Exploratory Study of Relationship Between Obstructive Sleep Apnea Syndrome and Growth Hormones and Inflammatory Factors in Children.

Purpose: In children, obstructive sleep apnea (OSA) is associated with growth hormone level abnormalities and chronic systemic inflammation. This study was performed to investigate the relationship of the degree of OSA with insulin-like growth factor 1 (IGF-1) and inflammatory cytokines in pediatric OSA and the inter-relationship between inflammatory cytokines and growth hormones. Methods: Children with OSA and controls without OSA participated in the study. Information included polysomnography followed by measurement of IGF-1 and inflammatory marker levels. In total, 226 patients aged 2 to 12 years were divided into 4 groups: non-OSA, n = 57 (25.2%); mild OSA, n = 116 (51.3%); moderate OSA, n = 23 (10.2%); and severe OSA, n = 30 (13.3%). Results: Body height was not significantly different among the 4 groups. However, the minimum oxygen saturation and IGF-1 significantly differed among the different OSA groups (P = .0001 and P = .036, respectively). IGF-1 was significantly higher in the non-OSA group (P < .05) and mild OSA group (P < .01) than in the severe OSA group. As the severity of OSA increased, the interleukin-5 level significantly increased, which caused a difference between mild OSA and moderate OSA (P < .05) and between mild OSA and severe OSA (P < .001). In the univariate quantile regression analysis of IGF-1, there was a negative relationship between IGF-1 and IL-5 (P < .001). IGF-1 was positively correlated with age, height, and minimum oxygen saturation. Furthermore, there was a negative correlation between the IGF-1 level and the severity of OSA. Quantile regression analysis on the multivariable analysis of the IGF-1 association showed that height, sex, and severity of OSA played important roles in affecting IGF-1 levels. Conclusion: High IL-5 levels may lead to the low secretion of growth hormone level (IGF-1) in children, thus affecting growth and development.

Quantitative Proteomics Analysis of Serum and Urine With DIA Mass Spectrometry Reveals Biomarkers for Pediatric Obstructive Sleep Apnea.

OBJECTIVES: Identification of suitable biomarkers that facilitate the screening and evaluation of pediatric obstructive sleep apnea (OSA) and its severity was explored. METHODS: Data-independent acquisition quantitative proteomic analysis was employed to identify serum and urine proteins with differential expression patterns between children with OSA and controls. Differentially expressed proteins that gradually increased or decreased with the severity of OSA were retained as potential biomarkers and underwent ELISA validation. RESULTS: We found that with increasing severity of OSA, there was a gradual upregulation of 34 proteins in the serum and 124 proteins in the urine, along with a respective downregulation of 10 serum proteins and 64 urinary proteins in the initial cohort of 40 children. These proteins primarily participate in immune activation, the complement pathway, oxygen transport, and reactive oxygen metabolism. Notably, cathepsin Z exhibited a positive correlation with the obstructive apnea hypopnea index, whereas sex hormone-binding globulin (SHBG) was negatively correlated. These proteins were then validated by ELISA in an independent cohort (n=21). Circulating cathepsin Z and SHBG levels displayed acceptable diagnostic performance of OSA with AUC values of 0.863 and 0.738, respectively. CONCLUSIONS: We identified two promising circulating proteins as novel biomarkers for clinical diagnosis and assessment of pediatric OSA severity. Furthermore, the comprehensive proteomic profile in pediatric OSA should aid in exploring the underlying pathophysiological mechanisms associated with this prevalent condition.

Cyanidin-3-O-glucoside alleviates ethanol-induced liver injury by promoting mitophagy in a Gao-binge mouse model of alcohol-associated liver disease.

