ObjectiveTo explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and aortic dissection (AD).MethodsFifty three patients with AD diagnosed by CTA in our hospital from January 2016 to January 2018 were selected. All the patients with AD were scored by the STOP-BANG questionnaire. The patients who scored more than or equal to 3 received polysomnography (PSG) after surgical or conservative treatment, and according to whether the sleep apnea-hypopnea index was higher than or equal to 5. Fifty-three patients were divided into an OSAHS group and a non OSAHS group.ResultsThere were 18 patients with 17 males and 1 female at average age of 43.3±8.4 years in the OSAHS group, and 35 patients with 23 males and 12 females at average age of 56.6±12.9 years in the non OSAHS group. There was no statistical difference between the two groups in the Stanford classification of aortic dissection, the time of onset, personal history, the history of diabetes, coronary heart disease and hyperlipidemia, or post-treatment systolic/diastolic blood pressure before sleep (P>0.05). The age of patients in the OSAHS group was significantly less than that in the non OSAHS group (P<0.01), the proportion of men/women (P=0.021), weight (P<0.01), height (P=0.028), body mass index (P<0.01), and post-treatment systolic/diastolic blood pressure after waking up (P=0.028,P=0.044) in the OSAHS group were significantly higher than those in the non OSAHS group. In the OSAHS group, the proportion of previous hypertension was significantly higher than that in the non OSAHS group (P=0.042).ConclusionAD patients combined with OSAHS are mostly male patients. The number of young and high-fat people is significantly more than that in the non OSAHS group. OSAHS may be one of the risk factors for young, high-fat men with AD.
Objective To investigate the role of plasma neuropeptide Y ( NPY) level in obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods The patients underwent polysomnography ( PSG)monitoring in the sleep disorder center of Zhongda Hospital from January 2008 to December 2009 were analyzed. Plasma NPY levels were compared between different groups allocated according to apnea-hypopnea index ( AHI) and body mass index ( BMI) . Plasma NPY levels were measured by enzyme-linked immunoassay. Results The plasmaNPY levels in the severe and moderate OSAHS groups were significantly higher than the groups withoutOSAHS of the same weight degree ( P lt;0. 05) . The plasmaNPY levels in the severe OSAHS groups were significantly higher than the groups with mild and moderate OSAHS of the sameweight degree. In the severe OSAHS patients, the plasma NPY level of the obese group was significantly higher than the overweight group and the normal weight group( P lt;0. 05) . In the non-OSAHS and mild to moderate OSAHS patients, there was no significant difference among different groups of weight ( P gt;0. 05) .Plasma NPY level in the OSAHS patients was correlated positively with AHI ( r =0. 667, P lt;0. 05) and BMI( r =0. 265, P lt;0. 05) , but negatively with LSaO2 ( r = - 0. 523, P lt; 0. 05) and MSaO2 ( r = - 0. 422, P lt;0. 05) . Conclusion Plasma NPY level is correlated with OSAHS, and increases with the severity of OSAHS. Plasma NPY level has no correlation with obesity.
Objective To investigate the changes of steps walks daily in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) before and after the initiation of nasal continuous positive airway pressure ( nCPAP) ventilation. Methods 62 patients diagnosed by polysomnogaphy ( PSG) in the sleep respiratory disease center of Nanjing FirstHospital Affiliated to Nanjing Medical University were recruited as the OSAHS group, and divided into mild,moderate, and severe subgroups according to apnea-hypopnea index ( AHI) .28 subjects without OSAHS were recruited as the control group. All the subjects were evaluated by Epworth Sleepiness Scale ( ESS) and Functional Outcomes of Sleep Questionnaire ( FOSQ) . Steps walked daily were measured by electronic pedometer.10 patients with moderate and severe OSAHS were treated with nCPAP. Results Compared with the control group and the mild OSAHS patients, ESS scores were significantly higher while FOSQ scores and steps walked daily were significantly lower in the moderate and severe OSAHS patients ( P lt; 0. 05) . In the OSAHS patients, steps walked daily were correlated positively with FOSQ scores but negatively with BMI, ESS scores, AHI, oxygen desaturation index ( ODI) and saturation impair time below 90% ( SIT90) ( P lt; 0.05) . After one month of nCPAP therapy, ESS scores were significantly decreased, FOSQ scores and steps walked daily were significantly increased (Plt;0.05) . Conclusions Increased OSAHS severity is associated with decreased steps walked daily which is an objective index of routine physical activity. Untreated OSAHS may negatively impact the patients’ability to have an active lifestyle. nCPAP therapy can significantly improve steps walks daily of patients with OSAHS.
