Objective To systematically review the correlation between obstructive sleep apnea syndrome (OSAS) and the incidence of carotid atherosclerosis. Methods PubMed, EMbase, CNKI, WanFang Data, CBM, and VIP databases were electronically searched to collect studies on the correlation between OSAS and carotid atherosclerosis and carotid intima-media thickness (CIMT) from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 16.0 software and RevMan 5.3 software. Results A total of 32 studies, including 2 915 patients were included. The results of the meta-analysis showed a higher incidence of carotid atherosclerotic plaque in OSAS patients than in the control group (OR=5.56, 95%CI 0.27 to 8.38, P<0.000 01); subgroup analysis revealed that, compared with the control group, patients who were male (OR=5.38, 95%CI 2.79 to 10.38, P<0.000 01) or had mild-to-moderate OSAS (OR=3.9, 95%CI 1.66 to 9.15, P=0.002) or severe OSAS (OR=19.86, 95%CI 6.49 to 60.82, P<0.000 01) had a higher risk of carotid atherosclerosis. The CIMT of the OSAS group was significantly higher than that of the control group (SMD=1.24, 95%CI 0.97 to 1.51, P<0.000 01). There was a positive correlation between the apnea hypopnea index (AHI) and CIMT in OSAS patients (r=0.52, 95%CI 0.44 to 0.60, <0.000 1), and the CIMT increased with OSAS severity. Conclusion OSAS is associated with a high incidence of carotid atherosclerotic plaque that is highly correlated with CIMT, which increases with an increase in the AHI. These findings are required to be verified in prospective high-quality studies to overcome the limitations of quantity and quality of studies included in this systematic review.
Objective To evaluate the effects of selective serotonin reuptake inhibitors ( SSRIs) on sleep apneas in Sprague-Dawley ( SD) rats. Methods Thirty adultmale SD rats were randomly divided into two groups ( 15 rats in each group) . The treatment group and the control group were injected intraperitoneally with paroxetine ( 10 mg· kg- 1 · d - 1 ) and sterile distilled water ( 2 mL· kg- 1 · d - 1) for 7 days respectively. Parameters about sleep apnea and sleep structure were measured before and after the treatment. Results In the treatment group, there was a significant reduction of apnea index ( AI) from ( 12. 4 ±3. 7)times /hour to ( 7. 4 ±2. 2) times/ hour ( P = 0. 000) . Both post sigh apnea index ( PSAI) and spontaneous apnea index ( SPAI) were decreased significantly ( P = 0. 000 and 0. 021 respectively) in non-rapid eye movement ( NREM) sleep, but not in REM sleep. REM sleep was reduced from 8. 6% to 8. 0% ( P =0. 013) and its latency was increased from ( 54. 1 ±48. 4) min to ( 110. 9 ±43. 4) min ( P = 0. 001) in the treatment group, as well as the sleep-onset latency [ from ( 20. 7 ±9. 1) min to ( 30. 0 ±15. 7) min, P =0. 038] . Conclusion Paroxetine can reduce sleep apneas in SD rats during NREMsleep. Its effects on sleep structure include reducing REM time, increasing REM latency and sleep-onset latency.
ObjectiveTo investigate the diagnostic value of oximetry in sleep apnea hypopnea syndrome (SAHS). MethodsAdult patients suspected for SAHS were enrolled between May 2010 and May 2013. The patients underwent both polysomnography (PSG) and oximetry for further diagnosis. Apnea hyponea index (AHI) and oxygen desaturation index four (ODI4) were calculated on a single night. The relationship between AHI and ODI4 were analyzed. ResultsA total of 628 adult patients were recruited.ODI4 was linearly correlated with AHI with a regression coefficient of almost 1. The cut-off values of ODI4 for indentifing SAHS and moderate to severe SAHS were 10 events per hour and 20 events per hour, with specificities of 99.9% and 99.3%, and AUCs of 0.931 and 0.934, respectively. Female, lower weight and less severe SAHS patients were easily misdiagnosed. ConclusionsThere is a high agreement between AHI and ODI4. Oximetry is less likely misdiagnose SAHS.
