Obstructive Sleep Apnea-hypopnea Syndrome Group Research Articles

A mandibular advancement device attenuates the abnormal morphology and function of mitochondria from the genioglossus in obstructive sleep apnea-hypopnea syndrome rabbits.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a serious and potentially life-threatening disease. Mandibular advancement device (MAD) has the characteristics of non-invasive, comfortable, portable and low-cost, making it the preferred treatment for mild-to-moderate OSAHS. Our previous studies found that abnormal contractility and fibre type distribution of the genioglossus could be caused by OSAHS. However, whether the mitochondria participate in these tissue changes is unclear. The effect of MAD treatment on the mitochondria of the genioglossus in OSAHS is also uncertain. To examine the morphology and function of mitochondria from the genioglossus in a rabbit model of obstructive sleep apnea-hypopnea syndrome (OSAHS), as well as these factors after insertion of a mandibular advancement device (MAD). Thirty male New Zealand white rabbits were randomised into three groups: control, OSAHS and MAD, with 10 rabbits in each group. Animals in Group OSAHS and Group MAD were induced to develop OSAHS by injection of gel into the submucosal muscular layer of the soft palate. The rabbits in Group MAD were fitted with a MAD. The animals in the control group were not treated. Further, polysomnography (PSG) and cone-beam computed tomography (CBCT) scan were used to measure MAD effectiveness. CBCT of the upper airway and PSG suggested that MAD was effective. Rabbits in the three groups were induced to sleep for 4-6 h per day for eight consecutive weeks. The genioglossus was harvested and detected by optical microscopy and transmission electron microscopy. The mitochondrial membrane potential was determined by laser confocal microscopy and flow cytometry. Mitochondrial complex I and IV activities were detected by mitochondrial complex assay kits. OSAHS-like symptoms were induced successfully in Group OSAHS and rescued by MAD treatment. The relative values of the mitochondrial membrane potential, mitochondrial complex I activity and complex IV activity were significantly lower in Group OSAHS than in the control group; however, there was no significant difference between Group MAD and the control group. The OSAHS-induced injury and the dysfunctional mitochondria of the genioglossus muscle were reduced by MAD treatment. Damaged mitochondrial structure and function were induced by OSAHS and could be attenuated by MAD treatment.

Effect of fractional exhaled carbon monoxide on patients with sleep apnea-hypopnea syndrome and its mechanism.

Sleep-disordered breathing (SDB) is a common sleep disorder as-sociated with chronic airway inflammation and lung function impairment. This article aimed to investigate the fractional exhaled carbon monoxide (FeCO) expression level in obstructive sleep apnea-hypopnea syndrome (OSAHS) and its correlation with disease indicators. Subjects with OSAHS, asthma, chronic obstructive pulmonary disease (COPD), and healthy subjects were selected to collect clinical data. FeCO concentration, eosinophil (Eos), erythrocyte sed-imentation rate (ESR), C-reactive protein (CRP), FEV1, and FEV1/FVC were measured. The Pearson correlation coefficient and receiver operating charac-teristic (ROC) curve were used for statistical analysis. The FeCO concentra-tion, Eos count, ESR and CRP levels, and lung function in the OSAHS group were higher than the healthy and COPD groups (p<0.05) and slightly lower than the asthma group. FeCO was positively correlated with Eos, ESR, and CRP (p<0.05), but there was no apparent correlation between FeCO and lung func-tion. FeCO has a high sensitivity and specificity in the diagnosis of OSAHS. There is chronic airway inflammation and systemic inflammation in patients with OSAHS. Lung function impairment in patients with OSAHS is mild, but some limitations remain. FeCO may be an auxiliary diagnostic index particu-larly valuable in diagnosing OSAHS.

Association between mean platelet volume and obstructive sleep apnea-hypopnea syndrome: A systemic review and meta-analysis.

