Effect of CPAP therapy on dynamic glucose level in OSAHS patients with newly diagnosed T2DM

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a common disorder in the general population. The aim of this study was to investigate the homocysteine (Hcy) level in the patients with OSAHS of varying degrees and the effect of continuous positive airway pressure (CPAP) treatment on OSAHS patients. A total of 117 OSAHS patients were recruited and divided into 3 groups (mild OSAHS, moderate OSAHS and severe OSAHS), while 33 non-OSAHS people were selected as control group. For all cases, polysomnography (PSG) variables and the concentrations of Hcy, methane dicarboxylic aldehyde (MDA) and glutathione (GSH) were recorded. Serum Hcy was measured by cyclophorase. The values of MDA and GSH were measured by a spectrophotometer. In the severe OSAHS group, a total of 30 patients received CPAP for more than 4 h every night and were re-examined 6 months later. The serum levels of Hcy, MDA and GSH showed a significant difference in OSAHS patients and controls. The Hcy and GSH concentrations of OSAHS patients with CPAP treatment showed no apparent change compared with the prior treatment, but the MDA level was obviously lower after CPAP treatment. In controls and the mild/moderate OSAHS groups, multi-element linear regression analysis results indicated that there was a statistically significant relationship between the Hcy concentration and various independent variables (age, MDA, GSH, and the apnea-hypopnea index - AHI). The change of the Hcy level was not proportional to the severity of the disease in different groups of OSAHS patients, and CPAP did not affect the Hcy levels.

To investigate the effect of short-term continuous positive airway pressure (CPAP) treatment on the arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Cardio ankle vascular index (CAVI) and blood pressure (BP) were measured before and after sleep in 60 non-hypertensive patients with OSAHS and gender and 60 age-matched healthy controls. CPAP was administrated in 22 of the 60 OSAHS patients. And on the first and third days of the CPAP treatment CAVI and BP were measured in the morning, i. e., after sleep. In the morning, the CAVI of the OSAHS patients was 8.0 +/- 1.2 m/s, significantly higher than that before sleep (7.3 +/- 1.0, P = 0.000), the diastolic BP (DBP) was (86 +/- 12) mm Hg, significantly higher than that before sleep (83 +/- 13 mmHg, P = 0.001), and the mean BP (MBP) was (101 +/- 12) mm Hg, significantly higher than that before sleep (98 +/- 14, P = 0.00116). However, there were no significant differences in these parameters among the controls The systolic BP (SBP) of the OSAHS patients did not changed significantly after sleep, however, there was a tendency to decrease in the controls [(123 +/- 14) vs (121 +/- 13) mm Hg, P = 0.074). After the first night treatment, the CAVI, SBP, DBP, and mean BP of the 22 severe OSAHS patients decreased significantly (all P < 0.05), and after three nights treatment, only the CAVI showed further significant decrease (P < 0.05). Sleep induces increase of artery stiffness in OSAHS patients, but not in the normal controls. Short-term CPAP may decrease CAVI without affecting the blood pressures. Early atherosclerosis in the patients with OSAHS may be reversed by CPAP therapy.

To investigate the effect of uvlopalatopharyngoplasty (UPPP) on post-surgery continuous positive airway pressure (CPAP) treatment during sleep in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Thirty-one OSAHS patients after UPPP surgery were recruited and studied on for more than 12 months after the procedure. Among them, 24 patients were treated with classical UPPP (cUPPP), which removes all of uvula and part of the soft palate. Seven had modified UPPP (mUPPP), keeping part of the uvula. The control group was 31 years in age, body mass index (BMI) and apnea-hypopnea index (AHI) matched, and newly diagnosed OSAHS patients without prior treatment. A manual titration of CPAP was performed during both (NREM) and non-rapid eye movement (NREM) sleep in all 62 patients. Patients were asked to keep a supine position while sleeping during the test. When significant mouth air leakage occurred and/or titration worsened with an increase of CPAP pressure, the pressure level was considered as the highest CPAP (hCPAP) a patient can tolerate in that sleep stage. The CPAP machine used for titration could produce highest pressure at 20 cm H2O. There were 74% (23/31) of UPPP patients who had less than 50% decrease in AHI, and 84% (26/31) of the 31 patients still had AHI>15 (range 16-110) during post-operation polysomnography (PSG) test. Most of them need further CPAP therapy. All of the untreated OSAHS patients could tolerate 17-20 cm H2O of CPAP during sleep. None had severe mouth air leak before an optimal pressure was reached. In contrast, four in the surgery group failed to respond to CPAP treatment during both NREM and REM sleep and one more during REM sleep. All of the seven patients who had a mUPPP could tolerate CPAP. One of the three tested both before and after surgery failed in the CPAP treatment after surgery during REM sleep. UPPP may compromise nasal CPAP therapy in OSAHS, especially in procedures with greater resection of the soft palate.

