ObjectiveTo systematically review the prevalence of obstructive sleep apnea syndrome (OSAS) in China. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data, and VIP databases were electronically searched to collect cross-sectional studies of the prevalence of OSAS in China from inception to October 30th, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software. ResultsA total of 27 studies were included, with a total sample size of 97 746 cases and 10 853 confirmed OSAS patients. Meta-analysis results showed that the prevalence of OSAS in China was 11% (95%CI 5% to 17%), of which females was 12% (95%CI 5% to 19%) and males was 12% (95%CI 5% to 20%). OSAS cases grouped by regions were as follows: Central China 4% (95%CI 2.7% to 4.5%), South China 5% (95%CI 2.7% to 6.7%), North China 7% (95%CI 4.6% to 9.3%), Northeast China 22% (95%CI 17.7% to 61.2%), Southwest China 4% (95%CI 3.2% to 5%), Northwest China 16% (95%CI 14.5% to 17.7%), and East China 17% (95%CI 2.8% to 30.6%). OSAS patients grouped by ages were as follows: 4% (95%CI 3% to 5%) for ≤14 years old, 5% (95%CI 2% to 7%) for 15-44 years old, 13% (95%CI 6% to 20%) for 45-59 years old, 16% (95%CI 6% to 25%) for 60-74 years old, 13% (95%CI 4% to 23%) for 75-89 years old, and 11% (95%CI 2% to 21%) for ≥ 90 years old. A subgroup analysis based on the year of publication found that the prevalence of OSAS fluctuated between 6% and 9% from 2005 to 2020, and the prevalence was the highest from 2000 to 2005 accouted with 21% (95%CI 0.8% to 40.5%). ConclusionsThe prevalence of OSAS in China is relatively high, and there are differences in the prevalence among individuals of different ages and regions. The 60-year-old groups in addition to the Northeast and East China regions have a high incidence. The prevalence of OSAS is substantially consistent between males and females. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To investigate the correlation between serum level of visfatin and obesity in patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods Forty-seven patients with OSAHS and 20 healthy controls were recruited in this study. Polysomnography was performed in all subjects to detect apnea-hypopnea index ( AHI) . The serumlevels of cisfatin, C-reactive protein ( CRP) , TNF-α, and IL-6 were measured by enzyme linked immunosorbent assay. The body mass inex ( BMI) was calculated.The level of cisfatin was compared between the OSAHS patients with different severity and the controls, and its relationship with the levels of AHI, BMI, CRP, TNF-α, and IL-6 was analyzed. Results The serumlevel of visfatin in the OSAHS patients was higher significantly than that in the controls ( P lt;0. 01) and increased by the severity of OSAHS. There were positive correlations between the serum level of visfatin and AHI,BMI, CRP, TNF-α, IL-6 in the OSAHS patients ( P lt;0. 05) . Conclusion The expression of visfatin may play an important role in the pathogenesis of 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 correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and biochemical indexes in children. Methods Seventy-eight children with OSAHS in our hospital from January 2015 to February 2017 were recruited as an observation group, and 100 normal children who underwent physical examination were selected as a control group in the same period. The mean values and positive rates of biochemical markers were compared between two groups including alanine aminotransferase (ALT), blood urea nitrogen (BUN), total cholesterol (TC), triglyceride (TG), creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), fasting blood glucose (FPG) level. Results The mean values of biochemical indexes showed significant differences between the observation group and the control group except BUN and FPG [ALT, (52.1±26.2) U/L vs. (41.3±18.5) U/L; TC, (4.9±0.9) mmol/L vs. (4.3±0.8) mmol/L; TG, (1.4±0.7) mmol/L vs. (1.0±0.4) mmol/L; CK-MB, (24.3±9.5) U/L vs. (11.2±8.2) U/L; cTnI, (1.4±0.7) μg/L vs. (1.0±0.6) μg/L] (all P<0.05). The positive rates also showed significant differences between the observation group and the control group except BUN and FPG [ALT (48.7%vs. 14.0%), TC (24.4% vs. 8.0%), TG (23.1% vs. 8.0%), CK-MB (41.0% vs. 11.0%), cTnI (34.6% vs. 7.0%) (all P<0.05). Conclusions The cardiac function and liver function are significantly impaired in children with OSAHS, showing the disorder of lipid metabolism to some extent. These abnormal indexes may be the occurrence and development of OSAHS. More attention should be paid to the detection of biochemical indexes in children with OSAHS.
