Study on intermittent hypoxia in children sleep apnea hypopnea syndrome model and insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels in serum / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Using rats fed in intermittent hypoxia environment to study the relationship between sleep apnea hypopnea syndrome (SAHS) of children and growth retardation.</p><p><b>METHODS</b>The hypoxic chamber was designed and manufactured, the control of intermittent hypoxia was achieved. Twenty-four rats were randomly divided into three groups: mild and severe hypoxia group, and control group. In control group, the animals were normally fed, without interruption. The animals in other two groups were kept in the cabin, simulated mild and severe intermittent hypoxia conditions 8-hour a day, a total of 35 days. According to the results of preliminary experiments, the concentration of intermittent hypoxia and frequency were determined. The animals with mild hypoxia events occurred nearly six times per hour, the average minimum oxygen saturation dropped to 0.853, the animals with severe hypoxia events occurred nearly 24 times per hour, the average minimum oxygen saturation dropped to 0.776. Body mass and length were measured before and after experiment. The serum insulin-like growth factor (IGF)-1 and insulin-like growth factor binding protein (IGFBP)-3 expression were tested from venous blood by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The length and body mass of rats in three groups before and after experiment were not statistically different (P>0.05). Before the experiment the serum IGF-1 and IGFBP-3 levels were not significantly different (P>0.05). 35 d after the experiment, the serum IGF-1 (x±s, the same below) in the control group, mild hypoxia and severe hypoxia were (60.0±18.5) ng/ml, (40.6±9.9) ng/ml and (13.1±8.6) ng/ml, F=25.840, P<0.01; the serum IGFBP-3 were (1.93±0.23) µg/ml, (1.39±0.30) µg/ml and (0.90±0.21) µg/ml, F=33.929, P<0.01. The differences were statistically significant. The IGF-1 and IGFBP-3 levels decreased as the hypoxia increased (P<0.05).</p><p><b>CONCLUSION</b>In simulated sleep apnea hypopnea syndrome, the intermittent hypoxia in young rats does not show physical growth retardation, but the serum IGF-1, IGFBP-3 levels decreased with the increase of hypoxia and decline of oxygen saturation.</p>

Long term follow up of midline partial glossectomy and uvulopalatopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the long-term results of midline partial glossectomy with uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Twenty-four severe OSAHS patients treated with midline partial glossectomy and UPPP from January 2003 to March 2004 were included in this study, the follow-up was 5 years. The median of preoperative lowest arterial oxygen saturation (LSaO(2)) of this group at night (the same below) 0.650, and AHI was 56.5 times/h, UPPP was performed under general anesthesia, no tracheotomy performed. Criteria of curative effects: AHI < 5 times/h was recovery, AHI < 20 times/h and decreased beyond 50% marked improvement, only AHI decreased beyond 50% improvement.</p><p><b>RESULTS</b>Post-operation AHI (6 months, 1 year, 2 years and 5 years after surgery) decreased significantly compared to that before the surgery, and post-operation LSaO(2) was significantly higher than that of preoperative (Wilcoxon's signed rank test, the same below, P < 0.01). The LSaO(2) and AHI were significantly different between 1 year, 2 years, 5 years and 6 months post-operatively (P < 0.01). Six months after surgery, PSG results showed that 21 were recovery, marked improvement for the other 3 cases, the recovery rate was 87.5%. One year after surgery, 18 were recovery, marked improvement in 3 cases, the recovery rate 75.0%. Two years after surgery, 14 cases recovery, marked improvement in 4 cases, the recovery rate 58.3%. Five years after surgery, 6 were recovery, the recovery rate 25.0%. Among 5 cases with hypertension before the surgery, after surgery antihypertensive drugs were not necessary in 4 cases, and the dosage was decreased in 1 case.</p><p><b>CONCLUSION</b>The midline partial glossectomy with UPPP surgery may be an effective treatment for the severe OSAHS, long-term effect is satisfactory.</p>

Growth retardation in children with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe changes of growth, body composition and biochemical markers associated with growth (IGF-1) in prepubertal children with obstructive sleep apnea syndrome (OSAHS).</p><p><b>METHODS</b>Thirty-one children aged 3-10 years with OSAHS were followed up for 1 year after the corresponding surgery. During the same period of time, 20 children of similar age without OSAHS (excluded any other diseases that could result growth retardation or hypoxemia) were also followed up for 1 year. PSG, height, weight as well as insulin-like growth factor-1 (IGF-1) were measured during the preoperative period, 3 months, 6 months and 1 year after surgery in patient group. The same indexes were measured before surgery, and only height and weight were recorded after surgery in the control group. Wilcoxon signed- rank test and Mann-Whitney U test are used to analyze the data.</p><p><b>RESULTS</b>The lowest oxyhemoglobin saturation of the patient group (0.88) is significantly lower than that of the control group (0.98), and was found increased at the 6 months post-op follow up (0.97, U = 238.5, P > 0.05), no significant change was found at the 1 year follow up. The post-op AHI (6 months after surgery) of the patient group (6.0/h) decreased to the similar level of the control group (0/h, U = 240.0, P > 0.05), and was similar to 1 year after surgery. Height of the patient group (116 cm), which was lower than the control group (U = 127.0, P < 0.001), significantly increased 1 year (138 cm) after the corresponding surgery (Z = 3.726, P < 0.01), and reached the similar levels of the control group (137 cm) 1 year after the surgery (U = 123.5, P > 0.05). The serum IGF-1 levels of the patient group (33.7 ng/ml), which were significantly lower than those of the controls preoperatively (44.1 ng/ml, U = 206.0, P < 0.05), increased to similar levels with the controls 6 months after the operation (50.3 ng/ml, U = 261.0, P > 0.05), and the 1 year post-op follow up was similar to the control group too (48.6 ng/ml, U = 163.0, P > 0.05).</p><p><b>CONCLUSIONS</b>The cure of OSAHS could accelerate growth in prepubertal children, and the serum IGF-1 levels increases at the same time. The growth retardation is presumed in children with OSAHS.</p>