Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

A survey of neonatal births in maternity departments in urban China in 2005 / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the epidemiology of births in urban China.</p><p><b>METHODS</b>A retrospective study was conducted on neonates born in 2005 in the maternity departments of 72 urban hospitals from 22 provinces in China.</p><p><b>RESULTS</b>A total of 45722 infants born between January 1, 2005 and December 31, 2005 were enrolled. The male to female sex ratio was 1.13:1. Preterm births accounted for 8.1%. The incidence of very low birth weight infants was 0.7%. A total of 99.7% of mothers delivering at term had conceived naturally and 0.3% had experienced assisted reproduction. A total of 98.4% of mothers who delivered preterm had conceived naturally and 1.6% had experienced assisted reproduction. The proportion of vaginal deliveries was 50.8% compared to 49.2% delivered by cesarean sections. Many cesarean sections (38.1%) were due to social factors. Infants with an Apgar score≤7 at 1 minute accounted for 4.8%, and 1.6% of infants had an Apgar score≤7 at 5 minutes. Of all the infants included in the study, 7.14% were admitted to neonatal units for treatment. The death rate of all included infants was 0.74%.</p><p><b>CONCLUSIONS</b>The proportion of preterm births was higher in 2005 than in 2002-2003. The proportion of cesarean section deliveries was much higher in urban China than in most other Asian countries and America.</p>

Maxillomandibular advancement for obstructive sleep apnea/hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore effectiveness of maxillomandibular advancement (MMA) in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>MMA was performed in 10 OSAHS patients with mandibular dysplasia diagnosed by mandibular protrusion angle (SNB) < 75 degrees and a posterior airway space (PAS) < 11 mm. Six patients had uvulopalatopharyngoplasty (UPPP) also. Six patients had over 6 months postoperative follow up.</p><p><b>RESULTS</b>The blood loss was about 250-600 ml in the operation, and the serious complications didn't happen. The patients were satisfied with the postoperative facial change. Based on success criteria of 2009, of 5 patients showed highly responsive result and 1 patient was responsive (valid). rate was 83% and the responsive rate 100%. The snoring loudness score and Epworth sleepy score were reduced from preoperative 8 (6-10) and 15 (11-24) to postoperative 2 (0-4) and 5 (1-8). AHI was reduced from preoperative 52.2 (23.7-83.8) to postoperative 12.6 (7.6-31.8), lowest mean oxygen saturation increased from 0.64 (0.57-0.83) to 0.82 (0.78-0.93). Percentage of time with oxyhemoglobin saturation below 0.90 (CT90) reduced from 21.0% (12.0%-37.2%) to 2.0% (0%-8.0%).</p><p><b>CONCLUSIONS</b>MMA is effective for the OSAHS patients with mandibular dysplasia.</p>

Effectiveness and related factors of Z-palatopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and related factors of Z-palatopharyngoplasty for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Thirty four OSAHS patients with graded 1-3 tonsil, posterior airway space (PAS) > or = mm , Friedman II and III oropharyngeal airway were included in this study, all cases had Z-palatopharyngoplasty. The follow up was at least 6 months postoperatively. Measurement parameters of responders and nonresponders were analyzed.</p><p><b>RESULTS</b>According to related criterion of China, cure rate was 35.3%, accumulative total excellence rate 64.7% and accumulative valid rate 70. 6%. The cured and excellence patients were considered as responders, the other as nonresponders. The lowest oxygen saturation (LSaO2), percentage of time with oxyhemoglobin saturation below 0.90 (CT90), mandibular plane angle (MPA), mandibular body length, position of tongue and Friedman clinical stage are statistically significant between responder and nonresponder. The best cut points of LSaO2, CT90 and MPA were 0.72, 22.80% and 29.40 degrees respectively. The logistic regression showed that Friedman stage and MPA entered into equation, which was Y = ln [P/(1-P)] = -122.85 + 31.57X1 + 1.01X2, if setting X1 as Friedman stage, and X2 as MPA.</p><p><b>CONCLUSIONS</b>Z-palatopharyngoplasty is effective surgical approach for OSAHS patients with posterior airway space (PAS) > or = 11 mm. The affective factors of Z-palatopharyngoplasty included LSaO2, CT90, MPA, mandibular body length, position of tongue and Friedman clinical stage. Among them, the mandibular plane angle and Friedman clinical stage were predominant factors.</p>

Relationship between alveolar epithelial type II cells and pulmonary surfactant protein A levels in young rats with acute lung injury / 中国当代儿科杂志

