Glucocorticoid receptors mRNA expression in peripheral blood mononuclear cell in patients with obstructive sleep apnea hypopnea syndrome / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo study the mRNA expression of glucocorticoid receptor(GR) in peripheral blood mononuclear cells in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and its clinical significance. METHODSReal-time fluorescent quantitative PCR was used to detect GRα mRNA and GRβ mRNA exprssion in PBMC of 30 male patients with moderate to severe OSAHS and 27 healthy male subjects. The relationships between the expression of glucocorticoid receptor mRNA and the apnea hypopnea index, body mass index, neck circumference, waist circumference, the lowest oxygen saturation, the average oxygen saturation, the Epworth sleepiness scale(ESS) score, fasting blood glucose, heart rate and blood pressure were analyzed.RESULTSCompared with the control group, the expression level of GRα mRNA was lower in the OSAHS group(t=2.25,P0.05). We had not found the significant correlation between the expression of GRα mRNA and the clinical parameters above in OSAHS patients.CONCLUSIONThe expression of GRα mRNA in PBMC in moderate to severe OSAHS male patients have a downward trend compared with healthy group, but the mechanism remains unclear.

Prevalence and prognostic factors for postoperative complications of uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the complication incidence and risk factors within immediate 24 hours after uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and provide theoretical foundation for preventing postoperative complication incidence.@*METHOD@#162 patients undergoing UPPP procedure between Mar, 2002, and Oct 2006, were analysed retrospectively. All patients were divided into two groups according to the development of postoperative complications or not. The retrospective chart review focused on the demographic data and pertinent history, preoperative sleep evaluation, surgical and anesthetic management, and need for postoperative interventions. Potential risk factors were first evaluated with univariate analysis followed by multivariate logistic regression with the occurrence of complications within immediate 24 hours after operation as the dependent variable.@*RESULT@#A total of 162 consecutive cases for UPPP were enrolled into current study. 31 cases (19.1%) had postoperative complications necessitating a medical intervention, including respiratory complications (n =21, 13.0%), cardiovascular complications (n =6, 3.7%) and hemorrhage (n =9, 5.6%). The differences in body mass index (BMI), apnea-hypopnea index (AHI), lowest oxygen saturation (LSAT) and difficult intubation were significant between two groups. Risk factors for postoperative complications were BMI (OR =1.136, 95% CI: 1.007-2.558, P =0.049), preoperative AHI (OR =4.828, 95% CI: 1.827-13.924, P =0.012) and difficult intubation (OR = 1.971, 95% CI: 1.251- 4.839, P =0.034).@*CONCLUSION@#Baseline BMI and AHI, difficult intubation in anaesthetic procedure were the most important predictors of postsurgical morbidity. Keeping in mind the aforementioned cautionary notes, aggressively preoperative preparation should be applied for such populations to avoid the occurrence of postoperative complications.

Impact of adenotonsillectomy on quality of life in children with sleep disordered breathing / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare improvement in quality of life after adenotonsillectomy in children with similar demographics but with either obstructive sleep apnea hypopnea syndrome (OSAHS) or with milder forms of sleep-disordered breathing (SDB). To evaluate the relationship between polysomnogram (PSG) results and disease-specific quality of life for children with obstructive sleep apnea 18 item survey (OSA-18).@*METHOD@#Children with SDB who were suspected of having OSAHS were enrolled. All study participants underwent overnight PSG using standardized techniques. The effectiveness of adenotonsillectomy for the relief of SDB was evaluated by using the OSA-18. Follow-up was assessed at 6-9 months. Preoperative and postoperative OSA-18 scores for each group of children (OSAHS and mild SDB) were compared.@*RESULT@#The study population included 51 children with SDB, and 28 of them met PSG criteria for OSAHS, the other 23 of them without OSAHS. The clinical data in the two groups were similar. OSA-18 scores were not significantly different between children with and without OSAHS. The total OSA-18 scores and the scores for all domains showed significant improvement after surgery for both groups of children (P0.05). The domains of sleep disturbance, physical suffering and caregiver concerns showed significant association with PSG parameters (P0.05).@*CONCLUSION@#Both groups of children showed a dramatic improvement in quality of life after adenotonsillectomy and the degree of improvement was similar. Fortunately, surgical therapy with adenotonsillectomy was associated with marked improvement in quality of life for children with either OSAHS or mild SDB. However, the association between PSG findings and OSA-18 scores was only moderate.