Obstructive sleep apnoea and the incidence and mortality of cancer: a meta-analysis.

As there are conflicting reports regarding the association between obstructive sleep apnoea (OSA) and cancer incidence and mortality, a meta-analysis was performed to evaluate whether OSA is independently associated with cancer incidence and mortality. Pubmed, EMBASE and Web of Science were searched up until November 2014. Studies that assessed OSA and the future risk of cancer incidence or mortality were included. Pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) were calculated. Subgroup analysis was conducted based on the polysomnographic variable, apnoea-hypopnoea index. Six studies, which involved 114 105 participants, were pooled in this meta-analysis. Fixed-effects analysis showed the pooled adjusted HR of cancer incidence as 0.91 (95% CI, 0.74-1.13; P = 0.408) for mild OSA, 1.07 (95% CI, 0.86-1.33; P = 0.552) for moderate OSA and 1.03 (95% CI, 0.85-1.26; P = 0.743) for severe OSA. Random-effects analysis demonstrated neither mild OSA (adjusted HR, 0.79; 95% CI, 0.46-1.34; P = 0.381), moderate OSA (adjusted HR, 1.92; 95% CI, 0.63-5.88; P = 0.251) nor severe OSA (adjusted HR, 2.09; 95% CI, 0.45-9.81; P = 0.349) correlated with cancer mortality. This meta-analysis indicates that OSA is not independently associated with cancer incidence and mortality according to currently available data. Additional experimental and human research is required to determine the exact association between OSA and cancer.

Vascular endothelial growth factor levels in patients with obstructive sleep apnea: a meta-analysis.

Published articles regarding the blood levels of vascular endothelial growth factor (VEGF) in obstructive sleep apnea (OSA) patients are contradictory. The objective of this study was to explore whether VEGF levels is high or not in OSA subjects via quantitatively statistical analysis. The electronic databases of Pubmed, Web of Science, EMBASE were systematic searched. The VEGF levels and clinical characteristics of participants between OSA group and control group were extracted for analysis. Weighted mean difference (WMD) or standard mean difference (SMD) with 95 % confidence interval (CI) was calculated by fixed effects or random effects model. Appropriate statistical software was employed for data synthesis. Totaling 15 articles with 697 participants were included in this study. Pooled meta-analysis showed that blood VEGF concentrations were significantly higher in OSA patients than in control subjects (SMD 1.89, 95 % CI 0.92-2.87, p = 0.000). Subgroup analysis demonstrated that when compared with control group, OSA patients with age ≥50 years (SMD 2.54, 95 % CI 1.28-3.80, p = 0.000), apnea hypopnea index ≥30 events/h (SMD 2.47, 95 % CI 1.20-3.73, p = 0.000) had higher VEGF levels. Compared with control subjects, OSA patients had an elevated VEGF in serum (SMD 3.55, 95 % CI 1.82-5.28, p = 0.000) rather than in plasma. High blood VEGF concentrations were observed in OSA patients, particularly in the older and more serious patients.

Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure.

In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.

Does continuous positive airway pressure reduce aldosterone levels in patients with obstructive sleep apnea?

PURPOSE: Aldosterone is associated with the development of obstructive sleep apnea (OSA) and cardiovascular diseases. Continuous positive airway pressure (CPAP) is an effective treatment for OSA, but the impact of CPAP therapy on aldosterone levels in patients with OSA remains unclear. To address this issue, a meta-analysis was conducted to evaluate the effects of CPAP therapy on serum aldosterone levels in OSA. METHODS: Two reviewers independently searched PubMed, Cochrane library, Embase, and Web of Science before March 2015. Information on characteristics of subjects, study design, and pre- and post-CPAP treatment of serum aldosterone was extracted for analysis. Standardized mean difference (SMD) was calculated to estimate the treatment effects of CPAP therapy. RESULTS: A total of 5 studies involving 329 patients were pooled into this meta-analysis, including 3 observational studies and 2 randomized controlled studies. Results indicated significantly decreased aldosterone levels after CPAP therapy (SMD = -0.236, 95 % confidence interval (CI) = -0.45 to -0.02, z = 2.12, p = 0.034). CONCLUSIONS: This meta-analysis suggested that CPAP therapy was associated with a decrease in serum aldosterone in patients with OSA. Further large-scale, well-designed interventional investigations are needed to clarify this issue.

