Modified uvulopalatopharyngoplasty: "8" suture abduction-suspension of the palatopharyngeal muscle.

Objective To explore the influencing factors of daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the correlation between daytime sleepiness and pulse oxygen decline rate in patients with severe OSAHS. Methods From January 2018 to April 2021, 246 consecutive patients with OSAHS diagnosed by polysomnography (PSG) in our hospital were selected. All patients were grouped according to the minimum nocturnal oxygen saturation and apnea hypopnea index (AHI). There were 33 cases in the no sleep hypoxia group, 34 cases in the mild hypoxia group, 119 cases in the moderate hypoxia group, and 60 cases in the severe hypoxia group. There were 30 cases in the simple snoring group, 55 cases in the mild OSAHS group, 48 cases in the moderate OSAHS group, and 113 cases in the severe OSAHS group. The Epworth Sleepiness Scale (ESS) scores of each group were compared. All patients were grouped according to ESS score. Those with score ≥9 were included in the lethargy group (n = 118), and those with score ≤10 were included in the no lethargy group (n = 128). Univariate and multivariate logistic regression analyses were used to explore the influencing factors of daytime sleepiness in OSAHS patients. Pearson correlation analysis showed the correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS. Results The ESS score of the severe hypoxia group > the moderate hypoxia group > the mild hypoxia group > the no sleep hypoxia group. There was significant difference among the groups (F = 19.700, P < 0.0001). There were significant differences between the severe hypoxia group and other groups and between the moderate hypoxia group and the no sleep hypoxia group and the mild hypoxia group (P < 0.05). The ESS score of the severe OSAHS group > the moderate OSAHS group > the mild OSAHS group > the simple snoring group. There was significant difference among the groups (F = 19.000, P < 0.0001). There were significant differences between the severe OSAHS group and other groups and between the moderate OSAHS group and the simple snoring group (P < 0.05). Univariate analysis showed that BMI, neck circumference, snoring degree, total apnea hypopnea time, AHI, micro arousal index (MAI), oxygen saturation (CT90%), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) were the influencing factors of daytime sleepiness in OSAHS patients (P < 0.05). Multiple logistic regression analysis showed that AHI and CT90% were independent risk factors for daytime sleepiness in OSAHS patients (P < 0.05). Pearson correlation analysis showed that there was a positive correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS (r = 0.765, P < 0.0001). Conclusion OSAHS patients may be accompanied by daytime sleepiness in varying degrees, which may be independently related to AHI and CT90%. The degree of daytime sleepiness in patients with severe OSAHS may be closely related to the decline rate of pulse oxygen, which should be paid great attention in clinic.