Objective To reveal the worldwide research status and hot topics of sleep apnea syndrome ( SAS) . Methods Articles were searched from Web of Science ( SCI) , Essential Science Indicator ( 2000 to 2010) database using sleep apnea syndrome or apnea as keywords. Retrieved documents were analyzed using the database with its own statistical functions and histcite software ( version 8.12. 16) .Results Since 1992 the international scientific papers on the SAS study showed a gradual upward trend.The United States is a world leader in this field. Recent research has focused on vascular endothelial barrier function and repair, oxidative stress, inflammation, cognitive function, special populations such as the elderlyor children patients with SAS. Conclusion Clinical researchers have paid more attention to SAS than before, but there are still many important issues unresolved.
ObjectiveTo determine the correlation between obstructive sleep apnea syndrome (OSAS) and nonarteritic ischemic optic neuropathy (NAION).MethodsIt was a perspective study. A total of 41 consecutive patients with NAION (NAION group) and 41 age- and sex-matched physical examination subjects (control group) in Xi’an No.3 Hospital from December 2016 to December 2018 were enrolled in this study. The apnea hypopnea index (AHI, the number of sleep apneas per hour) was monitored using a polysomnography for patients in NAION group and control group. At the same time, the blood oxygen saturation was continuously recorded. The OSAS can be diagnosed if the AHI value was ≥5. OSAS severity was graded as mild: 5≤AHI＜15; moderate: 15≤AHI＜30; severe: AHI ≥30. The grading of OSAS severity between two groups was compared by Fisher's exact test. The AHI and minimum blood oxygen saturation were compared between NAION group and control group using the Mann-Whitney U test. Spearman correlation analysis was performed on the correlation between OSAS and NAION.ResultsAmong the patients in the NAION group, 31 patients (75.61%) were diagnosed with OSAS. Among them, 6 patients (14.63%) were mild, 9 patients (21.95%) were moderate, and 16 patients (39.03%) were severe. In the control group, 19 patients (46.34%) were diagnosed with OSAS. Among them, 10 patients (24.39%) were mild, 5 patients (12.20%) were moderate, and 4 patients (9.75%) were severe. The difference of OSAS patients of mild, moderate and severe between two groups were statistically significant (Z=0.235, 0.245, 0.312; P=0.012, 0.014, 0.032). The average AHI of patients in the NAION group was 20.25±7.74, and the mean minimum oxygen saturation at night was (87.38±5.53)%. The average AHI of the control group was 18.67±11.67, and the mean minimum oxygen saturation at night was (85.06+4.25)%. The differences of the mean AHI and mean minimum oxygen saturation between two groups were statistically significant (Z=1.124, 2.317, P=0.003, 0.020). There was a positive correlation between OSAS and NAION (Spearman correlation coefficient=0.229, P=0.030).ConclusionThere is a positive correlation between OSAS and NAION.
ObjectiveTo assess the polysomnographic characteristics of insomnia patients with comorbid obstructive sleep apnea-hypopnea syndrome (OSAHS). MethodsWe performed a comparative analysis on the polysomnographic features among patients with pure insomnia (n=80), patients with pure OSAHS (n=80), and patients with insomnia and OSAHS (n=50) between August and December 2013. ResultsCompared with OSAHS group, patients with insomnia and comorbid OSAHS had a higher percentage of female, older age, lower body mass index, shorter total sleep time during the night, longer sleep latent period and wake after sleep onset (WASO), lower sleep efficacy, lower arousal index and apnea hypoventilation index (AHI), higher average and the lowest oxygen saturation of blood, lower Epworth Sleepiness Scale scores and sleep perception (P < 0.05). Compared with the insomnia group, patients with insomnia and comorbid OSAHS had a lower percentage of female, shorter total sleep time, lower sleep efficacy, longer WASO and higher AHI (P < 0.05). ConclusionPatients with insomnia and comorbid OSAHS have all the characteristics of insomnia and OSAHS patients:nocturnal hypoxia, sleep fragmentation, broken sleep continuity, decreased sleep efficiency, damaged perception of sleep time and sleep perception.
