코골이 및 폐쇄성 수면 무호흡증의 두부 규격 방사선 계측학적 기여 인자

Objective:To examine the changes of carotid artery elasticity in patients with obstructive sleep apnea（OSA） before and after continuous positive airway pressure（CPAP） treatment by ultrafast pulse wave velocity（UFPWV） technique，and to explore the influencing factors of carotid artery elasticity in OSA patients，and to provide guidance for clinical prevention and treatment of cardiovascular complications. Methods：Fifty cases of moderate and severe OSA patients diagnosed with PSG monitoring from January 2020 to December 2020 were collected as the OSA group，at the same time，40 healthy subjects who participated in physical examination and matched with OSA group in age and gender were selected as the control group.The OSA group was treated with CPAP for 12 weeks.Clinical indicators，carotid intima-media thickness（IMT），and pulse wave velocity at the beginning of systole（PWVBS） and pulse wave velocity at the end of systole（PWVES） were recorded in the control group，and the above data were collected in the OSA group before and after treatment.The changes of various indicators between the control group and the OSA group，and between the OSA group before and after treatment were compared.The correlative factors and influencing factors of PWVBS and PWVES are analyzed. Results：The serum lipid indexes，IMT，PWVBS and PWVES in OSA group were higher than those in control group（P<0.05）.Comparison between post-treatment and pre-treatment with CPAP in OSA group：PWVBS，PWVES，apnea hypopnea index（AHI），blood oxygen saturation（SaO₂） less than 90% of the time，the percentage of monitoring time when SaO₂ was less than 90%（T90），low density lipoprotein cholesterol（LDL-C）and triglyceride（TG） were decreased（P<0.05）.Lowest blood oxygen saturation（LSaO₂） and high density lipoprotein cholesterol（HDL-C） increased（P<0.05）.Age，systolic blood pressure，IMT，AHI，T90 and time of oxygen saturation below 90% were positively correlated with PWVBS and PWVES，while HDL-C and LSaO₂ were negatively correlated with them（P<0.05）.The risk factors of PWVBS and PWVES included systolic blood pressure，AHI，TC，T90.Conclusion：Moderate and severe OSA can reduce arterial elasticity.CPAP can improve carotid artery elasticity function in patients with OSA.UFPWV technique is more sensitive to quantitatively evaluate the changes of arterial elasticity in patients with OSA than traditional two-dimensional ultrasound.

Obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis and alterations in glucose metabolism with increased risk for type 2 diabetes. The aim of the current study was to compare morning plasma cortisol levels and glucose metabolism parameters between moderate (apnea-hypopnea index (AHI): 15-30events/h) and severe OSA patients (AHI >30events/h), with respective controls. A total of 56 male OSA patients, 24 moderate (AHI=21.1±5.3) and 32 severe (AHI=49.7±18.1), underwent a full-night polysomnography, oral glucose tolerance test (OGTT), and measurement of morning plasma cortisol levels. These groups were compared to 20 matched subjects in a control group. Morning plasma cortisol levels were statistically lower in severe OSA group than in moderate OSA and control groups (303.7±93.5 vs. 423.9±145.1 vs. 417.5±99.8pmol/L, P<0.001). Significant negative correlations were found between morning plasma cortisol levels and AHI (r=-0.444, P=0.002), as well as oxygen desaturation index (r=-0.381, P=0.011). Fasting plasma glucose (5.0±0.5 vs. 5.4±0.7 vs. 4.9±0.6mmol/L, P=0.009) was higher in the severe OSA group compared to moderate OSA and controls. Homeostasis model assessment insulin resistance (HOMA-IR) was higher in the severe OSA group compared to moderate OSA and controls (4.6±3.7 vs. 2.7±2.0 and 2.2±1.8, respectively, P=0.006). In conclusion, our study showed that morning plasma cortisol levels measured at 8a.m. were significantly lower in severe OSA patients than those in moderate OSA group and controls. Morning plasma cortisol levels showed a negative correlation with AHI and oxygen desaturation index. Additionally, this study confirmed the evidence of glucose metabolism impairment in moderate and severe OSA patients, with more pronounced effect in the severe OSA patients group.

