Detecting of obstructive sleep apnea hypopnea syndrome using a multi-parameter pressure sensitive sleep monitor / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of an electro-mechanical film-based(EMFi) multi-parameter pressure sensitive sleep monitor(MPSSM)on clinical diagnosis and research significance of obstructive sleep apnea hypopnea syndrome(OSAHS).@*METHODS@#Retrospective analysis was made of 58 test subjects at Peking University Third Hospital with suspected OSAHS who were simultaneously monitored by MPSSM and polysomnography(PSG). The PSG test results were used as the gold standard in evaluating the sensitivity and specificity of OSAHS diagnosis of MPSSM. The test result consistency of sleep apnea and hypopnea index(AHI)and total apnea time of the two methods was evaluated. Real-time waveform comparison of sleep respiratory events of a randomly selected patient diagnosed with OSAHS was performed.@*RESULTS@#For 58 test subjects, 48 were male, 10 were female, with an average age of(40.6±12.2)years. Thirty-nine out of the 58 test subjects were diagnosed with OSHAS by PSG. The sensitivity of MPSSM for OSAHS diagnosis was 92.3%, with 95% confidence interval of 79.1%-98.4%, and the specificity of MPSSM for OSAHS diagnosis was 100%, with 95% confidence interval of 82.3%-100%. Kappa test k=0.887 (P < 0.001) showed OSAHS diagnosis results of the two methods were almost identical. The AHI measured by MPSSM [12.0(2.6-32.2) times/h] and PSG [13.4(3.1-38.8) times/h] were highly correlated (ρ=0.939, P < 0.001). The total apnea time measured by MPSSM [37.9(9.9-80.5) min] and PSG [32.3(8.6-93.0) min] were highly correlated(ρ=0.924, P < 0.001). Bland-Altman plot showed that the consistency between the test results of the two methods was very high.@*CONCLUSION@#As a portable, non-contact, fully automatic monitoring device, MPSSM is reliable in the screening of OSAHS compared with PSG. It is suitable to be promoted and applied in primary medical institutions, nursing homes and domestic usage. However, further research is required in improving the analysis of different sleep phase and the differentiation of central sleep apnea syndrome respiratory events in order to effectively assist medical personnel in making an accurate sleep apnea diagnosis.

The application of acoustic pharyngometry in diagnosis and treatment of OSAHS / 临床耳鼻咽喉头颈外科杂志

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common clinical disease that seriously threatens human health and life. Accurate location of the upper airway obstruction is the key to the diagnosis and treatment of OSAHS. Acoustic pharyngometry uses sound reflection to quickly assess the cross-sectional area and volume of the upper airway. Acoustic pharyngometry represents a simple, quick, non-invasive method for measuring upper airway dimensions which could predict sleep apnea risk. In this article we sought to introduce the application of acoustic pharyngometry in the diagnosis and treatment of OSAHS.

Observation on curative effect of low-temperature plasma assisted uvulopalatopharyngoplasty in positional and non-positional OSAHS patients / 重庆医学

Objective To investigate the curative effect of low-temperature plasma-assisted uvulopalatopharyngoplasty(UP-PP)in the patients with positional and non-positional obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Twenty-six patients with OSAHS diagnosed by polysomnography monitoring receiving the low-temperature plasma-assisted UPPP in our hospital from January 2014 to December 2015 were selected and divided into the positional OSAHS group(PPs) and non-positional OSAHS group(NPPs) according to the apnea-hypopnea index (AHI) under different sleep positional status.The AHI change before and after operation and operation effective rate were compared between the two groups.Results Theoverall AHI,supine position AHI and lateral position AHI in the PPs group all were lower than those in the NPPs group(P＜0.05),moreover the blood oxygen related indexes were higher than those in the NPPs group(P＜0.05).The overall surgical effective rate in the OSAHS patients was 73.08％ (19/26),in which the surgical effective rate was 100％ (7/7) in the PPs group and 63.16％ (12/19) in the NPPs group,the difference between the two groups had no statistical significance(P=0.13).The postoperative total AHI,supine position AHI and lateral position AHI in the two groups were decreased compared with before operation(P＜0.05);the decrease range of lateral position AHI in the NPPs group was significantly higher than that in the supine position AHI[0.96(0.86,1.00)vs.0.53(0.34,0.77),P＜0.01].78.95 ％ (15/19) postoperation patients in the NPPs group converted to PPs.Conclusion Low-temperature plasma-assisted UPPP has some effects on OSAHS patients,in which the benefit of NPPs are more apparent.

