Objective To explore the relationship between obstructive sleep apnea hypopnea syndrome ( OSAHS) and airway hyperresponsiveness ( AHR) . Methods 197 subjects suspected for OSAHS were enrolled in the study. They were all performed overnight polysomnogram ( PSG) monitoring and lung function test. Acoording to the results of FEV1% pred, they were performed bronchial provocation test( BPT)or brochial dilation test( BDT) . The relation between apnea hypopnea index ( AHI) and the degree of airway hyperresponsiveness ( AHR, expressed as PD20 -FEV1 ) was evaluated by linear correlation analysis. Results 117 patients were diagnosed as OSAHS, in which 28 cases were complicated with AHR( 3 cases with positive BDT result, 25 cases with AHR) . In 80 non-OSAHS patients, 7 cases were complicated with AHR. Theincidence of AHR was higher in the OSAHS patients compared with the non-OSAHS patients( 23. 9% vs 8. 8% , P lt; 0. 01 ) . AHI of OSAHS patients with AHR was higher than OSAHS patients without AHR[ ( 30. 3 ±5. 1) /h vs ( 23. 7 ±2. 4) /h, P lt;0. 01] . There was a positive correlation between AHI and degree of AHR in OSAHS patients with AHR( r=0. 62, P lt;0. 05, n=25) . Conclusion OSAHS is associated with an increased risk of AHR.
Objective To study the changes of receptor activator of nuclear factor-κB ligand (RANKL, an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG, the decoy receptor for RANKL), oxidative stress and bone turnover markers in obstructive sleep apnea-hypopnea syndrome (OSAHS), in order to understand the potential mechanisms underlying bone loss in OSAHS patients. Methods Ninety-eight male patients with OSAHS, confirmed by polysomnography (PSG) study, were enrolled. The patients were divided into mild-moderate groups and severe groups. Forty-two male subjects who were confirmed as not having OSAHS served as the controls. The subjects’ bone mineral density (BMD) and T-score were assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry. Blood samples were collected from all subjects for measurement of RANKL, OPG, the bone formation marker bone-specific alkaline phosphatase (BAP), the bone resorption marker tartrate-resistant acid phosphatase-5b (TRAP-5b), total antioxidant capacity (TAOC). Twenty-eight severe OSAHS patients accepted continuous positive airway pressure (CPAP) treatment voluntarily. After 6 months, PSG was conducted, and serum RANKL, OPG, TAOC, TRAP-5b, BAP was measured after six months treatment. Results The BMD, T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group. The level of BAP was significantly decreased in the OSAHS group as compared to the control group, and there was no significant difference in TRAP-5b level between two groups. As compared with the control group, levels of OPG, TAOC and the OPG/RANKL ratio decreased significantly. None of these parameters (BMD, T-score, RANKL, OPG, TRAP-5b, BAP) showed significant difference between patients with mild-moderate and severe OSAHS group. Correlation analysis showed that the apnea hypopnea index and oxygen desaturation index were correlated with TAOC. BAP level was positively correlated with TAOC and lowest pulse oxygen saturation. The serum level of TAOC was lower in the OSAHS group after CPAP therapy, but the levels of RANKL, OPG, TRAP-5b, BAP were not different. As compared with the OSAHS group before CPAP therapy, the BMD of the femoral neck and the lumbar spine were not significant difference. Conclusions In patients with OSAHS, the oxidative stress response is enhanced, and imbalance of OPG/RANKL is shifted, which participates in the occurrence of osteoporosis. The oxidative stress injury of severe OSAHS patients was relieved after non-invasive ventilation treatment, but the effect of oxidative stress response on bone metabolism still needs further evaluation.
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.
Objective To investigate the prevalence of obstructive sleep apnea hypopnea syndrome ( OSAHS) in patients with idiopathic pulmonary fibrosis ( IPF) and its clinical significance. Methods Sleep quality and breathing disorders were measured by polysomnography and the relationship with lung function was analyzed in 20 IPF patients. Results Thirteen of 20 subjects ( 65% ) had OSAHS as defined by an AHI ≥5 events per hour. Three subjects ( 15% ) had mild OSAHS ( AHI,5 to 20 events per hour) , and 10 subjects ( 50% ) had moderate-to-severe OSAHS ( AHI≥20 events per hour) . The sleep architecture in these patients showed a reduction in sleep efficiency, rapid eye movement ( REM) sleep and slow wave sleep, and a marked sleep fragmentation due to an increased arousal index. The AHI was negatively correlated with FVC% pred ( r =-0.672, P=0.001) and FEV1% pred ( r =-0.659, P=0.002) , and positively correlated with body mass index ( BMI) ( r=0.791, Plt;0.0001) . Conclusions OSAHS is a common comorbidity in IPF. Early treatment of OSAHS may improve quality of life and the prognosis of patients with IPF.