<p><b>OBJECTIVE</b>This study examined the relationship between the ultrastructural alterations of alveolar epithelial cells type II (AEC-II) and pulmonary surfactant protein A (SP-A) levels in the lung tissue of young rats with acute lung injury (ALI) in order to explore the possible mechanism of ALI.</p><p><b>METHODS</b>Forty-eight young Sprague-Dawley rats were randomly divided into control and ALI groups. The rats in the ALI group were intraperitoneally injected with 4 mg/kg of lipopolysaccharide (LPS) in order to induce ALI. The control subjects were injected with the same volume of normal saline. Rats were sacrificed at 24, 48 and 72 hrs after LPS or NS injection. Lung samples were obtained from the lower parts of the left lung and fixed with 2.5% glutaraldehyde for transmission electron microscope examination and for Western blot test of SP-A.</p><p><b>RESULTS</b>The microvilli of AEC-II disappeared 24 hrs after LPS injection. After 24 and 48 hrs of LPS injection, lamellar body (Lb) increased in number, enlarged in size and reduced in density, and the ring-like arrangement of Lb was present. By 48 hrs after LPS injection, giant Lb with vacuole-like deformity appeared. The contents of lung SP-A in the ALI group 24 hrs (6.52+/-0.62 vs 5.02+/-0.35; P<0.01) and 48 hrs (6.65+/-0.62 vs 5.01+/-0.36; P<0.01) after LPS injection were significantly higher than those in the control group. By 72 hrs after LPS injection, Lbs ruptured and were reduced in number. The shape of the nuclei was irregular and the border was blurred. The content of lung SP-A was greatly reduced in the ALI group 72 hrs after LPS injection compared with that in the control group (3.87+/-0.50 vs 5.22+/-0.36; P<0.01).</p><p><b>CONCLUSIONS</b>The alterations of AEC-II and lung SP-A were time-dependent in young rats with ALI induced by LPS. In the early stage of ALI, the lung SP-A content showed a compensatory increase. With the increasing injury of AEC-II cells, the secretion of SP-A presented with a decompensation and the lung SP-A content decreased. This may be one possible mechanism for the development of ARD.</p>

Genetic polymorphism of surfactant protein A in neonatal respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of gene expression of surfactant protein A in Chinese premature infants and the association between surfactant protein A and the risk of neonatal respiratory distress syndrome (RDS).</p><p><b>METHODS</b>Vein-blood samples (2 mL) from 18 Chinese premature infants with RDS and 28 controls were assayed for SP-A genotypes 6A2, 6A3, 1A0 and 1A1 by SSCP.</p><p><b>RESULTS</b>The frequency of allele distribution of SP-A1 allele 6A2 and 6A3 was 0.50 and 0.056 respectively in the RDS group and was 0.214 and 0.107 in the control group. Compared with the controls, SP-A1 allele 6A2 was over-represented in the RDS group (P<0.05). In contrast, SP-A1 allele 6A3 tended to be under-represented in the RDS group but there was no statistical difference when compared with the controls. The frequency of allele distribution of SP-A2 allele 1A0 and 1A1 was 0.722 and 0.667 respectively in the RDS group and was 0.679 and 0.821 respectively in the control group. There were no significant differences in the distribution frequency of SP-A2 allele 1A0 and 1A1 between the two groups. In the infants born at gestation >32 weeks, SP-A1 allele 6A2 was over-represented in the RDS group compared with the control group (frequency: 0.56 vs 0.15; P<0.05).</p><p><b>CONCLUSIONS</b>The frequency of SP-A1 allele 6A2 and 6A3 was low, in contrast, the frequency of SP-A2 allele 1A0 and 1A1 was high in normal Chinese premature infants. SP-A1 allele 6A2 may be a susceptible gene for RDS.</p>

