Effect of nocturia in patients with different severity of obstructive sleep apnea on polysomnography: A retrospective observational study

Patients with suspected OSA were examined using PSG.They were divided into two groups based on the presence of nocturia.Nocturia was defined as a patient who needed to void at least once.Apneaehypopnea index(AHI)was employed to classify patients according to degrees of severity:AHI<5 events/h,5 events/hAHI<15 events/h,15 events/hAHI<30 events/h,and AHI30 events/h,defined as normal,mild OSA,moderate OSA,and severe OSA,respectively.Demographic variables,PSG parameters,International Prostate Symptom Scores(IPSSs),and quality of life scores due to urinary symptoms were analyzed.Results:In total 140 patients,114 patients had OSA(48 had mild OSA;34 had moderate OSA;and 32 had severe OSA)and 107 patients had nocturia.The total IPSS was significantly higher in nocturia patients in all groups except the group of severe OSA patients.With the increasing severity of OSA,more correlated factors related to nocturia were determined.In mild OSA patients,nocturia related to increased age(p=0.025),minimum arterial blood oxygenation saturation(p=0.046),and decreased AHI of non-rapid eye movement(p=0.047),AHI of total sleep time(p=0.010),and desaturation index(p=0.012).In moderate OSA patients,nocturia related to increased age(p<0.001),awake time(p=0.025),stage 1 sleep(p=0.033),and sleep latency(p=0.033),and decreased height(p=0.044),weight(p=0.025),and sleep efficiency(p=0.003).In severe OSA patients,nocturia related to increased weight(p=0.011),body mass index(p=0.009),awake time(p=0.008),stage 1 sleep(p=0.040),arousal number(p=0.030),arousal index(p=0.013),periodic limb movement number(p=0.013),and periodic limb movement index(p=0.004),and decreased baseline arterial blood oxygenation saturation(p=0.046).Conclusion:Our study revealed that there were more correlated factors related to nocturia with increasing severity of OSA.This study helps in clinical education and treatment for OSA patients with different severity.

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.

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

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

Recent advances in managing obstructive sleep apnea

Obstructive sleep apnea(OSA)is a rapidly increasing global concern.If it remains untreated,it can lead to cardiovascular,metabolic,and psychiatric complications and may result in premature death.The efficient and effective management of OSA can have a beneficial effect and help reduce the financial burden on the health sector.There has been constant development in OSA management,and numerous options are available.The mainstay of therapy is still the conventional measures and behavioral modifications.However,in cases of failure of these modalities,surgical therapy is the only option.Numerous studies have shown that proper management of OSA has beneficial effects with good long-term outcomes.

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.

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.

The Relationship Between NLRP3 Inflammasome and Its Downstream Inflammatory Factors in Obstructive Sleep Apnea Patients with Carotid Atherosclerosis Under Cigarette Exposure

Aim:To study the relationship between NLRP3(nucleotide oligomerization domain[NOD]-,leucine-rich repeats[LRR]-,and pyrin domain-containing protein 3)inflammasome and its downstream inflammatory factors in obstructive sleep apnea(OSA)patients with carotid atherosclerosis(CAS)under cigarette exposure,further exploring the risk factors of CAS in OSA patients.Methods:A total of 109 adult males who underwent polysomnography and carotid artery ultrasonography in our hospital from October 2019 to December 2021 were selected.According to the detection results,they were divided into the OSA group,the CAS group,and the OSA combined CAS group;additionally,29 healthy subjects who underwent a physical examination were also included.According to whether they were smoking,the groups were further divided into smoking and non-smoking groups.The age,body mass index(BMI),blood pressure,apnea-hypopnea index(AHI),lowest blood oxygen saturation(LSaO2),carotid intima-media thickness(CIMT),levels of blood sugar,blood low-density lipoprotein cholesterol(LDLc),and serum NLRP3,interleukin-1β(IL-1β),and interleukin-18(IL-18)of all subjects were recorded.Results:The OSA combined CAS group had higher LDLc levels and AHI and lower LSaO2 than the OSA group and CAS group.The levels of serum NLRP3,IL-1β,and IL-18 in the OSA group were higher than those in the normal control group(P<0.05);and those in the OSA combined CAS group were higher than the OSA group and CAS group(P<0.05),regardless of cigarette exposure.Considering cigarette exposure,serum NLRP3,IL-1β,and IL-18 levels were higher in the OSA,CAS,and OSA combined CAS smoking groups than those in the non-smoking group(P<0.05).Under cigarette exposure,AHI,LDLc,NLRP3,IL-1β,and IL-18 were significantly positively correlated(P<0.05),and LSaO2 was negatively correlated with CAS in OSA(P<0.05).AHI,LSaO2,LDLc,NLRP3,and IL-1βare the risk factors for OSA combined with CAS.Conclusion:LSaO2,AHI,LDLc,NLRP3,and IL-1βare the important risk factors for OSA combined with CAS under cigarette exposure,and their levels can be used to predict the occurrence of CAS in OSA.