To study the risk factors contributing to the development of hypertension in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS), and the clinical characteristics of OSAHS with hypertension. A total of 2397 OSAHS patients aged above 30 years old and diagnosed by the sleep-disordered breathing center of Guangxi between July 2012 and August 2015 were recruited. OSAHS patients with new-onset hypertension (OSAHS with hypertension group) and those without hypertension (simple OSAHS group) were identified and their clinical data, including general status, family history of hypertension or snoring, Epworth Sleepiness Scale (ESS) score for daytime sleepiness, physical examination findings, and polysomnography monitoring data were collected. OSAHS patients with new-onset hypertension (n=101) and OSAHS patients without hypertension (n=202) matched by age and body mass index (BMI) (age difference, 2 years; BMI difference, 1.5 kg/m(2)) were recruited in the OSAHS with hypertension group and the simple OSAHS group. A case-control study was used to compare the clinical characteristics of these two groups, and univariate and multivariate Logistic regression were used to analyze all the factors contributing to hypertension development besides age and BMI. The average age and BMI of the OSAHS with hypertension group and the simple OSAHS group were respectively (46.2±9.3), (46.2±9.2) years old and (28.2±2.8), (28.2±2.8) kg/m(2). Patients in the two groups were well-matched with respect to age and BMI (P>0.05). The systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the OSAHS with hypertension group were significantly higher than those in the simple OSAHS group at the first admission to the clinic and before and after the PSG examination. ESS values in the OSAHS with hypertension group and the simple OSAHS group were respectively 10.0±6.4 and 9.2±6.3 (P>0.05). There was no significant intergroup difference in neck circumference, waist circumference, duration of snoring, family history of snoring, and family history of hypertension (P>0.05) either. The apnea-hypopnea index (AHI) and apnea index (AI) in the OSAHS with hypertension group were higher than those in the simple OSAHS group (P<0.05); the longest apnea duration (LAD), mean apnea duration (MAD), and the total time spent with oxygen saturation below 90% (T90%) in the OSAHS with hypertension group were significantly longer than those in the simple OSAHS group (P<0.05). The minimal pulse oxygen saturation (MinSpO2) in the OSAHS with hypertension group was significantly lower than that in the simple OSAHS group (P<0.05). Six factors were identified to be associated with OSAHS with hypertension through univariate analysis: AHI (OR=0.985, P=0.001), AI (OR=0.983, P<0.001), LAD (OR=0.955, P=0.013), MAD (OR=0.874, P=0.015), MinSpO2 (OR=0.874, P=0.015), T90% (OR=0.997, P=0.036). Only MinSpO2 (P<0.001, OR=0.894) was closely related to OSAHS hypertension development in the multivariate Logistic regression model. OSAHS patients with hypertension may show lower MinSpO2, higher AHI and AI, and longer LAD, MAD, and T90% than OSAHS patients without hypertension. MinSpO2 is probably closely related to OSAHS hypertension development.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease that seriously affects health. Continuous positive airway pressure (CPAP) therapy is the preferred treatment for moderate-to-severe OSAHS patients. However, poor adherence to CPAP is a major obstacle in the treatment of OSAHS. Information-motivation-behavioral (IMB) skills, as a kind of mature technology to change the behavior, has been used in various health areas to improve treatment adherence. This study aims to explore the effects of the IMB skills intervention on CPAP adherence in OSAHS patients. Patients who were primary diagnosed with moderate-to-severe OSAHS were randomly divided into the IMB group (n=62) and the control group (n=58). The patients in the IMB group received CPAP therapy and the IMB skills intervention for 4 weeks. The patients in the control group received CPAP therapy and a usual health care provided by a registered nurse. We collected the baseline data of the general information, including age, sex, body mass index (BMI), the Epworth Sleepiness Scale (ESS) score, the Hospital Anxiety and Depression Scale (HADS) score, and indicators about disease severity [apnea-hypopnea index (AHI), percentage of time with arterial oxygen saturation SaO2<90% (T90), average SaO2, lowest SaO2, arousal index]. After CPAP titration, we collected CPAP therapy-relevant parameters (optimal pressure, maximum leakage, average leakage, 95% leakage, and residual AHI), score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. After 4 weeks treatment, we collected the ESS score, HADS score, CPAP therapy-relevant parameters, effective CPAP therapy time per night, CPAP therapy days within 4 weeks, CPAP adherence rate, score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. Visual analog scale (VAS) of 0-5 was used to evaluate the satisfaction and acceptance of IMB intervention measures in the IMB group. There were no significant differences in the baseline level of demographic parameters, ESS score, HADS score, disease severity, and CPAP therapy related parameters between the IMB group and the control group (all P>0.05). There were no significant differences in score of willingness to continue CPAP therapy, as well as score of satisfaction and acceptance of CPAP therapy after CPAP titration between the IMB group and the control group (both P>0.05). After 4 weeks treatment, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group were significantly decreased, while the score of satisfaction and acceptance of CPAP therapy and willingness to continue CPAP therapy of the IMB group were significantly increased (all P<0.05); while the above indexes in the control group were not different before and after 4 weeks treatment (all P<0.05). Compared with the control group, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group after 4 weeks treatment were significantly lower (all P<0.05); the effective CPAP therapy time, CPAP therapy days within 4 weeks, score of satisfaction and acceptance of CPAP therapy, score of willingness to continue CPAP therapy of the IMB group were significantly higher (all P<0.05). The rate of CPAP therapy adherence in 4 weeks of the IMB group was significantly higher than that of the control group (90.3% vs 62.1%, P<0.05). The VAS of overall satisfaction with IMB skills intervention measures was 4.46±0.35. IMB skills intervention measures can effectively improve the adherence of CPAP therapy in OSAHS patients, and is suitable for clinical promotion.

