Lowest Pulse Oxygen Saturation Research Articles

Correlation between arousal threshold and occurrence of hypertension in patients with obstructive sleep apnea hypopnea syndrome

Objective: To investigate the relationship between arousal threshold (ArTH) and hypertension in patients with obstructive sleep apnea hypopnea syndrome (OSA). Methods: This study recruited 648 patients diagnosed with OSA at the Sleep Center of the Second Affiliated Hospital of Soochow University from January 2020 to August 2021, including 569 males and 79 females, aged 42(35,52) years. The basic demographic information and clinical data of all patients were collected, including blood pressure measurement, and relevant questionnaire scores, and nocturnal polysomnography (PSG) parameters. A clinical predictive model based on sleep apnea hypopnea index (AHI), lowest pulse oxygen saturation (LSpaO2) and hypopnea ratio (FHypopneas) was used to access the arousal threshold of OSA patients. Patients were divided into OSA group and OSA with hypertension group according to whether they were combined with hypertension. The differences in the above indexes between the two groups were analyzed to explore the relationship between arousal threshold and hypertension in OSA patients, using a binary logistic stepwise regression analysis. Results: A total of 648 OSA patients were enrolled, including 415 in the OSA with hypertension group and 233 in the OSA group. Compared with OSA group, OSA with hypertension group had older age, higher body mass index (BMI), higher blood pressure at bedtime and at awakening, higher AHI and lower proportion of hypopnea (all P<0.05). There were no significant differences between other general data and PSG parameters (all P>0.05). The proportion of patients with low arousal threshold (AHI<30 events per hour, LSpO2>82.5%, Fhypopneas>58.3%) in OSA with hypertension group was lower, and the proportion of phenotypic patients with low arousal threshold was significantly lower (30.1% vs. 52.4% P<0.001). Binary logistic stepwise regression analysis showed that the high arousal threshold (OR=1.930, 95%CI:1.326-2.808, P=0.001) was an independent risk factor for OSA complicated with hypertension. Conclusion: The arousal threshold is associated with the development of hypertension in OSA patients, and OSA patients with a high arousal threshold have a higher risk of developing hypertension.

Effect of Palatal Botulinum Toxin Injection in Habitual Snoring

Snoring is a loud buzzing noise caused by the soft palate and pillar vibration. Loud snoring at least three nights per week is described as habitual snoring (HS). Aim of the Study: To evaluate the effect of palatal botulinum toxin in snoring patients. Patients and Methods: An Experimental clinical trial study was conducted on thirty-seven patients with habitual snoring between July 2021 and January 2022. The participants and their partners completed a questionnaire submitted before and after injection. Recordings of snoring sounds before injection (as a baseline) and after injection were monitored by a mobile application designed to record and analyze snoring (Goodsomia Lab.). Unilateral injections of 10 botulinum toxin type A units were done into the soft palate muscles. Result: Snoring was improved in all patients, with no significant side effects reported. Epworth Sleepiness Scale was 9.9 ± 0.9 before botulinum toxin injection and 8.2 ± 1.7 one week after injection, while the snoring index was 131 ± 66 and 61.5 ± 28, respectively. The average Intensity of Snoring and maximal Intensity of Snoring before botulinum injection were 57 ± 7.5 and 90.5 ± 1.6, respectively, and changed to 44 ± 4.2 and 87.8 ± 1.9 seven days after injection. Regarding the lowest pulse oxygen saturation, there is a statistically better rate after toxin injection, 90.7 ± 0.9, than before injection, 89.1 ± 1.8. Discussion: Snoring treatment with botulinum toxin is safe, easy to perform, non-invasive, and reversible.

Effect of remimazolam tosilate on the incidence of hypoxemia in elderly patients undergoing gastrointestinal endoscopy: A bi-center, prospective, randomized controlled study.

