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.

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.

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.

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,

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.

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.

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

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

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

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

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

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

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.

Diurnal changes in retinal nerve fiber layer thickness with obstructive sleep apnea/hypopnea syndrome

AIM： To compare the retinal nerve fiber layer （RNFL） thickness in the morning and evening in Thai patients with varying degrees of obstructive sleep apnea/ hypopnea syndrome （OSAHS）. METHODS： In this cross-sectional study, potential OSAHS patients at Siriraj Hospital underwent polysomnography to determine the severity of OSAHS and an eye examination （including best corrected visual acuity, slit-lamp examination, and Goldmann applanation tonometry）. RNFL thickness was recorded once in the morning and once in the evening, using spectral domain optical coherence tomography. Thickness was expressed as an average and given for each quadrant. Patients with ocular or systemic diseases that might affect RNFL thickness were excluded. RESULTS： Forty-one eyes of 41 patients were classified into 40SAHS groups. The average and mean RNFL thickness in most of the four quadrants of the severe OSAHS group trended toward being less than those in the comparable quadrants of the other groups in both the morning and evening. In the moderate OSAHS group, the average RNFL thickness and temporal and superior quadrant thickness in the morning were significantly higher than in the evening （P=0.01, P=0.01, and P=0.03, respectively）. In the severe OSAHS group, the inferior quadrant thickness in the morning was significantly higher than in the evening （P =0.03）. CONCLUSION： The RNFL thickness in the morning was higher than in the evening in moderate 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.

Effect of continuous positive airway pressure treatment on vascular endothelial function in patients with obstructive sleep apnea hypopnea syndrome and coronary artery disease

Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However,it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels,NO/ET ratio,total ischemic burden (TIB) of the myocardium,apnea hypopnea index (AHI),and minimal and mean pulse oxygen saturation (SpO_2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET [(51.39±11.69) ng/L] and NO [(36.67±11.86) μmol/L],NO/ET (0.71±0.14),AHI (32.4±7.9),minimal SpO_2 [(68.9±11.4)%],and myocardial TIB [(66.29±16.37) mm·min] before treatment,there were significant decreases in ET [(33.41±10.03) ng/L] ( P <0.05),increases in NO [(59.89±10.26) μmol/L] and NO/ET (1.79±0.38) ( P <0.01),decreases in AHI (1.9±0.5),and increases in minimal SpO_2 [(90.6±1.8) %] (all P <0.01) and myocardial TIB [(36.42±10.87) mm·min] ( P <0.05) after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.