The clinical significance and changes of serum tumor necrosis factor and plasma endothelium in patients with OSAHS associated Type 2 diabetes mellites / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the significance of tumor necrosis factor-alpha (TNF-α) and plasma endothelium (ET) in pathophysiologic process of patients with obstructive sleep apnea hypopnea syndrome(OSAHS) with type 2 diabetes mellitus (T2DM).@*METHOD@#All observed subjects were divided into 4 groups. A number of 80 patients with OSAHS, 65 cases of OSAHS with T2DM patients, 20 patients with T2DM, and 32 cases of healthy control group were observed in this study. The serum levels of TNF-α and ET were detected by double antibody sandwich ELISA, the content of TNF-α and ET were compared between OSAHS group and OSAHS + T2DM group. It were also compared before and after treatment of CPAP or surgery.@*RESULT@#TNF-α level is higher in OSAHS+T2DM group than that in the OSAHS group, T2DM group and the control group (P 0.05).@*CONCLUSION@#TNF-α may be involved in the development of OSAHS and T2DM, while ET may have little effect on the occurrence and development of OSAHS and T2DM.

Analysis of the relation between dental arch size and upper airway morphology in patients with obstructive sleep apnea hypoventilation syndrome / 实用口腔医学杂志

Objective:To study the anatomical correlation between dental arch and the volume of upper airway in patients with obstruc-tive sleep apnea hypoventilation syndrome(OSAHS). Methods: Dental arch architecture and upper airway volume were measured by cone beam CT(CBCT) in the subjects with OSAHS(n=22) and without OSAHS(n=19). The correlation between dental arch and the supper airway volume in OSAHS patients was analyzed. Results:The length of the upper dental arch and the height of palate in OSAHS patients were larger than those of the controls(All, P<0. 05). Cross-sectional area of nasopharynx and retropalatal and the total volume of upper airway were negatively correlated with the palatal height and upper dental arch length(P<0. 05), while positively correlated with upper dental arch of molar regions(P<0. 05). Conclusion:The abnormal shape of upper dental arch is related to the airway vol-ume of nasopharynx and retropalatal region in patients with OSAHS.

The clinical effect observation for surgery of nose and pharyngeal auxiliary oral appliance in severe OSAHS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the therapeutic effects of oral modified device combined with nasopharyngeal enlargement surgery and evaluate the oral modified device' s adjuvant therapy meaning in severe OSAHS patients after surgery treatment.@*METHOD@#46 cases with severe OSAHS were diagnosed by PSG according to AHI and the lowest arterial oxygen saturation (LSaO2). We performed the nasal or pharyngeal cavity expansion surgery for them according to the pathological change part correspondingly. Then all subjects were divided into combined group (n=26) and surgery alone group (n=20) according to their personal willingness. We monitored the PSG for all subjects aftter 2 weeks and 3 months respectively, then we calculate the diversity between the two group or intragroup change on the basis of the AHI, LAT, LSaO2, mean arterial oxygen saturation (MSaO2) and sleep structures recorded by PSG. At the same time, we collected the subjective sensations by questionnaire.@*RESULT@#The AHI and LAT in combined group were significantly lower and LSaO2 was significantly higher than these in surgery alone group(P0. 05). The N 1% was more shorter and the N2% and N3% were more longer after nasal or pharyngeal operation compared with pre-operative states in both groups(P. 05). The data of PSG also showed that the shallow sleep proportion was more shorter and the slow wave sleep proportion was more longer in combined group compared with surgery alone group. The subjective sensations results also showed significantly alleviated in combined group, such as mental state, daytime sleepiness and physical strength. The efficiency ratio of treatment was 85. 0% and 92. 3% in surgery alone group and combined group respectively.@*CONCLUSION@#Nasal and pharyngeal cavity enlargement surgery combined with oral modified device is a more effective treatment in patients with severe OSAHS, and it is meaningful for the long-term curative effect of surgery to prevent relapse and improve.

