Obstructive Sleep Apnea-hypopnea Syndrome Patients Research Articles

EVALUATION OF CARDIAC FUNCTION IN PATIENTS WITH OSAHS THROUGH DOBUTAMINE STRESS 99MTC-TETROFOSMIN QUANTITATIVE GATED SPECT

ObjectivesLittle is known about ventricular function in OSHAS (obstructive sleep apnoea hypopnoea syndrome) patients without clinical symptoms of cardiovascular disease. The aims of this study was therefore to evaluate whether...

Factors Associated With Increased Carotid Intima-Media Thickness in Obstructive Sleep Apnea/Hypopnea Syndrome

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is strongly associated with the increase of cardiovascular and cerebrovascular disorders. Carotid intima-media thickness (IMT) is used as a surrogate marker for subclinical or early atherosclerosis. Knowledge regarding early atherosclerosis in patients with OSAHS is scarce, and factors predicting carotid IMT have not been well studied. To compare IMT in patients with OSAHS versus controls and explore the factors associated with increased IMT in OSAHS. One hundred fifty-six OSAHS patients and 35 controls without history of vascular events, hypertension, and diabetes mellitus who underwent polysomnography were consecutively enrolled. Carotid IMT was measured using B-mode ultrasonography. Body mass index, waist circumference, hip circumference, waist-to-hip circumference ratio, Epworth Sleepiness Scale, and polysomnographic variables including arousal index, apnea/hypopnea index, mean oxygen saturation, and lowest oxygen saturation were assessed. Fasting plasma glucose, blood lipid profile, and high-sensitivity C-reactive protein were measured. Average carotid IMT of OSAHS patients was significantly thicker than controls (0.66 vs. 0.58 mm, P=0.002) and multivariable logistic regression analysis revealed that arousal index [odds ratio (OR), 0.77; confidence interval (CI), 0.63-0.95; P=0.01] and lowest oxygen saturation (OR, 1.91; CI, 1.24-2.95; P=0.003) were significantly associated with OSAHS patients. Among the OSAHS patients, age (OR, 1.16; CI, 1.10-1.22; P<0.0001), fasting plasma glucose (OR, 1.05; CI, 1.01-1.10; P=0.04), low-density lipoprotein cholesterol (OR, 1.03; CI, 1.02-1.05; P<0.0001), and high-sensitivity C-reactive protein (OR, 1.48; CI, 1.13-1.95; P=0.005) were significantly associated with patients with IMT≥0.65 mm. IMT was thicker in OSAHS patients without history of vascular events, hypertension, and diabetes mellitus. This study demonstrates that early atherosclerosis exists in this group of patients.

