. RESULTS:Among 54 OSAS patients, 35 cases (65%) reported poor quality of sleep, only 7(13%) cases reported good. A significant negative correlation was found between apnea/hypopnea index (AHI) and PSQI, and part of its components. CONCLUSION:Elderly patients with OSAS often complain of poor quality of sleep. Daytime dysfunction, poor subjective sleep quality, low habitual sleep efficiency and long sleep latency constitutes the principal parts of the symptoms about sleep.

Effects of China-Germany Follow Up Systems on Ventilator Therapy in Patients with Obstructive Sleep Apnea Syndrome

Objective:To investigate the effects of different follow-up systems in China and Germany on ventilator therapy in patients with obstructive sleep apnea syndrome.Method:From March 2013 to October 2015,three hundred patients with moderate to severe obstructive sleep apnea syndrome and those who are suitable for ventilator treatment were followed up according to the follow-up system of both China and Germany.The follow-up was carried out for one year to compare the rate of loss to follow-up,ventilator therapy compliance,treatment effect,ventilator side effects and others in the two groups of patients.Statistical analysis was performed using x2 test,P<0.05 for the difference was statistically significant.Results:The rate of loss to follow-up in the German group was lower than that in the Chinese group.The compliance of the German group with respiratory therapy was lower than that of the Chinese group.The side effects of ventilator treatment were lower than those in the Chinese group(P<0.05).Conclusion:The German follow-up system is more effective than the Chinese follow-up system in improving the compliance and effectiveness of ventilator therapy in patients with obstructive sleep apnea syndrome.

The Comparison of Clinical analysis of Chinese and German Patients with Obstructive Sleep Apnea Syndrome

Objective:To compare the sex ratio,age distribution,severity of the illness,comorbidities,and the treatment of the patients with obstructive sleep apnea syndrome in China and Germany.Methods:A retrospective study of the data was conducted,and a total of 200 patients diagnosed with obstructive sleep apnea syndrome in Germany and China from March 2013 to October 2015 were analyzed.The sex ratio,age distribution,severity of the illness,comorbidities and treatment methods were analyzed.Results:There was no significant difference in the severity of disease,sex ratio,and age distribution between the patients with obstructive sleep apnea syndrome in China and Germany(P>0.05).In terms of comorbidities,the combination of moderate and severe patients in the German group,compared with the moderate and severe patients in the Chinese group,except for cerebrovascular disease,the comorbidities were less than those in the Chinese group(P<0.05),the difference was statistically significant.In terms of treatment,the patients in the German group were compared with the patients in the Chinese group with light,moderate,and severe patients.Except for the German patients who received oral appliances and surgical treatment,more patients were treated than Chinese patients(P<0.05),the difference is statistically significant.Conclusion:The two country(Germany and China)are basically the same in the diagnosis and treatment of obstructive sleep apnea syndrome,but Germany pays more attention to details and individualization in treatment.

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 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.

Risk factors and management countermeasures for obstructive sleep apnea hypoventilation syndrome in children

BACKGROUND Obstructive sleep apnea hypoventilation syndrome(OSAHS)in children is a sleep respiratory disorder characterized by a series of pathophysiologic changes.Statistics in recent years have demonstrated an increasing yearly incidence.AIM To investigate the risk factors for OSAHS in children and propose appropriate management measures.METHODS This study had a case–control study design.Altogether,85 children with OSAHS comprised the case group,and healthy children of the same age and sex were matched at 1:1 as the control group.Basic information,including age,sex,height,weight and family history,and medical history data of all study participants were collected.Polysomnography was used to detect at least 8 h of nocturnal sleep.All participants were clinically examined for the presence of adenoids,enlarged tonsils,sinusitis,and rhinitis.RESULTS The analysis of variance revealed that the case group had a higher proportion of factors such as adenoid grading,tonsil indexing,sinusitis,and rhinitis than the control group.CONCLUSION A regression model was established,and glandular pattern grading,tonsil indexing,sinusitis,and pharyngitis were identified as independent risk factors affecting OSAHS development.