The effect of CPAP therapy on dizziness / 临床耳鼻咽喉头颈外科杂志

Objective:To implore the effect of continuous positive airway pressure (CPAP) therapy on dizziness patients and its mechanism. Method:Seventy-five dizziness patients were enrolled. All patients accepted polysomnographic test, dizziness handicap inventory, Pitsburgh sleep quality index and Epworth sleepiness scale before and after CPAP therapy. Patients were divided into two groups according to a polysomnographic test: OSAHS group (AHI≥15) and without OSAHS group (AHI<15); divided into three groups according to dizziness handicap inventory score: mild dizziness group (0<DHI≤30), moderate dizziness group (30<DHI≤60), severe dizziness group (60<DHI≤100); divided into three groups according to therapy time: 0-<3 months group, 3-<6 months group, 6-12 months group; divided into four groups according to age: youngth group (age<45), middle age group (45-<60), younger old group (60-<75) and old group (≥75). Result:①There was a significant difference in all dizziness patients before and after CPAP therapy according DHI (P<0.01). ②The effectiveness of CPAP therapy between OSAHS group and without OSAHS group has no difference (P>0.05), but CPAP therapy could ameliorate sleep disorder of the OSAHS group. ③Different levels of dizziness had no impact on improving DHI during CPAP therapy. However, the effect on sleep improvement decreased when patients had heavier dizziness. ④Treating by CPAP after three months could significantly improve patients dizziness (P<0.01). ⑤The dizziness of the patients in younger old group and old group have significant improvement after CPAP therapy (P<0.01). However, only younger old group has better sleep. Conclusion:CPAP therapy could dramatically improve dizziness in patients with sleep disorders.

The curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleep apnea hypopnea syndrome and its influencing factors / 临床耳鼻咽喉头颈外科杂志

Objective:To observe the clinical curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleepapnea hypopnea syndrome (OSAHS) and to explore the related influencing factors. Method:The cross-sectional area of the narrowest plane in the nasopharyngeal region, velopharyngealregion, glossopharyngeal region, and hypopharynx region were measured using Spiral CT combined with Müller's experiment and computer processing system. All the elderly patients were administered with proton pump inhibitors (rabeprazole sodium, 20 mg/d) and domperidone tablets (10 mg×3/d) for 3 months. After treatment, repeat tests were performed to evaluate the therapeutic effects. Result:Before and after 3 months of treatment, significant difference was found in the total number of reflux, total reflux time, reflux symptom index and reflux symptoms scale (P<0.05), however, there's no significant difference in respiratory disorder index (P>0.05). After 3 months treatment, the cross-sectional area of those four structural regions was increased in different degrees in the patients with reduced OSAHS. However, no significant changes in the cross sectional area was observed in the patients with unchanged OSAHS. Conclusion:Anti-reflux therapy has curative effect in only 60% of the elderly patients with laryngopharyngeal reflux and OSAHS. In addition to the laryngopharyngeal reflux disease, age, BMI and medical history might be the reasons that lead to the failure of the improvement in the other 40% of the elderly patients.

The meaning of serum myeloperoxidase in obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the clinical significance of detecting peripheral blood myeloperoxidase in OSAHS patients. Method:Sixty cases of OSAHS patients in our hospital was selected as OSAHS group, which was subdivided into light, medium and heavy groups according to the PSG, each with 20 cases, and 20 cases of healthy persons were selected as control group; ELISA method was used to detect the MPO level of peripheral blood. 20 cases of severe OSAHS patients detect MPO level again three months after the fist detection, and analyze the correlation between serum MPO level and indicators of sleep respiratory related events. Result:①The level of peripheral serum MPO level positively correlated with the severity of the patients' condition. The control group, light, medium and heavy groups' serum MPO levels were (7.93±2.44), (10.58±3.31), (18.91±8.37), (29.03±10.06)ng/mg, respectively (F=19.102, P<0.05). ②OSAHS patients' peripheral blood MPO concentration had no correlation with gender, age and BMI, but was positively correlated with AHI and negatively correlated with LSaO₂ (P<0.05). ③Twenty cases of severe MPO and AHI patients with OSAHS were decreased and LSaO₂ increased, the difference was statistically significant (P<0.05). Conclusion:The detection of serum MPO in patients with OSAHS has important significance in judging the severity of the disease, evaluating the treatment effect and predicting the risk of cardiovascular disease in patients with severe OSAHS.