Changes of ophthalmic blood flow in obstructive sleep apnea-hypopnea syndrome

To observe the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) blood flow and the changes of eye vascular auto-regulation in patients with obstructive sleep apnea-hypopnea syndrome (OSAS). It was a case-control study. Fifteen health overweight male adult (as normal control) and 42 patients with OSAS were randomly selected from examination center and sleep detection center, respectively. The OSAS patients were divided into mild (14 patients) and moderate and severe (28 patients) groups based on the apnea-hypopnea index (AHI). All subjects filled the sleep questionnaire and carried out polysomnogram monitoring all night for at least 7 hours. Fasting peripheral venous blood was collected at 7 AM on next day. The end-tidal CO(2) (ETCO(2)), intraocular pressure and color doppler sonography were examined next day to record the data in the inspection process before and after Mueller maneuver. Doppler ultrasound measurement of ocular blood flow diameter and blood flow velocity values were described in the median (max, min) and compared with Kruskal-Wallis test. And then two groups were compared with Bonferroni t test. Ocular blood flow velocity of patients with OSAS and PSG monitoring indicators were analyzed using partial correlation analysis. OA inner diameter in moderate and severe OSAS group [0.08 (0.15, 0.06) cm] was lower than that in healthy control [0.15 (0.26, 0.11) cm] and the difference was statistically significant (P = 0.000). PCA inner diameter in moderate and severe OSAS group [0.10 (0.13, 0.07) cm] were higher than that in healthy controls [0.05 (0.09, 0.04) cm]. CRA peak systolic velocity (PSV) in moderate and severe OSAS group [16.50 (19.40, 13.10) cm/s] was greater than that in healthy controls [11.30 (16.70, 8.20) cm/s]. The differences between these two groups were statistically significant (PCA inner diameter: P = 0.000, CRA-PSV: P = 0.001). The difference of CRA end diastolic velocity (EDV) between the moderate and severe group [8.90 (9.90, 5.10) cm/s], mild group [7.00 (8.30, 4.50) cm/s] and healthy control group [5.50 (7.40, 3.40) cm/s] was statistically significant (χ(2) = 14.45, P < 0.05). PCA-PSV [32.50 (43.10, 19.10) cm/s] and PCA-EDV [12.80 (15.20, 5.70) cm/s] in the moderate and severe group were higher than those in healthy control group [22.60 (32.20, 12.40) cm/s] and [7.20 (11.20, 3.90) cm/s], as well as those in the mild group [24.00 (30.70, 13.30) cm/s] and [8.00 (9.90, 3.90) cm/s]. These differences were statistically significant (PCA-PSV: P = 0.000, 0.002; PCA-EDV: P = 0.000, 0.001). The diameter of OA and PCA correlated negatively with ETCO(2) (r = -0.41, -0.34; P < 0.05); CRA-PSV was correlated with SaO2 min (r = -0.37, P < 0.05). CRA-EDV was correlated with ETCO(2) and SaO2 mean (r = 0.57, -0.39; P < 0.05). PCA-PSV was correlated with SaO2 min and MAI (r = -0.34, 0.56; P < 0.05). PCA-EDV was correlated SaO2 min and MAI (r = -0.29, 0.61; P < 0.05). The diameter and blood flow of OA, PCA and CRA change in OSAS patients. Compared with non-OSAS patients, the autoregulation function of PCA and CRA is weakened in OSAS patients.

Controlled trial of combined radiofrequency-assisted uvulopalatoplasty in the treatment of snoring and mild to moderate OSAS (pilot study)

The aim of this study was to assess the efficacy of radiofrequency treatment (RFT) of the soft palate and combined radiofrequency-assisted uvulopalatoplasty (RF-UPP) in the treatment of snoring and mild to moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). In the study group consisting of 32 snoring and mild to moderate OSAHS patients with excessive soft tissue of the soft palate or uvula, 13 patients underwent RFT of the soft palate and 19 patients underwent combined RF-UPP. The baseline and posttreatment polysomnography and clinical test battery consisting of Visual Analogue Scales (VAS), Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg's Trait-State Anxiety Inventory, Beck Depression Inventory-second edition (BDI-II), and Epworth Sleepiness Scale were applied to assess the treatment outcomes. After a short-term follow-up of 2 to 3 months, the group of the RFT patients showed improvement in mean VAS snoring and SAQLI-LT scores, while the group of RF-UPP patients showed statistically significantly improvement in mean apnea-hypopnea index (AHI) (12.51 ± 7.66 vs. 7.88 ± 6.05, p < 0.05, β = 0.107), SAQLI-LT, and BDI-II scores. The group of RF-UPP patients had superior and statistically significant improvement compared to the RFT alone patients with regard to mean AHI (effect size 4.63 ± 4.65 vs. 0.95 ± 4.83, p < 0.05) and SAQLI-LT (effect size 0.75 ± 0.59 vs. 0.33 ± 0.40, p < 0.05) scores. Combined RF-UPP showed to be effective in the treatment of snoring and mild to moderate OSAS overcoming the RFT alone.

Cognition in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS): Current Clinical Knowledge and the Impact of Treatment

Obstructive sleep apnea-hypopnea syndrome (OSAS) is characterized by the presence of disordered breathing events that occur during sleep, as well as symptoms such as sleepiness and snoring. OSAS is associated with a number of adverse health consequences, and a growing literature focuses on its cognitive correlates. Although research in this field is mixed, multiple studies indicate that OSAS patients show impairment in attention, memory, and executive function. Continuous positive airway pressure (CPAP) is the most effective and widely used treatment of OSAS, and supplemental medications may supplement CPAP treatment to ameliorate associated symptoms. Here, we review the literature on OSAS and cognition, including studies that have investigated the impact of CPAP and stimulant medication on cognitive performance in patients with OSAS. In general, no consistent effect of CPAP use on cognitive performance was evident. This may be due, in part, to variability in study design and sampling methodology across studies. Studies of stimulant medications generally reported positive effects on cognitive performance. We conclude with a discussion of the mechanisms that have been proposed to explain cognitive dysfunction in OSAS and directions for future research.

