Prevalence and characteristics of comorbid insomnia and sleep apnea in community population / 中华健康管理学杂志

Objective:To analysis the prevalence and characteristics of comorbid insomnia and sleep disordered breathing (SDB) in community population.Methods:This is a cross-sectional study. Cluster sampling was applied. Community residents in Shantou and Meizhou were investigated during April to May, 2021. Essential information collection, sleep related health investigation, and sleep study were conducted. Insomnia was defined as the insomnia severity index (ISI)≥8. A type Ⅳ wearable intelligent sleep monitor was applied for sleep study. Comorbid insomnia and SDB was defined as both diagnosis of insomnia and SDB. Statistical analysis was conducted by SPSS 25. Prevalence and characteristics of insomnia only, SDB only and comorbid insomnia and SDB were analyzed. Logistic regression was conducted to analyze the relationship between sleep disorders and unrestored sleep, abnormal glucose metabolism, hyperlipidemia, and cardiovascular disease.Results:There were 3 730 residents completed the investigation. The median age was 55.0 (46.0, 63.0) years. The prevalence of insomnia only, SDB only, and comorbid insomnia and SDB were 26.0%, 20.2%, and 10.4% respectively. The incidence of unrestored sleep in insomnia only and comorbid insomnia and SDB were 2.900 times and 3.777 times of that in no insomnia or SDB (both P<0.001); the risk of hyperlipidemia was elevated in insomnia only, SDB only and comorbid insomnia and SDB ( OR=1.553, 1.415, and 1.868; all P<0.05); the risk of cardiovascular disease increased 40.8% in SDB only ( P=0.001), and 42.1% in comorbid insomnia and SDB ( P=0.007), after adjusted by age, sex, body mass index (BMI), smoking, drinking, abnormal glucose metabolism, and hyperlipidemia. Stratified analysis revealed that young female (age<60 years) with normal BMI (<25 kg/m 2) and comorbid insomnia and SDB were associated with higher risk of cardiovascular disease. Female with normal body weight and insomnia only or comorbid insomnia and SDB were associated with higher risk of hyperlipidemia. Conclusions:The prevalence of comorbid insomnia and SDB is high in community population. Patients with comorbid insomnia and SDB present with more significant unrestored sleep, and are correlated with higher risk of hyperlipidemia and cardiovascular diseases.

A new model of OSA screening and intervention among civil servants and its influencing factors / 中华健康管理学杂志

Objective:To explore the new mode of screening and intervention for obstructive sleep apnea (OSA) in civil servants and its influencing factors.Methods:From September to December 2017, 1 241 civil servants who underwent annual physical examination in the outpatient department of a civil servant unit in Guangdong province were enrolled. They were screened for high-risk patients with OSA by Berlin questionnaire, and then those high-risk patients would receive type 3 home sleep testing (HST). Patients diagnosed with OSA were given free continuous positive airway pressure (CPAP) intervention and follow-up. The HST acceptance of high-risk OSA patients, OSA prevalence, CPAP initial treatment response rate and adherence trend and influencing factors were analyzed among the civil servants.Results:A total of 1036 civil servants completed the Berlin Questionnaire screening, of which 22.0% (228/1 036) were positive for the Berlin Questionnaire and were considered to be at high risk for OSA. A total of 228 high-risk OSA patients underwent free HST screening, and 32.5% (74/228) refused sleep monitoring. 154 people received sleep monitoring, 103 people were eventually diagnosed with OSA, of which 41 were mild (40.2%), 35 were moderate (33.3%), and 27 were severe (26.5%). The estimated prevalence of OSA among civil servants was 9.9% (103/1 036). All OSA patients were provided with free auto-CPAP treatment, and only 55.3% (57/103) received initial CPAP treatment. Multivariate logistic regression analysis showed that the CPAP treatment response rate was positively correlated with the severity of OSA ( OR=5.65, 95% CI: 1.007―31.693); it was negatively correlated with the general health status score of the 36-Item Short Form of the Medical Outcomes Survey (SF-36, OR=0.968, 95% CI: 0.938―0.998).Self-determined behavioral interventions and self-perceptions that treatment not needed were the reasons for not receiving treatment.In the first week of initial CPAP treatment follow-up, 70.2% (40/57) patients had good adherence ≥4 h/night, and the median adherence was 5.0(4.0, 6.0) h/night. The adherence of 17 cases (29.8%) was less than 4 h/night, and the median adherence was 0 (0, 2.0) h/night. Univariate analysis showed that those with difficulty falling asleep, anxiety, depression, and adverse reactions to CPAP (nasal mask discomfort and suffocation) had worse adherence. The long-term adherence to CPAP treatment gradually declined, and by the 2-year follow-up period, only 22.0% of patients had good adherence. Conclusions:Even with free sleep screening and disease intervention mode, the acceptance of sleep monitoring and CPAP treatment is still low, and the short-term and long-term adherence to CPAP is poor. Epworth sleepiness Score, hypertension, and disease cognition affected the acceptance of sleep monitoring. Psycho psychological factors and adverse reactions to CPAP affect patient compliance.