Alterations in renal function in patients with obstructive sleep apnea syndrome and effects of continuous positive airway pressure

Objective To assess renal function in patients with obstructive sleep apnea syndrome (OSAS) during two nights when they were untreated and treated with continuous positive airway pressure (CPAP). Methods Tubular function was estimated on the basis of the renal lithium clearance and its derived formulae, urinary osmolality, osmolal clearance and free water clearance; while glomerular function was evaluated by endogenous creatinine clearance. Twenty patients with OSAS and sixteen normal controls were studied. Results The untreated patients with OSAS had significantly lower fractional proximal tubular sodium reabsorption (59.1%±7.1%,P<0.001 vs controls), lower fractional distal tubular sodium reabsorption (93.8%±1.7%, P<0.05 vs controls) and urinary osmolality (573.0±107.9 mosm·kg 1 , P<0.05 vs controls). The absolute distal tubular reabsorption rate of sodium and osmolal clearance in the untreated patients were higher 47.0±26.0 mmol·L 1 and 25.0±4.1 ml·L 1 ; P< 0.01 and P<0.05 respectively vs controls). During CPAP treated nights all abnormal renal function indexes in the OSAS patients restored to normal control values (P>0.05). Conclusions The natriuresis and diuresis of OSAS patients were due to the decrease in proximal and distal tubular sodium reabsorption and in tubular concentration ability during their nocturnal sleep and were returned to normal by CPAP therapy.

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.

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.

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.

Effects of Continuous Positive Airway Pressure on Cognitive Deficits in Middle-aged Patients with Obstructive Sleep Apnea Syndrome： A Meta-analysis of Randomized Controlled Trials

Background： Current views on continuous positive airway pressure （CPAP） treatment to improve the cognitive deficits of patients with obstructive sleep apnea syndrome （OSAS） are controversial, so we performed a meta-analysis. Methods： A comprehensive literature search was undertaken in PubMed, CINAHL, Medline, Psyclnfo, EMBASE, Cochrane Library, CNKI, WanFang, VIP, and CBMdisc for studies published from June 1971 to July 2014. The outcome measures included neuropsychological tests of the 7 cognitive domains detailed below. Results： After screening the titles and abstracts and thoroughly reading the fuU text, we obtained 13 studies with little risk of bias that incorporated 1744 middle-aged obese participants with mild to severe OSAS. The studies were published from 1994 to 2012. Treatment durations varied from 1 to 24 weeks. The effect sizes of attention, vigilance, processing speed, working memory, memory, verbal fluency, and visuoconstructive skills domains were -0.10 （P = 0.24）, -0.12 （P = 0.04）, -0.08 （P = 0.16）, 0.00 （P = 0.95）, -0.04 （P = 0.30）, -0.06 （P = 0.34）, and -0.01 （P = 0.92）, respectively. Conclusions： Cognition partially improved in patients with OSAS after CPAP treatment. The only domain with significant improvement was vigilance. Rigorous randomized controlled trials need to be performed to obtain clear results.

Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome

Background Recent research suggested that obstructive sleep apnea syndrome （OSAS） might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes etc. This study was conducted to investigate the effect of continuous positive airway pressure （CPAP） treatment on changes of both serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients. Methods Twenty-three adult male patients with moderate-to-severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood samples were collected and morning mean arterial pressure （MAP） was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay. Results Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment （P〉0.05）. It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur （P〈0.01）. Meanwhile, the MAP showed no statistically significant difference among its levels before CPAP, on day 3 and day 7 of CPAP treatment （P〉0.05）. However, on day 14 of CPAP treatment, a significantly lower MAP than that obtained before treatment was observed （P〈0.05）. Conclusions CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAS patients. Hypoadiponectinemia might be involved in the pathogenesis of OSAS-mediated hypertension.

Burdened breaths:The influence of depression on obstructive sleep apnea

Depression and metabolic syndrome could exacerbate the risks of the other,leading to a series of severe coexisting conditions.One notable comorbidity that must be mentioned is obstructive sleep apnea(OSA).Current studies suggested that depression increases susceptibility to OSA.As the prevalence of depression rises,it becomes critical to prevent and manage its complications or comorbidities,including OSA.Predictive models,non-invasive electroencephalogram moni-toring,genetic research,and other promising technologies are being applied to the prevention,diagnosis,and personalized treatment of depression and OSA.

Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome

Background The nocturnal nondipping and elevated morning blood pressure （BP） in patients with obstructive sleep apnea syndrome （OSAS） have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS. Methods Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points （daytime, evening, nighttime and morning） and polysomnography （PSG） was performed and subjects were classified into four groups by their apnea-hypopnea index （AHI）： control, n=213 with AHI 〈5; mild, n=420 with AHI -〉5 and 〈15; moderate, n=460 with AHI -〉15 and 〈30; and severe, n=1204 with AHI -〉30. SPSS 11.5 software package was used for statistical analysis and figure drawing. Results All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a ＂reversed BP dipping＂ pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild. Conclusions OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.

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.

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.

Evaluation of choroidal thickness using spectral-domain optical coherence tomography in patients with severe obstructive sleep apnea syndrome: a comparative study

AIM: To assess choroidal thickness in patients with severe obstructive sleep apnea syndrome(OSAS) and compare them with healthy controls, using spectral domain optical coherence tomography(OCT).METHODS: In this observational, cross-sectional study,choroidal thicknesses of 23 newly severe OSAS patients and 23 body mass index- age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain- OCT device( λ = 840 nm,26 000 A-scans/s, 5 μm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day(9:00 a.m.), in order to minimize the effects of diurnal variation.RESULTS: There was a statistically significant difference in median choroidal thickness between the OSAS patients(201 μm; range 145-237 μm) and the controls(324 μm; range 296-383 μm;P 【0.001). There were significant differences at all measurement points(P 【0.001 for all). The apnea-hypopnea index(AHI)values were more than 30 in all OSAS patients and the mean AHI was 48.57 ±6.54. The interexaminer intraclass correlation coefficient(ICC) for the mean choroidal thickness was 0.938(95% CI, 0.908-0.985) and ICC was greater than 0.90 for all measurement points.CONCLUSION: The decreased choroidal thickness of patients with severe OSAS might be related to the the autonomic disregulation associated with this disease.Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and OSAS.

Effects of plasma ghrelin, obestatin, and ghrelin/obestatin ratio on blood pressure circadian rhythms in patients with obstructive sleep apnea syndrome

Background Obstructive sleep apnea syndrome （OSAS） is strongly associated with obesity and with cardiovascular disease.Ghrelin and obestatin are two peptides from the same source but have opposite roles.Both of them can affect feeding and regulate vascular tune.The aim of this study was to investigate the relationship between plasma ghrelin,obestatin,the ratio of ghrelin and obestatin （G/O） and sleep parameters and blood pressure circadian rhythms in patients with OSAS.Methods This study enrolled 95 newly diagnosed over-weight OSAS patients （OSAS group）,30 body mass index （BMI）-match non-OSAS adults （over-weight group） and 30 non-OSAS normal weight adults （control group）.Polysomnography （PSG） was performed in the OSAS group and over-weight group.Blood pressure of all subjects was monitored by means of 24-hour ambulatory blood pressure monitoring.The concentration of plasma ghrelin and obestatin was detected by enzyme-linked immunosorbent assay （ELISA）.Results Plasma ghrelin levels in the OSAS group and over-weight group were significantly lower than that of the control group （P ＜0.05）.Plasma obestatin levels were lower in the over-weight group and OSAS group,but there was no significant difference among the three groups.The blood pressure in OSAS patients was higher,and there was a significant difference in all blood pressure parameters compared to the control group,and in the daytime average diastolic blood pressure （DBP）,nocturnal average systolic blood pressure （SBP） and DBP,DBP variability values as compared to over-weight subjects.Furthermore,there were significantly more non-dipper patterns of blood pressure （including hypertension and normotension） in the OSAS group than in the other two groups （P ＜0.01）.Correlation analysis showed that ghrelin levels had a significant correlation with BMI and nocturnal average DBP but not with PSG parameters.In contrast,the G/O ratio had a negative correlation with apnea-hypopnea index （AHI） （P ＜0.05）,as well as a strong positive correlation with the blood pressure variability values （P ＜0.01）.In multivariate analyses,AHI （P ＜0.05） and G/O （P ＜0.05）were independently related to SBP variability changes,while AHI （P ＜0.05）,G/O （P ＜0.01） and BMI （P ＜0.05） were independently related to DBP variability changes.Conclusions Our data show plasma ghrelin and obestatin levels were related to obesity in OSAS.Sleep apnea in OSAS patients could have led to an imbalance in G/O in the basis of obesity.Moreover,the imbalance may promote nighttime blood pressure elevation and affect blood pressure circadian disorder.