Neurite Orientation Dispersion and Density Imaging (NODDI) reveals white matter microstructural changes in Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) patients with cognitive impairment.

PURPOSE: This study aimed to assess changes in white matter microstructure among patients undergoing obstructive sleep apnea hypopnea syndrome (OSAHS) complicated by cognitive impairment through neurite orientation dispersion and density imaging (NODDI), and evaluate the relationship to cognitive impairment as well as the diagnostic performance in early intervention. METHODS: Totally 23 OSAHS patients, 43 OSAHS patients complicated by cognitive impairment, and 15 healthy controls were enrolled in OSA, OSACI and HC groups of this work. NODDI toolbox and FMRIB's Software Library (FSL) were used to calculate neurite density index (NDI), Fractional anisotropy (FA), volume fraction of isotropic water molecules (Viso), and orientation dispersion index (ODI). Tract-based spatial statistics (TBSS) were carried out to examine the above metrics with one-way ANOVA. This study explored the correlations of the above metrics with mini-mental state examination (MMSE), and montreal cognitive assessment (MoCA) scores. Furthermore, receiver operating characteristic (ROC) curves were plotted. Meanwhile, area under curve (AUC) values were calculated to evaluate the diagnostic performance of the above metrics. RESULTS: NDI, ODI, Viso, and FA were significantly different among different brain white matter regions, among which, difference in NDI showed the greatest statistical significance. In comparison with HC group, OSA group had reduced NDI and ODI, whereas elevated Viso levels. Conversely, compared to the OSA group, the OSACI group displayed a slight increase in NDI and ODI values, which remained lower than HC group, viso values continued to rise. Post-hoc analysis highlighted significant differences in these metrics, except for FA, which showed no notable changes or correlations with neuropsychological tests. ROC analysis confirmed the diagnostic efficacy of NDI, ODI, and Viso with AUCs of 0.6908, 0.6626, and 0.6363, respectively, whereas FA's AUC of 0.5042, indicating insufficient diagnostic efficacy. CONCLUSIONS: This study confirmed that NODDI effectively reveals microstructural changes in white matter of OSAHS patients with cognitive impairment, providing neuroimaging evidence for early clinical diagnosis and intervention.

The impact of surgical intervention on peripheral blood T lymphocyte subsets and natural killer cell activity in pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).

OBJECTIVE: This study aimed to investigate the impact of surgical intervention on peripheral blood T lymphocyte subsets and natural killer (NK) cell activity in pediatric patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: A total of 36 OSAHS children, 32 children with tonsillar hypertrophy, and 30 healthy children were enrolled. Clinical data and polysomnography (PSG) results were collected. Peripheral blood samples were analyzed for T lymphocyte subsets, NK cells, and cytokine levels including Th1 (IFN-γ, IL-2, TNF-α), Th2 (IL-4, IL-10), and Th17 (IL-17). RESULTS: At baseline, OSAHS children exhibited lower LSaO2 levels and higher AHI values compared to healthy children. They also showed decreased percentages of CD3 + T cells, CD4 + T cells, NK cells, and elevated CD8 + T cells and CD4+/CD8 + ratio. Levels of IFN-γ, IL-2, TNF-α, IL-4, and IL-17 were significantly lower in OSAHS children. Post-surgery improvements were observed in LSaO2, AHI, and immune markers at 3 months and 6 months. Pearson's correlation analysis revealed significant associations between LSaO2, AHI, and peripheral blood immune parameters at baseline and 6 months post-surgery. CONCLUSION: Surgical intervention in pediatric OSAHS influences peripheral blood T lymphocyte subsets and NK cell activity. Early intervention and monitoring of immune function are crucial for the recovery and healthy development of affected children.

Evaluation of the efficacy of a custom-made monoblock mandibular advancement device in treatment of obstructive sleep apnea hypopnea syndrome.