To observe the effect of continuous positive airway pressure ventilation on hypersensitive C reaction protein (hsCRP) and 8-isoprostane in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 78 OSAHS patients were enrolled and monitored by polysomnography (PSG) in January to March, 2013. Another 40 healthy persons were chosen as controls during the same time. According to apnea hypopnea index (AHI) and oxygen saturation, the patients were divided into mild, moderate and severe groups. Blood and urinary 8-isoprostane and hsCRP levels were detected before and after monitoring. After continuous positive airway pressure treatment for three months, blood and urinary 8-isoprostane and hsCRP were also detected in three groups. (1) In OSAHS patients, blood 8-isoprostane levels before and after sleep monitoring were (273.80±55.83) ng/L and (337.18±56.28) ng/L urinary 8-isoprostane (35.65±7.08) ng/L and (48.30±14.17) ng/L, hsCRP (7.63±6.10) µg/L and (9.68±8.55)µg/L, respectively. Each parameter reached a significant difference before and after sleep (P<0.05). (2) The levels of blood CRP and urinary 8-isoprostane in the control group before sleep were (4.56±2.43) µg/L, (264.14±33.61) ng/L, (32.77±9.61) ng/L, after sleep were (4.33±2.08) µg/L, (284.27±47.51) ng/L, (31.13±8.24) ng/L. All the levels were less than those of OSAHS group (P<0.05). (3) The levels of blood 8-isoprostane in mild, moderate and severe groups after monitoring were (308.16±53.48) ng/L, (327.36±59.05) ng/L, (340.39±55.31) ng/L respectively, and urinary 8-isoprostane were (35.23±11.28) ng/L, (38.30±10.89) ng/L, (44.57±12.69) ng/L, hsCRP were (5.63±4.26) µg/L, (6.96±4.43) µg/L, (8.92±7.84) µg/L. None of these three parameters showed significant difference between the three groups (P>0.05). However, compared with the control group, blood and urine 8-isoprostane and hsCRP levels of any groups had significant differences (all P values<0.05). (3) There was no significant difference in the levels of hsCRP and 8-isoprostane after sleep between the three groups in OSAHS (P>0.05). (4) Urinary 8-isoprostane level after PSG was positively correlated with hsCRP (r=0.498, P<0.01). Either 8-isoprostane or hsCRP level was correlated with AHI (r=0.479, r=0.550; P<0.01). 8-isoprostane and hsCRP levels were positively correlated with time of blood hemoglobin oxygen saturation below 90% (r=0.413, r=0.502; P<0.01). (5) After continuous positive airway pressure treatment, the levels of 8-isoprostane and hsCRP both in blood or urine were decreased in the three groups of OSAHS patients (P<0.05). Long term intermittent hypoxia in patients with OSAHS results in enhanced oxidative stress reaction and over-generated inflammatory mediators. There is a positive correlation between oxidative stress and inflammatory mediators, which promotes each other, leading to the organ dysfunction induced by hypoxia.

