Mild Obstructive Sleep Apnea Hypopnea Syndrome Research Articles

#1543 Risk factors of obstructive sleep apnea-hypopnea syndrome in patients with chronic kidney disease

Abstract Background and Aims Both obstructive sleep apnea-hypopnea syndrome (OSAHS) and chronic kidney disease (CKD) are common disease. Patients with OSAHS were evidenced to have oxidative stress, increased albuminuria and renal injury. Previous reports show high prevalence of OSAHS among CKD patients, while its risk factors are hardly investigated. The objective of this study is to assess the risk factors of OSAHS in patients with CKD. Method We selected 181 patients with CKD who were hospitalized in department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital from September 2020 to February 2023. All participants underwent full-night standard nocturnal polysomnography (PSG) monitoring in the sleep center using Alice 4, 5 or 6 devices. An apnea hypopnea index (AHI)>5 events/h was consistent with the diagnosis of OSA. The 181 Patients are divided into three groups based on the level of AHI to studied the differences of clinical and biochemical characteristics. According to Kidney Disease Improving Global Outcomes (KDIGO) risk categories, all patients are divided into non very high risk and very high risk group, logistic regression is used for analyzing risk factors of OSAHS in patients with CKD. Results The prevalence of OSAHS was 86.7% (157 of 181), with 29.8% mild, 30.9% moderate and 25.9% severe respectively. The urea nitrogen (P=0.039) and cystatin C (P = 0.030) levels in patients of severe OSAHS group were significantly higher than those within non or mild OSAHS group. The eGFR in non or mild OSAHS group was significantly higher than moderate OSAHS group (P = 0.036). Pearson correlation analysis showed a significant negative correlation between AHI (p = 0.022), ODI (p = 0.033), and hypopnea index (p = 0.004) of sleep parameters and eGFR, while a significant positive correlation was found between LaSO2 (p = 0.005), MaSO2 (p = 0.030), and eGFR. Stepwise linear regression analysis showed that the hypopnea index was an independent risk factor for eGFR (p = 0.033, R2: 0.215), and CT90 was an independent risk factor for UACR (p < 0.001, R2: 0.105). Logistic regression analysis revealed that hypopnea index (OR = 1.058) was significantly correlated with very high risk in KDIGO risk categories (p < 0.05). Conclusion OSAHS is high prevalence in patients with CKD. Regression analysis shows that hypopnea index is not only an independent risk factor for eGFR but also a significant predictor associated with very high risk according to KDIGO risk category.

Correlation between serum leptin level and sleep monitoring indexes in patients with obstructive sleep apnea hypopnea syndrome and its predictive value: a cross-sectional analysis.

To investigate the association between serum leptin (LP) level and polysomnography (PSG) parameters in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A cross-sectional study was conducted. The data of subjects who underwent PSG at hospital between January 2021 and December 2022 were collected retrospectively, 220 participants were included. The subjects were categorized into simple snoring group (n = 45), mild OSAHS group (n = 63), moderate OSAHS group (n = 52), and severe OSAHS group (n = 60). The general characteristics, PSG indices, and serological indices were collected retrospectively. Pearson correlation analysis was used to observe the correlation between serum LP level and PSG parameters. The value of serum LP level in predicting OSAHS was analyzed by receiver operating characteristic curve. The serum LP level was positively correlated with micro-arousal count, micro-arousal index (MAI), high apnea hypopnea index, times of blood oxygen decreased by≥3% and time in saturation lower 90%, and negatively correlated with lowest nocturnal oxygen saturation and mean oxygen saturation (p < 0.05). The area under the curve (AUC) of serum LP level in predicting the occurrence of OSAHS was 0.8276 (95% CI: 0.7713-0.8839), and when the Youden index was 0.587, the sensitivity was 72.00%, and the specificity was 86.67% (p < 0.0001). In the population with high MAI, the AUC of serum LP level in predicting the occurrence of OSAHS was 0.8825 (95% CI: 0.7833-0.9817), and when the Youden index was 0.690, the sensitivity was 79.00% and the specificity was 90.00% (p < 0.0001). Serum LP level is associated with the severity of OSAHS. Serum LP level demonstrates a strong predictive value for the occurrence of OSAHS, particularly in population with high MAI.

