Effect of continuous positive airway pressure on nocturnal blood pressure in patients complicated with obstructive sleep apnea-hypopnea syndrome and different circadian rhythms of hypertension / 中华健康管理学杂志

Objectives:To analysis the effect of continuous positive airway pressure (CPAP) on nocturnal blood pressure in patients complicated with obstructive sleep apnea-hypopnea syndrome (OSAHS) and different circadian rhythms of hypertension.Methods:A total of 61 eligible patients were monitored by overnight polysomnography (PSG) at the Sleep Center of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University between January 2020 and April 2021. During the period of PSG monitoring, continuous non-invasive blood pressure (BP) and heart rate variability (HRV) were monitored simultaneously. Frequency domain analysis was used to measure HRV and low/high frequency was used to indirectly reflect sympathetic activity. According to the nighttime systolic BP decrease rate, patients were divided into three groups: dipper pattern (descent rate ≥10%), non-dipper pattern (descent rate was less than 10% but higher than 0) and reverse dipper pattern (descent rate≤0). The PSG parameters, BP data as well as sympathetic activity etc. were compared within and among groups before and after CPAP treatment. Multiple linear regression analyses were used to explore the influencing factors of antihypertensive effect of CPAP.Results:There were no significant differences in awake systolic BP (SBP) values, the severity of OSAHS, ESS scores, awake sympathetic activity and the other baseline data among the three groups. After CPAP treatment, the mean value of asleep BP in entire group showed a modest decline as compared to the baseline values [SBP decreased 4.6 mmHg (1 mmHg=0.133 kPa); diastolic blood pressure (DBP) decreased 2.4 mmHg, both P<0.001]. Subgroup analysis showed a significant reduction in asleep SBP of 11.1 mmHg and DBP of 4.9 mmHg (both P<0.001) in reverse dipper group, respectively, compared with the baseline values. While in dipper and non-dipper group, there were no significant differences before and after CPAP treatment in terms of BP (both P>0.05). In addition, there was no difference in awake sympathetic activity among three groups, while sleep sympathetic activity showed a gradual increasing trend. Sleep sympathetic activity decreased significantly from baseline after CPAP treatment in reverse dipper group ( P<0.001), while no differences were found in the other two groups before and after treatment. After controlling for baseline data such as age etc., the line regression model showed that the antihypertensive effect of CPAP was correlated with reverse dipper (SBP: β=0.548, P=0.002; DBP: β=0.454, P=0.013) and the improvement of nocturnal MpO 2 (SBP: β=0.410, P=0.046), but not with the severity of OSAHS, daytime sleepiness, or baseline BP values. Conclusion:For patients with moderate to severe OSAHS and hypertension, reverse dipper is an effective indicator to predict the antihypertensive effect of CPAP therapy.

Common risk factors for daytime sleepiness and hypertension in patients with obstructive sleep apnea syndrome / 中华健康管理学杂志

Objectives:To investigate the common risk factors for excess daytime sleepiness (EDS) and hypertension in obstructive sleep apnea-hypopnea syndrome(OSAHS) patients.Methods:Between January 2020 and February 2021, a total of 103 OSAHS patients diagnosed in the Department of Sleep Medicine Center, the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University were enrolled as the study population. During polysomnography (PSG) monitoring, noninvasive continuous blood pressure (BP) and heart rate variability (HRV) were monitored simultaneously. Low/high frequency components (LF/HF) were used to reflect sympathetic-vagal balance in frequency domain analysis. According to Epworth Sleepiness Scale (ESS) and BP levels, patients were divided into four groups: simple OSAHS group (ESS<10 scores and BP<140/90 mmHg, n=30)(1 mmHg=0.133 kPa), OSAHS+hypertension group (ESS<10 scores and BP≥140/90 mmHg, n=23), OSAHS+EDS group (ESS≥10 scores and BP<140/90 mmHg, n=26) and OSAHS+hypertension+EDS group (ESS≥10scores and BP≥140/90 mmHg, n=24). The clinical and PSG parameters were analyzed and compared among the four groups. Regression analyses were used to explore the common causative factors for EDS and hypertension. Results:The LF/HF in OSAHS+hypertension+EDS group was significantly higher than the other three groups [3.2% (2.6%, 4.2%) vs 1.4% (1.2%, 1.6%), 2.2% (1.8%, 2.9%), 2.5% (1.6%, 3.1%), all P<0.05]. No difference was observed between OSAHS+hypertension group and OSAHS+EDS group ( P=0.779), but both higher than simple OSAHS group. The linear regression equation showed that LF/HF was most correlated with the percentage of sleep time with oxygen saturation<90% (T90) as compared to the other parameters of sleep disordered breathing (β=0.201, P=0.006). In addition, Pearson correlation analysis showed that LF/HF was significantly correlated with ESS scores and asleep BP levels ( r=0.536, r=0.456, all P<0.05). The logical regression equation showed that LF/HF was a causative risk factor for both EDS and hypertension in OSAHS (β=0.164, 95% CI: 1.018-1.364, P=0.028). Conclusion:The sympathetic-vagal imbalance is a common risk factor for EDS and hypertension in OSAHS patients

