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.

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.

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.

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.

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.

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.

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.

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.

Numerical analysis for the effcacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea-hypopnea syndrome（OSAHS） patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The effcacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram（PSG） test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further,provide a theoretical basis to solve relevant clinical problems.

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,

超声监测心功能参数及SENP-1/HIF-1α通路变化预测OSAHS合并心脑血管疾病患者疗效的研究

目的:探讨超声监测心功能参数与血清SUMO特异性蛋白酶1(SENP-1)/缺氧诱导因子-1α(HIF-1α)通路表达水平的相关性及二者对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并心脑血管疾病患者疗效的预测价值。方法:回顾性选取2021年1月至2023年6月新疆医科大学第一附属医院收治的100例OSAHS合并心脑血管疾病患者,均采取持续气道正压通气(CPAP)治疗,根据治疗效果将其分为有效组(65例)和无效组(35例)。采用超声测定心功能参数,酶联免疫吸附法(ELISA)测定血清SENP-1/HIF-1α通路表达水平,比较两组治疗前后的心功能参数和SENP-1/HIF-1α通路水平。采用皮尔逊(Pearman)法分析治疗前心功能参数与SENP-1/HIF-1α通路水平的相关性,绘制受试者工作特征(ROC)曲线评估治疗前心功能参数与SENP-1/HIF-1α通路单独和联合检测对OSAHS合并心脑血管疾病疗效的预测效能。结果:有效组治疗后的左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)及心肌做功指数(Tei)指数均低于治疗前,且有效组低于无效组,差异有统计学意义(t=4.257、3.400、5.454,P<0.05);有效组治疗后的左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、二尖瓣舒张早期血流峰速度(E)与晚期血流峰速度(A)比值(E/A)均高于治疗前,且有效组高于无效组,差异有统计学意义(t=4.517、2.280、4.952,P<0.05)。有效组治疗后的血清SENP-1、HIF-1α水平均低于治疗前,且有效组低于无效组,差异有统计学意义(t=2.648、4.520,P<0.05)。Pearman相关性分析显示,LVEDD、LVESD及Tei指数与SENP-1呈正相关(r=0.523、0.572、0.513,P<0.05),与SENP-1/HIF-1α呈负相关(r=-0.508、-0.411、-0.479,P<0.05);LVEF、LVFS及E/A与HIF-1α呈正相关(r=0.453、0.511、0.426,P<0.05),LVEF、LVFS、E/A与SENP-1/HIF-1α呈负相关(r=-0.489、-0.479、-0.421,P<0.05)。心功能参数与血清SENP-1/HIF-1α通路联合检测预测OSAHS合并心脑血管疾病患者疗效的ROC曲线下面积(AUC)为0.909(95%CI:0.843~0.975)。结论:超声测定心功能参数与SENP-1/HIF-1α通路二者联合检测对OSAHS合并心脑血管疾病患者疗效具有较高的预测价值。

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.

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。

LXR及其靶基因COX-2和CETP在肥胖OSAHS幼鼠肝组织中的保护作用

目的阐明肝X受体(liver X receptor,LXR)及其靶基因环氧化酶-2(cyclooxygenase-2,COX-2)、胆固醇酯转移蛋白(cholesteryl ester transfer protein,CETP)的高表达是肥胖幼鼠阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)发病过程中的保护性因素,为肥胖儿童OSAHS的发病机制提供基础研究资料。方法24只3~4周龄雄性Wistar幼鼠分为正常对照组(control组)、单纯肥胖组(obesity组)、单纯OSAHS组(OSAHS组)、肥胖+OSAHS组(obesity+OSAHS组)。HE染色观察幼鼠肝组织病理变化;蛋白免疫印迹法(Western blotting)检测幼鼠肝组织中LXRα、COX-2、CETP的表达水平;运用免疫组化方法检测幼鼠肝组织中LXRα、COX-2、CETP的表达水平及分布情况。结果单纯肥胖组和肥胖+OSAHS组幼鼠体质量、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)含量与正常对照组相比均明显增加(P<0.05),单纯OSAHS组和肥胖+OSAHS组幼鼠血氧饱和度与正常对照组相比均明显降低(P<0.05)。单纯肥胖组、单纯OSAHS组及肥胖+OSAHS组肝组织与正常对照组肝组织相比均有明显损伤,肥胖+OSAHS组肝组织损伤较单纯肥胖组、单纯OSAHS组肝组织损伤程度明显升高。单纯OSAHS组和单纯肥胖组幼鼠肝组织中LXRα、COX-2、CETP表达水平较正常对照组均明显升高(P<0.05)。肥胖+OSAHS组幼鼠肝组织中LXRα、COX-2、CETP表达水平较其余各组均明显升高(P<0.05)。结论LXR及其靶基因COX-2、CETP在肥胖OSAHS幼鼠肝脏中高表达,是发病过程中的可能保护性因素。