The impact of obstructive sleep apnea hypopnea syndrome on nonalcoholic fatty liver disease in the nonobese elderly / 中华老年医学杂志

Objective To investigate the impact of obstructive sleep apnea hypopnea syndrome (OSAHS) on development of nonalcoholic fatty liver disease (NAFLD) in the non-obese elderly.Methods A total of 91 non-obese elderly patients were divided into 3 groups,29 cases with mild to moderate SAHS (mild-to-moderate OSAHS group),31 cases with severe OSAHS (severe OSAHS group),30 cases without OSAHS and matched with age,sex and BMI (control group).The changes in NAFLD severity index including serum liver enzyme levels,Type Ⅲ procollagen peptide (PⅢ P)and liver/spleen CT ratio were observed,and the influence factors for the changes were analyzed.Results Serum alanine aminotransferase (ALT),aspartate aminotransferase (AST)ALT/AST ratio and serum PⅢ P levels were significantly higher in severe OSAHS group than in mild-to-moderate OSAHS and the control group(F=25.71,15.15,18.64,respectively,all P＜0.01).There was no significant differences in serum liver enzyme ALT,AST and P Ⅲ P levels between mild-to-moderate OSAHS and the control groups(all P＞0.05),and the ALT/AST ratio was significantly higher in mild-to-moderate OSAHS group than in the control group(P＜0.01).The Liver/spleen CT ratio was significantly lower in OSAHS groups than in control group,while the ratio was lower in severe OSAHS group than in mild-to-moderate OSAHS group(all P＜0.01 or 0.001).Serum PⅢ P level was significantly higher in OSAHS groups than in control group(F=31.46,P＜0.01),while PlⅢ P levels were not significantly different between the mild-to-moderate OSAHS group and the control group(P ＞ 0.05).The correlation analysis showed that the liver/spleen CT ratio in OSAHS group was negatively correlated with AHI(r=-0.785,P＜0.001),but was positively correlated with the lowest oxygen saturation(r=0.517,P=0.001).The ALT/AST ratio and serum P Ⅲ P level in OSAHS patients were positively correlated with AHI (r=0.463,0.770,both P＜0.001),but were negatively correlated with the lowest oxygen saturation (r=-0.395,-0.514,P＜0.01 or 0.001).The multiple regression analysis showed that AHI was the only variable that affected liver/spleen CT ratio and serum P Ⅲ P level in OSAHS patients.Conclusions OSAHS patients in the non-obese elderly are always complicated with NAFLD,characterized by abnormal liver enzymes,hepatic steatosis and fibrosis.The severity of lesion is increased with the deterioration of OSAHS.AHI may play an important role in the development of NAFLD in the non-obese elderly with OSAHS.

Diagnostic value of serum cysteine leukotriene levels for obstructive sleep apnea hypopnea syndrome in children / 中华实用儿科临床杂志