Background: Remimazolam tosilate is a new ultra-short-acting benzodiazepine sedative medicine. In this study, we evaluated the effect of remimazolam tosilate on the incidence of hypoxemia during sedation in elderly patients undergoing gastrointestinal endoscopy. Methods: Patients in the remimazolam group received an initial dose of 0.1mg/kg and a bolus dose of 2.5mg of remimazolam tosilate, whereas patients in the propofol group received an initial dose of 1.5mg/kg and a bolus dose of 0.5mg/kg of propofol. Patients received ASA standard monitoring (heart-rate, non-invasive blood pressure, and pulse oxygen saturation) during the entire examination process. The primary outcome was the incidence of moderate hypoxemia (defined as 85%≤ SpO2< 90%, >15s) during the gastrointestinal endoscopy. The secondary outcomes included the incidence of mild hypoxemia (defined as SpO2 90%-94%) and severe hypoxemia (defined as SpO2< 85%, >15s), the lowest pulse oxygen saturation, airway maneuvers used to correct hypoxemia, patient's hemodynamic as well as other adverse events. Results: 107 elderly patients (67.6 ± 5.7years old) in the remimazolam group and 109 elderly patients (67.5 ± 4.9years old) in the propofol group were analyzed. The incidence of moderate hypoxemia was 2.8% in the remimazolam group and 17.4% in the propofol group (relative risk [RR] = 0.161; 95% confidence interval [CI], 0.049 to 0.528; p < 0.001). The frequency of mild hypoxemia was less in the remimazolam group, but not statistically significant (9.3% vs. 14.7%; RR = 0.637; 95% CI, 0.303 to 1.339; p = 0.228). There was no significant difference in the incidence of severe hypoxemia between the two groups (4.7% vs. 5.5%; RR = 0.849; 95% CI, 0.267 to 2.698; p = 0.781). The median lowest SpO2 during the examination was 98% (IQR, 96.0%-99.0%) in patients in the remimazolam group, which was significantly higher than in patients in the propofol group (96%, IQR, 92.0%-99.0%, p < 0.001). Patients in the remimazolam group received more drug supplementation during endoscopy than patients in the propofol group (p = 0.014). There was a statistically significant difference in the incidence of hypotension between the two groups (2.8% vs. 12.8%; RR = 0.218; 95% CI, 0.065 to 0.738; p = 0.006). No significant differences were found in the incidence of adverse events such as nausea and vomiting, dizziness, and prolonged sedation. Conclusion: This study explored the safety of remimazolam compared with propofol during gastrointestinal endoscopy in elderly patients. Despite the increased supplemental doses during sedation, remimazolam improved risk of moderate hypoxemia (i.e., 85%≤ SpO2 < 90%) and hypotension in elderly patients.

Intensive care unit readmission and unexpected death after emergency general surgery

BackgroundIntensive care unit (ICU) readmission and unexpected death are closely associated with increased length of hospitalization and total mortality. However, data about readmission or unexpected death after discharge from ICU in patients who have undergone emergency general surgery (EGS) is very limited. MethodsIn total, 1133 patients who underwent EGS were identified in the Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database. Of these 1133 patients, 124 underwent readmission into the ICU or death unexpectedly after their initial discharge. The clinical characteristics of the patients were investigated. A logistic regression model was implemented for the analysis of the independent risk factors associated with ICU readmission or unexpected death. A nomogram model was established to predict the risk of ICU readmission or unexpected death within 72 h after EGS. ResultsPeripheral vascular disease and atrial fibrillation, vasopressor requirement, a higher respiratory rate or heart rate, a lower pulse oxygen saturation or a platelet count of <150 K/μL and a relatively low Glasgow coma scale score in the last 24 h before ICU discharge were independent risk factors for ICU readmission or death within 72 h. The nomogram had moderate accuracy with an area under the curve of 0.852, which had a stronger prediction power than the Stability and Workload Index for Transfer (SWIFT) score, a classic prediction model for ICU readmission risk. ConclusionsIn critically ill patients who undergo EGS, ICU readmission or unexpected death within 72 h can be predicted using a nomogram model based on eight parameters including physiological and laboratory test values in the last 24 h before discharge and comorbidities. ICU physicians should prudently assess patients to make effective discharge decisions.

Prediction of low pulse oxygen saturation in COVID-19 using remote monitoring post hospital discharge

BackgroundMonitoring systems have been developed during the COVID-19 pandemic enabling clinicians to remotely monitor physiological measures including pulse oxygen saturation (SpO2), heart rate (HR), and breathlessness in patients after discharge from hospital. These data may be leveraged to understand how symptoms vary over time in COVID-19 patients. There is also potential to use remote monitoring systems to predict clinical deterioration allowing early identification of patients in need of intervention. MethodsA remote monitoring system was used to monitor 209 patients diagnosed with COVID-19 in the period following hospital discharge. This system consisted of a patient-facing app paired with a Bluetooth-enabled pulse oximeter (measuring SpO2 and HR) linked to a secure portal where data were available for clinical review. Breathlessness score was entered manually to the app. Clinical teams were alerted automatically when SpO2 < 94 %. In this study, data recorded during the initial ten days of monitoring were retrospectively examined, and a random forest model was developed to predict SpO2 < 94 % on a given day using SpO2 and HR data from the two previous days and day of discharge. ResultsOver the 10-day monitoring period, mean SpO2 and HR increased significantly, while breathlessness decreased. The coefficient of variation in SpO2, HR and breathlessness also decreased over the monitoring period. The model predicted SpO2 alerts (SpO2 < 94 %) with a mean cross-validated.sensitivity of 66 ± 18.57 %, specificity of 88.31 ± 10.97 % and area under the receiver operating characteristic of 0.80 ± 0.11. Patient age and sex were not significantly associated with the occurrence of asymptomatic SpO2 alerts. ConclusionResults indicate that SpO2 alerts (SpO2 < 94 %) on a given day can be predicted using SpO2 and heart rate data captured on the two preceding days via remote monitoring. The methods presented may help early identification of patients with COVID-19 at risk of clinical deterioration using remote monitoring.

