Estudio de prevalencia de Síndrome de Apneas - Hipopneas Obstructivas del Sueño en pacientes con obesidad

Introducción: La obesidad es una enfermedad epidémica multifactorial en constante aumento en los últimos años. Asocia el desarrollo de múltiples patologías con aumento de la morbimortalidad, entre ellas el síndrome de apneas e hipopneas obstructivas del sueño (SAHOS). Objetivo: Estudiar la prevalencia de SAHOS en una población de obesos pertenecientes a un Programa de Obesidad y Cirugía Bariátrica de un hospital público de Montevideo. Metodología: Estudio observacional descriptivo de cohorte transversal. Se incluyeron pacientes en valoración preoperatoria desde abril 2015 a marzo 2020. Se les realizó una polisomnografía. Se evaluó la prevalencia de SAHOS y la relación con otros factores de riesgo cardiovascular. El análisis estadístico se realizó con SPSS versión 25.0. Resultados: Se estudiaron 358 pacientes con predominio del sexo femenino (86,3%), edad media de 42,8 ± 10,7 años y un índice de masa corporal (IMC) promedio de 50,1 ± 11,4 kg/m2. Se evidenció una prevalencia de SAHOS de 69%: 43,3% leve; 23,9% moderada y 32,8% severo. El Índice apnea hipopnea (IAH) se correlacionó positivamente con IMC (p ≤ 0,001). Se demostró la asociación de SAHOS con hipertensión arterial (HTA), diabetes 2 (DM2), sexo masculino e hipertrigliceridemia. Conclusiones: El SAHOS es altamente prevalente en la obesidad. Este estudio sugiere la realización de un screening en todos los obesos, así como su estudio con polisomnografía o poligrafía respiratoria a aquellos que vayan a someterse a una cirugía bariátrica.

Introduction: Obesity is a multifactorial epidemic disease that has been constantly increasing in recent years. It associates the development of multiple pathologies with increased morbidity and mortality, including obstructive sleep apnea and hypopnea syndrome (OSAHS). Objective: To study the prevalence of OSAHS in a population of obese patients belonging to an Obesity and Bariatric Surgery Program of a public hospital in Montevideo. Methodology: Observational descriptive cross-sectional study. Patients in preoperative evaluation were included from April 2015 to March 2020. A polysomnography was performed. The prevalence of OSAHS and the relationship with other cardiovascular risk factors were evaluated. Statistical analysis was performed with SPSS version 25.0. Results: 358 patients were studied, predominantly female (86.3%), mean age of 42.8 ± 10.7 years and mean BMI of 50.1 ± 11.4 kg/m2. A prevalence of OSAHS of 69% was evidenced: 43.3% mild; 23.9% moderate and 32.8% severe. The Apnea Hypopnea Index (AHI) was positively correlated with the Body Mass Index (BMI) (p=<0.001). The association of OSAHS with arterial hypertension (AHT), diabetes 2 (DM2), male gender and hypertriglyceridemia was demonstrated. Conclusions: OSAHS is highly prevalent in obesity. This study suggests screening all obese people, as well as polysomnography or respiratory polygraphy for those who are going to undergo bariatric surgery.

Introdução: A obesidade é uma doença epidêmica multifatorial que vem aumentando constantemente nos últimos anos. Associa o desenvolvimento de múltiplas patologias ao aumento da morbimortalidade, incluindo a síndrome da apneia e hipopneia obstrutiva do sono (SAHOS). Objetivo: Estudar a prevalência de SAHOS em uma população de pacientes obesos pertencentes a um Programa de Obesidade e Cirurgia Bariátrica de um hospital público de Montevidéu. Metodologia: Estudo observacional descritivo transversal. Os pacientes em avaliação pré-operatória foram incluídos de abril de 2015 a março de 2020. Foi realizada polissonografia. A prevalência de SAHOS e a relação com outros fatores de risco cardiovascular foram avaliadas. A análise estatística foi realizada com SPSS versão 25.0. Resultados: Foram estudados 358 pacientes, predominantemente do sexo feminino (86,3%), idade média de 42,8 ± 10,7 anos e IMC médio de 50,1 ± 11,4 kg/m2. Evidenciou-se prevalência de SAHOS de 69%: 43,3% leve; 23,9% moderado e 32,8% grave. O Índice de Apnéia e Hipopnéia (IAH) correlacionou-se positivamente com o Índice de Massa Corporal (IMC) (p=<0,001). Foi demonstrada a associação da SAHOS com hipertensão arterial (HA), diabetes 2 (DM2), sexo masculino e hipertrigliceridemia. Conclusões: A SAHOS é altamente prevalente na obesidade. Este estudo sugere a triagem de todos os obesos, bem como a polissonografia ou poligrafia respiratória para aqueles que serão submetidos à cirurgia bariátrica.

