Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, Plt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97). Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.
摘要：目的：探讨低温双极射频消融技术治疗多平面阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）的价值。方法：对67例多平面OSAHS患者采用低温双极射频消融治疗，根据术前、术后症状改善情况及多导睡眠监测（polysomnography，PSG）结果的比较判定疗效。结果：67例患者中治愈21例，显效22例，有效15例，无效9例，总有效率86.57%。术前与术后1年AHI和SaO2结果经t检验，差异有显著性(P＜0.01)。所有病例均无并发症发生。结论：低温双极射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）疗效肯定，特别是同期治疗多平面阻塞安全可靠，具有独特的优势。
Objective To explore the contribution of obstructive sleep apnea hypopnea syndrome(OSAHS) in the variations of blood pressure in the evening to morning and possible mechanisms.Methods In Sleep and Breathing Disorders Centre，from September 2003 to September 2007，adult patients whose Epworth sleeping scoregt;9 were undergone polysomnography(PSG) and divided into 4 groups according to apnea hyponea index(AHI).The levels of blood pressure were monitored and compared between evening and morning.Correlations between PSG indexes and variations of the systolic blood pressure(SBP) and diastolic blood pressure(DBP) were analyzed in OSAHS patients.Results 1 528 patients were enrolled in this study.There was no significant difference between the evening and morning blood pressure in the non-OSAHS group(AHIlt;5，n=172)，whereas DBP rised about 1.73 mm Hg in the mild OSAHS group(AHI≤20，n=435)，SBP and DBP rised about 3.52 and 3.71 mm Hg respectively in the moderate OSAHS group(AHI≤40，n=307)，and SBP and DBP rised about 3.72 and 4.22 mm Hg respectively in the severe OSAHS group(AHIgt;40，n=614).The variation of SBP during the night correlated positively with the arousal index in the mild OSAHS group（r=0.25，Plt;0.05），but with the body mass index (BMI) in the moderate OSAHS group（r=0.25，Plt;0.05）.In the severe OSAHS group，the variation of SBP during the night correlated positively with BMI and the longest apnea time (LA)（r=0.26，0.25，both Plt;0.05），the variation of DBP during the night correlated positively with AHI and mean apnea duration(MA)（r=0.22，0.17，both Plt;0.05），and the variation of mean arterial pressure during the night correlated positively with AHI and MA（r=0.25，0.20，both Plt;0.05）.Conclusion OSAHS may induce mild rises of the blood pressure at night.The relevant factors that influence the blood pressure are different in different severity of the OSAHS.
Objective To investigate the changes of 8-isoprostane ( 8-isoPG) , leukotriene B4 ( LTB4 ) , TNF-α, IL-10 and hypersensitive C-reactive protein( Hs-CRP) in serum of patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods Forty OSAHS patients ( 20 cases underwent therapeutic Auto-CPAP or UPPP treatment for over three months) and 30 normal controls were included in the study. Serum 8-isoPG, LTB4, TNF-α and IL-10 were measured by ELISA. Hs-CRP was detected by automatic biochemistry analyzer. Results ①The serum levels of 8-isoPG, LTB4, TNF-α, Hs-CRP were significantly higher and IL-10 was considerably lower after sleep in 40 OSAHS patients [ ( 36. 59 ±14. 89) ng/L, ( 14. 75 ±6. 25) μg/L, ( 1022. 13 ±97. 57 ) ng/L, ( 2. 46 ±1. 58 ) mg/L, ( 4. 68 ±3. 42) ng/L, respectively ] than those in the normal controls [ ( 19. 91 ±7. 76 ) ng/L, ( 1. 43 ±0. 72) μg/L, ( 540. 00 ±78. 70) ng/L, ( 0. 30 ±0. 16) mg/L, ( 7. 41 ±4. 49) ng/L, respectively] ( P lt;0. 01) . ② Serum 8-isoPG, LTB4, TNF-α, and Hs-CRP levels elevated gradually following the severity of OSAHS while serum IL-10 level was decreased( P lt; 0. 05) . ③Serum 8-isoPG, LTB4, TNF-α, and Hs-CRP levels in OSAHS patients after sleep were correlated positively with AHI ( r =0. 863, 0. 746, 0. 868, 0. 842,all P lt; 0. 01) and negatively with LSpO2 ( r = - 0. 623, - 0. 524, - 0. 618, - 0. 