Impaired intestinal barrier in patients with obstructive sleep apnea

Background

Obstructive sleep apnea (OSA) is often associated with multisystem damage. The gut is a pivotal organ that initiates the pathophysiological processes of multisystem diseases. Intermittent hypoxia resulting from OSA may impair the intestinal barrier prior to the induction of systemic inflammation. We hypothesize that the intestinal barrier markers D-lactic acid (D-LA) and intestinal fatty acid–binding protein (I-FABP) levels would be higher in patients with OSA.

Methods

Consecutive snoring and nonsnoring adults were included in this study and were grouped based on their apnea-hypopnea index (AHI) scores: the control group (AHI < 5) and the OSA group (AHI ≥ 5). Plasma D-LA and I-FABP levels were measured using colorimetry and ELISA, respectively. Other parameters, such as fasting levels of lipids, routine blood tests, and glucose were also assessed.

Results

Of 76 participants, patients in the OSA group accounted for 73% (55/76). Plasma D-LA and I-FABP levels were significantly higher in patients with OSA [7.90 (7.42) (IQR) vs. 0.88 (2.79) (IQR) mmol/L, p < 0.001 and 1851.99 ± 754.23 (SD) vs. 1131.98 ± 383.38 pg/mL, p < 0.001, respectively]. Increased glucose, triglycerides (TGs), leukocytes, neutrophils, and monocytes but decreased high density lipoprotein (HDL) were also found in patients with OSA. It was also observed that the increase in D-LA and I-FABP exhibited the strongest positive association with AHI (r = 0.443, p < 0.001; r = 0.645, p < 0.001), followed by the lowest SaO2 (p ≤ 0.001), BMI (p ≤ 0.017), glucose (p ≤ 0.011), and TGs (p ≤ 0.025). Moreover, multivariate regression analysis showed that D-LA (B = 0.823, p < 0.001) and I-FABP (B = 0.002, p = 0.017) were independently associated with OSA.

Conclusions

The systemic expression of D-LA and I-FABP is dramatically higher in OSA patients, suggesting that hypoxia resulting from OSA might have the capacity to impair the intestinal barrier prior to the induction of multisystem dysfunction.

     

Impaired swallowing reflex in patients with obstructive sleep apnea syndrome.

BACKGROUND: The swallowing reflex is well coordinated with breathing patterns in normal humans. However, patients with obstructive sleep apnea syndrome (OSAS) may have a swallowing disorder that reflects the abnormal function of nerves and muscles in the suprapharynx. OBJECTIVE: To examine the relationship between the swallowing function and sleep-disordered breathing in patients with OSAS. PARTICIPANTS: Twenty patients with OSAS with a mean (+/-SD) age of 53.4+/-8.9 years old, and 20 age-matched control subjects with a mean age of 51.4+/-9.1 years old. METHODS: OSAS was diagnosed using the recordings of overnight polysomnography. The swallowing function in the subject was tested using a swallowing provocation test. The swallowing reflex was determined according to the following criteria: latent time (LT), the time following a bolus injection of distilled water at the suprapharynx to the onset of swallowing; inspiratory suppression time (IST), the time from the termination of swallowing to the next onset of inspiration; and threshold volume, the minimum volume of water (range, 0.4 to 2 mL) that could evoke the swallowing response. RESULTS: Whereas the LT values in patients with OSAS were larger than the LT values in the control subjects, the IST values (which may reflect the switching mechanism from deglutition apnea to breathing) were actually shorter. In addition, a greater bolus volume was necessary to elicit swallowing in patients with OSAS than was necessary in the control subjects. CONCLUSION: Patients with OSAS are likely to exhibit an impaired swallowing reflex, probably due to the perturbed neural and muscular function of the upper airways.     

阻塞性睡眠呼吸暂停低通气综合征患者糖代谢异常的研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者糖代谢异常的发生情况及与OSAHS严重程度的关系;短期持续气道正压(CPAP)通气治疗后,糖代谢异常是否会有所改善.方法 监测214例OSAHS者的睡眠和糖代谢,对糖代谢异常者行CPAP通气治疗.结果 糖代谢异常者OSAHS组88例(54.3%),对照组17例(32.7%).Logistic回归分析显示,糖代谢异常与OSAHS相关.OSAHS患者[呼吸暂停低通气指数(AHI)≥10次/h]发生糖代谢异常的风险是普通人群的2.44倍(95%CI 1.201～4.958).7例患者行CPAP通气治疗,治疗前后血糖变化差异无统计学意义(P＞0.05).结论 OSAHS患者(AHI≥10次/h)糖代谢异常的发生率高,OSAHS是糖代谢异常的独立危险因素之一;超重和(或)肥胖在糖代谢异常的发生、发展中起主要作用,排除超重和(或)肥胖的干扰,OSAHS患者的血糖水平与AHI、最长呼吸暂停时间相关;短期CPAP通气治疗改善OSAHS患者糖代谢异常的效果不明显.