Effective treatment of a child with adenoidal hypertrophy and severe asthma by omalizumab: a case report

BackgroundChildhood adenoid hypertrophy (AH) is common and is often associated with allergic asthma, resulting in complications like obstructive sleep apnea syndrome (OSAS). Management of the disease and its complications is often challenging.Case presentationWe report here a case of a 10-year-old boy who suffered from severe allergic asthma and rhinitis and was treated with omalizumab. Before the treatment, the childhood asthma control test (C-ACT, 14), visal analog scale (VAS, 7) and lung function (mild obstructive ventilation dysfunction and moderate to severe dysfunction in ventilation in small airway) were seriously affected. Polysomnography showed OSAS (apnea hypopnea index, AHI, 6.4), low hypooxia saturation (lowest pulse oxygen saturation, LoSpO2, 70%), and adenoid hypertrophy (at grade III). After treating with omalizumab for 4 weeks (once treatment), the ventilation function, symptoms of asthma and allergic rhinitis (C-ACT, 24; VAS, 2), and OSAS (AHI: 1.8 and LoSpO2: 92.6%) were all improved, and the adenoids size was also significantly reduced to grade II. And during the following 3 times of treatment, the allergic symptoms continued improving, and the size of adenoid was reduced to grade I. Even 6.5 months after cessation of omalizumab, the size of adenoid remained at grade I.ConclusionThis is the first documented case that childhood adenoid hypertrophy can be significantly improved by omalizumab.

Sleep, short-term memory, and mood states of volunteers with increasing altitude.

PurposeThis study sought to identify the changes and potential association between sleep characteristics and short-term memory, and mood states among volunteers at different altitudes and times.MethodA total of 26 healthy volunteers were recruited from the PLA General Hospital, and we conducted a longitudinal prospective survey for over 1 year from November 2019 to April 2021. First, we collected demographic data, sleep parameters by overnight polysomnography (PSG), short-term memory by digit span test, and mood states by completing a questionnaire with a brief profile of mood states among participants in the plain (53 m). Then, we continuously followed them up to collect data in the 3rd month at an altitude of 1,650 m (on the 3rd month of the 1-year survey period), the 3rd month at an altitude of 4,000 m (on the 6th month of the 1-year survey period), and the 9th month at an altitude of 4,000 m (on the 12th month of the 1-year survey period). Multiple linear regression analysis was used to construct models between sleep parameters and short-term memory, and mood states.ResultsThe prevalence of sleep apnea syndrome (SAS) significantly increased with rising elevation (P < 0.01). The apnea-hypopnea index (AHI), the mean apnea time (MAT), the longest apnea time (LAT), and the duration of time with SaO2 < 90% (TSA90) were increased (P < 0.05), and the mean pulse oxygen saturation (MSpO2), the lowest pulse oxygen saturation (LSpO2), and heart rate were significantly decreased with increasing altitude (P < 0.05). Digit span scores were decreased with increasing altitude (P < 0.001). A negative mood was more severe and a positive mood increasingly faded with rising elevation (P < 0.001). Additionally, linear correlation analysis showed that higher AHI, LAT, and MAT were strongly associated with a greater decline in short-term memory (in the 3rd and 9th month at an altitude of 4,000 m, respectively: rs = −0.897, −0.901; rs = −0.691, −0.749; rs = −0.732, −0.794, P < 0.001), and also were strongly associated with more severe negative mood (in the 3rd month at altitudes of 1,650 m and 4,000 m, respectively: rs = 0.655, 0.715, 0.724; rs = 0.771, 0.638, 0.737, P < 0.000625). Multiple linear regression pointed out that AHI was a significant predictor of negative mood among people at different altitudes (in the 3rd month at an altitude of 1,650 m: TMD = 33.161 + 6.495*AHI; in the 3rd month at an altitude of 4,000 m: TMD = 74.247 + 1.589*AHI, P < 0.05).ConclusionSAS developed easily in high altitudes, most often in CSA (central sleep apnea, CSA). The sleep, short-term memory, and negative mood were significantly more damaged with elevation in volunteers. Sleep parameters were closely associated with short-term memory and mood states in volunteers at high altitudes; the higher the sleep parameters (AHI, LAT, and MAT) scores, the more significant the mood disorders and the more obvious impairment of short-term memory. AHI was a critical predictor of the negative mood of volunteers at different altitudes. This study provides evidence that could help with the prevention and control of sleep disorder, cognitive disorder, and negative mood among populations with high altitudes.

