Severe Obstructive Sleep Apnea Hypopnea Syndrome Patients Research Articles

Consistency analysis and influencing factors of performing VOTE scores for drug-induced sleep endoscopy

Objective: To investigate the consistency of Velum, Oropharygneal, Tongue base, Epiglottis (VOTE) scores between two surgeons with similar clinical experience in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different degree of disease, and to analyze the influencing factors leading to the difference in score. Methods: This was a cross-sectional study. 64 preoperative drug-induced sleep endoscopy (DISE) videos of OSAHS patients during December 2014 to July 2018, from Nanfang Hospital, Southern Medical University were analyzed. The VOTE score was assessed single-blind by two similar experienced surgeons, and the Kappa value between the two scorers was calculated by the third researcher. According to the characteristics of the case, Fisher's exact test or chi-square test method was used to further explore the factors that influenced the consistency. Results: Sixty-four patients were divided into four groups according to the severity of the disease, including mild (7 cases), moderate (30 cases), severe(18 cases), and extremely severe (9 cases). The scores evaluated between two researchers were analysed for consistency. For mild patients, the two scorers were completely consistent in the configuration and degree of obstruction in the velum and epiglottis (Kappa=1). There was no agreement on whether obstruction or not, obstructed configuration, obstructed degree of the oropharynx and tongue base, and presence of velum and epiglottis obstruction. For moderate patients, the two scorers had a good consistency in the configuration and degree of the velum (0.61≤Kappa≤0.80), and there was no consistency in the evaluation of the degree of tongue base and epiglottis (P>0.05). The consistency of the remaining obstructed conditions in the four planes was generally or moderate (0.21≤Kappa≤0.60). For patients with severe OSAHS, the two raters were completely consistent in the evaluation of palatopharyngeal and epiglottic planes for the presence of obstruction, but there was no consistency in the degree of obstruction. Although the degree of obstruction in the oropharyngeal plane can be assessed with good consistency, the consistency of whether the plane was blocked or not was generally not high. In the assessment of other obstructive conditions in the four planes of severe patients, the agreement between the two scorers was moderate or generally. For extremely severe patients, the two scorers were completely consistent in the evaluation of the velum obstruction, but there was no consistency in the degree of obstruction of the oropharynx and tongue base, and the obstruction configuration and degree of the epiglottis. The evaluation of other obstructed conditions in the four planes is good or moderate. Among the patients with severe OSAHS, the difference in the assessment of obstruction of the oropharynx was associated with tonsil size (P<0.05). Conclusion: When physicians with similar clinical experience scored VOTE, the consistency of whether the velum and oropharyngeal planes are obstructed is related to the severity of the disease. Better consistency is observed among more severe OSAHS patients. The reason for the poor consistency of the oropharyngeal plane in severe OSAHS patients OSAHS is due to the difference of the tonsils size. For severe OSAHS patients with small tonsils, the assessment of whether the oropharynx is obstructed should be more cautious.

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.

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.

The characteristics and determining factors of attention and short-term memory impairment in young patients with obstructive sleep apnea-hypopnea syndrome

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

Implication of mixed sleep apnea events in adult patients with obstructive sleep apnea-hypopnea syndrome.

Although mixed sleep apnea (MSA) is one of the three types of sleep apnea, it is not considered a separate disease entity. It is generally seen as a part of obstructive sleep apnea-hypopnea syndrome (OSAHS), but its implications are often ignored. In this study, we examined its features and the potential impact on OSAHS patients. Subjects diagnosed with OSAHS by polysomnography (PSG) were enrolled. All participants underwent physical checkups and tests of blood biochemistry. They were anthropometrically, clinically, and polysomnographically studied. MSA events were common in patients with severe OSAHS patients. There were significant differences between the pure OSAHS group and its mixed counterpart in apnea-hypopnea indices during REM (AHIREM) and non-REM (AHINREM) and in percentages of N2 or N3 sleep. Logistic regression analysis showed that, after adjustment of other parameters, patients with MSA events were mostly male, had higher body mass index (BMI), higher scores on Epworth Sleepiness Scales (ESS), higher triglyceride (TG) levels, and higher apnea-hypopnea index (AHI). The combined predictive probability of the aforementioned variables was 0.766 (95% CI = 0.725~0.806; sensitivity 61.6%, specificity 82.1%). Our study suggested that MSA was related to the stability of the ventilatory control in OSAHS patients. MSA events occur more frequently in patients with severe OSAHS, and male gender, obesity, daytime sleepiness, and elevated TG levels were risk factors for the mixed OSAHS.