Abstract：

Objective To investigate the prevalence of impaired glucose-insulin metabolism in obstructive sleep apnea hypopnea syndrome (OSAHS); to examine the relation between severity of OSAHS and impaired glucose metabolism; and to evaluate the effectiveness of continuous positive airway pressure (CPAP) on impaired glucose metabolism.Methods A total of 214 patients who were free of diabetes at baseline underwent both nocturnal polysomnography (PSG),and 2-h oral glucose-tolerance test,insulin and hemoglobin Alc test.CPAP treatment for glucose-insulin metabolism ( + ) was given to OSAHS group after informed consent had been obtained.Results Eighty-eight patients and 17 patients with impaired glucoseinsulin metabolism were found in OSAHS group and the control group respectively.Impaired glucose-insulin metabolism was present in 54.3% of OSAHS group and 32.7% of control group.Logistic regression analysis showed a significant positive correlation with OSAHS ( AHI ≥ 10 times/h ) and impaired glucose-insulin metabolism in all patients (OR = 2.440,95% CI 1.201-4.958 ).Plasma glucose level changes had no significant differences between before and after CPAP treatment (P ＞ 0.05 ).ConclusionOSAHS is associated with a high frequency of impaired glucose metabolism.The relationship between OSAHS and impaired glucose metabolism is independent of obesity.Longest apnea time (LAT) and AHI are important contributors to impaired glucose metabolism in OSAHS patients.Short-term CPAP therapy has no significant improvement on glucose metabolism in patients with OSAHS.     

Mycosis fungoides as a cause of severe obstructive sleep apnea

We report the case of a 38-year-old woman, affected by a cutaneous form of mycosis fungoides (MF) who presented with a history of loud snoring associated with sleep apnea. A polysomnographic study confirmed the presence of severe obstructive sleep apnea syndrome (OSAS). Cranial and neck MRI revealed a neoplastic infiltration of the tongue base and the posterior pharynx wall. Upper airway neoplastic infiltration is rarely reported as a cause of OSAS and extra-cutaneous localizations of MF are uncommon. This is the first case in the literature of a patient with nocturnal polysomnogram documented OSAS caused by a mucosal involvement of MF.     

Nocturnal oxyhemoglobin desaturation following tracheostomy for obstructive sleep apnea

Eleven obese men with coexistent obstructive sleep apnea and chronic obstructive pulmonary disease underwent tracheostomy. Nocturnal polysomnography prior to tracheostomy revealed oxyhemoglobin desaturation associated with obstructive apnea. Following surgery, repeated polysomnography was performed to assess the effect of tracheostomy on nocturnal oxygen saturation. Non-apneic desaturation characteristic of that previously described in patients with "type B" chronic obstructive pulmonary disease was noted in six subjects. Oxyhemoglobin saturation in these six fell more than 8 percent below baseline waking and non-rapid-eye-movement (REM) sleep levels. These episodes usually lasted five minutes or longer, occurred almost uniformly during REM sleep, and were acutely ameliorated by low-flow (4 liters per minute) supplemental oxygen. The subjects with REM-associated desaturation did not differ from the subjects without desaturation by preoperative anthropomorphic, blood gas, or pulmonary function criteria. However, subjects with REM-associated desaturation tended to have lower right and left ventricular ejection fractions by pooled gated wall studies. It is concluded that patients with obstructive sleep apnea and chronic obstructive pulmonary disease should be re-evaluated after tracheostomy, since they may be at risk for continued oxyhemoglobin desaturation and progressive right ventricular deterioration despite adequate treatment of their apneic condition.     