Association between Serum Cystatin C levels and long-term cardiovascular outcomes and all-cause mortality in older patients with obstructive sleep apnea.

Background and Aims: To investigate the association between obstructive sleep apnea (OSA) severity and baseline serum cystatin C (Cys-C) concentration and to explore the association between baseline serum Cys-C and long-term cardiovascular outcomes and mortality in older patients with OSA. Methods: Between January 2015 and October 2017, a total of 1107 consecutive eligible older patients (≥60 years) with OSA were included in this multicenter, prospective cohort study, and baseline demographics, clinical characteristics, sleep parameters, and follow-up outcomes were collected. Participants were divided into different groups based on baseline serum Cys-C levels. The primary end point was major adverse cardiovascular events (MACE) and the secondary end point was all-cause mortality. The correlation between OSA severity and baseline serum Cys-C was evaluated by Spearman correlation analysis. Multivariate Cox regression was used to analyze the association between Cys-C and the incidence of MACE and mortality. Results: Participants included 672 men and 435 women, with a median age of 66 (range, 60–96) years. At baseline, apnea–hypopnea index (AHI) (r = 0.128, p < 0.05), oxygen desaturation index (ODI) (r = 0.116, p < 0.05), and the lowest pulse oxygen saturation (LSpO2) (r = −0.097, p < 0.05) were correlated with serum Cys-C concentration. During the median follow-up period of 42 months, 97 patients (8.8%) experienced MACE and 40 patients (3.6%) experienced death. The association between serum Cys-C levels and the risk of MACE and all-cause mortality was slow rising shaped. The multivariable Cox regression analysis showed patients with a serum Cys-C concentration of ≥1.14 mg/L had higher risks of MACE (HR = 5.30, 95% CI: 2.28–12.30, p < 0.05) and all-cause mortality (HR = 9.66, 95% CI: 2.09–44.72, p < 0.05) compared with patients with serum Cys-C of ≤0.81 mg/L in older patients with OSA. The receiver-operating characteristic curve showed baseline serum Cys-C levels exhibited moderately capable of identifying patients with a long-term risk of clinical adverse events (MACE and mortality). Conclusion: OSA severity was positively correlated with serum Cys-C concentration. High levels of Cys-C were independently associated with increased risks of MACE and all-cause mortality in older patients with OSA, suggesting that lowering Cys-C levels should be considered as a therapeutic target, and monitoring serum Cys-C may be beneficial to the favorable prognosis of older patients with OSA.

Elevated resting heart rates are a risk factor for mortality among patients with coronavirus disease 2019 in Wuhan, China.

ABSTRACTBackground:We evaluated the association between higher resting heart rates (RHRs) and adverse events in COVID-19 patients.Methods:One hundred and thirty-six patients with laboratory-confirmed COVID-19 were admitted. Outcomes of patients with different RHRs were compared.Results:Twenty-nine patients had RHRs of <80 bpm (beat per min), 85 had 80–99 bpm and 22 had ≥100 bpm as tachycardia. Those with higher RHRs had lower pulse oxygen saturation (SpO2) and higher temperatures, and there was a higher proportion of men upon admission (all P < 0.05). Patients with higher RHRs showed higher white blood cell counts and D-dimer, cardiac troponin I (TnI), N-terminal pro-B-type natriuretic peptide and hypersensitive C-reactive protein levels, but lower albumin levels (all P < 0.05) after admission. During follow-up, 26 patients died (mortality rate, 19.1%). The mortality rate was significantly higher among patients with tachycardia than among the moderate and low RHR groups (all P < 0.001). Kaplan–Meier survival curves showed that the risks of death and ventilation use increased for patients with tachycardia (P < 0.001). Elevated RHR as a continuous variable and a mean RHR as tachycardia were independent risk factors for mortality and ventilator use (all P < 0.05) in the multivariable adjusted Cox proportional hazards regression model.Conclusions:Elevated average RHRs during the first 3 days of hospitalisation were associated with adverse outcomes in COVID-19 patients. Average RHRs as tachycardia can independently predict all-cause mortality.

Clinical application of preserving spontaneous breathing non-intubation anesthesia in thoracoscopic surgery for lung cancer under ERAS concept.

