Background:This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach.Methods:PubMed,Embase and Co...Background:This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach.Methods:PubMed,Embase and Cochrane Library were searched from the inception of each database to November 2015.Randomized controlled trials (RCTs) concerning the comparisons in the therapeutic effects of eight placebo-controlled drugs on OSAHS in children were included in this study.Network meta-analysis combined direct evidence and indirect evidence to evaluate the weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) of therapeutic effects of eight drugs on OSAHS in children.Results:A total of seven RCTs were finally incorporated into our network meta-analysis.Pairwise meta-analysis results revealed that therapeutic effect of placebo was significantly poorer than that of intranasal mometasone furoate,montelukast,budesonide and fiuticasone concerning apnea hypopnea index (AHI) value [WMD=1.40,95% confidence interval (CI)=1.17-1.63;WMD=2.80,95% CI=1.01-4.59;WMD=3.50,95% CI=3.34-3.66;WMD=7.20,95% CI=5.26-9.14,respectively],and fluticasone is better than placebo concerning sleep efficiency (WMD=3.50,95% CI=2.42-4.58);regarding visual analogue scale,the therapeutic effect of placebo was poorer compared with sucralfate and clindamycin (WMD=1.94,95% CI=1.13-2.75;WMD=I.06,95%CI=0.22-1.90),and sucralfate is better than clindamycin (WMD=-0.88,95% CI=-1.65 to-0.11).However,network meta-analysis results showed no obvious difference in the therapeutic effects of different drugs on OSAHS regarding AHI and sleep efficiency.Furthermore,the best SUCRA value was very high for fluticasone concerning AHI (86.6%) and budesonide concerning sleep efficiency (94.0%) for OSAHS treatment.Conclusion:Fluticasone and budesonide have relatively good effects in the treatment of OSAHS in children,thus providing an important guiding significance for the treatment of OSAHS in children.展开更多
Background：Obstructive sleep apnea hypopnea syndrome （OSAHS） constitutes an independent factor for high warfarin dose for patients with pulmonary embolism （PE）.The aim of this study was to investigate whether the...Background：Obstructive sleep apnea hypopnea syndrome （OSAHS） constitutes an independent factor for high warfarin dose for patients with pulmonary embolism （PE）.The aim of this study was to investigate whether the 6-month anticoagulation treatment by warfarin is enough for patients with PE complicated by OSAHS.Methods：We investigated 97 PE patients,32 of them had OSAHS and 65 non-OSAHS.Warfarin was administered for 6-month if no abnormal circumstances occurred.All patients were followed up for 18 months.Adverse events （AE） included death,major bleeding,hospitalization due to heart failure or pulmonary hypertension,and recurrence or aggravation of PE （including deep vein thrombosis）.Recurrence rate of PE after warfarin cessation was compared between the two groups.Results：OSAHS patients required a significantly higher dose of warfarin than their non-OSAHS counterparts （4.73 mg vs.3.61 mg,P 〈 0.001）.During warfarin treatment,no major bleeding and aggravation of PE occurred among OSAHS patients,and the rates of various AE were not significantly different between the OSAHS and non-OSAHS groups.PE recurrence was higher in OSAHS than non-OSAHS groups after withdrawal of warfarin （21.43% vs.6.78%,P =0.047）.Compared with non-OSAHS patients,OSAHS group had lower international normalized ratio （INR） value but higher plasminogen on baseline and INR resumed to a relatively low level after warfarin discontinuation.Conclusions：OSAHS patients may present with hypercoagulation and relatively high-risk of recurrence of PE after cessation of 6-month warfarin treatment.展开更多
Objectives To characterize the prethrombotic state ( PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilat...Objectives To characterize the prethrombotic state ( PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation on their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease.Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6:00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.展开更多
Objective A general review was made of studies involving： （1） the relationship between sleep apnea hypopnea syndrome/sleep apnea style intermittent hypoxia and liver injury and （2） the mechanism that causes the l...Objective A general review was made of studies involving： （1） the relationship between sleep apnea hypopnea syndrome/sleep apnea style intermittent hypoxia and liver injury and （2） the mechanism that causes the liver injury. Data sources The data used in this review were mainly from Medline and PubMed published in English from 1993 to February 2009. The search term was ＂sleep apnea hypopnea syndrome＂. Study selection （1） Clinical and laboratory evidence that sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia leads to liver injury; （2） the mechanism that causes the liver injury. Results The effect of sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia on the liver function is characterized by serum aminotransferase elevation. The liver histological injury includes hepatic steatosis, hepatocyte ballooning, Iobular inflammation, Iobular necrosis, and liver fibrosis. Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can cause insulin resistance and oxidative stress. Conclusions Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can lead to chronic liver injury, which, in most cases, is shown as nonalcoholic fatty liver disease. Insulin resistance and oxidative stress caused by sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia play an important role in the mechanism of chronic liver disease development.展开更多
Background Epidermic studies have suggested a pathophysiological link between obstructive sleep apnea hypopnea syndrome （OSAHS） and atherosclerosis （AS）; for which carotid intima-media thickness （IMT） has been c...Background Epidermic studies have suggested a pathophysiological link between obstructive sleep apnea hypopnea syndrome （OSAHS） and atherosclerosis （AS）; for which carotid intima-media thickness （IMT） has been considered as an early marker. The pathogenesis by which OSAHS can induce AS has not been elucidated. This study was conducted to investigate the association among plasma interleukin-18 （IL-18） levels, carotid IMT and the severity of OSAHS. Methods Based on the apnea hypopnea index （AHI） during sleep monitored by polysomnography, 52 male patients with OSAHS were recruited as the OSAHS group which was further divided into mild OSAHS （n=16）, moderate OSAHS （n=18）, and severe OSAHS （n=18） subgroups. Eighteen healthy subjects were selected as the control group. Of all OSAHS patients, 20 with moderate-to-severe OSAHS underwent continuous positive airway pressure （CPAP） treatment for 90 days. HDL5000 color Doppler ultrasonography was used to measure carotid IMT. Plasma IL-18 levels were measured bv ELISA.Results Compared with the plasma IL-18 levels in the control group （（250.27±76.48） pg/ml）, there was a significant increase in the mild OSAHS subgroup （（352.08±76.32） pg/ml）, the moderate subgroup （（600.17±83.91） pg/ml）, and the severe OSAHS subgroup （（9797.64 ± 109.83） pg/ml） （all P〈0.01）. Moreover, there was a significant difference in plasma IL-18 levels among the three OSAHS subgroups （P〈0.01）. Carotid IMT was significantly greater in the severe OSAHS subgroup than in the mild OSAHS subgroup （P〈0.01）. Before CPAP treatment, plasma IL-18 levels were positively correlated with carotid IMT （r=0.486, P 〈0.001） and with AHI （r=0.865, P〈0.001）. On day 90 of CPAP treatment, plasma IL-18 levels were significantly declined but carotid IMT was not changed significantly. Conclusions In untreated OSAHS patients carotid IMT and plasma IL-18 were positively correlated and were significantly higher than in normal controls; 展开更多
Background Excessive daytime sleepiness （EDS） is often associated with obstructive sleep apnea hypopnea syndrome （OSAHS） and contributes to a number of comorbidities in these patients. Therefore, early detection o...Background Excessive daytime sleepiness （EDS） is often associated with obstructive sleep apnea hypopnea syndrome （OSAHS） and contributes to a number of comorbidities in these patients. Therefore, early detection of EDS is critical in disease management. We examined the association between Epworth Sleepiness Scale （ESS） and multiple sleep latency test （MSLT） and diagnostic accuracy of ESS in assessing EDS in OSAHS patients. Methods The ESS, MSLT and overnight polysomnography were administered to 107 Chinese patients to assess EDS and its correlations with polysomnographic parameters. The diagnostic accuracy of ESS in classifying EDS （mean sleep latency （MSL） 〈10 minutes） was evaluated by calculating the area under ROC curve. Results As the severity of OSAHS increased, MSL decreased with increase in ESS score. Conversely, patients with worsening EDS （shorter MSL） were characterized by advanced nocturnal hypoxaemia and sleep disruption compared to those with normal MSL, suggesting EDS is associated with more severe OSAHS. There was a negative correlation between ESS score and MSL and both moderately correlated with some polysomnographic nocturnal hypoxaemic parameters. The area under ROC curve of ESS for identifying EDS was 0.80 （95% CI： 0.71 to 0.88） and ESS score 〉12 provided the best predictive value with a sensitivity of 80% and specificity of 69%. Conclusion The ESS score moderately correlates with MSL and our ROC study supports ESS as a screening strategy for assessing EDS in OSAHS.展开更多
Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea sy...Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However,it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels,NO/ET ratio,total ischemic burden (TIB) of the myocardium,apnea hypopnea index (AHI),and minimal and mean pulse oxygen saturation (SpO_2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET [(51.39±11.69) ng/L] and NO [(36.67±11.86) μmol/L],NO/ET (0.71±0.14),AHI (32.4±7.9),minimal SpO_2 [(68.9±11.4)%],and myocardial TIB [(66.29±16.37) mm·min] before treatment,there were significant decreases in ET [(33.41±10.03) ng/L] ( P <0.05),increases in NO [(59.89±10.26) μmol/L] and NO/ET (1.79±0.38) ( P <0.01),decreases in AHI (1.9±0.5),and increases in minimal SpO_2 [(90.6±1.8) %] (all P <0.01) and myocardial TIB [(36.42±10.87) mm·min] ( P <0.05) after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.展开更多
Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is underdiagnosed.Screening patients at high risk of OSAHS is extremely important.Using the standard questionnaire to screen OSAHS is a practical method.T...Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is underdiagnosed.Screening patients at high risk of OSAHS is extremely important.Using the standard questionnaire to screen OSAHS is a practical method.This study aimed to evaluate the value of the STOP-Bang questionnaire （SBQ） in screening OSAHS in sleep-disordered breathing clinic by comparing it with the Epworth sleepiness scales （ESS）,Berlin questionnaire,and STOP questionnaire.Methods In this study,212 patients at the sleep-disordered breathing clinic of the Peking Union Medical College Hospital between May 2011 and January 2012 were prospectively included.They were asked to fill in the SBQ,ESS,Berlin questionnaire,and STOP questionnaire before overnight polysomnography （PSG）.Using PSG as gold standard,the sensitivities and specificities of SBQ were compared with those of ESS,Berlin questionnaire,and STOP questionnaire.Results There was no significance in applying ESS score ≥11 to screen OSAHS and detect moderate and severe OSAHS （P ＞0.05）.SBQ was superior to Berlin questionnaire and STOP questionnaire in screening OSAHS and detecting the severity of OSAHS patients.The sensitivities of SBQ score ≥3 with apnea hypopnea index （AHI） ≥5/h,AHI ≥15/h,and AHI ≥30/h as gold standards were 94.9％,96.5％,and 97.7％,respectively.The specificities were 50.0％,28.6％,and 17.9％,respectively.The area upper curves were 0.815 （0.706-0.925,P ＜0.01）,0.746 （0.665-0.828,P ＜0.01）,and 0.751 （0.686-0.817,P ＜0.01）,respectively.According to SBQ,the population was classified into high-risk group and low-risk group.The gender,BMI,neck circumference,AHI,LSpO2,and number of subjects ofAHI ≥5/h,AHI ≥15/h,and AHI ≥30/h of these two groups were significantly different.Conclusions The SBQ has superior predictive value compared with ESS,Berlin questionnaire,and STOP questionnaire.It should be used further in screening for OSAHS in the general population.展开更多
Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is the most common sleep-disordered breathing and is still underdiagnosed.This study was designed to evaluate the value of the STOP-Bang questionnaire （...Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is the most common sleep-disordered breathing and is still underdiagnosed.This study was designed to evaluate the value of the STOP-Bang questionnaire （SBQ） in screening OSAHS in sleep-disordered breathing clinics in order to extend it into the general Chinese population.Methods Two hundred and twelve patients undergoing overnight polysomnography （PSG） in the sleep-disordered breathing clinic of Pecking Union Medical College Hospital between May 2011 and January 2012 were prospectively included and were asked to fill in the SBQ.A score of 3 or more of the SBQ indicated a high risk of OSAHS.We analyzed the sensitivities and specificities of SBQ in screening OSAHS.Logistic regression analysis was used to evaluate the probabilities of the severity of OSAHS based upon the apnea hypopnea index （AHI）.Results The patients at high risk of OSAHS had higher AHI,higher oxygen desaturation index （ODI）,lower pulse oxygen saturation （LSpO2） during sleep time and less sleep time in stage N3.SBQ scores were positively correlated with AHI,ODI and the ratio of SpO2 lower than 90％,and negatively correlated with LSpO2 during sleep.The sensitivities of the SBQ with AHI ≥5/h,AHI ≥15/h,AHI ≥30/h as cut-offs were 94.9％,96.5％,and 97.7％,respectively,and the specificities were 50.0％,28.6％,and 17.9％,respectively.The Logistic regression analysis showed the probability of severe OSAHS increased and the probability of normal subjects decreased with increasing SBQ score.Conclusions The STOP-Bang questionnaire has excellent sensitivity in screening OSAHS patients and can predict the severity of OSAHS.More studies will be required to determine the value of SBQ in the general Chinese population.展开更多