Objective To investigate the differences in clinical characteristics and polysomnographic characteristics between the elderly obstructive sleep apnea-hypopnea syndrome ( OSAHS) patients and the young and middle-aged OSAHS patients. Methods The clinical manifestations and the polysomnographic characteristics of 37 elderly OSAHS patients and 294 young and middle-aged patients were analyzed. The differences in polysomnographic indicators between two groups were compared according to the body mass index.Results The nocturia frequency in the elderly OSAHS patients was higher( P =0. 01) ,however, the othert clinical manifestations between the elderly group and the young and middle-aged group were not different significantly. The elderly group had a lower body mass index ( P =0. 018) , a smaller neck circumference ( P =0. 003) , and a larger chance of diabetes ( P = 0. 001) and hypertension( P lt; 0. 001) .The phase Ⅰ and phase Ⅱ sleep of the elderly group took a longer duration ( P lt; 0. 001) and a larger proportion( P lt;0. 001) . The sleep apnea-hypopnea index between two groups did not show any significant difference( P =0. 082) . The lowest night oxyhemoglobin saturation of the elderly group was higher than that of the young and middle-aged group( P =0. 009) , but such difference disappeared after adjustment by weight ( P =0. 114) . Conclusions The major clinical manifestations of the elderly OSAHS patients are similar to the young and middle-aged patients. The elderly patients are thinner than the young and middle-aged patients, but have more complications and a higher frequency of nocturia. The night oxyhemoglobin saturation is lower in young and middle-aged patients which is associated with higher body mass index.
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.
Objective To investigate the changes and clinical relationship of plasma adrenomedullin( ADM) , atrial natriuretic polypeptide( ANP) , and heart rate variability( HRV) in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Seventy-five inpatients with OSAHS were enrolled in this study. According to the apnea hypopnea index ( AHI) by polysomnography, the subjects were divided into a mild group, a moderate group, and a severe group. Meanwhile, HRV was screened bydynamic electrocardiogram in sleep laboratory. HRV parameters were obtained including LF ( low frequency power) , HF( high frequency power) , pNN50( percentage of NN50 in the total number of N-N intervals) ,SDNN( standard deviation of the N-N intervals) , rMSSD( square root of the mean squared differences of successive N-N intervals ) . Plasma levels of ADM/ANP were measured by radioimmunoassay. Results The levels of SDNN ( P lt;0. 05) , rMSSD, pNN50, LF ( P lt; 0. 05) and HF were gradually reduced, and the levels of ADM ( P lt;0. 05) and ANP ( P lt; 0. 05) were increased with increasing severity of OSAHS. Linear correlation analysis demonstrated that SDNN was negatively correlated with ADM( r = - 0. 423, P lt;0. 05)and ANP( r = - 0. 452, P lt; 0. 05) , and LF was also negatively correlated with ADM( r = - 0. 348, P lt;0. 05) . Conclusion Lower HRV is associated with more sever OSAHS, and it may be modulated neurohumorally by ADM and ANP.
Objective To investigate the changes in mitochondrial morphology, structure and function in rats with severe intermittent hypoxia, as well as the effects of intermittent hypoxia and its severity on cognitive function. Methods A total of 18 rats were selected to construct a model of severe intermittent hypoxia, which were divided into a normal control group, an intermittent air control group, and a 5% intermittent hypoxia group for 8 weeks, with 6 rats in each group. The structural and functional changes of mitochondria in the hippocampal CA1 region were observed. A total of 30 rats were randomly divided into 5 groups: a normal control group, an intermittent air control group, a 5% intermittent hypoxia 4-week group, a 5% intermittent hypoxia 6-week group, and a 5% intermittent hypoxia 8-week group, with 6 rats in each group. The cognitive function of the rats in each group was evaluated by Morris water maze experiment. Results In the mitochondria of the hippocampal CA1 region of severely intermittent hypoxic rats, bilayer membranes or multilayer membranes were visible, the mitochondria were swollen, cristae were broken and vacuolated, and their respiratory function was significantly weakened, the membrane permeability was increased, and the membrane potential was reduced. In the Morris water maze, there was no significant difference in swimming speed between the rats. With the prolongation of intermittent hypoxia action time, the latency of finding the hidden platform in each group of rats increased significantly, and the residence time of the target quadrant decreased significantly. Conclusions Mitochondrial structure in the hippocampal CA1 region of the rat brain is destroyed during severe intermittent hypoxia, and dysfunction and cognitive impairment occur. With the prolongation of intermittent hypoxic injury, the degree of cognitive impairment worsens.