Obstructive sleep apnea (OSA) can lead to serious complications such as coronary heart disease and hypertension due to oxidative stress. Sestrin2 expression is upregulated under conditions of oxidative stress. This study aimed to explore whether Sestrin2 was involved in OSA. OSA and healthy control subjects were recruited and matched with age, gender, and body mass index (BMI). Plasma Sestrin2 levels were measured and compared. A multivariate stepwise regression model was used to detect the relationship between Sestrin2 and other variable factors. The Sestrin2 levels were compared between before and after four weeks treatment by nasal continuous positive airway pressure (nCPAP) in severe OSA patients. Fifty-seven subjects were divided into two groups: control group (39.33 ± 9.40 years, n = 21) and OSA group (38.81 ± 7.84 years, n = 36). Plasma Sestrin2 levels increased in the OSA group (control group 2.06 ± 1.76 ng/mL, OSA group 4.16 ± 2.37 ng/mL; P = 0.001). Sestrin2 levels decreased after four-week nCPAP treatment (pre-nCPAP 5.21 ± 2.32 ng/mL, post-nCPAP 4.01 ± 1.54 ng/mL; P = 0.004). Sestrin2 was positively correlated with apnea/hypopnea index (AHI) oxygen desaturation index, while negatively correlated with mean oxygen saturation. Moreover, these correlations remained unchanged after adjusting for gender, age, waist-to-hip ratio, and body mass index. Multiple regression analysis showed that there was an association between Sestrin2 and AHI. Our findings suggest that Sestrin2 is involved in OSA. The increase of plasma Sestrin2 is directly related to the severity of OSA. To some extent, Sestrin2 may be useful for determining the severity of OSA and monitoring the effect of CPAP. In addition, since some complications of OSA such as coronary heart disease and diabetes are usually related with oxidative stress, the role of Sestrin2 in those OSA complications needs further study.

Objective:To explore the relationship between obstructive sleep apnea(OSA) and renal function. Method:We collected the clinical data of 487 patients who underwent sleep monitoring in our hospital from January 2013 to December 2017 and excluded history of chronic heart disease, acute and chronic glomerulonephritis, and pyelonephritis. Among the 487 patients, 54 were in nonOSA control group and 433 were in OSA group, including 64 patients with mild OSA, 77 patients with moderate OSA, 108 patients with severe OSA, and 188 patients with extremly severe OSA. The eGFR was calculated using an equation combined serum creatinine and cystatin C. Then propensity score matching(PSM) was used to reduce differences in confounders among groups. The differences of creatinine, cystatin and eGFR between the control group and different degrees of OSA were compared, and the relationship between OSA severity and renal dysfunction was analyzed.Result:There was no statistically significant difference in creatinine between the OSA group and the control group. Serum cystatin C levels in the moderate OSA group and the extremly severe OSA group were higher compared with the control group(0.90±0.18)mg/L, (0.82±0.21) mg/L,P=0.026;(0.92±0.22) mg/L,(0.82±0.21) mg/L,P=0.006,there was no statistically significant difference in cystatin C level of mild OSA group or severe OSA group compared with the control group.The eGFR levels in the moderate OSA group and extremly severe OSA group were lower than that in the control group, 100.64±16.09, 108.57±19.31,P=0.012; 102.03±18.39, 108.57±19.31, P=0.024.After matching with the PSM, the serum cystatin C levels in the moderate OSA group and in the extremely severe OSA group were higher compared with the control group, (0.91±0.19) mg/L,P=0.028;(0.91±0.23) mg/L,P=0.031;(0.82±0.21) mg/L, but only in moderate OSA group, eGFR was lower than the control group,100.86±17.31,108.57±19.31,P<0.05. Conclusion: The renal function of OSA patients has different degrees of impairment. Renal function impairment and the severity of OSA do not show a single linear relationship.

