ObjectiveTo analyze the the characteristics of pulse oximetry (SpO2) curve changes in patients with obstructive sleep apnea (OSA), hypoxic parameters and to explore the difference and connection between obstructive apnea (OA) events and hypopnea (Hyp) events, evaluate the impact of different types of obstructive respiratory events on hypoxia, and provide a theoretical basis for exploration of hypoxic differences in each type of respiratory events and construction of prediction models for respiratory event types in the future. MethodsSixty patients with OSA diagnosed by polysomnography (PSG) were selected for retrospective analysis, and all respiratory events with oxygen drop in the recorded data overnight were divided into OA group (5972) according to the type of events and Hyp group (4110), recorded and scored events were exported from the PSG software as comma-separated variable (.csv) files, which were then imported and analyzed using the in-house built Matlab software. Propensity score matching was performed on the duration of respiratory events and whether they were accompanied by arousal in the two groups, and minimum oxygen saturation of events (e-minSpO2), the depth of desaturation (ΔSpO2), the duration of desaturation and resaturation (DSpO2), the duration of desaturation (d.DSpO2), duration of resaturation (r.DSpO2), duration of SpO2<90% (T90), duration of SpO2<90% during desaturation (d.T90), duration of SpO2<90% during resaturation (r.T90), area under the curve of SpO2<90% (ST90), area under the curve of SpO2<90% during desaturation (d.ST90), area under the curve of SpO2<90% during resaturation (r.ST90), oxygen desaturation rate (ODR) and oxygen resaturation rate (ORR), a total of 13 hypoxic parameters differences. ResultsVarious hypoxic parameters showed that more severe SpO2 desaturation in severe OSA patients, compared with mild and moderate OSA patients (P<0.05); There were statistically significant differences in the respiratory events duration and whether accompanied by arousal between the Hyp group and OA group (P<0.05), and the respiratory events duration and whether accompanied by arousal were significantly correlated with most hypoxic parameters; After accounting for respiratory events duration and whether accompanied by arousal by propensity score matching, compared with the Hyp group, e-minSpO2 was significantly lower in the OA group, ΔSpO2, d.DSpO2, r.DSpO2, ODR, ORR, T90, d.T90, r.T90, ST90, d.ST90, r.ST90 were significantly increased (P<0.05). ConclusionsDue to pathophysiological differences, all hypoxic parameters suggest that OA events will result in a more severe desaturation than Hyp events. Clinical assessment of OSA severity should not equate OA with Hyp events, which may cause more damage to the organism, establishing a basis for applying nocturnal SpO2 to automatically identify the type of respiratory event.
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.
Objective To investigate the effect of continuous positive airway pressure (CPAP) on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease (AD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of forty-two early AD patients with OSAHS were randomly divided into a CPAP combined treatment group (20 cases) and a simple medicine treatment group (22 cases). The changes of neurocognitive function were assessed by Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE) and Hopkins Verbal Learning Test-revised (HVLT). Patient Health Questionnaire-9 (PHQ9) was used to evaluate the depression mood changes. The sleep characteristics and respiratory parameters were evaluated by polysomnography. The changes of the patients’ sleep status were assessed by Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The changes of sleep status, cognitive function and mood in the CPAP combined treatment group were compared before and three months after CPAP treatment, and with the simple medicine treatment group. Results After three months of CPAP treatment, the ESS, PSQI and PHQ9 scores in the CPAP combined treatment group were significantly decreased compared with those before treatment, whereas MoCA, MMSE and HVLT (total scores and recall ) in the CPAP combined treatment group were increased compared with those before treatment (P<0.05). After CPAP treatment, the respiratory parameters apnea hypopnea index in the CPAP combined treatment group was significantly lower than that before treatment (P<0.05), and the minimum blood oxygen saturation was significantly higher than that before treatment (P<0.05). However, the sleep characteristics and parameters did not show statistically significant changes compared with those before treatment (P>0.05). The ESS, PSQI and PHQ9 scores were significantly reduced in the CPAP combined treatment group compared with the simple medicine treatment group (P<0.05), while there was no statistically significant changes of cognitive scores between the two groups (P>0.05). Conclusions The degree of low ventilation and hypoxia is alleviated, and the daytime sleepiness and depression is improved in early AD patients with OSAHS after three-month continuous CPAP treatment. Cognitive function is significantly improved, whereas there is no significant change in sleep structure disorder.