INTRODUCTION: Mandibular advancement devices (MAD) are an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). We aimed to evaluate the efficiency of a custom-made monoblock MAD for the treatment of OSAHS. MATERIALS AND METHODS: We carried out a monocentric retrospective observational study including patients with OSAHS (mild, moderate or severe) or isolated ronchopathy from January 2005 to March 2023. The primary objective was to evaluate the overall efficiency of the MAD assessed by the percentage of patients successfully treated. The secondary objectives included the global efficiency of the device in the treatment of snoring, the report of side effects, and the identification of predictive factors for efficacy or failure. RESULTS: The medical records of 586 patients were collected, and 293 patients (229 OSAHS and 64 isolated ronchopathy) were included in the analysis. After a mean 2.9 years follow-up, 72.5 % of patients were successfully treated by MAD. We observed a significant improvement in ronchopathy, both in terms of intensity and percentage of time per night. Regarding patients with isolated ronchopathy, 87.5 % reported an improvement in their symptoms and satisfaction with their treatment. Finally, 14.0 % of the patients declared side-effects, the dentoskeletal modifications being the most frequent (6.1 % of the patients). CONCLUSION: This study confirmed the long-term efficacy and good tolerance of a custom-made monoblock orthosis in OSAHS.

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.

Correlation of serum nicotinamide phosphoribosyl transferase with hypoxia and Framingham risk score in patients with obstructive sleep apnea-hypopnea syndrome.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for atherosclerosis (AS), but the mechanism is different from classical AS risk factors. Nicotinamide phosphoribosyltransferase (NAMPT) is involved in the pathophysiology of AS via multiple pathways, and its expression is closely related to hypoxia. The association of NAMPT with hypoxia and the risk of cardiovascular morbidity in the patients of OSAHS remains to be defined. Therefore, we carried out this study to investigate the association of NAMPT with hypoxia and the risk of early cardiovascular disease [based on the Framingham risk score (FRS)] in patients with OSAHS. METHODS: A total of 82 patients diagnosed with OSAHS were enrolled in this cross-sectional survey design, along with 18 healthy controls who were age- and gender-matched. The general characteristic parameters including height and weight as well as biochemical parameters including blood glucose and lipid were collected from the subjects. The Framingham vascular risk score calculates the risk of developing vascular disease based on the above indicators. Polysomnography was performed in patients with OSAHS, and blood oxygen saturation and apnea-hypopnea index (AHI) were collected, and patients were grouped by disease extent by AHI. The serum NAMPT level of the research subjects was detected using an enzyme-linked immunosorbent assay. Spearman correlation analysis and multiple linear regression to explore the independent correlations of hypoxia on serum NAMPT activity in OSAHS patients. RESULTS: Serum NAMPT level in patients with OSAHS increased with the severity of the disease. Correlation analysis showed that NAMPT was significantly positively correlated with FRS in patients with OSAHS (r=0.829, P<0.05). Multiple linear regression analysis with FRS as the outcome measure showed that NAMPT activity and minimum blood oxygen saturation were independent associated with the risk of developing cardiovascular disease (ß=0.03, P=0.000; ß=-0.13, P=0.034). Univariate and multivariate regression analyses revealed that hypoxia was significantly associated with NAMPT levels in OSAHS patients, and the oxygen desaturation index (ODI) was independent associated with the expression of NAMPT activity (ß=4.09, P=0.000). CONCLUSIONS: In patients with OSAHS, hypoxia is independently associated with NAMPT. NAMPT increases the risk of cardiovascular morbidity in this population may be influenced by hypoxia.

Clinical case control study analysis of vestibular function in patients with obstructive sleep apnea-hypopnea syndrome.

