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Apnea, sleep, obstructive [keywords]
- Overweight and obesity in patients with cystic fibrosis: A center-based analysis. [JOURNAL ARTICLE]
- Pediatr Pulmonol 2014 Apr 23.
Cystic fibrosis (CF) has long been associated with malnutrition. However, due to early diagnosis, nutritional supplements, and increased prevalence of obesity in the general population, overweight, and obesity in the CF patient population is becoming a concern. The aim of this study was to determine the prevalence of obesity and overweight in patients with CF seen at our center, to analyze factors associated with nutritional status, to evaluate the relation between nutritional status and lung function, and to document any adverse health outcomes.The CF Patient Registry was queried for patients aged 2-18 who were seen at our center between June 2011 and June 2012. Nutritional statuses of patients were classified in accordance with the CF Foundation guidelines. Analysis of variance was utilized to analyze the differences in lung function between the five weight status groups.Of the 226 patients with CF aged 2-18 years, 129 (57%) had a BMI percentile consistent with a healthy weight status, 16 (7%) were in nutritional failure, 28 (12%) were at risk of nutritional failure, 35 (15%) were overweight, and 18 (8%) were obese. Based on fecal elastase levels, 50% of the overweight patients and 20% of the obese patients were pancreatic insufficient. FEV1 % predicted was lowest in patients with nutritional failure (P = 0.005). No significant differences were noted between the other four weight groups. In our obese and overweight population, three patients have impaired glucose tolerance, one has CF-related diabetes (CFRD) with fasting hyperglycemia, three have hypertension, and one has obstructive sleep apnea (OSA).The prevalence of overweight and obesity in our CF center is noteworthy, and a significant number of the patients were pancreatic insufficient. In our patient population, overweight, and obesity were not associated with further improvement of lung function. Nutritional approaches need to address the adverse outcomes of overweight and obesity. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
- Is the grading system of the severity of the OSAHS used presently rational or not?: from the view of incidence of hypertension in different severity groups. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Apr 23.
The grading system of the severity of obstructive sleep apnea hypopnea syndrome (OSAHS) used presently showed that the severe OSAHS had an extensive range of apnea hypopnea index (AHI) (≥30, even over 100). So this grading system is not rational. From Jan 1999 to June 2011, there were 2,618 patients complaining of snoring took the polysomnography. The patients were divided into 11 groups according to their AHI. Frequencies of OSAHS with hypertension in each group were tested using crosstabs. The incidence of hypertension was increased as the increasing of AHI. Crosstab analysis showed that there were four cutoff points of AHI (5, 30, 50, 100). There was a significant difference in the incidence of hypertension between the groups of AHI more than the cutoff point and AHI less than the cutoff point. So from the view of hypertension in each group, we recommend that the AHI <5 should be considered as normal or simple snorer, AHI = 5-30 as mild degree of OSAHS, AHI = 30-50 as moderate degree of OSAHS, AHI = 50-100 as severe degree of OSAHS, and AHI ≥100 as profound degree of OSAHS.
- The Association of 5-HT2A, 5-HTT, and LEPR Polymorphisms with Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis. [Journal Article]
- PLoS One 2014; 9(4):e95856.
A consensus has not been reached regarding the association of several different gene polymorphisms and susceptibility to obstructive sleep apnea syndrome (OSAS). We performed a meta-analysis to better evaluate the associations between 5-HT2A, 5-HTT, and LEPR polymorphisms, and OSAS.5-HT2A, 5-HTT, and LEPR polymorphisms and OSAS were identified in PubMed and EMBASE. The pooled odd rates (ORs) with 95%CIs were estimated using a fixed-effect or random-effect models. The associations between these polymorphisms and OSAS risk were assessed using dominant, recessive and additive models.Twelve publications were included in this study. The -1438 "A" allele of 5-HT2A was identified as a candidate genetic risk factor for OSAS (OR: 2.33, 95%CI 1.49-3.66). Individuals carrying the -1438 "G" allele had a nearly 70% reduced risk of OSAS when compared with AA homozygotes (OR: 0.30, 95%CI 0.23-0.40). There was no significant association between 5-HT2A 102C/T and OSAS risk, using any model. The "S" allele of 5-HTTLPR conferred protection against OSAS (OR: 0.80, 95%CI 0.67-0.95), while the "10" allele of 5-HTTVNTR contributed to the risk of OSAS (OR: 2.08, 95%CI: 1.58-2.73). The "GG" genotype of LEPR was associated with a reduced risk of OSAS (OR: 0.39, 95%CI 0.17-0.88).The meta-analysis demonstrated that 5-HTR-1438 "A" and 5-HTTVNTR "10" alleles were significantly associated with OSAS. The "S" allele of 5-HTTLPR and the "GG" genotype of LEPR conferred protection against OSAS. Further studies, such as Genome-Wide Association study (GWAS), should be conducted in a large cohort of OSAS patients to confirm our findings.