Conclusion: Our findings suggest that, in Asian patients with severe obstructive sleep apnea (OSA), obesity is a better predictor of uvulopalatopharyngoplasty (UPPP) failure than Friedman stage III. Objectives: This study evaluated UPPP success rates in obese and non-obese Asian patients treated for severe OSA. Methods: Records of patients who underwent UPPP for treatment of OSA were retrospectively reviewed. Preoperative and postoperative apnea/hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) score, and Friedman stage were compared in non-obese (body mass index (BMI) <27 kg/m2) and obese (BMI ≥27 kg/m2) patients. Treatment success was defined as >50% reduction in preoperative AHI or postoperative AHI of <20 events/h. Results: Treatment success was significantly lower (p < 0.0001) in the obese group (24.6%) compared with the non-obese group (62.5%). After adjusting for gender, age, BMI, Friedman stage, and preoperative AHI and ESS score, obesity was a significant independent negative predictor of treatment success (adjusted OR = 0.297, 95% CI = 0.114–0.773, p = 0.013).

To explore the association between serum inflammation levels and cognitive function in patients with obstructive sleep apnea-hypopnea syndromes (OSAHS) and evaluate the effects of continuous positive airway pressure treatment (CPAP) on serum inflammation levels and cognitive function. A total of 139 eligible patients were monitored by overnight polysomnography (PSG) at Sleep Center, Second Affiliated Hospital, Soochow University from June 2011 to April 2013. Based on the results of apnea-hypopnea index (AHI), they were divided into 4 groups of primary snoring (n = 18), mild OSAHS(n = 23), moderate OSAHS (n = 29) and severe OSAHS (n = 69). The questionnaires of Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Epworth Sleepiness Scale (ESS) were administered to assess cognitive function and daytime sleepiness. The serum levels of high-sensitivity C-reactive protein (Hs-CRP), leptin and tumor necrosis factor alpha (TNF-α) were detected to evaluate systemic inflammation. The questionnaire scores, serum levels of Hs-CRP, leptin and TNF-α and PSG parameters were compared among 4 groups. Thirty-three patients in severe OSAHS group (treatment group) with good adherence were evaluated at baseline and after long-time CPAP treatment. Compared to primary snoring group, the serum Hs-CRP ((1.77 ± 1.19) vs (0.92 ± 0.82) mg/L), leptin ((15.21 ± 13.26) vs (6.35 ± 4.51) mmol/L) and TNF-α ((21.04 ± 7.78) vs (10.30 ± 5.23) pmol/L) levels increased significantly in severe OSAHS group (P < 0.05). After adjusting for body mass index (BMI), age and education years, MoCA scores showed negative correlations with serum TNF-α, AHI, oxygen reduction index (ODI) and TS90% (r = -0.266, -0.236, -0.201, -0.18 respectively, all P < 0.05) and positive correlations with minimum oxygen saturation (LSaO(2)) (r = 0.224, P < 0.05). The evaluations of MoCA subdomains further revealed selective reductions in visual space, executive function, attention and delayed memory function. The treatment group with good adherence to > 6-month continuous positive airway pressure (CPAP) treatment and after CPAP treatment, the serum levels of Hs-CRP, TNF-α and leptin improved markedly ((1.20 ± 0.88) vs (2.03 ± 1.58) mg/L, (14.12 ± 4.34) vs (22.74 ± 6.72) pmol/L and (7.37 ± 5.30) vs (13.69 ± 7.17) mmol/L respectively). The scores of MoCA and ESS also improved (27.79 ± 1.69 vs 24.76 ± 2.57, 4.33 ± 3.14 vs 12.61 ± 5.80 respectively) (all P < 0.01). The score of all MoCA subdomains improved after treatment. Cognitive dysfunction and inflammatory reaction are common in OSAHS patients. MoCA scores are correlated significantly with serum level of TNF-α and nocturnal intermittent hypoxia. Systemic inflammation may play an important role in cognitive dysfunction of OSAHS patients. And long-time CPAP treatment can improve systemic inflammatory response and cognitive impairment.

