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.

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.

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.

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.

Characteristics of glucolipid metabolism as well as atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome combined with cerebral infarction

Objective:To evaluate the characteristics of glucolipid metabolism as well as atherosclerosis in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) combined with cerebral infarction.Methods:Patients who were treated in the hospital due to acute cerebral infarction between March 2015 and February 2018 were selected, and according to the combination of OSAHS, the 300 patients with cerebral infarction were divided into the cerebral infarction group A who were combined with OSAHS and the cerebral infarction group B who were not combined with OSAHS;the 100 cases of healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The contents of glucolipid metabolism indexes, cytokines and plaque hydrolysis molecules in serum were determined.Results: Serum F-Ins, TC, LDL-C, VE-cadherin, YKL-40, FKN, M-CSF, MCP-1, MMP9, Caspase-3, ICTP and VCAM-1 levels of cerebral infarction group A and cerebral infarction group B were significantly higher than those of control group whereas HDL-C levels were significantly lower than that of control group;serum F-Ins, TC, LDL-C, VE-cadherin, YKL-40, FKN, M-CSF, MCP-1, MMP9, Caspase-3, ICTP and VCAM-1 levels of cerebral infarction group A were significantly higher than those of cerebral infarction group B whereas HDL-C level was significantly lower than that of cerebral infarction group B.Conclusion: There are more significant glucolipid metabolism disorder and worse plaque stability in patients with OSAHS combined with cerebral infarction.

Reliability and Validity of Simplified Chinese STOP-BANG Questionnaire in Diagnosing and Screening Obstructive Sleep Apnea Hypopnea Syndrome

The main purpose of this study was to assess the reliability and validity of the simplified Chinese STOP-BANG Questionnaire(SBQ)as a diagnosing and screening tool for obstructive sleep apnea hypopnea syndrome(OSAHS).Two hundred and ten patients with suspected OSAHS were recruited in this study.The simplified Chinese SBQ was completed twice before and after polysomnography(PSG)monitoring.SPSS 20.0 was used to analyze the test-retest reliability,discriminant validity,comparative validity and predictive validity of the SBQ.Fourteen patients were excluded on account of fragmentary data,and valid 196 were divided into four groups:non-OSAHS group(n=28,14.29%),mild OSAHS group(n=28,14.29%),moderate OSAHS group(n=31,15.81%)and severe OSAHS group(n=109,55.61%).The test-retest coefficient tor the first four items was 0.810,0.679,0.775,0.963 respectively and the total score of the STOP questionnaire was 0.854.The analysis of discriminant validity revealed that there were significant differences among four groups in the total score of the SBQ and scores of item 1,3,7 and 8,which were also validated between patients with normal blood oxygen saturation and different degrees of hypoxemia.The SBQ evaluation showed low consistency with diagnostic gold standard PSG(k=0.3O3,P<0.05).When taking apnea hypopnea index(AHI)≥5/h,≥15/h and≥30/h as cut-offs to evaluate the SBQ predictive value,the areas under ROC curve were 0.77,0.81 and 0.78,the sensitivity was 90.48%,93.57%and 93.33%,and corresponding negative predictive values were 40.74%,66.67%and 85.19%,respectively.It was suggested that the simplified Chinese version of SBQ had good reliability,and could distinguish the severity of OSAHS.Despite its limited diagnostic accuracy,the SBQ can be considered as an ideal tool for screening OSAHS with superior predictive validity.

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.

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

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.