Changes of Serum Adiponectin Level in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Its Relationship with Sleep Monitoring Indexes.

To observe the changes of serum adiponectin (AP) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and explore the correlation between serum AP and polysomnography (PSG) parameters in patients with OSAHS. The data of subjects who underwent PSG at the hospital between January 2021 and December 2022 were collected retrospectively and divided into simple snoring group (AHI < 5 times/h, n = 45), mild OSAHS group (5 ≤ AHI < 15 times/h, n = 63), moderate OSAHS group (15 ≤ AHI ≤ 30 times/h, n = 52), and severe OSAHS group (AHI > 30 times/h, n = 60). The general data, PSG indices, and serological indices of the subjects were collected and compared between groups. Pearson correlation analysis and partial correlation analysis were employed to examine the correlation between serum AP level and PSG parameters. Ordered logistic regression was employed to analyze the risk factors influencing the severity of OSAHS. The predictive capability of the serum AP level in determining the occurrence of OSAHS was assessed using ROC. The serum AP levels of subjects with different subtypes of PSG indicators were compared. In the simple snoring group, mild OSAHS group, moderate OSAHS group, and severe OSAHS group, there were statistically significant differences in microarousal count, MAI, AHI, times of blood oxygen decreased by ≥ 3%, L-SaO2, and TS90% among the 4 groups (P < 0.05). The level of serum AP was positively correlated with L-SaO2 and negatively correlated with the proportion of REM, microarousal count, MAI, AHI, times of blood oxygen decreased by ≥ 3%, TS90%, and LP (P < 0.05). High AHI was a risk factor affecting the severity of OSAHS (95% CI: 1.446-4.170). The AUC of serum AP level in diagnosing OSAHS was 0.906 (95% CI: 0.8601-0.9521), and when the Youden Index was 0.678, the sensitivity was 88.9%, and the specificity was 78.9% (P < 0.0001). In the population with a high microarousal count, high AHI, and high times of blood oxygen decreased by ≥ 3% and high TS90%, the serum AP level was lower than that in the low-level population (P < 0.05). In the population with high L-SaO2, the serum AP level was higher than that in low-level population (P < 0.05). The level of serum AP decreased with the increase of the disease severity of patients with OSAHS and demonstrates a significant predictive capability for the occurrence of OSAHS. Monitoring the level of serum AP can effectively forecast the risk of OSAHS. Furthermore, alterations in serum AP levels are associated with both hypoxemia and a heightened frequency of arousal in patients with OSAHS.

Clinical significance of elevated soluble T-cell immunoglobulin and mucin domain 1 and soluble P-selectin in individuals with obstructive sleep apnea-hypopnea syndrome.

To assess the serum concentrations of soluble T-cell immunoglobulin and mucin domain 1 (sTIM-1) and soluble P-selectin (sP-selectin) in individuals who had obstructive sleep apnea-hypopnea syndrome (OSAHS). Between December 2020 and November 2022, 134 participants from the Sleep Monitoring Center of the Branch Hospital of Huai'an First People's Hospital, Jiangsu, China, engaged in this cross-sectional study. Participants were categorized as mild OSAHS (n=19), moderate OSAHS (n=22), severe OSAHS (n=57), and non-OSAHS (n=36) groups. Serum levels of sTIM-1, sP-selectin, and interleukin (IL)-6, as well as baseline clinical characteristics and polysomnography outcomes were assessed in each participant. Compared to the non-OSAHS group, sTIM-1 and sP-selectin levels were considerably elevated in people who had moderate or severe OSAHS (all p<0.05), but there were no notable changes between those who had mild OSAHS and non-OSAHS participants (p>0.05). The sTIM-1 and sP-selectin levels showed positive associations with the apnea-hypopnea index, body mass index (BMI), and IL-6 levels (all p<0.001). While elevated sTIM-1 was independently related to OSAHS (odds ratio [OR]=1.134, p=0.001), sP-selectin was not associated with OSAHS after adjusting for BMI (OR=1.013, p=0.467). People with moderate or severe OSAHS had higher serum sTIM-1 and sP-selectin levels, and elevated sTIM-1 is an independently related factor for OSAHS.