Despite polysomnography (PSG) being acknowledged being considered the gold standard for diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS), researchers have been seeking a biomarker that is less invasive, more practical in detection, and cost-effective for diagnosing and assessing the severity of the disease. To address this concern, the values of mean platelet volume (MPV) between patients with OSAHS and healthy controls were compared, and the relationship between MPV and multiple sleep monitoring parameters was analyzed in this study. A comprehensive search was conducted across medical databases, including PubMed, Web of Science, EMBASE, CNKI, and Wanfang, up until August 2, 2023, to identify published articles related to OSAHS. This study reviewed the literature regarding the values of MPV in individuals with OSAHS and control groups, the Pearson/Spearman correlation coefficients between MPV and sleep monitoring parameters, and the odds ratios (OR) of MPV concerning the occurrence of cardiovascular diseases (CVDs) in patients with OSAHS. Meta-analyses were performed using standardized mean difference (SMD), Fisher's z values correlation coefficients (ZCOR) and odds ratio (OR) as effect variables. A fixed-effect model was used if the heterogeneity was not significant (I2<50%); otherwise, a random-effect model was applied. We will also combine the treatment effect estimates of individual trials using fixed-effect and random-effects models. Statistical analysis was carried out by employing STATA 11.0 and R 4.1.3. In total, 31 articles were selected for the final analysis. The study involved 3604 patients and 1165 control individuals. The MPV in the OSAHS group was considerably elevated in comparison to the healthy controls (SMD = 0.37, 95%CI = 0.21-0.53, P < 0.001), particularly among individuals with severe OSAHS (SMD = 0.57, 95%CI = 0.23-0.90, P = 0.001). Subgroup analysis based on ethnicity, mean body mass index (BMI), and study design type also revealed a considerably higher MPV in the OSAHS category in comparison to the healthy controls. Furthermore, MPV showed correlations with various sleep monitoring parameters. The elevation of MPV may be one of the risk factors for CVDs in individuals with OSAHS (adjusted OR = 1.72, 95%CI = 1.08-2.73, P = 0.022). MPV is a relatively simple, cost-effective, and practical indicator of the severity of OSAHS, with its values being linked to the risk of CVDs in individuals with OSAHS.

Evaluation of nocturnal apnea and airflow limitation as indicators for cognitive dysfunction in patients with chronic obstructive pulmonary disease/obstructive sleep apnea hypopnea syndrome overlap syndrome.

The aim of this study is to investigate how much intermittent hypoxemia and airflow limitation contribute to cognitive impairment in overlap syndrome (OS), which is the coexistence of two common diseases, obstructive sleep apnea hypopnea syndrome (OSAHS) and chronic obstructive pulmonary disease (COPD). We conducted a cross-sectional study of patients with OSAHS, COPD or OS, compared with normal controls, to determine the association between sleep apnea/pulmonary function-related indicators and cognitive dysfunction in individuals with OSAHS, COPD or OS. A total of 157 participants were recruited. Both OSAHS and OS presented lower adjusted Montreal cognitive assessment (MoCA) scores compared with COPD group. In addition, the MoCA score was significantly lower in COPD group compared with control group. The incidence of cognitive impairment was 57.4% in OSAHS group, and 78% in OS group, which were significantly higher than COPD group (29%) and control group (8.8%). Furthermore, a broader range of cognitive domains were affected in OS group compared with OSAHS group. Elevated levels of oxygen desaturation index (ODI) and/or apnea hypopnea index (AHI) were positively correlated with increased Epworth sleeping scale (ESS) in OSAHS and OS. Forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and peak expiratory flow (PEF) were positively correlated with cognitive scores in OSAHS but not in OS. Serum level of hypoxia-inducible factor-1α (HIF-1α) was significantly higher in OS. Logistic regression identified ODI as an independent risk factor for cognitive impairment in OS, while severity of snoring and PEF were independent risk factors in OSAHS. This study revealed significant cognitive impairment in OS, OSAHS and COPD. Sleep-related indicators are warranted in OS patients for detection, differentiation and grading of cognitive impairment, whereas pulmonary functions are warranted in OSAHS patients for detection and early intervention of cognitive impairment.

Relationship between obstructive sleep apnea-hypopnea syndrome and osteoporosis adults: A systematic review and meta-analysis.

This study is undertaken to explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and osteoporosis, including the relationship between OSAHS and osteoporosis incidence, lumbar spine bone mineral density (BMD), and lumbar spine T-score. Cochrane Library, PubMed, Embase, Web of Science, and other databases are searched from their establishment to April 2022. Literature published in 4 databases on the correlation between OSAHS and osteoporosis,lumbar spine BMD,lumbar spine T-score is collected. Review Manager 5.4 software is used for meta-analysis. A total of 15 articles are selected, including 113082 subjects. Compared with the control group, the OSAHS group has a higher incidence of osteoporosis (OR = 2.03, 95% CI: 1.26~3.27, Z = 2.90, P = 0.004), the lumbar spine BMD is significantly lower (MD = -0.05, 95% CI: -0.08~-0.02, Z = 3.07, P = 0.002), and the lumbar spine T-score is significantly decreased (MD = -0.47, 95% CI: -0.79~-0.14, Z = 2.83, P = 0. 005). Compared with the control group, the OSAHS group has a higher incidence of osteoporosis and decreased lumbar spine BMD and T-score. In order to reduce the risk of osteoporosis, attention should be paid to the treatment and management of adult OSAHS, and active sleep intervention should be carried out.