The activated pathways by hypoxia in patients with Obstructive sleep apnea hypopnea syndrome / 实用医学杂志

Objective To investigate the activation of nuclear factor-B (NF-B)and hypoxia-inducible factor-1 (HIF-1)in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Subjects were classified into mild-to-moderate OSHAS group (n = 16), severe OSAHS group (n = 14) and the matched control group (n=30). Gene and protein expressions of NF-B and HIF-1 were measured by RT-PCR, Western blot in peripheral blood mononuclear cells (PBMC). Results NF-κB p65 mRNA and NF-κB p65 protein,HIF-1α mRNA and HIF-1α protein in PBMC were significantly higher in severe OSAHS group than those in mild–to-moderate group and control group (P<0.01). But there were no significant difference in NF-κB p65 mRNA and NF-κB p65 protein between mild-to-moderate group and control group (P=0.068, P=0.254 respectively). Only gene (P<0.05) not the protein (P=0.777) of HIF-1αwas higher in mild-to-moderate as compared with control group. Both NF-κB p65 mRNA and HIF-1αmRNA were positively correlated with AHI (r=0.493, P=0.006, r=0.508, P=0.004), while negatively correlated with nighttime lowest blood oxygen saturation (LSaO2)(r=-0.488, P=0.006, r=-0.46, P=0.011). There was a positive correlation between NF-κB p65 protein level and AHI (r=0.669, P<0.001). HIF-1αprotein level was positively correlated with AHI, ODI (r=0.628, P=0.001;r=0.480, P=0.018). There were positive correlations between NF-κBp65mRNA and HIF-1αmRNA (r=0.543, P=0.002), NF-κBp65 and HIF-1αprotein respectively (r=0.716, P<0.001). Conclusions As the gene and protein of NF-κB and HIF-1 were up-regulated in patients with OSAHS, and also positively correlated with the severity of sickness. We conclude that both NF-κB and HIF-1 were involed in the pathogenesis of OSAHS.

Activation and its influence of nuclear factor-κB in peripheral blood mononuclear cells in elderly patients with obstructive sleep apnea-hypopnea syndrome / 中华老年医学杂志

Objective To evaluate the influence of nuclear factor (NF)-κB activation in peripheral blood mononuclear cells (PBMCs) on vascular inflammation in elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The 40 elderly subjects (≥65years old) were classed into control, mild, moderate and severe groups (n = 10, respectively)according to polysomnography (PSG). After PSG, the samples of peripheral venous blood were collected, and PBMCs were isolated. Nuclear protein was extracted and NF-κB was measured by Western blotting. ELISA was applied to measure the levels of TNF-α and IL-6 in serum. Blood samples from 10 cases (moderate 5 and severe 5) were measured again after four weeks of continuous positive airway pressure (CPAP) treatment. Results The expression of NF-κB in PBMCs and the concentration of TNF-α in serum were significantly increased in severe and moderate OSAHS patients compared with controls (P＜0. 05). The NF-κB expression was positively correlated with AHI (r=0. 617, P＜ 0. 001) and TNF-α concentration (r = 0. 498, P＜ 0. 001 ), negatively correlated with LSaO2 (r= -0. 548, P＜0. 001), and not correlated with IL-6 concentration (r=0. 365, P=0. 201).The CPAP treatment could significantly inhibit NF-κB activation in PBMCs and reduce TNF-αexcretion (P＜0.05, respectively). Conclusions PBMCs may play an important role in vascular endothelial injury through NF-κB expression and TNF-α excretion in elderly OSAHS patients, which is closely associated with the severity of the syndrome and night hypoxemia. CPAP treatment can inhibit the pathophysiologic process effectively.

