[Correlation between peripheral blood Th17 cells and carotid intima-media thickness in OSA patients].

Objective:To study the carotid intima-media thickness （IMT） level of OSA patients of different severity, the proportion of Th17 cells in peripheral blood and the mRNA level of nuclear transfer factor RORγt, and to explore the relationship between Th17 cells and atherosclerosis in OSA patients. Method:Sixty-two patients who underwent respiratory and sleep monitoring were selected and divided into three groups according to the AHI index: 15 patients in the normal control group（AHI<5）, there were 22 cases in the mild group（AHI 5-15） and 25 cases in the moderate and severe group（AHI≥15）. Carotid intima-media thickness（IMT） was measured in all subjects, the ratio of Th17 cells in peripheral blood monouelear cells（PBMC） were analysed by flow cytometry. The expression of RORγt mRNA were detected by real-time polymerase chain reaction. Result:The carotid IMT of patients in the normal control group, the mild OSA group and the moderate to severe OSA group were （0.74±0.21） mm, （1.09±0.23） mm and （1.60±0.30） mm, respectively. The moderate to severe group was higher than the mild group and the normal control group, the difference was statistically significant （P<0.01）. The proportion of Th17 in peripheral blood of the three groups was（2.54±0.20）%, （4.34±0.30）%, and （8.27±0.31）%, respectively. The moderate to severe group was significantly higher than the mild group and the control group （P<0.01）, the difference was statistically significant. The relative mRNA expression levels of RORγt in the three groups were 0.92±0.24, 2.60±0.59, and 4.93±0.72, respectively. The moderate to severe group was significantly higher than the mild group and the control group （P<0.01）, the difference was statistically significant. The proportion of Th17 in peripheral blood and the relative expression of RORvt mRNA were positively correlated with the carotid IMT （r value was 0.80, 0.78, respectively, all P<0.01）. Conclusion:Th17 cells differentiation is increased in OSA patients, and Th17 cells are correlated with indicators reflecting the progression of atherosclerosis. Th17 cells may be involved in the development of atherosclerosis in OSA patients.

[The value of the pharyngeal airway pressure monitoring test in topodiagnosis of OSA].

Objective:To analyses the value of an improved methods of Muller's test, pharyngeal airway pressure monitoring test（PAPMT）, in topodiagnosis of OSA. Method:One hundred and one cases with OSA（AHI≥5 times per hour） and 30 normal adults were included in the study. Under the pressure monitoring, the electronic laryngoscope were stayed at the palatopharyngeal and glossopharyngeum. First, observe the maximum expiratory pressure and the minimum spiratory pressure. And then measure and record changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum under the different pressure. At Last, analyses the correlation between changes of Pharynx cross-sectional area with polysomnography（PSG）. Result:①In 101 cases with OSA, the maximal inspiratory pressure of Müller's manerver distribution is between 1 and 8 kPa. ②The changes of pharynx cross-sectional area of OSA at palatopharyngeal and glossopharyngeum is significantly greater than the control group, and there were obvious differences between OSA and the control group. ③In OSA group, the plug rate at palatopharyngea was 96% and the plug rate at glossopharyngeum is 34% at the minimum pressure. There are no cases have pharynx jams at the control group. ④The main cause of the palatopharyngeal obstruction was strictures in left and right（73%）, and the anatomical factors causing obstruction mainly were, thicken of the pharyngeal wall. The main cause of the hypopharyngeal obstruction was strictures in front and back（71%）, and the redundant lymph tissue at tongue base and posterior displacement of the tongue base, and collapse of pharyngeal wall played an important role at tongue-pharyngeal obstruction. ⑤The changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum when the pressure is ±4 kPa is greater than when the pressure is ±2 kPa. ⑥When the pressure is ±2 kPa, The changes of pharynx cross-sectional area at palatopharyngeal is greater than at glossopharyngeum. ⑦Diminished pharyngeal apertures and collapsibility were associated with increased rates of apnea and hypopnea index and the suction pressure（P<0.05）. Conclusion:①PAPMT is able to measure and calculate the changes of pharynx cross-sectional area, determine the site of obstruction, and help the treatment. ②The primary site of obstruction is at velopharyngeal in OSA group. ③The changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum of patients can reflects the severity of the OSA.