Changing Effects of Minimally Invasive Surgical Intervention on ALT, AST, and UA in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome.

Background This study aims at exploring the effect of obstructive sleep apnea–hypopnea syndrome (OSAHS) on the liver and kidney function indexes of patients and analyze the changes in these indexes after minimally invasive surgery. Method Patients with OSAHS (n = 51) who were diagnosed via polysomnography (PSG) and received minimally invasive surgery in the sleep disorders diagnosis and treatment center of the West China Fourth Hospital of Sichuan University from January 2017 to January 2019 were selected as test subjects and placed in the OSAHS group. At the same time, 79 healthy people with no snoring or breathing difficulties were selected from the medical examination center of the hospital as the control group (tested as normal by PSG). These two groups were used to compare the differences in the related indexes of serum liver and kidney function and evaluate the changes in sleep monitoring and related liver and kidney function indexes in patients with OSAHS after minimally invasive surgery. Results The alanine aminotransferase (ALT), aspartate aminotransferase (AST), and uric acid (UA) levels were higher in the OSAHS group (48.98 ± 36.34, 28.88 ± 14.80, and 422.30 ± 98.65, respectively) than in the control group (21.91 ± 11.61, 22.18 ± 6.19, and 330.49 ± 64.45 and t = 6.514, 3.549, and 6.373, respectively; p < 0.05). Of the patients with OSAHS, 17 were followed up for one year. After minimally invasive surgery, ALT decreased from 44.29 ± 20.61 to 26.47 ± 9.91 (t = 4.395), AST decreased from 27.71 ± 8.32 to 21.82 ± 4.81 (t = 3.673), and UA decreased from 397.35 ± 92.14 umol/L to 362.94 ± 106.76 umol/L (t = 2.580), and these differences were statistically significant (p < 0.05).The changes in ALT (r = −0.635) and AST (r = −0.504) were related to the difference in the lowest blood oxygen saturation (p < 0.05), and the change in UA was related to the difference in the apnea–hypopnea index (r = −0.532, p < 0.05). Conclusion There are some abnormalities in liver- and kidney-function-related indexes in patients with OSAHS, and minimally invasive surgery can help to improve liver and kidney function in these patients.

Research on the Association Between Obstructive Sleep Apnea Hypopnea Syndrome Complicated With Coronary Heart Disease and Inflammatory Factors, Glycolipid Metabolism, Obesity, and Insulin Resistance

The aim of this study is to explore the association between obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with coronary heart disease (CHD) and inflammatory factors, glycolipid metabolism, obesity, and insulin resistance. A total of 400 patients diagnosed with OSAHS who underwent polysomnography (PSG) monitoring in the Sleep Diagnosis and Treatment Center of Beijing Luhe Hospital from March 2015 to September 2018 were selected and divided into the OSAHS group (n = 200) and the OSAHS + CHD group (n = 200) according to disease condition. The questionnaire survey was conducted, the somatology indexes were measured, and the PSG, insulin, glycolipid metabolism parameters, and serum inflammatory factors were detected. Body weight, body mass index, waist circumference, and Epworth sleepiness scale (ESS) score were all significantly increased in the OSAHS + CHD group compared with those in the OSAHS group (p < 0.05). The microarousal index (MAI), apnea hypopnea index (AHI), cumulative percentage of time spent at oxygen saturation below 90% (CT90%), oxygen desaturation index (ODI), lowest oxygen saturation (LSaO2), total apnea time (TAT), and mean oxygen saturation (MSaO2) had statistically significant differences between the OSAHS + CHD group and the OSAHS group (p < 0.05). According to the Spearman correlation analysis of AHI, LSaO2, MSaO2, CT90%, ODI, and MAI with HOMA-IR in both groups, MAI, AHI, CT90%, and ODI were positively correlated with HOMA-IR (r > 0), while LSaO2 and MSaO2 were negatively correlated with HOMA-IR (r < 0). Compared with the OSAHS group, the OSAHS + CHD group had an obviously increased level of triglyceride (TG) (p < 0.05), and obviously increased levels of serum inflammatory factors C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interferon-γ (IFN-γ) (p < 0.05). The occurrence of OSAHS complicated with CHD is related to inflammatory factors, glycolipid metabolism, obesity rate, and HOMA-IR.

