[Progress in studies on obstructive sleep apnea and intestinal microecological balance].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Nov;33(11):1113-1116
Authors: Chen QC, Wang HY, Zhang PP, Fu AS, Ge YL, Zhu XY, Zhang Q, Zhang X, Yu HL
SummaryObstructive sleep apnea （OSA） is closely related to the development of various diseases. Hypoxic perfusion caused by OSA can mediate the occurrence of inflammatory reactions or aggravate metabolic disorders to affect intestinal microecological balance. Intestinal bacteria can participate in the development of inflammatory reaction or metabolic disorder by itself or its components, and the oxidative stress reaction of the body develops in a vicious circle. The mechanism has not yet been fully elucidated, so we reviewed the research progress on OSA and intestinal microecological balance.
PMID: 31914308 [PubMed - indexed for MEDLINE]
[Research on the effects of CPAP for OSA combined CHD long-term prognosis].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Nov;33(11):1031-1035;1039
Authors: Wang JF, Fang JR, Xie YP, Ma W, Hui PL, Su XY, Guo B, Liu Y
Objective:To investigate the effects of CPAP for obstructive sleep apnea（OSA） combined CHD（coronary heart disease） long-term prognosis. Method:One hundred and twenty cases of OSA combind CHD in gansu province people's hospital sleep center were randomly divided into two groups according to apnea hypopnea index（AHI）, group A（light, medium OSA and CHD） 60 cases, group B（severe OSA and CHD） 60 cases. Contrast analysis and comparison between two groups PSG（Polysomnography） parameters, and the differences between the degree of coronary artery lesions and CPAP therapy effect on coronary long-term prognosis. Result:Compared group B with A, AHI, BMI, LSaO2, Epworth sleepiness scale（ESS） score, the amino acid homocysteine, the prevalence of hypertension, type 2 diabetes, the prevalence of acute myocardial infarction（ami） and vascular lesions and SYNTAX score increased significantly（P<0.05）. The ejection fraction decreased significantly（P<0.05）. The BNP（Brain natriuretic peptide） and cTNT（cardiac troponin, cTn） concentration there was no significant difference between the two groups（P>0.05）. CPAP treatment（30.0±4.2） months later, Group B: CAPA + conventional treatment group, compared with the simple routine LSaO2, ejection fraction increased significantly（P<0.05）, AHI, cardiovascular adverse events, vascular lesions, SYNTAX score, the BNP and TNT concentration significantly reduced（P<0.05）; Group A: AHI, decreased significantly（P<0.05）, LSaO2increased significantly（P<0.05）, ejection fraction, cardiovascular adverse events, vascular lesions, SYNTAX score, there was no significant difference between the BNP and TNT concentration; Survival analysis showed that: Group A CPAP+conventional treatment group cumulative survival rate higher than the conventional treatment group, but there was no statistically significant difference（P=0.260）. Group B: CPAP+conventional treatment group total survival rate was significantly higher than that of the conventional treatment group（P<0.001）; Conclusion:With the increase of the severity of OSA, OSA merge CHD coronary artery pathological changes degree aggravating, CPAP therapeutic benefit the long-term prognosis of CHD.
PMID: 31914288 [PubMed - indexed for MEDLINE]
Sleepiness and Driving: The Role of Official Regulation.
Sleep Med Clin. 2019 Dec;14(4):491-498
Authors: McNicholas WT
Sleepiness accounts for approximately 20% of major highway motor vehicle accidents (MVAs) and the most common medical disorder associated with sleepiness is obstructive sleep apnea (OSA). OSA patients are 2 to 3 times more likely to have an MVA than the general population, although continuous positive airway pressure therapy can remove this excess risk. Several jurisdictions have introduced regulations to limit driving in patients with moderate or severe OSA associated with sleepiness until the disorder is effectively treated. Successful implementation of such regulations requires education regarding risk-benefit relationships of relevant stakeholders, including patients, clinicians, and employers in the transportation industry.
PMID: 31640877 [PubMed - indexed for MEDLINE]
Assessment of Sleepiness in Drivers: Current Methodology and Future Possibilities.
Sleep Med Clin. 2019 Dec;14(4):441-451
Authors: Dwarakanath A, Elliott MW
Many patients with obstructive sleep apnea syndrome (OSAS) drive a vehicle both for pleasure and as part of their employment. Some, but not all, patients with OSAS are at increased risk of being involved in road traffic accidents. Clinicians are often asked to make recommendations about an individual's fitness to drive, and these are likely to be inconsistent in the absence of objective criteria. This article discusses the current practice of the assessment of individuals' sleepiness with respect to driving, the limitations of available techniques, and future possibilities.
PMID: 31640872 [PubMed - indexed for MEDLINE]
Sleep Apnea, Sleepiness, and Driving Risk.
Sleep Med Clin. 2019 Dec;14(4):431-439
Authors: Bonsignore MR, Marrone O, Fanfulla F
Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scale.
PMID: 31640871 [PubMed - indexed for MEDLINE]
Postoperative pain and bleeding after adenotonsillectomy versus adenotonsillotomy in pediatric obstructive sleep apnea: an RCT.
Eur Arch Otorhinolaryngol. 2019 Nov;276(11):3231-3238
Authors: Borgström A, Nerfeldt P, Friberg D
PURPOSE: Our previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain.
METHODS: A double-blinded RCT including 79 children, aged 2-6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered.
RESULTS: 63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group.
CONCLUSIONS: The results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain.
TRIAL REGISTRATION: This study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).
PMID: 31377901 [PubMed - indexed for MEDLINE]