BACKGROUND: To investigate the effects of hypoxia degree and sleep duration on vestibular function in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients. We made further study of the low oxygen levels of OSAHS and hypoxic duration on the impact of vestibular function, and further studied the OSAHS the longest apnea time and Vestibular Evoked Myogenic Potential (VEMP) abnormal rate and the relationship between the vestibular function of canal paralysis (CP). METHODS: A total of 87 OSAHS patients and 47 healthy individuals were enrolled in this study. There was no difference in gender, age and body mass index (BMI) values in matched experimental groups. Other diseases of other systems were excluded. All the participants completed sleepiness questionnaires (i.e., the Epworth sleepiness scale and the STOP-BANG questionnaire) and the Dizziness Handicap Inventory (DHI). Additionally, a caloric test, positional test, electrocochleogram, and VEMP test were administered to evaluate the vestibular function of all the participants. A polysomnography (PSG) was also performed. RESULTS: The current investigation generated the following three major findings: (I) there was a significant correlation between body mass index and canal paresis [CP; P=0.014, odds ratio (OR) =1.791, 95% confidence interval (CI): 1.125-2.851] and a significant positive correlation between the DHI score and VEMP results (P=0.0061, OR =3.667, 95% CI: 1.449-9.276); (II) the CP abnormality rate of the OSAHS group was significantly higher than that of the control group (P<0.05); (III) there was a significant correlation between the longest apnea duration and the DHI score (r=-0.191, P<0.05). CONCLUSIONS: The abnormality rate of the vestibular function of OSAHS patients is higher than that of healthy people. OSAHS intermittent hypoxia can affect vestibular function in the inner ear, and the longer the duration of prolonged hypoxia, the more serious the vestibular function damage.

The correlation of serum/plasma IGF-1 concentrations with obstructive sleep apnea hypopnea syndrome: A meta-analysis and meta-regression.

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease that has serious cardiovascular and metabolic effects. Insulin-like growth factor 1 (IGF-1) levels are reportedly reduced in patients with OSAHS; however, this is still a matter of debate. Therefore, we investigated the association between serum/plasma IGF-1 levels and OSAHS in this meta-analysis. Methods: Wan Fang, Excerpta Medica dataBASE, Web of Science, China National Knowledge Infrastructure, VIP, PubMed, and other databases were searched for materials published in any language before April 2, 2022. Two researchers analyzed the studies for quality according to the Newcastle-Ottawa Scale. The acquired data were analyzed using Stata 11.0 and R 3.6.1 software. The effect size was estimated and calculated using standard mean differences and correlation coefficients. Moreover, a combined analysis was conducted using either a random- or fixed-effects model. Results: Ultimately, 34 studies met our inclusion criteria. Our findings revealed that the plasma/serum IGF-1 concentrations in patients with OSAHS was significantly reduced compared with those in healthy subjects. Subgroup analyses were performed according to OSAHS severity, ethnicity, age, body mass index, specimen testing method, and study design. The outcomes suggested that nearly all subgroups of patients with OSAHS had reduced serum IGF-1 levels. Disease severity and differences in ethnicity were identified as possible influencing factors of serum IGF-1 levels in patients with OSAHS in the meta-regression analysis, and no other factors were found to alter plasma/serum IGF-1 concentrations. Moreover, plasma/serum IGF-1 concentrations were negatively correlated with apnea-hypopnea index and oxygen desaturation index scores and positively associated with minimum oxygen saturation. Conclusion: Serum/plasma IGF-1 concentrations in patients with OSAHS were greatly reduced compared with those of patients in the control group, and were negatively correlated with apnea-hypopnea index and oxygen desaturation index scores and positively correlated with minimum oxygen saturation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022322738.

Application value of joint NoSAS score and Epworth Sleepiness Scale for assessment of obstructive sleep apnea hypopnea syndrome.

OBJECTIVE: By comparing the predictive value of the NoSAS (Neck circumference, Obesity, Snoring, Age and Sex) score combined with the Epworth Sleepiness Scale (ESS), STOP-Bang Questionnaire (STOP-Bang), STOP Questionnaire (STOP) and Berlin Questionnaire (Berlin), the application value of the NoSAS score combined with ESS in screening Obstructive sleep apnea hypopnea syndrome (OSAHS) in the population is evaluated. METHOD: 2560 suspected OSAHS patients visited the Sleep Medical Center of the First Hospital of Guangzhou Medical University between September 1, 2016 and October 31, 2020, and were monitored with a polysomnogram (PSG) after completing the NoSAS score, ESS, STOP-Bang, STOP and Berlin. The sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristic (ROC) curve of each scale were calculated, and the accuracy in predicting OSAHS of the NoSAS score combined with ESS and each scale was analyzed. RESULTS: The areas under the ROC curve scored by Berlin were higher than those of the other four questionnaires with Apnea Hypopnea Index (AHI) cutoffs of ≥5 and ≥ 10 events/h, while the area under the ROC curve scored by the NoSAS score was the highest with AHI cutoffs of ≥15, ≥20, ≥25 and ≥ 30 events/h. Among the five scales, the diagnostic odds ratio (DOR) of the NoSAS score was the highest. When a NoSAS score of ≥7 was used as the cutoff point for diagnostic NoSAS, it had higher sensitivity and specificity with a NoSAS score of ≥8 as the cutoff point for diagnostic NoSAS. A NoSAS score of ≥7 combined with ESS significantly improved its specificity for predicted OSAHS patients. CONCLUSION: The NoSAS score is a simple and effective new tool for screening patients for OSAHS, while a NoSAS score of ≥7 combined with ESS can further improve its specificity. Thus, we suggest further screening with ESS after a NoSAS score of ≥7 in suspected populations.