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

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

Turbulent Kinetic Energy of Flow during Inhale and Exhale to Characterize the Severity of Obstructive Sleep Apnea Patient

This paper aims to investigate and present the numerical investigation of airflow characteristics using Turbulent Kinetic Energy(TKE)to characterize the upper airway with obstructive sleep apnea(OSA)under inhale and exhale breathing conditions.The importance of TKE under both breathing conditions is that it showan accuratemethod in expressing the severity of flow in sleep disorder.Computational fluid dynamics simulate the upper airway’s airflow via steady-state Reynolds-averaged Navier-Stokes(RANS)with k–ωshear stress transport(SST)turbulencemodel.The three-dimensional(3D)airway model is created based on the CT scan images of an actual patient,meshed with 1.29 million elements using Materialise Interactive Medical Image Control System(MIMICS)and ANSYS software,respectively.High TKE were noticed around the region after the necking(smaller cross-sectional area)during the inhale and exhale breathing.The turbulent kinetic energy could be used as a valuablemeasure to identify the severity of OSA.This study is expected to provide a better understanding and clear visualization of the airflow characteristics during the inhale and exhale breathing in the upper airway of patients for medical practitioners in the OSA research field.

Effects of obstructive sleep apnea on retinal microvasculature

AIM:To detect retinal microvascular variations in obstructive sleep apnea syndrome patients.METHODS:This prospective,observational case-control study included healthy controls and patients with mild,moderate,and severe obstructive sleep apnea syndrome.Vascular parameters,foveal avascular area,and flow areas in macula-centered,6.00×6.00 mm2 scan size optical coherence tomography angiography images were compared.RESULTS:The control group had the highest whole image,parafoveal,and perifoveal vessel density among the groups in both superficial and the deep capillary plexus(all P<0.05).Rapid eye movement sleep apnoea-hypopnoea index was reversely correlated with whole(Rho=-0.195,P=0.034),parafoveal(Rho=-0.242,P=0.008),perifoveal(Rho=-0.187,P=0.045)vessel density in the superficial capillary plexus,and whole(Rho=-0.186,P=0.046),parafoveal(Rho=-0.260,P=0.004),perifoveal(Rho=-0.189,P=0.043)vessel density in the deep capillary plexus,though the mean and non-rapid eye movement sleep apnoeahypopnoea index related with only parafoveal vessel density in the superficial capillary plexus(Rho=-0.213,P=0.020;Rho=-0.191,P=0.038)and the deep capillary plexus(Rho=-0.254,P=0.005;Rho=-0.194,P=0.035).CONCLUSION:This study shows decreased vessel density and its reverse correlation with the apnoea-hypopnoea index in patients with obstructive sleep apnea syndrome.