The aim of this study was to investigate differences in dual-energy X-ray absorptiometry (DXA) parameters, trabecular bone score (TBS), bone turnover markers and inactive matrix Gla protein (dp-ucMGP) between patients with obstructive sleep apnea (OSA) and healthy controls. This study enrolled 53 male patients diagnosed with OSA, and 50 age- and body mass index (BMI)-matched control subjects. All participants underwent DXA imaging, TBS assessment and blood sampling for biochemical analysis of bone metabolism markers. Mean apnea-hypopnea index (AHI) score of OSA patients was 43.8 ± 18.8 events/h. OSA patients had significantly higher plasma dp-ucMGP levels in comparison to controls (512.7 ± 71.9 vs. 465.8 ± 50.9 pmol/L, p < 0.001). OSA and control group did not significantly differ regarding standard DXA results, while TBS values were significantly lower in the OSA group (1.24 ± 0.17 vs. 1.36 ± 0.15, p < 0.001). AHI score was a significant independent correlate of plasma dp-ucMGP levels (β ± SE, 1.461 ± 0.45, p = 0.002). In addition, TBS retained a significant relationship with dp-ucMGP values (β ± SE, -93.77 ± 38.1, p = 0.001). dp-ucMGP levels are significantly higher in patients with OSA and correlate with disease severity. In addition, TBS values in OSA patients are lower in comparison with the control group and decrease with disease severity.

Obstructive sleep apnea (OSA) is associated with obesity, sympathetic activation, systemic inflammation, and cardiovascular morbidity. Obesity, beta-adrenergic agonists, and inflammation are linked to decreased expression and/or secretion of an adipose tissue-derived antiatherogenic hormone, adiponectin. The purpose of the study was to investigate whether OSA affected plasma levels of adiponectin, which might help explain OSA-associated cardiovascular morbidity. We randomly selected 68 otherwise healthy male subjects, either with moderate/severe OSA [apnea-hypopnea index (AHI)>or=20; n=35] or without OSA (AHI<or=5; n=33). The diagnosis of OSA was made based on prospective full polysomnography. Adiponectin was measured before polysomnography between 8 and 10 pm. AHI was higher in the OSA group (49.5+/-4.4 vs. 2.9+/-0.4 events/h; p<0.001). OSA subjects were also more obese, with greater BMI (33+/-1 vs. 30+/-1; p=0.016) and percentage body fat (29+/-1% vs. 26+/-1%; p=0.030). Adiponectin levels were 7.67+/-0.73 and 6.33+/-0.51 microg/mL in the OSA and non-OSA groups, respectively, and this difference was significant in covariate analysis (taking into account age, hemodynamic characteristics, measures of body fat, and OSA severity) (p=0.009). After excluding from both groups the subjects with extreme BMI, such that the OSA and non-OSA study cohorts had similar BMI and percentage body fat, subjects with OSA had significantly higher plasma adiponectin (8.49+/-0.92 vs. 6.32+/-0.55 microg/mL; p=0.042), differences also evident in covariate analysis (p=0.017). Plasma adiponectin levels are elevated in otherwise healthy subjects with OSA. Therefore, low adiponectin is unlikely to explain the association between OSA and cardiovascular disease.

Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. The study population comprised 25,901 participants (16-75 years, 54.4% women) from 4 Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and nonrespiratory disorders. Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.6), chronic obstructive pulmonary disease (adjusted OR, 1.8; 95% CI, 1.3-2.4), asthma (adjusted OR, 1.9; 95% CI, 1.6-2.3), daytime sleepiness (adjusted OR, 7.9; 95% CI, 7.1-8.8), and the use of hypnotics (adjusted OR, 7.5; 95% CI, 6.1-9.1) was highest for the group with both insomnia symptoms and snoring. Participants with both snoring and insomnia run an increased risk of hypertension, chronic obstructive pulmonary disease, asthma, daytime sleepiness, and use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia. Hägg SA, Ilieva E, Ljunggren M, etal. The negative health effects of having a combination of snoring and insomnia. J Clin Sleep Med. 2022;18(4):973-981.