Efficacy and safety assessment of expiratory positive airway pressure (EPAP) mask for OSAHS therapy

ObjectiveWe have designed the expiratory positive airway pressure (EPAP) mask to provide a new sort of therapeutic strategies for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). And this study aims to assess the safety, efficacy and compliance of the EPAP therapy. Methods40 healthy volunteers were enrolled to measure the end-tidal carbon dioxide pressure (PETCO2) while being treated by EPAP mask. 40 symptomatic moderate or severe OSAHS patients (AHI≥15/h) recruited were equally divided into two groups randomly and treated with CPAP or mask for a week respectively. After a week of washing out, the patients were applied with exchanged therapeutic methods for another week. The PSG was performed at the end of each week of treatment with device-on. ResultsThere were no significant differences of PETCO2 under different exhaled positive pressure level between CPAP, EPAP therapies and non-therapy for the healthy volunteers (P>0.05). After being treated, among the OSAHS patients in the two groups, the ESS scores and AHI decreased, and minimum SaO2 and mean SaO2 increased significantly (all P>0.05). There was no significant differences of the efficacy between EPAP and CPAP therapy. ConclusionsEPAP mask therapy was safe and reliable with significant efficacy for selected OSAHS patients. However, the compliance needs further improvement.

Vitamin D deficiency and interleukin-17 relationship in severe obstructive sleep apnea–hypopnea syndrome

PURPOSE:We aimed to assess Vitamin D (VD) abnormalities in patients with severe obstructive sleep apnea–hypopnea syndrome (OSAHS), to study its association with clinical and polygraphic data, and to correlate VD levels with interleukin-17 (IL-17).METHODS:Ninety-two patients with severe OSAHS were consecutively enrolled between September 2014 and February 2016 and compared to age-, sex-, and body mass index (BMI)-matched controls. Anthropometric parameters and medical history were collected. The serum levels of VD and IL-17 were determined by radioimmunoassay and enzyme-linked immunosorbent assay, respectively.RESULTS:Ninety-two severe OSAHS patients and thirty controls were enrolled in the study. All OSAHS patients had VD deficiency. The mean level of VD was at 7.9 ng/ml among OSAHS group versus 16.8 ng/ml among control group. IL-17A levels were elevated (20.3 pg/ml) in OSAHS group compared to healthy group (10.05 pg/ml). VD levels were negatively correlated with nocturia severity (r = −0.26; P = 0.01) and positively correlated with mean O2 saturation (r = 0.59; P = 0.02) and lowest O2 saturation (r = 0.3; P = 0.03). IL-17 levels were positively correlated with nocturia severity (r = 0.24; P = 0.03) and negatively correlated with mean O2 saturation (r = −0.42; P = 0.03). A significant negative association was observed between IL-7 and VD levels (r = −0.64, P = 0.2 10−4). The magnitude of this correlation was higher for important nocturia, lower MSaO2, or higher BMI.CONCLUSIONS:VD deficiency in patients with severe OSAHS is common with a negative association between IL-17 and VD serum levels. Hypoxia could play an important role in this association. Further studies are needed to clarify this relationship.

The expression of macrophage migration inhibitory factor in obstructive sleep apnea hypopnea syndrome and its injury to endothelial cells