Objective To assess the clinical value of the measurement of cysteine leukotriene (CysLTs) concentration in serum as a diagnostic predictor to screen the obstructive sleep apnea hypopnea syndrome (OSAHS) in children.Methods Serum CysLTs concentration was measured with ELISA kit in 75 patients with snoring before per.forming polysomnography (PSG).Subsequently,all the subjects underwent PSG test.Forty-one subjects were diagnosed as OSAHS,and 34 subjects didn't have OSAHS.These 34 non-OSAHS subjects were served as control group.Among the OSAHS group,25 subjects were the Han nationality and 12 subjects were the Uyghur nationality.According to apnea hyponea index(AHI),the OSAHS group was divided into 3 groups,which were light,moderate and severe groups.And the serum CysLTs level of the OSAHS group was taken for correlation analysis with the sleep respiratory parameters.Compared with the PSG results,the clinical value of the measurement of CysLTs concentration in serum was taken as a diagnostic predictor to screen patients with OSAHS in children.Results 1.The serum CysLTs level of OSAHS group [(683.102 ±89.825) ng/L] was significantly higher than that in the control group [(461.985 ± 84.951) ng/L] (P ＜ 0.05).And it was correlated positively with AHI,longest apnea time,sleep apnea low aeration time (r =0.417,0.422,0.208,all P ＜ 0.05),but correlated negatively with the lowest oxygen saturation and the mean oxygen saturation (r =-0.192,-0.255,all P ＜ 0.05).2.The serum CysLTs level [(773.118 ± 92.015) ng/L] in severe OSAHS group was significantly higher than that in the moderate OSAHS group [(712.144 ± 41.331) ng/L] (P ＜ 0.05),and much more significantly higher than that in the light OSAHS group [(642.206 ± 77.250) ng/L] (P ＜ 0.05).3.When the serum CysLTs level was 560.872 ng/L,there was the best critical point with the highest sensitivity rate (92.7％)and specificity rate (94.1％),and the lowest misdiagnosis rate and the false dismissal rate,as diagnose accordance rate was 93.3％.4.The serum CysLTs level of Han [(704.417 ± 77.149) ng/L] was higher than that of Uygur [(628.053 ± 105.443) ng/L],and there was significant difference between the 2 groups (P ＜ 0.05).Conclusions Serum CysLTs level is closely related with the severity of OSAHS.There is difference in serum CysLTs level between different nationalities.The serum CysLTs level of the Han nationality is higher than the Uygnr nationality.The serum level of CysLTs may be used as a predictor in screening 0SAHS children and a biological marker of the severity of OSAHS children.

The effect of uvulopalatopharyngoplasty by radio frequency plasma / 临床耳鼻咽喉头颈外科杂志

Objective:To study the effect of uvulopalatopharyngoplasty(UPPP) by using radio frequency plasma on obstructive sleep apnea-hypopnea syndrome(OSAHS) with Velopharyngeal obstruction.Method:Eighty-one cases that were diagnosed as OSAHS with Velopharyngeal obstruction were randomized into two groups, UPPP group and radio frequency plasma Velopharynoplasty group. Result:Six months after operation, the effects in both groups were similar.Conclusion:Radio frequency plasma Uvulopalatopharyngoplasty is safe, time saving, less hemorrhage with good effects.

Clinical observation on obstructive sleep apnea-hypopnea syndrome cases in snoring children / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the necessity of monitoring polysomnography (PSG ) in snoring children.Method:The PSG were monitored in 162 children with snoring or apnea.Acording to results of PSG,162 cases were separated into two groups:group obstructive sleep apnea hypopnea syndrome(OSAHS) and group primary snoring(PS),monitoring data including:apnea hypopnea index(AHI),snoring index(SI),lowest oxygen saturation(LSaO_2) and time of SaO_2<0.9,all data were undertaked statistical analysis. Result:In all 162 snoring cases,150 cases(92.6%) belong to group OSAHS,12 cases(7.4%) belong to group PS;Differences of data of age,sex and body mass index(BMI) are not significant but that of AHI,SI,LSaO_2 and time of SaO_2<0.9 are significant(P<0.05).Conclusion:It's necessary to monitor PSG in snoring children for early diagnosis and correct treatment to avoid disadvantage of OSAHS.

Research on apoptosis changes of tensor veli palatini in patients with obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

Objective:To explore apoptosis changes of dilator muscles in the upper airway by detecting the expression of Bax, Bcl-2 in tensor veli palatini in patients with OSAHS.Method:The expression of Bax and Bcl-2 were detected in tensor veli palatini in 30 cases with OSAHS and 10 cases chronic tonsillitis without OSAHS by immunohistochemistry and image analytical system, and the results were analyzed.Result:①The expression levels of Bax in the OSAHS group increased significantly compared to control group(P<0.05), but there were no significant differences of Bcl-2 expression between two groups, the ratio of Bax/Bcl-2 increased significantly(P<0.05). ②There were positive correlations between AHI and the expression levels of Bax(r=0.697,P<0.01) respectively in the test group.Conclusion:The results indicate that apoptosis occurred in tensor veli palatini in patients with OSAHS, and the more severity of OSAHS , the more apoptosis.