Clinical study on efficacy of nasal surgical expansion as a basic operation in treatment of patients with OSAHS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the clinical effect of nasal surgical expansion as basical surgical treatment of patients with OSAHS.@*METHOD@#A total of 320 patients with OSAHS were retrospectively analyzed. The patient was diagnosed by PSG. The electronic nasopharyngolarygnoscope exam airway CT, and MRI were applied to determining the nasal plane block. According to the concrete reasons, the nasal endoscopic nasal septum corrective surgery and open surgery were carried out, respectively. Nasal sinus neoplasm resection of off shoring, inferior turbinate fracture surgery or inferior turbinate back-end 1/3 line expansion and low temperature plasma ablation of nasal surgery, respectively. Pittsburgh sleep quality index (PSQI), snore outcome survey (SOS), epworth sleepiness score (ESS), the lowest arterial oxygen saturation (LSaO2) and AHI, time and ratio of slow wave sleep (SWS) stage and rapid eye movement (REM) stage were applied to comparing the curative effect between pre-operation and post-operation periods.@*RESULT@#Snoring, sleep apnea, subjective mental symptoms of all patients with OSAHS were improved after operation; PSQI, SOS and ESS score were improved compared to pretreatment (P < 0.05); according to the 2009 OSAHS diagnosis and curative effect evaluation standard, 38 cases cured, 189 cases had obvious effect, 93 cases effective, and the total effective rate was 100%; there was statistical difference between the pre-operative period and 6 months post-operative in PSQI, SOS and ESS, LSaO2, AHI and proportion of REM (P < 0.05); sleep structure was improved, time and proportion of SWS were increased after the operation (P < 0.05).@*CONCLUSION@#Solving the problem of nasal airway obstruction is the first step in surgical treatment of patients with OSAHS.

The changes and significance of IL-6 levels in patients with OSAHS associated Type 2 diabetes Mellites / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the changes of serum interleukin-6 (IL-6) level in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and OSAHS associated type 2 diabetes mellitus (T2DM) and their significance.@*METHOD@#All observed subjects were divided into 3 groups: 20 cases of normal subjects, 35 cases of simple OSAHS patients, 48 cases of OSAHS associated T2DM patients, IL-6 concentrations of serum were measured by the enzyme-linked immunosorbent.@*RESULT@#IL-6 level was higher in the group of OSAHS with T2DM than the group of OSAHS and the healthy control group (P < 0.05); IL-6 level was higher in the simple OSAHS group than the healthy controls.@*CONCLUSION@#IL-6 and other inflammatory factors may involved pathological physiological process in OSAHS patients sugar metabolic abnormalities; and is associated with the development of OSAHS associated with type 2 diabetes.

The curative effect analysis of continuous positive airway pressure combined with modified oral appliance in the treatment of severe OSAHS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the curative effect of continuous positive airway pressure(CPAP) combined with modified oral appliance (MOA) in the treatment of severe OSAHS.@*METHOD@#The research chose 120 male patients with severe OSAHS. They were treated with CPAP and MOA (30 cases), CPAP (30 cases), and MOA (30 cases) respectively. At the same time, the rest 30 cases without any treatment were in control group (matching factors: age, gender, IBM). After 3 months treatment, the characteristics of PSG and respiratory machine wear condition were observated in four groups.@*RESULT@#The ESS score in CPAP and MOA group was significantly lower than that in other groups (P < 0.05); After 3 months treatment, the AHI, awake index (AI), and Ni (non-rapid eyemovement sleep1, N1) and N2 (non-rapid eye movement sleep2, N2) period of total sleep time (TST) percentage in CPAP assisted MOA group and CPAP group were significantly lower than that in MOA group and control group (P < 0.05); Sleep efficiency, ESS score, average blood oxygen saturation (MSaO₂), the lowest oxygen saturation (LSaO₂), slow wave sleep phases (SWS) and rapid eyemovement sleep (REM) accounted for the proportion of TST increased significantly (P < 0.05); There was no significant difference between CPAP assisted MOA group and CPAP group in AHI, MSaO₂, AI, sleep efficiency, N1, N2, SWS and REM percentage of TST and ESS score. The LSaO₂ and average machine time in CPAP assisted MOA group were significantly greater than that in CPAP group (P < 0.05), but 90% pressure and average air leakage were significantly lower in the CPAP group (P < 0.05) CONCLUSION: The curative effect of CPCR combined with modified oral appliance was better than CPCR or MOA alone in the treatment of severe OSAHS.

Change of AHI and ODI in OSAHS patients with different sleep body positions / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo assess the sleep body position's effects on AHI and ODI during sleep in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different severity.METHODSThe clinical data of 113 subjects who had been diagnosed OSAHS or normal by polysomnography (PSG) between 2013 and 2014 in our department were retrospectively studied. They were divided into normal control group (AHI30/h, 40 patients). PSG data of AHI and ODI in different body position in each group were further analyzed.RESULTSIn normal group, The AHI and ODI in supine position were significantly higher than that in the left or right lateral position, and the difference between the left and right lateral position was not significant. In the mild to moderate OSAHS group, the AHI and ODI in supine were higher than that in the left lateral position slightly, while the data in supine was higher than that in the right lateral position significantly. In the severe group, the data between the supine and the left lateral position was not statistically different, while the supine position data was higher compared with that of the right lateral position. CONCLUSIONAHI and ODI were higher in supine position than that in lateral position, while the AHI and ODI in right lateral position is higher than that in left lateral position in OSAHS patients with different severity. The ODI and AHI are consistent in reflecting the severity of the OSAHS.