Gastroesophageal and laryngopharyngeal reflux profiles in patients with obstructive sleep apnea/hypopnea syndrome as determined by combined multichannel intraluminal impedance–pH monitoring

The profiles of gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) have never been explored. The aim of the study was to investigate the reflux profile in OSAHS patients. Consecutive snoring out-patients suspected with having OSAHS and 20 healthy volunteers were included. All subjects underwent simultaneous 24-h combined multichannel intraluminal impedance-pH (MII-pH) monitoring and polysomnography. Obstructive sleep apnea/hypopnea syndrome was defined when the apnea/hypopnea index was over 5. Stepwise multiple logistic regression analysis was performed to determine the predictor for OSAHS. Fifty-three patients were included, 37 with and 16 without OSAHS. The prevalence of reflux symptoms was similar between OSAHS (35.1%) and non-OSHAS (37.5%) patients. More OSAHS patients, compared with non-OSAHS patients and healthy volunteers, had pathologic acid GER, nocturnal acid GER, and prolonged acid clearance (P < 0.001). However, no difference in non-acid reflux episodes was observed among the three groups. Laryngopharyngeal reflux was detected in 51.4%, 43.8%, and 35.0% of OSAHS, non-OSAHS, and healthy volunteers, respectively (P = 0.034). In OSAHS patients, there was no difference in the sleep parameters between patients with and without LPR. Body mass index was the only predictor of OSAHS in the regression analysis. OSAHS patients have more pathologic acid GER and prolonged acid clearance than non-OSAHS patients whereas non-acid reflux was similar between the two groups. However, BMI, not GER, is the only independent predictor for OSAHS. Laryngopharyngeal reflux occurs in more than half of OSAHS patients despite no significant association with OSAHS.

Elevated fractalkine in patients with obstructive sleep apnea hypopnea syndrome

Obstructive sleep apnea hypopnea syndrome (OSAHS) has been increasingly linked to cardiovascular disease. Inflammatory processes associated with OSAHS may contribute to atherosclerosis in these patients. Fractalkine is a unique chemokine which has both adhesive and chemoattractant functions. We tested the hypothesis that OSAHS patients have increased fractalkine. We studied 20 patients (18 males and 2 females) with newly diagnosed OSAHS, who were free of other diseases, had never been treated for OSAHS, and were taking no medications. We compared fractalkine measurements in these patients to measurements obtained in 15 control subjects (14 males and 1 female) who were matched for age and body mass index, and in whom occult OSAHS was excluded. Plasma fractalkine levels were significantly higher in patients with OSAHS than in controls (463.15 ± 110.78 versus 364.67 ± 64.81 pg/mL, F = 2.58, P = 0.004). Fractalkine were associated with AHI (r = 0.756, P < 0.0001), lowest oxygen saturation (r = -0.466, P = 0.005), and mean oxygen saturation (r = -0.344, P = 0.043). Plasma fractalkine levels were significantly decreased in patients with OSAHS after four nights nCPAP (463.15 ± 110.78 versus 416.75 ± 97.67 pg/mL, P = 0.001). OSAHS is associated with elevated levels of fractalkine, a marker of inflammation related to atherosclerosis. The severity of OSAHS is proportional to the fractalkine level.