To explore the safety and feasibility of thoracoscopic surgery in patients with lung cancer under non-intubation anesthesia, and to evaluate the advantages of the non-intubation anesthesia compared with intubation anesthesia on enhanced recovery after surgery (ERAS). A retrospective cohort study was conducted in which 100 patients who underwent thoracoscopic lung cancer surgery from January 2020 to February 2021 in the Department of Thoracic Surgery of the First Affiliated Hospital of Soochow University were included and divided into non-intubation group (n=50) and intubation group (n=50). The primary outcome was the comparison of intra- and postoperative parameters. Secondary outcomes included inflammatory response indicators and intra- and postoperative complications. There was no significant difference between the two groups in anesthesia effect score, blood loss, lowest pulse oxygen saturation, operation time, postoperative chest tube indwelling time (P>0.05). Non-intubation group had less intraoperative remifentanil dosage, less change of blood pressure and heart rate, lower postoperative pain numerical score(NRS), less medical costs, smaller incidence rate of throat discomfort (P<0.05). The non-intubation group was also associated with less extubation time, postanesthesia care unit recovery time, ambulation time, food intake time, postoperative antibiotic use time, and hospital stay (P<0.05). The increase of C-reactive protein in the non-intubation group was lower than that in the intubation group (P<0.05). Non-intubation anesthesia for thoracoscopic lung cancer surgery is safe and feasible. Compared with the intubation anesthesia, it has advantages in ERAS and reducing medical costs.

Efficacy of high-flow nasal oxygenation compared with tracheal intubation for oxygenation during laryngeal microsurgery: a randomised non-inferiority study

BackgroundOxygenation via a high-flow nasal cannula (HFNC) can be an alternative to tracheal intubation during short apnoeic procedures. This randomised, non-inferiority study assessed the efficacy of HFNC compared with tracheal intubation in laryngeal microsurgery. MethodsPatients (≥20 yr old) undergoing laryngeal microsurgery under general anaesthesia and neuromuscular blockade were randomised to either the HFNC or tracheal intubation groups. The primary endpoint was lowest pulse oxygen saturation (SpO2) during the first 30 min of surgery. Secondary endpoints included incidence of desaturation (SpO2 <95%), hypercarbia (transcutaneous carbon dioxide [CO2] ≥8.7 kPa), and rescue intervention. ResultsAmongst 130 patients randomised, 118 were included in the analysis. The lowest SpO2 was 100 (98–100)% in the HFNC group (n=56) and 100 (100–100)% in the tracheal intubation group (n=62), with a mean difference of –1.4% (95% confidence interval: –2.4% and –0.3%), failing to confirm non-inferiority with a non-inferiority margin of 2%. The peak transcutaneous CO2 and end-tidal CO2 at the end of surgery were higher in the HFNC group compared with the tracheal intubation group. Incidences of desaturation, hypercarbia, and rescue intervention were more frequent in patients receiving HFNC compared with tracheal intubation. ConclusionsHFNC oxygenation was not non-inferior to tracheal intubation for maintaining oxygen saturation during laryngeal microsurgery. Considering more frequent desaturation, hypercarbia, and requirement for rescue intervention compared with tracheal intubation, HFNC should be used with cautious monitoring even for short duration airway surgery. Clinical trial registrationNCT03629353.

The effect of high flow nasal oxygen therapy in intensive care units: a systematic review and meta-analysis

ABSTRACT Background High flow nasal oxygen (HFNO) therapy has been widely used in intensive care units (ICU); however, its efficacy remains inconclusive. This systematic review and meta-analysis aimed tocompare the efficacy of HFNO therapy with that of alternative noninvasive oxygen therapies such as conventional oxygen therapy (COT) and noninvasive ventilation (NIV) in ICU. Methods A Pubmed, Embase, Web of Science, Cochrane Library database search was performed in March 2020. Results: The meta-analysis ultimately included 17 clinical studies. Compared with the overall effect of COT and NIV, HFNO was associated with a low incidence of pneumonia (95% CI: 0.6–0.99, P = 0.04) and improvement in lowest pulse oxygen saturation (SpO₂) during oxygenation (95% CI: 0.02–1.61; P = 0.04). However, no differences were detected in the following outcomes: length of ICU stay, the rate of intubation or reintubation, mortality at day 28, hospital mortality, and SpO₂ at the end of oxygen therapy (all P > 0.05). Conclusions In adult patients in ICU, HFNO may improve oxygenation and decrease pneumonia rate without affecting the length of ICU stay, intubation or reintubation rate, mortality, and SpO₂ at the end of oxygen therapy.