Effect of obstructive sleep apnea syndrome on blood lipid and blood glucose in elderly hypertensive patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of obstructive sleep apnea syndrome (OSAS) on blood lipid and blood glucose in elderly hypertensive patients.</p><p><b>METHOD</b>a One hundred and seven elderly hypertensive patients received examinations by polysomnography and according to the apnea-hypopnea index (AHI), the patients were divided into four groups, namely uncomplicated hypertension group (n=23) and 3 hypertension groups with mild (n=31), moderate (n=29) and severe (n=24) OSAS. The fasting and 2-hour postprandial plasma glucose, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), Apo-A, and Apo-B of these patients were measured.</p><p><b>RESULTS</b>aCompared with the non-OSAS patients, all the OSAS patients showed increased fasting and 2-hour postprandial plasma glucose, HbA1c, TC, TG, LDL and TC/HDL, and the increments were statistically significant in severe OSAS patients (P<0.05). The level of HDL was lowered in the OSAS groups, showing significant difference between severe OSAS group and the non-OSAS group (P<0.05). Apo-A level was lowered and Apo-B increased in the OSAS groups, but the differences were not statistically significant (P>0.05).</p><p><b>CONCLUSIONS</b>OSAS may produce harmful affect on the blood glucose and blood lipids in elderly hypertensive patients.</p>

An evaluation of obstructive sleep apnea syndrome in elderly patients with cardiovascular disease / 中华老年医学杂志

Objective To evaluate the prevalence of obstructive sleep apnea syndrome (OSAS) and its characteristics in elderly patients with cardiovascular diseases, and provide reference for the clinical decisions. Methods All patients who were hospitalized in department of cardiovascular medicine from January to June in 2007 were invited to participate in the current study. A total of 317 hospitalized elderly patients were recruited into this study. All participants were assessed by portable bedside nocturnal polysomnograph and Epworth sleepiness scale (ESS). Results Among 317 patients, 281 cases (88.6%) met the criterion of obstructive sleep apnea (OSA) [apnea and hypopnea index (AHI)≥5] and 47 cases (14.8%) met the criteria of obstructive sleep apnea syndrome (OSAS) (AHI≥5 and ESS≥9). When the severity of OSA (as indicated by AHI) was considered as a dependent variable, multiple regression analysis indicated that it was significantly associated with minimal SaO2 and the oxygen desaturation index, while age, habitual snoring, ESS, BMI, mean SaO2 and the duration of SaO2≤ 90% did not show significant effects on the severity of OSA. Conclusions High prevalence of obstructive sleep apnea syndrome (with daytime sleepiness) is found in elderly hospitalized patients and the rate of obstructive sleep apnea is much higher in patients without daytime sleepiness symptoms. Minimal SaO2 and the oxygen desaturation index are the important predicting factors for the severity of OSA, while age, BMI, habitual snoring, sleepiness are not correlated with the severity of OSA after adjusting minimal SaO2 and oxygen desaturation index.