The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients

The main pathological event of obstructive sleep apnea hypopnea syndrome (OSAHS) is the apneic collapse of the upper airways (UA). Frequently, UA collapse occurs at the same time at different section levels. Identifying the site and the dynamic pattern of obstruction is mandatory in therapeutical decision-making, and in particular if a surgical therapy option is taken into account. Nowadays, awake fiberoptic nasopharyngeal endoscopy represents the first level diagnostic technique to be performed in such patients, but recently, the drug-induced sleep endoscopy (DISE) has been introduced to overcome the limits of the awake nasopharyngeal endoscopy. Whatever diagnostic tool we decide to use, one of the main problems encountered is the standardization of the description of the sites and dynamic patterns of UA collapses. In this paper, the authors describe the NOHL classification, which could be applied during awake and sleep endoscopy, and allows a simple, quick, and effective evaluation of grade and patterns of UA collapse, suggesting its application, especially in therapeutical decision-making and in the analysis of surgical outcomes.

Relationship between obstructive sleep apnea-hypopnea syndrome and hypertension

To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and hypertension. There were 1149 middle aged patients who were suspected to have OSAHS underwent polysomnography (PSG) from Jan, 1999 to June, 2011. The age of the patients ranged from 45 to 65 years. The patients were divided into 10 groups according to sleep apnea hypopnea index (AHI), group 1: AHI < 5; group 2: 5 ≤ AHI < 15; group 3: 15 ≤ AHI < 30; group 4: 30 ≤ AHI < 40; group 5: 40 ≤ AHI < 50; group 6: 50 ≤ AHI < 60; group 7: 60 ≤ AHI < 70; group 8: 70 ≤ AHI < 80; group 9: 80 ≤ AHI < 90; group 10: AHI ≥ 90. The incidence of hypertension in each group was tested using crosstabs method. The correlation between AHI, lowest oxygen saturation (LSaO2), age, body mass index (BMI) and hypertension were analyzed. Among 1149 suspected OSAHS patients, 1004 were diagnosed as OSAHS by PSG. There were positive correlation between AHI and diastolic, systolic blood pressure (r were 0.239 and 0.305, respectively, P < 0.01). AHI was independent risk factor of hypertension (P < 0.001). No statistically significant difference in the incidence of hypertension was found among group 1 and group 2, 3, group 4 and group 5, group 6 to group 10 (χ(2) were 3.821, 0.005 and 1.325, P > 0.05, respectively). There was significant difference in the incidence of hypertension among group 4 and group 1, 2, 3, group 5 and group 6 (χ(2) were 2.615 and 4.300, P < 0.05, respectively). There were two cutoff points at the AHI of 30 and 50. With OSAHS exacerbations, the incidence of hypertension was significantly increased.

Normal Tension Glaucoma in Patients With Obstructive Sleep Apnea/Hypopnea Syndrome

To determine the prevalence of normal tension glaucoma (NTG) in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) and further investigate whether the severity of OSAHS would increase the risk of glaucoma. Two hundred fifty-six participants were consecutively admitted for polysomnographic exam to diagnose OSAHS. All participants, then underwent a complete ophthalmologic evaluation, including best-corrected visual acuity, intraocular pressure, slit lamp biomicroscopy, gonioscopy, fundoscopy, automated visual field (VF), and retinal nerve fiber layer (RNFL) evaluation. A total of 247 participants were enrolled in the study. Two hundred nine patients were OSAHS and 38 participants were classified as the normal group. Among the OSAHS patients, NTG was found in 12 patients with a prevalence of 5.7%, which was higher than that in the normal group (P=0.003). In the NTG patients, 1 was in the mild, 3 were in the moderate, and 8 were in the severe OSAHS group. There was no glaucoma patient in the normal group. The prevalence of NTG in moderate/severe OSAHS patients was 7.1%, significantly higher (P=0.033) than that in normal/mild OSAHS patients. The mean saturation of oxygen and lowest saturation of oxygen correlated with the average thickness of RNFL in the OSAHS patients. Patients with OSAHS had a high prevalence of NTG, especially in patients with moderate and severe OSAHS. The severity of OSAHS inversely correlated with retinal nerve fiber layer thickness. Clinicians need to consider the possibility of glaucoma in patients with moderate and severe OSAHS.