Study on the Changes of Liver and Kidney Function-Related Indicators and Clinical Significance in Patients with OSAHS.

Purpose To study the changes of liver and kidney function-related indexes in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and analyze their clinical significance. Method Ninety OSAHS patients treated in our hospital from April 2019 to April 2021 were selected. According to the apnea-hypopnea Index (AHI), they were divided into mild OSAHS group (5 ≤ AHI < 15 times/h, 35 people), moderate OSAHS group (15 ≤ AHI < 30 times/h, 35 people), and severe OSAHS group (AHI ≥ 30 times/h, 20 people). In addition, 50 healthy people who underwent physical examination in our hospital at the same time were selected as the control group, and the liver and kidney function and polysomnography (PSG)-related indexes of the above subjects were detected, and the comparison between the groups was carried out. Result The serum BUN and SCR levels of the severe group were significantly higher than those of the moderate group, the moderate group had significantly higher levels than the mild group, and the mild group had significantly higher levels than the control group (P < 0.05). The blood AST level of the severe group was significantly lower than that of the moderate group, the moderate group had a significantly lower level than the mild group, and the mild group had a significantly lower level than the control group (P < 0.05). The blood ALT level of the severe group was significantly higher than that of the moderate group, the moderate group had significantly a higher level than the mild group, and the mild group had a significantly higher level than the control group (P < 0.05). The proportions of abnormal liver and kidney function in the control group, mild group, moderate group, and severe group were significantly different (P < 0.05). The AHI of the severe group was significantly higher than that of the moderate group, the moderate group had a higher value than the mild group, and the mild group had a higher value than the control group (P < 0.05). The ASpO2 and MSpO2 of the severe group were significantly lower than those of the moderate group, the moderate group had significantly lower values than the mild group, and the mild group had significantly lower values than the control group (P < 0.05). Spearman correlation analysis showed that the liver and kidney function indexes of OSAHS patients were significantly correlated with PSG indexes (P < 0.05). Conclusion Patients with OSAHS will have obvious liver and kidney dysfunction, and the monitoring of liver and kidney function in such patients should be strengthened. If abnormality occurs, early intervention is recommended.

Serum hepcidin and paraoxonase levels in patients with severe, moderate, and mild obstructive sleep apnea hypopnea syndrome (OSAS): A comparison between OSAS patients and simple snoring patients

ABSTRACT Objective To investigate the importance of hepcidin and paraoxonase in obstructive sleep apnea syndrome (OSAS). Methods Eighty-eight patients with sleep disorders were included and divided into four groups: simple snoring (SS), mild, moderate, and severe OSAS. All patients underwent polysomnography. The hepcidin and paraoxonase levels were examined and compared between the groups. Results There were significant differences between the four groups in terms of paraoxonase levels. In the SS group, the paraoxonase value was significantly higher than in the other three groups. In the analysis, Apnea Hypopnea Index (AHI) was negatively correlated with paraoxonase levels. Conclusion A significant difference was found between the OSAS groups with respect to paraoxonase enzyme, and a negative correlation with AHI was observed. Paraoxonase level could be used as a biomarker in OSAS. No significant data was found for hepcidin levels; therefore, hepcidin cannot be used as a biomarker in OSAS.

Evaluation of the Ocular Surface and Meibomian Gland in Obstructive Sleep Apnea Hypopnea Syndrome.