The effects of obstructive sleep apnea-hypopnea syndrome (OSAHS) on learn and memory function of 6-12 years old children.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a sleep disorder causing cognitive impairments. AIMS: We use the auditory verbal learning test (AVLT), clock drawing test (CDT), Wechsler intelligence scale for children (WISC) and Montreal cognitive assessment (MoCA) to evaluate the memory and spatial impairments of OSHAS in 6-12 years old children patients with different severity. MATERIAL AND METHODS: A total of 137 children of snoring were enrolled following the inclusion criteria of this study. According to the apnea-hypopnea indices (AHI), they were divided into three groups. The AVLT, CDT, WISC and MoCA tests were executed by physicians. The self-rating depression scale (SDS) test was performed for depression screening. RESULTS: Compared with the children in the primary snoring group, the other two groups had higher body mass index (BMI), longer periods of snoring and older age. The AHI, oxygen desaturation index (ODI) and 90% oxygen saturation (TS90%) showed increasing trends whereas the lowest blood oxygen saturation (LSaO2) showed a decreasing trend. Besides, compared with the primary snoring group, the two groups had lower immediate recall scores in AVLT. CONCLUSION: AVLT had clinical values for evaluation of impaired memory function in OSAHS children, suggesting a correlation between cognitive impairments and nocturnal hypoxia.

Obstructive sleep apnea-hypopnea syndrome complicated with idiopathic intracranial hypertension: a case report.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repetitive episodes of hypopnea or apnea during sleep. With the improved living conditions of the population and the increased number of obese individuals, the incidence of OSAHS is rising. Hypopnea in OSAHS patients can cause and aggravate cerebrocardiovascular diseases and metabolic disorders However, OSAHS patients with idiopathic intracranial hypertension is rare and we just have searched one paper so far. CASE DESCRIPTION: In this paper, we report the case of an OSAHS patient with idiopathic intracranial hypertension (IIH) as a prominent symptom. The patient was suffering weakness and fatigue lasting about half a year without the headache symptom. The IIH was diagnosed by lumbar puncture and the results showed that the cerebrospinal fluid (CSF) pressure was higher than 400 mmH2O. After treatment with non-invasive positive pressure ventilation, the symptoms were completely resolved and the quality of life of the patient was significantly improved. The CSF pressure was 200 mmH2O in the last lumbar puncture. CONCLUSIONS: For patients with unexplained IIH, the possibility of OSAHS should be warned. Lumbar puncture is easy to perform and obtain the results. Regular ventilator treatment is important and necessary to these patients. The symptoms of some OSAHS patients is atypical that we may need new insights into this disease.

Correlation between obstructive sleep apnea hypopnea syndrome and hypertension: a systematic review and meta-analysis.

BACKGROUND: Obstructive sleep apnea hypopnea syndrome (OSAHS) is defined as more than 30 recurrent episodes of apnea or a sleep apnea hypopnea index (AHI) of more than 5 times/hour at a night. It is more common in people over 40 years old and is more prevalent in men. The pathogenesis factors and correlations of OSAHS are worth studying. METHODS: A literature search was performed in the PubMed, Embase, and Ovid-Medline databases from the date when the database was established to April 2021. Keywords included obstructive sleep apnea hypopnea syndrome, sleep apnea hypopnea syndrome, hypertension, and correlation. RESULTS: Eight articles involving 3,484 OSAHS patients were included. Analysis results showed that OSAHS was correlated with hypertension [odds ratio (OR) =6.44, 95% confidence interval (CI): 5.38-7.71, P<0.00001]. The severity of OSAHS revealed that the correlation of hypertension to mild, moderate, and severe OSAHS showed OR =1.93, 95% CI: 0.69-5.43, P=0.21, OR =0.43, 95% CI: 0.24-0.74, P=0.0003, and OR =0.85, 95% CI: 0.42-1.73, P=0.66, respectively. The results indicated that mild, moderate, and severe OSAHS are risk factors for hypertension. DISCUSSION: Eight articles were included to determine the correlation between OSAHS and hypertension. It was found that OSAHS was closely correlated with hypertension, and they may be risk factors for each other.

