Prevalence and incidence of hypertension in obstructive sleep apnea patients and the relationship between obstructive sleep apnea and its confounders

Based on available population-based studies, Obstructive Sleep Apnea （OSA） associated with accompanying daytime sleepiness affects 3% to 7% of adult men and 2% to 5% of adult women in the general population. In some population subsets, like obese or older people, this prevalence is even higher. The health risk in OSA patients shows a strong association with acute cardiovascular events such as stroke, myocardial infarction and nocturnal sudden death. And with chronic conditions such as coronary artery disease,     

Adiponectin alleviates contractile dysfunction of genioglossus in rats exposed to chronic intermittent hypoxia

Background Genioglossal dysfuntion takes an important role in pathogenesis of obstructive sleep apnea hypopnea syndrome (OSAHS) in which chronic intermittent hypoxia (CIH) is the major pathological ori...     

Resolvin-D1 inhibits interleukin-8 and hydrogen peroxide production induced by cigarette smoke extract in 16HBE cells via attenuating NF-κB activation

Background Cigarette smoke induced airway inflammation plays a role in pathogenesis of airway inflammation.Resolvin-D1 derived from omega-3 polyunsaturated fatty acids is an endogenous anti-inflammatory and proresolving lipid mediator.Resolvin-D1 ameliorated inflammatory responses in lung injury,asthma,peritonitis and atherosclerosis.We investigated whether resolvin-D1 suppressed the productions of chemokines and oxidative stress induced by cigarette smoke extract （CSE） in vitro and its possible mechanism.Methods We examined the proinfiammatory chemokine interleukin-8 and hydrogen peroxide （H2O2）productions induced by CSE in 16 human bronchial epithelial （16HBE）cells after resolvin-D1 treatment and their mechanisms.16HBE cells were treated with resolvin-D1 at up to 10 nmol/L,for 30 minutes before CSE up to 16％ （v/v） exposure.Release of interlukin-8 proteins was assessed by enzyme linked immunosort assay （ELISA） and its mRNA level by RT-PCR.We evaluated extracellular H2O2 expression in the supematant.Phosphorylation of NF-KB/p65 and degradation of Ⅰ-KB in 16HBE cells were determined by Westem blotting analysis and NF-KB DNA binding activity by electrophoretic mobility shift assay （EMSA）.Results 16HBE cells treated with 8％ CSE showed significantly higher interlukin-8 production.Resolvin-D1 pretreatment inhibited CSE induced intedukin-8 production （mRNA and protein） in a dose and time dependent manner.Extracellular H2O2 level decreased after resolvin-D1 treatment.Resolvin-D1 attenuated CSE triggered Ⅰ-KB degradation and NF-KB/p65 activation dose dependently and inhibited NF-KB DNA binding activity.Conclusion Resolvin-D1 inhibits CSE induced interlukin-8 and H2O2 production in 16HBE cells by modulating NF-KB activation and has therapeutic potential for pulmonary inflammation.     

Sleep disorders and its related risk factors in patients undergoing chronic peritoneal dialysis