To detect the plasma estrogen level and estrogen receptors expression in palatine tonsils of male patients with obstructive sleep apnea hypopnea syndrom (OSAHS). Seventy-six patients with OSAHS were selected as experimental group, 45 patients with chronic tonsillitis as the control group. The tonsils and adipose tissues in space veli palatin were surgically resected in the experimental group, the tonsils were resected in the control group. The plasma level of estrogen was evaluated in patients of the two groups with chemiluminescence immunoassay respectively. The expression of estrogen receptors (ER alpha, ER beta) in palatine tonsils was detected with immunohistochemical methods in the two groups. The relationships between the expression of estrogen receptors and the patient's age, history of snoring, history of apnea, apnea hypopnea index (AHI), body mass index (BMI), neck circumference, abdominal circumference, blood pressure, smoking, alcohol drinking, the degree of velopharyngeal stenosis, the Epworth sleepiness scale score (ESS), and accompanied systemic diseases were analyzed. The estradiol levels did not show significant statistical difference between the two groups [(94.94 ± 25.54)pmol/L, (104.23 ± 34.75)pmol/L, respectively]. The estrogen levels in OSAHS patients were positively correlated with the patients' AHI (r = 0.76, P < 0.01), showed positively correlated trends with BMI (r = 0.43, P < 0.01), ESS (r = 0.34, P < 0.01), neck circumference (r = 0.31, P = 0.01), abdominal circumference (r = 0.32, P < 0.01); the expressions of ER alpha and ER beta in the experimental group (36.8%, 48.7%) were lower than that in the control group (60.0%, 68.9%) respectively, the difference was statistically significant (χ(2) were 5.17 and 4.69, P < 0.05); the expressions of ER alpha and beta in OSAHS patients showed negatively correlated trends with the patients' AHI (r = -0.48, P < 0.01; r = -0.26, P < 0.05). The expressions of ER alpha in OSAHS patients showed positively correlated trends with the patients' lowest oxygen saturation. Estrogen may promote the occurrence of male OSAHS. The ER expression in palatine tonsils of male OSAHS patients accorded to the severity of illness, may be associated with hypoxia.

The aim of the study was to inspect the acoustic properties and sleep characteristics of a preapneic snoring sound. The feasibility of forecasting upcoming respiratory events by snoring sound was also investigated. Participants with habitual snoring or a heavy breathing sound during sleep were recruited consecutively. Polysomnography was conducted, and snoring-related breathing sound was recorded simultaneously. Acoustic features and sleep features were extracted from 30-second samples, and a machine learning algorithm was used to establish 2 prediction models. A total of 74 eligible participants were included. Model 1, tested by 5-fold cross-validation, achieved an accuracy of 0.92 and an area under the curve of 0.94 for respiratory event prediction. Model 2, with acoustic features and sleep information tested by Leave-One-Out cross-validation, had an accuracy of 0.78 and an area under the curve of 0.80. Sleep position was found to be the most important among all sleep features contributing to the performance of the 2 models. Preapneic sound presented unique acoustic characteristics, and snoring-related breathing sound could be deployed as a real-time apneic event predictor. The models, combined with sleep information, serve as a promising tool for an early warning system to forecast apneic events. Wang B, Yi X, Gao J, etal. Real-time prediction of upcoming respiratory events via machine learning using snoring sound signal. J Clin Sleep Med. 2021;17(9):1777-1784.