Diagnostic accuracy of the Berlin questionnaire and therapeutic effect of nasal continuous positive airway pressure in OSAHS patients with glucose metabolic dysfunction.

PURPOSE: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with alterations in glucose metabolism. The Berlin questionnaire (BQ) is effective in identifying subjects with high risk of OSAHS. However, its validity in patients with glucose metabolic dysfunction remains unclear. Our study aims to examine the diagnostic efficacy of the BQ in detecting OSAHS in patients with glucose metabolic dysfunction and to explore the effect of nasal CPAP on glucose metabolism. METHODS: Patients with glucose metabolic dysregulation were first asked to complete the BQ and then recruited for polysomnogram (PSG). The diagnostic accuracy of the BQ and the relationships between groups with normal glucose tolerance (NGT), elevated fasting blood glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM) were analyzed. Subjects with both OSAHS and glucose dysregulation received CPAP treatment and underwent an oral glucose tolerance test. Changes in apnea-hypopnea indices (AHI) and glycemic parameters were calculated to determine the efficacy of CPAP. RESULTS: Glycosylated hemoglobin and insulin levels were statistically different between the high-risk and low-risk groups according to the BQ. For diagnosis of subjects with OSAHS who also had glucose metabolic dysfunction, the sensitivity and specificity of the BQ using AHI cut-off values at 5 events per hour were 73% and 67%. CPAP therapy effectively reduced the blood glucose, HOMA-IR, and insulin levels. CONCLUSIONS: The BQ can be considered to be an effective and economical screening tool for patieints with OSAHS who also have glucose metabolic dysfunction. Treatment with CPAP may improve glycemic parameters.

Establishment of upper respiratory tract model of patients with obstructive sleep apnoea hypopnoea syndrome before and after surgical treatment and its hydrodynamics analysis.

OBJECTIVE: The study aimed to explore the method of constructing the upper respiratory tract model of patients with obstructive sleep apnoea hypopnoea syndrome (OSAHS) and its application in the detection of the changes of flow field characteristics of the upper respiratory tract before and after surgical treatment. METHODS: A 34-year-old male OSAHS patient was taken as the study subject. The improved Han-uvulopalato pharyngoplasty was adopted for treatment. A 3D model of the patient's upper respiratory tract was constructed based on CT scan results before and after surgery. The characteristics of upper respiratory tract flow field were analyzed based on computational hydrodynamics under unsteady respiratory conditions. RESULTS: A 3D model of the patient's upper respiratory tract was successfully constructed. And after the comparison, it was found that the patients' respiratory tract stenosis was significantly improved after surgical treatment. During inhalation and exhalation, the high pressure areas of the patient were located in the nasal vestibule and oropharynx respectively. Surgical treatment can significantly reduce maximum stress. The total pressure of the upper respiratory tract decreased by 16.9%, and the pressure of the nasopharynx and oropharynx decreased by 70.1% and 38.4%, respectively. CONCLUSIONS: For the oropharyngeal area, the surgical treatment had obvious efficacy for inspiration, and during expiration, it had no efficacy but with adverse symptoms being increased.