Studies on the association between continuous positive airway pressure (CPAP) treatment and liver diseases such as non-alcoholic fatty liver disease (NAFLD) and cirrhosis in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) are limited. To the best of our knowledge, none exists that makes use of a national database in an Asian population. This study aims to evaluate the effects of CPAP treatment on patients with these two disorders in a retrospective, population-based study in Taiwan. Using the Taiwan National Health Insurance claims database, this study collected the data of OSAHS patients diagnosed between 2000 and 2008 and divided them into CPAP treatment and non-CPAP treatment groups. All subjects were followed up until 2010. Liver disease incidence and risk were calculated. The CPAP group had a lower cumulative incidence rate of developing liver disease than the non-CPAP group within the observation periods (p<0.001). After adjusting for age, gender, urbanization level, and comorbidities, the CPAP treatment group showed a lower risk of developing liver disease compared with the non-CPAP treatment group (sub-aHR of 0.66 (95% CI 0.55-0.80), p<0.001). Our observations suggest that CPAP treatment may play an important role to delay the progression of liver disease in OSAHS patients and decreases the incidence of liver disease among OSAHS patients. Thus, CPAP therapy may be a feasible way to decrease the risk of liver disease among patients with OSAHS.

By including untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) patients as the control group, this study explores the influence of minimally invasive surgical treatment and continuous positive airway pressure (CPAP) therapy on OSAHS patients, with the subjective and objective performance. The study also discusses their relationship, determines the effect factor, and provides a simple and practical method for evaluation of clinical efficacy. A total of 90 OSAHS patients, who were diagnosed in the Sleep Disorders Diagnosis and Treatment Center of Sichuan Province from May 2014 to May 2016, were selected for the present study. These patients were divided into three groups: surgery group, CPAP group, and untreated group. These patients were followed up at six months, one year, and two years, respectively. The physiological indicators, clinical symptoms, degree of daytime sleepiness and quality of life were compared among these three groups. The daytime sleepiness and the quality of life before and after minimally invasive surgery and CPAP treatment were evaluated, and the subjective and objective efficacy of surgery and CPAP treatment was explored. Among these 90 patients, 11 (12.2%) patients had hypertension, while two (2.2%) patients had diabetes. The average AHI score was 50.53±23.39 per hour, and the mean minimum oxygen saturation and mean oxygen saturation was 71.25±14.16% and 90.13±5.90%, respectively. There were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness in the group having received surgery at 0.5 year and one year. In the CPAP group, there were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness at 0.5 year, one year and two years. Moreover, there were statistically significant differences in memory loss at one year and two years, and there were statistically significant differences in frequent nocturia at one year. The ESS value in the surgery group decreased at 0.5 year and one year, but increased at two years. The situation was the same in terms of the total points and in each dimension of the SF-36 paramter. The delta values of ESS among the three groups had statistical significance at 0.5 year, one year and two years, in which the CPAP group experienced the most changes, followed by the surgery group and the group received health education. For minimally invasive surgery, CPAP therapy and health education can improve daytime sleepiness and quality of life. CPAP therapy was found to be the most effective, followed by minimally invasive surgery and provision of health education. However, the treatment of OSAHS should be comprehensive.