Changes of plasma C-reactive protein, endothelin-1 and tumor necrosis factor-α in patients with obstructive sleep apnea-hypopnea syndrome

Objective To investigate plasma C-reactive protein (CLRP),endothelin-1 (ET-1) and tumor necrosis factor-α (TNF-α) levels in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods Select system by polysomnography (PSG) diagnosis and without treatment and the exclusion of other diseases,60 patients with OSAHS were recruited,50 cases of PSG monitoring to rule and the exclusion of other diseases as control group.Plasma CRP,ET-1,TNF-α levels were detected in 60 OSAHS patients as well as in 50 controls.Results Plasma CRP,ET-1 and TNF-α levels in OSAHS patients were (7.87 ± 6.56) mg/L,( 84.24 ± 23.46 ) ng/L and ( 24.83 ± 5.89 ) ng/L respectively,Compared with control group,the plasma levels of CRP,ET-1,TNF-α were significantly higher in OSAHS group (P ＜ 0.05).Conclusion Plasma CRP,ET-1,TNF-α levels were increased in patients with OSAHS,suggesting that they were involved in the pathophysiology of OSAHS,OSAHS patients have a systemic inflam－matory. Key words: Obstructive sleep apnea syndrome; C-reactive protein; Endothelin-1; Tumor necrosis factor-α

Peculiarities of clinical profile of snoring and mild to moderate obstructive sleep apnea–hypopnea syndrome patients

The purpose of this study is to perform comprehensive evaluation of the snoring and mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) patients for their anatomical, functional, and psychoemotional clinical properties. Seventy-four snoring patients, aged 24 to 64 (mean 41.83 ± 11.01) years underwent full-night polysomnography, nasopharyngoscopy, and Mueller maneuver. Clinical tests battery consisting of visual analogue scales (VAS) scales, Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg's State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess their distinctive clinical properties. The total group of snoring and mild to moderate OSAHS patients presented with considerably enlarged VAS snoring and daytime sleepiness scores (mean 66.32 ± 19.07 and 35.03 ± 27.83 points), mild BDI-II scores (mean 10.96 ± 9.42 points), and moderate trait anxiety scores (mean 41.51 ± 8.62 points). All the scores of daytime complaints measured with the VAS correlated statistically significantly with the mean scores of the ESS, SAQLI-LT, trait anxiety, and BDI-II. Both groups, of snoring and mild to moderate OSAHS patients, indicated similar intensity of the major complaints according to the VAS, same as similar BDI-II, STAI, and SAQLI-LT scores. A higher Friedman's score of palatal tonsils was found in the group of snoring patients, comparing to that of the group of mild to moderate OSAHS patients (p < 0.05). Snoring and mild to moderate OSAHS patients have resemblances in their distinctive anatomical and clinical properties. This group of the patients revealed mild depression and moderate trait anxiety scores when measured with the BDI-II and STAI, which correlated significantly with the severity of the patients' daytime complaints measured with the VAS.

Influence of Marital Status and Employment Status on Long-Term Adherence with Continuous Positive Airway Pressure in Sleep Apnea Patients

BackgroundLong-term adherence is a major issue in patients receiving home continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS). In a multicenter prospective cohort (the Institut de Recherche en Santé Respiratoire des Pays de la Loire [IRSR] sleep cohort) of consecutive OSAHS patients in whom CPAP had been prescribed for at least 90 days, we studied the impact on long-term treatment adherence of socioeconomic factors, patients and disease characteristics prior to CPAP initiation.Methods and Principal FindingsAmong 1,141 patients in whom CPAP had been prescribed for an average of 504±251 days (range: 91 to 1035), 674 (59%) were adherent with a mean daily use of CPAP≥4 h (mean: 6.42±1.35 h). Stepwise regression analysis identified 4 independent factors of CPAP adherence including apnea-hypopnea index (AHI) (OR: 1.549, 95%CI 1.163 to 2.062 for AHI≥30 vs. AHI<30; p = 0.003), body mass index (BMI) (OR: 1.786, 95%CI 1.131 to 2.822 for BMI≥25 and <30 kg/m2, p = 0.01; OR: 1.768, 95%CI 1.145–2.731 for BMI≥30 kg/m2, p = 0.01 vs. BMI<25 kg/m2), employment status (OR: 1.414, 95%CI 1.097–1.821 for retired vs. employed; p = 0.007) and marital status (OR: 1.482, 95%CI 1.088–2.019 for married or living as a couple vs. living alone; p = 0.01). Age, gender, Epworth sleepiness scale, depressive syndrome, associated cardiovascular morbidities, educational attainment and occupation category did not influence CPAP adherence.ConclusionsMarital status and employment status are independent factors of CPAP adherence in addition to BMI and disease severity. Patients living alone and/or working patients are at greater risk of non-adherence, whereas adherence is higher in married and retired patients. These findings suggest that the social context of daily life should be taken into account in risk screening for CPAP non-adherence. Future interventional studies targeting at-risk patients should be designed to address social motivating factors and work-related barriers to CPAP adherence.