Transient receptor potential canonical 5 channel is involved in the cardiac damage related to obstructive sleep apnea-hypopnea syndrome in rats.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is recognized as an independent risk factor of cardiovascular disease. The release of Ca2+ mediated by transient receptor potential canonical (TRPC) channels participates in the hypoxia-induced pathophysiological changes in the cardiovascular systems in case of OSAHS. This study aimed to investigate which subtypes of TRPCs were involved in OSAHS in a rat model of intermittent hypoxia. METHODS: OSAHS was induced by exposure of rats to intermittent hypoxia. The expression of TRPCrelated genes and proteins in the cardiomyocytes by qRT-PCR and Western Blotting, respectively. RESULTS: The mRNA expression of TRPC3/TRPC4/TRPC5 increased significantly in OSAHS group compared with the control group (P<0.05). The TRPC5 protein expression was significantly higher in the OSAHS control than the control group (P<0.05). CONCLUSIONS: The TRPC5 channel is likely to be involved in the OSAHS induced pathophysiological changes in the myocardium and may become a target to prevent OSAHS related cardiac damage.

The specific branches leading to the genioglossus muscle: three-dimensional localisation using skin reference points.

INTRODUCTION: Supra-selective stimulation of the branches destined for the horizontal part of genioglossus muscle (GGh) could be a target of choice in the treatment of mild-to-severe obstructive sleep apnea syndrome. The main aim of our study was to assess a percutaneous method for the three-dimensional localisation of the terminal branches destined to GGh. MATERIALS AND METHODS: Twenty cadaveric hypoglossal nerves were dissected and included in the injection protocol. The distance between the posterior edge of the mandibular symphysis and the hyoid bone on the sagittal midline as the approximated distance of the geniohyoid muscle (dGH) was measured before any dissection. Methylene blue mixed with a thickening agent, was injected. The injection point was defined in relation to dGH, in an orthonormal coordinate system. For each dissection, we recorded the theoretical and the real (X, Y, Z) coordinates of GGh motor points and measured their distance to each other. RESULTS: X was accurately estimated. Y and Z were overestimated by + 5.34 ± 5.21 mm ([Formula: see text]) and + 4.79 ± 3.99 mm ([Formula: see text]) on average, respectively. We found a more significant difference between the theoretical and real Y and Z coordinates in the subgroup BMI < 25 kg/m2 (8.6 ± 4.5 mm and 6.9 ± 2.5 mm, respectively, p = 0.0009), and of Z in subgroup with dGH ≥ 50 mm (6.89 ± 3.26 mm, p = 0.0494). CONCLUSIONS: X can be estimated accurately using the relationship [Formula: see text]. Y seems to be related to BMI and Z may be estimated with the relationship [Formula: see text]. This three-dimensional localisation could be very helpful to facilitate placement of cuff electrodes to manage refractory sleep apnea.

The No-apnea score vs. the other five questionnaires in screening for obstructive sleep apnea-hypopnea syndrome in patients with cerebral infarction.

BACKGROUND: Given the growing number of patients suspected of having obstructive sleep apnea-hypopnea syndrome (OSAHS), screening methods have become increasingly important for sleep clinics. We analyzed the clinical value of the No-apnea score which is used to diagnose OSAHS in patients with cerebral infarction, and compared the accuracy of the No-apnea score with the accuracy of the NoSAS score, the STOP-Bang questionnaire (SBQ), the Epworth Sleepiness Scale (ESS), the STOP questionnaire (STOP) and the Berlin questionnaire (BQ). METHODS: Between January 2014 and December 2018, a total of 221 cerebral infarction patients, suspected of having OSAHS, underwent the polysomnography (PSG) for one night at the sleep medical center of Guangdong Medical University Affiliated Second Hospital. The PSG data were collected and analyzed with the NoSAS score, the SBQ, the ESS, the STOP, the BQ, and patients' demographic information. Based on the apnea-hypopnea index (AHI), the patients were classified into four groups: the normal group (<5 events/h), mild OSAHS group (5-15 events/h), moderate OSAHS group (15-30 events/h) and severe OSAHS group (≥30 events/h). The sensitivity, specificity, positive predictive value, negative predictive value and areas under the curve (AUC) of the Receiver Operating Curve (ROC) were calculated for the five questionnaires to compare their relative efficacies for diagnosing OSAHS. RESULTS: When using the standard of AHI ≥5 for diagnosing OSAHS, the NoSAS score had an AUC of 0.831; the SBQ had an AUC of 0.730; the BQ had an AUC of 0.698; and the STOP had an AUC of 0.735, so these techniques are relatively accurate in diagnosing OSAHS. On the other hand, the No-apnea score and the ESS score are relatively less accurate comparing to the rest: the No-apnea had an AUC of 0.626, and the ESS had an AUC of 0.650. Using the NoSAS score to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the sensitivity and specificity were 0.867 and 0.731, 0.888 and 0.476, 0.889 and 0.369, respectively; Using the SBQ to predict AHI ≥5 events/h, AHI 15 events/h and AHI ≥30 events/h, the sensitivity and specificity were 0.903 and 0.268, 0.914 and 0.200, 0.903 and 0.268, respectively; Using the STOP to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the values were 0.830 and 0.500, 0.871 and 0.390, 0.875 and 0.302, respectively; and using the BQ to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the values were 0.758 and 0.482, 0.810 and 0.429, 0.819 and 0.362, respectively. CONCLUSIONS: The study concludes that the NoSAS score and the SBQ had a better predictive value for cerebral infarction patients suspected with OSAHS disease. These questionnaires can also effectively help clinicians quickly address nocturnal hypoxia in patients with cerebral infarction to control subsequent complications in patients with cerebral infarction. More studies are needed to evaluate the efficacy of the NoSAS score in screening for OSAHS in patients with cerebral infarction.