Objective: To study the expression of macrophage migration inhibitory factor (MIF) in obstructive sleep apnea hypopnea syndrome (OSAHS) and its injury to endothelial cells. Methods: According to the PSG test results, subjects who were the first time to take PSG examination without treatment (n=71) were divided into a control group (n=20), a mild OSAHS group (n=19), a moderate OSAHS group (n=15) and severe OSAHS group (n=17). For each patients, 4 ml fasting peripheral blood was obtained when PSG was finished around 6: 30 in the next morning, and the MIF level in plasma was detected with the ELISA method. Peripheral blood mononuclear cells (PBMC) from the control group and the severe OSAHS patients were cocultured with umbilical vein endothelial cells (HUVEC) for 72 hours. The apoptosis of HUVEC was detected by flow cytometry, while ET-1, NO, sICAM-1 and IL-6 in the supernatants were measured with the ELISA method. Results: The plasma level of MIF in the control group and the mild, the moderate, and the severe OSAHS patients was (26±8), (28±9), (31±14), (39±15) ng/ml, respectively (F=15.65, P<0.001), and it was higher in the severe OSAHS group as compared to the control group(P<0.01). The level of MIF was associated positively with the apnea hypoventilation index (AHI, r=0.365, P=0.008) and the oxygen index reduction (ODI, r=0.308, P=0.308) n but negatively with the lowest blood oxygen (r=0.323, P=0.323). Endothelial cell apoptosis rate in the control group and the severe OSAHS group was (2.94±1.02) %, (8.23± 3.01) %, respectively, t=5.97, P<0.001. ET-1 in the control group and the severe OSAHS group was (6.71±5.52), (9.88±4.79) pg/ml, respectively, t=3.018, P=0.141. sICAM-1 in the control group and the severe OSAHS group was (11±8), (20±7) ng/ml, respectively, t=7.58, P=0.014. NO in the control group and the severe OSAHS group was (35±16), (25±5) mol/L, respectively, t=2.01, P=0.067. IL-6 in the control group and the severe OSAHS group was (220±42), (436±178) mol/L, respectively, t=2.77, P<0.05. Conclusion: MIF is closely related to the degree of OSAHS severity, and it may be involved in the development and endothelial injury in OSAHS.

CT with 3D reconstruction of upper respiratory tract in obstructive sleep apnea hypopnea syndrome application

Objective To investigate the relationship between the obstructive sleep apnea hypopnea syndrome (OSAHS) patient's structure of the upper airway and severity of OSAHS. Methods A total of 77 cases (22 cases of mild, moderate 22 cases, 33 cases of severe) of OSAHS patients and normal controls were 22 cases, in the three-dimensional structure of the downstream CT airway remodeling, measuring soft palate length, thickness, soft palate roots, uvula, tongue, epiglottis away from the posterior pharyngeal wall distance relationship with the severity of OSAHS. Results ⑴ In patients with OSAHS, the soft palate length [mild group (41.77±9.14) mm, moderate group (40.30±7.74) mm and severe group (40.64±9.64)mm] and normal control group [(40.25±7.55)mm] compared, the difference was not statistically significant (P>0.05); the thickness of soft palate [mild group (10.00±3.40)mm, moderate group (10.31±2.53)mm] and normal control group [(9.88±2.02)mm] compared, the difference was not statistically significant (P>0.05), severe group [(11.49±2.62)mm] and normal control group compared, the difference was statistically significant (P<0.05). ⑵ In calm inspiratory breath hold and severe OSAHS patients epiglottis from posterior pharyngeal wall distance was longer than the moderate OSAHS group [(10.75±5.18)mm vs (7.61±3.57)mm], the difference was statistically significant (P<0.05); after deep inspiratory breath hold, OSAHS patients in the severe group uvula from posterior pharyngeal wall distance was shorter than in normal control group [(4.82±3.33)mm vs (7.10±4.64)mm], the difference was statistically significant (P<0.05). ⑶ In patients with OSAHS thickness of soft palate with body mass index (BMI) and apnea hypopnea index (AHI) were positively correlated (r=0.333, P<0.01; r=0.226, P<0.05), and with lowest pulse oxygen saturation (LSpO2) and mean pulse oxygen saturation (MSpO2) were negative correlation (r=-0.283, P<0.05; r=-0.400, P<0.01); in calm breathing and forced inspiratory breath hold, the soft palate roots from the posterior pharyngeal wall distance and BMI were negatively related (r=-0.297, P<0.01; r=-0.232, P<0.05); in calm inspiratory breath hold root of the tongue from the posterior pharyngeal wall distance and MSpO2 was negatively related (r=-0.225, P<0.05); in calm inspiratory breath hold epiglottis from the posterior pharyngeal wall distance and AHI was positively correlated (r=0.277, P<0.05), and negatively related (r=-0.289, P<0.05) with MSpO2; in forced inspiratory breath hold uvula from retropharyngeal wall distance and MSpO2 was positively correlated (r=0.260, P<0.05). Conclusions OSAHS patients through upper airway CT reconstruction with polysomnography (PSG) indicators combine to determine the severity of OSAHS disease pathogenesis studies, can be used as indicators to determine the therapeutic effect, have clinical significance. Key words: Tomography, X-ray computed; Sleep apnea, obstructive/RA