Objective To investigate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) and type 2 diabetes mellitus. Methods This study was conducted from May 2008 to December 2009 from the subjects diagnosed at the Sleep Center of the First Affiliated Hospital of Nanjing Medical University. Based on polysomnography examination, 104 habitual snorers were assigned to the simple snorer group (control group) and the OSAHS group which was further assigned to the mild OSAHS group and the moderate-to-severe OSAHS group according to the apnea hypopnea index (AHI) during sleep to compare the incidence of type 2 diabetes mellitus. Parameters among different groups were compared with Chi-square test and analysis of variance respectively. Spearman correlation analysis and Logistic regressive analysis were used to evaluate the correlation among AHI, minimal SaO2 (mini-SpO2), mean SaO2, fasting blood glucose, true insulin, proinsulin, HOMA index, body mass index (BMI), waist circumference (WC) and neck circumference (NC). Results Type 2 diabetes mellitus was found in 15.3%(13/85) of all the OSAHS patients. The incidence of type 2 diabetes mellitus in moderate-to-severe OSAHS group (25.7%(9/35)) was significantly higher than that in the control group (5.3%(1/19), χ2=4.942, P=0.026) and in the mild OSAHS group (8.0% (4/50), χ2=4.011, P=0.045). Spearman correlation analysis indicated that HOMA index and PI were negatively correlated with nocturnal mini-SpO2 and mean SpO2. There was no statistically significant correlation of HOMA index and PI with AHI. Mini-SpO2 and mean SpO2 were negatively correlated with BMI, WC, and NC. Univariate logistic regression analysis suggested that the HOMA index and PI were risk factors of severe OSAHS (odds ratio was 1.924 (1.302 to 2.847; P<0.01) or 1.714 (1.175 to 2.507; P<0.01)). Conclusion There is an association between OSAHS and type 2 diabetes mellitus. Insulin resistance may play an important role in the coexistence of OSAHS and type 2 diabetes mellitus. The OSAHS patients with a lower SpO2 can be more susceptible to type 2 diabetes mellitus. Key words: Type 2 diabetes mellitus; Obstructive sleep apnea hypopnea syndrome; Insulin resistance

Objective To investigating the effects of dynamic glucose and insulin resistance of continuous positive airway pressure (CPAP) to the obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with type 2 diabetes. Methods 77 patients meeting the inclusion and exclusion criteria were using computer generated random sequence method divided into two groups, the experimental group (routine hypoglycemic treatment + CPAP) and the control group (routine hypoglycemic treatment). Contrast before intervention and intervention for 3 days, 1 month, 3 months, 6 months, 12 month of fasting plasma glucose, insulin levels, 2 hours blood sugar after meal, glycosylated hemoglobin, insulin resistance index, the average daily average blood sugar, blood sugar, 24 h average blood sugar, blood sugar fluctuation in the day and night blood glucose fluctuation. Results In the control group, intervention after 3 days, 1 month, 3 months, 6 months, 12 months each time compared with before intervention, improved the above indicators had no statistical significance (P>0.05). In the experimental group, compared with before intervention, the index change had no statistical significance intervention after 3 days (P>0.05), fasting blood glucose, blood sugar mean ambulatory glucose excursions (MAGE) at night to improve was statistically significant intervention after 1 month (P<0.05), dynamic blood sugar, insulin resistance, such as improving had statistical significance intervention after 3 months, 6 months and 12 month (P<0.05). Compared with 1 month after the intervention, the improvement of average blood sugar and blood sugar fluctuation in the day after were statistically significant in the intervention after 3 months (P<0.05). The insulin resistance index, the average blood glucose within 24 h, the average blood glucose, blood sugar fluctuation in the day, night improved blood sugar fluctuation was statistically different in intervention after 6 months and 12 month (P<0.05). Conclusions CPAP intervention can significantly improve the dynamic blood sugar and insulin resistance in OSAHS patients with type 2 diabetes mellitus, and the longer it is, the more obvious curative effect it is. Key words: Continuous positive airway pressure; Obstructive sleep apnea hypopnea syndrome; Diabetes; Insulin resistance

Objective To investigate the effects of continuous positive airway pressure(CPAP) treatment on glucose metabolism and glucocorticoid in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS) and type 2 diabetes mellitus(T2DM). Methods To use at least 30 days of CPAP treatment on 36 cases of patients with T2DM and newly diagnosed OSAHS hospitalized during July 2008 and December 2009 in the Department of Endocrinology, Beijing Hospital. To take CPAP treatment for the patients without contraindication.Insulin sensitivity and glucose metabolism were tested and compared to the data previously obtained.Paired-t-test were used for statistical analysis. Results After the application of CPAP treatment, the glycohemoglobin ((7.1±1.0)%) and fasting blood glucose((6.5±1.1) mmol/L) were lower than that been previous obtained (HbAlc(9.1±2.2)%, FBG(10.0±3.0) mmol/L; t=6.517, P 0.05). Conclusion CPAP can cause an overall improvement in insulin sensitivity in type 2 diabetes patients with OSAHS, CPAP is also an effective treatment in addition to lifestyle intervention and drug treatment. Key words: Type 2 diabetes mellitus; Obstructive sleep apnea-hypopnea syndrome; Continuous positive airway pressure; Insulin resistance