Cognitive and Emotional Factors Related to Obstructive Sleep Apnea Diagnoses: A Brief Review

Sleep apnea is a clinical condition characterized by cessation of breathing in the sleeper due to pharyngeal airway closure. The reduction in air exchange results in decreased cerebral blood circulation with consequential behavioral deficits cognitively and emotionally. Untreated sleep apnea is associated with chronic illnesses of depression, cardiovascular disorder, obesity and diabetes mellitus. Measured cognitive behavior before and following CPAP treatment demonstrates the cognitive deficit as the effectiveness of CPAP treatment. Emotional factors related to sleep apnea diagnosis and adherence to treatment are facilitated in patients with cognitive behavior therapy (CBT) interventions by sleep specialists. This is a brief review paper that presents findings about cognition and emotional factors related to sleep apnea. This is a brief review paper.

Effects and Predictions of Oral Appliances in Obstructive Sleep Apnea

Since April 2004, the Asahi University Medical and Dental Center (hereinafter referred to as our center) has been providing oral appliances (hereinafter referred to as OA) to treat patients diagnosed with obstructive sleep apnea. The effects of using the OA and progress of 71 patients who received treatment at our center by wearing OA from March 2005 to the end of March 2016 were examined through questionnaires sent by physical mail. In 21 of 24 patients who underwent polysomnography after wearing OA, the apnea-hypopnea index (hereinafter referred to as AHI) significantly decreased after wearing OA (9.44 ± 10.37) compared to that before wearing OA (24.02 ± 13.57) (p = 8.7 × 10-8). The results showed that for patients who continuously use OA, it is necessary to have sound sleep/sleep soundly;further, the patients experienced a decrease in snoring when wearing OA, with only a few side effects on the temporomandibular joints and teeth. In addition, the closer the distance from the plane of the lower margin of the mandible to the hyoid bone after wearing OA, the more likely it was for the AHI to decrease, which suggests that wearing OA contributes to the prediction of therapeutic effects.

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

BACKGROUND Epidemiological studies have revealed an association between obstructive sleep apnea(OSA)and hypertension in the general population,while the association in military personnel was rarely investigated.AIM To examine the association between high risk for OSA and hypertension by phenotypes in military young adults.METHODS A total of 746 military personnel,aged 27.9 years,were included in the cardiorespiratory fitness and health in armed forces(CHIEF)-sleep study in Taiwan in 2020.Antihypertensive medications were not used by the subjects.High risk for OSA was assessed using the Berlin Questionnaire.Hypertension was defined using the 7th Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure(JNC 7)and the 2017 American College of Cardiology(ACC)/American Heart Association(AHA)guidelines.The cutoff levels of systolic and diastolic blood pressure(SBP and DBP)for the 2017 ACC/AHA-and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg,respectively.Hypertension phenotypes included isolated systolic and diastolic hypertension(ISH,high SBP only and IDH,high DBP only)and combined hypertension(both high SBP and DBP).Multivariable logistic regression analysis with adjustment for demographics,lifestyle and metabolic biomarkers.RESULTS The prevalence of high risk for OSA,JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%,5.2%and 22.0%,respectively.Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension(odds ratios(ORs))and 95%confidence intervals:2.82(1.07-7.42)and 7.54(1.10-51.54),although the probabilities of ISH and IDH were unaffected by a high risk for OSA(ORs:1.96 and 2.35,respectively,both P>0.05).In contrast,no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.CONCLUSION A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

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.

Development of New Machine Learning Based Algorithm for the Diagnosis of Obstructive Sleep Apnea from ECG Data

In this study,a machine learning algorithm is proposed to be used in the detection of Obstructive Sleep Apnea(OSA)from the analysis of single-channel ECG recordings.Eighteen ECG recordings from the PhysioNet Apnea-ECG dataset were used in the study.In the feature extraction stage,dynamic time warping and median frequency features were obtained from the coefficients obtained from different frequency bands of the ECG data by using the wavelet transform-based algorithm.In the classification phase,OSA patients and normal ECG recordings were classified using Random Forest(RF)and Long Short-Term Memory(LSTM)classifier algorithms.The performance of the classifiers was evaluated as 90% training and 10%testing.According to this evaluation,the accuracy of the RF classifier was 82.43% and the accuracy of the LSTM classifier was 77.60%.Considering the results obtained,it is thought that it may be possible to use the proposed features and classifier algorithms in OSA classification and maybe a different alternative to existing machine learning methods.The proposed method and the feature set used are promising because they can be implemented effectively thanks to low computing overhead.