BACKGROUND: Alcohol-associated liver disease (ALD) is a leading cause of liver disease-related deaths worldwide. Unfortunately, approved medications for the treatment of this condition are quite limited. One promising candidate is the anthocyanin, Cyanidin-3-O-glucoside (C3G), which has been reported to protect mice against hepatic lipid accumulation, as well as fibrosis in different animal models. However, the specific effects and mechanisms of C3G on ALD remain to be investigated. EXPERIMENTAL APPROACH: In this report, a Gao-binge mouse model of ALD was used to investigate the effects of C3G on ethanol-induced liver injury. The mechanisms of these C3G effects were assessed using AML12 hepatocytes. RESULTS: C3G administration ameliorated ethanol-induced liver injury by suppressing hepatic oxidative stress, as well as through reducing hepatic lipid accumulation and inflammation. Mechanistically, C3G activated the AMPK pathway and enhanced mitophagy to eliminate damaged mitochondria, thus reducing mitochondria-derived reactive oxidative species in ethanol-challenged hepatocytes. CONCLUSIONS: The results of this study indicate that mitophagy plays a potentially important role underlying the hepatoprotective action of C3G, as demonstrated in a Gao-binge mouse model of ALD. Accordingly, C3G may serve as a promising, new therapeutic drug candidate for use in ALD.

Passive Self-Sustained Thermoelectric Devices Powering the 24 h Wireless Transmission via Radiation-Cooling and Selective Photothermal Conversion.

The rapid development of the Internet of Things has triggered a huge demand for self-sustained technology that can provide a continuous electricity supply for low-power electronics. Here, a self-sustained power supply solution is demonstrated that can produce a 24 h continuous and unipolar electricity output based on thermoelectric devices by harvesting the environmental temperature difference, which is ingeniously established utilizing radiation cooling and selective photothermal conversion. The developed prototype system can stably maintain a large temperature difference of about 1.8 K for a full day despite the real-time changes in environmental temperature and solar radiation, thereby driving continuous electricity output using the built-in thermoelectric device. Specifically, the large output voltage of >102 mV and the power density of >4.4 mW m-2 could be achieved for a full day, which are outstanding among the 24 h self-sustained thermoelectric devices and far higher than the start-up values of the wireless temperature sensor and also the light-emitting diode, enabling the 24 h remote data transmission and lighting, respectively. This work highlights the application prospects of self-sustained thermoelectric devices for low-power electronics.

Characteristics of ADHD Symptoms and EEG Theta/Beta Ratio in Children With Sleep Disordered Breathing.

Objectives. This study aimed to explore parent-reported symptoms of attention deficit-hyperactivity disorder (ADHD) and sleep electroencephalogram (EEG) theta/beta ratio (TBR) characteristics in children with sleep disordered breathing (SDB). Methods. The parents of children (aged 6-11 years) with SDB (n = 103) and healthy controls (n = 28) completed the SNAP-IV questionnaire, and children underwent overnight polysomnography. Children with SDB were grouped according to obstructive apnea/hypopnea index: primary snoring, mild, and moderate-severe obstructive sleep apnea (OSA) groups. The TBR in non-rapid eye movement (NREM) periods in three sleep cycles was analyzed. Results. Children with SDB showed worse ADHD symptoms compared with the healthy control. There was no intergroup difference in TBR. The time-related decline in TBR observed in the control, primary snoring and mild OSA groups, which was not observed in the moderate-severe OSA group. Overnight transcutaneous oxygen saturation was negatively associated with the hyperactivity/impulsivity score of ADHD symptom. The global TBR during the NREM period in the first sleep cycle was positively correlated with inattention score. Conclusion. Children with SDB showed more ADHD inattention symptoms than the healthy control. Although we found no difference in TBR among groups, we found significant main effect for NREM period. There existed a relationship between hypoxia, TBR, and scores of ADHD symptoms. Hence, it was speculated that TBR can reflect the nocturnal electrophysiological manifestations in children with SDB, which may be related to daytime ADHD symptoms.

Impaired declarative memory consolidation in children with REM sleep-related obstructive sleep apnea.