Prediction of optimal continuous positive airway pressure in Thai patients with obstructive sleep apnea

Continuous positive airway pressure (CPAP) is simple and effective treatment for obstructive sleep apnea (OSA) patients. However, the CPAP prediction equation in each country is different. This study aimed to predict CPAP in Thai patients with OSA. A retrospective study was conducted in Thai patients, who OSA was confirmed by polysomnography and CPAP titration from January 2015 to December 2018. Demographics, body mass index (BMI), neck circumference (NC), Epworth sleepiness scale, apnea–hypopnea index (AHI), respiratory disturbance index (RDI), mean and lowest pulse oxygen saturation (SpO2), and optimal pressure were recorded. A total of 180 subjects were included: 72.8% men, age 48.7 ± 12.7 years, BMI 31.0 ± 6.3 kg/m2, NC 40.7 ± 4.1 cm, AHI 42.5 ± 33.0 per hour, RDI 47.1 ± 32.8 per hour, and lowest SpO2 77.1 ± 11.0%. Multiple linear regression analysis identified NC, BMI, RDI, and lowest SpO2. A final CPAP predictive equation was: optimal CPAP (cmH2O) = 4.614 + (0.173 × NC) + (0.067 × BMI) + (0.030 × RDI) − (0.076 × lowest SpO2). This model accounted for 50.0% of the variance in the optimal pressure (R2 = 0.50). In conclusion, a CPAP prediction equation can be used to explain a moderate proportion of the titrated CPAP in Thai patients with OSA. However, the CPAP predictive equation in each country may be different due to differences of ethnicity and physiology.Trial registration: TCTR20200108003.

THE PREVALENCE AND RISK FACTORS OF HIGH-ALTITUDE PULMONARY HYPERTENSION AMONG THE HIGHLANDERS IN TIBETAN AREA

Objective: The study aimed to investigate the prevalence and risk factors of high-altitude pulmonary hypertension (HAPH) among the highlanders living at 3500m above sea level in Tibetan area of China. Design and method: we conducted a cross-sectional survey on the permanent Tibetans residing at an average altitude of 3500m. Age 18 years and above were selected by stratified cluster random sampling technique and screened for recording questionnaire, anthropometric indices, blood pressure, biochemical factors and echocardiography. HAPH was defined as mean pulmonary artery pressure over30mmHg indicated by echocardiography. Data of 1130 subjects were analyzed who were free of polycythemia and cardiorespiratory diseases to determine the prevalence of HAPH and its predisposing factors. Results: The prevalence of HAPH was different in males and females (8.7% vs 4.6%,P = 0.033). Patients with hypertension are more likely to develop HAPH compared with normal blood pressure (9.6% vs 4.4%,P = 0.010). T-test analysis suggested that patients with HAPH had lower pulse oxygen saturation and estimated glomerular filtration rate. In addition, patients with HAPH have more significant metabolic abnormalities (including elevated blood pressure, blood glucose, triglyceride, low density lipoprotein cholesterol, uric acid, waist circumference, hip circumference, BMI. all p value &lt; 0.05), patients with HAPH have mildly increased RV, RA, and diameter of the main pulmonary artery. After stepwise multivariate logistic regression, it was suggested that age, hemoglobin level, and increased TG were independent risk factors for HAPH. Conclusions: It can be concluded that HAPH is prevalent in 5.8% of natives of Tibetan area in China. Increasing age, hemoglobin and triglyceride are independent predisposing factors.

The Impact of Obstructive Sleep Apnea-Hypopnea Syndrome on T-Lymphocyte Subgroups and Natural Killer Cell Activity in the Peripheral Blood of Children

Background: Obstructive sleep apnea-hypopnea syndrome (OSAHS) can impact multiple organ systems in children. Objectives: To investigate the effects of OSAHS on T-lymphocyte subgroups and natural killer (NK) cell activity in the peripheral blood of affected children. Methods: A total of 85 children with OSAHS were enrolled into an experimental group (OSAHS) and 76 healthy children were placed in a control group (CON) to compare peripheral blood levels of CD3+, CD4+, CD8+, and NK cell activity using flow cytometry. Meanwhile, their polysomnography results were monitored to analyze the correlation between T-lymphocyte subgroups/NK cell activity and lowest pulse oxygen saturation (LSaO2)/apnea-hypopnea index (AHI). Results: Compared to the CON group, the CD3+ percentage in the OSAHS group showed no significant difference (65.98 ± 6.54 vs 64.36 ± 5.32; P &gt; 0.05), but the CD4+ percentage, CD4+/CD8+ ratio, and NK cell activity decreased markedly (33.52 ± 3.04 vs 35.26 ± 3.68,1.29 ± 0.14 vs 1.43 ± 0.26, and 11.47 ± 4.58 vs 12.69 ± 2.36, respectively; P &lt; 0.05). In addition, the CD8+ percentage increased significantly (26.18 ± 4.76 vs 24.36 ± 2.32; P &lt; 0.05). Linear regression analysis indicated that the CD3+ percentage was not related to LSaO2/AHI (P &gt; 0.05), but the CD4+ and CD8+ percentages, CD4+/CD8+ ratio, and NK cell activity were linearly related to LSaO2 and AHI (P &lt; 0.05). Conclusions: OSAHS can affect the cellular immunity of children. The AHI and LSaO2 may be involved in cellular immunity function.