Efficacy of magnetic traction hyoid suspension surgery in the animal model of OSAHS / 西安交通大学学报(医学版)

【Objective】 To explore the effectiveness of creating the obstructive sleep apnea hypopnea syndrome (OSAHS) animal model of glossocoma using the botulinum toxin type A in white rabbits, and to explore the effectiveness and safety of magnetic traction hyoid suspension operation in the OSAHS animal model of glossocoma. 【Methods】 A total of 12 adult male experimental white rabbits were randomly divided into two groups. The animals in the experimental group were injected with 0.4 mL (10 U) of botulinum toxin type A in the genioglossus muscle to construct the OSAHS animal model of glossocoma. The animals in the control group were injected with 0.4 mL of normal saline. We designed and 3D printed a polyacrylate shell that could be loaded with inner and outer neodymium iron boron (NdFeB) magnets. After the modeling, a polyacrylate shell with the inner magnet device was fixed on the hyoid bone of the animals in the experimental group. All animals in the experimental group wore the polyacrylate orthotic neck brace containing the outer magnet 10 days after the operation. The arterial blood oxygen detector was used to record the oxygen saturation (SaO2) of the femoral artery, and multi-slice CT plain scan was used to measure the diameter of the narrowest part of the upper airway. 【Results】 The animals in the experimental group gradually showed decreased activity, labored breathing, blue lips and ear margins and other manifestations of hypoxemia 5 days after intramuscular injection of botulinum toxin type A in the genioglossus, and their body weight dropped from (3.72±0.21)kg to (3.40±0.20)kg, the average SaO2 of the femoral artery decreased from (93.84±5.14)% to (84.00±3.35)%, and the diameter of the narrowest part of the upper airway decreased from (4.83±0.47)mm to (3.52±0.83)mm (P<0.05). In the control group, the animals’ weight, the average SaO2 of the femoral artery, and the diameter of the narrowest part of the upper airway did not significantly change before and after injection of normal saline into the genioglossus muscle (P>0.05). The animals in the experimental group completed the magnetic traction hyoid suspension surgery. After wearing the orthotic neck brace containing an external magnet for hyoid magnetic traction, the food intake and activity of the animals in the experimental group increased, the color of the lips changed from purple to pink, the SaO2 of the femoral artery increased significantly to (90.44±5.95)%, and the diameter of the narrowest part of the upper airway increased significantly to (4.42±0.15)mm (P<0.05). 【Conclusion】 The genioglossus muscle injection of botulinum toxin type A in white rabbits could successfully establish the OSAHS animal model of glossocoma. Magnetic traction hyoid suspension surgery in the treatment of OSAHS animal model could effectively correct the upper airway stenosis related symptoms and hypoxemia caused by glossocoma.

The experience of adult inpatients with obstructive sleep apnea-hypopnea syndrome after surgery: a qualitative research / 中国实用护理杂志

Objective:To explore the experience of the postoperative adult patients with obstructive sleep apnea-hypopnea syndrome from the patients′ angle and to provide references for improving the postoperative comfort of the patients.Methods:The phenomenology research method was adopted in this study. Thirteen postoperative adult patients with obstructive sleep apnea-hypopnea syndrome from Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology participated in the in-depth interview with the interview outline. Data were analyzed by using Colaizzi′s phenomenological method.Results:Three level-1 themes and ten level-2 themes were extracted. The physical discomfort included throat discomfort, lacking of enough sleep at night, restricted diet, limitation in speaking. The negative emotion included the sense of worry, helplessness, fidget and regret. The wish of support included the wish of coping strategy and being understanded.Conclusions:The main uncomfortable experience of the patients is the throat discomfort which has the chain reaction and causes the other discomfort. So the nurses should inquire patients initiatively, cooperate with doctors and patients′ family members to relieve patients′ discomfort particularly at night, and then the patients′ quality of life, nurse-patient relationship and patients′ satisfaction may be improved.