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.

The signal axis GATA2-EDN1-AGT induced hypertension from obstructive sleep apnea-hypopnea syndrome with the clinical and animal study

Hypertension occurred in 50% obstructive sleep apnea-hypopnea syndrome (OSAHS) patients meanwhile OSAHS occurred in 30% hypertension patients. The present study aimed to explore the molecular mechanism of GATA2-EDN1-AGT induced hypertension in the development of obstructive sleep apnea-hypopnea syndrome. OSAHS patients (56 cases: 36 cases of male, 20 cases of female, 42~60 years old) were divided into two groups (case group: patients with hypertension monitored by 24 h ambulatory blood pressure and polysomnography; control group: patients without hypertension). Wistar rats were used to establish the OSAHS model (narrow pharyngeal cavity). PaO2 and PaCO2 of patients and rats were measured by an automatic blood gas analyzer. The profile of total protein in the OSAHS group and normal group was evaluated. Protein-protein-interaction (PPI) was carried out to show all matter proteins related. The levels of EDN-1, AGTII and atrial natriuretic peptide (ANP) in blood samples of patients and rats were analyzed by enzyme-linked immunosorbent assay (ELISA). The expression of GATA2, EDN1, endothelin-converting enzyme 1 (ECE-1) and AGTⅡ was measured. The results showed that SaO2 and AHI were positively associated with systolic pressure (P&lt;0.05) in OSAHS patients. There was no correlation among other indexes (P&gt;0.05). It was also observed that GATA2 had a strong relationship with AGTⅡ and EDN1. The results of ELISA presented that the levels of EDN1, AGTⅡ and ANP in the OSAHS group of human and animal models were significantly increased (P&lt;0.05). The results of immunochemistry showed that the expression of GATA2 and AGTⅡ in the vascular of OSAHS group was upregulated manifestly (P&lt;0.05). It was concluded that OSAHS can induce AHI, which increases hypertension via the GATA2-EDN1-AGT Ⅱ axis.

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

The differences in plasma/serum ghrelin levels between obstructive sleep apnea-hypopnea patients and controls: A protocol for systematic review and meta-analysis.

Background:The association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and plasma/serum ghrelin levels remains controversial. We performed a meta-analysis to evaluate the difference in plasma/serum ghrelin levels between OSAHS patients and controls.Methods:Database of PubMed, SCI, and Elsevier were searched entirely. Two independents identified eligible studies of ghrelin levels in OSAHS patients. ReviewManager (version 5.3) was adopted for data synthesis.Results:The meta-analysis A pooled the comparison of ghrelin concentrations in OSAHS patients and controls, which included 7 studies and involving 446 participants. The result of the meta-analysis A indicated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group (standard mean difference (SMD) = 0.08, 95% confidence interval (CI) = −0.12 to 0.28, P = .43). As a supplementary, meta-analysis B pooled the comparison of plasma/serum ghrelin levels in OSAHS patients before and after continuous positive airway pressure (CPAP) therapy, which included 155 participants from 4 studies, it revealed that plasma/serum ghrelin levels were no significant differences between before and after CPAP therapy (SMD = 0.12, 95%CI = −0.07 to 0.31, P = .22).Conclusion:The meta-analysis A demonstrated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group. The meta-analysis B showed plasma/serum ghrelin levels have no significant changes after CPAP therapy in OSAHS patients.