Small-world properties of the whole-brain functional networks in patients with obstructive sleep apnea-hypopnea syndrome.

OBJECTIVE: To explore the small-world properties of brain functional networks in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) to aid diagnosis. METHODS: A total of 29 OSAHS patients and 26 matched healthy volunteers were scanned with blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) separately, and the whole brain was divided into 90 districts via automated anatomical labeling. The matrix Z was then built through a Fisher Z transformation. Two-sample t tests were applied to evaluate the changes in small-world properties in OSAHS patients compared to the control group. The properties included Eglobal, Elocal, and small-world parameters Lp, Cp, γ, λ, and σ. RESULTS: Both groups satisfied the small-world properties (σ > 1) within the sparsity range of 0.1-0.2. However, compared with the control group, the OSAHS group performed significantly lower in Cp, Elocal, and Eglobal (p < 0.05) and higher in Lp (p < 0.05). The γ, σ, and λ values were not significantly different between the two groups. CONCLUSION: Both healthy and OSAHS patients exhibited small-world properties in functional networks, but a subset of these small-world properties in OSAHS patients performed differently. These changes will not only provide a new perspective for pathophysiological mechanisms of OSAHS but will also help in understanding the disease in terms of whole-brain functional networks.

Association between serum/plasma levels of adiponectin and obstructive sleep apnea hypopnea syndrome: a meta-analysis.

BACKGROUND: The relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and a variety of disease from obesity, type 2 diabetes mellitus and cardiovascular disease has been investigated previously. Reduced adiponectin levels are also associated with increased risk of these disease. However, whether serum/plasma adiponectin levels in OSAHS patients are lower than their counterparts remain controversial. Therefore, this study evaluated the association between serum/plasma adiponectin levels and OSAHS. METHODS: We performed a comprehensive literature search to locate eligible articles published on electronic databases including PubMed, EMBASE, Cochrane Library, WANFANG (Chinese database), VIP (Chinese Database) and Chinese National Knowledge Infrastructure (CNKI). The methodological quality of included studies was evaluated using the Newcastle-Ottawa scale (NOS). Pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated as effect size. Heterogeneity test was performed by Cochrane Q test and I2 test. Subgroup analysis and meta-regression analysis were employed to detect the sources of the heterogeneity. RevMan 5.3 and Stata 12.0 software were used in this meta-analysis for data synthesis. RESULTS: A total of 20 eligible studies with 28 databases involving 1356 participants were included in this meta-analysis. Results revealed that serum/plasma adiponectin levels in OSAHS patients were significantly lower than that in controls [SMD = - 0.71, 95% CI = - 0.92 to - 0.49, p < 0.001]. Subgroup analysis indicated that the heterogeneity would decreased when subgroup analysis was stratified by race. In addition, meta-regression analysis also suggested that the adiponectin levels were only significantly correlated with race. The removal of any independent study did not affect the pooled SMD in the sensitivity analysis. CONCLUSION: The serum/plasma adiponectin levels were significantly lower in OSAHS patients than that in control subjects, suggesting a possible role of adiponectin in OSAHS pathogenesis, deserves further studies as a potential marker of OSAHS.

