Obstructive sleep apnea in relation to beat-to-beat, reading-to-reading, and day-to-day blood pressure variability.

We investigated blood pressure (BP) variability as assessed by beat-to-beat, reading-to-reading and day-to-day BP variability indices in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). In 786 hospitalized hypertensives (mean age, 53.2 years; 42.2% women), we performed 10-min beat-to-beat (n = 705), 24-h ambulatory (n = 779), and 7-day home BP (n = 445) measurements and the full overnight polysomnography. Mild, moderate and severe OSAHS were defined as an apnea-hypopnea index of 5-14, 15-29, and ≥ 30 events per hour, respectively. BP variability indices including variability independent of the mean (VIM), average real variability (ARV), and maximum-minimum difference (MMD), were compared across the OSAHS severity groups. In univariate analysis, beat-to-beat systolic VIM and MMD, reading-to-reading asleep systolic and diastolic ARV and MMD increased from patients without OSAHS, to patients with mild, moderate and severe OSAHS. This increasing trend for beat-to-beat systolic VIM and MMD remained statistically significant after adjustment for confounders (P ≤ 0.047). There was significant (P ≤ 0.039) interaction of the presence and severity of OSAHS with age and body mass index in relation to the beat-to-beat systolic VIM and MMD and with the presence of diabetes mellitus in relation to asleep systolic ARV. The association was stronger in younger (age < 50 years) and obese (body mass index ≥ 28 kg/m²) and diabetic patients. None of the day-to-day BP variability indices reached statistical significance (P ≥ 0.16). BP variability, in terms of beat-to-beat systolic VIM and MMD and asleep reading-to-reading asleep systolic ARV, were higher with the more severe OSAHS, especially in younger and obese and diabetic patients.

A higiene do sono como início do tratamento do ronco primário e síndrome da apneia e hipopneia do sono / Sleep hygiene as a starting point for the treatment of primary snoring and sleep apnea and hypopnea syndrome

O valor inestimável ao sono, devido a estudos que comprovaram sua importância à saúde e à qualidade de vida. Tais conhecimentos levaram a identificação de doenças específicas, dentre elas a Síndrome de Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS). Esta doença incide na obstrução das vias aéreas superiores durante o sono, acarretando paradas na respiração e consequências sistêmicas. Estudos atuais e características que interferem na qualidade de vida dos sujeitos, tal como produtividade. O objetivo deste trabalho é o profissional saber que com atitudes cotidianas podemos anemizar o quadro necessitando dessa forma de um tratamento mais brando e de melhor acesso a todos(AU)

The priceless value of sleep, due to studies that have proven its importance to health and quality of life. Such knowledge led to the identification of specific diseases, among them the Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS). This disease focuses on obstruction of the upper airways during sleep, causing breathing stops and systemic consequences. Current studies and characteristics that inter the quality of life of subjects, such as productivity. The objective of this work is for the professional to know that with everyday attitudes we can anemize the condition, thus needing a milder treatment and better access to all(AU)

Thinning of the inner and outer retinal layers, including the ganglion cell layer and photoreceptor layers, in obstructive sleep apnea and hypopnea syndrome unrelated to the disease severity.

PURPOSE: The aim of this study was to analyze the segmented layers of the macula in patients with obstructive sleep apnea and hypopnea syndrome (OSAS) using spectral domain optical coherence tomography (SD-OCT). MATERIAL AND METHODS: This single-center, cross-sectional study included 31 OSAS patients and 31 age- and gender-matched control subjects. SD-OCT and overnight polysomnography were performed on all participants. The OSAS patients were categorized according to disease severity (mild, moderate, severe). The groups were compared in respect of each segmented macular layer through the use of segmentation software on SD-OCT. Total retinal thickness (RT), peripapillary retina nerve fiber layer (pRNFL) thickness, central corneal thickness (CCT) and intraocular pressure (IOP) values were also compared between the groups. RESULTS: Mean CCT (p:0.015) and nasal pRNFL values (p:0.042) were lower and mean IOP was higher (p:0.018) in OSAS patients than in the control group. The statistical analysis revealed significantly thinner total RT, inner retinal layers (IRL), outer retinal layers (ORL), photoreceptor layers (PRL) and ganglion cell layer (GCL) thicknesses in the OSAS groups compared to healthy subjects. No significant differences were found between the three OSAS subgroups in all segmented macular layers and pRNFL measurements. CONCLUSION: The results of this study showed relatively thinner nasal pRNFL, total RT, IRL, ORL, PRL and GCL layers in OSAS patients compared to healthy subjects. Moreover, this thinning of the segmented layers was unrelated to disease severity.