Diagnostic value of portable monitor device in patients with potential obstructive sleep apnea hypopnea syndrome

To evaluate the diagnostic value of portable monitor device (PMD) in potential obstructive sleep apnea hypopnea syndrome (OSAHS) patients. All patients met the inclusion criteria were asked to finish the questionniar and underwent anthropometric measurements, and then completed polysomnography (PSG) test and PMD test simultaneously. The correlation between AHI-PMD and AHI-PSG, between MinSaO2-PMD and MinSaO2-PSG were analyzed by Spearman analysis. T test was used to compare the correlation coefficient between the two groups; ROC analysis was used to evaluate the sensitivity and specificity of PMD in diagnosis of OSAHS, and got the Cut-off value between moderate and severe OSAHS and mild OSAHS. Through PSG test, of all the 111 cases, including 4 simple snoring cases, accounting for 3.6%, OSAHS patients with 107 cases, accounting for 96.4% which including 11 patients (9.9%) with mild, 17 patients (15.3%) with moderate, 79 patients (71.2%) with severe. The correlation of AHI-PMD and AHI-PSG between moderate and severe OSAHS patients was stronger than simple snoring and mild OSAHS patients. The coefficient test between the two groups was statistically significant (P=0.026). The correlation of MinSaO2-PMD and MinSaO2-PSG was statistically significant (P<0.001), the correlation of MinSaO2-PMD and MinSaO2-PSG between moderate and severe OSAHS group and snoring and mild OSAHS group was not statistically significant (P=0.270). A statistically significant correlation between AHI-PMD and AHI-PSG was found (P<0.001). PMD had a sensitivity and specificity of 96.9% and 86.7%, respectively (AUC=0.990, 95%CI 0.970-1.000). The cut-off value between moderate and severe OSAHS and mild OSAHS was AHI-PMD≥12 times/h. PMD had a satisfactory sensitivity and specificity for diagnosing and judging the severity of moderate and severe OSAHS.

Reliability and Validity of the Beijing Version of the Montreal Cognitive Assessment in the Evaluation of Cognitive Function of Adult Patients with OSAHS.

BackgroundThe patients with obstructive sleep apnea hypopnea syndrome (OSAHS) tend to develop cognitive deficits, which usually go unrecognized, and can affect their daily life. The Beijing version of the Montreal cognitive assessment (MoCA-BJ), a Chinese version of MoCA, has been used for the assessment of cognitive functions of OSAHS patients in clinical practice. So far, its reliability and validity have not been tested. This study examined the reliability and validity of MoCA-BJ in a cohort of adult OSAHS patients.Methods152 OSAHS patients, ranging from mild, moderate to severe, 49 primary snoring subjects and 40 normal controls were evaluated for cognitive functions by employing both MoCA-BJ and the Mini Mental State Examination (MMSE). Forty of them were re-tested by MoCA-BJ 14 days after the first test. Internal consistency, test-retest reliability, discriminate and concurrent validity of MoCA-BJ were analyzed.ResultsInternal consistency reliability by Cronbach’s alpha was adequate (0.73). Intra-class correlation coefficient (ICC), an measure of test-retest reliability, was 0.87 (P<0.001). The total MoCA-BJ scores were significant higher in normal controls than in OSAHS groups (p<0.05). The performances of visuospatial ability in severe OSAHS group were significantly weaker than in normal controls and primary snoring group. The performances of executive ability in severe OSAHS patients were weaker than in normal controls. An optimal cut-off between normal controls and non-normal subjects was at 26 points (total MoCA score). Moreover, cut-off between non-severe and severe OSAHS was at 2 points on visuospatial subscale. Analysis of the correlation between MoCA total scores and MMSE total scores revealed a statistically significant, though relatively weak, correlation (r=0.41, P<0.05).ConclusionIn conclusion, our study showed that the Beijing version of the MoCA was reliable and stable. The MoCA-BJ was capable of detecting cognitive dysfunction by visuospatial and total MoCA-BJ score.