Obstructive Sleep Apnea/Hypopnea Syndrome and Poor Response to Sertraline in Patients With Coronary Heart Disease

Evidence from several clinical trials in patients with coronary heart disease suggests that depression that does not respond to treatment is associated with a particularly high risk of adverse cardiac outcomes. The purpose of this study was to determine whether obstructive sleep apnea/hypopnea syndrome (OSAHS) is associated with a poor response to antidepressant medication in patients with coronary heart disease. This was a secondary analysis of data from a randomized, double-blind, placebo-controlled clinical trial of omega-3 fatty-acid augmentation of sertraline for depression in patients with coronary heart disease. Patients with documented coronary heart disease were recruited between May 2005 and December 2008 from cardiology practices in St Louis, Missouri, and through cardiac diagnostic laboratories affiliated with Washington University School of Medicine, St Louis, Missouri. One hundred five patients (mean age = 58 years) with coronary heart disease and current major depressive disorder (DSM-IV) were randomized to receive sertraline plus either omega-3 or placebo for 10 weeks. Cyclical heart-rate patterns associated with OSAHS were detected via ambulatory electrocardiography prior to treatment. Symptoms of depression were measured at baseline and follow-up with the Beck Depression Inventory-II (BDI-II) and the 17-item Hamilton Depression Rating Scale (HDRS-17). The primary endpoint was the BDI-II score at 10 weeks. Thirty of the 105 patients (29%) were classified as having probable moderate to severe OSAHS on the basis of nighttime heart-rate patterns. These OSAHS patients had significantly higher scores on both the BDI-II (t = -2.78, P = .01) and the HDRS-17 (t = -2.33, P = .02) at follow-up as compared to the reference group. Adjustment for baseline depression score, treatment arm (omega-3 vs placebo), body mass index, and inflammatory markers did not change the results. Patients with OSAHS reported higher item scores at follow-up on all depressive symptoms measured with the BDI-II compared to those without OSAHS. Obstructive sleep apnea/hypopnea syndrome is associated with a relatively poor response to sertraline treatment for depression. Future research should determine the contribution of OSAHS to the increased risk of adverse cardiac outcome associated with treatment-resistant depression.

Overnight hemoglobin-oxygen saturation monitoring the first day following revised uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome

To investigate the characteristics of overnight arterial oxygen saturation (SaO2) the first day after upper airway reconstruction surgery in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). One hundred and thirteen subjects with OSAHS underwent revised uvulopalatopharyngoplasty (H-UPPP), among them, 46 subjects underwent same phase transpalatal pharyngoplasty under general anesthesia. After transferred to general ward from intensive care unit the first day after operation they received an overnight hemoglobin-oxygen saturation monitoring. Twelve subjects (10.2%) had lower lowest SaO2 than preoperative value. ≥ 0.03 oxygen desaturation index (ODI3) decreased in an median of 36.9 [16.9; 52.2] events/hour compared with preoperative values (Z = -9.221, P < 0.001). One subjects (0.8%) had increased ODI3. No hemorrhages, cardiovascular complications or airway obstruction occurred. The subjects with any two of the following conditions (n = 51) had lower average SaO2, lowest SaO2 and higher ODI3 than the others (n = 62, Z were -3.084, -4.083 and -4.593, P < 0.001). The three subjects were: (1) BMI ≥ 27.0 kg/m(2); (2) Lowest SaO2 < 0.600; (3) AHI ≥ 60.0 events/h. Some OSAHS patients had a decreased LSaO2 than preoperative values the first day after operation. As part of a patient safety initiative, SaO2 monitoring for those who have high risk for hypoxemia is necessary.