STUDY OBJECTIVES: We explored whether declarative memory consolidation is impaired in children with rapid eye movement sleep-related obstructive sleep apnea (REM-OSA) and investigated the correlation between memory consolidation and sleep-related respiratory parameters. METHODS: Participants were children with habitual snoring aged 6-14 years and control children. Participants underwent polysomnography and declarative memory testing. Participants with snoring were categorized as primary snoring (PS), non-rapid eye movement sleep-related obstructive sleep apnea (NREM-OSA), stage-independent (SI)-OSA, and REM-OSA according to obstructive apnea-hypopnea index (OAHI), OAHI in REM sleep (OAHIREM), and OAHI in NREM sleep (OAHINREM). Declarative memory consolidation level was assessed by recall and recognition rates. RESULTS: There were 34 controls and 228 children with sleep-disordered breathing: 73 PS, 48 NREM-OSA, 59 SI-OSA, and 48 REM-OSA. Total arousal index was lower in the REM-OSA group than in the NREM-OSA group. In all groups, retest scores were higher than immediate test scores. Recall consolidation in PS, SI-OSA, and REM-OSA groups was lower than for controls and lower in REM-OSA than in NREM-OSA. There were no correlations between recall consolidation or recognition consolidation and OAHI, OAHINREM, oxygen desaturation index in REM sleep, total arousal index, or REM sleep percent. Recognition consolidation was negatively correlated with OAHIREM. CONCLUSIONS: Memory consolidation is impaired in children with REM-OSA compared with NREM-OSA and controls. There was no significant correlation between memory consolidation and OAHI, and recognition consolidation was negatively correlated with OAHIREM. It is important to pay attention to the OSA subtype in children. CITATION: Tang Y, Yang C, Wang C, Wu Y, Xu Z, Ni X. Impaired declarative memory consolidation in children with REM sleep-related obstructive sleep apnea. J Clin Sleep Med. 2024;20(3):417-425.

Hypoxia Induces Tumor-Derived Exosome SNHG16 to Mediate Nasopharyngeal Carcinoma Progression through the miR-23b-5p/MCM6 Pathway.

This study aims to investigate the mechanism of tumor-derived exosomal (EVs) SNHG16 in promoting the progression of nasopharyngeal carcinoma (NPC). QRT-PCR was used to detect the expression of SNHG16, miR-23b-5p and MCM6 in NPC. MTT, flow cytometry and transwell were used to detect the effects of them on the proliferation, cycle, apoptosis and invasion ability of NPC. Transmission electron microscopy, Western blotting and BCA were used to verify the regulation of exosome secretion under different oxygen environments. Our results showed that hypoxia induces tumor-derived exosome SNHG16 to mediate NPC progression through the miR-23b-5p/MCM6 pathway.

Identification of novel biomarkers in obstructive sleep apnea via integrated bioinformatics analysis and experimental validation.

Background: Obstructive sleep apnea (OSA) is a complex and multi-gene inherited disease caused by both genetic and environmental factors. However, due to the high cost of diagnosis and complex operation, its clinical application is limited. This study aims to explore potential target genes associated with OSA and establish a corresponding diagnostic model. Methods: This study used microarray datasets from the Gene Expression Omnibus (GEO) database to identify differentially expressed genes (DEGs) related to OSA and perform functional annotation and pathway analysis. The study employed multi-scale embedded gene co-expression network analysis (MEGENA) combined with least absolute shrinkage and selection operator (LASSO) regression analysis to select hub genes and construct a diagnostic model for OSA. In addition, the study conducted correlation analysis between hub genes and OSA-related genes, immunoinfiltration, gene set enrichment analysis (GSEA), miRNA network analysis, and identified potential transcription factors (TFs) and targeted drugs for hub genes. Finally, the study used chronic intermittent hypoxia (CIH) mouse model to simulate OSA hypoxic conditions and verify the expression of hub genes in CIH mice. Results: In this study, a total of 401 upregulated genes and 275 downregulated genes were identified, and enrichment analysis revealed that these differentially expressed genes may be associated with pathways such as vasculature development, cellular response to cytokine stimulus, and negative regulation of cell population proliferation. Through MEGENA combined with LASSO regression, seven OSA hub genes were identified, including C12orf54, FOS, GPR1, OR9A4, MYO5B, RAB39B, and KLHL4. The diagnostic model constructed based on these genes showed strong stability. The expression levels of hub genes were significantly correlated with the expression levels of OSA-related genes and mainly acted on pathways such as the JAK/STAT signaling pathway and the cytosolic DNA-sensing pathway. Drug-target predictions for hub genes were made using the Connectivity Map (CMap) database and the Drug-Gene Interaction database (Dgidb), which identified targeted therapeutic drugs for the hub genes. In vivo experiments showed that the hub genes were all decreasing in the OSA mouse model. Conclusions: This study identified novel biomarkers for OSA and established a reliable diagnostic model. The transcriptional changes identified may help to reveal the pathogenesis, mechanisms, and sequelae of OSA.