Objective To examine the prevalence of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS), and to evaluate the relationship of OSA with inflammatory biomarkers in ACS patients. Methods Patients with ACS treated at Beijing Anzhen Hopital from June 2015 to May 2017 were enrolled. Subjects were evaluated for OSA by sleep study, and were divided into a normal-mild OSA group (Apnea Hypopnea Index, AHI < 15 times/h) and a moderate-severe OSA group (AHI≥15 times/h). Laboratory examination and sleep study were monitored to analyze the effects of OSA on biomarkers by LSD-t test, Mann-whitney U test, or Chi-square test. Correlation analysis was performed to analyze the association of OSA with high sensitivity C-reactive protein (hs-CRP) by Spearman correlation anaylsis. Results A cohort of 836 patients with ACS were enrolled including 408 patients in the normal-mild OSA group and 428 patients in the moderate-severe OSA group. The levels of leukocyte(×109L) [7.78 (6.33, 9.86) vs 7.29 (6.01, 9.16), P=0.006], neutrophils(×109L) [5.05 (3.84, 7.23) vs 4.80 (3.74, 6.66), P=0.044], monocytes(×109L) [0.42 (0.33, 0.54) vs 0.39 (0.31, 0.51), P=0.033], hs-CRP(mg/L) [3.18 (1.10, 11.52) vs 1.78 (0.65, 6.46), P<0.01], fibrinogen(g/L) [3.17 (2.87, 3.74) vs 2.97 (2.59, 3.50), P=0.002], and uric acid(μmol/L) [360 (302, 422) vs 341(283, 407), P=0.006] in the moderate-severe OSA group were significant higher than those in the normal-mild OSA group. AHI (correlation coefficient=0.171, R2=0.020, P<0.01), ODI (correlation coefficient = 0.201, R2=0.027, P<0.01), and TSaO2 < 90% (correlation coefficient = 0.105, R2=0.005, P<0.01) were positively correlated with hs-CRP; minimal SaO2 (correlation coefficient=-0.100, R2=0.001, P=0.008) and mean SaO2 (correlation coefficient = -0.127, R2= 0.006, P<0.01) were negatively correlated with hs-CRP. Conclusions For patients with ACS, the level of inflammatory markers in the moderate-severe OSA group is significantly higher than that in the normal-mild OSA group. Hs-CRP is significantly associated with the severity of OSA. Diagnosis and monitoring of OSA should be considered in ACS management in the future. Key words: Acute coronary syndrome; Obstructive sleep apnea; Inflammatory marker; C-reactive protein

During an apnea, hemodynamic complications such as hypoxemia, a rise in systemic and pulmonary arterial pressure, and changes in heart rate occur in patients with obstructive sleep apnea (OSA). Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction. Hypertension is common in patients with OSA. This study aims to assess OSA patients' renal functions and investigate the creatinine clearance (CC) values across OSA patients with and without hypertension. The study included 530 individuals with OSA and 60 individuals with an apnea-hypopnea index (AHI) of &lt;5. CC calculated with the Cockcroft-Gault Equation. Patients with OSA divide into two groups as the group of patients with hypertension (HT) (group 1) and without HT (group 2). The study included 339 (64%) male and 191 (36%) female patients. It found that 32.4% of OSA patients had HT (Group 1). There was a significant difference in CC and urea levels between groups 1 and 2 (p&lt;0.001; p=0.005). While CC was low in the OSA group, CC values were not statistically significantly different between the OSA patients and the control group (p&gt;0.05). A statistically significant difference was detected in urea and creatinine levels between the OSA and control groups (p=0.005; p=0.012). Creatinine clearance decreases in patients with OSA in the presence of HT. Patients with OSA often experience cardiovascular disorders, and glomerular endothelial dysfunction occurs in OSA patients.