Serum adropin level is associated with endothelial dysfunction in patients with obstructive sleep apnea and hypopnea syndrome.

OBJECTIVE: Adropin is a recently discovered peptide hormone that plays a vital role in metabolism and cardiovascular-cerebrovascular function. The purpose of this study is to investigate the role of circulating adropin levels in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and further determine the relationship between serum adropin concentration and endothelial dysfunction in patients with OSAHS. METHODS: Forty polysomnography-diagnosed patients with OSAHS and 21 age and sex-matched healthy controls were enrolled in the current study. Serum adropin level, endothelial function parameters including flow-mediated dilatation (FMD) of brachial artery, endothelin-1 (ET-1), and nitric oxide (NO) were measured in all participants. RESULTS: Serum adropin levels were significantly lower in patients with OSAHS compared to the control subjects. FMD was lower and serum ET-1 levels were higher in patients with OSAHS compared to control subjects. No significant difference was seen in serum NO levels between the two groups. Multivariate linear regression analysis revealed that serum adropin level was positively associated with FMD and negatively correlated with AHI. Additionally, serum adropin levels were lower in patients with OSAHS who had endothelial dysfunction compared with those patients without endothelial dysfunction. The receiver operating characteristic (ROC) analysis showed that area under the curve (AUC) for serum adropin in predicting endothelial dysfunction status in patients with OSAHS was 0.815 (95% CI 0.680-0.951, p = 0.001). The cutoff value of serum adropin level was less than 235.0 pg/mL, which provided the sensitivity and specificity of 81% and 75%, respectively, for the detection of endothelial dysfunction in patients with OSAHS. CONCLUSION: Lower circulating adropin levels are closely associated with endothelial dysfunction in patients with OSAHS. Circulating adropin level may serve as an early biomarker to predict the development of endothelial dysfunction before the emergence of clinical symptoms in patients with OSAHS.

Correlation between sleepiness and anxiety,depression in patients with OSAHS / 中国基层医药

Objective To investigate the correlation between daytime sleepiness and anxiety,depression in patients with obstructive sleep apnea and hypopnea syndrome(OSAHS).Methods A total of 117 patients with sleep -snoring from September 2015 to September 2017 who admitted to the Department of Respiratory Medicine of Shengjing Hospital Affiliated to China Medical University were collected for general information.ESS,SDS,SAS questionnaire and polysomnography were detected.The differences between simple snoring and OSAHS group were compared,and the correlation between Epworth Sleepiness Scale (ESS),Self-rating Depression Scale (SDS),Self-rating Anxiety Scale(SAS) score was analyzed.Results The scores of ESS,SDS and SAS in the OSAHS group were (16.24 ± 3.82) points,(46.27 ± 9.01) points,(48.21 ± 9.44) points,respectively,which were higher than those in the simple snoring group [(6.0 ± 2.58) points,(35.50 ± 18.40) points,(36.55 ± 17.97) points] (t =-14.425,-2.521,-2.780,all P ＜ 0.05).There was a correlation between SDS or SAS score and ESS score in OSAHS group(r=0.419,0.313,all P ＜0.05).Conclusion The sleepiness and anxiety,depression in OSAHS patients is more severe than simple snoring;ESS score in OSAHS patients can reflect the severity of the disease,the degree of sleepiness in patients with OSAHS is related to depression and anxiety.

[The relationship between oxygen saturation and related respiratory events in patients with obstructive sleep apnea-hypopnea syndrome].

Objective:To explore the relationship between variation of hemoglobin saturation and related respiratory events in patients with obstructive sleep apnea and hypopnea syndrome (OSAHS).Method:According to the SaO2, the respiratory events were divided into two groups, followed or not followed the second events (SRE and N-SRE). Four features were extracted from SaO2 and compared within groups under SRE versus N-SRE, and comparisons were also developed between moderate patients and severe patients.Result:ΔSaO2, max, the duration and Dvmax was significantly higher in SRE than N-SRE (P< 0.01), while Nadir was significantly lower in SRE than N-SRE (P< 0.01). There was also significant difference in the blood oxygen index between moderate and severe patients. The change of SaO2 is correlated with the ventilation restoration. The results also suggest that the severity of the patient's condition will affect the change of SaO2 related indicators. Conclusion:This study provides information on the further study of ventilation restoration. Moreover, this study may provide a possible solution for the treatment of OSAHS.