Objective:To explore the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) diagnosed during pregnancy.To explore the effect on maternal and infant after treated with CPAP.Method:Data of 117 patients with OSAHS diagnosed by nocturnal blood oxygen saturation (SaO₂) monitoring and PSG during pregnancy were analyzed retrospectively. All the 117 patients were voluntary and divided into intervention group [received continuous positive airway pressure (CPAP) treatment with good compliance under informed consent and conventional drug] 70 cases and control group(received conventional drug) 47 cases. Record the relevant data during the treatment about maternal and infant.Result:There was no statistical significance on the difference of cesarean delivery and postpartum hemorrhage in the pregnant women with mild OSAHS (P> 0.05), there was no statistical significance on the difference of cesarean delivery and postpartum hemorrhage in the pregnant women with moderate OSAHS (P> 0.05) and there were statistical significance on the difference of cesarean delivery and postpartum hemorrhage in the pregnant women with severe OSAHS (P< 0.05 or P< 0.01). There was no statistical significance on the difference of asphyxia neonatorum, fetal growth restriction and fetal distress in the pregnant women with mild OSAHS (P> 0.05), there were statistical significance on the difference of fetal growth restriction and fetal distress in the pregnant women with moderate OSAHS (P< 0.05), and there were statistical significance on the difference of asphyxia neonatorum, fetal growth restriction and fetal distress in the pregnant women with severe OSAHS (P< 0.05 or P< 0.01).Conclusion:Pregnant women who have OSAHS risk factors should be paid attention to during the perinatal care and nocturnal SaO₂ monitoring or PSG should be performed in the suspected OSAHS patients. Strongly advise that those serious OSAHS patients should be treated by CPAP early before delivery. CPAP was a safe and effective treatment to OSAHS patients in pregnancy.