Introduction Cardiovascular disease (CVD) remains the leading cause of death in the United States. We previously showed a high prevalence of obstructive sleep apnea (OSA) among former National Football League (NFL) players. Further, we hypothesized that post-career OSA impacts CVD risk among retired professional athletes, even though these former NFL players are often near peak physical fitness for a significant portion of their lifespan. The Living Heart Foundation Heart-Obesity-Prevention-Education Group aimed to provide an in-depth health assessment for CVD risk factors among former NFL players to examine the role of OSA on blood pressure (BP) and echocardiographic measurements. Methods Forty-three former NFL players completed an at-home sleep study and outpatient health assessment to determine CVD risk including office BP and transthoracic echocardiogram (TTE) measurements. Seated BP readings were made in triplicate, TTE measurements, including ejection fraction, left atrial size, left ventricular size and thickness, and ascending aortic diameter, were obtained in 17 former NFL players without OSA (age: 46±10 years, BMI: 32±5 kg/m2, apnea-hypopnea index: 3±1 events/hour) and 26 with OSA (age: 51±9 years, BMI: 33±5 kg/m2, apnea-hypopnea index: 17±12 events/hour). Independent sample t-tests were utilized to determine differences in blood pressure and TTE measurements between OSA and non-OSA groups (α=0.05). Results Systolic BP was similar in non-OSA vs. OSA groups (131±12 vs. 135±16 mmHg, p=0.443), while diastolic BP was higher in former NFL players with OSA (78±8 vs. 86±9 mmHg, p=0.007). Ejection fraction, left atrial size, left ventricular size, and left ventricular thickness were similar between groups (p&amp;gt;0.05 for all). However, ascending aortic diameter was modestly larger in former NFL players with OSA (3.3±0.19 vs. 3.5±0.40 cm, p=0.048). Conclusion These findings suggest OSA may be a primary driver of increased BP and increased aortic diameter in former NFL players, and impact cardiac structural health, suggesting augmented CVD risk in former NFL players. Future work is warranted to investigate impact of race and player position on OSA-mediated CVD risk in retired NFL players. Support (if any) NFL Players Association, NIH T32-DK007013, and the American Heart Association (24POST1241616)

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of body mass index (BMI): 43 nonobese (BMI < 30 kg/m2) and 57 obese (BMI > or = 30 kg/m2) patients. A comprehensive cephalometric analysis with a multivariate statistical method was performed in order to define the different principal components (PCs) of cervico-craniofacial skeletal and upper airway soft tissue morphology in each group and how they contributed to selected elements of the patient demographic data, ie, apnea-hypopnea index (AHI), nocturnal oxyhemoglobin saturation, and BMI. Thirty cephalometric variables of cervico-craniofacial skeletal morphology were reduced to 8 PCs describing 84.4% and 85.4% of the total variance in obese and nonobese OSA patients, respectively. Sixteen cephalometric variables of hyoid bone position and head posture were reduced to 4 PCs describing 84.4% and 85.9% of the total variance in obese and nonobese OSA patients, respectively. Twenty cephalometric variables of upper airway soft tissue morphology were reduced to 7 PCs describing 89.5% and 84.6% of the total variance in obese and nonobese OSA patients, respectively. For further analysis of PCs, a stepwise multiple regression analysis was chosen. Two dependent variables of interest are the minimal distance of the posterior pharyngeal airway space (PASmin) and AHI. PASmin accounted for 95.3% (obese OSA group) and 74.3% (nonobese OSA group) with 7 PCs and AHI for 46% with 3 PCs in both groups. Three canonical variables and their correspondents with different loadings were established differently for both OSA groups. A canonical correlation successfully clarified the complexity of simultaneous relationship of the relevant variables. These analyses are proved useful to demonstrate the relationship of cervico-craniofacial skeletal and upper airway soft tissue morphology and selected demographic data. This lays down a basis for understanding the complicated pathogenic components of obese and nonobese OSA patients.