Imbalance of osteoprotegerin/receptor activator of nuclear factor-κB ligand and oxidative stress in patients with obstructive sleep apnea-hypopnea syndrome

Background:Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with a higher prevalence of osteoporosis.However,the underlying mechanisms linking OSAHS with bone loss are still unclear.The aim of this study was to investigate the changes of receptor activator of nuclear factor-κB ligand (RANKL,an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG,the decoy receptor for RANKL),oxidative stress and bone metabolism markers in OSAHS,in order to understand the potential mechanisms underlying bone loss in OSAHS patients.Methods:Forty-eight male patients with OSAHS,confirmed by polysomnography (PSG) study,were enrolled.Twenty male subjects who were confirmed as not having OSAHS served as the controls.The subjects’bone mineral density (BMD) was assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA).Blood samples were collected from all subjects for measurement of RANKL,OPG,the bone formation marker bone-specific alkaline phosphatase (BAP),the bone resorption marker tartrate-resistant acid phosphatase 5b (TRAP-5b),and total antioxidant capacity (TAOC).Results:The BMD and the T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group (P< 0.05).The serum level of BAP was significantly decreased in the OSAHS group (15.62 ± 5.20 μg/L) as compared to the control group (18.83 ± 5.50 μg/L,t= -2.235,P< 0.05),while the levels of TRAP-5b did not differ between the two groups (t= -1.447,P> 0.05).The serum level of OPG and the OPG/RANKL ratio were lower in the OSAHS group compared to the control group (bothP< 0.05).TAOC level was also decreased significantly in the OSAHS group (P< 0.05).Correlation analysis showed that the TAOC level was positively correlated with BAP in the OSAHS group (r= 0.248,P= 0.04),but there were no correlations between TAOC and the BMD or the T-scores.The correlations between the level of OPG (or the OPG/RANKL ratio) and BMD or TAOC did not reach significance.Conclusion:In OSAHS patients,lower levels of TAOC were associated with decreased bone formation,suggesting a role of oxidative stress in bone loss,while the role of OPG/RANKL imbalance in bone metabolism in OSAHS needs further evaluation .

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background： For patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） and type 2 diabetes mellitus （T2DM）, the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure （CPAP） therapy in patients with OSAHS and T2DM. Methods： Continuous glucose monitoring system （CGMS） was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin （HbAlc） were measured and compared to the pretreatment data. Results： After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose （MBG） and the night time MBG were significantly reduced （P 〈 0.05 and P = 0.03, respectively）. The mean ambulatory glucose excursions （MAGEs） and the mean of daily differences were also significantly reduced （P 〈 0.05 and P = 0.002, respectively） compared to pretreatment levels. During the night, MAGE also significantly decreased （P = 0.049）. The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment （P 〈 0.05 and P = 0.024, respectively）. The 24 h and night time durations of high blood glucose （〉7.8 mmol/L and 〉 11.1 mmol/L） decreased （P 〈 0.05 and P 〈 0.05, respectively） after the treatment. In addition, HbA 1 c levels were also lower than those before treatment （P 〈 0.05）, and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment （P = 0.034）. Conclusions： CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.

Analysis of the characteristics of coronary artery lesions in patients with obstructive sleep apnea-hypopnea syndrome and influencing factors

Objective:The current study involved an analysis of the characteristics of coronary artery lesions of patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and the correspond-ing influencing factors.Methods:One hundred twenty patients were selected by sleep apnea monitoring and coronary angiography.According to the apnea-hypopnea index(AHI),the patients were divided into the following 3 groups:patients with an AHI<10 times/h as the control group(n=25);patients with an AHI=10~15 times/h as the mild OSAHS group(n=32);and patients with an AHI>15 times/h as the moderate-to-severe OSAHS group(n=63).The clinical and laboratory test data of patients in each group were collected.A single-factor ANOVA and multi-factor logistic regression analysis were performed on the study data to analyze the coronary artery lesions in patients with OSAHS and the corresponding influencing factors.Results:(1)With respect to smoking,alcohol consumption,BMI,blood glucose,blood lipids,and blood pressure among the three groups,there were no significant differences between the three groups;however,age did differ among the three groups(P<0.05).(2)The incidence of anterior descending artery,right coronary artery,single-vessel,and coronary artery lesions as determined by coronary angiography was significantly different(P<0.05).The incidence of these vascular lesions in the moderate-to-severe group was higher than the mild group,and the incidence of coro-nary artery lesions in the moderate-to-severe group was higher(P<0.0167).(3)Based on multi-factor logistic regression analysis,alcohol consumption(OR=7.058;95%CI,1.953-25.508),age(OR=1.845;95%CI,1.121-3.038),and the AHI(OR=2.404;95%CI,1.088-5.314)were the major risk factors for coronary artery lesions.Alcohol consumption(OR=12.114;95%CI,3.058-47.979)and the AHI(OR=3.052;95%CI,1.210-7.694)were the risk factors for single-vessel disease.Age(OR=2.812;95%CI,1.236-6.400)was the major risk factor for multi-vessel disease.Conclusion:The probability of coronary artery lesions increased with OSAHS severity.The main manifestation of the increased possibility was single-vessel coronary artery lesions.In single-vessel disease,the anterior descending branch and the right coronary artery were the most vulner-able,which may be related to the anatomic distribution.Alcohol consumption,age,and AHI are the major risk factors for coronary artery lesions.Alcohol consumption and AHI are major risk factors for single-vessel disease.Age is the main risk factor for multi-vessel disease.