Correlation between blood pressure and level of catecholamine in children with obstructive sleep apnea hypopnea syndrome / 上海交通大学学报（医学版）

Objective • To investigate the correlation between blood pressure and catecholamine levels in children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods • From January 2014 to December 2014, children and adolescents aged 2 to 12 years old who complained mainly of snoring during sleep were admitted to Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital and underwent surgery. Allnight polysomnography (PSG) was used to monitor and measure the systolic blood pressure (SBP) and diastolic blood pressure (DBP) in conscious state. According to the blood pressure reference standard of Chinese children and adolescents in 2010, the children with OSAHS were divided into normal blood pressure group, SBP increased group, DBP increased group, and SBP and DBP increased group. The children with OSAHS were divided into light, moderate and severe OSAHS subgroups according to the apnea hypopnea index (AHI) and the lowest oxygen saturation (LSpO2). The correlation between blood pressure and the level of catecholamine was analyzed in the children with OSAHS. Results • Two hundred and twenty-three subjects were included in the analysis. The average SBP was (100.3±9.8) mmHg (1 mmHg=0.133 kPa) and the average DBP was (63.0±9.8) mmHg. There were 50 cases (22.42%) diagnosed as hypertension, in which 20 cases (8.97%) were severe hypertension. The 223 children with OSAHS were divided into mild OSAHS subgroup (n=59), moderate OSAHS subgroup (n=127) and severe OSAHS subgroup (n=37) according to OSAHS grades. The difference of adrenaline level between the normal blood pressure group and the DBP increased group was statistically significant (P=0.032). The difference of LSpO2 between the DBP increased group and the SBP and DBP increased group was statistically significant (P=0.031). There were no significant differences in dopamine and noradrenaline levels among the four groups. There were significant differences in SBP and adrenaline level between OSAHS mild subgroup and moderate subgroup (P=0.038, P=0.000), but there were no significant differences between the moderate OSAHS subgroup and the severe OSAHS subgroup. There were no significant differences in dopamine and noradrenaline levels among the three OSAHS subgroups. Conclusion • The increase of plasma catecholamine level in children with OSAHS can lead to the increase of SBP, which will increase with the development of OSAHS. Therefore, early diagnosis and treatment of OSAHS should be taken into consideration.

Lung function impairment is not associated with the severity of acute coronary syndrome but is associated with a shorter stay in the coronary care unit.

BACKGROUND: Previous population-based studies have suggested that lung function impairment (LFI) could be associated with an increase in the mortality of cardiovascular events. METHODS: We evaluated the association between LFI and the severity and short-term prognosis of acute coronary syndrome (ACS). LFI was established through presence of a forced expiratory volume in one second (FEV1) and/or a forced vital capacity (FVC) less than 80% of predicted. RESULTS: Seventy-one LFI subjects (61.45±10.70 years, 83.10% males) and 247 non-LFI subjects (58.98±11.18 years, 80.57% males) with ACS were included. Subjects with LFI exhibited a higher prevalence of systemic hypertension (57.75% vs. 40.89%, P=0.02) and tobacco exposure (28.50±26.67 vs. 18.21±19.83 pack-years, P=0.007). No significant differences between groups were found regarding the severity of ACS (ejection fraction, Killip class, number of affected vessels, and peak plasma troponin). However, in comparison to non-LFI subjects, a significantly shorter length of stay in the coronary care unit (CCU) was observed in the LFI group (1.83±1.10 vs. 2.24±1.21 days, P=0.01) and this was even shorter in subjects with obstructive LFI (1.62±1.17 days, P=0.009). When considering obstructive sleep apnea (OSA), an interaction with length of stay was found, revealing that OSA subjects with obstructive LFI had the shortest length of stay in the CCU (0.60±0.89 days, P=0.05) also in comparison to non-LFI. CONCLUSIONS: This study indicates a possible association between LFI and a shorter length of stay in the CCU but does not show a significant association with ACS severity.