文摘Background:This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach.Methods:PubMed,Embase and Cochrane Library were searched from the inception of each database to November 2015.Randomized controlled trials (RCTs) concerning the comparisons in the therapeutic effects of eight placebo-controlled drugs on OSAHS in children were included in this study.Network meta-analysis combined direct evidence and indirect evidence to evaluate the weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) of therapeutic effects of eight drugs on OSAHS in children.Results:A total of seven RCTs were finally incorporated into our network meta-analysis.Pairwise meta-analysis results revealed that therapeutic effect of placebo was significantly poorer than that of intranasal mometasone furoate,montelukast,budesonide and fiuticasone concerning apnea hypopnea index (AHI) value [WMD=1.40,95% confidence interval (CI)=1.17-1.63;WMD=2.80,95% CI=1.01-4.59;WMD=3.50,95% CI=3.34-3.66;WMD=7.20,95% CI=5.26-9.14,respectively],and fluticasone is better than placebo concerning sleep efficiency (WMD=3.50,95% CI=2.42-4.58);regarding visual analogue scale,the therapeutic effect of placebo was poorer compared with sucralfate and clindamycin (WMD=1.94,95% CI=1.13-2.75;WMD=I.06,95%CI=0.22-1.90),and sucralfate is better than clindamycin (WMD=-0.88,95% CI=-1.65 to-0.11).However,network meta-analysis results showed no obvious difference in the therapeutic effects of different drugs on OSAHS regarding AHI and sleep efficiency.Furthermore,the best SUCRA value was very high for fluticasone concerning AHI (86.6%) and budesonide concerning sleep efficiency (94.0%) for OSAHS treatment.Conclusion:Fluticasone and budesonide have relatively good effects in the treatment of OSAHS in children,thus providing an important guiding significance for the treatment of OSAHS in children.
文摘Background：Obstructive sleep apnea hypopnea syndrome （OSAHS） constitutes an independent factor for high warfarin dose for patients with pulmonary embolism （PE）.The aim of this study was to investigate whether the 6-month anticoagulation treatment by warfarin is enough for patients with PE complicated by OSAHS.Methods：We investigated 97 PE patients,32 of them had OSAHS and 65 non-OSAHS.Warfarin was administered for 6-month if no abnormal circumstances occurred.All patients were followed up for 18 months.Adverse events （AE） included death,major bleeding,hospitalization due to heart failure or pulmonary hypertension,and recurrence or aggravation of PE （including deep vein thrombosis）.Recurrence rate of PE after warfarin cessation was compared between the two groups.Results：OSAHS patients required a significantly higher dose of warfarin than their non-OSAHS counterparts （4.73 mg vs.3.61 mg,P 〈 0.001）.During warfarin treatment,no major bleeding and aggravation of PE occurred among OSAHS patients,and the rates of various AE were not significantly different between the OSAHS and non-OSAHS groups.PE recurrence was higher in OSAHS than non-OSAHS groups after withdrawal of warfarin （21.43% vs.6.78%,P =0.047）.Compared with non-OSAHS patients,OSAHS group had lower international normalized ratio （INR） value but higher plasminogen on baseline and INR resumed to a relatively low level after warfarin discontinuation.Conclusions：OSAHS patients may present with hypercoagulation and relatively high-risk of recurrence of PE after cessation of 6-month warfarin treatment.
文摘Objectives To characterize the prethrombotic state ( PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation on their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease.Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6:00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.
文摘Objective A general review was made of studies involving： （1） the relationship between sleep apnea hypopnea syndrome/sleep apnea style intermittent hypoxia and liver injury and （2） the mechanism that causes the liver injury. Data sources The data used in this review were mainly from Medline and PubMed published in English from 1993 to February 2009. The search term was ＂sleep apnea hypopnea syndrome＂. Study selection （1） Clinical and laboratory evidence that sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia leads to liver injury; （2） the mechanism that causes the liver injury. Results The effect of sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia on the liver function is characterized by serum aminotransferase elevation. The liver histological injury includes hepatic steatosis, hepatocyte ballooning, Iobular inflammation, Iobular necrosis, and liver fibrosis. Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can cause insulin resistance and oxidative stress. Conclusions Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can lead to chronic liver injury, which, in most cases, is shown as nonalcoholic fatty liver disease. Insulin resistance and oxidative stress caused by sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia play an important role in the mechanism of chronic liver disease development.