Sleep apnea causes cardiac arrest, sleep rhythm disorders, nocturnal hypoxia and abnormal blood pressure fluctuations in patients, which eventually lead to nocturnal target organ damage in hypertensive patients. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) is extremely high, which seriously affects the physical and mental health of patients. This study attempts to extract features associated with OSAHS from 24-hour ambulatory blood pressure data and identify OSAHS by machine learning models for the differential diagnosis of this disease. The study data were obtained from ambulatory blood pressure examination data of 339 patients collected in outpatient clinics of the Chinese PLA General Hospital from December 2018 to December 2019, including 115 patients with OSAHS diagnosed by polysomnography (PSG) and 224 patients with non-OSAHS. Based on the characteristics of clinical changes of blood pressure in OSAHS patients, feature extraction rules were defined and algorithms were developed to extract features, while logistic regression and lightGBM models were then used to classify and predict the disease. The results showed that the identification accuracy of the lightGBM model trained in this study was 80.0%, precision was 82.9%, recall was 72.5%, and the area under the working characteristic curve (AUC) of the subjects was 0.906. The defined ambulatory blood pressure features could be effectively used for identifying OSAHS. This study provides a new idea and method for OSAHS screening.
In recent years, more and more studies have shown that obstructive sleep apnea hypopnea syndrome (OSAHS) and metabolic syndrome are closely related and interact with each other, while hypertension, abnormal glucose metabolism, lipid metabolism disorders and obesity, as the main components of metabolic syndrome, have been further studied. Continuous positive airway pressure is currently the main treatment for OSAHS. This review focuses on the association between OSAHS and hypertension, glucose metabolism abnormalities, lipid metabolism disorders, obesity and the effects of treatment with positive airway pressure, aiming to provide a theoretical basis for the pathogenesis and treatment of OSAHS complicated with metabolic syndrome.
Objective To evaluate prognostic impact of treatment with Continuous Positive Airway Pressure (CPAP) or upper airway surgery on the patients with obstructive sleep apnea (OSA) and coronary heart disease (CHD). Methods Database search in The Cochrane Library, PubMed, OVID and CBM (from establishment dates to October 2009) were conducted. Cohort studies and randomized controlled trials of OSA with CPAP or upper airway surgery in CHD patients were identified. We assessed the quality of the included trials and extracted the relevant data. Statistical analysis was performed using RevMan 4.3.2 software. Results A total of 4 cohort studies involving 945 participants were included. The results of meta-analysis were as follows: a) there were no significant differences in the rate of late lumen loss and 10-year mortality between CHD patients with OSA treated by CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80, 95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in the treatment of OSA on CHD patients after PCI had a significant decrease in the rate of 5-year cardiac death when compared with those untreated OSA patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no differences in the rate of 5-year all-cause mortality, major adverse cardiac events (MACE) between the two groups respectively (RR=0.66, 95%CI 0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or upper airway surgery in treating OSA significantly reduced the risk of MACE occurrence during the 86.5±39 months follow-up period (RR=0.22, 95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that treating OSA with CPAP or upper airway surgery in CHD patients might be associated with a decrease in the risk of cardiac death. But more studies are necessary to evaluate prognostic impact of treatment with CPAP or upper airway surgery on the patients with OSA and CHD. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.