Characteristics of the Attentional Network in Children with Sleep-Disordered Breathing.

Purpose: To explore the characteristics of the attentional network and related factors in children with sleep-disordered breathing (SDB). Patients and Methods: A total 228 children (200 children aged 6-10 years with snoring or mouth breathing, admitted to our hospital from May 2020 to July 2022, and 28 healthy children recruited from the community as the control group) were enrolled. All participants underwent polysomnography (PSG) and completed the ADHD rating scale and child version of the Attention Network Test. According to their SDB history and obstructive apnea hypopnea index (OAHI), the participants were divided into control (n = 28), primary snoring (PS; n = 67) and obstructive sleep apnea (OSA; n = 133) groups. Results: The OSA and PS groups were younger than controls (P < 0.05). The proportion of boys was higher in the OSA than control group (P < 0.05). Body mass index was higher in the OSA than control and PS groups (P < 0.01). Attention deficit and hyperactive impulsivity scores were independently associated with the OAHI (P < 0.001). The efficiency of the alerting network was higher in the OSA than in controls (P = 0.020), but was not correlated with OAHI after adjusting for age, sex and SDB history duration (P > 0.05). Conclusion: Children with OSA have impaired attention, characterized by excessive alerting network activation. However, alerting network efficiency did not change linearly with disease severity. More research is needed to elucidate the neural mechanisms underlying attention deficits in pediatric OSA.

The hepatic GABAergic system promotes liver macrophage M2 polarization and mediates HBV replication in mice.

Macrophages display functional phenotypic plasticity. Hepatitis B virus (HBV) infection induces polarizations of liver macrophages either to M1-like pro-inflammatory phenotype or to M2-like anti-inflammatory phenotype. Gamma-aminobutyric acid (GABA) signaling exists in various non-neuronal cells including hepatocytes and some immune cells. Here we report that macrophages express functional GABAergic signaling components and activation of type A GABA receptors (GABAARs) promotes M2-polarization thus advancing HBV replication. Notably, intraperitoneal injection of GABA or the GABAAR agonist muscimol increased HBV replication in HBV-carrier mice that were generated by hydrodynamical injection of adeno-associated virus/HBV1.2 plasmids (pAAV/HBV1.2). The GABA-augmented HBV replication in HBV-carrier mice was significantly reduced by the GABAAR inhibitor picrotoxin although picrotoxin had no significant effect on serum HBsAg levels in control HBV-carrier mice. Depletion of liver macrophages by liposomal clodronate treatment also significantly reduced the GABA-augmented HBV replication. Yet adoptive transfer of liver macrophages isolated from GABA-treated donor HBV-carrier mice into the liposomal clodronate-pretreated recipient HBV-carrier mice restored HBV replication. Moreover, GABA or muscimol treatment increased the expression of "M2" cytokines in macrophages, but had no direct effect on HBV replication in the HepG2.2.15 cells, HBV1.3-transfected Huh7, HepG2, or HepaRG cells, or HBV-infected Huh7-NTCP cells. Taken together, these results suggest that increasing GABA signaling in the liver promotes HBV replication in HBV-carrier mice by suppressing the immunity of liver macrophages, but not by increasing the susceptibility of hepatocytes to HBV infection. Our study shows that a previously unknown GABAergic system in liver macrophage has an essential role in HBV replication.