PurposeTo assess the ocular surface and meibomian gland (MG) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the effects of surgery for OSAHS on the ocular surface and MG.MethodsBased on the apnea hypopnea index (AHI), 21 patients with mild OSAHS (Group A, 5/h ≤ AHI < 15/h), 20 patients with moderate OSAHS (Group B, 15/h ≤ AHI < 30/h), 62 patients with severe OSAHS (Group C, AHI ≥ 30/h) were examined. The ocular surface and MG were evaluated using Keratograph 5M. In addition, detailed Ophthalmic examination including visual acuity, refraction, slit-lamp examination of the anterior segment, corneal fluorescein staining (CFS), ocular surface disease index (OSDI) scoring, Schirmer I test (SIT) and serum lipid measurement was performed. For OSAHS patients with dry eye syndrome (DES) who underwent uvulopalatopharyngoplasty for improving AHI, the conditions of the ocular surface and MG were compared before surgery and 3 months after surgery. Only the data of the right eyes were analyzed.ResultsThere were no significantly different in the OSDI score, tear meniscus height (TMH), or loss ratio of the lower eyelid (LRLE) among these groups. The first non-invasive tear film breakup time (fNIBUT), average non-invasive tear film breakup time (avNIBUT), bulbar redness index (BRI), lipid layer grading (LLG), CFS, plugged orifices and distortion in MG, the loss ratio of upper eyelid (LRUE), and the incidence of DES, floppy eyelid syndrome (FES) and meibomian gland dysfunction (MGD) showed significant differences between Groups A and C (p = 0.015, p = 0.018, p < 0.001, p = 0.022, p = 0.036, p = 0.007, p = 0.019, p = 0.017, p = 0.045, p = 0.013, and p = 0.029, respectively). The SIT in the Group A was significantly higher than in Group B (p = 0.025) and in Group C (p < 0.001). In the correlation analyses, the fNIBUT, avNIBUT, SIT and LLG had negative correlations with the AHI (p = 0.013, p = 0.010, p = 0.003, p < 0.001, and p = 0.006, respectively). The BRI, CFS and LRUE were positively correlated with the AHI (p = 0.006, p = 0.007, and p = 0.046, respectively). Three months after surgery, there were no significant differences in the ocular surface or MG.ConclusionPatients with severe OSAHS have poor stability of tear film and are prone to lipid-deficient dry eye as a result of the loss of meibomian gland. By improving the AHI, the ocular surface damage of OSAHS patients cannot be reversed in a short time.

White matter lesions are associated with obstructive sleep apnea hypopnea syndrome

ABSTRACT Background Study on the association of white matter lesions with obstructive sleep apnea hypopnea syndrome and its risk factors. Methods A recruited study with a sample of 172 patients from the department of neurology of the Third Affiliated Hospital of Southern Medical University between 2015 and 2019. Results According to the univariate analysis, the independent variables where P < 0.1 were included in the multivariate logistic regression model. After adjusting for confounding factors, the two-category logistic regression showed that Obstructive sleep apnea hypopnea syndrome (OSAHS) (OR = 8.347, 95%CI: 2.561 ~ 27.212, P < 0.001) were independent risk factors for WML, and that the prevalence of Cerebral white matter lesions (WML) increased with the severity of OSAHS (P = 0.002). In the non-OSAHS group, the mild OSAHS group, and the moderate-to-severe OSAHS group the apnea-hypopnea index (AHI) in the supine position was significantly higher than that in the left or right lateral position, showing a decreasing trend. The SaO2 < 90% total sleep time (TST SaO2 < 90%) showed an increasing trend, as did the body mass index. In the OSAHS severity groups, the AHI in the supine position was significantly higher than that in the left or right lateral position. Spearman correlation analysis showed that WML was positively related to AHI in the supine position (r = 0.209, P = 0.006). Conclusions OSAHS was an independent risk factor for WML. There was a positive relationship between WML and AHI in the supine position. Abbreviations AHI, apnea-hypopnea index; OSAHS, obstructive sleep apnea hypopnea syndrome; WML, white matter lesions; MRI, magnetic resonance imaging; BMI, body mass index; TSTSaO2 <90%, SaO2 <90% total sleep time; LSaO2, lowest oxygen saturation level; CI, confidence interval; OR, odds ratio

Influencing Factors of Daytime Sleepiness in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Its Correlation with Pulse Oxygen Decline Rate.

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.

The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial

BackgroundPediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia.MethodsA sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway.DiscussionThe results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS.Trial registrationClinicalTrials.gov: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).