Effect of information-motivation-behavior skills on adherence of continuous positive airway pressure therapy in patients with obstructive sleep apnea hypopnea syndrome / 中南大学学报(医学版)

OBJECTIVES@#Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease that seriously affects health. Continuous positive airway pressure (CPAP) therapy is the preferred treatment for moderate-to-severe OSAHS patients. However, poor adherence to CPAP is a major obstacle in the treatment of OSAHS. Information-motivation-behavioral (IMB) skills, as a kind of mature technology to change the behavior, has been used in various health areas to improve treatment adherence. This study aims to explore the effects of the IMB skills intervention on CPAP adherence in OSAHS patients.@*METHODS@#Patients who were primary diagnosed with moderate-to-severe OSAHS were randomly divided into the IMB group (n=62) and the control group (n=58). The patients in the IMB group received CPAP therapy and the IMB skills intervention for 4 weeks. The patients in the control group received CPAP therapy and a usual health care provided by a registered nurse. We collected the baseline data of the general information, including age, sex, body mass index (BMI), the Epworth Sleepiness Scale (ESS) score, the Hospital Anxiety and Depression Scale (HADS) score, and indicators about disease severity [apnea-hypopnea index (AHI), percentage of time with arterial oxygen saturation SaO2<90% (T90), average SaO2, lowest SaO2, arousal index]. After CPAP titration, we collected CPAP therapy-relevant parameters (optimal pressure, maximum leakage, average leakage, 95% leakage, and residual AHI), score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. After 4 weeks treatment, we collected the ESS score, HADS score, CPAP therapy-relevant parameters, effective CPAP therapy time per night, CPAP therapy days within 4 weeks, CPAP adherence rate, score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. Visual analog scale (VAS) of 0-5 was used to evaluate the satisfaction and acceptance of IMB intervention measures in the IMB group.@*RESULTS@#There were no significant differences in the baseline level of demographic parameters, ESS score, HADS score, disease severity, and CPAP therapy related parameters between the IMB group and the control group (all P>0.05). There were no significant differences in score of willingness to continue CPAP therapy, as well as score of satisfaction and acceptance of CPAP therapy after CPAP titration between the IMB group and the control group (both P>0.05). After 4 weeks treatment, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group were significantly decreased, while the score of satisfaction and acceptance of CPAP therapy and willingness to continue CPAP therapy of the IMB group were significantly increased (all P<0.05); while the above indexes in the control group were not different before and after 4 weeks treatment (all P<0.05). Compared with the control group, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group after 4 weeks treatment were significantly lower (all P<0.05); the effective CPAP therapy time, CPAP therapy days within 4 weeks, score of satisfaction and acceptance of CPAP therapy, score of willingness to continue CPAP therapy of the IMB group were significantly higher (all P<0.05). The rate of CPAP therapy adherence in 4 weeks of the IMB group was significantly higher than that of the control group (90.3% vs 62.1%, P<0.05). The VAS of overall satisfaction with IMB skills intervention measures was 4.46±0.35.@*CONCLUSIONS@#IMB skills intervention measures can effectively improve the adherence of CPAP therapy in OSAHS patients, and is suitable for clinical promotion.

Cone-beam computed tomography study of upper airway morphology in children with obstructive sleep apnea-hypopnea syndrome / 口腔疾病防治

Objective @#To evaluate the morphology of the upper airway of children with obstructive sleep apnea-hypopnea syndrome (OSAHS) using cone-beam computed tomography (CBCT) combined with polysomnography (PSG) and provide references for clinical practice.@*Methods@# CBCT data of 45 OSAHS children and 45 normal children and PSG data of the OSAHS group were retrospectively collected. Three-dimensional reconstructions were performed using NNT 9.0 software. The total upper airway volume, nasopharyngeal volume, palatopharyngeal volume, glossopharyngeal volume, laryngopharyngeal volume, minimum cross-sectional area, anterior-posterior diameter of the minimum cross-section, and lateral diameter of the minimum cross-section were measured and recorded. According to PSG monitoring results, patients with an obstructive apnea hypopnea index (OAHI) and lowest oxygen saturation (LSaO2) were assessed. Body mass index (BMI) was recorded. The correlation between airway volume parameters, BMI and PSG test results was analyzed. @*Results@#The total upper airway volume, nasopharyngeal volume, palatopharyngeal volume, glossopharyngeal volume, laryngopharyngeal volume, minimum cross-sectional area, anterior-posterior diameter of the minimum cross-section, and lateral diameter of the minimum cross-section of the OSAHS group were significantly reduced compared with those of the control group (P<0.05). In the OSAHS group, the total upper airway volume, the minimum cross-sectional area and the lateral diameter of the minimum cross-section showed moderate negative correlations with the obstructive apnea hypopnea index (OAHI) (P<0.05). Moreover, the total upper airway volume, minimum cross-sectional area, anterior-posterior diameter of the minimum cross-section and lateral diameter of the minimum cross-section showed no correlation with the minimum blood oxygen saturation (P>0.05). No significant correlation was noted between BMI and PSG in the OSAHS group (P>0.05).@*Conclusion @#The morphology of the upper airway of children with OSAHS was significantly smaller than that of normal children. CBCT three-dimensional technology for analyzing the upper airway has a certain value in evaluating the morphology and degree of obstruction of the upper airway in children with OSAHS.