Facial Emotion Recognition Deficit in Children with Moderate/Severe Obstructive Sleep Apnea.

Although previous studies have reported a facial expression classification deficit among adults with SDB, we do not know whether these findings can be generalized to children. In our study, children with sleep-disordered breathing (SDB) were divided into three groups: primary snoring (n = 51), mild obstructive sleep apnea (OSA) (n = 39), and moderate/severe OSA (n = 26). All participants, including 20 healthy controls, underwent an overnight polysomnography recording and the Emotional Expression Recognition Task. Psychosocial problems were evaluated using the parent-reported Strengths and Difficulties Questionnaire (SDQ). There was a borderline significant interaction between expression category and group on reaction times. Further analysis revealed that positive classification advantage (PCA) disappeared in the moderate/severe OSA group, whereas it persisted in the control, primary snoring, and mild OSA groups. Emotional symptoms were positively correlated with OAHI. In both the happy and sad conditions, RT was negatively related to age and body mass index (BMI) but was independent of the obstructive apnea-hypopnea index (OAHI), arterial oxygen (SaO2) and total sleep time. The accuracy of identifying a sad expression was negatively related to conduct problems. Children with moderate/severe OSA exhibited dysfunction in facial expression categorization, which could potentially affect social communication ability.

Overweight/Obese Status Synergistically Worsens Nocturnal Time-to-Time Blood Pressure in Children with Obstructive Sleep Apnea.

Objective: To investigate the influence of obstructive sleep apnea (OSA) severity and weight on blood pressure (BP) during nighttime sleep in children. Methods: Habitually snoring children who were 3-14 years old and from Beijing Children's Hospital between 1 January 2018 and 31 December 2020 were recruited. All participants completed polysomnography (PSG) and BP monitoring during different sleep stages using pulse transit time analysis. Subjects were divided into three groups based on the obstructive apnea-hypopnea index (OAHI), ie, primary snoring (PS), mild-to-moderate OSA, and severe OSA group. Results: Totally, 284 habitually snoring children were enrolled, including 85 with PS, 152 with mild-to-moderate OSA, and 47 with severe OSA. The differences of age and sex ratio among groups were not statistically significant (all P>0.05). For the normal weight group, compared with those in the PS group, children in the severe OSA group had higher BP, mainly in N2 and R stages, and children in the mild-to-moderate OSA group had lower BP in all sleep and wake stages (all P<0.01). For the overweight/obese group, compared with the PS group, children in the severe OSA group had higher BP in all sleep and wake stages, and children in the mild-to-moderate group had higher BP mainly in sleep stages (all P<0.01). Compared with normal weight children, those who were overweight/obese and had OSA had higher BP in all sleep and wake stages (all P<0.01). There was a synergistic effect of OSA and weight status on BP (P<0.01). Conclusion: The influence of OSA on both systolic and diastolic pediatric BP differs between children with normal weight and overweight/obese status. Overweight/obese status synergistically worsens nocturnal blood pressure in children with OSA. Early diagnosis and risk stratification are more important in overweight/obese children with OSA to achieve timely initiation of treatment.

Subtypes of obstructive sleep apnea in children and related factors.