562, all P lt; 0. 01) and MSpO2 ( r = - 0. 654, - 0. 573, - 0. 537, - 0. 589, all P lt;0. 01) . SerumIL-10 level in OSAHS patients was correlated negatively with AHI ( r = - 0. 722, P lt; 0. 01) and positively with LSpO2 ( r = 0. 564, P lt; 0. 01) and MSpO2 ( r = 0. 505, P lt; 0.01) . ④ After three months of auto continuous positive air pressure( Auto-CPAP) or uvulopalatopharyngoplasty( UPPP) treatment, serum 8-isoPG, LTB4, TNF-α, and Hs-CRP levels of the OSAHS patients after sleep were obviously decreased [ ( 23. 10 ±9. 54) ng/L, ( 4. 02 ±2. 15) μg/L, ( 810. 25 ±135. 85) ng/L, ( 0. 79 ±0. 60) mg/L, respectively] , and serum IL-10 level was obviously increased[ ( 6. 93 ±3. 91) ng/L] ( P lt; 0. 01) . ⑤ serum 8-isoPG and IL-10 had no statistics difference and serum LTB4, TNF-α, Hs-CRP levels were higher in OSAHS underwent therapy compared with the normal controls. Conclusions The results suggest that inflammation and oxidative stress are activated and antiflammatory cytokines are decreased in the OSAHS patients. The serum levels of 8-isoPG, LTB4 , TNF-α, Hs-CRP and IL-10 may prove to be useful in severity monitoring and intervention efficacy judgement in OSAHS patients.
睡眠呼吸暂停低通气综合征( SAHS) 是一种常见病症,临床上以阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 最为常见[1] 。1993 年一项基于社区人群的研究中, Young 等[2] 发现年龄介于30 ～60 岁的人群中, 以睡眠呼吸暂停低通气指数( AHI) ≥5 次/h 定义的OSAHS在女性的患病率为9% ,在男性为24% , 2% 的女性和4% 的男性同时存在嗜睡症状。越来越多的证据表明睡眠呼吸暂停可导致许多并发症, 包括行为和躯体两方面。行为并发症包括日间嗜睡、注意力下降和神经心理异常, 而躯体并发症主要包括心脑血管疾病, 尤其是高血压[3, 4] 。OSAHS 是全身多个脏器功能损害的独立危险因素, 其中心血管并发症是主要死因[5] 。如何评价OSAHS 病情严重程度, 对患者的诊断、治疗及预后判断具有非常重要的意义。目前AHI 仍然是诊断OSAHS 的金标准,但其与靶器官损害的相关性存在诸多争议。
Objective To evaluate the value of Epworth sleepiness scale ( ESS) in evaluating the severity of obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 340 cases with suspected OSAHS were enrolled. The ESS scores and polysomnography ( PSG) monitoring data were analyzed. According to the PSG monitoring results the patients were classified into non-OSAHS, mild, moderate and severe OSAHS groups. The average ESS scores and the ratio of patients whose ESS score was ≥9 were compared among the four groups. The diagnostic value of ESS score was evaluated by ROC curve. The correlation of ESS scores with age, apnea hypopnea index ( AHI) , the lowest SpO2( LSpO2 ) and microarousal index was analyzed. Results The ESS scores had an ascending tendency as the severity of OSAHS was increased but only in the severe OSAHS cases the difference was significant statistically compared with the other three groups ( P lt; 0. 05) . The mean ESS scores in the four groups were 9. 96 ± 4. 81,10. 21 ±5. 48, 11. 48 ±5. 28 and 13. 52 ±5. 84, respectively. There was no statistical significance while comparing the ratio of patients whose ESS scores were ≥9 among the four groups. The analysis of ROC curve showed the area under the ROC curve ( AUC) was lesser( 0. 601) and a best cutoff could not be obtained. When ESS score ≥9 was made as the cutoff in screening OSAHS patients the sensitivity was 70. 0% and the misdiagnosis rate was 63. 21% . The ESS scores had positive correlation with the apnea hypopnea index ( AHI)( r =0. 240, P lt; 0. 01) and negative correlation with LSpO2 ( r = - 0. 198, P lt;0. 01) . The ESSscores had no correlation with age or the microarousal index ( P gt; 0. 05) . Conclusions The ESS score has some significance in screening severe OSAHS patients but can not exactly reflect the severity of OSAHS patients among Chinese population, suggesting ESS score has limited value in the evaluation of OSAHS severity. The ESS score ≥9 as a cutoff is not a reliable parameter to estimate the severity of OSAHS. A more effective scoring system need to be established for better screening of OSAHS patients.