P1281CLINICAL CHARACTERISTICS OF OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract Background and Aims To explore the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in maintenance hemodialysis patients. Method 42 patients with maintenance hemodialysis in our hemodialysis center from April 2019 to December 2019 were enrolled for night-time sleep breathing monitoring. The patients were divided into the OSAHS group(n=25) and the non-OSAHS group(n=17) defined by AHI. The OSAHS group was further divided into a mild group (n=14) and a moderate-severe group (n=11). The clinical datas, sleep breathing monitoring datas, and echocardiographic parameters of the OSAHS group and the non-OSAHS group, the mild OSAHS group, and the moderate-severe OSAHS group were compared. Results 1. There were no differences in gender, age, dialysis age, spKt / V, BMI, TBW, ECW, ICW, E / I ratio, Ca, P, HB, and diastolic blood pressure between the the OSAHS group and the non-OSAHS group. 2. Incidence of left ventricular concentric hypertrophy (84.0% VS 47.1%, P = 0.011), left ventricular wall thickness (12.0 VS 10.2, P = 0.029) and systolic blood pressure (147.0 ± 9.6 VS 139.4 ± 13.8, P = 0.041) ) in OSAHS group was significantly higher than the non-OSAHS group; 3: There was no statistical difference in serum carbon dioxide binding capacity (CO2CP) between the two groups (23.1 ± 2.7 VS 23.8 ± 2.6, P = 0.392), but the daily intake of sodium bicarbonate in the OSAHS group was higher than that of the non-OSAHS group (2.5 ± 1.0 VS 1.5 ± 0.5, P = 0.004); the CO2CP of the moderate-severe OSAHS group was lower than that of the mild group (21.7 ± 2.2 VS 24.2 ± 2.7, P = 0.019 ), the left ventricular wall thickness was significantly higher than the mild group (11.4 ± 1.4 VS 12.6 ± 1.1, P = 0.025). Conclusion Clinicians should pay attention to the early diagnosis and prevention of OSAHS in maintenance hemodialysis patients. Because the dialysis population is different from the general population of OSAHS patients, the serum CO2CP of this population is negatively correlated with the degree of OSAHS, and clinicians need to pay particular attention to the amount of sodium bicarbonate to correct acidosis.

Injury and Apoptosis in the Palatopharyngeal Muscle in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome.

BackgroundThis study aimed to elucidate the possible activity of the mitochondrial-mediated apoptotic pathway (MMAP) in obstructive sleep apnea-hypopnea syndrome (OSAHS).Material/MethodsA control group, a mild OSAHS group, a moderate OSAHS group, and a severe OSAHS group were included. Masson staining, hematoxylin and eosin staining, and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay were performed to assess collagen fiber hyperplasia, pathological morphology, and cell apoptosis, respectively, in muscle samples.ResultsIn the OSAHS groups, the palatopharyngeal muscle fibers were larger, with apparent hypertrophy and increased elastic fiber content. The proportions of type I fibers were markedly higher in the control group than in the moderate and severe OSAHS groups (P<0.05). Moreover, apoptosis was significantly enhanced in the muscle cells of the OSAHS groups. The Bax expression levels gradually increased across the 4 groups (lowest in the control group and highest in the severe OSAHS group) (P<0.05); conversely, the p38 and p62 expression levels did not significantly differ among groups (P>0.05).ConclusionsA decrease in the proportion of the different fiber types can result in collapse of the upper airway. The pathogenesis of OSAHS appears to involve muscle cell apoptosis via MMAP.

ApEn for assessing hypoxemia severity in obstructive sleep apnea hypopnea syndrome patients.