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.

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.

新型冠状病毒感染与阻塞性睡眠呼吸暂停低通气综合征相关性的研究进展

自2019年12月起,新型冠状病毒感染(COVID-19)迅速蔓延,对世界公共卫生安全构成了严峻威胁。COVID-19患者合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的情况并不少见,但对两者共病缺乏认识,因此OSAHS的危害性往往被低估甚至忽略,OSAHS也未被确定为增大感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)可能性及加重病情的独立危险因素,并且目前关于中医药预防、治疗COVID-19合并OSAHS的研究较少。本文旨在增强临床医师对COVID-19合并OSAHS的认识与理解,以期为应对该疾病提供一定参考。

Polysomnographic sleep aspects in liver cirrhosis: A case control study

AIM: To study sleep aspects and parameters in cirrhotic patients and assess the role of liver dysfunction severity in polysomnographic results. METHODS: This was a case-control study. Patients with a diagnosis of liver cirrhosis were consecutively enrolled in the study. Clinical examinations and laboratory liver tests were performed in all patients, and disease severity was assessed using the Child-Pugh score. The control group consisted of ageand gender-matched healthy volunteers. All individuals answered a questionnaire about habits, behaviors, and complaints related to sleep and were submitted to polysomnography. Sleep parameters were compared between the two groups, and separate analyses were performed among classesof Child-Pugh classification in the cirrhotic group. RESULTS: Forty-two cirrhotic patients and forty-two controls were enrolled. Compared to the control group, the cirrhotic group exhibited lower sleep efficiency (mean ± SD: 73.89% ± 14.99% vs 84.43% ± 8.55%, P < 0.01), increased latency (151.27 ± 93.24 min vs 90.62 ± 54.74 min, P < 0.01) and a lower percentage of rapid eye movement (REM) sleep (14.04% ± 5.64% vs 20.71% ± 6.77%, P < 0.05) as well as a higher frequency of periodic limb movements (10.56 ± 2.85/h vs 2.79 ± 0.61/h, P < 0.01). The comparison of sleep parameters among Child A, B and C cirrhotic patients revealed a significant reduction of REM sleep stage occurrence in individuals with severe liver disease (Child C patients) compared to Child A/B patients (polysomnography percentage of REM sleep stage of patients Child A: 16.1% ± 1.2%; Child B: 14.9% ± 1.2%; Child C: 8.6% ± 1.6%, P < 0.05). CONCLUSION: Cirrhosis was associated with shorter sleep time, reduced sleep efficiency, increased sleep latency, increased REM latency and reduced REM sleep. Additionally, disease severity influences sleep parameters.