Objective To investigate the changes and significance of serum inflammatory factors in coronary heart disease ( CHD) patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) , and the treatment effects of continuous positive airway pressure( CPAP) . Methods A total of 76 CHD patients in Renmin Hospital of Wuhan University from October 2007 to October 2008 were enrolled. Polysomnography ( PSG) was performed in these CHD patients to identify if they were complicated by OSAHS. The levels of inflammatory factors including TNF-α, IL-6, high sensitive C-reactive protein ( hs-CRP) in serum were determined in the CHD patients and 23 normal subjects. The CHD patients with moderate-severe OSAHS ( AHI≥15 episodes/hour) were treated by Auto-CPAP for 3 months and all parameters above were measured again. Results There were 41 /76 ( 53. 9% ) of CHD patients had moderate-severe OSAHS and were treated with CPAP. The levels of TNF-α, IL-6 and hs-CRP were significantly higher in the CHD patients than those in the normal controls ( all P lt; 0. 01) , and were significantly higher in moderate-severe OSAHS patients than those in the non-OSAHS CHD patients. Auto-CPAP ventilation significantly decreased the levels of inflammatory factors in the CHD patients with moderate-severe OSAHS. Conclusions An obvious proinflammatory state is detected in CHD patients, and is aggravated with OSAHS. CPAP is a useful treatment for CHD patients with mediate to severe OSAHS.
Objective To study the relationships among health-related quality of life( HRQL) ,social support, excessive daytime sleepiness ( EDS) and PSG parameters in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Eighty-five patients were recruited who were diagnosed as OSAHS by overnight polysomnography from August 2007 through November 2007 in West China Hospital.The Calgary sleep apnea quality of life index ( SAQLI) was used for HRQL, social support rating scale ( SSRS) was used for social support, and Epworth sleepiness scale( ESS) was used for EDS. The Pearson linear correlation and stepwise multiple regression analysis were used to analyze the correlation among SAQLI, SSRS, ESS, and PSG. Results The SAQLI was correlated with SSRS score ( r =0. 402, P lt;0. 01) ;ESS score ( r = - 0. 505, P lt;0. 01) ; apnea-hypopnea index ( AHI) ( r = - 0. 269, P lt; 0. 05) and lowest artery oxygen saturation ( LSaO2) ( r = 0. 226, P lt; 0. 05) . Stepwise multiple regression analysis determined two variables, the SSRS and ESS score, as independent factors for predicting the total score of SAQLI which accounted for 37. 3% of the total variance in the total score on SAQLI ( R2 = 0. 373, P lt; 0.001) .Conclusions The HRQL of patients with OSAHS was correlated with the SSRS score, ESS score and PSG parameters. The former two were the more important factors to affect the HRQL of patients with OSAHS.