Neurocognitive impairment in Chinese patients with obstructive sleep apnoea hypopnoea syndrome

Sleep-disordered breathing is known to be associated with impairment in cognitive function. The aim of this study was to characterize neurocognitive impairment in a cohort of Chinese patients with varying severities of obstructive sleep apnoea hypopnoea syndrome (OSAHS), and to develop a sensitive instrument for routine screening of cognitive impairment. Eligible patients (n = 394) were categorized into a primary snoring group, and mild, moderate and severe OSAHS groups, based on assessment of AHI. The Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) questionnaires were administered to assess cognitive function, and the correlations between questionnaire scores and clinical and polysomnographic parameters were further evaluated by stepwise multivariate regression. MoCA scores decreased progressively across the spectrum from primary snoring to severe OSAHS. Importantly, mild neurocognitive impairment as defined by a MoCA score <26 was more common in the moderate (38.6%) and severe (41.4%) OSAHS groups than in the mild OSAHS (25.0%) and primary snoring (15.2%) groups. In contrast, MMSE scores were largely normal and comparable among all four groups. Evaluation of MoCA subdomains further revealed selective reduction in memory/delayed recall, visuospatial and executive function, and attention span in the severe OSAHS group compared with the other groups. Stepwise multivariate regression analysis demonstrated that MoCA scores correlated significantly with lowest oxygen saturation (L-SaO(2) ) and years of education. Neurocognitive impairment is common in patients with OSAHS. The MoCA is a brief and sensitive tool for the assessment of cognitive impairment in OSAHS patients, whose performance on the MMSE is in the normal range.

Evaluation of airway obstruction at soft palate level in male patients with obstructive sleep apnea/hypopnea syndrome: Dynamic 3-dimensional CT imaging of upper airway

This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) by using dynamic 3-Dimensional (3-D) CT imaging. A total of 41 male patients who presented with 2 of the following symptoms, i.e., daytime sleepiness and fatigue, frequent snoring, and apnea with witness, were diagnosed as having OSAHS. They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller's maneuver. The soft palate length (SPL), the minimal cross-sectional area of the retropalatal region (mXSA-RP), and the vertical distance from the hard palate to the upper posterior part of the hyoid (hhL) were compared between the two breathing states. These parameters, together with hard palate length (HPL), were also compared between mild/moderate and severe OSAHS groups. Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index (AHI) and the lowest saturation of blood oxygen (LSaO(2))] was examined. The results showed that 31 patients had severe OSAHS, and 10 mild/moderate OSAHS. All the patients had airway obstruction at soft palate level. mXSA-RP was significantly decreased and SPL remarkably increased during Muller's maneuver as compared with the quiet breathing state. There were no significant differences in these airway parameters (except the position of the hyoid bone) between severe and mild/moderate OSAHS groups. And no significant correlation between these airway parameters and the severity of OSAHS was found. The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group. The patients in group with body mass index (BMI)≥26 had higher collapse ratio of mXSA-RP, greater neck circumference and smaller mXSA-RP in the Muller's maneuver than those in group with BMI<26 (P<0.05 for all). It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients. All the OSAHS patients had airway obstruction of various degrees at soft palate level. But no correlation was observed between the airway change at soft palate level and the severity of OSAHS. The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI<26.

The effect of H-UPPP operation on obstructive sleep apnea hypopnea syndrome patients with hypertension

Objective To explore the effect of the H-uvulopalatopharyngology(H-UPPP)on the obstructive sleep apnea hypopnea syndrome(OSAHS)with hypertension sufferers.Methods The clinical data of 100 cases of OSAHS patients with hypertension were analyzed retrospectively,and the related parameters about changes of blood pressure and respiration were analyzed.Results The sargical operation treatment cure rate of OSAHS eas 37%,and the effective rate was 81%.In those patients.all the hypertension patients who in the first stage were completely cured (46/46),while for whom in the second stage,the cure rate was 37%(13/35).So the total effective rate of experimental group Was 88%(30/35).19 cases was ineffective.In those 19 patients,there were 16 patients in the second stage,while 3 cases in the third stage.Conclusion H-UPPP could completely cure OSAHS,meanwhile,it also obviously lowered hypertension which induced by OSAHS,and made the sufferers keep at relative normal blood pressure for a long time.So H-UPPP Was a best treatment method to the OSAHS patients with hypertension. Key words: Sleep apnea,obstructive; H-uvulopalatopharyngology; Hypertension