文摘Background Epidermic studies have suggested a pathophysiological link between obstructive sleep apnea hypopnea syndrome （OSAHS） and atherosclerosis （AS）; for which carotid intima-media thickness （IMT） has been considered as an early marker. The pathogenesis by which OSAHS can induce AS has not been elucidated. This study was conducted to investigate the association among plasma interleukin-18 （IL-18） levels, carotid IMT and the severity of OSAHS. Methods Based on the apnea hypopnea index （AHI） during sleep monitored by polysomnography, 52 male patients with OSAHS were recruited as the OSAHS group which was further divided into mild OSAHS （n=16）, moderate OSAHS （n=18）, and severe OSAHS （n=18） subgroups. Eighteen healthy subjects were selected as the control group. Of all OSAHS patients, 20 with moderate-to-severe OSAHS underwent continuous positive airway pressure （CPAP） treatment for 90 days. HDL5000 color Doppler ultrasonography was used to measure carotid IMT. Plasma IL-18 levels were measured bv ELISA.Results Compared with the plasma IL-18 levels in the control group （（250.27±76.48） pg/ml）, there was a significant increase in the mild OSAHS subgroup （（352.08±76.32） pg/ml）, the moderate subgroup （（600.17±83.91） pg/ml）, and the severe OSAHS subgroup （（9797.64 ± 109.83） pg/ml） （all P〈0.01）. Moreover, there was a significant difference in plasma IL-18 levels among the three OSAHS subgroups （P〈0.01）. Carotid IMT was significantly greater in the severe OSAHS subgroup than in the mild OSAHS subgroup （P〈0.01）. Before CPAP treatment, plasma IL-18 levels were positively correlated with carotid IMT （r=0.486, P 〈0.001） and with AHI （r=0.865, P〈0.001）. On day 90 of CPAP treatment, plasma IL-18 levels were significantly declined but carotid IMT was not changed significantly. Conclusions In untreated OSAHS patients carotid IMT and plasma IL-18 were positively correlated and were significantly higher than in normal controls;
基金This study was supported by grants fi-om the National Natural Science Foundation of China （NSFC） （No. 81170070, No. 81270147）, and from the Scientific Research Foundation of the Chinese Ministry of Health （No. W2012w4）.
文摘Background Excessive daytime sleepiness （EDS） is often associated with obstructive sleep apnea hypopnea syndrome （OSAHS） and contributes to a number of comorbidities in these patients. Therefore, early detection of EDS is critical in disease management. We examined the association between Epworth Sleepiness Scale （ESS） and multiple sleep latency test （MSLT） and diagnostic accuracy of ESS in assessing EDS in OSAHS patients. Methods The ESS, MSLT and overnight polysomnography were administered to 107 Chinese patients to assess EDS and its correlations with polysomnographic parameters. The diagnostic accuracy of ESS in classifying EDS （mean sleep latency （MSL） 〈10 minutes） was evaluated by calculating the area under ROC curve. Results As the severity of OSAHS increased, MSL decreased with increase in ESS score. Conversely, patients with worsening EDS （shorter MSL） were characterized by advanced nocturnal hypoxaemia and sleep disruption compared to those with normal MSL, suggesting EDS is associated with more severe OSAHS. There was a negative correlation between ESS score and MSL and both moderately correlated with some polysomnographic nocturnal hypoxaemic parameters. The area under ROC curve of ESS for identifying EDS was 0.80 （95% CI： 0.71 to 0.88） and ESS score 〉12 provided the best predictive value with a sensitivity of 80% and specificity of 69%. Conclusion The ESS score moderately correlates with MSL and our ROC study supports ESS as a screening strategy for assessing EDS in OSAHS.