Correlation between the oxygen desaturation rate and blood pressure among patients with severe obstructive sleep apnea syndrome and the possible mechanism / 中华健康管理学杂志

Objective:To investigate the association between oxygen desaturation rate and blood pressure (BP) among severe obstructive sleep apnea syndrome (OSAS) and the possible mechanism.Methods:Patients with snoring were enrolled from the Department of Sleep Medicine Center, the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University form March 2018 to January 2019 and underwent polysomnography (PSG). Noninvasive BP and Heart rate variability were full-night monitored continuously and synchronized with PSG. Based on the PSG results and exclusion criteria, a total of 86 severe OSAS patients were enrolled in this study and divided into two groups according to the ambulatory BP measurements: hypertensive group ( n=44) and normotensive group ( n=42). Oxygen desaturation rate was expressed as the change in the percentage of pulse oxyhemoglobin saturation (SpO 2) per second during desaturation events after the obstructive apnea events occurred. The PSG parameters were compared between the two group and the multiple regression analyses were used to explore the association between oxygen desaturation rate and BP and its possible mechanism. Results:The apnea-hyperpnoea index (AHI) and respiratory event-related arousals (RERAs) were significantly higher in hypertensive group than those in normotensive group [(69.8±18.2) vs. (56.5±13.9) event/h; (40.5±17.4) vs. (30.2±14.6) event/h, both P<0.01]. In addition, hypoxia exposure conditions in the hypertensive group were more severe than those in the normotensive group, especially oxygen desaturation rate [(0.45±0.14)%/s vs. (0.33±0.10)%/s, P<0.001]. After adjusting for age, sex, neck circumference, waist circumference, smoking, drinking, the regression analyses showed that only the oxygen desaturation rate was significantly associated with both awake and asleep BP in OSAS patients ( β=0.473, 0.478, both P<0.01) and the correlation analyses suggested that the oxygen desaturation rate was related to the both awake and asleep sympathetic-parasympathetic imbalance ( r=0.367, 0.337, both P<0.01). Conclusion:Oxygen desaturation rate is closely related to BP levels in patients with severe OSAS, and the underlying mechanism is associated with the increased sympathetic activity.

Stroke after cardiac surgery / 国际脑血管病杂志

Stroke is one of the most devastating complications after cardiac surgery,and contributes to both mortality and morbidity.Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are the common procedures for the treatment of coronary artery disease.This article reviews the pathophysiologic mechanisms,risk factors,treatment and prognosis of stroke after CABG and PCI.

Clinical Study on Autologous Peripheral Blood Stem Cells Transplantation for Myocardial infarction / 昆明医科大学学报

Objective To study the clinical efficacy of autologous peripheral blood stem cell transplantation for the treatment myocardial infarction,in the same period of coronary artery bypass grafting (CABG).Methods From January 2012 to January 2015,76 patients with myocardial infarction were selected.Patients were divided into transplantation group (n =46) and control group (n =30) on the basis of whether being treated by autologous peripheral blood stem cell transplantation.After myocardial infarction patients were taken to the hospital with the therapy of conventional drug,5 days before CABG,transplantation group was given the autologous peripheral blood stem cell mobilization and expansion,24 hours before CABG,taking autologous peripheral blood stem cell collection.76 patients took CABG with non-cardiopulmonary by pass,transplantation group was given autologous peripheral blood stem cell via transplantation vessels and subepicardial,while the control group was not given the injection of autologous peripheral blood stem cell.The LV morphology,wall motion score index (WMSI) and index of cardiac function before and after the operation in both groups were evaluated by echocardiography.Results Six months after CABG,there was a significant decrease in Left ventricular end-diastolic diameter and wall motion score index,Left ventricular ejection fraction was increased.The indexes of cardiac function in the transplantation group were better than the control group.Conclusion Autologous peripheral blood stem cell transplantation for the treatment myocardial infarction can improve the heart function,and has obvious recent clinical curative effect in the same period of CABG.

Randomized controlled study on mechanical ventilation with bronchoalveolar lavage therapy for COPD combined with respiratory failure / 实用医学杂志

Objective To investigate the effects of continuous invasive mechanical ventilation combined with BAL on COPD patients with respiratory failure. Methods Sixty COPD patients with respiratory failure were divided into BAL and control group randomly. Control group were treated with sputum suction tube to aspire sputum and BAL group treated with BAL. The changes in the indicators were observed. Results The SpO2, airway peak inspiratory pressure and blood gas analysis were improved significantly compared with the control group (P < 0.01). The number of peripheral blood leucocytes and the level of CRP in BAL group were lower than those in control group at the seventh day (P < 0.01). The duration of invasive mechanical ventilation and hospital stay in BAL group was shorter than that in control group (P < 0.01) and there was no severe complication in both groups. Conclusion BALwith continuous mechanical ventilation support are safe and effective and shorten hospitalization time and improve the prognosis of COPD patients with respiratory failure.