- Positive airway pressure in patients with coronary artery disease and obstructive sleep apnea syndrome. [Journal Article]
- J Cardiovasc Med (Hagerstown) 2014 May; 15(5):402-6.
We designed a prospective nonrandomized study aiming at assessing the impact of continuous positive airway pressure (CPAP) after a new diagnosis of obstructive sleep apnea syndrome (OSAS) in patients with coronary artery disease (CAD).Consecutive patients referred to coronary angiography underwent an overnight sleep study during their hospital stay. Among those with angiographically confirmed CAD and a new diagnosis of moderate or severe OSAS, we compared the 3-year major adverse cardiac or cerebrovascular event (MACCE)-free survival stratified by CPAP at discharge.Of 496 patients undergoing an overnight sleep study, 129 had angiographically confirmed CAD and presented with moderate or severe OSAS. The incidence of 3-year MACCE was significantly lower in the CPAP-treated group (n = 17) than in the untreated group (n = 112; 12 vs. 44%, P = 0.02). After adjusting for differences in baseline characteristics, CPAP was significantly associated with a decreased risk of MACCE [adjusted hazard ratio 0.18, 95% confidence interval (CI) 0.04-0.78, P = 0.02]. Among men, CPAP was associated with a significant 3-year risk reduction in MACCE (adjusted hazard ratio 0.12, 95% CI 0.02-0.87, P = 0.04), whereas no significant benefit of CPAP was seen in women (adjusted hazard ratio 2.1, 95% CI 0.10-41.6, P = 0.63). The statistical interaction between CPAP and sex trended to be significant (adjusted P for interaction = 0.10).In patients with OSAS and CAD, the initiation of CPAP is associated with a significant reduction in MACCE compared with patients left untreated.
- [Effects of continuous positive airway pressure treatment of inflammatory factors in patients with overlap syndrome]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2014 Feb 14; 94(6):416-9.
To explore the effects of continuous positive airway pressure (CPAP) treatment on the serum levels of associated inflammatory factors in patients with overlap syndrome (OS).Seventy-four patients with obstructive sleep apnea syndrome (OSAS) or chronic obstructive pulmonary disease (COPD) or overlap syndrome (OS) were recruited from Department of Respirology and Affiliated Sleep Center of our hospital from March 2012 to September 2013. They were divided into OSAS (n = 25), COPD (n = 26) and OS (n = 23) groups according to the results of polysomnography (PSG) and spirometry. By enzyme linked immunosorbent assay (ELISA), the serum levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and asymmetric dimethylarginine (ADMA) were measured and compared before and at Day 30 post-CPAP in OSAS and OS groups.At pre-CPAP, there was no statistical difference in serum levels of CRP ((7.2 ± 6.6),(8.4 ± 6.8),(8.5 ± 7.9) mg/L) and TNF-α ((33 ± 13),(52 ± 34),(41 ± 33) ng/L) among OSAS, COPD and OS groups (all P > 0.05).However, serum ADMA level in OSAS group were significantly lower than those in COPD group ((0.50 ± 0.08) vs (0.71 ± 0.31) µmol/L, P = 0.002). Compared with before and at Day 30 post-CPAP, although no significant difference existed in serum levels of ADMA (all P > 0.05), at Day 30 post-CPAP there were significantly lower serum levels of CRP ((4.5 ± 4.2) and (5.5 ± 4.1) mg/L) and TNF-α levels ((31 ± 9) and (35 ± 24) ng/L) than those pre-CPAP in OSAS and OS groups respectively (all P < 0.05).No significant difference existed between OSAS and OS groups (all P > 0.05).CPAP treatment significantly reduces the serum levels of CRP and TNF-α so as to improve inflammation responses in OS and OSAS patients.
- [Effects of continuous positive airway pressure on daytime sleepiness in patients with severe obstructive sleep apnea syndrome]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2014 Feb 14; 94(6):412-5.