睡眠呼吸暂停与脑血流关系的研究

目的研究睡眠呼吸暂停综合征（ＳＡＳ）对脑血流及脑血管疾病的影响。方法选择年龄、性别和基础疾病相配对，ＳＡＳ组３０例，对照组３２例。ＳＡＳ经多导睡眠监测仪检查而诊断。用阿克松多功能彩超仪，检测双侧大脑前、中、后动脉的血流速度和频谱形态。结果ＳＡＳ组与对照组收缩期血流峰值（ＶＳ），平均血流速度（ＶＭ），阻力指数（ＲＩ）等９项指标差异均有显著性（Ｐ＜０．０５～Ｐ＜０．０１），血流频谱形态异常ＳＡＳ组增多，并且ＶＳ、ＶＭ与呼吸暂停指数（ＡＩ）呈显著负相关（ｒ＝－０．４１３～－０６２８，Ｐ＜０．０５～００１），与ＳａＯ２呈显著正相关（ｒ＝０．４３５～０７１２，Ｐ＜０．０５～００１）。结论ＳＡＳ患者脑血流速度减慢，频谱形态异常增多，提示ＳＡＳ可促发脑供血不足，脑动脉硬化，易导致缺血性脑卒中等脑血管疾病的发生     

Hypoxemia vs sleep fragmentation as cause of excessive daytime sleepiness in obstructive sleep apnea

To determine the effects of intermittent hypoxemia on daytime sleepiness in the clinical setting of obstructive sleep apnea syndrome, we enrolled seven patients in a prospective, randomized, crossover study. We had two experimental conditions with NCPAP treatment as follow: (1) to correct apneas, sleep fragmentation, and hypoxemia; and (2) to correct apneas and sleep fragmentation and at the same time, induce intermittent hypoxemia. The outcome variable, daytime sleepiness, was measured objectively with the multiple sleep latency test following completion of baseline and each treatment condition. Compared with sleep latencies in the untreated condition, both experimental treatment arms prolonged sleep latencies (p less than 0.05). We found no statistically significant differences between mean MSLT scores obtained after NCPAP treatment under hypoxemic and nonhypoxemic conditions. In summary, two nights of intermittent nocturnal hypoxemia during NCPAP treatment for OSAS did not diminish the objective improvement in daytime somnolence seen with NCPAP treatment in the absence of nocturnal hypoxemia. Results lend further support to the hypothesis relating excessive daytime sleepiness to sleep fragmentation.     

睡眠呼吸暂停低通气综合征问卷对阻塞性睡眠呼吸暂停综合征诊断价值

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的流行病学调查表筛查价值.方法 疑似OSAHS的987例患者为研究对象,按照中华医学会呼吸病学分会睡眠学组睡眠呼吸暂停低通气综合征流行病学调查表进行问卷并行多导睡眠监测.将此问卷表进行量化评分,用克隆巴赫信度系数(α系数)进行信度计算,将各相关因素做方差分析及x2检验,筛选出有统计学意义的因素最后做Logistic回归分析.以鼾声中度以上的打鼾及体质量指数≥25 kg/m2为高危,反之为低危,进行敏感性,特异性,假阳性,假阴性,阳性似然比,阴性似然比,阳性预测值等.结果 疑似OSAHS患者987例,其中男800例(81.05％),女187例(18.95％),年龄18～80岁,平均(47±12)岁,平均体质量指数(29±5) kg/m2.＞60岁者156例(15.81％),≤60岁者831例(84.19％).克隆巴赫信度系数(Cronbach'salpha)是0.803,假阳性者20,假阴性者142,真阳性者742,真阴性者83,问卷的敏感性是83.94％,特异性是80.58％,假阳性率19.42％,假阴性率16.06％,阳性似然比4.32,阴性似然比0.20,阳性预测值0.97,阴性预测值0.37,正确率83.59％.结论 该睡眠调查表对OSAHS筛查具有一定意义,可用于临床OSAHS的初筛,尤其适合在社区和基层医院中推广使用.     

阻塞性睡眠呼吸暂停低通气综合征患者血细胞变化的研究进展

OSAHS是一种常见疾病,可以导致血液系统的病理损害,如红细胞、血小板及白细胞数目、形态和功能的变化.研究OSAHS患者血细胞的变化,可以帮助明确其导致心血管系统及免疫系统等损害的机制,本文将就国内外关于血细胞的变化的研究进展作简要介绍.     