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.

Association between non-alcoholic fatty liver disease and obstructive sleep apnea

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is an emerging liver disease and currently the most common cause of incidental abnormal liver tests.The pathogenesis of NAFLD is multifactorial and many mechanisms that cause fatty liver infiltration,inflammation,oxidative stress and progressive fibrosis have been proposed.Obstructive sleep apnea(OSA)may be linked with the pathogenesis and the severity of NAFLD.AIM To study the association between NAFLD and OSA considering also the efficacy of continuous positive airway pressure(CPAP)treatment.METHODS A Pub Med search was conducted using the terms"non-alcoholic fatty liver disease AND(obstructive sleep apnea OR obstructive sleep disorders OR sleep apnea)".Research was limited to title/abstract of articles published in English in the last 5 years;animal and child studies,case reports,commentaries,letters,editorials and meeting abstracts were not considered.Data were extracted on a standardized data collection table which included:First author,publication year,country,study design,number of patients involved,diagnosis and severity of OSA,diagnosis of NAFLD,patient characteristics,results of the study.RESULTSIn total,132 articles were initially retrieved on Pub Med search and 77 in the last five years.After removal of irrelevant studies,13 articles were included in the qualitative analysis.There was a total of 2753 participants across all the studies with a mean age between 42 and 58 years.The proportion of males ranged from21%to 87.9%and the mean body mass index ranged from 24.0 to 49.9 kg/m2.The results of this review showed an increased prevalence of NAFLD in patients with diagnosis of OSA,even in the absence of coexisting comorbidities such as obesity or metabolic syndrome.Furthermore,the severity of NAFLD is associated with the increase in OSA severity.Effective CPAP treatment,although not always decisive,may stabilize or slow NAFLD progression with benefits on metabolic and cardiovascular functions.CONCLUSION In NAFLD patients,although asymptomatic,it is recommended to systematically perform polysomnography in order to early and better treat them before the development of potentially life threatening systemic dysfunctions.

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

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

Neuropsychological Functioning after Adenotonsillectomy in Children with Obstructive Sleep Apnea:A Meta-analysis

The present study aimed to investigate the efficacy of adenotonsillectomy(AT) for children with obstructive sleep apnea syndrome(OSAS) and the improvement of their cognitive function. Studies on cognitive performance of OSAS children treated with or without AT were identified by searching the Pubmed, EMBASE and Cochrane library. A meta-analysis was conducted to analyze the literature. The random-effects model was used to evaluate 11 eligible studies using an inverse-variance method. The neuropsychological test results of 4 cognitive domains(general intelligence, memory, attention-executive function and verbal ability) were obtained and analyzed. By comparison of cognitive function between OSAS children and healthy controls, the effect sizes of each domain were achieved as follows: general intelligence, –0.5(P<0.0001); memory, –0.18(P=0.02); attention-executive function, –0.21(P=0.002); and verbal ability, –0.48(P=0.0006). The effect sizes of general intelligence, memory, attention-executive function, and verbal ability after AT compared to baseline level were –0.37(P=0.008), –0.36(P=0.0005), –0.02(P=0.88), and –0.45(P=0.009), respectively. Comparing the cognitive ability between OSAS children after AT and healthy controls showed that the effect sizes were –0.54(P=0.0009), –0.24(P=0.12), –0.17(P=0.35), and –0.45(P=0.009) in general intelligence, memory, attention-executive function, and verbal ability, respectively. Our results confirmed that OSAS children performed worse than healthy children in terms of the 4 cognitive domains investigated. After 6–12 months of observation, significant improvement in attention-executive function and verbal ability were found in OSAS children treated with AT compared to their baseline level; restoration of attention-executive function and memory were observed in OSAS children after AT in comparison to healthy controls. Further rigorous randomized controlled trials should be conducted to obtain definitive conclusions.

Correlation between obstructive sleep apnea and central retinal vein occlusion

To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.