Οι ασθενείς με Σύνδρομο Απνοιών-υποπνοιών στον Ύπνο (ΣAY) παρουσιάζουν αυξημένη νοσηρότητα και θνητότητα από καρδιαγγειακά νοσήματα. Βιβλιογραφικά δεδομένα αναφέρουν αυξημένα επίπεδα παραγόντων που έχουν συνδεθεί με καρδιαγγειακό κίνδυνο καθώς και διαταραχές στη ρύθμιση του σακχάρου στους ασθενείς με ΣΑΥ. Τα παραπάνω έχουν μελετηθεί σε ασθενείς πριν από την εφαρμογή θεραπείας με CPAP, δεν υπάρχουν ωστόσο δεδομένα για τις μεταβολές των παραγόντων αυτών στους ασθενείς με ΣΑΥ με βάση τη συμμόρφωση τους στη θεραπεία με CPAP. Σκοπός της μελέτης ήταν α) να εξετάσει τις διαφορές στα επίπεδα δεικτών καρδιαγγειακού κινδύνου και δεικτών ρύθμισης του σακχάρου μεταξύ ασθενών με ΣΑΥ χωρίς άλλα συνοδά νοσήματα και υγιών μαρτύρων (ομάδα ελέγχου) β) να διερευνήσει πιθανές συσχετίσεις στα επίπεδα των εξεταζόμενων παραγόντων με ανθρωπομετρικά χαρακτηριστικά και παραμέτρους του ύπνου των ασθενών με ΣΑΥ και γ) να εξετάσει την επίδραση της συμμόρφωσης στη θεραπεία με CPAP στα επίπεδα των εξεταζόμενων παραγόντων. Υλικό - μέθοδοι: Σε νεοδιαγνωσθέντες, με πολυυπνογραφία, ασθενείς με ΣΑΥ (n=53), με δείκτη απνοιών-υποπνοιών (Apnea-Hypopnea Index-ΑΗΙ) ?15/h, μη καπνιστές, χωρίς συνοδά νοσήματα ή συστηματική χρήση φαρμάκων, μελετήθηκαν δείκτες που σχετίζονται με καρδιαγγειακό κίνδυνο (hs-CRP, ουρικό οξύ, ολική χοληστερόλη, τριγλυκερίδια, HDL-C, LDL-C, ApoA-I, ApoB, ομοκυστεΐνη και ινωδογόνο), καθώς και δείκτες ρύθμισης του σακχάρου (γλυκόζη νηστείας, HbA1C, ινσουλίνη, δείκτης ΗΟΜΑ-IR) μετά από ολονύχτια νηστεία. Μετά από 6 μήνες οι ασθενείς αυτοί επανεξετάστηκαν και όσοι παρέμειναν χωρίς συνοδά νοσήματα, συστηματική χρήση φαρμάκων και σημαντική μεταβολή του δείκτη μάζας σώματος (Body Mass Index - ΒΜΙ), μελετήθηκαν ως προς τους ίδιους παράγοντες αφού πρώτα ταξινομήθηκαν ανάλογα με τη συμμόρφωση στη θεραπεία με CPAP (όπως καταγραφόταν από το χρονομετρητή του μηχανήματος) σε 3 ομάδες: Ομάδα 1: καλή συμμόρφωση (χρήση ?4 ώρες /νύχτα), ομάδα 2: μέτρια/ κακή συμμόρφωση (χρήση &lt;4 ώρες /νύχτα), ομάδα 3: άρνηση εφαρμογής CPAP. Όλοι οι ασθενείς εξετάστηκαν εκ νέου με πολυυπνογραφία: οι ασθενείς της ομάδας 1 και 2 εφαρμόζοντας CPAP, ενώ της ομάδας 3 χωρίς CPAP. Την ομάδα ελέγχου (n=30) αποτέλεσαν άτομα τα οποία επίσης εξετάστηκαν με πολυυπνογραφία και είχαν ΑΗΙ&lt;5/h. Τα άτομα αυτά ήταν μη καπνιστές, χωρίς συνοδά νοσήματα ή συστηματική χρήση φαρμάκων. Αποτελέσματα: Οι ασθενείς (47 άρρενες, 6 θήλεις) ήταν μέσης ηλικίας 46.09±10.87 ετών και σε σύγκριση με την ομάδα ελέγχου, είχαν σημαντικά μεγαλύτερο ΒΜΙ (p&lt;0.000), περίμετρο λαιμού (p=0.013), μέσης (p=0.044) και γλουτών (p=0.046) χωρις να διαφέρουν σημαντικά ως προς την ηλικία. Τα επίπεδα των hs-CRP και των λόγων ολική χοληστερόλη/HDL-C και ΑpoΒ/ΑpoΑ-Ι ήταν στατιστικά υψηλότερα στους ασθενείς με ΣΑΥ σε σχέση με την ομάδα ελέγχου (p=0.003, p=0.040 και p&lt;0.000, αντίστοιχα). Ομοίως, τα επίπεδα όλων των εξεταζόμενων παράγοντων σχετικών με τη ρύθμιση του σακχάρου ήταν σημαντικά υψηλότερα στους ασθενείς με ΣΑΥ σε σχέση με τους μάρτυρες [γλυκόζη νηστείας (p&lt;0.000), HbA1C (p=0.004), ινσουλίνη (p&lt;0.000), δείκτης ΗΟΜΑ-IR (p&lt;0.000)],. Ανάμεσα στις δύο ομάδες στατιστικά σημαντική ήταν και η διαφορά στην αναλογία αυτών που πληρούσαν τα κριτήρια του μεταβολικού συνδρόμου, το οποίο εμφανίστηκε συχνότερα στους ασθενείς με ΣΑΥ συγκριτικά με την ομάδα ελέγχου (p&lt;0.005). Δείκτες της οξυγόνωσης στον ύπνο όπως η μέση τιμή του κορεσμού (avSpO2) ή η ελάχιστη τιμή του κορεσμού της οξυαιμοσφαιρίνης (minSpO2) εμφάνισαν σημαντικές συσχετίσεις με παράγοντες καρδιαγγειακού κινδύνου και ρύθμισης του σακχάρου. Αντίθετα, ο δείκτης ΑΗΙ εμφάνισε στατιστικά σημαντική συσχέτιση μόνο με την τιμή του ουρικού οξέος. Στον εξάμηνο επανέλεγχο, στην ομάδα 1 (n=20), παρατηρήθηκε σημαντική ελάττωση των επιπέδων της hs-CRP (p=0.030), του ουρικού οξέος (p=0.045), της ομοκυστεΐνης (p=0.005), της ολικής χοληστερόλης (p=0.021), του λόγου ApoΒ/ApoΑ-Ι (p=0.021), του λόγου ολική χοληστερόλη/HDL-C (p=0.018) και της HbA1C (p=0.003). Στην ομάδα 2 (n=19) καταγράφηκε σημαντική ελάττωση μόνο στα επίπεδα της ομοκυστεΐνης (p=0.021). Στην ομάδα 3 (n=14), δεν καταγράφηκαν στατιστικά σημαντικές διαφορές σε κανένα από τους εξεταζόμενους παράγοντες. Συμπεράσματα: Οι ασθενείς με ΣΑΥ εμφανίζουν αυξημένα επίπεδα παραγόντων που έχουν συνδεθεί με καρδιαγγειακό κίνδυνο καθώς και παραγόντων σχετικών με τη ρύθμιση του σακχάρου. Η συμμόρφωση στη θεραπεία με CPAP μειώνει σημαντικά τα επίπεδα της hs-CRP, του ουρικού οξέος, της ομοκυστεΐνης, της ολικής χοληστερόλης, της HbA1C και των δεικτών ολική χοληστερόλη/HDL-C και ΑpoB/ΑpoA-I ελαττώνοντας το συνολικό καρδιαγγειακό κίνδυνο των ασθενών αυτών.