ObjectiveTo investigate the effects and clinical significance of edaravone on serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and intercellular adhesion molecule-1 (ICAM-1) in elderly patients with obstructive sleep apnea hypopnea syndrome (OSAHS).MethodsA total of 90 elderly patients with moderate to severe OSAHS confirmed by polysomnography were recruited from North China University of Science and Technology Affiliated Hospital in February 2016 to October 2017. According to random number table method the OSAHS patients were randomly divided into group A (n=30), group B (n=30) and group C (n=30). Group A received continuous positive airway pressure treatment for six months, group B received edaravone therapy and continuous positive airway pressure treatment for six months, and group C only received edaravone therapy for six months. The changes of serum TNF-α, IL-6 and ICAM-1 were detected by enzyme-linked immunosorbent assay before and after treatment.ResultsThe differences of serum TNF-α, IL-6 and ICAM-1 before treatment in the three groups were not statistically significant (P>0.05). Compared with before treatment, the levels of serum TNF-α, IL-6 and ICAM-1 decreased in the three groups (P<0.05). After six months of treatment, the levels of serum TNF-α, IL-6 and ICAM-1 decreased in group A and group B compared with group C (P<0.05), and decreased significantly in group B compared with group A (P<0.05).ConclusionEdaravone can inhibit the expressions of serum TNF-α, IL-6 and ICAM-1 in elderly patients with moderate to severe OSAHS, and thereby reduce vascular endothelial dysfunction and injury.
ObjectiveTo explore the potential relationship between sleep apnea characterized by different Sleep Apnea subtype and cardiac structure and function.MethodsBased on the composition of sleep respiratory events, this study aimed to analyze whether patients with different subtype of sleep apnea exhibit specific cardiac structural characteristics. A retrospective analysis was conducted on 223 patients admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine between 2018 and 2024 who completed polysomnography (PSG) and echocardiography. Participants were categorized into four groups based on respiratory event: ① with Cheyne-Stokes respiration Events (CSB), ② with central sleep apnea events and without CSB Event (ICA), ③ with obstructive sleep apnea events mainly (IOA), ④ non-sleep apnea controls (NSA), and observed the correlation of PSG parameters and echocardiographic.ResultsPatients with sleep apnea accompanied by CSR were older (χ2=36.014, P<0.001) and exhibited significantly larger left atrial diameter (χ2=41.823, P<0.001) and left ventricular end-systolic diameter (χ2=20.397, P<0.001) compared to other groups. Other sleep apnea subtypes demonstrated varying degrees of increased interventricular septal thickness (χ2=25.272, P<0.001) and left ventricular wall thickness (χ2=21.650, P<0.001) relative to non-apneic controls.ConclusionsAll sleep apnea subtypes are associated with hypertension-related cardiac structural alterations. Notably, patients with CSR-complicated sleep apnea exhibit more severe cardiac remodeling, leading to impaired systolic and diastolic functions.
Objective To evaluate the application value of optical coherence tomography angiography (OCTA) in obstructive sleep apnea syndrome (OSAS). Methods A comprehensive search of both domestic and international databases was conducted to identify clinical studies on the use of OCTA in OSAS, from the establishment of the databases to May 2024. A meta-analysis was performed using Revman 5.4 software. Results A total of 134 studies were initially identified, with 14 studies meeting the inclusion criteria, encompassing 999 subjects (739 in the OSAS group and 260 in the healthy group). Meta-analysis results indicated that the superficial capillary plexus (SCP) density in the fovea (MD=–2.05, 95%CI –3.75 to –0.35, P=0.02) and parafovea (MD=–1.56, 95%CI –2.44 to –0.68, P=0.000 5) was significantly lower in the OSAS group compared with the healthy group. In the mild to moderate OSAS group, SCP density was significantly lower in the fovea (MD=–2.41, 95%CI –4.32 to –0.49, P=0.01), parafovea (MD=–1.17, 95%CI –2.01 to –0.32, P=0.007), and perifovea (MD=–1.73, 95%CI –2.69 to –0.77, P=0.000 4) compared with the healthy group. In the severe OSAS group, SCP density in the perifovea (MD=–1.33, 95%CI –2.53 to –0.13, P=0.03) was significantly lower than that of the healthy group. SCP density in the whole area (MD=0.36, 95%CI 0.05 to 0.68, P=0.02) was significantly higher in the mild to moderate OSAS group compared with the severe OSAS group. In the deep capillary plexus (DCP) density, the OSAS group showed significantly lower densities in the whole area (MD=–2.16, 95%CI –3.51 to –0.81, P=0.002), fovea (MD=–2.38, 95%CI –4.38 to –0.37, P=0.02), and parafovea (MD=–2.33, 95%CI –3.93 to –0.73, P=0.004) compared with the healthy group. The mild to moderate OSAS group also showed significantly lower densities in the whole area (MD=–2.02, 95%CI –3.33 to –0.72, P=0.002) and parafovea (MD=–1.65, 95%CI –3.04 to –0.26, P=0.02) compared with the healthy group. The severe OSAS group had significantly lower DCP density in the whole area (MD=–2.26, 95%CI –3.85 to –0.66, P=0.006) and parafovea (MD=–1.47, 95%CI –2.31 to –0.62, P=0.000 7) compared with the healthy group. DCP density in the whole area (MD=0.54, 95%CI 0.02 to 1.07, P=0.04) was significantly higher in the mild to moderate OSAS group compared with the severe OSAS group. Regarding the retinal nerve fiber layer (RNFL) thickness, the inferior quadrant (MD=4.01, 95%CI 0.69 to 7.32, P=0.02) and temporal quadrant (MD=4.35, 95%CI 1.88 to 6.82, P=0.000 6) were significantly thicker in the mild to moderate OSAS group compared with the severe OSAS group. In terms of the foveal avascular zone (FAZ) area, the severe OSAS group showed a significantly larger FAZ area (MD=0.06, 95%CI 0.03 to 0.08, P<0.000 01) compared with the healthy group. Conclusion OCTA-related ocular biomarkers may be associated with the occurrence and progression of OSAS and have potential applications in the diagnosis and treatment of OSAS.