Severe obstructive sleep apnea in children with elevated blood pressure

The objective was to determine the prevalence of habitual snoring and obstructive sleep apnea (OSA) in a cohort of children referred for elevated blood pressure (BP), and to determine the association between OSA and BP elevation, learning difficulties, and behavioral problems. We performed a retrospective review of 446 consecutive new patients referred for elevated BP. One hundred four (23%) had habitual snoring. Patients with habitual snoring were more likely to be obese (86.5 vs. 55.6%, P < .001) and to have Medicaid insurance (52.4 vs. 36%, P = .004). Seventy-four patients had polysomnography, of which 57 (77%) had OSA; 21 (37%) had severe OSA. Severe OSA was associated with higher office systolic BP index after adjusting for body mass index, age, sex, and socioeconomic status (β = 0.07, P = .014). Fifty-two percent of patients with severe OSA had office systolic BP in the Stage 2 hypertension range. Children with habitual snoring or OSA were not at increased risk of receiving school services for a learning disability or receiving medications for inattention or mood problems. In summary, habitual snoring is common in children referred for elevated BP, and those with severe OSA are at higher risk of significantly increased BP.     

阻塞性睡眠呼吸暂停对动态血压影响的研究

目的　探讨阻塞性睡眠呼吸暂停 (OSA)夜间低氧血症对动态血压变化的影响。方法　选择阻塞性睡眠呼吸暂停综合征 (OSAS)患者 60例和正常对照组 2 0例进行多导睡眠图检查和 2 4h血压监测。结果　轻度OSAS患者的动态血压及其昼夜节律的改变与正常对照组相比无显著性差异 ;中度OSAS患者的nMDP及血压昼夜节律与正常对照组相比已有显著性差异 ;而重度OSAS组的动态血压改变则更加明显 ,2 4hMDP、2 4hMAP、dMSP、dMDP、dMAP、nMSP、nMDP、nMAP均明显高于对照组 ,其中 2 4hMDP、dMDP、dMAP、nMSP、nMDP与轻、中度组比较有显著性差异 ,同时夜间血压下降节律紊乱 ,昼夜血压差值减小。OSAS患者 2 4hMDP、dMDP、nMSP、nMDP、nMAP与睡眠呼吸暂停低通气指数 (AHI)呈显著正相关 ,而 2 4hMSP、2 4hMAP、nMSP、nMAP、ΔSBP、ΔDBP与睡眠中经皮血氧饱和度(SpO2 )降低大于 0 0 4的总次数、SpO2 低于 0 90的时间均呈正相关 ,而与睡眠中SpO2 最低值、SpO2 平均值呈负相关。结论　OSAS患者各期血压的平均水平与AHI、呼吸暂停持续时间及SpO2 降低的程度显著相关 ,OSAS的病情越重 ,这种血压变化及昼夜节律改变越显著     

阻塞性睡眠呼吸暂停低通气综合征的血液系统改变

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)可引起血液系统的变化已被证实,包括能影响红细胞、血小板、血液黏滞性、血管内皮、凝血和纤溶机制等多个环节.研究提示其中的凝血异常可能参与OSAHS患者心脑血管疾病发病机制,但OSAHS影响血液凝固机制的许多细胞尚有待阐明.     

Sleep quality and blood pressure dipping in obstructive sleep apnea

Background:Obstructive sleep apnea (OSA) is associated with poor sleep quality and a high incidence of nondipping. The aim of this study was to determine the association of sleep quality and nocturnal blood pressure (BP) dipping in an OSA population.Methods:A total of 44 untreated subjects with mild to severe OSA underwent overnight-attended polysomnography and 24-h ambulatory BP monitoring. Subjects were off antihypertensive medication. The percentage of slow wave sleep, percentage of time awake after sleep onset during the sleep period, sleep efficiency, and arousal index were chosen as measurements of sleep quality. Dipping was evaluated using the change in systolic BP, diastolic BP, and mean arterial pressure. Patients were classified as dippers and nondippers based on a nocturnal drop in mean arterial pressure > 10%. Differences between groups were evaluated by independent sample t tests. Pearson correlation and linear regression were used to evaluate the association of sleep quality and dipping.Results:There were no differences between dippers and nondippers with regard to body mass index, age, or respiratory disturbance index. A total of 84% were nondippers. No difference was found between dippers and nondippers in sleep quality. None of the sleep quality measures correlated with the measurements of dipping. In multiple regression analyses, the percentage of slow wave sleep and arousal index each independently predicted only a small percentage of the variance (approximately 10%) of nocturnal DBP dipping.Conclusions:The prevalence of nondipping was very high in a population of untreated patients with mild to severe OSA. Nonetheless, sleep quality did not appear to be related to BP dipping.