We recently applied untargeted metabolomic profiling on the plasma obtained from consecutive attenders referred for conventional Level 3 home-sleep studies with excessive daytime somnolence, comparing 17 OSAHS patients (AHI≥15, Epworth...

Objective To observe the effects of continuous positive airway pressure(CPAP) treatment on inflammation and insulin resistance in patients with type 2 diabetes mellitus(T2DM) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Seventy-four patients (51 males and 23 females, with an age range of 45-66 years old) diagnosed as T2DM and OSAHS syndrome from January 2012 to January 2014 were randomly and equally divided into the treatment group(n=37) and the control group(n= 37). Patients in the treatment group were treated with CPAP for 14 days. The fasting blood glucose (FBG), fructosamine (FMN), fasting insulin (FINS), white blood cell (WBC)count, high sensitive C reactive protein (hs-CRP), hypoxia inducible factor-1α(HIF-1α) and soluble vascular cell adhesion molecule-1(sVCAM-1) was detected before and after treatment. The homeostasis model assessment (HOMA) insulin resistance (HOMA-IR) index, the mean pulse oxygen saturation (MSpO2), the lowest pulse oxygen saturation (LSpO2) and apnea hypopnea index (AHI) were monitored by polysomnography (PSG) before and after treatment. T test, χ2 test and Spearman correlation analysis were used to evaluate the data. Results Compared to the control group, the level of FBG, FMN, FINS, MSpO2, LSpO2, AHI was improved in the treatment group by a certain degree after treatment(t =-123.761-120.676, all P<0.05). The level of hs-CRP, HIF-1α, sVCAM-1 and HOMA-IR was significantly reduced from(7.3±0.3)mg/L, (275±53) ng/L, (717±73) ng/L and 3.7±0.2 before treatment to(2.4±0.4)mg/L, (211±6) ng/L, (589±57) ng/L and 2.1±0.7 after treatment, respectively(t= -53.046, -19.827, -12.827, -28.342, respectively, all P<0.05). The improvements showed by Pearson analysis in HOMA-IR after treatment were positively correlated with HIF-1α and sVCAM-1 improvements (r=0.87, 0.86, both P<0.05). Conclusion CPAP may improves the inflammation status, sleep quality, insulin resistance in patients with T2DM and OSAHS. Key words: Sleep apnea, obstructive; Diabetes mellitus, type 2; Inflammatory factor