ObjectiveTo detect the expression level of phosphate and tension homolog deleted on chromsome ten(PTEN) and its downstream signal molecules phosphorylated protein kinase B (p-AKT) in liver cells of rats during intermittent hypoxia,to investigate the effect of PTEN and p-AKT of liver cells on insulin resistance which intermittent hypoxia is relevant. MethodsA total of 24 healthy male SD rats were selected and divided into 3 groups randomly,ie.CIA (chronic intermittent air) group,CIH4 (chronic intermittent hypoxia for 4 weeks) group,and CIH8 (chronic intermittent hypoxia for 8 weeks) group. The fasting blood glucose,fasting insulin,PTEN and p-AKT expressions in the liver cells were detected. The insulin resistance was evaluated systematically by the insulin sensitive index (ISI) and homeostasis model assessment of insulin resistance (HOMA-IR). Average gray value was used to represent the protein expressions of PTEN and p-AKT. ResultsCompared with CIA group,the decline of ISI in CIH4 group and CIH8 group was significant (P<0.05). Furthermore,the decline in CIH8 group was more significant than that in CIH4 group (P<0.05). Compared with CIA group,the rise of HOMA-IR in CIH4 and CIH8 groups was statistically significant (P<0.05). In addition,the rise in CIH8 group was more significant than that in CIH4 group (P<0.05). Compared with CIA group,there was a significant rise in the protein expressions of PTEN in CIH4 and CIH8 groups (P<0.05). Compared with CIH4 group,the rise of the protein expressions of PTEN in CIH8 group was still statistically significant (P<0.05). Compared with CIA group,there was a significant decline in the protein expressions of p-AKT in CIH4 and CIH8 groups (P<0.05). Compared with CIH4 group,the decline of protein expression of p-AKT in CIH8 group was still of statistical significance (P<0.05). There was a significantly increasing trend for the expression of PTEN in the liver cells of rats with intermittent hypoxia along with the decline of ISI and rise of HOMA-IR. The expression increased significantly with the longer duration of intermittent hypoxia. The expression of p-AKT in liver cells of rats with intermittent hypoxia decreased along with the decline of ISI and rise of HOMA-IR. Furthermore,the decline tendency was more significant with the long duration of intermittent hypoxia. ConclusionThe fasting blood glucose of rats and insulin level increase due to the chronic intermittent hypoxia,resulting in the insulin resistance. The degree of insulin resistance increases with the longer duration of intermittent hypoxia. The expression of PTEN protein increases with intermittent hypoxia,and that of p-AKT protein decreases,which is obviously correlated with ISI and HOMA-IR. It is indicated that the PTEN protein possibly play an important role in the mechanism of insulin resistance for rats with intermittent hypoxia.
Objective To prospectively verify the accuracy and reliability of the diagnostic model of obstructive sleep apnea (OSA), including the probability model and disease severity model, and to explore a simple and cost-effective method for screening of OSA. Methods A total of 996 patients who underwent polysomnography in Zigong Fourth People’s Hospital(590 cases) and West China Hospital of Sichuan University(406 cases) were consecutively and prospectively included as the research subjects. Firstly, the OSA diagnostic model was used for the diagnostic test; then polysomnography was performed; Finally, taking polysomnography as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and area under the ROC curve of OSA diagnostic model were calculated, and the reliability analysis of the model’s results was carried out. Results The sensitivity, specificity and accuracy of the OSA diagnostic model were 76.38%(595/779), 83.41%(181/217) and 77.91%(776/996) respectively, the positive predictive value is 94.29%, negative predictive value is 45.49%, positive likelihood ratio is 4.604, negative likelihood ratio is 0.283; and the area under the ROC curve was 0.866. The reliability analysis of OSA diagnostic model showed that there was no significant difference in the bias comparison of AHI; the intra-class correlation coefficient(ICC) between AHI in the OSA diagnostic model and AHI in polysomnography was 0.659, with a relatively strong consistency degree; the intra-class correlation coefficient between the lowest SpO2 in the OSA diagnostic model and the lowest SpO2 in polysomnography was 0.563, with a moderate consistency degree. Conclusions The OSA diagnostic model can better predict the probability of illness and assess the severity of the disease, which is helpful for the early detection, diagnosis and treatment of OSA. The OSA diagnostic model is suitable for popularization and application in primary hospitals and when polysomnography is not available in time.