Syndrome d'apnées-hypopnées obstructives du sommeil: état des lieux des connaissances et de la pratique des médecins généralistes dans la ville de Kinshasa / Apneas-obstructive sleep hypopneas syndrome: state of the knowledge and practice of generalist physicians in the city of Kinshasa

Contexte et objectif. Le syndrome d'apnées hypopnées obstructives du sommeil (SAHOS) est une pathologie fréquente, mais méconnue. L'objectif de cette enquête était d'évaluer les connaissances ainsi que les habitudes diagnostique et thérapeutique des médecins généralistes (MG) vis-à-vis le SAHOS. Méthodes. Etude transversale, déclarative, observationnelle menée auprès des MG de la ville de Kinshasa, à partir d'un questionnaire anonyme n'ayant pas précisé au préalable l'objet de l'étude. Les réponses aux questions et le nombre des répondants sont exprimés en fréquence et en pourcentage. Résultats. Sur 177 MG ayant répondu au questionnaire, près de 70% avaient obtenu leur diplôme après l'année 2009. Le cursus universitaire avait été la principale source d'information. La majorité des MG de l'enquête (62%) n'était pas familiarisée avec le SAHOS. Les symptômes cardinaux (ronflements, apnées nocturnes, somnolence diurne) avaient été cités par plus de moitié des MG mais sans leur donner de signification réelle dans leur pratique médicale. L'obésité a été largement citée comme un facteur associé au SAHOS par 68 % de MG, cependant les autres facteurs ont été méconnus ou à peine cités. Plus de la moitié des MG (54,2 %) ne connaissait pas les répercussions et les complications des apnées nocturnes sur l'individu et son environnement. La polysomnographie comme examen clé du SAHOS avait été citée par 56 % des MG. Le niveau des connaissances révélé par l'ensemble des résultats s'est avéré globalement faible. Conclusion. Le SAHOS est une pathologie fréquente, méconnue et très peu intégrée dans les pratiques professionnelles médicales à Kinshasa. Cette situation appelle un approfondissement de la formation des médecins par l'enseignement universitaire et la formation médicale continue

Context and objective. Obstructive sleep apneahypopnea syndrome (OSAHS) is a frequent pathology. The objective was to assess the knowledge as well as the diagnostic and therapeutic habits of general practitioners (GPs) concerning the OSAHS. Methods. A crosssectional, observational study was conducted among GPs using an anonymous questionnaire that did not specify the purpose of the study beforehand. Results. Out of 177 GPs who answered the questionnaire, almost 70 % had graduated after 2009. University education had been the main source of information. The majority of GPs in the survey (62%) were not familiar with OSAHS. Cardinal symptoms of OSAHS (snoring, nocturnal apnea, daytime sleepiness) had been cited by more than half of GPs but without giving them any real significance in their medical practice. Half of them had never discussed the diagnosis of OSAHS with their patients. Obesity was widely cited as a factor associated with OSAHS by 68% of GPs, however other factors were either unrecognized or barely mentioned. More than half of GPs (54.2%) did not know the repercussions and complications of night apnea on the individual and his environment. Polysomnography as a key examination for OSAHS was cited by 56% of GPs. The existence of care was also indicated by a large number of them (87%) but without knowing the terms. Conclusion. OSAHS is a pathology affecting the population of Kinshasa, but little integrated into professional medical practices. Its cardinal symptoms, complications and diagnostic and therapeutic modalities are little known to GPs. This situation calls for further training of doctors through university education and continuing medical education.