STUDY OBJECTIVES: To investigate the prevalence of positional obstructive sleep apnea (P-OSA) and rapid eye movement-related OSA (REM-OSA) in children with OSA and identify related factors. METHODS: This was a cross-sectional study among children aged 2-12 years diagnosed with OSA using overnight polysomnography (PSG) between August 1, 2020, and July 31, 2021. Demographics, anthropometrics, PSG, and OSA-18 questionnaire data were recorded. RESULTS: Data from a total of 474 children were available for analysis. Children had a median age of 4.8 (4.1, 6.4) years, 66.7% were male, and 23.2% were obese. The prevalence of P-OSA was 38.2% and that of REM-OSA was 43.0%. P-OSA was correlated with age and obstructive apnea-hypopnea index (OAHI; odds ratio [OR] = 1.172, 0.947; P = .005, < 0.001, respectively), but not sex, obesity, and adenoid and tonsil size (OR = 1.265, 0.785, 0.826, 0.989; P = .258, 0.327, 0.153, 0.905, respectively). REM-OSA was correlated with age, adenoid size, tonsil size, and OAHI (OR = 0.876, 1.320, 1.387, 1.021; P = .024, 0.040, 0.001, 0.042) but not with sex and obesity (OR = 0.910, 1.281; P = .643, 0.315). CONCLUSIONS: The prevalence of P-OSA was 38.2% and that of REM-OSA was 43.0% in children with OSA. Age was correlated with both the prevalence of P-OSA and REM-OSA, with an increasing and decreasing prevalence as children grew older, respectively. The severity of OSA was significantly associated with the prevalence of both P-OSA and REM-OSA. Adenoid and tonsil size were correlated with the prevalence of REM-OSA but not P-OSA. Obesity and sex were not associated with the prevalence of P-OSA or REM-OSA. CITATION: Wu Y, Zheng L, Cui G, Xu Z, Ni X. Subtypes of obstructive sleep apnea in children and related factors. J Clin Sleep Med. 2022;18(10):2397-2404.

The effect of different intervention on disease outcomes and urinary leukotriene levels in pediatric sleep-disordered breathing.

BACKGROUND: The prognosis in children with sleep-disordered breathing (SDB) undergoing adenotonsillectomy (T&A), medication, and watchful waiting with supportive care, and the changes of urine cysteinyl leukotriene E4 (uLTE4) at pretreatment and post-treatment are not well studied. METHODS: Children aged 3-14 yrs suffering from SDB were enrolled. All children underwent polysomnography (PSG), completed OSA-18 Quality of Life questionnaire and uLTE4 levels were measured pre- and post-T&A, medication and watchful waiting with supportive care about six months later. Children with obstructive sleep apnea who demonstrated a resolution of disease (OAHI<1) were defined as remission. The remission in children with primary snoring (PS) was defined as the absence of snoring at the follow-up. Deterioration was defined as a progression of disease severity, such as PS progressing to OSA, mild OSA progressing to moderate-to-severe OSA, and moderate OSA progressing to severe OSA. All the others were defined as unchanged. RESULTS: A total of 78 children were enrolled. After treatment, 10 (50.0%), 6 (18.2%), and 7 (28.0%) children in T&A, medication, and watchful waiting were in remission respectively. PSG variables and OSA-18 Quality of Life scores were significantly improved in the T&A group and remission population. The levels of uLTE4 were not significantly different pre- and post-treatment in T&A group nor in the remission population. CONCLUSIONS: T&A can significantly reduce PSG variables and improve the Quality of Life in children with moderate to severe OSA. The levels of uLTE4 did not change after T&A nor in the remission population after six-month follow-up.

Detection of pediatric obstructive sleep apnea using a multilayer perceptron model based on single-channel oxygen saturation or clinical features.