ObjectiveTo systematically review the association between the level of plasma YKL-40 and obstructive sleep apnea hypopnea syndrome (OSAHS).MethodsWe searched PubMed, EMbase, MEDLINE, CNKI, WanFang Data, VIP database and supplemented by Google academic retrieval to collect case-control studies about the association between the level of plasma YKL-40 and OSAHS from inception to April 2017. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. And then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 5 case-control studies were included, involving 755 OSAHS patients and control population. The results of meta-analysis showed that the level of plasma YKL-40 in OSAHS patients was higher than that in control group (SMD=1.20, 95%CI 0.33 to 2.06, P=0.007). The subgroup analysis showed that the level of plasma YKL-40 in OSAHS patients from Asia was significantly higher than that in control group (SMD=1.79, 95%CI 0.83 to 2.75, P=0.000 2). The comparison between different severity of OSAHS showed that the wild-medium group had lower plasma level of YKL-40 than the severe group (SMD=–0.83, 95%CI –1.46 to –0.19, P=0.01).ConclusionYKL-40 may play an important role in the pathogenesis of OSAHS. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusions.
Objective To invesitgate the prevalence of pulmonary thromboembolism （PTE） in hospitalized patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）from January 2004 to December 2008，and analyse its impact on the severity of OSAHS. Methods Demographic and clinical characteristics of 24 OSAHS patients complicated with PTE were analyzed. 30 OSAHS patients without PTE were served as controls. Results PTE was detected in 2.44% （31/1268） of the OSAHS patients. When compared with the OSAHS patients without PTE，the OSAHS patients with PTE had a significantly higher apnea hypopnea index （AHI） [（27.8±11.6）/h vs. （18.2±8.1）/h，P=0.038] and a lower LSpO2 （lowest saturated pulse arterial oxygen level） [（78.4±8.5）% vs. （85.2±7.9）%，P=0.035]. Both groups received continuous positive airway pressure （CPAP） ventilation. Anticoagulation and/or thrombolysis treatment were used in the OSAHS patients with PTE. Conclusions We found a higher prevalence of PTE in patients with OSAHS. Compared with those without PTE，OSAHS patients with PTE have more severe sleep apnea-hypopnea and hypoxemia in sleep. Comprehensive treatments including anticoagulation and CPAP should be used in these patients.
Objective To evaluate the changes of right ventricular function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after continuous positive airway pressure (CPAP) treatment by two-dimensional speckle tracking imaging (2D-STI). Methods Fifty patients with moderate and severe OSAHS were selected for CPAP treatment, and another 40 healthy volunteers were selected as a control group. 2D-STI and traditional echocardiography were conducted in the study group before treatment, after 3 months of continuous treatment and after 6 months of continuous treatment and in the control group. Results The differences between the control subjects and the OSAHS patients were statistically significant in right ventricular global longitudinal strain (RVGLS), right ventricular free lateral wall longitudinal strain (RVLLS), apical segment of the right ventricular free wall longitudinal strain (Apical RV-SL), basal segment of the right ventricular free wall longitudinal strain (Basal RV-SL), and media segment of the right ventricular free wall longitudinal strain (Media RV-SL) (all P<0.05). RVGLS, RVLLS and Apical RV-SL were significantly improved after 3 months of CPAP treatment (all P<0.05). Basal RV-SL was significantly improved after 6 months of CPAP treatment (P<0.05). Conclusions The right ventricular function of patients with OSAHS is abnormal. CPAP treatment can improve the right ventricular function of OSAHS patients. 2D-STI can accurately assess the changes of right ventricular function.
ObjectiveTo investigate the expression of C/EBP homologous protein (CHOP) in lung tissue of chronic intermittent hypoxia rats, and explore the intervention effect of edaravone and its possible mechanism.MethodsA total of 120 adult male Wistar rats were randomly divided into three groups: a normal control group (UC group), a chronic intermittent hypoxia group (CIH group), an edaravone intervention group (NE group), and a normal saline group (NS group). The above four groups were also randomly divided into five time subgroups of 3 days, 7 days, 14 days, 21 days and 28 days, respectively, with 6 rats in each time subgroup. The histopathological changes of lung tissue were observed by hematoxylin-eosin (HE) staining and the expression of CHOP in lung tissue was detected by immunohistochemical method.ResultsHE staining results showed that there was no obvious pathological change in UC group. The epithelial cells of lung tissue in CIH group showed edema, hyperemia, widening of alveolar septum and inflammatory cell infiltration. The pathological injury was more serious with the prolongation of intermittent hypoxia time. There were also pathological changes in NE group, but the degree of lung tissue injury was significantly lower than that in CIH group. The results of immunohistochemistry showed that the expression of CHOP in CIH group was significantly higher than that in UC group. The expression of CHOP in NE group was higher than that in UC group, but it was still significantly lower than that in CIH group.ConclusionsThe expression of CHOP protein in lung tissue of chronic intermittent hypoxic rats is enhanced and the high expression of CHOP protein plays a certain role in the lung injury of chronic intermittent hypoxia rats complicated with lung injury. Edaravone may protect lung tissue from chronic intermittent hypoxia by inhibiting the expression of CHOP.
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 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.