Patient's experience of treatment for sleep apnoea with a mandibular advancement splint

Background and aimsObstructive sleep apnoea (OSA) is a well recognised clinical disorder in which there is narrowing and repeated collapse of the upper airway during sleep resulting in the cessation of breathing. Patients with mild to moderate sleep apnoea are often provided with mandibular advancement splint (MAS) therapy as a form of first line or definitive treatment. The aims of this audit were to evaluate patient satisfaction and success of MAS therapy.Methods93 patients diagnosed with sleep apnoea and suitable for a splint were recruited prospectively at Queen Victoria Hospital, East Grinstead between January 2009 and October 2010. A patient satisfaction questionnaire was developed by health professionals involved in the care of patients with sleep apnoea and assessed for face and content validity and reliability. Participants completed the questionnaire six weeks after the splint was fitted.Results44% who previously experienced snoring now reported no snoring and 47% reported less snoring since wearing the MAS appliance. 69% reported complete resolution of sleep apnoea symptoms. 37% experienced aching teeth and 33% experienced having a dry throat when wearing the appliance. 86% of sleeping partners felt that their quality of sleep was improved following their partners treatment.ConclusionsThe standards set for each criteria in this audit were met. MAS treatment has a key role to play in the management of obstructive sleep apnoea with high rates of patient satisfaction and the majority of patients partners reporting a significant improvement in their own and their partners sleep quality.     

Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing: Data from Beijing Child and Adolescent Metabolic Syndrome Study

Background:

Obstructive sleep apnea (OSA) syndrome has a negative impact on the health of millions of adolescents and youth. The aim of this study was to evaluate the associations of OSA syndrome with obesity and cardiometabolic risk factors among adolescents and youth at risk for metabolic syndrome (MS).

Methods:

A total of 558 subjects aged 14–28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study. Each underwent a 2-h oral glucose tolerance test (OGTT), echocardiography, and liver ultrasonography. Anthropometric measures, blood levels of glucose, lipids, and liver enzymes were assessed. Subjects with high or low risk for OSA were identified by Berlin Questionnaire (BQ).

Results:

Among the subjects in obesity, 33.7% of whom were likely to have OSA by BQ. Subjects with high risk for OSA had higher neck and waist circumference and fat mass percentage compared to those with low risk for OSA (P < 0.001). Moreover, significant differences in levels of lipids, glucose after OGTT, and liver enzymes, as well as echocardiographic parameters were found between the two groups with high or low risk for OSA (P < 0.05). The rates of nonalcoholic fatty liver disease (71.0% vs. 24.2%), MS (38.9% vs. 7.0%), and its components in high-risk group were significantly higher than in low-risk group.

Conclusions:

The prevalence of OSA by BQ was high in obese adolescents and youth. A high risk for OSA indicates a high cardiometabolic risk. Mechanisms mediating the observed associations require further investigation.     

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background:

For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM), the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM.

Methods:

Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data.

Results:

After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P = 0.03, respectively). The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P = 0.002, respectively) compared to pretreatment levels. During the night, MAGE also significantly decreased (P = 0.049). The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P = 0.024, respectively). The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05, respectively) after the treatment. In addition, HbA1c levels were also lower than those before treatment (P < 0.05), and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P = 0.034).

Conclusions:

CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.     

建立家兔梗阻性无精症模型对显微外科培训的实验性探讨

目的 建立家兔梗阻性无精症的动物模型,为男科医生“显微输精管附睾管吻合术”技能的培养寻找一种可行的方法.方法 依据月龄、体重及精液分析结果,筛选出38只健康5～6月龄加利福尼亚雄性大白兔作为实验对象.对家兔实施“双侧输精管近睾端结扎术”,以建立家兔梗阻性无精症模型.2月后取精检查,无精子发现后,家兔行双侧“显微纵向两针叠套式输精管附睾管吻合术”.术后2～4月内,对每只雄兔每月连续采精3次,每次间隔3d,连取3月结束实验.运用SCA精液分析仪行精液分析,并记录主要精液参数;若未见精子,先对精液标本离心处理,在高倍镜下检查精子有无,记录最终结果.结果 (1)家兔梗阻性无精模型建立实验中,1例家兔因睾丸附睾坏死、伤口感染死亡;1只因麻药推注速度过快,心脏骤停,余36例梗阻模型的建立进行顺利,术后无发热,元腹泻等; (2)吻合部分,2只家兔因为单侧输精管近端回缩与睾丸鞘膜、精索粘连严重,而只行单侧吻合,余34只实验进行顺利; (3)术后4月内,行精液分析辅助离心后检测,其结果显示:共23只雄兔精液中检测到精子,4只在离心后高倍镜下仅检测到少数精子而无精液分析结果.另3例中途曾检测到精子,继续实验又未见精子.结论 显微输精管附睾管吻合动物实验具有具有微创、简易、安全的特点,可作为临床男科医生开展“显微镜输精管附睾管吻合术”前的一种良好技能训练平台.     

