Continuous Positive Airway Pressure Effectively Alleviates Arrhythmias in Patients with Obstructive Sleep Apnea: Possible Relationship with Counteracting Oxidative Stress.

This work is aimed at exploring the clinical efficacy of continuous positive airway pressure (CPAP) in treatment of patients with arrhythmias combined with obstructive sleep apnea (OSA). Through evaluating serum native thiol, malonaldehyde (MDA) and nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months, we confirmed the impact of oxidative stress on arrhythmias. A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information. Patients were divided into two groups (paired experiment design): 32 patients in group A (control group), who received unchanged anti-arrhythmia treatment and 32 patients in group B, who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP. OSA related parameters were compared between the two groups after 3-month therapy. And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy. After 3 months of CPAP therapy, compared with the control group, the percentage of sage N3 (NREM 3) and stage R (REM) in total sleep time was significantly increased, while apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) score were evidently decreased. Meanwhile, the lowest oxygen saturation (LSpO2) was also elevated after CPAP treatment for 3 months. The CPAP therapy significantly prevented the occurrence of arrhythmias (P<0.05). Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A (P<0.05). But serum native thiol was improved by CPAP treatment (P<0.05). In conclusion, proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.

[Influence on antidiuretic hormone secretion in children with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To explore the influence of obstructive sleep apnea hypopnea syndrome (OSAHS) in children on the secretion of antidiuretic hormone (ADH). METHODS: Thirty pediatric patients with OSAHS were examined with polysomnography (PSG) and urinary volume was recorded during sleep, and vein blood was sampled in deep sleep to detect the level of ADH in serum using radioimmunoassay technique, which were performed before and after adenotonsillectomy. Among twenty heath children were also detected the secretion of ADH as normal controls. RESULTS: After surgery, apnea-hypopnea index (AHI) decreased (from 17.4 +/- 2.6 to 3.3 +/- 1.4, t = 27.68, P < 0.001), lowest SaO2 increased (from 0.783 +/- 0.134 to 0.954 +/- 0.062, t = 6.45, P < 0.001). The level of ADH in OSAHS patients (63.1 +/- 35.2) ng/L was much lower than that in health children (85.1 +/- 22.2) ng/L (t = 2.75, P < 0.01). The serum ADH level in postoperative patients (83.1 +/- 21.2) ng/L was increased significantly compared with that of preoperative (t = 2.56, P < 0.05), and no statistical difference versus that of health children (t = 0.17, P > 0.05). Nycturia volume of preoperative OSAHS children (492 +/- 90) ml was significant higher than that of postoperative (332 +/- 56) ml or normal controls (346 +/- 62) ml (t was 7.85 and 6.43, both P < 0.001). There was no significance in nycturia volume between postoperative group and control group (t = 0.77, P > 0.05). CONCLUSIONS: After adenotonsillectomy in children with OSAHS caused by adenotonsillar hypertrophy, the sleep pattern and ADH secretion could become normal.

[Recurrent laryngeal nerve decompression].

OBJECTIVE: To study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors. METHODS: From October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glottic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligated in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glottic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto's thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngoscope postoperatively. RESULTS: For the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glottic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient. CONCLUSIONS: Exploration and decompression as soon as possible to the paralysed recurrent laryngeal nerve because of thyroid surgery are very important for the restoration of the function of the nerve. For the patient with serve hoarseness, nerve decompression and type I thyroplasty at the same time is recommended in an effort to relieve hoarseness as soon as possible. For the functional disturbance of recurrent laryngeal nerve with thyroid neoplasm patient, early exploration and decompression of the nerve is imperative.