Clinical analysis of coronary artery disease in elderly patients with sleep disordered breathing / 南方医科大学学报

<p><b>OBJECTIVE</b>To understand the prevalence of sleep disordered breathing (SDB) in elderly patients with coronary artery disease (CAD) and explore the relations between SDB and CAD.</p><p><b>METHODS</b>Sixty-two elderly patients with and 18 without CAD identified by coronary angiography underwent examinations by polysomnography (PSG). Left ventricular ejection fraction (LVEF) was measured by 99Tc equilibrium radionuclide angiography.</p><p><b>RESULTS</b>In the 62 elderly patients with CAD, 53.2% had SDB, a rate significantly higher that (22.2%) in the 18 non-CAD patients. The CAD patients with SDB had higher respiratory disturbance index (RDI) and body mass index (BMI) and lower arterial saturation of oxygen (SaO2) during sleep, with longer duration of low SPO2 (less that 90%). The incidence of hypertension was higher in CAD patients with SDB than in those without SDB. No significant correlation was found between the severity of coronary artery disease and RDI (r=-0.16, P>0.05).</p><p><b>CONCLUSION</b>The elderly patients with CAD have higher incidence of SDB, and appropriate interventions should be administered in those with severe SDB.</p>

Relationship between chronic congestive heart failure and sleep-disordered breathing in elderly patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To determine the prevalence of sleep disordered breathing (SDB) in elderly patients with chronic congestive heart failure (CHF) and explore the relations between SDB and left ventricular function.</p><p><b>METHODS</b>By means of polysomnography, 56 elderly patients with CHF were divided into non-SDB, mild SDB, moderate SDB, and severe SDB groups, and the left ventricular ejection fraction (LVEF) was measure by (99)Tc equilibrium radionuclide angiography.</p><p><b>RESULTS</b>In the 56 elderly patients with CHF, 38 (67.9%) had SDB, including 12 (21.4%) mild SDB, 14 (25.0%) moderate SDB, and 12 (21.4%) severe SDB patients. Thirty (53.6%) of the 56 patients with CHF had obstructive sleep apnea (OSA), 4 (7.1%) had central sleep apnea and 22 (39.2%) had mixed sleep apnea. The moderate and severe SDB groups had lower minimum arterial oxyhemoglobin saturation during sleep than the non-SDB groups, and the apnea-hyponea index was closely related to LVEF (r=-0.74, P<0.01).</p><p><b>CONCLUSION</b>The prevalence of SDB, predominantly OSA, is high in elderly patients with CHF. Moderate and severe SDB might affect the left ventricular function in these patients, who require polysomnography monitoring.</p>

The clinical analysis of the daytime sleepiness in the middle aged and elderly patients with obstructive sleep apnea syndrome / 中华老年医学杂志

0.05),excepting the significant differences in the non-elderly ( P

The analaysis of excessive daytime sleepiness and relevant factors in the elderly / 中华老年医学杂志

Objective To investigate the prevalence rate and related factors of excessive daytime sleepiness (EDS) in the elderly. Methods Epworth Sleep Scales (ESS) was used to make a randomized questionnaire among the retired elderly. Results 1 000 questionnaires were released and totally 768 qualified answers were returned. The mean score of ESS was 4.22?0.10 and the score ≥8 was used as an abmormal value. The prevlence rate of EDS in the elderly group was 10.9%. Regression analysis was done based on ESS score as dependent variable, and age, sex, duration of sleep, difficulty in falling asleep, early wakeup, daytime sleepiness, habitual snoring and loud unstable snoring as independent variables. It was showed that daytime tiredness(r=1.458, P

The Risk Factors Affecting the QOL of OSAS Patients and the Influence of nCPAP Treatment on the QOL of OSAS Patients / 中国医师杂志

Objective To explore the risk factors affecting the quality of life (QOL) of patients with obstructive sleep apnea (OSAS) and the influence of nasal continual positive airway pressure (nCPAP) treatment on the QOL of OSAS patients. Methods Measuring the quality of life of 212 patients suffered from OSAS with WHOQOL-BREF and analyzing the influences of the sleepiness, quality of sleep, chronic disease and nCPAP treatment on the QOL of patients with OSAS. Results The scores on physical domain and psychological domain of patients who were sleepiness or had bad quality of sleep were less than that of patients who were non-sleepiness or had a good sleep respectively(P