232 USE OF NASAL CANNULA COMPARED TO THERMISTOR IN CHILDREN WITH FACIAL SYNDROMES AND RELEVANCE OF END-TIDAL PCO2 EXPIRED

To investigate the effect of obstructive sleep apnea (OSA) on different sleep stages, and the relationship between N3 stage of non-rapid eye movement sleep and respiratory abnormal events. A total of 188 adult patients who underwent overnight polysomnography(PSG)monitoring in Sir Run Run shaw Hospital of Zhejiang University from June 24th to December 26th 2019 were enrolled in the study. OSA patients were classified into 3 groups (mild, moderate and severe) according to the apnea-hypopnea index (AHI). PSG data, AHI and the lowest SPO2 in each stage of sleep were compared among three groups. There was no significant difference in total sleep time and sleep efficiency among patients with different severity of OSA (all P>0.05). The proportion of N3 stage in moderate and severe OSA groups were significantly smaller than that in mild OSA group (all P<0.05). The proportion of N3 stage in severe OSA group was also smaller than that in moderate OSA group (P<0.05). In addition, severe OSA group had a longer latency of N3 stage than mild and moderate OSA groups (all P<0.05). The latency of N3 stage in moderate OSA group was longer than that in mild OSA group (P<0.05). The AHI in N3 stage was markedly lower than that in other sleep stages (all P<0.01), regardless of the severity of OSA. Supine AHI in N3 stage in mild and moderate groups was significantly lower than that in N1, N2 and rapid eye movement (REM) stages (all P<0.01). Supine AHI in N3 stage in severe group was also lower than that in N2 and REM stages (P<0.05 or P<0.01). The lowest SPO2 in N3 stage was significantly higher than that in N1, N2 and REM stages (P<0.05 or P<0.01), regardless of the severity of OSA. s The proportion of N3 stage is lower in OSA patients, and N3 stage has less sleep respiratory events than non-N3 stages. The results suggest that the increased N3 stage proportion may indicate less severity of OSA.

BackgroundTo investigate factors associated with obstructive sleep apnea (OSA) in young, non-obese (body mass index [BMI] < 30) Middle Eastern adults and to identify characteristics that correlate with OSA severity.MethodsA retrospective case–control study was conducted on non-obese individuals aged 18–55 who underwent sleep studies between 2021 and 2022. The case group included individuals with OSA (apnea–hypopnea index [AHI] ≥ 5 events/hour), while the control group had normal AHI (< 5 events/hour). Demographic information, clinical measurements, and comorbidities were analyzed.ResultsOf the 2,517 records reviewed, 555 patients met inclusion criteria, with 67% diagnosed with OSA. The OSA group had a significantly higher proportion of males compared to females (80.6% vs. 19.4%, p < 0.005), was older (40.7 vs. 35.3 years, p < 0.005), had higher BMI (26.7 vs. 25.3 kg/m2, p < 0.005), and larger neck circumference (38.3 vs. 35.7 cm, p < 0.005). Hypertension, chronic obstructive pulmonary disease (COPD), and alcohol use were more prevalent in the OSA group. Multiple linear regression identified age, neck circumference, hypertension, and lowest peripheral oxygen saturation (SpO2) as significant predictors of OSA severity.ConclusionsMales with a larger neck circumference are at higher risk of OSA in this cohort. Despite being non-obese, OSA patients had higher BMIs than controls. Hypertension and alcohol intake were also more common in OSA patients. Age, neck circumference, and hypertension were significant predictors of OSA severity in this young, non-obese Middle Eastern population.

Craniofacial photography for prediction of obstructive sleep apnoea in a Hong Kong sleep clinic population