PURPOSE: This study was performed to develop and evaluate a method of detecting pediatric obstructive sleep apnea (OSA) using a multilayer perceptron (MLP) model based on single-channel nocturnal oxygen saturation (SpO2) with or without clinical data. METHODS: Polysomnography data for 888 children with OSA and 417 unaffected children were included. An MLP model was proposed based on the features obtained from SpO2 and combined features of SpO2 and clinical data to screen symptomatic children for OSA. The performance of the overall classification was evaluated with the receiver operating characteristics curve and the metrics of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy. RESULTS: The sensitivity, specificity, PPV, NPV, LR+, LR-, and accuracy of the MLP model for SpO2 of an obstructive apnea-hypopnea index (OAHI) cutoff value of 1, 5, and 10 were 0.62-0.96, 0.11-0.97, 0.70-0.81, 0.55-0.93, 1.08-21.0, 0.39-0.39, and 0.69-0.91, respectively. The area under the receiver operating characteristics curve of an OAHI cutoff value of 1, 5, and 10 was 0.720, 0.842, and 0.922, respectively. After adding the clinical data of age, sex, body mass index, weight category, adenoid grade, or tonsil scale, the performance of the MLP model was basically at the same level as only single-channel SpO2. CONCLUSIONS: Application of this MLP model using single-channel SpO2 in children with snoring has high accuracy in the diagnosis of moderate to severe OSA but a poor effect in the diagnosis of mild OSA. The combination of clinical data did not significantly improve the diagnostic performance of the MLP model.

Lung transplantation in a woman with paraquat poisoning that led to pulmonary fibrosis-Widely reported by the media: A case report.

RATIONALE: Paraquat is an extremely toxic herbicide with a high mortality rate on poisoning. It can damage vital organs, such as the lungs, liver, heart, and kidneys. In this study, we report a case of pulmonary fibrosis after paraquat poisoning in a patient who underwent a lung transplant procedure after preoperative administration of corticosteroids and immunosuppressive agents and continuous noninvasive ventilation support therapy. PATIENT CONCERNS: An 18-year-old student was hospitalized owing to diarrhea, chest pain, and gradually evolving dyspnea. DIAGNOSES: Owing to the inability to estimate the intake concentration and dose, paraquat was only detected in the urine on the 13th day, resulting in rapid progression of the disease and severe pulmonary fibrosis. INTERVENTIONS: Extensive media coverage has attracted the attention of all sectors of society. The patient received financial assistance; thus, she could receive a double-lung transplant with extracorporeal membrane oxygenation (ECMO) support on the 34th day after the poisoning. OUTCOMES: Postoperatively, the girl was actively rehabilitated, adhered to anti-rejection medication, followed up regularly, and had a good prognosis. LESSONS: Lung transplantation is currently the most effective treatment for pulmonary fibrosis, and mass media campaigns can provide economic support, influence potential organ donation, and provide such patients more chances to survive.

Autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing.

BACKGROUND: The objective of the study was to assess the relationship between autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing. METHODS: We enrolled habitually snoring children aged 3-14 years for overnight polysomnography (PSG) and high-sensitivity C-reactive protein (hsCRP) measurement. Low-grade inflammation was defined as hsCRP >1.0 mg/L to <10.0 mg/L. An electrocardiogram recording was extracted from PSG. Heart rate variability was analyzed using time and frequency domain methods. RESULTS: In total, 190 children were included, with 61 having primary snoring (PS), 39 mild obstructive sleep apnea (OSA), and 90 moderate-to-severe OSA. The average RR interval displayed a significant decline, whereas the low frequency/high frequency (LF/HF) ratio showed an increasing tendency in children with PS, mild OSA, and moderate-to-severe OSA. Mean RR was mainly influenced by age and the apnea hypopnea index (AHI) (all P < 0.01). AHI was an independent risk factor for the altered LF/HF ratio at all sleep stages except N3 stage (all P < 0.05). In the wake stage, low-grade inflammation was an independent risk factor of altered LF/HF ratio (P = 0.014). CONCLUSIONS: Autonomic nervous function was impaired in children with OSA. The sympathetic-vagal balance was influenced by low-grade inflammation in the wake stage, whereas it was only affected by AHI when falling asleep. IMPACT: We found that autonomic nervous function was impaired in children with OSA. We found that there was a negative correlation between systemic inflammation and autonomic nervous function in children with SDB only at wake stage. A negative association between systemic inflammation and autonomic nervous function was demonstrated in children in this study. Furthermore, altered LF/HF ratio maybe a good indicator of autonomic nervous dysfunction in children as it only correlated with the SDB severity, not with age.