Effect of transitional nursing combined with resistance breathing training on elderly obese obstructive sleep apnea-hypopnea syndrome / 中国实用护理杂志

Objective:To analyze the effect of transitional care model (TCM) mode combined with resistance breathing training on hypoxic reactivity of respiratory center in elderly obese obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:Totally 78 patients with OSAHS who met the criteria were selected from the geriatric department of Nanjing Drum Tower Hospital from January 2018 to December 2020 and divided into observation group and control group by random digits table method, with 39 cases in each group; the control group was intervened by basic nursing combined with resistance breathing training mode, and the observation group was intervened by TCM mode on the basis of the control group. Before nursing and 1 month after discharge, Pittsburgh Sleep Quality Index (PSQI), Short-Form 36-item Health Survey (SF-36), Montreal Cognitive Assessment (MoCA) were used to evaluate the sleep quality, quality of life and cognitive function of the patients. Besides, FVC, FEV 1, FEV 1/FVC were also tested before nursing and 1 month after discharge. Results:One month after discharge, the daytime dysfunction, use of sleep drugs, habitual sleep efficiency, subjective sleep quality, sleep disorder, sleep latency, sleep duration and total score of PSQI in the observation group were significantly lower than those in the control group (the control group: 2.27 ± 0.34, 2.03 ± 0.31, 2.09 ± 0.23, 1.85 ± 0.28, 2.11 ± 0.28, 1.40 ± 0.24, 2.12 ± 0.41, 13.87 ± 0.56; the observation group: 1.63 ± 0.33, 1.22 ± 0.29, 1.63 ± 0.29, 1.12 ± 0.31, 1.35 ± 0.34, 1.09 ± 0.28, 1.74 ± 0.26, 9.78 ± 0.59) ( t values were 4.91-31.61, all P<0.01). One month after discharge, the scores of mental health, physical pain, physiological function, physiological function, emotional function, life vitality, social function and overall health of SF-36 in the observation group were significantly higher than those in the control group (the control group: 62.83 ± 6.31, 68.94 ± 5.91, 61.99 ± 5.98, 64.85 ± 6.13, 43.28 ± 5.74, 64.85 ± 6.12, 61.21 ± 5.74, 62.31 ± 6.85; the observation group: 69.81 ± 5.74, 76.12 ± 6.02, 70.84 ± 6.08, 71.74 ± 5.99, 50.93 ± 6.12, 70.52 ± 5.94, 69.89 ± 5.53, 68.41 ± 4.99)( t values were 4.18-7.77, all P<0.01). One month after discharge, the scores of visual space and executive function, attention, language, delayed recall, orientation, abstraction and total score of MoCA in the observation group were significantly higher than those in the control group (the control group: 4.48 ± 0.37, 5.23 ± 0.29, 2.43 ± 0.27, 3.37 ± 0.31, 5.01 ± 0.33, 5.27 ± 0.26, 25.79 ± 1.17; the observation group:4.95 ± 0.31, 5.68 ± 0.27, 2.67 ± 0.24, 3.98 ± 0.19, 5.47 ± 0.28, 5.64 ± 0.23, 28.39 ± 1.09)( t values were 4.17-10.51, all P<0.01). One month after discharge, the levels of FVC, FEV 1 and FEV 1/FVC in the observation group were significantly higher than those in the control group, the control group: (2.59 ± 0.18) L, (1.60 ± 0.14) L, (61.78 ± 4.01)%; the observation group: (2.89 ± 0.19) L, (1.99 ± 0.17) L, (68.86 ± 3.99)% ( t = 7.21, 11.14, 7.87, all P<0.05). Conclusions:TCM combined with resistance breathing training can effectively improve the hypoxic response of respiratory center in elderly obese patients with OSAHS.

Application of NoSAS score, STOP-BANG Questionnaire and Epworth sleepiness scale in evaluating obstructive sleep apnea risk in patients with respiratory disease / 国际生物医学工程杂志

Objective:To compare the value of NoSAS score, STOP-BANG questionnaire (SBQ) and Epworth Sleepiness Scale (ESS) in assessing the risk of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with respiratory disease (RD).Methods:The clinical data, NoSAS, SBQ and ESS scores of 190 patients who underwent overnight polysomnography (PSG) were collected. According to the receiver operating characteristic (ROC) curve, with different apnea-hypopnea index (AHI) as the judgment cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio (DOR) and accuracy of the three scales were compared.Results:With AHI ≥5 times/h as the cutoff, the area under the ROC curve (AUC) of NoSAS and SBQ were 0.833 and 0.729, respectively, indicating that both have predictive value for mild OSAHS. Among them, NoSAS had a larger DOR value (16.150), indicating that NoSAS had the higher accuracy in assessing the risk of mild OSAHS. When AHI>15 times/h was used as the cutoff, the AUC value of NoSAS was 0.704, indicating that it has predictive value for moderate OSAHS. When AHI>30 times/h was used as the cutoff, the AUC value (0.706) and DOR value (6.527) of SBQ were high, indicating that it has predictive value and good accuracy for severe OSAHS. The SBQ is more sensitive than NoSAS and ESS when evaluating patients at high risk for OSAHS ( SBQ≥3). Conclusions:When evaluating the risk of mild and moderate OSAHS in RD patients, NoSAS is better than SBQ and ESS, and when evaluating severe OSAHS, SBQ is better than NoSAS and ESS. In clinical work, appropriate predictive tools should be selected according to the actual situation to assess the risk of OSAHS, so as to formulate and implement early intervention plans based on the assessment results.