To evaluate the effects of continuous positive airway pressure (CPAP) on daytime sleepiness in patients with severe obstructive sleep apnea syndrome (OSAS).Retrospective evaluations were performed for 70 consecutive patients at the medical sleep center, West China Hospital, Sichuan University from May 2013 to October 2013. They were all diagnosed with severe OSAS and underwent overnight CPAP titration. Their mean age and body mass index (BMI) were (42.7 ± 8.4) years and (29.2 ± 4.2) kg/m(2) respectively. The sleep structure, hypoxia and objective sleepiness was compared between baseline and CPAP titration. And correspondence analysis was performed between multiple sleep latency tests (MSLT) and other sleep and expiratory parameters.Comparing to the baseline polysomnogram (PSG) levels, CPAP titration significantly decreased apnea hypopnea index (AHI) ((4.4 ± 2.7) vs (67.7 ± 18.9)/h), significantly shortened the longest apnea time (24.0 (16.5, 29.6) vs 61.3(51.0, 74.8) s) and raised the lowest oxygen saturation ((84.8 ± 8.8)% vs (54.4 ± 18.7)%).Furthermore, the percentage of stage 3 (N3%) (18.2(12.5, 25.6)% vs 2.4 (0.1, 8.2)%), the percentage of stage rapid eye movement (REM) sleep (REM%) ((22.3 ± 7.7)% vs (12.7 ± 5.8)%) and sleep perception improved significantly (89.1(88.3, 91.2)% vs 82.7(82.7, 87.0)%, all P < 0.05).Furthermore, CPAP also significantly improved their mean sleep latency of multiple sleep latency test (MSLT) ((8.5 ± 3.8) vs (4.8 ± 2.3) min, P < 0.05); the mean sleep latency of MSLT was negatively correlated with AHI, the percentage of stage 1 (N1%) and the longest apnea (r = -0.501,-0.308,-0.309,-0.501, all P < 0.01); but positively correlated with REM%, N3%, mean oxygen saturation and minimal oxygen saturation during CPAP titration (r = 0.235,0.394,0.398,0.440, all P < 0.05).CPAP significantly improves nocturnal oxygen desaturation, sleep architecture and objective sleepiness in patients with severe OSAS.
- [Association between serum lipoprotein lipase level and dyslipidemia in patients with obstructive sleep apnea syndrome]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2014 Feb 14; 94(6):403-7.
To explore the association between serum lipoprotein lipase (LPL) level and dyslipidemia in patients with obstructive sleep apnea syndromes (OSAS).Overnight polysomnography (PSG) was performed for 158 patients with snoring at our Sleep Center from June 2011 to April 2013. Based on the results of apnea-hypopnea index (AHI) assessment, they were divided into 4 groups: primary snoring (AHI<5/h, n = 26), mild (5/h ≤ AHI ≤ 15/h, n = 23), moderate (15/h < AHI ≤ 30/h, n = 31) and severe (AHI>30/h, n = 78) OSAS. According to body mass index (BMI), primary snoring group was further divided into normal BMI and overweight (obese) groups. The level of LPL was determined by enzyme-linked immunosorbent assay (ELISA) and the correlations were observed with OSAS, blood total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL).In normal weight OSAS patients, the relationship was analyzed between different conditions, plasma lipid and serum LPL.In 49 OSAS groups, the level of LPL was observed after 6-month continuous positive airflow pressure (CPAP).From a comparison of four groups, it was found that AHI, night blood lowest oxygen saturation (L-SaO2) and time ratio of lowest SaO2<90% (TS90%) had statistical significance (all P < 0.01). The serum LPL gradually decreased in four groups. Compared with primary snoring group, there was a significant increase of serum LPL level in severe OSAS group ((37 ± 15) vs (45 ± 17) µg/L, P = 0.022). And severe OSAS group had significantly higher serum levels of TC, TG and LDL (P = 0.025,0.001,0.049).HDL of OSAS group was significantly lower than that of primary snoring group (all P < 0.05). Additionally, after adjustment for BMI and age, serum LPL levels showed significant negative correlations with TC and LDL (r = 0.221,0.199) .Serum LPL level was negative correlated with AHI and TS90 % and oxygen decrease index (ODI) (r = 0.231,0.228,0.184). Compared with normal BMI patients, there was a significant increase of VLDL ((0.77 ± 0.30) vs (0.46 ± 0.23) mmol/L, P = 0.034) and decrease of LPL ((37 ± 10) vs (523 ± 23) µg/L, P = 0.047) in weight (obesity) in primary snoring group. Compared with primary snoring group in normal BMI groups, there was a significant increase of TG,VLDL and decrease of LPL, HDL in OSAS group (all P < 0.05). The level of LPL significantly increased after 6-month CPAP ((60 ± 6) vs (38 ± 3) µg/L, P = 0.001).Serum LPL and plasma lipid decrease in OSAS patients. And serum LPL level is correlated significantly with the severity of OSAS and nocturnal hypoxia. Thus LPL may play some roles in dyslipidemia of OSAS patients.