Given the growing number of patients suspected of having obstructive sleep apnea-hypopnea syndrome (OSAHS), screening methods have become increasingly important for sleep clinics. We analyzed the clinical value of the No-apnea score which is used to diagnose OSAHS in patients with cerebral infarction, and compared the accuracy of the No-apnea score with the accuracy of the NoSAS score, the STOP-Bang questionnaire (SBQ), the Epworth Sleepiness Scale (ESS), the STOP questionnaire (STOP) and the Berlin questionnaire (BQ). Between January 2014 and December 2018, a total of 221 cerebral infarction patients, suspected of having OSAHS, underwent the polysomnography (PSG) for one night at the sleep medical center of Guangdong Medical University Affiliated Second Hospital. The PSG data were collected and analyzed with the NoSAS score, the SBQ, the ESS, the STOP, the BQ, and patients' demographic information. Based on the apnea-hypopnea index (AHI), the patients were classified into four groups: the normal group (<5 events/h), mild OSAHS group (5-15 events/h), moderate OSAHS group (15-30 events/h) and severe OSAHS group (≥30 events/h). The sensitivity, specificity, positive predictive value, negative predictive value and areas under the curve (AUC) of the Receiver Operating Curve (ROC) were calculated for the five questionnaires to compare their relative efficacies for diagnosing OSAHS. When using the standard of AHI ≥5 for diagnosing OSAHS, the NoSAS score had an AUC of 0.831; the SBQ had an AUC of 0.730; the BQ had an AUC of 0.698; and the STOP had an AUC of 0.735, so these techniques are relatively accurate in diagnosing OSAHS. On the other hand, the No-apnea score and the ESS score are relatively less accurate comparing to the rest: the No-apnea had an AUC of 0.626, and the ESS had an AUC of 0.650. Using the NoSAS score to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the sensitivity and specificity were 0.867 and 0.731, 0.888 and 0.476, 0.889 and 0.369, respectively; Using the SBQ to predict AHI ≥5 events/h, AHI 15 events/h and AHI ≥30 events/h, the sensitivity and specificity were 0.903 and 0.268, 0.914 and 0.200, 0.903 and 0.268, respectively; Using the STOP to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the values were 0.830 and 0.500, 0.871 and 0.390, 0.875 and 0.302, respectively; and using the BQ to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the values were 0.758 and 0.482, 0.810 and 0.429, 0.819 and 0.362, respectively. The study concludes that the NoSAS score and the SBQ had a better predictive value for cerebral infarction patients suspected with OSAHS disease. These questionnaires can also effectively help clinicians quickly address nocturnal hypoxia in patients with cerebral infarction to control subsequent complications in patients with cerebral infarction. More studies are needed to evaluate the efficacy of the NoSAS score in screening for OSAHS in patients with cerebral infarction.

The aim of this study was to characterize excessive daytime sleepiness (EDS) in a large cohort of Chinese patients with various severity of obstructive sleep apnea-hypopnea syndrome (OSAHS), and investigate its correlations with clinical/polysomnographic variables. A total of 1,035 consecutive Chinese patients with snoring (mean age ± SD 45 ± 15 years, BMI 26.6 ± 4.3 kg/m(2)) were examined by overnight polysomnography, and subjective EDS was assessed using the Epworth Sleepiness Scale (ESS). The 1,035 patients were compared according to severity of sleep-disordered breathing: AHI <5 (primary snoring group or normal overall AHI) (24.1%), AHI 5-20 (mild OSAHS, 21.7%), AHI >20-40 (moderate OSAHS 16.5%), and AHI >40 (severe OSAHS 37.7%). ESS score progressively increased as the severity of OSAHS aggravated among these patients. More severe OSAHS patients were characterized by EDS, nocturnal hypoxemia, and disruption of sleep structure. Progressive worsening of nocturnal hypoxemia was observed from mild to severe OSAHS patients with a strong correlation with ESS score. The stepwise multiple regression analysis performed to evaluate the correlations of individual clinical and polysomnographic variables with the ESS score revealed that the ESS score significantly correlated with the oxygen desaturation index (ODI), apnea-hypopnea index (AHI), and body mass index (BMI), and ODI was the strongest determinant of ESS score. EDS is correlated with the severity of OSAHS. More severe patients are characterized by higher ESS score, higher BMI, and progressive worsening of nocturnal hypoxemia. Nocturnal hypoxemia is a major determinant of EDS in Chinese OSAHS patients.