Exhaled nitric oxide from the central airway and alveoli in OSAHS patients: the potential correlations and clinical implications.

The aim of the study was to evaluate exhaled nitric oxide (eNO) derived from different areas of airway in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with NO exchange model and investigate the potential application and interpretation of eNO in clinical setting. This study was divided into two parts. Firstly, we performed a case control study in 32 OSAHS patients and 27 non-OSAHS participants. Fractional eNO (FeNO) and eNO from the central airway (J'awNO) and from alveoli (CANO) were compared in OSAHS and control groups. Also, correlation of eNO to severity of OSAHS was analyzed. Secondly, a prospective study was conducted in 30 severe OSAHS patients who received a short-term nasal continuous positive airway pressure (nCPAP) treatment. We evaluated eNO, plasma ET-1 concentration, and echocardiography during the treatment process and explored the potential relationship among them. FeNO and J'awNO were higher in OSAHS and associated with disease severity, while CANO was relatively lower. After nCPAP treatment in severe OSAHS patients, FeNO and J'awNO decreased and CANO increased significantly. Substantial agreement was shown between the elevation of CANO and the decrease of plasma ET-1 concentration after nCPAP by Kappa analysis for consistency. Tei index, which is considered indicative of global right ventricular function, might be predicted by plasma ET-1 levels in severe OSAHS patients. NO exchange model provides us with more information of eNO derived from different areas. eNO is not only confirmed to be an effective method for airway inflammation evaluation in the follow-up of OSAHS, CANO may also serve as a useful marker in monitoring endothelial function, resistance of pulmonary circulation, and right ventricular function for clinical implication.

Evaluation of choroidal thickness in patients with obstructive sleep apnea/hypopnea syndrome.

Purpose: To compare the subfoveal choroidal thickness (SFCT) of patients with different severities of obstructive sleep apnea/hypopnea syndrome (OSAHS) and normal controls via enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: In this retrospective, case-control study, 49 eyes from 49 patients that had undergone polysomnography were included. SFCT of the horizontal and vertical line scans were manually measured for all eyes based on EDI-OCT images. Two separate analyses were performed according to different apnea/hypopnea index (AHI) groupings. Initial testing was conducted using non-OSAHS, mild OSAHS (5≤AHI<15), moderate OSAHS (15≤AHI<30), and severe OSAHS (AHI≥30) patient groupings, while secondary testing used non-OSAHS, mild OSAHS (5≤AHI<15), and moderate/severe OSAHS (AHI≥15) patient groupings. Results: The mean SFCT was 314.5 μm in the non-OSAHS patients (n=14), 324.5 μm in the mild OSAHS patients (n=15), 269.3 μm in the moderate OSAHS patients (n=11), and 264.3 μm in the severe OSAHS patients (n=9). SFCT between the four groups revealed no significant differences despite a trend towards slight thinning in the severe group (P=0.08). When the moderate and severe groups were merged and compared with the mild OASHS and non-OSAHS groups, SFCT of the moderate/severe group was found to be significantly thinner than that of the mild group (P=0.016). A negative significant correlation was found between SFCT and AHI in OSAHS patients (r=0.368, P=0.033). Conclusions: In patients with moderate/severe OSAHS, EDI-OCT revealed a thinned SFCT. Other accompanying systemic or ocular diseases may induce perfusion and oxygenation deficiency in eyes of OSAHS patients. Further studies are required in order to determine the exact relationships between ocular pathologies and clinical grades of OSAHS.