The differences of carotid atherosclerosis among non-OSAHS and OSAHS patients of different severities: a cross-sectional study.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a widely prevalent problem with many complications, such as hypertension and cerebral vascular diseases. Atherosclerosis, whose most severe outcome is ischemic stroke, is reported being affected by OSAHS. The objective of this article is to investigate the differences of carotid atherosclerosis patients with or without OSAHS by a cross-sectional research. Patients diagnosed with carotid atherosclerosis by ultrasonography were recruited. They were requested to fill the primary screening OSAHS questionnaire. Patients with high tendency ofOSAHS underwent polysomnography (PSG) tests into OSAHS group, and patients without OSAHS were into non-OSAHS group. Blood tests and medical history were collected. Carotid atherosclerosis severity was analyzed by carotid artery intima-media thickness (IMT), carotid plaque, blood flow velocity, etc. Differences between the two groups and subgroups were analyzed. A total of 242 carotid atherosclerosis patients were enrolled including 118 non-OSAHS patients (38 males and 80 females) and 124 OSAHS patients (40 mild, 32 moderate, and 52 severe). Significant differences were found in PSV-ICA and EDV-ICA on both sides (p < 0.05) but no significant differences on IMT and velocity of CCV. CA patients with OSAHS were younger than ones without OSAHS. With the severity of OSAHS increasing, the age of CA patients decreased. The more severity of OSAHS, the younger the patients were. There were no significant differences in comparing cholesterol, triglyceride, HDL, LDL, and glucose. As far as CIMT, carotid plaque, blood flow velocity, and blood lipid are concerned, the severity of CA is not affected by the severity of OSAHS accordantly. The relationship between OSAHS and CA may not be dose dependent. This study has been registered on clinical trials (No. NCT03665818).

Serum periostin and TNF-α levels in patients with obstructive sleep apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) may cause pulmonary diseases, and periostin plays an important role on the development of pulmonary diseases. In addition, periostin and pro-inflammatory cytokine TNF-α can regulate each other in vivo. This study aimed to observe the changes of serum periostin and TNF-α levels in patients with OSAHS compared with healthy volunteers and to investigate their correlation. A convenience sample of 67 patients with OSAHS in our hospital from December 2018 to December 2019 was selected and categorized into mild, moderate, and severe groups according to apnea-hypopnea index by polysomnography. In addition, 21 healthy volunteers were selected as the control group. Serum levels of periostin and TNF-α were determined by enzyme-linked immunosorbent assay (ELISA). Results were analyzed using the SPSS software. Both serum periostin and TNF-α levels in all the three OSAHS groups were higher than those of the control group and increased with severity of OSAHS. The severe group had significantly higher serum periostin and TNF-α levels than the mild and moderate groups (p < 0.05). For patients with OSAHS, serum periostin and TNF-α levels positively correlated with the apnea-hypopnea index (AHI) (p < 0.01) and negatively correlated with the lowest saturation oxygen (LSaO2) and mean saturation oxygen (MSaO2) (both p < 0.01). In addition, there was a positive correlation between serum periostin and TNF-α levels in patients with OSAHS (p < 0.001). Serum periostin and TNF-α levels were significantly increased in patients with OSAHS and may serve as a potential biomarker for severity of OSAHS. These findings suggest that it may be fruitful to study the role of periostin and TNF-α in OSAHS-induced pulmonary diseases.

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.

Clinical Characteristics of Aldosterone Producing Adenoma and Idiopathic Hyperaldosteronism with Obstructive Sleep Apnea Hypopnea Syndrome

To investigate the clinical characteristics of aldosterone producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of OSAHS on renin-angiotensin-aldosterone system (RAAS) in APA and IHA patients. The clinical data of 127 patients with primary aldosteronism (PA) diagnosed from May 2010 to Aug. 2019 were retrospectively analyzed. There were 70 cases of APA, 53 cases of IHA. Another 4 cases were primary adrenal hyperplasia (PAH), so not included into further analysis. According to the results of polysomnography, the 123 patients of APA or IHA were divided into OSAHS group (96 cases) and non-OSAHS group (27 cases ). The patients with OSAHS were divided into mild, moderate and severe subgroups based on apnea hypopnea index (AHI).The clinical characteristics, biochemical parameters, plasma renin activity, aldosterone levels, and the ratio of aldosterone to renin activity (ARR) in the patients of APA and IHA complicated with OSAHS were compared with those of the patients without OSAHS. There were 49 OSAHS cases (49/70, 70.0%) in APA patients. and 47 OSAHS cases (47/53, 88.7%) in IHA patients. The age, male ratio, body mass index (BMI), waist circumference, triglyceride, blood uric acid, and blood creatinine in APA patients with OSAHS were higher than those in APA patients without OSAHS ( P<0.05), while high-density lipoprotein and estimated glomerular filtration rate (eGFR) were lower ( P<0.05). Compared to the patients without OSAHS, IHA-OSAHS patients had higher BMI and waist circumference ( P<0.05). Moderate/severe OSAHS-APA patients exhibited higher plasma renin activity levels and lower ARR values than the APA patients with no/mild OSAHS ( P<0.05). There were no significant differences in plasma renin activity, aldosterone levels, and ARR values between moderate/severe OSAHS-IHA group and no/mild OSAHS-IHA group. The prevalence of OSAHS is significantly higher in the patients with PA than normal population, and OSAHS may aggravate glycose, lipid and uric acid metabolism in PA patients. Moderate/severe OSAHS can increase renin levels and decrease ARR values in APA patients, but has no significant effect on RAAS in IHA patients.