[Effects of glutathione on oxidative stress, leptin and adiponectin in patients with obstructive sleep apnea complicated with metabolic syndrome].

Objective:The aim of this study is to analyze the effects of glutathione on oxidative stress, leptin and adiponectin in patients with obstructive sleep apnea（OSA） complicated with metabolic syndrome. Method:One hundred and fifty-nine patients with OSA and MS were enrolled in the group A according to the exclusion criteria. One hundred and fifty-nine patients with MS group were not included in the OSA group, and 159 patients were included in the control group. Before and after treatment, the levels of serum malondialdehyde （MDA）, superoxide dismutase （SOD）, Leptin and ADP were respectively detected, and the clinical effects of the three groups were compared. Result:Compared with the control group, the contents of MDA and Leptin in the case A and B groups were significantly higher than that of the control group, and the contents of SOD and ADP were significantly lower than that of the control group, and the difference was statistically significant, especially in case group A. The level of SOD and ADP was significantly higher in the group after treatment than before treatment, and the level of MDA and Leptin was significantly lower than before treatment. The difference was statistically significant, especially in case group A, too. Conclusion:Patients with OSA and MS are associated with oxidative stress. Glutathione can effectively improve the body's ability to resist oxidative stress, reduce oxidative damage, reduce leptin, and increase ADP levels.

Intervention effects of Jiawei Ditan Decoction on oxidative stress and inflammatory response in elderly patients with obstructive sleep apnea hypopnea syndrome / 中华老年医学杂志

Objective To investigate the intervention effects of Jiawei Ditan Decoction on oxidative stress and inflammatory reaction in elderly patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 60 OSAHS patients with deficiency of phlegm and blood stasis mutual junction were enrolled,and randomly divided into treatment group (n=30,receiving JiaweiDitan Decoction+ conventional treatment for 12 weeks) and control group (n=30,receiving conventional treatment for 12 weeks).The clinical symptoms integral,Epworth Sleepiness Scale (ESS),apnea hypopnea index (AHI),minimum oxygen saturation (SaO2),superoxide dismutase (SOD),malondialdehyde (MDA),tumor necrosis factor (TNF)-α interleukin (IL)-6,and C-reactive protein (CRP) were observed before and after treatment.Results The clinical symptoms integral,AHI value,minimum SaO2,ESS score,levels of SOD,MDA,TNF-α,IL-6 and CRP were significantly improved in treatment group after treatment as compared with pretreatment [(11.65 ± 3.82) points vs.(14.32±4.25) points,(21.18 ± 12.37) times/h vs.(29.16 ± 13.58) times/h,(83.24±7.42)％ vs.(76.92±11.91)％,(7.12±4.84)points vs.(10.01±4.16) points,(99.24± 13.15)×103 U/L vs.(87.511±14.82) ×103 U/L,(8.56 ± 3.23) μmol/L vs.(11.25±3.41) μmol/L,(50.63±10.57) ng/L vs.(58.92±11.65) ng/L,(78.12±15.92) ng/L vs.(89.13± 16.54) ng/L,(9.93±5.25) mg/L vs.(13.59±4.92) mg/L,t=2.559,2.379,2.467,2.480,3.243,3.137,2.887,2.651,2.786,respectively,all P＜0.05].All the above indicators after treatment had significant differences between the treatment group and the control group [(11.65 ± 3.82) points vs.(13.89±4.45) points,(21.18± 12.37) times/h vs.(28.03± 13.12) times/h,(83.24±7.42)％ vs.(78.26±10.15)％,(7.12±4.84) points vs.(9.56±7.12) points,(99.24± 13.15)×103 U/Lvs.(90.13±13.56)×103 U/L,(8.56±3.23) μmol/L vs.(10.86±3.65)μmol/ L,(50.63±10.57) ng/L vs.(56.52±11.04) ng/L,(78.12±15.92) ng/L vs.(87.81±15.61) ng/ L,(9.93±5.25) mg/L vs.(12.97±5.03) mg/L,t=2.092,2.018,2.169,2.009,2.642,2.585,2.111,2.380,2.290,respectively,all P＜0.05].Conclusions Jiawei Ditan Decoction could improve the clinical symptoms and has the intervention effect on oxidative stress and inflammatory reaction in elderly patients with OSAHS,which provides the experimental basis for the treatment of senile OSASH with Chinese herbal medicine.

Relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome / 中华全科医师杂志

Objective To study the relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS). Methods Sixth-seven patients definitely diagnosed by potysomnography (PSG) as OSAHS were divided into three groups according to their apnea-hypoventilation index (AHI), 14 in mild group (5 < AHI≤20), 21 in moderate group (20 < AHI≤40) and 32 in severe group (AHI 40). And, 18 healthy persons (AHI <5) were recruited as controls. Blood samples were obtained form all of them after PSG performance for measuring apoptotic endothelial cells (CD146AnnV+) and serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Results Serum level of MDA and CD146AnnV+ in moderate and severe OSAHS group were significantly higher than those in control group (all P < 0.05). Serum level of SOD in moderate and severe OSAHS group was significantly lower than that in control group (P < 0.05). CD146AnnV+ correlated positively with AHI, the longest apnea time (LAT) and oxygen desaturation index (ODI) (r = 0.778, 0.609 and 0.689, respectively, all P < 0.05) and correlated reversely with saturation of arterial blood oxygen at night (SaO2min) (r =-0.635, P < 0.01). CD146AAnnV+ correlated positively with serum level of MDA (r = 0. 698, P < 0.01), and correlated reversely with serum level of SOD (r =-0.705, P < 0.01). Results of linear multivariate regression analysis showed that AHI, serum levels of SOD and MDA were independent risk factors for endothelial cells apoptosis in patients with OSAHS. Conclusions There existed oxidative stress due to intermittent hypoxia in patients with OSAHS, which could be one of the major causes in exacerbating endothelial damage.

Diagnostic Significance of Pulmonary Function Test on Infants with Obstructive Sleep Apnea-Hypopnea Syndrome / 实用儿科临床杂志

Objective To evaluate the effect of pulmonary function test on infants with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Forty-eight patients were divided into two groups based on physical examination. Pulmonary function were measured in 48 patients. Age-matched healthy infants were enrolled as controls. The parameters included ratio of volume to PEF to total expiratory volume(VPTEF/VE,tPTEF/tE),inspiratory time/expiratory time(TI/tE),inspiratory time/total respiratory time(TI/Ttot),ratio of 50% of the tital inspiratory flow to tital volume(TIF_ 50 /V_T),mean inspiratory flow(V_T/TI),function capacity(FRCp),resistance effective(Reff).Results TI/Ttot,ratio of 50% of the tital expiratory flow to 50% of the tital inspiratory flow(TEF_ 50 /TIF_ 50 ),FRCp,Reff were significantly higher in patients compared with controls(P

A Study on Respiratory Impedance of Patients with Obstructive Sleep Apnea-hypopnea Syndrome / 中国医师杂志

Objective To investigate the characteristics of respiratory impedance in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The impulse oscillometry(IOS) and polysomnography (PSG) indices were measured in 52 patients with OSAHS, 13 patients with chronic obstructive pulmonary disease (COPD) and 17 healthy persons. Results The levels of R20, total respiratory impedence and central airway resistance in the patients with OSAHS were significantly higher than those in healthy persons (P