Orthodontic treatment in children to prevent sleep-disordered breathing in adulthood

The purpose of this article is to review human craniofacial growth and development, especially the growth of the mandible, to clarify the relationship between obstructive sleep apnea (OSA) syndrome and craniofacial abnormality, and finally, to propose the hypothesis that negative pressure produced in the chest of the OSA child inhibits the growth of the mandible. Recently, the development of diagnosis and treatment of OSA syndrome has progressed rapidly; however, the prevention of OSA syndrome was merely seen. Craniofacial abnormality is reported as one of the causes of OSA syndrome. If craniofacial abnormality is determined only by genetics, it is difficult to manage the craniofacial skeleton to prevent OSA syndrome. The role of epigenetic factors on craniofacial growth and development is still controversial. However, if we stand on the functional matrix hypothesis, we can manage not only growth of the mandible but also the craniofacial skeleton as a whole. The author proposes the hypothesis that the negative pressure produced in the chest prohibits the growth of the mandible even if the patients have a capacity for growth and development; therefore, if this negative pressure disappears because of the removal of the tonsil and/or adenoids or by an orthodontic treatment to make a patency of the airway, the mandible may grow normally, and we can prevent or reduce a number of OSA syndromes in the future.     

Obstructive sleep apnea and ischemic heart disease in southwestern US veterans: implications for clinical practice

This study describes associations between obstructive sleep apnea (OSA), intake of food rich in antioxidant nutrients, and ischemic heart disease (IHD) in military veterans. Subjects were male veterans (n=211), 54 to 85 years of age, and enrolled in primary care clinics at the Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, AZ. Measures included the SAVAHCS Minority Vascular Center Questionnaire, the Sleep Heart Health Study Sleep Habits Questionnaire, the Arizona Food Frequency Questionnaire, height, weight, and blood pressure. Veterans with OSA were significantly more likely to be obese, to have elevated systolic blood pressure and physician-diagnosed IHD, more likely to undergo coronary angiography, and less likely to consume foods rich in cardioprotective antioxidants compared to veterans without OSA. After adjusting for confounding variables, the association between OSA and IHD remains significant [adjusted OR=2.99, confidence interval (CI)=1.07–8.42]. These data reinforce the importance of recognizing OSA within the veterans affairs health care system and suggest that early detection of OSA may improve veterans' health and well-being and reduce associated medical costs. This study was presented as a poster at the 17th Annual American Professional Sleep Society Meeting, Chicago, IL, USA June 3–8 2003     

老年阻塞性睡眠呼吸暂停低通气综合征围术期血液指标变化及临床意义

目的分析并评价老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者围术期血液指标变化及临床价值。方法将2012年1月至2013年7月郯城县第一人民医院收治的54例OSAHS患者作为观察组,同时将参加健康体格检查的54例老年志愿者作为对照组,对比分析两组术前、术后血液中各指标变化。结果观察组轻中度和重度患者术前及术后红细胞计数(RBC)、血红蛋白(Hb)水平及血细胞比容(HCT)均显著高于对照组,且重度组RBC、Hb及HCT均高于轻中度组,差异有统计学意义(P<0.05);观察组轻中度及重度患者术后6个月RBC、Hb水平及HCT均低于术前(P<0.05)。观察组重度患者术后促红细胞生成素明显低于术前(P<0.05);术前重度患者呼吸紊乱指数(AHI)显著高于轻中度患者(P<0.05),夜间最低动脉血氧饱和度(LSa O2)显著低于轻中度患者(P<0.05);术后轻中度及重度患者AHI均低于术前(P<0.05),夜间LSa O2均高于术前(P<0.05)。结论改良等离子辅助下悬雍垂腭咽成型术对老年OSAHS的疗效理想,可有效降低患者的RBC、Hb以及HCT水平。     

A new EEG biomarker of neurobehavioural impairment and sleepiness in sleep apnea patients and controls during extended wakefulness

ObjectiveTo explore the use of detrended fluctuation analysis (DFA) scaling exponent of the awake electroencephalogram (EEG) as a new alternative biomarker of neurobehavioural impairment and sleepiness in obstructive sleep apnea (OSA).MethodsEight patients with moderate–severe OSA and nine non-OSA controls underwent a 40-h extended wakefulness challenge with resting awake EEG, neurobehavioural performance (driving simulator and psychomotor vigilance task) and subjective sleepiness recorded every 2-h. The DFA scaling exponent and power spectra of the EEG were calculated at each time point and their correlation with sleepiness and performance were quantified.ResultsDFA scaling exponent and power spectra biomarkers significantly correlated with simultaneously tested performance and self-rated sleepiness across the testing period in OSA patients and controls. Baseline (8am) DFA scaling exponent but not power spectra were markers of impaired simulated driving after 24-h extended wakefulness in OSA (r = 0.738, p = 0.037). OSA patients had a higher scaling exponent and delta power during wakefulness than controls.ConclusionsThe DFA scaling exponent of the awake EEG performed as well as conventional power spectra as a marker of impaired performance and sleepiness resulting from sleep loss.SignificanceDFA may potentially identify patients at risk of neurobehavioural impairment and assess treatment effectiveness.