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Although considerable research highlights the interactions between obstructive sleep apnea-hypopnea syndrome (OSAHS) and cardiovascular diseases, the effect of mandibular advancement device (MAD) treatment on cardiovascular complications in OSAHS patients remains unclear. We evaluated the effect of OSAHS treatment with MADs on the myocardium. All methods in this study were in accordance with relevant guidelines and regulations of the medical ethics committee in Hospital of Stomatology, Hebei Medical University approved the work. Thirty New Zealand rabbits were randomized into three groups: the control group, Group OSAHS, and Group MAD. Hydrophilic polyacrylamide gel was injected into the soft palate of the rabbits to induce OSAHS. In Group MAD, a MAD was positioned after OSAHS induction. All animals were induced to sleep in a supine position for 4–6 h/day for 8 weeks. Echocardiography was used to determine the structure and function of the heart. The histological changes were detected by optical microscopy and transmission electron microscopy (TEM). The levels of ET-1(endothelin-1) and Ang II (Angiotensin II) in the plasma were measured by an enzyme-linked immunosorbent assay (ELISA). The expression of ET-1 mRNA in heart tissue was detected by RT-PCR. Histological abnormalities, left ventricular hypertrophy, and left ventricular dysfunctions were demonstrated in Group OSAHS, and the abnormities were rescued with MAD treatment. Higher levels of plasma ET-1 and Ang II and elevated expression of ET-1 mRNA in cardiac tissue were detected in Group OSAHS compared with Group MAD and the control group. The blood oxygen saturation was negatively correlated with the levels of ET-1 and Ang II. OSAHS-induced elevated levels of ET-1 and Ang II may be attributed to myocardial structural abnormalities and dysfunction. Early treatment of MADs may play an important role in preventing myocardial damage in OSAHS rabbit model.

Serum Expression and Clinical Significance of Vascular Cell Adhesion Molecule-1 and MicroRNA-21 in Obstructive Sleep Apnea-Hypopnea Syndrome Patients in Chinese Population

The aim of this study was to detect the expression level of vascular cell adhesion molecule-1 and MicroRNA-21 in peripheral serum of adult Obstructive Sleep Apnea-Hypopnea Syndrome patients and healthy subjects, analyze the correlation between vascular cell adhesion molecule-1/microRNA-21 and the main indicators of polysomnography (apnea-hypopnea index, L-Saturation of Peripheral Oxygen) of subjects. To explore the relationship between the expression of vascular cell adhesion molecule-1/microRNA-21 and the severity of Obstructive Sleep Apnea-Hypopnea Syndrome and its clinical significance. Total of week 50 Obstructive Sleep Apnea-Hypopnea Syndrome patients and 27 control cases were collected as study objects from December 2018 to December 2019 in our hospital. Enzyme-linked immunoassay was used to detect the vascular cell adhesion molecule-1 expression. Quantitative Reverse Transcription-polymerase chain reaction analysis was performed to determine the MicroRNA-21 expression. The weight, body mass index and apnea-hypopnea index were higher while L-Saturation of Peripheral Oxygen was lower in both Mild and the Moderate-severe group Obstructive Sleep Apnea-Hypopnea Syndrome patients than control cases. Besides, the serum expression of vascular cell adhesion molecule-1 and MicroRNA-21 were increased significantly in Obstructive Sleep Apnea-Hypopnea Syndrome patients, and the level was positively correlated with the degree of the disease. We also demonstrated that vascular cell adhesion molecule-1 and MicroRNA-21 had a positive correlation with weight, body mass index and apnea-hypopnea index, whereas a negative correlation with L-Saturation of Peripheral Oxygen. Finally, there is a significant positive correlation between vascular cell adhesion molecule-1 and MicroRNA-21. We have proved that the expression level of vascular cell adhesion molecule-1 and MicroRNA-21 in serum of subjects is closely related to apnea-hypopnea index and L-Saturation of Peripheral Oxygen, which can reflect the severity of Obstructive Sleep Apnea-Hypopnea Syndrome and may become a new biological observation index for diagnosis and prognosis evaluation of Obstructive Sleep Apnea-Hypopnea Syndrome.