A new index, approximate entropy (ApEn) of oxygen saturation, was used to assess the severity of hypoxemia in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), determine the correlation with other parameters, and explore its clinical value. A retrospective analysis was performed on 1200 patients with OSAHS and snorers (normal control). All subjects underwent sleep apnea monitoring for 6 h. Subjects were divided into four subgroups by apnea-hypopnea index (AHI): normal control (AHI < 5), mild OSAHS (5 ≤ AHI < 15), moderate OSAHS (15 ≤ AHI < 30), and severe OSAHS 104 (AHI ≥ 30). ApEn was initially compared among the subgroups. Then a correlation analysis of AHI with ApEn and a correlation analysis of ApEn with oxygen desaturation index (ODI), lowest oxygen saturation (LO2), and T < 90% were performed. (2) The AHI was used as the gold standard, and an attempt was performed to determine the value of ApEn to assess the severity of hypoxemia in OSAHS. Among the 1200 subjects, 822 subjects were men (72%) and mean age was 53.2 ± 15.2 years (range 24-95 years). The ApEn in each group was significantly different (P <0.001), and the ApEn synchronously increased with AHI. Furthermore, a significant difference in ApEn was found among the groups (P <0.001). In addition, ApEn had a good correlation with ODI, LO2, and T <90%. According to the ROC analysis results, the boundary value of ApEn to judge OSAHS patients with mild, moderate, and severe hypoxia was 16.72, 17.84, and 20.06, respectively. ApEn synchronously increased with the AHI and had a good correlation with AHI, ODI, LO2, and T <90%. These findings suggest that ApEn may have clinical value for assessing hypoxia severity in OSAHS patients.

Association of diabetic nephropathy with the severity of obstructive sleep apnea-hypopnea syndrome in patients with type 2 diabetes mellitus.

This study aimed to analyze the effect of the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) on diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). A total of 322 patients with T2DM participated in this cross-sectional study. OSAHS was diagnosed according to the apnea-hypopnea index (AHI) and it was categorized as follows: normal, mild, moderate, and severe. Relevant clinical data retrieved from medical charts were cross-analyzed between different groups. The relationship between urinary albumin/creatinine ratio(UACR) and OSAHS parameters, which included AHI, lowest oxygen saturation (L-SaO2), and mean oxygen saturation (M-SaO2), was evaluated by partial correlation analysis. DN stages were classified into a non-DN group, a microalbuminuria group, and a macroalbuminuria group. Multiple factor logistic regression analysis was employed to analyze factors influencing DN. The results showed that mild OSAHS, moderate OSAHS, and severe OSAHS patients had a higher Body mass index (BMI), creatinine (CR) level, UACR, and a longer duration of T2DM (p < 0.05) than the non-OSAHS group. The prevalence of DN in the non-OSAHS, mild OSAHS, moderate OSAHS, and severe OSAHS groups was 18.4%, 19.2%, 34.6%, and 49.4%, respectively (p < 0.05). Multiple factor logistic regression analysis revealed that systolic blood pressure (SBP) (OR = 1.03), AHI (OR = 1.02), and duration of T2DM (OR = 1.04) were correlated with DN (p < 0.05). These findings revealed that OSAHS is highly prevalent in T2DM and AHI is independently associated with the presence of DN.

Влияние синдрома обструктивного апноэ/гипопноэ сна на экспрессию Е-кадгерина в эпителии пищевода

Aim: to evaluate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on E-cadherin expression and epithelium histoarchitectonics of the lower third of the esophagus. Patients and Methods: 108 patients were included in a cross-sectional comparative study. According to the results of somnology, a mild severity of OSAHS was diagnosed in 49 patients (group 1), an average severity — in 29 (group 2). Group 3 included 30 people without OSAHS. All patients underwent esophagogastroduodenoscopy with a biopsy of the lower third of the esophagus. Morphometrics of epithelial thickness, height of connective tissue papillae, and internuclear distances in all epithelial layers was performed. To assess the E-cadherin expression, immunohistochemistry was performed using monoclonal antibodies to E-cadherin. Results: in contrast to the comparison group, patients with mild and moderate OSAHS were characterized by a higher epithelium thickness (273 (228; 372), 360 (312; 411), 186 (168; 192) μm, respectively, р1–3=0.000, р2–3=0.000), higher connective tissue papillae (108 (96; 120), 144 (120; 228), 72 (60; 84) μm, respectively, р1–3=0,001, р2–3=0,000), and larger internuclear distances in superficial layer (9 (7; 10), 8 (7; 9), 6 (5; 7) μm, respectively, р1–3=0.000, р2–3=0.002), spinous layer (8 (6; 9), 8 (7; 8), 6 (5; 7) μm, respectively, р1–3=0.000, р2–3=0.000), basal layer (4 (3; 5), 3 (3; 4), 2 (2; 3) μm, respectively, р1–3=0.000, р2–3=0,001) of epithelium. E-cadherin expression decreased in patients with both mild OSAHS (0.748 (0.623; 0.833) and 0.539 (0.263; 0.676), respectively, p=0.044) and moderate OSAHS (0.748 (0.623; 0.833) and 0.163 (0.026; 0.365), respectively, p=0.000) versus the comparison group. Correlations were found between respiratory monitoring indicators and E-cadherin expression in the esophageal epithelium. Conclusion: OSAHS negatively affects the lining condition of the lower third of the esophagus, contributes to the loss of E-cadherin, which creates conditions for disorganization of epithelial tissue and increases the risk of precancerous diseases and esophageal cancer. KEYWORDS: obstructive sleep apnea-hypopnea syndrome, E-cadherin, esophageal epithelium, histoarchitectonics, epithelial-mesenchymal transition, intermittent hypoxia, apnea-hypopnea index. FOR CITATION: Shelkovich Yu.Ya. Effect of obstructive sleep apnea-hypopnea syndrome on E-cadherin expression in esophageal epithelium. Russian Medical Inquiry. 2020;4(5):268–273. DOI: 10.32364/2587-6821-2020-4-5-268-273.