ObjectiveTo investigate the pathogenesis and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) by detecting the changes of serum interleukin-23 (IL-23) and C-reactive protein (CRP) levels of the OSAHS patients before and after treatment with continuous positive airway pressure (CPAP).MethodsFifty-eight patients with moderate to severe OSAHS diagnosed by polysomnography were recruited as an experimental group, 57 out-patient healthy subjects with matched age, sex and body mass index of the experimental group were enrolled as a control group. The serum concentrations of IL-23 and CRP in the experimental group were detected and compared before and after CPAP application for 3 months. The serum concentrations of IL-23 and CRP in the control group were also measured.ResultsThe serum levels of IL-23 and CRP in the OSAHS patients were significantly higher than those in the normal control subjects (P<0.05). The serum levels of IL-23 and CRP in the OSAHS patients after CPAP treatment were significantly lower than those before CPAP treatment (P<0.05). The serum concentrations of IL-23 and CRP were positively correlated with apnea hypopnea index (r=0.756, r=0.345, P<0.05, respectively), and negatively correlated with mean oxygen saturation (r=–0.715, r=–0.334, P<0.05, respectively).ConclusionsThe serum levels of IL-23 and CRP are positively correlated with the severity of OSAHS. After CPAP treatment, the levels of IL-23 and CRP decrease, which indicates that CPAP treatment may reduce the inflammatory reaction and correct anoxia of OSAHS patients.
Objective To analyze a possible association of -A930G and C242T polymorphism with cognitive dysfunction in obstructive sleep apnea (OSA) patients, and assess potential interactions of CYBA alleles in OSA patients with cognitive dysfunction. Methods A total of 157 OSA patients with cognitive dysfunction were recruited as an experimental group, and 526 matched OSA patients without cognitive dysfunction as an control group. The neurocognitive assessment, polysomnography, genetic analyses, NADHP oxidase (NOX) activity, determination of urinary 8-OH-dG were completed in all subjects. Results Frequencies of the -930G allele carriers were not significantly different between two groups (P>0.05). Frequencies of the TT/CT genotypes were significantly higher in the OSA patients without cognitive dysfunction (P<0.05). NOX activity was assessed and found to be increased in the OSA patients with cognitive dysfunction (P<0.01). NOX activity was significantly higher in whom the allelic T variant was absent (P<0.05). The level of urinary 8-OH-dG was higher in the OSA patients with cognitive dysfunction (P<0.05). The level of urinary 8-OH-dG was significantly higher in whom the allelic T variant was absent (P<0.05). Conclusion The p22phox C242T polymorphism may be involved in the development of oxidative stress reaction in OSA patients with cognitive dysfunction.
Objective To investigate the role of red cell distribution width ( RDW) in coronary artery diseases patients complicated with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods 134 coronary artery diseases patients who had at least one-vessel disease confirmed by coronary angiography were investigated by polysomnography for OSAHS. The patients were classified according to theapneahypopnea index(AHI) . The level of RDW, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, hemoglobin, white blood cells and hematocritwere measured. The receiver operating characteristic curve was drawn to predict the moderate-severe OSAHS in coronary artery diseases patients according to RDW value. Results When 134 coronary artery diseases patients were classified into a control group and an OSAHS group according to the AHI, the level of RDW in two groups was not significantly different [ ( 13.44 ±1.30) % vs. ( 13.12 ±0.92) % , P gt; 0.05] . When 134 coronary artery diseases patients were classified into a control and mild OSAHS group and a moderate-severe OSAHS group according to the AHI, the level of RDW in two groups was significantly different [ ( 13.07 ±0.94) vs. ( 14.02 ±1.41) % , P lt; 0.05] . And no difference was found in hemoglobin, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, platelet, and hematocrit between two groups. The ROC curve analysis revealed that the area under ROC curve was 0.748 ( 0.523-0.972) , and the best cut-off for moderate-severe OSAHS was 13.95% with sensitivity of 71.43% and specificity of 82.98% . Conclusion RDW may be a useful and simple tool to predict moderate-severe OSAHS in coronary artery diseases patients.
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.