Follow-up study on natural course changes of obstructive sleep apnea hypopnea syndrome among young and middle aged patients

Objective: To explore the natural course of obstructive sleep apnea-hypopnea syndrome (OSAHS) and its associated factors in young and middle-aged patients with OSAHS. Methods: A total of 52 young and middle-aged OSAHS patients were recruited in this study from West China Hospital of Sichuan University. All patients were performed twice overnight polysomnography (PSG) examinations. At the baseline, patients underwent the first PSG and clinical evaluation from September 2009 to September 2017 and the patients received the second PSG from January 2017 to January 2019. During the follow-up period, these patients had no treatment. All patients were categorized into two groups including mild-to-moderate [5/h≤ apnea-hypopnea index (AHI)<30/h] group and severe (AHI ≥ 30/h) group according to the baseline AHI value. Differences in the clinical characteristics and PSG variables between baseline and follow-up were compared in two groups separately using t-tests or Mann-Whitney U test. The general linear correlation analysis was used to explore the factors related to the severity of OSAHS including AHI, the mean oxyhemoglobin saturation and the minimal oxyhemoglobin saturation during the follow-up period. Results: This study recruited 28 OSAHS patients in mild-to-moderate group [mean age, (39.7±10.2) y] and 24 patients in severe group [mean age, (41.0±7.1) y]. Compared to the baseline, there was a significant increase in AHI value [(45.0±25.3) vs (33.6±27.3)/h, P<0.001] in all OSAHS patients. Notably, the increase of AHI was more significant in the mild-to-moderate OSAHS group [(32.1±22.2) vs (13.6±8.7)/h, P<0.05] but not in severe OSAHS patients [(60.7±19.5) vs (58.0±21.5)/h, P>0.05]. A person correlation analysis revealed that the AHI value was positively related to the age (r=0.531, P=0.004) in mild-to-moderate OSAHS patients. Conclusion: The severity of OSAHS is increased with the age in young and middle-aged patients with mild-to-moderate OSAHS, but not in those with severe OSAHS.

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

Neuroimaging consequences of cerebral small vessel disease in patients with obstructive sleep apnea–hypopnea syndrome

ObjectiveThis study aimed to investigate the association between severity of obstructive sleep apnea–hypopnea syndrome (OSAHS) and the neuroimaging consequences of cerebral small vessel disease (SVD).MethodsPatients with OSAHS and age‐ and gender‐matched healthy control subjects completed the mini‐mental state examination and underwent an evoked‐related potential study and overnight polysomnographic monitoring. Magnetic resonance imaging (MRI) was performed to detect markers of silent cerebral SVD, including Virchow–Robin spaces (VRS) rated on a five‐point scale, white matter lesions, lacunar infarcts, and deep microbleeds. Multinomial logistic regression models were used to examine the associations of the apnea–hypopnea index (AHI) and arousal index (AI) values, mean oxyhemoglobin saturation, the duration of snoring history, and MRI markers of small vessel disease with the incidence of enlarged VRS.ResultsThe study included 72 patients with severe OSAHS and 53 volunteers without OSAHS. The duration of snoring history ranged from 5 to 22 years in the OSAHS group. Smaller P3 amplitudes at Cz were found in OSAHS patients than control subjects (p < .05), which is associated with neurocognitive impairment. Enlarged VRS were more prevalent in the basal ganglia and centrum semiovale of patients with OSAHS than in the control group. No significant between‐group differences were observed in the number of white matter lesions, lacunar infarcts, and deep microbleeds. Enlarged VRS were positively correlated with AHI and AI values in the OSAHS group (r = .63, p < .001; r = .55, p < .001, respectively).ConclusionsSilent cerebral SVD was more prevalent in patients with OSAHS than in the controls. Enlarged VRS observed in the basal ganglia and centrum semiovale were positively correlated with severity of OSAHS, which may contribute to cognitive impairment.