Progress on the influence of seasonal and environmental factors on OSAHS in children / 国际儿科学杂志

Obstructive sleep apnea hypopnea syndrome(OSAHS) is one of the common diseases harmful to children′s health.OSAHS is a disease characterized by complete or partial obstruction of the upper respiratory tract, accompanied by blood gas changes and atypical sleep patterns.The incidence of OSAHS is on the rise.OSAHS can cause a series of physical, mental and developmental abnormalities in children, resulting in negative consequences for children.Common causes of OSAHS in children include mechanisms such as compliance changes caused by increased upper airway resistance and influence of neural regulation.Meanwhile, studies have shown that season、environmental factors have certain effects on the incidence and severity of OSAHS and sleep structure.This paper reviews the effects of season and environmental factors on children with OSAHS.

Research progress of obstructive sleep apnea hypopnea syndrome and ocular surface diseases / 国际眼科杂志(Guoji Yanke Zazhi)

Obstructive sleep apnea hypopnea syndrome(OSAHS)is a group of diseases which occurred in the upper respiratory tract with transient, recurrent, partial or complete obstruction during night sleep. It can affect the regulation of hemodynamics, endocrine systems and autonomic nerve, and then result in the reduction of body oxygen saturation, chronic hypoxia and hypercapnia. Beside being an independent risk factor for cardiovascular and cerebrovascular diseases, many studies have shown that it is also associated with ocular surface diseases in OSAHS, such as floppy eyelid syndrome, dry eye, keratoconus, etc., but there is still a lack of perfect systematic analysis. This paper reviews the relationship between OSAHS and relevant ocular surface diseases including pathogenesis,clinical manifestations and treatment progress, in order to reduce the ophthalmic complications of OSAHS patients in clinical diagnosis and treatment,and better improve the quality of life of patients.

Recomendaciones para el manejo clínico del niño en el posoperatorio de adenoamigdalectomía / Recommendations for the clinical management of the child in the postoperative adenoamygdalectomy

El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía

Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.

Evaluation of the effect of nursing intervention on the compliance of non-invasive mechanical ventilation in patients with obstructive sleep apnea hypopnea syndrome / 国际生物医学工程杂志

Objective:To explore the effect of nurse-led management model in adherence of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent non-invasive mechanical ventilation.Methods:92 patients with severe OSAHS diagnosed by polysomnography(PSG) and treated with non-invasive mechanical ventilation in Tianjin medical university general hospital from September 2019 to August 2020 were enrolled. The patients were divided into intervention group (45 cases) and control group (47 cases) by random number table. Then, basing on routine treatment and subsequent visit, the patients in intervention group received regular telephone follow-up interviews within one week of ventilator purchasing, and the interview was based on a standard telephone follow-up manuscript designed by Duffy and lasted for six months. The patients in control group received routine nursing treatment and regular subsequent visit, and were not followed up by telephone, but were encouraged to have telephone consultation. The Epworth sleepiness scale(ESS) scores of the two groups before and after the intervention and the compliance of non-invasive mechanical ventilation of the two groups after the intervention were compared.Results:After the intervention, the ESS scores of the two groups were lower than those before the intervention ( P<0.001), and the ESS scores of the intervention group were lower than those of the control group ( P<0.001). After the intervention, the compliance of noninvasive mechanical ventilation in the intervention group was better than that in the control group ( P<0.001). Conclusions:The nurse-led management model in combination with telephone follow-up can improve the sleepiness of patients and the adherence of using non-invasive mechanical.

