ABSTRACT
Objectives@#Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. @*Methods@#A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. @*Results@#A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. @*Conclusions@#PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.
ABSTRACT
Objectives@#Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. @*Methods@#A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. @*Results@#A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. @*Conclusions@#PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.
ABSTRACT
PURPOSE: To evaluate the involvement of apoptosis in N-methyl-D-aspartate (NMDA)-induced excitotoxicity in the rabbit retina. METHODS: After intravitreal injection of 680 and 2,000 nmoles of NMDA in rabbit eyes, the eyes were enucleated at 2, 16, and 60 hours and 1 and 2 weeks. The apoptotic cell death was determined with TdT-mediated biotin-dUTP nick end labeling (TUNEL) stain, and immunohistochemical stains of Bcl-2, Bax, and caspase-3 were performed. RESULTS: TUNEL showed increased labeling scattered in the ganglion cell layer and inner nuclear layer from 16 to 60 hours. The number of TUNEL-positive nuclei decreased at 60 hours, and none was observed at 2 hours, 1 week, and 2 weeks. More TUNEL-positive nuclei were seen with injection of 2,000 nmoles compared to 680 nmoles. Bcl-2, Bax, and caspase-3 were seen histologically as early as 2 hours in the ganglion cell layer and inner nuclear layer; there was no stained nuclei with the TUNEL stain. At 2 hours after intravitreal NMDA injection, Bcl-2, Bax, and caspase-3 were also stained in Muller cells. CONCLUSIONS: This study showed that apoptosis is involved in NMDA-induced excitotoxicity in the rabbit retina. Bcl-2, Bax, and caspase-3 may play important roles in modulating the apoptosis in NMDA-induced excitotoxicity, and Muller cells are involved in the apoptotic pathway.