Purpose: To compare the subfoveal choroidal thickness (SFCT) of patients with different severities of obstructive sleep apnea/hypopnea syndrome (OSAHS) and normal controls via enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: In this retrospective, case-control study, 49 eyes from 49 patients that had undergone polysomnography were included. SFCT of the horizontal and vertical line scans were manually measured for all eyes based on EDI-OCT images. Two separate analyses were performed according to different apnea/hypopnea index (AHI) groupings. Initial testing was conducted using non-OSAHS, mild OSAHS (5≤AHI<15), moderate OSAHS (15≤AHI<30), and severe OSAHS (AHI≥30) patient groupings, while secondary testing used non-OSAHS, mild OSAHS (5≤AHI<15), and moderate/severe OSAHS (AHI≥15) patient groupings. Results: The mean SFCT was 314.5 μm in the non-OSAHS patients (n=14), 324.5 μm in the mild OSAHS patients (n=15), 269.3 μm in the moderate OSAHS patients (n=11), and 264.3 μm in the severe OSAHS patients (n=9). SFCT between the four groups revealed no significant differences despite a trend towards slight thinning in the severe group (P=0.08). When the moderate and severe groups were merged and compared with the mild OASHS and non-OSAHS groups, SFCT of the moderate/severe group was found to be significantly thinner than that of the mild group (P=0.016). A negative significant correlation was found between SFCT and AHI in OSAHS patients (r=0.368, P=0.033). Conclusions: In patients with moderate/severe OSAHS, EDI-OCT revealed a thinned SFCT. Other accompanying systemic or ocular diseases may induce perfusion and oxygenation deficiency in eyes of OSAHS patients. Further studies are required in order to determine the exact relationships between ocular pathologies and clinical grades of OSAHS.

Objective To investigate the instant influences of nasal continuous positive airway pressure(nCPAP) on sleep architecture of obstructive sleep apnea-hypopnea syndrome(OSAHS) patients. Methods Eighty-seven OSAHS patients were diagnosed by polysomnography (PSG). The CPAP pressure was titrated during the first night. The patients accepted the whole night nCPAP treatment while PSG was monitored. The sleep architectures, apnea-hypopnea index(AHI) and arterial O2 saturation (SaO2) of OSAHS patients were analyzed before and during nCPAP therapy. Results Sleep architecture, AHI and SaO2 were significantly improved during therapy. AHI reduced from (54, 45±28. 85) times/h to (8.11± 13.41) times/h(F = 184. 528, P<0. 001). Minimum SaO2 increased from (64.33±14.73) % to (75.08 ± 15.52)% (F =21. 948, P <0. 001). Average SaO2 increased from (88.19±6.80)% to (91.99±3.87)% (F = 20. 469, P < 0.001). Stage I time vs total sleep time (TST) reduced from (22.63 ± 20.95) % to (18. 56±16.92) %,total REM sleep time vs TST increased from (13.28± 10.25)% to (16.07±9.87)%, but neither differences were significant (F = 1. 984, P = 0. 161 ; F = 3. 347, P = 0.069). Stage Ⅱ time vs TST reduced greatly from (58.84±22.87)% to (48.67±19.57)%(F =9. 947, P =0. 002). Total slow wave sleep times vs TST increased from (6.29±7.16) % to (17.01±9.84) %(F =67. 511, P <0. 001). Conclusions While AHI and SaO2 are significantly improved during therapy, nCPAP can improve the sleep architecture on OSAHS patients significantly. Key words: Positive pressure; Respiration; Sleep apnea; Obstructive; Sleep architecture