Background The prevalence of sleep disorders has been shown to be high in patients with chronic dialysis patients and may contribute to impaired quality of life and higher mortality in this population.However,there are few data on the relationship of sleep disorders and their risk factors in chronic dialysis patients.The aim of this study was to evaluate the relationship of sleep disorders and their risk factors in chronic dialysis patients.Methods A total of 42 continuous ambulatory peritoneal dialysis （CAPD） patients were involved in this cross-sectional study.Sleep quality was assessed by the Pittsburgh Sleep Quality Index （PSQI）.Restless legs syndrome （RLS） was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group.And depression was assessed by Hamilton depression scale.General information and laboratory data were collected.Results The prevalence of sleep disorders was 47.6％ in the CAPD patients.According to the PSQI,the 42 CAPD patients were divided into sleep disturbance group and non-sleep disorders group.There were no significant differences in age,gender,dialysis duration,hemoglobin,serum creatinine,urea nitrogen,β2-microglobulin,parathyroid hormone,calcium,and phosphorus between CAPD patients with sleep disorders and those without sleep disorders.But the level of serum albumin （AIb） in CAPD patients with sleep disorders was significantly lower than that in CAPD patients without sleep disorders （31.3±1.4 vs.34.3±3.7,t=3.603,P=0.001）.And the prevalence of RLS and depression was significantly higher than that in CAPD patients without sleep disorders （RLS：11/22 vs.1/20,x2=10.395,P=0.001; depression：7/22 vs.1/20,x2=4.886,P=0.027）.In CAPD patients with RLS,the prevalence of sleep disorders was significantly higher than that in CAPD patients without RLS （11/22 vs.11/30,x2=10.395,P=0.001）.And in CAPD patients with depression,the prevalence of sleep disorders was significantly higher than that in CAPD patients without depression （7/8 vs.15/34,x2=4.886,P=0.027）.In CAPD patients,bivariate correlation analysis showed that sleep disorders was negatively correlated with serum AIb （r=-0.606,P=0.000） and positively correlated with RLS （r=0.497,P=0.001） and depression （r=0.341,P=0.029）.Multivariate regression analysis revealed that the odds ratio of RLS,depression,and low serum AIb was 22.900,42.209,and 0.597,respectively.Conclusions The prevalence of sleep disorders was relatively high in CAPD patients.RLS,depression,and low serum AIb were the risk factors for CAPD patients with sleep disorders.     

Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome

Background Excessive daytime sleepiness （EDS） is often associated with obstructive sleep apnea hypopnea syndrome （OSAHS） and contributes to a number of comorbidities in these patients. Therefore, early detection of EDS is critical in disease management. We examined the association between Epworth Sleepiness Scale （ESS） and multiple sleep latency test （MSLT） and diagnostic accuracy of ESS in assessing EDS in OSAHS patients. Methods The ESS, MSLT and overnight polysomnography were administered to 107 Chinese patients to assess EDS and its correlations with polysomnographic parameters. The diagnostic accuracy of ESS in classifying EDS （mean sleep latency （MSL） 〈10 minutes） was evaluated by calculating the area under ROC curve. Results As the severity of OSAHS increased, MSL decreased with increase in ESS score. Conversely, patients with worsening EDS （shorter MSL） were characterized by advanced nocturnal hypoxaemia and sleep disruption compared to those with normal MSL, suggesting EDS is associated with more severe OSAHS. There was a negative correlation between ESS score and MSL and both moderately correlated with some polysomnographic nocturnal hypoxaemic parameters. The area under ROC curve of ESS for identifying EDS was 0.80 （95% CI： 0.71 to 0.88） and ESS score 〉12 provided the best predictive value with a sensitivity of 80% and specificity of 69%. Conclusion The ESS score moderately correlates with MSL and our ROC study supports ESS as a screening strategy for assessing EDS in OSAHS.     

Inhibition of central Na＋/H＋ exchanger type 3 can alleviate sleep apnea in Sprague-Dawley rats