Efficacy of positive airway pressure on brain natriuretic peptide in patients with heart failure and sleep-disorder breathing: a meta-analysis of randomized controlled trials.

OBJECTIVE: Positive airway pressure (PAP) has been recognized as an effective therapeutic option for sleep-disordered breathing (SDB) in patients with heart failure (HF), and it can improve left ventricular function. Whether PAP can ameliorate serum brain natriuretic peptide (BNP) levels, a biomarker of HF, is controversial. The purpose of the present study was to quantitatively assess the efficacy of PAP on BNP in patients with HF and SDB. METHODS: A systematic search of PubMed, Embase, Web of Science and Cochrane library identified six randomized controlled trials (RCTs), in which PAP was compared with medical therapy, subtherapeutic PAP or different types of PAP. The data of BNP were extracted and pooled into meta-analysis using STATA 12.0. RESULTS: Totally 6 RCT studies (7 cohorts) with 222 patients were enrolled into analysis. The quality of each study was high and the heterogeneity (I(2) = 58.1%) was noted between studies. A significant reduction of BNP was observed after PAP treatment in patients with HF and SDB (SMD -0.517, 95% CI -0.764 to -0.270, z = 4.11, p = 0.000). CONCLUSION: Our meta-analysis of RCTs demonstrated that PAP elicits significant reduction of BNP in patients with HF and SDB.

[Influence of mutations in epidermal growth factor receptor gene on growth, metastasis and survival rate of non-small cell lung carcinoma].

OBJECTIVE: To evaluate the influence of mutations in epidermal growth factor receptor (EGFR) gene on the prognosis of non-small cell lung cancer (NSCLC). METHODS: A total of 107 NSCLC patients undergoing tumor resection from December 2005 to August 2009 at our hospital were recruited. Mutations of exons 18 - 21 of EGFR gene in patients were detected by polymerase chain reaction (PCR) amplification and gene sequencing. The influence of mutations in EGFR gene on the growth, metastasis and survival rate of NSCLC was evaluated. RESULTS: EGFR mutations were detected in 30 (28.0%) of 107 patients. The mutation distribution was as follows: exon 18 (n = 1), exon 19 (n = 8), exon 21 (n = 20), and exons 18 and 19 multiple (triple mutations, n = 1). NSCLC with EGFR mutations had a higher growth velocity than that without EGFR mutations [M(Q(1-3)): 0.42 (0.17 - 1.04) mm/d vs 0.21 (0.19 - 1.00) mm/d, P < 0.05]. EGFR mutations had no significant impaction on neither the lymph node metastasis of NSCLC (P > 0.05) nor on the tumor metastasis to other organs (P > 0.05). The mean survival time of patients with and without EGFR mutations were (18.2 ± 8.9) and (25.5 ± 7.8) months respectively. The 1, 2 and 3-year survival rate were 62.2% vs 72.2%, 47.7% vs 57.3% and 46.9% vs 56.3% respectively between patients with and without EGFR mutations. Log-rank test didn't show a significant difference among them (χ(2) = 0.59, P > 0.05). CONCLUSIONS: The EGFR mutations promote the growth of NSCLC. But it may not be a factor of predicting prognosis.

Effects of silencing endothelin-1 on invasion and vascular formation in lung cancer.

Endothelin-1 (ET-1), which exists not only in the vascular endothelium but is also widely present in various tissues and cells, is an important cardiovascular regulatory factor that serves an important role in maintaining the basal vascular tone and homeostasis in the cardiovascular system. In the present study, the ET-1 gene was silenced by RNA interference, and the effects on lung cancer cell proliferation and tumor cell invasion were then detected by Cell Counting kit-8 and Transwell assays. In addition, the expression of apoptosis, growth and invasion-associated proteins, including RhoA/C, vascular endothelial growth factor, pigment epithelium-derived factor, AKT, E-cadherin and cyclooxygenase-2 was evaluated by western blotting upon silencing ET-1. In the present study, Endostar, a recombinant human endostatin injectable drug, was also used, and it was assessed whether the sensitivity of tumor cells to this drug could be increased by silencing ET-1. Both in vivo and in vivo tests were carried out in the present study. The experimental data indicated that ET-1 silencing can inhibit tumor cell proliferation and invasion, particularly in the presence of Endostar.