Elderly hypertension patients with obstructive sleep apnea syndrome and heart rate and blood pressure variability and the intervention effects of home-based continuous positive airway pressure therapy

Objective To study the correlation of the degree of sleep apnea with arrhythmia, heart rate variability(HRV)and blood pressure variability(BPV)in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS), and to investigate the intervention effects of home-based continuous positive airway pressure(CPAP)treatment. Methods A total of 122 elderly hypertension patients with OSAHS were recruited in the prospective study.Patients were divided into three groups according to the sleep apnea hypopnea index(apnea hypopnea index, AHI): the mild OSAHS group(5 times/h≤AHI≤15 times/h, n=42), moderate OSAHS group(15 times/h 30 times/h, n=40). All patients took ambulatory electrocardiogram and ambulatory blood pressure examinations before and after three months of CPAP treatment.The incidences of arrhythmia, HRV and BPV indexes of each group before and after CPAP treatment were compared between the groups. Results The incidences of premature atrial contraction, atrial tachycardia and premature ventricular beats were higher in the moderate and severe OSAHS groups than in the mild OSAHS group(P<0.01). Compared with the mild OSAHS group, the RR interval standard deviation(SDNN), root mean square of successive differences(rMSSD), proportion of patients with consecutive RR-interval differences greater than 50 ms(PNN5), standard deviation of the averaged normal RR intervals for all 5 min segments and deceleration capacity of rate increased in the moderate and severe OSAHS groups(P<0.05), and the increases were more obvious in the severe group.Compared with the mild OSAHS group, the standard deviation of 24-h systolic blood pressure, standard deviation of 24-h diastolic blood pressure, standard deviation of daytime systolic blood pressure, standard deviation of nighttime systolic blood pressure and incidence of non-dipper hypertension increased in the moderate and severe OSAHS groups(P<0.05), with the increases were more obvious in the severe group, and the differences was significant between the moderate and severe OSAHS groups(P<0.05). HRV and BPV indicators improved except for high frequency(HF)/low frequency(LF)in all groups(P<0.05)after home treatment of CPAP, and the improvement was more obvious in the severe group.The incidence of non-dipper circadian rhythm of blood pressure improved more significantly in the severe OSAHS group than in the moderate OSAHS group. Conclusions With aggravated sleep apnea, the incidences of arrhythmias such as premature atrial contraction, atrial tachycardia, and premature ventricular contraction are increased and the HRV and BPV are enlarged in elderly hypertension patients complicated with OSAHS.The home treatment of CPAP can improve the above indicators, and it is an effective way to treat OSAHS complicated by hypertension in elderly patients. Key words: Hypertension; Sleep apnea, obstructive; Intermittent pressure ventilation

The No-apnea score vs. the other five questionnaires in screening for obstructive sleep apnea-hypopnea syndrome in patients with cerebral infarction.

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.