Clinical analysis of pharyngeal musculature and genioglossus exercising to treat obstructive sleep apnea and hypopnea syndrome.

OBJECTIVE: To evaluate the effect of pharyngeal musculature and genioglossus exercising on obstructive sleep apnea and hypopnea syndrome (OSAHS). METHODS: We conducted a non-randomized retrospective clinical trial of 75 patients with OSAHS. Fifty-four patients were managed by exercising of the pharyngeal musculature and genioglossus (exercising group). Twenty-one patients, who refused to undertake any treatment, were defined as the control group. We took the Epworth Sleepiness Scale (ESS), checked patients' polysomnography, and took 320-detector computed tomography (CT) before treatment. Six and twelve months later, we made records of apnea hypopnea index (AHI), lowest arterial oxygen saturation (LSaO2), body mass index (BMI), the shortest sagittal diameter, and transverse diameter, and the effective rates of exercising were calculated and compared with the 21 patients without any treatment (control group) at the same time. SPSS 10.0 was used to analyze the data. RESULTS: Before treatment, the ESS value was 7.67; 6 and 12 months later, the values were 3.54 and 3.25, respectively in the exercising group. AHI was decreased to 15.36 after 6 months and 13.79 after 12 months from 22.84 at the beginning. LSaO2 values were up to 81.18% after 6 months and 81.93% after 12 months from 74.05% at the beginning. There were significant differences in ESS scores, AHI, and LSaO2 between pre-treatment and post-treatment in the exercising group (P<0.05). However, there was no statistical difference in all the parameters between 6 and 12 months of exercising. The effective rates were 70.37% and 74.07% after 6- and 12-month exercising, respectively. There were significant differences between the exercising and control groups (P<0.0001). There was no statistical difference in the effective rate of the exercising group between 6 and 12 months of exercising (P>0.05). At 12 months of exercising, the compliance of the anteroposterior pharyngeal wall of the retropalatal area was lower (P<0.01) than that before treatment. There was no significant change of BMI in either group. CONCLUSIONS: Exercising pharyngeal musculature and genioglossus is a kind of non-invasive and cost-effective method to treat some OSAHS patients, especially those who are old, without surgical complications, and especially mild and moderate OSAHS patients who do not want to take surgery and continuous positive airway pressure (CPAP) treatment. In addition, exercising pharyngeal musculature and genioglossus can be considered as remedial treatment of OSAHS to surgery and other therapies.

Association between 5-HT2A receptor polymorphisms and risk of obstructive sleep apnea and hypopnea syndrome: a systematic review and meta-analysis.

Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a common disorder with several predisposing factors, which may include genetic causes. Studies of the association of susceptibility to and severity of OSAHS with the polymorphisms of the 5-HTR 2A/2C genes have had low statistical power and have yielded inconsistent results. To clarify the association we perform a meta-analysis that combines the genotyping data from all eligible published studies. We quantitatively analyzed five publications, which included a pool of 633 cases and 512 controls, addressing the 5-HT receptor polymorphism and the risk of OSAHS. Hardy-Weinberg equilibrium (HWE) and the minor allele frequency of genetic frequency distributions for the controls were calculated. Differences in the distribution of genotypes between cases and controls were compared by odds ratios (ORs) with their 95% confidence intervals (CIs). For each genetic model, data were pooled using fixed- or random-effects models, depending on the inter-publication heterogeneity. Our results from pooled data showed that individuals carrying the 5-HTR 2A -1438G/A AA genotype had an increased risk of OSAHS (OR=3.69, 95% CI=1.92-7.08) compared with those carrying the GG genotype. Significant results were also reached under a recessive model (OR=3.16, 95% CI=2.33-4.30, p<0.01). However, the results declined to an OR of 2.16 (95% CI=0.9-5.21) in a homozygote model when the studies were restricted to HWE. No statistically significant results concerning an association of the 102C/T polymorphism of the 5-HTR 2A gene with OSAHS were reached (p>0.05 for each genetic model). This meta-analysis suggested that the 5-HTR 2A -1438G/A genotype might modulate an elevated risk of OSAHS. No association of the 5-HTR 2A 102C/T genotype polymorphism with OSAHS was established. However, some publications exhibited HWE bias, which might influence the reliability of pooled data. Further studies in this field, using larger samples, better designs and additional ethnicities, are warranted.