Objective: To explore the characteristics and determining factors of attention and short-term memory impairment in young patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: A total of 203 eligible patients with snoring were recruited for the study at Sleep Center, Second Affiliated Hospital of Soochow University from July 2016 to July 2017, and they were all monitored with overnight polysomnography(PSG), recording sleep parameters [NREM (Ⅰ+Ⅱ) sleep ratio, NREM Ⅲ sleep ratio, REM sleep ratio] and respiratory parameters (AHI, ODI, LSaO(2), TS90%, RRMAI). Based on apnea/hypopnea index(AHI), the patients were categorized into non-OSAHS group (0<AHI≤5/h), mild and moderate OSAHS group (5<AHI≤30/h), and severe OSAHS group (AHI>30/h). All patients were assessed for sleepiness and the Motreal Cognitive Assessment (MoCA) questionnaires, Mini-mental State Examination (MMSE), Epworth Sleepiness Scale(ESS), attention and short-term memory assessment which included Trail Marking Test(TMT), digit span test(DST), and Complex Figure Test(CFT). The PSG parameters, ESS scores, total MoCA scores, attention and short-term memory were compared among groups, and a multivariate logistic regression analysis was conducted to investigate the characteristics of attention and short-term memory impairment in young patients with OSAHS and their determining factors. Results: In the overall cognitive function assessment, severe OSAHS patients's MoCA scores were lower than those of the other two groups [27.0 (25.0, 28.0) vs 27.0 (26.0, 28.0) , 27.0 (26.0, 27.0) , P<0.01]. In the sleepiness self-assessment, severe OSAHS patients's ESS scores were significantly higher than those of the other groups (11.4±5.4 vs 5.3±4.5, 8.0±5.0, P<0.01) . In the attention tests, scores on the DST-D (8.1±1.1 vs 8.8±0.9, 8.5±1.0) and DST-B[5.5 (4.0, 7.0) vs 6.0 (5.0, 7.0) , 6.0 (5.0, 7.0) ] were significantly lower in severe OSAHS patients than in the other two groups (P<0.01) . In the memory tests, the re-drawing scores of severe OSAHS patients were significantly lower than those of the other two groups [23.0 (16.0, 27.0) vs 26.0 (24.0, 28.0) , 24.0 (20.0, 28.0) , P<0.01]. In the executive function tests, severe OSAHS patients spent much longer on both TMT-A (46.7±19.0 vs 40.2±17.4, 34.6±17.2) and TMT-B (76.9±32.6 vs 67.2±21.2, 58.6±27.5) than the other two groups (P<0.01). Multivariate logistic stepwise regression analysis showed that, AHI, ODI and NREM (Ⅰ+Ⅱ) sleep ratios were the independent determining factors. Conclusion: Attention and short-term memory functions of young patients with OSAHS were impaired. The severity of apnea and hypoxia, NREM (Ⅰ+Ⅱ) ratio were all determining factors.

A one-way nasal resistor has recently been shown to reduce sleep disordered breathing (SDB) in a subset of patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). The purpose of this study was to examine characteristics predictive of therapeutic response to the device and provide pilot data as to its potential mechanisms of action. PATIENTS, INTERVENTIONS, AND MEASUREMENTS: 20 subjects (15M/5F, age 54 ± 12 years, BMI 33.5 ± 5.6 kg/m²) with OSAHS underwent 3 nocturnal polysomnograms (NPSG) including diagnostic, therapeutic (with a Provent® nasal valve device), and CPAP. Additional measurements included intranasal pressures and PCO₂, closing pressures (Pcrit), and awake lung volumes in different body positions. In 19/20 patients who slept with the device, RDI was significantly reduced with the nasal valve device compared to the diagnostic NPSG (27 ± 29/h vs 49 ± 28/h), with 50% of patients having an acceptable therapeutic response. Among demographic, lung volume, or diagnostic NPSG measures or markers of collapsibility, no significant predictors of therapeutic response were found. There was a suggestion that patients with position-dependent SDB (supine RDI > lateral RDI) were more likely to have an acceptable therapeutic response to the device. Successful elimination of SDB was associated with generation and maintenance of an elevated end expiratory pressure. No single definitive mechanism of action was elucidated. The present study shows that the nasal valve device can alter SDB across the full spectrum of SDB severity. There was a suggestion that subjects with positional or milder SDB in the lateral position were those most likely to respond.