Biological Effects of OSAHS Surgery on Endothelial Dysfunction and Oxidative Stress

Objectives: Prospectively study the changes of biomarkers related to cardio- or cerebro-vascular diseases in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) before and after OSAHS surgery. Methods: Patients who failed continuous positive airway pressure (CPAP) therapy and then underwent OSAHS surgery were enrolled in this study. We assessed serum biomarkers of metabolic status, oxidative/antioxidative balance and sICAM-1, sVCAM-1, sE-selectin, sL-selectin and sP-selectin preoperatively and postoperatively at 6 month follow-up. Results: Eighty OSAHS patients (mean, 45 years) completed data for analysis. When both mild/moderate and severe OSAHS patients were considered, the level of triglyceride, sICAM-1, and sE-selectin were significantly decreased 6 months following surgery, while body mass index did not show significant decrease. Most biomarkers on endothelium dysfunction (sICAM-1 in mild/moderate and severe OSAHS patients, sL-selectin in mild/moderate group, and sE-selectin in severe group) showed a decrease 6 months following surgery. There is a trend of decrease changes on level of TBARS and increased level of superoxide dismutase 6 months after surgery.; However, the difference is not significant. Conclusions: This study shows that surgical treatment could improve some of the biomarkers of metabolic status, oxidative/antioxidative balance, and inflammatory cell adhesion molecules in OSAHS patients. The successful translation of these approaches may offer the promise of reducing the cardiovascular risks associated with OSAHS patients undergoing upper airway surgery.

ZPPP Combined with Endoscopic Coblator Open Tongue Base Resection for Severe OSAHS

Objectives: Retrospectively investigate the safety and outcomes of Z-palatopharyngoplasty (ZPPP) combined with endoscopic coblator open tongue base resection (ECO-TBR) for the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods: Thirty-five consecutive patients with severe OSAHS who had multilevel obstruction, failed continuous positive airway pressure therapy, and then underwent ZPPP combined with ECO-TBR were enrolled in this study. The subjective symptoms and objective PSG parameters were collected preoperatively and at a minimum of 3 months postoperatively. Statistical analysis was determined by Wilcoxon signed rank test. Results: Three female and 32 male patients (mean, 42 years) had a minimum follow-up of 3 months and complete data available for analysis. None of the patients had perioperative or postoperative complications. No long-term obvious velopharyngeal insufficiency was encountered. The classical success rate was 62.9% (22/35). Three months postoperatively, the Epworth sleepiness scale decreased from 11.0 ± 4.2 to 8.7 ± 4.3 (p = 0.0006). The apnea/hypopnea index (/hr.), lowest oxygen saturation (%), and bed partner evaluation of patient’s snoring visual analog scale (0-10) decreased from 50.6±16.6 to 26.5 ± 23.5, 70.4 ± 9.9 to 80.1 ± 11.3, 9.86 ± 0.69 to 3.27 ± 1.96, respectively (all p&lt;0.0001). Conclusions: This study shows the significant benefits of ZPPP plus ECO-TBR in severe OSAHS patients.

Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea–hypopnea syndrome (OSAHS)

To assess the peripapillary retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) morphologic parameters, and macular thickness and volume in patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS). This prospective, observational case-control study consisted of 96 eyes of 50 OSAHS patients (mean age of 50.9 ± 12.4 years, best-corrected visual acuity ≥ 20/20, refractive error less than 3 spherocylindrical diopters, and intraocular pressure <21 mmHg) who were enrolled and compared with 64 eyes of 33 age-matched controls. Peripapillary RNFL thickness, ONH parameters, macular thickness and volume were measured by optical coherence tomography (OCT). OSAHS patients showed a significant reduction of the nasal quadrant RNFL thickness (74.7 ± 15.8 μm) compared with those values observed in control patients (81.1 ± 16.6 μm, p=0.047, Student's t-test). No differences in peripapillary RNFL thickness were observed when dividing the OSAHS group in accordance with disease severity. Vertical integrated rim area (VIRA) (0.67 ± 0.41 mm(3) in OSAHS vs 0.55 ± 0.29 mm(3) in controls; p=0.043, Student's t-test), horizontal integrated rim width (HIRW) (1.87 ± 0.31 mm(2) in OSAHS vs 1.8 ± 0.25 mm(2) in controls; p=0.039, Student's t-test) and disc area (2.74 ± 0.62 mm(2) in OSAHS vs 2.48 ± 0.42 mm(2) in controls; p=0.002, Student's t-test) showed significant differences, all of them being higher in the OSAHS group. Severe OSAHS had significant higher disc area (2.8 ± 0.7 mm(2)) than controls (2.5 ± 0.4 mm(2); p=0.016, ANOVA test). Temporal inner macular thickness was significantly higher in mild-moderate OSAHS patients (270 ± 12 μm) than in severe OSAHS patients (260 ± 19 μm; p=0.021, ANOVA test). OSAHS patients showed decreased peripapillary nasal RNFL thickness, and increased ONH area and volume parameters when they were evaluated by OCT. These findings suggest that neuronal degeneration might be present in the retina of OSAHS patients, as previously observed in some neurodegenerative disorders.