ObjectiveTo observe the correlation between obstructive sleep apnea syndrome (OSAS) and central serous chorioretinopathy (CSC).MethodsFrom October 2016 to December 2018, 50 cases of CSC patients (CSC group) and 50 healthy people (control group) matched by age and sex who were diagnosed in the ophthalmological examination of Xi’an No.3 Hospital were included in the study. According to the course of the disease, CSC was divided into acute phase and chronic phase, with 20 and 30 cases respectively. The average age (Z=1.125) and body mass index (BMI) (Z=0.937) of the two groups were compared, and the difference was not statistically significant (P＞0.05); the age of patients with different courses of CSC (Z=1.525) and gender composition ratio (χ2=0.397) and BMI (Z=1.781) were compared, the difference was not statistically significant (P＞0.05). The Berlin questionnaire was used to assess the OSAS risk of subjects in the CSC group and the control group; polysomnography was used to monitor the apnea-hypopnea index (AHI) and minimum blood oxygen saturation (MOS) during night sleep. OSAS diagnostic criteria: typical sleep snoring, daytime sleepiness, AHI (times/h) value ≥ 5. The severity of OSAS was classified as mild OSAS: 5≤AHI＜15; moderate OSAS: 15≤AHI＜30; severe OSAS: AHI≥30. Non-normally distributed measurement data were compared by rank sum test; count data were compared by χ2 test. Spearman correlation analysis was performed on the correlation between OSAS and CSC.ResultsThe AHI data in the CSC group and the control group were 17.46±3.18 and 15.72±4.48 times/h, respectively; the MOS were (83.48±4.68)% and (87.40±3.82)%, respectively; those diagnosed with OSAS were respectively 36 (72.00%, 36/50) and 13 (26.00%, 13/50) cases. AHI (Z=0.312), MOS (Z=0.145), and OSAS incidence (χ2=21.17) were compared between the two groups of subjects, and the differences were statistically significant (P=0.028, 0.001,＜0.001). The AHI of acute and chronic CSC patients were 15.95±3.02 and 18.47±2.92 times/h; the MOS were (86.10±11.07)% and (81.73±4.58)%, respectively. There were statistically significant differences in AHI (Z=0.134) and MOS (Z=0.112) in patients with different course of disease (P=0.005, 0.001). The results of Spearman correlation analysis showed that OSAS and CSC were positively correlated (r=0.312, P=0.031).ConclusionOSAS may be a risk factor for the onset of CSC.
Objective To analyze the risk factors of prethrombotic state of obstructive sleep apnea and hyponea syndrome (OSAHS), providing basis and reference for the prevention of prethrombotic state of OSAHS. Methods Two hundred and thirty-eight patients excluding the presence of possible effects of coagulation factors from June 2014 to July 2016 were diagnosed as OSAHS by polysomnography (PSG) and underwent coagulation, thrombosis, fibrinolysis, and inflammatory factors testing. Fifty-six patients met the standard of prethrombotic state (prethrombotic state group) and 59 patients randomly selected from the remaining 182 patients did not meet the standard (non-prethrombotic state group). The age, sex, body mass index (BMI), sleep apnea and hypopnea index (AHI), interleukin-6 (IL-6), complicating chronic obstructive pulmonary disease (COPD) and hypertension were compared between two groups. Results Non conditional Logistic regression analysis showed that the risk factors of prethrombotic state of OSAHS were age (OR=1.202, 95%CI: 1.107 to 1.305), IL-6 (OR=1.127, 95%CI: 1.014 to 1.252), AHI (OR=1.151, 95%CI: 1.055 to 1.256), and complicating COPD (OR=4.749, 95%CI: 1.046 to 21.555). Conclusion Age, AHI, IL-6, and complicating COPD may be the risk factors of prethrombotic state of OSAHS, among which complicating COPD may be the most important risk factor.