基金ThisworkwassupportedbytheInternationalCooperationProjectFoundationoftheJiangsuScienceandTechnologyCommittee (No BJ2 0 0 3 0 48)
文摘Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However,it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels,NO/ET ratio,total ischemic burden (TIB) of the myocardium,apnea hypopnea index (AHI),and minimal and mean pulse oxygen saturation (SpO_2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET [(51.39±11.69) ng/L] and NO [(36.67±11.86) μmol/L],NO/ET (0.71±0.14),AHI (32.4±7.9),minimal SpO_2 [(68.9±11.4)%],and myocardial TIB [(66.29±16.37) mm·min] before treatment,there were significant decreases in ET [(33.41±10.03) ng/L] ( P <0.05),increases in NO [(59.89±10.26) μmol/L] and NO/ET (1.79±0.38) ( P <0.01),decreases in AHI (1.9±0.5),and increases in minimal SpO_2 [(90.6±1.8) %] (all P <0.01) and myocardial TIB [(36.42±10.87) mm·min] ( P <0.05) after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.
文摘Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is underdiagnosed.Screening patients at high risk of OSAHS is extremely important.Using the standard questionnaire to screen OSAHS is a practical method.This study aimed to evaluate the value of the STOP-Bang questionnaire （SBQ） in screening OSAHS in sleep-disordered breathing clinic by comparing it with the Epworth sleepiness scales （ESS）,Berlin questionnaire,and STOP questionnaire.Methods In this study,212 patients at the sleep-disordered breathing clinic of the Peking Union Medical College Hospital between May 2011 and January 2012 were prospectively included.They were asked to fill in the SBQ,ESS,Berlin questionnaire,and STOP questionnaire before overnight polysomnography （PSG）.Using PSG as gold standard,the sensitivities and specificities of SBQ were compared with those of ESS,Berlin questionnaire,and STOP questionnaire.Results There was no significance in applying ESS score ≥11 to screen OSAHS and detect moderate and severe OSAHS （P ＞0.05）.SBQ was superior to Berlin questionnaire and STOP questionnaire in screening OSAHS and detecting the severity of OSAHS patients.The sensitivities of SBQ score ≥3 with apnea hypopnea index （AHI） ≥5/h,AHI ≥15/h,and AHI ≥30/h as gold standards were 94.9％,96.5％,and 97.7％,respectively.The specificities were 50.0％,28.6％,and 17.9％,respectively.The area upper curves were 0.815 （0.706-0.925,P ＜0.01）,0.746 （0.665-0.828,P ＜0.01）,and 0.751 （0.686-0.817,P ＜0.01）,respectively.According to SBQ,the population was classified into high-risk group and low-risk group.The gender,BMI,neck circumference,AHI,LSpO2,and number of subjects ofAHI ≥5/h,AHI ≥15/h,and AHI ≥30/h of these two groups were significantly different.Conclusions The SBQ has superior predictive value compared with ESS,Berlin questionnaire,and STOP questionnaire.It should be used further in screening for OSAHS in the general population.
文摘Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is the most common sleep-disordered breathing and is still underdiagnosed.This study was designed to evaluate the value of the STOP-Bang questionnaire （SBQ） in screening OSAHS in sleep-disordered breathing clinics in order to extend it into the general Chinese population.Methods Two hundred and twelve patients undergoing overnight polysomnography （PSG） in the sleep-disordered breathing clinic of Pecking Union Medical College Hospital between May 2011 and January 2012 were prospectively included and were asked to fill in the SBQ.A score of 3 or more of the SBQ indicated a high risk of OSAHS.We analyzed the sensitivities and specificities of SBQ in screening OSAHS.Logistic regression analysis was used to evaluate the probabilities of the severity of OSAHS based upon the apnea hypopnea index （AHI）.Results The patients at high risk of OSAHS had higher AHI,higher oxygen desaturation index （ODI）,lower pulse oxygen saturation （LSpO2） during sleep time and less sleep time in stage N3.SBQ scores were positively correlated with AHI,ODI and the ratio of SpO2 lower than 90％,and negatively correlated with LSpO2 during sleep.The sensitivities of the SBQ with AHI ≥5/h,AHI ≥15/h,AHI ≥30/h as cut-offs were 94.9％,96.5％,and 97.7％,respectively,and the specificities were 50.0％,28.6％,and 17.9％,respectively.The Logistic regression analysis showed the probability of severe OSAHS increased and the probability of normal subjects decreased with increasing SBQ score.Conclusions The STOP-Bang questionnaire has excellent sensitivity in screening OSAHS patients and can predict the severity of OSAHS.More studies will be required to determine the value of SBQ in the general Chinese population.