- Sleep disorders in combat-related PTSD. [JOURNAL ARTICLE]
- Sleep Breath 2014 Apr 22.
We sought to assess the rate of sleep complaints and sleep disorders among active duty soldiers with deployment-related PTSD and to determine whether any clinical features differentiated those with sleep disorders.Retrospective review of consecutive soldiers diagnosed with PTSD. We recorded subjective measures of sleep and polysomnographic data. We compared clinical and demographic variables including psychoactive medication use, psychiatric comorbidity, and combat-related traumatic injury with the presence of sleep disorders.One hundred thirty patients were included (91.5 % male, mean age of 35.1 ± 10.6 years, mean body mass index (BMI) 28.9 ± 4.4 Kg/m(2)). About 88.5 % had comorbid depression, with the majority (96.2 %) taking psychoactive medications (mean 3.4 ± 1.6 medications per patient). Over half of the cohort suffered combat-related traumatic physical injuries (54.6 %). The obstructive sleep apnea syndrome (OSAS) was diagnosed in 67.3 % (80 % of the cohort underwent polysomnography), with a mean apnea hypopnea index of 24.1 ± 22.8 events/hour and a mean oxygen saturation nadir of 84.2 ± 5.7 %. OSAS was significantly more common in the non-injured soldiers (72.9 vs. 38.0 %, p < 0.001). In multivariate analysis, absence of physical injury showed a trend towards predicting OSAS.Sleep complaints are common among soldiers with PTSD. We observed significantly higher rates of OSAS among those without physical injuries, raising the possibility that underlying sleep-disordered breathing is a risk factor for the development of PTSD. This potential association requires further validation.
- [Cardiovascular morbidity associated with obstructive sleep apnea syndrome.] [REVIEW]
- Rev Mal Respir 2014 Apr; 31(4):375-385.
The obstructive sleep apnoea syndrome (OSAS) had become a major public health concern in modern society due to its high prevalence but, above all, to its associated morbidity, especially cardiovascular.Untreated OSAS is associated with an increased incidence of fatal (myocardial infarction and stroke) (odds ratio: 2.87) and non-fatal cardiovascular events (myocardial infarction, stroke, coronary artery bypass surgery and coronary angiography) (odds ratio: 3.17). Moreover, the prevalence of hypertension in patients with OSAS is high, between 35 and 80%. The pathophysiological mechanisms leading to these complications are mainly due to intermittent hypoxia secondary to repeated episodes of apnoea/hypopnoea during sleep. These mechanisms include sympathetic hyperactivation, impairment of vasomotor reactivity, vascular inflammation, oxidative stress and metabolic disorders. In patients with OSAS, the impact of continuous positive pressure is proven in terms of prevention of cardiovascular events although blood pressure reduction is limited. Obviously these effects are proportional to observance.OSAS does increase the cardiovascular risk, independently of other risk factors. Although the impact of treatment is relatively low in decreasing blood pressure, it seems essentially effective in preventing cardiovascular morbidity. Therefore, OSAS screening, and the association of specific treatments in cardio-metabolic patients and OSAS patients respectively, should be included in clinical strategies.
- [Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation.] [REVIEW]
- Rev Mal Respir 2014 Apr; 31(4):312-322.
Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to daytime assessment. This paper reports the findings of an international consensus group, which systematically analysed nocturnal polygraphic or polysomnographic tracings recorded with either volume-cycled or pressure-cycled ventilators. A systematic description of nocturnal respiratory events, which occur during NIV, is proposed: leaks, obstruction at different levels of the upper airway (glottis and/or pharynx), with or without decrease of respiratory drive and asynchrony.