Objective To explore effects of edaravone on apoptosis and expressions of apoptotic proteins Smac and XIAP in hippocampal CA1 pyramidal cell of rats under intermittent hypoxia. Methods A total of 96 adult male Wistar rats were randomly divided into control group, 5% intermittent hypoxic group and edaravone group, and each group was divided into 4 time groups at 7 d, 14 d, 21 d and 28 d, respectively, with 8 rats in each subgroup. The content of reactive oxygen species (ROS) in hippocampal tissues of the experimental rats was detected by the reactive oxygen species detection kit. Immunohistochemistry and Western blot were used to detect the expressions of Smac and XIAP protein in hippocampal CA1 region. The Tunel method detected the apoptosis of neurons. Results Compared with the control group, the content of ROS, the expressions of Smac and XIAP proteins and the neuronal apoptosis index in the hippocampus were increased in the 5% intermittent hypoxia group and the edaravone group at each time point (all P<0.05). The content of ROS, the Smac protein expression and the neuronal apoptosis index in the edaravone group were significantly lower than those in the 5% intermittent hypoxia group (all P<0.05). The expression of XIAP protein in the edaravone group was significantly higher than that in the 5% intermittent hypoxia group (P<0.05). Conclusion Edaravone may improve the antioxidant capacity of the body by scavenging oxygen free radicals and regulate Smac and XIAP- mediated apoptosis, thus playing a protective role on neurons.
Objective To investigate the clinical efficacy and safety of coblation-assisted adenotonsillectomy for treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods From June 2007 to May 2008, after monitoring polysomnography (PSG) confirmed 82 cases of OSAHS in children aged 3 to 14 years, with an average age of 6.2 years old, the ENT CoblatorII surgical instrument made by Arthrocare in the US and one-time EVac 70 T amp; A segment was used under complete anesthesia to remove tonsils and(or)adenoid ablation. Polysomnography monitoring was used preoperatively and 6 months postoperatively to determine the therapeutic effect. Results No significant complications occurred among the children both during the operation and postoperatively. Patients were followed for 6 months, and a satisfactory effect was achieved. The lowest oxygen saturation (LSaO2) improved significantly (Plt;0.001); the apnea-hypopnea index (AHI) decreased significantly after the operation (Plt;0.001). In accordance with OSAHS diagnosis and efficacy evaluation standards, 45 patients were cured after 6 months, 21 patients showed an excellent effect, 10 patients showed a good effect, six patients had no effect, and the total effective rate was 92.6%. Conclusion Low-temperature coblation-assisted adenotonsillectomy has good clinical efficacy with a shortened surgical time, less intraoperative and postoperative blood loss, less postoperative pain, few complications, and a simple operation procedure. It can effectively expand the nasopharynx, oropharynx ventilation cross-sectional area, lift the upper airway obstruction, and can be especially suitable for surgical treatment of children with OSAHS.
Objective To assess the correlation between obstructive sleep apnea-hypopnea syndrome (OSAHS) and hypertension. Methods Such databases as MEDLINE (1950 to April 2011), EMbase (1989 to April 2011), VIP (1989 to April 2011), WANFANG (1977 to April 2011), CBM (1978 to April 2011) and CNKI (1979 to April 2011) were searched to collect literatures about the correlation between OSAHS and hypertension. The literatures in conference proceedings and some unpublicized articles were also retrieved. All cohort studies and case control studies were included. Two reviewers independently collected the data, assessed the quality, and conducted the Meta-analysis by using RevMan5.1 software. Results Among the total 11 studies involving 4 019 participants were included, 1 was prospective cohort study and the other 10 were case control studies. The results of Meta-analyses showed that: a) the OSAHS was correlated with hypertension (P=0.16, RR=2.52, 95%CI 2.21 to 2.87); and b) the correlation between OSAHS and hypertension was related with the different grades of OSHAS (P=0.83, RR=1.84, 95%CI 1.53 to 2.22). The more severe grade the OSAHS, the greater possibility the hypertension. Conclusion OSAHS is significantly related with hypertension, and they may be the mutual risk factor for each other. The correlation between OSAHS and hypertension may be related with different grades of OSAHS.