Critical Care Thresholds in Children with Bronchiolitis

Reduction in mortality from bronchiolitis in developed health is principally achieved from the availability of critical care. Different health care providers and countries demonstrate considerable variance in admission rates, but globally the use and cost of this resource are increasing. The reasons of this are multifold and include organizational, cultural, and clinical aspects. The organization of care has evolved differently in different health care settings at the threshold of critical need, with local priorities and resources determining the location of care (ward or critical care). Critical care areas adopting high-flow oxygen therapy (HFOT) (a ward-based therapy in some institutions) have seen significant increase in their occupancy, without change in rates of mechanical ventilation. Culturally, some countries appear to have a lower threshold for intubation and mechanical ventilation: United States (18%), Finland (4%), and even in countries with high rates of critical care admission (27% in Australia and New Zealand), intubation rates can decline with time (reducing from 27% to 11%). Baseline clinical characteristics of children admitted to critical care are remarkably similar, children are young (c30-60 days) and often born prematurely (21-46%). Clinical thresholds for admission as predefined by critical care units in online guidance focus on presence of apnea (observed in 7-42% of admissions), low pulse oxygen saturation and subjective measures (exhaustion and reduced consciousness). Clinical characteristics of children at the time of admission are commonly reported in relation to the modified Woods Clinical Asthma Score (mean = 3.8 to ≥7) and raised pCO2 (range = 8.0-8.8 kPa), with pCO2 the only significant parameter in a multivariate analysis of factors associated with intubation. KEY POINTS: · More children are being admitted to intensive care over time with increased costs.. · Cultural, organizational, and clinical variance exist between centers and countries.. · Comparing and aligning admissions is difficult as there are no standardized criteria..

Preliminary comparison of the efficacy of several surgical treatments based on maxillomandibular advancement procedures in adult patients with obstructive sleep apnoea: a systematic review and network meta-analysis.

To evaluate the efficacy of eight different surgical treatments based on maxillomandibular advancement (MMA), which has emerged in recent years, for adult obstructive sleep apnoea (OSA) patients. The literature was searched from January 2010 to May 2020 for studies of adult OSA patients with different types of MMA procedures to perform a network meta-analysis. The outcomes were changes in the apnoea-hypopnoea index (AHI), the lowest pulse oxygen saturation (SpO2 min) and the Epworth Sleepiness Scale (ESS). Treatment hierarchy was summarized according to the rank charts. Eight studies were included and encompassed a total of 227 adult patients diagnosed with OSA. Among them, 225 patients underwent combined surgery or simple MMA surgery, including modified maxillomandibular advancement (MMMA),counterclockwise maxillomandibular advancement (CMMA), drug-induced sleep endoscopy and maxillomandibular advancement (MMA + DISE), transoral robotic surgery and maxillomandibular advancement (MMA + TORS), uvulopalatopharyngoplasty (UPPP), maxillomandibular advancement and uvulopalatopharyngoplasty (MMA + UPPP), uvulopalatopharyngoplasty with uvula preservation and maxillomandibular advancement (MMA + HUPPP); MMA consisting of Le Fort I osteotomy and bilateral inverted-L osteotomy (ILOs), genioplasty and iliac bone grafting; and MMA consisting of Le Fort I osteotomy, bilateral sagittal split ramus osteotomies and genioplasty. The results showed that the most effective surgical treatment is MMA + HUPPP [-56.79 (WMD); 95% confidence interval (CI): -113.02 to -3.33] (P < 0.00001), which was far superior to other approaches. MMA combined with HUPPP had the highest efficacy. The MMA consisted of Le Fort I osteotomy, bilateral sagittal split ramus osteotomies and genioplasty; CMMA and MMA + TORS are likely also great choices.