Difference of upper airway variety with respiration in the sufferer of OSAHS and normal adult / 临床耳鼻咽喉头颈外科杂志

Objective:To inquiry the variety difference of upper airway caliber OSAHS sufferer and normal person in quiet respiration Method:Twenty OSAHS sufferer who were viewed by PSG and 16 normal adults who hadve no chief complaint of sleeping disease were selected.The curves of the subjects in a respiratory cycle were recorded by respiratory monitoring system in PSG,while the morphological changes in the harynx of all subjects were observed by fiberscope in a calm respiratory cycle,and then both of the two processes simultaneously were recorded on the same computer.According to the different stages of respiratory cycle by analyzing respiratory curve the video had been edited into pictures about the various anatomical areas in the upper airway,he cross section area and the dimension of palate and lingua and root of the tongue region upper irway wereas studied by the image tools in computer,and the changes of areas and dimensions at palate,and lingua and root of the tongue region upper airway were calculated.Result:It was found that there wasis a morphological change f the upper airway with the respiratory movement in the both groups.The upper airway caliber decrease with inspiration begin and reach the most narrowing at the end of inspiration,then upper airway caliber enlarges with the expiration begin and reach the most widening at the end of expiration.No matter the normal group or the OSAHS roup has the obvious changes in the palate and lingua region on the diameter,the cross section area and the dimension in respiration.The changes in the palate and lingua region on the diameter,the cross section area and the dimension of OSAHS group were greater than normal group.No matter OSAHS group or normal group on the diameter nd cross section area change in the palate was obviously more than the tongue area and the root of tongue area.The changes of OSAHS group on the dimension in the palate were greater than the tongue area and the root of tongue area.Conclusion:There are periodically changes of upper airway during respiration cycle in normal adults and SAHS patients.The effects of respiration on upper airway caliber of OSAHS patients are more obviously than normal adults.and the increasing effects in OSAHS patients is one of OSAHS etiology.

The relationship between the abnormal behavior and serum C-reactive protein in children with obstructive sleep apnea-hypopcea syndrom / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the pathogenesis of abnormal behavior in children with obstructive sleep apnea-hypopnea syndrome(OSAHS).Method:The behavioral problems and C-reactive protein were measured in 40 children with OSAHS and 30 children with habitual snoring who underwent overnight Polysomnography,40 cases of healthy children for the control group.Result:The ratio of abnormal behavior in OSAHS and abitual snoring children was significantly higher than that of the healthy control group,while no significant difference between the two groups.The content of C-reactive protein in OSAHS children(4.24 mg/L)was significantly higher than habitual snoring(2.76mg/L)and healthy control group(1.27mg/L);in habitual snoring children C-reactive protein was higher than in healthy control group.The content of serum C-reactive protein in OSAHS children accompanied by abnormal behavior(4.63 mg/L)was significantly higher than that without abnormal behavior(3.23 mg/L).The content of serum C-reactive protein content in habitual snoring children accompanied y abnormal behavior (3.63 mg/L)was significantly higher than that without abnormal behavior(1.76 mg/L).Conclusion:OSAHS and habitual snoring children have more behavior problems.C-reactive protein levels are higher in children with OSAHS and habitual snoring.and the levels of C-reactive protein are related to the abnormal ehavior in these children.

An independent association detected between metabolic syndrome and obstructive sleep apnea-hypopnea syndrome / 中华内分泌代谢杂志

Objective To investigate possible independent association between metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods According to polysomnography (PSG) examination, 82 obese patients were divided into OSAHS group (n = 55) and non OSAHS group (n = 27) and 30subjects with normal weight were recruited as the control group. PSG parameters such as AHI (apnea hyponea index), oxygen saturation (Spo2,) in obese patients were measured. MS-associated parameters, such as fasting blood glucose (FBG), fasting insulin (FINS), plasma lipid profile, insulin homeostasis model assessment of insulin resistance (HOMA-IR) and blood pressure, height, body weight, waist circumference, were measured in all cases. The prevalence of MS and the parameters were compared among different groups. The correlations between them were analyzed. Results The prevalence of MS in obese patients with OSAHS was significantly higher than that in obese patients without OSAHS (69.09% vs 37.04%, P <0.01). Systolic blood pressure and diastolic blood pressure (DBP), FBG and HOMA-IR were higher in subjects with OSAHS than those without OSAHS (P <0.05 or P <0.01). Multiple stepwise regression showed that DBP was negatively correlated with Spo2, FINS and HOMA-IR were positively correlated with AHI. Conclusion OSAHS is found to be independently associated with MS, which may be a risk factor of cardiovascular disease and other systemic diseases.