Objective To investigate the prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in pilots and to provide reference on prevention and cure of OSAHS in pilots. Methods Two hundred and thirty-six pilots were randomly picked and were asked to fill out a questionnaire about Epworth sleepiness scale (ESS) score. Their age, smoking and drinking habit were gathered. Their neck circumference, height, body weight and body mass index (BMI) were also measured. The sleepiness of pilots were monitored by nocturnal oxygen saturation, apnea hypopnea index (AHI) and other indicators. Results The 236 pilots were divided into three groups according to the ESS and sleep monitoring results: no snoring group (n=207), simple snoring group (n=26) and OASHS group (n=3). The prevalence of OSAHS was 1.27%. Age, smoking and drinking habits were significantly different among three groups (χ2=17.533, 9.870, 13.302, P<0.01). ESS, AHI, neck circumference and BMI were significantly different among three groups (F=14.231-92.801, P<0.01). Conclusions Pilots′ OSAHS are correlated to such factors as their age, smoking, drinking, neck circumference and BMI. The prevalence of OSAHS is lower in pilots than that in common people. Since OSAHS can cause metabolic disorder, cognitive decline and other clinical manifestations, it may become a potential risk to flight operation, and thus attention should be paid on detection and treatment of OSAHS in pilots. Key words: Sleep apnea syndromes; Prevalence; Cross-sectional studies; Pilots

ObjectiveThe aim of this case-control study was to assess the efficacy of dapagliflozin combined with metformin for type-2 diabetes mellitus (T2DM) with obstructive sleep apnea hypopnea syndrome (OSAHS).MethodsA total of 36 patients with newly-diagnosed T2DM and OSAHS were randomized divided into two groups. Eighteen OSAHS patients with T2DM, who were treated with dapagliflozin and metformin, were assigned as the dapagliflozin group. These patients were given dapagliflozin and metformin for 24 weeks between February 2017 and February 2018. Another 18 OSAHS patients with T2DM, who were treated with glimepiride and metformin for 24 weeks, were assigned as the control group. Fasting plasma glucose (FPG) level, postprandial blood glucose (PPG), hemoglobin A1C (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, body mass index (BMI), blood pressure, apnea-hypopnea index (AHI), minimum oxygen saturation (LSpO2), and Epworth Somnolence Scale (ESS) score were measured before and at 24 weeks after the initiation of treatment.ResultsIn the dapagliflozin group, triglyceride (TG), systolic pressure (SBP) and diastolic pressure (DBP) significantly decreased following treatment, while high-density lipoprotein cholesterol (HDL-C) significantly increased (P < 0.05). Furthermore, a reduction in AHI, an increase in LSpO2 and a decrease in ESS score were observed in the dapagliflozin group (P < 0.05), but not in the control group. Moreover, blood glucose, HbA1c, HOMA-IR, and BMI significantly decreased in these two groups, and the decrease was more significant in the dapagliflozin group.ConclusionThese present results indicate that dapagliflozin can significantly reduce glucose, BMI, blood pressure and AHI, and improve hypoxemia during sleep and excessive daytime sleepiness, which thereby has potential as an effective treatment approach for OSAHS.

To evaluate the availability of tonsillectomy in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) staged as Friedman I. Fifty-six patients with OSAHS in Friedman stage I who refused uvulopalatopharyngoplasty (UPPP) received tonsillectomy merely from January 2004 to March 2010. There were 20 mild, 24 moderate and 12 serious patients respectively in this group. The other 68 OSAHS patients in Friedman stage I received UPPP at the same time as matched group, including 26 mild, 28 moderate and 14 serious patients. There was no significant difference before operation in terms of age, body mass index, apnea hypopnea index (AHI), the lowest pulse oxygen saturation (SPO(2)) and average SPO(2) between the two groups. There were significant difference in mean length of operation (U = 0.000, P < 0.01), hospitalization day (U = 458.5, P < 0.01), visual analogue scale after surgery (U = 0.000, P < 0.01) in these two group. There was no significant difference in surgical effective rate between the two groups (χ(2) = 0.857, P > 0.05). There was also no significant difference in terms of age, body mass index, AHI, the lowest SPO(2) and average SPO(2) after operation between the two groups (t test P > 0.05). The surgical effective rate for the long term of the two groups was equal (χ(2) = 0.857, P > 0.05). Even patients with serious OSAHS in Friedman stage I, the surgical effective rate of the two groups was equivalent (Fisher's exact test, P > 0.05). Tonsillectomy is a safe and effective surgery for OSAHS in Friedman stage I, whose main structural load lies in the hypertrophic tonsil. It should be the first surgical choice for OSAHS in Friedman stage I.

Otolaryngology office-based treatment of obstructive sleep apnea-hypopnea syndrome with titratable and nontitratable thermoplastic mandibular advancement devices