Clinical and PSG Characteristics of Children with Mild OSA and Respiratory Events Terminated Predominantly with Arousal.

Objective: To analyze the clinical and polysomnographic characteristics in children with mild OSA and respiratory events terminated predominantly with arousal. Methods: Children aged 3-10 yrs who had mild obstructive sleep apnea (OSA) were enrolled. All children underwent polysomnography, and patients' data were collected by using sleep-related breathing disorders (SRBD) questionnaire and OSA-18 quality of life questionnaire. Results: In total, five hundred and seventy-seven children were eligible. Children in arousal predominant group were younger and showed a lower rate of male and obesity. Compared with that of the nonarousal predominant group, the total arousal index, arousal index related to respiratory event, the percentage of NREM stage 1 (N1%), the fraction of respiratory events that were hypopnea, and the mean and minimum oxygen saturation in the arousal predominant group were significantly greater. The percentage of NREM stage 3 (N%), index of obstructive, central, mixed apnea, the fraction of respiratory events that were obstructive, and central and mixed apnea were significantly lower in arousal predominant group. Conclusion: Children with mild OSA in the arousal predominant group had specific characteristics, including younger age, lower rate of male and obesity, worse sleep architecture, higher rates of hypopnea events, and better oxygenation. This trial is registered with NCT02447614.

Mediating effects of lower extremity function on the relationship between night sleep duration and cardiovascular disease risk: a cross-sectional study in elderly Chinese without cardiovascular diseases.

OBJECTIVE: The purpose of this study is to investigate the mediating effect of physical performance on the relationship between night sleep duration and risk of cardiovascular disease (CVD) in elderly Chinese without CVD. METHODS: 782 participants without CVD over 65 years (average: 70.82±3.86 years, 448 women) were included in this study. CVD risk was calculated by the Framingham Risk Score and participants were divided into four groups of night sleep duration (in hours): <7 hours, ≥7-8 hours, >8-9 hours and >9 hours. Upper extremity function was measured by grip strength and lower extremity function was measured by the Short Physical Performance Battery (SPPB), consisting of balance, 4 m walk and chair stands tests. RESULTS: After adjusting for covariates, long night sleep duration (>9 hours) and CVD risk were significantly positively associated compared with moderate night sleep duration (≥7-8 hours) (ß=1.152; 95% CI 0.05 to 2.25). SPPB total score (indirect effect ab=-0.122; 95% CI -0.291 to -0.0008) rather than grip strength partially mediated the relationship between long night sleep duration and CVD risk, in which chair stands played a major mediating role (indirect effect ab=-0.171; 95% CI -0.040 to -0.0006), while balance (indirect effect ab=-0.016; 95% CI -0.100 to 0.063) and 4 m walk (indirect effect ab=0.048; 95% CI -0.066 to 0.201) did not. CONCLUSIONS: Lower extremity function, especially lower limb muscle strength, partially mediates a positive association between long night sleep duration and CVD risk in the elderly without CVD. Suitable interventions for physical performance and sleep may minimise the risk of subsequent CVD.

Generation and characterization of iPSC lines (BCH001) from a boy with intron 14 mutation in the ret proto-oncogene (RET) gene.

Congenital central hypoventilation syndrome (CCHS) is characterized by an alteration of the ventilatory response to hypercapnia and hypoxia, and is classically presented in neonates with abnormalities of the autonomic nervous system. Here, we generated human induced pluripotent stem cell (iPSC) lines from peripheral blood mononuclear cells (PBMCs) isolated from a male patient clinically diagnosed with CCHS. These iPSC lines carry a heterozygous RET mutation (c.2608-125C > T), express pluripotency markers, have the capacity to differentiate into the normal teratoma tissue, retain the RET mutation and display the normal karyotype, which will also provide a useful resource to study the pathogenesis of CCHS.