The Association of Salivary Biomarkers With the Severity of Obstructive Sleep Apnea and Concomitant Hypertension

BackgroundWe aimed to assess the association between salivary alpha-amylase and salivary cortisol, and obstructive sleep apnea (OSA) severity. MethodsFifty-eight adults with suspected OSA were divided into the following 4 groups based on the apnea hypopnea index (AHI): control (AHI <5 events/hour), mild OSA (5 events/hour < AHI ≤15 events/hour), moderate OSA (15 events/hour < AHI ≤30 events/hour) and severe OSA (AHI >30 events/hour) groups. Salivary samples were collected after overnight polysomnography. Correlations between the salivary biomarkers and polysomnography parameters were analyzed. ResultsSalivary alpha-amylase levels of the moderate and severe OSA groups were significantly higher than those of the control and mild OSA groups, and no association was found between salivary cortisol and OSA severity. The salivary alpha-amylase levels were positively correlated with the AHI (r = 0.538; P < 0.01) and microarousal index (r = 0.541, P < 0.01), and negatively correlated with the lowest pulse oxygen saturation (r = −0.375, P < 0.01). Salivary cortisol levels were significantly higher in patients with hypertension than in those without hypertension (10.01 ± 2.77 ng/mL vs. 5.52 ± 1.90 ng/mL, P < 0.05), and the salivary alpha-amylase levels were highest in the OSA concomitant hypertension group (32.81 ± 11.85 U/mL). Areas under the receiver operator characteristic analysis revealed that the cutoff values of salivary alpha-amylase for identifying moderate-severe OSA and OSA concomitant hypertension were 17.64 U/mL (sensitivity 85%, specificity 91%) and 25.35 U/mL (sensitivity 70%, specificity 94%), respectively. ConclusionsSalivary alpha-amylase is positively associated with the severity of OSA and OSA concomitant hypertension.

Long noncoding RNA TUG1 promotes cardiac fibroblast transformation to myofibroblasts via miR‑29c in chronic hypoxia.

Cardiac fibroblast‑myofibroblast transformation(FMT) contributes to the fibrotic deterioration evoked by chronic hypoxia. Growing evidence implicates long noncoding RNAs (lncRNAs) in various types of cardiac physiological and pathological processes, especially in cardiac fibrosis. In the present study, the lncRNA Taurine Upregulated Gene1(TUG1), reported as a regulator of hypoxia fibrosis in the lungs, was found to also be an important regulator of cardiac FMT. Specifically, the possible role of TUG1 in cardiac FMT and fibrosis under chronic hypoxia was investigated. It was revealed that the degree of fibrosis in heart tissues collected from congenital heart surgery patients with low pulse oxygen saturation and mice housed under chronic hypoxic and atmospheric pressure conditions was negatively correlated with pulse oxygen saturation. Moreover, TUG1 expression was positively correlated with the degree of fibrosis but negatively correlated with pulse oxygen saturation. Cardiac fibroblasts showed increased myofibroblast marker, collagen I and α‑SMA expression levels as the hypoxia time increased. TUG1 knockdown ameliorated the hypoxia‑induced FMT. A bioinformatics analysis predicted that TUG1 had miR‑29c binding sites in its 3'‑UTR and miR‑29c is a key regulator of cardiac fibrosis. The present study demonstrated that TUG1, along with miR‑29c, may contribute to cardiac FMT activation and promote fibrosis in chronic hypoxia.

A comprehensive scoring system in correlation with perioperative airway management for neonatal Pierre Robin Sequence.

PurposeTo evaluate a comprehensive scoring system which combines clinical manifestations of Pierre Robin Sequence (PRS) including severity of breathing difficulties, body weight and preoperative Cormack-Lehane grade, for its correlation with perioperative PRS airway management decision.DesignForty PRS children were retrospectively recruited after surgery. Specialists examined all subjects and scored for clinical manifestations (1´ - 4´), weight gain (1´- 4´), dyspnea scores (1´- 4´), and Cormack-Lehane grade (1´- 4´). The correlation of the integrated scores and the necessity of endotracheal intubation or laryngeal mask application were analyzed. In addition, the score correlation with postoperative dyspnea and/or low pulse oxygen saturation (SPO2) levels after extubation was determined.FindingsIn our study every individual patient had a score from 0´ to 16´, while the higher in the numbers represented higher risk of breathing difficulty. All patients with comprehensive scores <10 points underwent endotracheal intubation successfully. Patients scoring 10–12 points had an intubation success rate of 47%, whereas all patients scored >13 points required a laryngeal mask assisted airway management and were considered to have difficult airways. Dyspnea after extubation and postoperative low SPO2 occurred among patients who scored over 10 points.ConclusionIn PRS patients, preoperative weight gaining status and severity of dyspnea in combination with Cormack-Lehane classification provide a scoring system that could help to optimize airway management decisions such as endotracheal intubation or laryngeal mask airway placement and has the potential to predict postoperative dyspnea or low SPO2 levels.