Background Recent studies showed the central Na＋/H＋ exchanger type 3 （NHE3） has a close relationship with ventilation control.The objective of the study is to investigate the role of NHE3 in sleep apnea in Sprague-Dawley （SD） rats.Methods A sleep study was performed on 20 male SD rats to analyze the correlation between the sleep apneic events and total NHE3 protein content and inactive NHE3（pS552） in the brainstem measured by Western blotting.Another 20 adult male SD rats received 3 days of sleep and respiration monitoring for 6 hours a day,with adaption on the first day,0.5％ DMSO microinjection into the fourth ventricle on the second day,and AVE0657 （specific inhibitor of NHE3） microinjection on the third day.Rats were divided into two groups with injection of 5 μmol/L or 8 μmol/L AVE0657 before the sleep study.The effects of AVE0657 on sleep apnea and sleep structure of rats were analyzed through self-control.Results The total post-sigh apnea index （TPSAI） and post-sigh apnea index in non-rapid eye movement （NREM） sleep （NPSAI） and total apnea index （AI） in NREM sleep （NAI） were negatively correlated with NHE3（pS552） protein contents in the brainstem （r=-0.534,-0.547 and-0.505,respectively,P＜0.05）.The spontaneous apnea index in REM sleep （RSPAI） was positively correlated with the level of NHE3（pS552） protein expression in the brainstem （r=0.556,P＜0.05）.However,the sleep AI had no relationship with total NHE3 protein.Compared with the blank control and microinjection of 0.5％ DMSO,5 μmol/L AVE0657 significantly reduced the total AI and NPSAI （both P＜0.05） without a significant effect on sleep architecture.In contrast to blank control and microinjection of 0.5％ DMSO,injection of 8 μmol/L AVE0657 significantly reduced the AI and PSAI in NREM and REM sleep （all P＜0.05）.Conclusions The severity of sleep apnea was negatively correlated with central inactive NHE3.A specific inhibitor of NHE3 decreased the sleep AI.Thus,our results indicate that central NHE3 might be a molecular target for sleep apnea treatment,whose inhibitors may be potential therapeutic drugs for sleep apnea.     

Major advances in respiratory medicine in China

Respiratory disease is the term for diseases of the respiratory system. These diseases range from mild and self-limiting such as the common cold to life-threatening such as bacterial pneumonia or pulmonary embolism. They are common and important causes of illness and death. In the US, people suffer 1 billion colds per year. One out of 7 people in the UK are affected by some kinds of chronic lung diseases, most commonly chronic obstructive pulmonary disease （COPD） and asthma. Respiratory disease accounts for over 10% of hospitalizations and over 16% of deaths in Canada.     

Emergency scenario of fentanyl induced faciocervical rigidity and complete upper airway obstruction during anesthesia induction

Muscle rigidity is one of the common complications caused by fentanyl and its derivatives.1＇2 The classical clinical manifestation of opioids-induced muscle rigidity is increased truncal muscle tone,which can lead to difficult ventilation.1-3 However,faciocervical rigidity following fentanyl is rare.Here we present a rare case of face and neck rigidity following intravenous fentanyl and complete upper airway obstruction in consequence of glottic closure in a patient with co-existing vocal cord paralysis.Keywords：muscle rigidity; airway obstruction; glottic closure; vocal cord paralysis     

Delayed endotracheal tube obstruction by mucus plug in a child

Endotracheai intubation is a common technique of airway control for surgical procedures requiring general anesthesia. Untortunately, hawng an endotracheal tube （ETT） in place does not guarantee a patent airway and the ETT itself may become a source of airway obstruction. We reported a pediatric case of delayed ETT obstruction due to mucus plug.     

Severe airway obstruction caused by tonsillar polyp in anesthetized patient

The tonsillar polyp is a rare benign tumor of the pharynx.1 We describe a successful management of a case with severe airway obstruction by the tonsillar polyp after anesthesia induction in an adult patient with a known difficult airway.In this case,airway was successfully rescued with a difficult airway management scheme incorporating a videolaryngoscope.     

Genotoxicity and reduced heat shock protein 70 in human airway smooth muscle cells exposed to cigarette smoke extract

Cigarette smoke is associated with the development of several diseases, such as chronic ob- structive pulmonary disease （COPD）. The purpose of this study was to investigate genotoxicity and heat shock protein 70 （Hsp70） in human airway smooth muscle cells （HASMCs） exposed to cigarette smoke extract （CSE）. HASMCs was exposed to CSE with different doses for 24 h. The level of 8-hydroxydeoxyguanosine （8-OHdG） was determined by using HPLC-ECD, the DNA damage was ana- lyzed by using comet assay, and apoptosis was examined by using Annexin-FITC/PI staining. The pro- duction of Hsp70 after CSE stimulation was tested. Results indicated that CSE significantly increased the level of 8-OHdG, DNA damage and cell apoptosis, and reduced the production of Hsp70. In par- ticular, levels of Hsp70 were inversely correlated with 8-OHdG, DNA damage and cell apoptosis. It was concluded that cigarette smoke induced genotoxicity and decreased the production of cell protective protein Hsp70, which may contribute to the development of some airway diseases.     