Analysis of polysomnographic monitoring results of 523 children in a tertiary hospital in Gansu province / 中国小儿急救医学

Objective:To analyze the results of polysomnography(PSG) in 523 children, and explore the sleep monitoring results and related influencing factors of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The PSG monitoring results of children with OSAHS and non-OSAHS were analyzed for children aging from 0 to 16 years old, who were monitored at Sleep Medicine Center of Gansu Maternal and Child Health Hospital from January 2014 to December 2019.Results:A total of 523 children underwent PSG monitoring during the past 5 years.The male to female ratio was 1∶0.47, of which 66.9%(350/523)were children with OSAHS.The average proportion of rapid eye movement sleep was 1.95%(7.7/394). The height of non-OSAHS group was significantly higher than that of OSAHS group[(108.72±16.39)cm vs.(104.80±16.60)cm, P=0.016]. The incidence of OSAHS decreased with age( P=0.038). The apnea index, hypopnea index, apnea hypopnea index, obstructive apnea index, microarousal index, oxygen desaturation index, mean apnea time, and longest apnea time in the OSAHS group were higher than those in the non-OSAHS group( P<0.05). And the lowest oxygen saturation and the mean oxygen saturation during sleep were lower than those in the non-OSAHS group( P<0.05). Logistic regression analysis on the clinical data of OSAHS children showed that open mouth breathing and snoring at night had significant effects on children′s OSAHS, and the differences were statistically significant( P<0.05). Conclusion:PSG is of great significance for the diagnosis of OSAHS.The more severe the degree of OSAHS, the worse severe the night sleep hypoxemia.PSG should be recommended before taking any treatment for children with sleep disorders.

Characteristics of polysomnography in depression patients complicating moderate-to-severe obstructive sleep apnea hypopnea syndrome / 四川精神卫生

ObjectiveTo investigate the characteristics of polysomnography （PSG） in depression patients complicating moderate-to-severe obstructive sleep apnea hypopnea syndrome （OSAHS）. MethodsA retrospective analysis was conducted on the outpatients， inpatients and physical examination population who completed overnight PSG monitoring in the sleep medicine center of Suzhou Guangji Hospital from December 2017 to October 2019. Four groups of subjects were finally enrolled， including depression patients with moderate-to-severe OSAHS （n=31）， depression patients without OSAHS （n=79）， moderate-to-severe OSAHS patients （n=96） and normal control group （n=32）. The sleep process related indicators （total sleep time， sleep latency， number of awakenings）， sleep structure related indicators （N1， N2， N3， percentage of REM sleep， REM latency， REM sleep duration）， sleep-related respiratory variables （oxygen reduction index） and other polysomnographic parameters of the four groups were compared. ResultsIn terms of sleep process， the total sleep time， sleep latency and number of awakenings yielded significant differences among the four groups （F=2.874， 3.959， 12.291， P<0.05 or 0.01）. In terms of sleep structure， the percentage of total sleep time in N2 and N3 stages demonstrated significant differences among the four groups （F=13.885， 48.013， P<0.01）. The REM latency， REM sleep duration and percentage of REM sleep manifested significant differences among the four groups （F=41.492， 11.827， 10.552， P<0.01）. In terms of sleep-related respiratory variables， the oxygen reduction index exhibited significant differences among the four groups （F=170.585， P<0.05）. ConclusionDepression patients complicating moderate-to-severe OSAHS suffer from severe sleep process and structural disturbances， accompanied by quite frequent and severe sleep-related respiratory events.

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.

Adiponectin Ameliorated Pancreatic Islet Injury Induced by Chronic Intermittent Hypoxia through Inhibiting the Imbalance in Mitochondrial Fusion and Division / 中国医学科学杂志(英文版)

Objective This study aimed to assess the protective value of adiponectin (APN) in pancreatic islet injury induced by chronic intermittent hypoxia (CIH). Methods Sixty rats were randomly divided into three groups: normal control (NC) group, CIH group, and CIH with APN supplement (CIH+APN) group. After 5 weeks of CIH exposure, we conducted oral glucose tolerance tests (OGTT) and insulin released test (IRT), examined and compared the adenosine triphosphate (ATP) levels, mitochondrial membrane potential (MMP) levels, reactive oxygen species (ROS) levels, enzymes gene expression levels of

Sleep apnea hypopnea syndrome prolongs rapid eyes movement sleep time in depressive state and shortens deep sleep time in manic state in patients with bipolar disorder / 上海交通大学学报（医学版）

Objective:To observe the effect of sleep apnea hypopnea syndrome (SAS) on sleep staging of bipolar disorder patients in different states. Methods:A total of 210 healthy controls aged 18-65 and 235 bipolar disorder patients of the same age were collected. The bipolar disorder patients were divided into depressive, manic and mixed states. Sleep time structure, sleep posture, heart rate and other indicators were collected by using sleep quality assessment system based on cardiopulmonary coupling analysis. According to whether the apnea-hypopnea index (AHI) was ≥ 5 times/h, whether they had SAS were determined. Two-way multivariate analysis of variance was conducted, investigating the effect of clinical states and SAS, on several sleep indicators. Results:SAS significantly prolonged rapid eyes movement (REM) sleep time of patients in depressive state (P=0.000) and shortened deep sleep time of patients in manic state (P=0.011). In addition, the heart rate during sleep (including deep sleep, light sleep and REM sleep) of patients in manic state increased most significantly among the three clinical states (P=0.000). Lying supine aggravated SAS most significantly in manic state among the three clinical states (P=0.002). Conclusion:SAS has different effects on the sleep staging of bipolar disorder patients in different states.

