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 evaluate the correlation of vascular endothelial growth factor (VEGF) and vascular endothelial cadherin (VE-Cadherin) in serum with the severity of obstructive sleep apnea (OSA) and explore their clinical value in OSA. Methods A total of 90 patients with OSA admitted to the Sleep Monitoring Center of the Affiliated Hospital of Xuzhou Medical University from April 2023 to June 2024 were prospectively selected. Based on the apnea-hypopnea index (AHI), the patients were divided into a mild group (5 - 15 times/hour, n=30), a moderate group (>15 - 30 times/hour, n=28), and a severe group (>30 times/hour, n=32). Thirty healthy individuals who underwent physical examinations during the same period were included as a control group. The levels of serum VEGF and soluble VE-Cadherin (sVE) in all subjects were detected by enzyme-linked immunosorbent assay. The differences in serum VEGF and sVE levels among the groups were compared, and the correlations between serum VEGF and sVE levels and sleep parameters were explored. The moderate and severe OSA patients were given 3 months of continuous positive airway pressure (CPAP) treatment, and the changes in sleep parameters and serum VEGF and sVE levels before and after treatment were compared. Results The levels of serum VEGF and sVE in the OSA patients increased with the severity of the disease; the levels of serum VEGF and sVE in the moderate and severe OSA groups were significantly higher than those in the healthy control group and the mild OSA group (P<0.05). The levels of serum VEGF and sVE in the severe OSA group were significantly higher than those in the moderate OSA group (P<0.05). There was no significant difference in the expression levels of serum VEGF or sVE between the mild OSA group and the healthy control group (P>0.05). The sensitivity and specificity of serum VEGF in diagnosing OSA were 65.6% and 93.3%, respectively, with an area under curve (AUC) value of 0.845. The sensitivity and specificity of serum VE-Cadherin in diagnosing OSA were 64.4% and 96.7%, respectively, with an AUC value of 0.835. After 3 months of CPAP treatment, AHI, longest apnea time, serum VEGF and sVE levels in the moderate and severe OSA groups decreased significantly, mean arterial oxygen saturation and lowest arterial oxygen saturation increased significantly (P<0.05). Conclusions The levels of VEGF and VE-Cadherin in serum of OSA patients are significantly elevated and positively correlated with the severity of OSA. Monitoring the changes in the levels of VEGF and VE-Cadherin in serum of OSA patients is helpful for evaluating the therapeutic effect of CPAP.
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.
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 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.
ObjectiveTo analyse the hundred top-cited articles in obstructive sleep apnea hypopnea syndrome (OSAHS), and summarize the development trend of OSAHS research.MethodsWe searched the Web of Science core collection for all published articles on OSAHS or sleep disorders from January 1st, 1992 to May 23th, 2018. The hundred top-cited articles with the most frequent citation were selected. The publication time, country of origin, journal, institution, professional field of corresponding author, funding type, publication type, etc. were analyzed.ResultsThe hundred top-cited articles were published between 1992 and 2013, with 300～5 980 citations and a total of 65 719 citations. The main types of articles were clinical studies (73 articles), reviews (20 articles), guidelines (4 articles) and basic research (3 articles). Fourteen authors published more than one first-author paper, and fifteen authors published more than one articles as corresponding authors. These authors were distributed across 22 subject areas. The most cited country was the United States (60 articles), and the most cited institution was the University of Wisconsin (10 articles). The hundred top-cited articles were published in 31 journals, most of which were cited less than 1 000 times, and a few articles were cited more than 2 000 times.ConclusionsOSAHS has attracted much attention in respiratory medicine, neurology, epidemiology and other fields, and many articles about clinical research types of OSAHS have been cited. In addition, most of the highly cited articles in the OSAHS field come from the developed countries; our country needs to devote more resources to OSAHS research.
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 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 evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，Plt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，Pgt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
Objective To investigate the relationship between adipocyte fatty acid binding protein ( A-FABP) and obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 120 patients were recruited and underwent polysomnography. The groups were allocated according severity of OSAHS and obesity. Plasma A-FABP ( ng/mL) levels were measured by ELISA. The associations between A-FABP and AHI, BMI, LSaO2 , MSaO2 , neck collar, waist /hip ratio, insulin resistance index were analyzed. Results Plasma A-FAPB levels were significantly higher in the OSAHS group than in the non-OSAHS group of same weight, independent of age and gender. In the non-OSAHS group and the severe OSAHS group, plasma A-FABP levels of obesity persons were significantly higher than those without obesity, independent of age and gender. Plasma A-FAPB level was positively correlated with AHI, BMI, insulin resistance index, neck collar, SLT90% , and waist/hip ratio, but negatevely correlated with LSaO2 and MSaO2 in the OSAHS group. In the non-OSAHS group, plasma A-FAPB level was positively correlated with BMI and insulin resistance index. Conclusions Plasma A-FABP level is higher in patients with severe OSAHS. Plasma A-FABP level is positively correlated with BMI and insulin resistance index both in OSAHS and non-OSAHS patients.