Value of STOP-Bang questionnaire in screening patients with obstructive sleep apnea hypopnea syndrome in sleep disordered breathing clinic

Background Obstructive sleep apnea hypopnea syndrome （OSAHS） is the most common sleep-disordered breathing and is still underdiagnosed.This study was designed to evaluate the value of the STOP-Bang questionnaire （SBQ） in screening OSAHS in sleep-disordered breathing clinics in order to extend it into the general Chinese population.Methods Two hundred and twelve patients undergoing overnight polysomnography （PSG） in the sleep-disordered breathing clinic of Pecking Union Medical College Hospital between May 2011 and January 2012 were prospectively included and were asked to fill in the SBQ.A score of 3 or more of the SBQ indicated a high risk of OSAHS.We analyzed the sensitivities and specificities of SBQ in screening OSAHS.Logistic regression analysis was used to evaluate the probabilities of the severity of OSAHS based upon the apnea hypopnea index （AHI）.Results The patients at high risk of OSAHS had higher AHI,higher oxygen desaturation index （ODI）,lower pulse oxygen saturation （LSpO2） during sleep time and less sleep time in stage N3.SBQ scores were positively correlated with AHI,ODI and the ratio of SpO2 lower than 90％,and negatively correlated with LSpO2 during sleep.The sensitivities of the SBQ with AHI ≥5/h,AHI ≥15/h,AHI ≥30/h as cut-offs were 94.9％,96.5％,and 97.7％,respectively,and the specificities were 50.0％,28.6％,and 17.9％,respectively.The Logistic regression analysis showed the probability of severe OSAHS increased and the probability of normal subjects decreased with increasing SBQ score.Conclusions The STOP-Bang questionnaire has excellent sensitivity in screening OSAHS patients and can predict the severity of OSAHS.More studies will be required to determine the value of SBQ in the general Chinese population.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

1,25-dihydroxyvitamin D₃ pretreatment enhances the efficacy of allergen immunotherapy in a mouse allergic asthma model

Background Allergen-specific immunotherapy can induce immune tolerance to specific allergens by regulating immune status of individuals. However, its clinical application is limited due to individual differences in efficacy among patients and un-confirmed safety. 1,25 Dihydroxyvitamin D3 （1,25（OH）2D3） has been shown to be involved in a variety of physiological processes, including immune response regulation. In the present study we explored the role of 1,25（OH）2D3 pretreatment for immunotherapy.Methods Seventy-five BALB/c mice were randomly divided into five groups （15 mice per group）. The mouse allergic asthma model was established by intra-peritoneal injection of ovalbumin （OVA, 10 μg） and aluminium hydroxide （2 mg）as an adjuvant. Intra-peritoneal injection of 50 ng of 1,25（OH）2D3 served as a pretreatment, subcutaneous injection of OVA （100 μg） as an immunotherapy, and 1% OVA inhalation as a challenge. Histopathological analysis was performed on four mice per group. The number of cells and their classification in bronchoalvolar lavage （BAL） fluid were assayed.Levels of serum OVA-specific immunoglobulin E （slgE） and IFN-Y, IL-4, IL-5 and IL-10 in BAL fluid were measured by ELISA.Results After 1,25（OH）2D3 pretreatment, immunotherapy could significantly inhibit the infiltration of inflammatory cells into lung tissues and BAL fluid of mice with allergic asthma when compared with un-treated animals （eosinophils：（7.46±1.34）×104/ml vs. （13.41±1.67）×104/ml, P ＜0.05）. In addition, levels of IL-4 （（36.g1±7.87） pg/ml vs. （43.70±6.42）pg/ml, P ＞0.05） and IL-5 （（41.97±7.93） pg/ml vs. （60.14±8.35） pg/ml, P ＜0.05） in BAL fluid and serum slgE （（0.42±0.05）vs. （0.75±0.06） OD units, P ＜0.05） were profoundly reduced. However, the IL-10 level in BAL fluid was significantly increased （（67.74±6.57） pg/ml vs. （44.62±8.81） pg/ml, P ＜0.05）.Conclusions These results indicated that 1,25（OH）2D3 pretreatment enhanced the inhibitory effects of immunotherapy on allergic airway inflammation. In the treatment of allergic diseases, 1,25（OH）2D3 pretreatment may be beneficial for improving the efficacy of immunotherapy.     