Therapeutic effect of noninvasive positive pressure ventilation on the patients with nonischemic central retinal vein occlusion combined with severe obstructive sleep apnea hypopnea syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of non-invasive positive pressure ventilation in patients with nonischemic central retinal vein occlusion(RVO)combined with severe obstructive sleep apnea hypopnea syndrome.<p>METHODS: A retrospective analysis was performed on 66 patients(66 eyes)with nonischemic central retinal vein occlusion combined with severe obstructive sleep apnea hypopnea syndrome in our hospital from December 2017 to December 2018. 30 of the patients(30 eyes)received intraocular anti-vascular therapy with Lucentis and retinal laser irradiation therapy combined with noninvasive positive pressure ventilation(observation group). Totally 36 patients(36 eyes)only received intraocular anti-vascular therapy with Lucentis and retinal laser irradiation therapy(control group). The differences of the best corrected visual acuity(BCVA)and retinal thickness at lesion sites were compared and analyzed between two groups before treatment and at the 1mo, 3mo and 6mo after treatment.<p>RESULTS: There were statistically significant differences of both retinal thickness and BCVA between two groups at different time points(<i>P</i><0.05). Both retinal thickness and BCVA of the observation group were lower than those of the control group at the 3 and 6mo after treatment(<i>P</i><0.01). There was no significant difference between the retinal thickness of the 3mo after treatment and that of the 6mo after treatment in the control group(<i>P</i>>0.05), while there were significant differences of retinal thickness between two groups of the other time points in the control group or any two groups of the time points in the observation group(<i>P</i><0.05); BCVAs of the 1, 3 and 6mo after treatment were significantly lower than that of before treatment in the observation group(<i>P</i><0.05), while the BCVAs of the 3, 6mo after treatment were significantly higher than that of the 1mo after treatment in the control group(<i>P</i><0.05), but no significant difference of BCVA was observed between any two group of the other time points in the observation group or control group(<i>P</i>>0.05).<p>CONCLUSION: Noninvasive positive pressure ventilation is beneficial for patients with nonischemic(RVO)combined with severe obstructive sleep apnea hypopnea syndrome to improve the therapeutic effect.

An observational study of macular optical density in patients with obstructive sleep apnea hypopnea syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the change of macular pigment optical density(MPOD)in the patients of obstructive sleep apnea-hypopnea syndrome(OSAHS). <p>METHODS: Totally 70 OSAHS patients as observation group and 32 healthy subjects as control group with their right eyes were enrolled from Chongqing Emergency Medical Center during January to December of 2019. All the subjects used Visucam 200 to measure the mean/max MPOD. <p>RESULTS: Both mean/max MPOD(0.0916±0.0149, 0.2675±0.0419Log unit)of OSAHS group are significantly lower than the control group(0.1193±0.0159, 0.3235±0.0400Log unit, <i>P</i><0.001).There are significant difference of mean/max MPOD between mild(<i>n</i>=12)/moderate(<i>n</i>=17)/severe(<i>n</i>=41)groups divided by AHI(<i>P</i><0.001). The increasing severity of OSAHS lead to lower mean/max MPOD.Furthermore there is negative correlation between mean/max MPOD and AHI(<i>r</i>=-0.685, -0.492; <i>P</i><0.001).<p>CONCLUSION: Our study results suggest that the mean/max MPOD were reduced in the patients of OSAHS. Moreover, the decreased degree of mean/max MPOD is positively related to the severity of OSAHS. It shows that the MPOD of OSAHS have already changed before they feel the significant syndrome. The reducing of MPOD may cause dysfunction of macular and finally rise up to macular disease.

Efficacy of weight management combined with uvulopalatopharyngoplasty for obesityrelated obstructive sleep apnea-hypopnea syndrome / 南方医科大学学报

OBJECTIVE@#To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS).@*METHODS@#Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (@*RESULTS@#After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group (@*CONCLUSIONS@#Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.