Relationship between obstructive sleep apnea-hypopnea syndrome(OSAHS)and liver fibrosis

Objective:The current study discusses the relationship between sleep apnea-hypopnea syn-drome(OSAHS)and liver fibrosis by determining the level of plasma hyaluronic acid(HA),pro-collagen III(PIII),collagen IV(IVC),and laminin(LN)in OSAHS patients and non-OSAHS patients with obesity and normal body weight.Methods:The patients who underwent polysomnographic(PSG)examinations in the outpatient and inpatient departments of our hospital between December 2010 and June 2013 were selected.The patients were divided into two groups based on the apnea-hypopnea index(AHI;OSAHS and non-OSAHS patients),and both groups were further divided based on obesity and normal body weight based on the body mass index(BMI).Sleep breathing indicators,including BMI,AHI,LSaO_(2),and MSaO_(2),were measured in all patients.All of the patients had their blood drawn on the morning after the day of the PSG examination,and the samples were sent to the biochemical laboratory of our hospital for determination of the levels of HA,PIII,IVC,and LN.Results:Among the obese and normoweight patients,the levels of HA,PIII,IVC,and LN in OSAHS patients were higher than the non-OSAHS patients(P value<0.05).Amongst the OSAHS and non-OSAHS patients,the levels of HA,PIII,IVC,and LN in the obese patients were also higher than the non-obese patients(P value<0.05).The levels of HA,PIII,IVC,and LN in the obese OSAHS patients were higher than the remaining three groups(P value<0.05).The levels of HA,PIII,IVC,and LN had positive correlations with the AHI and BMI(r=0.701,0.523,0.639,and 0.421,respectively,P<0.05;and r=0.565,0.441,0.475,and 0.401,respectively,P<0.05),and nega-tive correlations with the LSaO_(2) and MSaO_(2) in OSAHS patients(r=-0.432,-0.394,-0.403,and-0.267,respectively,P<0.05;and r=-0.591,-0.517,-0.533,and-0.484,respectively,P<0.05).Conclusion:The levels of plasma HA,PIII,IVC,and LN in OSAHS patients were related to OSAHS.OSAHS might lead to liver fibrosis.

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。

肿瘤坏死因子-α在OSAHS-COPD重叠综合症及OSAHS中的血清水平研究

目的探讨OSAHS及OSAHS-COPD重叠综合症患者肿瘤坏死因子-α的血清水平和经过经鼻持续气道正压通气治疗的影响。方法采用双抗体夹心酶联免疫吸附法(ELISA)测定阻塞性睡眠呼吸暂停-低通气综合症组20例、重叠综合症组20例和健康对照组20例的血清肿瘤坏死因子-α水平。OSAHS组及OSAHS-COPD重叠综合症均经1个月持续气道正压通气(nCPAP)治疗一个月,然后复查血清肿瘤坏死因子-α。结果:OSAHS组及OSAHS-COPD重叠综合症组患者血清肿瘤坏死因子-α水平较健康对照组明显升高(P<0.001)。经鼻持续气道正压通气(nCPAP)显著地降低了OSAHS组及OSAHS-COPD重叠综合症组血清肿瘤坏死因子-α水平。但OSAHS组及OSAHS-COPD重叠综合症组血清肿瘤坏死因子-α水平相比较无论治疗前后均无明显统计学差异。结论血清肿瘤坏死因子-α水平在OSAHS组及OSAHS-COPD重叠综合症组患者中明显升高,经过经鼻气道正压通气治疗后下降。OSAHS组及OSAHS-COPD重叠综合症组无论治疗前、后比较均无明显统计学差异。

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

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