Relationship between excessive daytime sleepiness and oxygen saturation in obstructive sleep apnea-hypopnea syndrome

To investigate polysomnographic determinants of excessive daytime sleepiness (EDS) and potential relationship in Chinese patients with obstructive sleep apnea-hypopnea syndrome (OSAS). A total of 410 patients with obstructive sleep apnea-hypopnea syndrome were analyzed retrospectively who were obtained in Sleep medicine center of West China hospital from January to April in 2010. All of the patients with an apnea-hypopnea index (AHI) greater than 5 h(-1) were evaluated using the Epworth Sleepiness Scale (ESS) and sleep disorders questionnaire. The patients who ESS score was more than 10 were defined as EDS; otherwise, the other was considered to without EDS. A total of 176 patients with EDS (ESS: 15 ± 3) and 234 without EDS (ESS: 6 ± 3) were studied. Patients with EDS were slightly higher BMI (28 ± 4 vs 26 ± 4) and shorter REM sleep latency (99 ± 65 vs 125 ± 81) than patients without EDS. Furthermore, there were significant difference in awake SaO2, AHI, minimum SaO2, oxygen desaturation index and arousal index between EDS group were No-EDS group (P < 0.001). There was a significant difference in waking SaO2 of severe OSAS between both groups. Long-term chronic hypoxia already exists in severe OSAS patients with prominent sleepiness. Waking SaO2 may play a role as a predictor in evaluation and diagnosis in patients with OSAS.

Obstructive sleep apnea hypopnea syndrome: surgical complications and strategy for avoidance

To analyze the surgical complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and discuss the risk factors and preliminary strategies for prevention of complications. From September 1998 to March 2007, 653 OSAHS patients confirmed by polysomnography were treated by different surgical approaches according to their obstructive sites, which included uvulopalatopharyngoplasty (UPPP) in 586 cases, nasal surgery in 104 cases/times, hyoid suspension surgery in 53 cases/times, respectively or at the same time. Local anesthesia was used in 294 cases and general anesthesia in 359 cases. Two hundreds and seventeen cases were treated by continuous positive airway pressure (CPAP) 3 to 7 days pre-operation and 2 to 3 days post-operation. Perioperative complications were found in 57 OSAHS cases (93 times), the incidence of peri-operative complications was 8.7% (57/653), including respiratory problems in 19 cases/times and 1 death occurred during inducing stage in general anesthesia. Profuse bleeding was encountered in 9 cases/times during operation and primary and secondary bleeding in 27 cases/times, cardiopathy and hypertension crisis in 31 cases/times and cerebral stroke and hemiplegia in 1 case, reactive somnolence in 3 cases/times and reactive hyperglycemia in 3 cases/times. Data were analyzed by the multivariate logistic regression model. The results showed that the complications were significantly reduced after CPAP treatment during peri-operative stage and increased accompanied with patients' hypertension, choice of general anesthesia, BMI and AHI. All patients were followed-up more than 1 year. After UPPP, 23.9% cases (140/586) had sensation of foreign body in pharynx and alleviated in 6 to 12 months. Scar tissues in oropharynx in 7 cases, nasopharyngeal stenosis in 1 case, atrophy rhinitides and atrophy pharyngitis in 3 cases, nasopharyngeal un-closure and long-term nasopharyngeal reflex in 3 cases. Conclusions Peri-operative complications are more common in obese and severe OSAHS patients, especially when they accompanied with hypertension. The corresponding strategies should be taken to reduce complications in OSAHS surgery, which include controlling the hypertension effectively, performing CPAP treatment actively, cooperating with interdisciplinary doctors, monitoring closely after operation. It is important to reduce surgical sequelae through improving surgical skills and not enlarging the surgical scale blindly.