改良悬雍垂腭咽成形术治疗重度阻塞性睡眠呼吸暂停低通气综合征对患者生活质量的改善评估

目的观察改良悬雍垂腭咽成形术治疗重度阻塞性睡眠呼吸暂停低通气综合征对患者生活质量的改善情况。方法选取2014年3月至2015年3月该院接诊的100例重度阻塞性睡眠呼吸暂停低通气综合征患者作为研究对象。对照组采取低温等离子射频消融术,观察组采取改良悬雍垂腭咽成形术,观察两组患者治疗前后生活质量指数(SAQLI)评分、呼吸暂停低通气指数(AHI)、血氧饱和度(SPO2)及嗜睡量表(ESS)评分情况。结果治疗后,观察组日常活动、社会影响、情感活动、症状改善评分及总均分[(5.99±1.03)、(4.79±1.13)、(5.82±1.23)、(3.76±1.12)、(4.98±0.92)分]均优于对照组[(4.98±1.04)、(4.21±1.11)、(5.07±1.21)、(3.09±1.01)、(4.12±0.90)分],差异均有统计学意义(P<0.05);观察组AHI[(12.59±10.72)次/h]小于对照组[(17.03±10.28)次/h],SPO2[(92.30±8.21)min/h]高于对照组[(87.31±7.39)min/h],差异均有统计学意义(P<0.05);观察组ESS评分[(4.52±1.01)分]低于对照组[(7.36±2.10)分],差异有统计学意义(P<0.05)。结论改良悬雍垂腭咽成形术治疗重度阻塞性睡眠呼吸暂停低通气综合征疗效明显,能有效改善患者的生活质量。

改良悬雍垂腭咽成形术联合鼻部同期手术对重度阻塞性睡眠呼吸暂停低通气综合征的疗效分析

目的:探讨改良悬雍垂腭咽成形术联合鼻部同期手术在治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的近期和远期效果。方法:根据治疗方式的不同,将30例重度OSAHS分为观察组(n=10)和对照组(n=20)。观察组应用改良悬雍垂腭咽成形术加鼻腔扩容术,对照组应用单纯腭咽成形术。观察患者术后半年、1年和2年的呼吸暂停低通气指数(AHI)、夜间最低动脉血氧饱和度(LSaO 2)、Epworth嗜睡量表(ESS)评分以及视觉模拟量表(VAS)。结果:术后半年、术后1年,两组患者AHI和LSaO 2比较,差异无统计学意义(P>0.05);术后2年,观察组AHI明显低于对照组[(21.40±10.15)次/h vs.(30.51±8.71)次/h],LSaO 2明显高于对照组[(80.05±8.56)%vs.(71.11±9.17)%],差异有统计学意义(P<0.05);术后半年、1年、2年,两组患者ESS评分和整体VAS评分比较,差异无统计学意义(P>0.05),观察组术后半年、1年、2年鼻塞VAS评分均低于对照组[(2.07±0.55)vs.(8.05±2.44),(3.37±1.72)vs.(7.74±2.55),(3.98±1.52)vs.(8.75±2.07)],差异有统计学意义(P<0.01);观察组总有效率为90%,高于对照组的75%,差异有统计学意义(P<0.05)。结论:改良悬雍垂腭咽成形术联合鼻部同期手术治疗重度OSAHS近期及远期效果均良好。

nCPAP治疗重度OSAS合并高血压患者血浆尾加压素Ⅱ的研究

目的探讨经鼻持续气道正压通气(nCPAP)治疗重度阻塞性睡眠呼吸暂停综合征(OSAS)合并高血压病患者尾加压素(U-II)在其过程中病理生理的作用及临床意义。方法采用放射免疫法分析30例患者经nCPAP治疗前后U-II的水平;采用夜间多导睡眠(PSG)监测患者治疗前后SaO2及夜间7h血压水平。结果治疗前、后患者血浆U-II的水平及SaO2分别为(9.01±1.0)pg/ml、(7.2±0.8)pg/ml,(51.2±3.64)%、(85.3±3.6)%,均有统计学意义(P<0.005);治疗前、后夜间7h平均收缩压及舒张压分别为(156.67±9.56)mmHg、(137.57±15.309)mmHg、(105.50±4.89)mmHg、(83.45±14.9)mmHg,均有统计学意义(P<0.001)。结论U-II的增高可能是重度阻塞性睡眠呼吸暂停综合征合并高血压病患者疾病发生、发展的重要因素,通过nCPAP治疗后可使患者血浆中血浆U-II的水平明显降低,氧饱和度改善,具有明显的临床疗效。