High flow nasal cannula therapy for obstructive sleep apnea in adults.

PURPOSE: Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by the aggravation of upper airway constriction or obstruction, and it is associated with high incidence of various metabolic diseases and high mortality. Continuous positive airway pressure (CPAP) is now recommended as the first-line therapy for OSAHS, but its application is limited by its unsatisfactory patient tolerance. Previous studies have showed that high flow nasal cannula (HFNC) may improve symptoms in some patients with OSAHS. Therefore, the aim of the present study was to evaluate the effect of HFNC on OSAHS in a larger cohort than in previous research and to study the details of its therapeutic characteristics. METHODS: Polysomnography recording with and without HFNC was performed in 56 OSAHS patients with a wide spectrum of disease severity. Subgroups were divided by different treatment response criteria to identify the effect of this device. RESULTS: Of 56 patients enrolled, 9 were of mild severity (AHI, 5 to <15 events/h), 30 were of moderate severity (AHI, 15 to <30 events/h), and 17 patients were severe (AHI ≥ 30 events/h); 34 patients were younger than 50 years old and 22 patients were older than 50 years old. AHI decreased significantly (from 26.9 ± 14.7 to 21.5 ± 17.0 events/h, p < 0.001) after HFNC treatment in general. The subjects of responder group accounted for 21%. There was a negative correlation between the difference of AI and the difference of HI in nonresponder group before and after HFNC treatment, and the negative correlation was strong (Pearson's test, r = - 0.804, p = 0.000). Of the patients with mild to moderate severity, 76% achieved any AHI reduction and 24% of patients achieved at least 50% reduction in AHI. Older patients (the age of responder group 52.6 ± 11.7 vs. nonresponder group 43.7 ± 12.1 years old, p < 0.05), especially patients older than 50 years, had a better response rate (≤ 50 years 9% vs. > 50 years 41%, p = 0.007). CONCLUSION: HFNC may be useful in treating patients with OSAHS, especially older patients and those with mild to moderate severity. HFNC may be an alternative treatment when patients are intolerant of CPAP.

Poly-pharmacokinetic strategy-delineated metabolic fate of bioactive compounds in a traditional Chinese medicine formula, Yuanhu Zhitong tablets, using parallel reaction monitoring mode.

OBJECTIVE: To evaluate the pharmacokinetics of eight constituents in Yuanhu Zhitong tablets, which may provide a method for the poly-pharmacokinetic study of traditional Chinese medicine. METHODS: A robust platform using Thermo Scientific™ Dionex™ UltiMate™ 3000 rapid separation LC, integrated with Thermo Scientific™ Q Exactive™ MS, was developed and validated to acquire, in a high-resolution full-scan mode, a global profile of all ionized components in rat plasma after oral administration of a suspension of Yuanhu Zhitong tablets. RESULTS: This robust UPLC-HRMS method was successfully applied for pharmacokinetic evaluation after oral administration of Yuanhu Zhitong tablets. The MS response showed a good linear relationship, with a coefficient of determination (r2) of >0.99. The levels of detection were in the range of 0.088-0.414 ng·ml-g for the different constituents. The recoveries ranged from 92.23% to 104.47%, and the matrix effect ranged from 85.24% to 101.02%. The intra- and inter-day accuracy was in the range of 0.00-12.54%, while the intra- and inter-day precision ranged from 0.44% to 7.63%. Short-term stability, long-term stability, freeze-thaw stability, and post-preparative stability ranged from -recision rangedThe time to reach peak plasma concentration (tmax) values for the analytes was less than 10 h, except that for tetrahydropalmatine, which was quickly absorbed into the bloodstream. The large area under the concentration-time curve (AUC) values (≥105 ng·h·l-g) for the eight compounds indicated good absorption and utility in rat plasma. The mean residence time was more than 6 h, indicating slow elimination. CONCLUSION: UPLC-HRMS was shown to be a very promising and powerful tool for the kinetic screening and characterization of compounds in medicinal herbs and traditional Chinese medicine formulas. Pharmacokinetic profiling of multiple compounds enables the clarification of metabolic processes and fates of the selected medicinal herbs or traditional Chinese medicine formula. This allows us to better understand the actions and associated therapeutic mechanisms of the traditional Chinese medicine.