Effect of dexamethasone on the content of pulmonary surfactant protein D in young rats with acute lung injury induced by lipopolysaccharide / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Pulmonary surfactant protein-D (SP-D) is regarded as a valuable biomarker in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). This study was to explore the changes of SP-D content in lung tissue following ALI and the effect of dexamethasone (Dex) on the SP-D content in young rats.</p><p><b>METHODS</b>One hundred and forty-four 21-day-old Sprague-Dawley rats were randomly assigned into control, ALI and Dex-treated groups. ALI was induced by intraperitoneal injection of lipopolysaccharide (LPS) (4 mg/kg) in the rats from the ALI and Dex-treated groups. Normal saline was given for the control group. Dex (5 mg/kg) was administered 1 hr after LPS injection in the Dex-treated group. At each time interval of 6, 12, 24, 36, 48 and 72 hrs after LPS injection, eight rats of each group were randomly chosen and sacrificed. Western blot was employed to detect the content of SP-D in lung tissues.</p><p><b>RESULTS</b>The pulmonary SP-D content decreased significantly at 36, 48 and 72 hrs after LPS administration in the ALI group, and reduced to a nadir (0.92 +/-0.11 vs 3.27 +/- 0.52) at 48 hrs compared with that of the control group (P < 0.01). The SP-D content in the Dex-treated group increased significantly at 36,48 and 72 hrs after LPS administration when compared with the ALI group (P < 0.01). A significant difference in the SP-D content between the Dex-treated and the control group was noted only at 72 hrs after LPS administration (P < 0.05).</p><p><b>CONCLUSIONS</b>The SP-D content in lung tissue was reduced following ALI in young rats at the early stage. Early administration of Dex can significantly increase the pulmonary SP-D content.</p>

Effectiveness of combined surgery for treating severe obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the efficiency of a comprehensive surgical approach of genioglossus advancement and hyoid suspension (GAHM) plus uvulopalatopharyngoplasty (UPPP) for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS) and to evaluate related factors on surgery outcomes.</p><p><b>METHODS</b>Eighteen patients with severe OSAHS (apnea hypopnea index, AHI > 40/h) confirmed with polysomnography received genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty. The obstruction in both the oropharynx and the hypopharynx were evaluated by preoperative physical examination, fiberoptic pharyngolaryngoscopy, cephalometry, and computed tomography of the upper airway. The follow up was at least 6 months postoperatively. The Wilcoxon signed rank test was used to compare the preoperative and postoperative results by SPSS 11.0 for windows. The Mann-Whitney test was used to analyze the difference between responders and nonresponders.</p><p><b>RESULTS</b>The follow up time ranges from 6 to 24 months, there were statistically significance in all but body mass index (BMI) between preoperative and postoperative measurements. Mean AHI was reduced from preoperative (x +/- s, 63.8 +/- 16.3)/h to postoperative (23.6 +/- 19.5)/h, lowest mean oxygen saturation increased from 0.72 +/- 0.07 to 0.81 +/- 0.13(x +/- s). According to criterion at home, the 6-month rate of responder is 83%, if AHI <20/h and decreased by at least 50% as success, the rate of success is 67%. The age, posterior airway space (PAS) and percentage of time with oxyhemoglobin saturation below 0.90 (CT90) were (39.1 +/- 7.4) years, (8.3 +/- 0.9) mm, (18.5 +/- 10.9)% in responder, while (52.5 +/- 9.4) years, (6.8 +/- 1.3) mm, (37.7 +/- 23.6) % in nonresponder, and there are statistically significant between responder and nonresponder.</p><p><b>CONCLUSIONS</b>GAHM plus UPPP is effective surgical approach for patients with severe OSAHS who suffer from oropharyngeal and hypopharyngeal obstruction. Age, PAS and CT90 were possible affective factors on surgical outcomes.</p>

Etiology of laryngeal stridor in neonates: analysis of 16 cases / 中华儿科杂志

<p><b>OBJECTIVE</b>To reduce misdiagnosis and explore etiology of laryngeal stridor in neonates.</p><p><b>METHODS</b>Sixteen neonates with laryngeal stridor were reviewed. All the patients were examined with CT scan for larynx and lungs and some were examined with laryngoscopy. Laboratory examination and chromosome analysis were also done in all or some patients.</p><p><b>RESULTS</b>All the 16 neonates were diagnosed before admission as congenital simple laryngeal stridor in other hospitals. Of the 16 neonates with laryngeal stridor, 5 (31%) had thyroglossal ductal cyst, 1 (6%) neonate with cri du chat (5p(-)) syndrome, 2 (13%) neonates with Pierre-Robin syndrome and the rest 8 (50%) were suspected of congenital simple laryngeal stridor.</p><p><b>CONCLUSION</b>Neonates with laryngeal stridor are easily misdiagnosed; neonatal thyroglossal duct cyst is one of common causes. The diagnosis for a congenital simple laryngeal stridor should be carefully made excluding the possibility of related diseases. The authors recommend that laryngoscopy and CT scan for larynx should be performed in the neonates with laryngeal stridor.</p>