Effectiveness of Nasal Continuous Positive Airway Pressure (CPAP) Therapy on Cardiovascular Outcomes in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Background: There are ethical issues about randomizing individuals with obstructive sleep apnea-hypopnea syndrome (OSAHS) into groups that receive therapy and those that do not, which means that longitudinal studies are necessary. Objective: To evaluate the effectiveness of nasal continuous positive airway pressure (CPAP) therapy on cardiovascular outcomes in OSAHS patients and to discuss the use of OSAHS treatment. Design: A prospective, patient-based study using retrospective observational data was performed. Cox multivariate regression analysis was performed to determine the adjusted effect of CPAP-treatment on survival in cardiovascular events (CVE). Setting: Sleep Unit of Burgos, Spain. Patients: All 887 patients (791 men) with OSAHS were diagnosed by Polysomnography in the Sleep Unit, between 1997 and 2002. Intervention: CPAP-treatment versus non CPAP-treatment, according to Spanish Society of Pulmonary and Thoracic Surgery (SEPAR) criteria. Measurements: The cardiovascular disease data were obtained from hospital records. Results: The average follow-up period was 4.1 years. CPAP-treatment patients had a higher mean apnea-hypopnea index score than the untreated group (45.9 [Standard Deviation (SD): 28.2] versus 25.3 (SD: 17.8), respectively; P < 0.001), as well as a higher Body Mass Index, Epworth and Arousals, but age and sex were similar in both groups. Cardiovascular disease was more common in the untreated group than in the CPAP-treated group during follow-up (3.0 versus 1.99 cardiovascular events/100 persons-years, respectively; P=0.1547). Upon multivariate analysis, age, sex, prior cardiovascular disease, diabetes mellitus and CPAP (hazard ratio= 0.519, 95% confidence interval: 0.288-0.935) remained as statistically significant predictors of survival in cardiovascular events. The mortality rate was greater in women than men. Conclusions: The data support a protective effect of CPAP therapy against cardiovascular disease in patients with OSAHS and different cardiovascular morbidity and mortality by gender. CPAP therapy shows a positive benefit/risk balance.

Evaluation of Thyroid Gland Function in Children with Obstructive Apnea Hypopnea Syndrome

Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and thyroid function abnormalities, such as hypothyroidism and Hashimoto's thyroiditis, usually have closely resembling clinical features. Differentiation between these disorders is made more difficult because hypothyroid patients are also at risk for secondary sleep-disordered breathing. The aim of our study is to evaluate the prevalence of thyroid function abnormalities in children with OSAHS. Forty-four children (15 females: 29 males), 2.5-14.5 (7.43±2.98) years old were studied with overnight polysomnography. Biochemical screening of thyroid gland function was also carried out. Patients were judged to have OSAHS based mainly on the evaluation of Apnea Hypopnea index per hour of sleep (AHI). 15/44 (34.1%) children had mild OSAHS, 17/44 (38.6%) moderate and 12/44 (27.3%) severe OSAHS. Hypothyroidism was recorded only in 5/44 (11.4%) and Hashimoto's thyroiditis in 3/44 (6.8%) of OSAHS patients. Two patients with hypothyroidism showed mild and three severe OSAHS, while from the 3 children with Hashimoto's thyroiditis one presented mild, one moderate and one severe degree of OSAHS. Although the majority of studies in bibliography worldwide do not consider necessary the systemic evaluation of thyroid gland function in patients with breathing disorders during sleep, it seems that in children this type of screening is required for the differential diagnosis between primary sleep apnea and hypothyroid sleep-disordered breathing in order to differentiate these two conditions. Therefore, the laboratory investigation of thyroid gland function could be considered necessary.