Saffron （Crocus sativus L.） and major depressive disorder： a meta-analysis of randomized clinical trials

Due to safety concerns and side effects of many antidepressant medications, herbal psychopharmacology research has increased, and herbal remedies are becoming increasingly popular as alternatives to prescribed medications for the treatment of major depressive disorder （MDD）. Of these, accumulating trials reveal positive effects of the spice saffron （Crocus sativus L.） for the treatment of depression. A comprehensive and statistical review of the clinical trials examining the effects of saffron for treatment of MDD is warranted. OBJECTIVE： The purpose of this study was to conduct a meta-analysis of published randomized controlled trials examining the effects of saffron supplementation on symptoms of depression among participants with MDD. SEARCH STRATEGY： We conducted electronic and non-electronic searches to identify all relevant randomized, double-blind controlled trials. Reference lists of all retrieved articles were searched for relevant studies. INCLUSION CRITERIA： The criteria for study selection included the following： （1） adults （aged 18 and older） with symptoms of depression, （2） randomized controlled trial, （3） effects of saffron supplementation on depressive symptoms examined, and （4） study had either a placebo control or antidepressant comparison group. DATA EXTRACTION AND ANALYSIS： Using random effects modeling procedures, we calculated weighted mean effect sizes separately for the saffron supplementation vs placebo control groups, and for the saffron supplementation vs antidepressant groups. The methodological quality of all studies was assessed using the Jadad score. The computer software Comprehensive Meta- analysis 2 was used to analyze the data. RESULTS： Based on our pre-specified criteria, five randomized controlled trials （n = 2 placebo controlled trials, n = 3 antidepressant controlled trials） were included in our review. A large effect size was found for saffron supplementation vs placebo control in treating depressive symptoms （M ES = 1.62, P 〈 0.001）, revealing that saffron supplementation significantly reduced depression symptoms compared to the placebo control. A null effect size was evidenced between saffron supplementation and the antidepressant groups （M ES = -0.15） indicating that both treatments were similarly effective in reducing depression symptoms. The mean Jadad score was 5 indicating high quality of trials. CONCLUSION： Findings from clinical trials conducted to date indicate that saffron supplementation can improve symptoms of depression in adults with MDD. Larger clinical trials, conducted by research teams outside of Iran, with long-term follow-ups are needed before firm conclusions can be made regarding saffron＇s efficacy and safety for treating depressive symptoms.     

Association between intervertebral disc degeneration and disturbances of blood supply to the vertebrae

Low back pain is a common public health problem in western industrialized societies and the world as well.Studies indicate that the prevalence rate ranges to 35%, with around 10% of patients from 12% becoming chronically disabled. It also places an enormous economic burden on society. Although the exact cause of low back pain has yet to be defined, intervertebral disc degeneration is considered a major source of it. Since patients with degenerative discs are often asymptomatic, the mechanisms of it are still unclear.