[Comparative study on cefdinir and cefaclor in the treatment of patients with mild to moderate bacterial community acquired pneumonia].

OBJECTIVE: To evaluate the efficacy and safety of cefdinir in the treatment of patients with mild to moderate bacterial community acquired pneumonia (CAP). METHODS: A prospective single-blind randomized controlled clinical study was performed comparing cefdinir with cefaclor in the treatment of sixty-four patients with CAP. The clinical and bacteriological efficacy and safety were compared between cefdinir and cefaclor in treating mild to moderate CAP. Thirty-three patients were treated with cefdinir 100 mg, orally, three times a day (cefdinir group), thirty-one patients were treated with cefaclor 500 mg, orally, three times a day (cefaclor group). In both groups 7-14 d was a treatment course. RESULTS: The cure rate of cefdinir and cefaclor was 84.8% and 77.4% respectively and the overall efficacy rate was 93.9% and 87.1% respectively. The bacterial positive rates and bacterial eradication rates of the two groups were 81.8%, 80.7% and 96.3%, 88%, respectively. The adverse drug reaction rate were 3% in cefdinir group and 6.5% in cefaclor group. There was no statistical significant difference between the two groups for the above results (P >0.05). The time of given medicine of cefdinir and cefaclor was (10.8 +/- 1.6) d and (12.1 +/- 1.7) d (P <0.01) respectively. CONCLUSION: cefdinir is safe and effective, shorten the course of treatment in the treatment of mild to moderate bacterial community acquired pneumonia.

Effect of continuous positive airway pressure on serum cystatin C among obstructive sleep apnea syndrome patients.

PURPOSE: The purpose of the present study was to evaluate the influence of continuous positive airway pressure (CPAP) on serum cystatin C, a novel biomarker of early renal impairment, among obstructive sleep apnea (OSA) patients. MATERIALS AND METHODS: Newly diagnosed severe OSA patients who treated with CPAP for 3 months were enrolled from two sleep laboratories. Serum biomarkers of renal impairment, cystatin C, creatinine and estimated glomerular filtration rate (eGFR), were detected before and after CPAP treatment. RESULTS: A total of 39 severe OSA patients were enrolled, 29 (74.4 %) were male, and mean age was 51.2 ± 12.2 years. After CPAP treatment, there were no changes of creatinine and eGFR (77.80 ± 20.00 vs. 75.3 ± 16.60 and 98.69 ± 31.74 vs. 100.20 ± 28.30, all p > 0.05), but cystatin C declined significantly (0.87 ± 0.18 vs. 0.77 ± 0.21, p = 0.000). CONCLUSION: CPAP can decrease cystatin C levels among severe OSA patients and may prevent the latent renal impairment.

Efficacy of continuous positive airway pressure on testosterone in men with obstructive sleep apnea: a meta-analysis.

OBJECTIVE: To evaluate the efficacy of continuous positive airway pressure (CPAP) on serum testosterone in men with obstructive sleep apnea (OSA). METHODS: Two reviewers independently searched PubMed, Cochrane library, Embase and Web of Science before June 2014. Information on characteristics of subjects, study design, pre- and post-CPAP treatment of serum total testosterone, free testosterone and sexual hormone blinding protein (SHBG) was extracted for analysis. RESULTS: A total of 7 studies with 9 cohorts that included 232 men were pooled into meta-analysis. There was no change of total testosterone levels before and after CPAP treatment in OSA men (standardized mean difference (SMD) = -0.14, 95%CI: -0.63 to 0.34, z = 0.59, p = 0.558), even subdivided by CPAP therapeutic duration (>3 months). Meanwhile, no significant differences in free testosterone and SHBG were detected after CPAP treatment (SMD =  0.16, 95%CI: -0.09 to 0.40, z = 1.25, p = 0.211 and SMD = -0.58, 95%CI: -1.30 to 0.14, z = 1.59, p = 0.112, respectively). CONCLUSION: CPAP has no influence on testosterone levels in men with OSA, further large-scale, well-design interventional investigation is needed.