Nocturnal reduction in circulating adiponectin concentrations related to hypoxic stress in severe obstructive sleep apnea-hypopnea syndrome

Previous reports demonstrated that adiponectin has antiatherosclerotic properties. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is reported to exacerbate atherosclerotic diseases. We investigated nocturnal alternation of serum adiponectin levels before sleep and after wake-up in OSAHS patients and the effect of sustained hypoxia on adiponectin in vivo and in vitro. We measured serum adiponectin concentrations in 75 OSAHS patients and 18 control subjects before sleep and after wake-up and examined the effect of one-night nasal continuous positive airway pressure (nCPAP) on adiponectin in 24 severe OSAHS patients. We investigated the effects of hypoxia on adiponectin in mice and cultured adipocytes with a sustained hypoxia model. Circulating adiponectin levels before sleep and after wake-up were lower in severe OSAHS patients than in control subjects [before sleep: 5.9 +/- 2.9 vs. 8.8 +/- 5.6 microg/ml (P < 0.05); after wake-up: 5.2 +/- 2.6 vs. 8.5 +/- 5.5 microg/ml (P < 0.01), respectively; means +/- SD]. Serum adiponectin levels diminished significantly during sleep in severe OSAHS patients (P < 0.0001), but one-night nCPAP improved the drop in serum adiponectin levels [-18.4 +/- 13.4% vs. -10.4 +/- 12.4% (P < 0.05)]. In C57BL/6J mice and 3T3-L1 adipocytes, hypoxic exposure decreased adiponectin concentrations by inhibiting adiponectin regulatory mechanisms at secretion and transcriptional levels. The present study demonstrates nocturnal reduction in circulating adiponectin levels in severe OSAHS. Our experimental studies showed that hypoxic stress induced adiponectin dysregulation at transcriptional and posttranscriptional levels. Hypoxic stress is, at least partly, responsible for the reduction of serum adiponectin in severe OSAHS. Nocturnal reduction in adiponectin in severe OSAHS may be an important risk for cardiovascular events or other OSAHS-related diseases during sleep.

Significance of apnea hypopnea time index in obstructive sleep apnea hypopnea syndrome patients and possible correlation between polysomnographic parameters and severity of the disease

To find out the polysomnography (PSG) indexes that reflex the degree of pathology of obstructive sleep apnea hypopnea syndrome (OSAHS). Six hundred and twenty-one male OSAHS patients, aged over 21, underwent measurement of weight, height, and neck circumference. Polysomnography was conducted to detect the apnea and hypopnea index (AHI), apnea and hypopnea time (AHT), and apnea and hypopnea time index (AHTI). A questionnaire survey based on Epworth sleep scaling (ESS) was conducted among 392 patients to assess the symptoms, such as excessive daytime sleepiness. 324 patients with an AHTI of 68.4 +/- 17.16 events/hour were regarded as severe group, and those with an AHTI >or= 7 events/hr were regarded as very severer group. The relationship among clinical characteristics and polysomnographic parameters were analyzed. The AHI, AHTI, and lowest SaO(2) of the patients were significantly correlated with the ESS7 scores, morning mouth dryness, daytime fatigue (all P < 0.01), and significantly correlated with sour regurgitation, and heartburn, (all P < 0.05). AHTI was significantly correlated (r = 0.317), morning mouth dryness (r = 0.239); and sour regurgitation, and heartburn (r = 0.137). AHT was significantly correlated (r = 0.344), morning mouth dryness (r = 0.261); and sour regurgitation, and heartburn (r = 0.138). Very significant differences existed in morning mouth dryness, sour regurgitation and heartburn, and ESS7 scores between the severe and very severe patients (all P < 0.01). Among the PSG indexes, AHTI is better associated with sleepiness and other clinical symptoms than AHI. In severe OSAHS patients, there are significant differences in their clinical symptoms between the AHI < 70 events/hr group and AHI >or= 70 events/hr group.