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

The main purpose of this study was to assess the reliability and validity of the simplified Chinese STOP-BANG Questionnaire (SBQ) as a diagnosing and screening tool for obstructive sleep apnea hypopnea syndrome (OSAHS). Two hundred and ten patients with suspected OSAHS were recruited in this study. The simplified Chinese SBQ was completed twice before and after polysomnography (PSG) monitoring. SPSS 20.0 was used to analyze the test-retest reliability, discriminant validity, comparative validity and predictive validity of the SBQ. Fourteen patients were excluded on account of fragmentary data, and valid 196 were divided into four groups: non-OSAHS group (n=28, 14.29%), mild OSAHS group (n=28, 14.29%), moderate OSAHS group (n=31, 15.81%) and severe OSAHS group (n=109, 55.61%). The test-retest coefficient for the first four items was 0.810, 0.679, 0.775, 0.963 respectively and the total score of the STOP questionnaire was 0.854. The analysis of discriminant validity revealed that there were significant differences among four groups in the total score of the SBQ and scores of item 1, 3, 7 and 8, which were also validated between patients with normal blood oxygen saturation and different degrees of hypoxemia. The SBQ evaluation showed low consistency with diagnostic gold standard PSG (κ=0.303, P<0.05). When taking apnea hypopnea index (AHI) ≥5/h, ≥15/h and ≥30/h as cut-offs to evaluate the SBQ predictive value, the areas under ROC curve were 0.77, 0.81 and 0.78, the sensitivity was 90.48%, 93.57% and 93.33%, and corresponding negative predictive values were 40.74%, 66.67% and 85.19%, respectively. It was suggested that the simplified Chinese version of SBQ had good reliability, and could distinguish the severity of OSAHS. Despite its limited diagnostic accuracy, the SBQ can be considered as an ideal tool for screening OSAHS with superior predictive validity.

Effect of HCO3- level on the accuracy of NoSAS screening for obstructive sleep apnea hypopnea syndrome

Objective: To evaluate the effect of arterial blood HCO3- level on the accuracy of NoSAS questionnaire screening for obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: The hospitalized patients with suspected OSAHS were recruited from March 2016 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. NoSAS scores, blood gas analysis and polysomnography (PSG) were performed in these patients. Patients were divided into non OSAHS group and mild, moderate and severe OSAHS group according to the PSG results. According to the NoSAS questionnaire score, the patients were divided into OSAHS high-risk group and low risk group. The correlation between arterial blood HCO3- level and apnea hypopnea index (AHI) was analyzed. The receiver operating characteristic (ROC) curve was plotted to analyze the accuracy of HCO3- prediction OSAHS. Predictive parameters(sensitivity, specificity, positive and negative predictive values)for NoSAS scores and HCO3- level were calculated. Results: A total of 243 patients with suspected OSAHS were included, including 186 males (76.5%), 57 females (23.5%), age (49±13) years, body mass index (BMI) (26.9±4.4) kg/m2, and neck circumference (38.6±4.5) cm. The HCO3- level was positively correlated with AHI (r=0.206, P=0.001). The proportion of patients with HCO3- level ≥26 mmol/L in non-OSAHS group was lower than that in OSAHS group (13.0% vs 34.5%, P=0.004); the proportion of patients with HCO3- level ≥26 mmol/L in severe OSAHS group was higher than that in mild OSAHS group (37.7% vs 15.0%, P=0.008), and there was no difference in the ratio of patients with severe OSAHS and moderate OSAHS (37.7% vs 35.3%, P=0.767). The specificity of OSAHS predicted by HCO3- level 25 and 26 mmol/L was 69.6% and 87.0%, respectively. With the NoSAS score of 8 or 7 as cutoffs for analysis, the sensitivity for OSAHS was 61.9% and 79.2%, the specificity for OSAHS was 57.4% and 40.4%, respectively. With the addition of HCO3- level ≥ 26 mmol/L to the NoSAS score ≥ 7, the specificity for OSAHS improved to 93.6%, while the sensitivity decreased to 27.4%. Conclusion: Combined with the arterial blood HCO3- level, the specificity of the NoSAS questionnaire increases and the sensitivity decreases.

Homocysteine level in patients with obstructive sleep apnea/hypopnea syndrome and the impact of continuous positive airway pressure treatment.

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.