Objective To investigate the risk factors of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea (OSA) and its relationship with apnea-hypopnea index (AHI). Methods Clinical data of 216 COPD patients with OSA were retrospectively chosen in the period from January 2016 to December 2019 in our hospital. All patients were divided into different groups according to with or without OSA and the clinical features of patients with and without OSA were compared. Multivariate analysis was used to analyze the influencing factors of COPD with OSA and the correlation between AHI and COPD with OSA was also evaluated. Results ① The age, body mass index (BMI), neck circumference, smoking index, forced expiratory volume in 1 second (FEV1), FEV1% predicted (FEV1pred), the ratio of FEV1 to the forced vital capacity of the lungs (FEV1/FVC), COPD assessment test (CAT) score, Epworth sleepiness scale (ESS) score, Charlson comorbidity index (CCI) score, sleep apnea clinical score (SACS) score and proportion of patients with essential hypertension in OSA group were significantly higher than non-OSA group (P<0.05). The course of disease and the proportion of severe COPD and GOLD grade 4 in OSA group were significantly less than non-OSA group (P<0.05). ② AHI was positively correlated with age, BMI, neck circumference, smoking index, FEV1%pred, FEV1%pred<50%, CAT score, ESS score, CCI score and SACS score (P<0.05); and negatively correlated with FEV1%pred<50% (P<0.05). ③ Multivariate analysis showed that BMI, FEV1%pred<50%, CAT score and ESS score were the independent factors of COPD patients with OSA (P<0.05). ④ The proportion of AHI<5 times/h in GOLD grade 4 was significantly higher than GOLD grade 1-3 (P<0.05). The proportion of AHI> 30 times/h in GOLD grade 4 was significantly lower than GOLD grade 1-3 (P<0.05). Conclusion The incidence of COPD with OSA was independently correlated with BMI, FEV1%pred, CAT score and ESS score; patients with severe COPD possess lower OSA risk.
ObjectiveTo investigate the expression and significance of CD73 in rats with intermittent hypoxia and high fat diet.MethodsThe rat model of chronic intermittent hypoxia combined with high fat diet was established. Twenty-four healthy male Wistar rats in the SPF level were randomly divided into 4 group, with 6 rats in each group, namely group A (normoxia and normal diet), group B (normoxia and high fat diet), group C (intermittent hypoxia and normal diet)and group D (intermittent hypoxia and high-fat diet). After 6 weeks of experiment, the serum lipid levels, myocardial morphological changes under microscope, the expression level of CD73 protein detected byimmunohistochemistry and Western blot in myocardial cells in rats were compared among these groups.ResultsThe serum lipid levels were significantly different among these groups (P<0.05). HE results showed that the myocardial cells of group A had no obvious abnormalities; disorganized visible myocardial fibers with focal necrosis in groups B and C; myocardial cell injury was most obvious in group D, in which visible muscle fibers arranged in disorder, and grain was not clear, part of the muscle fibers were dissolved predominantly. Compared with group A, CD73 protein expression levels in myocardial cells in groups B, C, and D were significantly elevated (P<0.01). Furthermore, CD73 protein expression level in myocardial cells in group D was significantly higher than those in groups B and C (P<0.01). Western blot showed consistent results as immunohistochemistry: compared with group A, CD73 protein expression levels in groups B, C, and D were significantly elevated (P<0.05), and CD73 protein expression level in myocardial cells in group D was significantly higher than those in groups B and C (P<0.01).ConclusionChronic intermittent hypoxia and high fat diet can cause myocardial cell damage and upregulate CD73 expression in the cardiomyocytes.
In clinical, manually scoring by technician is the major method for sleep arousal detection. This method is time-consuming and subjective. This study aimed to achieve an end-to-end sleep-arousal events detection by constructing a convolutional neural network based on multi-scale convolutional layers and self-attention mechanism, and using 1 min single-channel electroencephalogram (EEG) signals as its input. Compared with the performance of the baseline model, the results of the proposed method showed that the mean area under the precision-recall curve and area under the receiver operating characteristic were both improved by 7%. Furthermore, we also compared the effects of single modality and multi-modality on the performance of the proposed model. The results revealed the power of single-channel EEG signals in automatic sleep arousal detection. However, the simple combination of multi-modality signals may be counterproductive to the improvement of model performance. Finally, we also explored the scalability of the proposed model and transferred the model into the automated sleep staging task in the same dataset. The average accuracy of 73% also suggested the power of the proposed method in task transferring. This study provides a potential solution for the development of portable sleep monitoring and paves a way for the automatic sleep data analysis using the transfer learning method.