Objective To retrospectively analyze the cardiovascular outcomes of the elderly patients with obstructive sleep apnea syndrome (OSAS) and the influence factors. Methods According to polysomnography examination, 79 OSAS patients and 60 patients without OSAS were selected and divided into 3 groups: elder OSAS group [39 patients older than 65 years, respiratory apnea index (AHI)≥5], non-elder OSAS group (40 patients less than 65 years old, AHI≥5) and elder control group (60 patients older than 65 years, AHK5). All patients were followed up by telephone and clinic consulting. The median follow-up duration was 25 months. All patients received the following studies: (1)Flow-mediated vasodilation (FMD), which was assessed by high-resolution ultrasound technique. (2)The sleep-related breathing events and serum biochemical indexes. (3)The death due to cardiovascular disease (CVD), angina, myocardial infarction and stroke. Results (1) FMD was significantly lower in elder OSAS group than in elder control group (P<0. 01). (2)In elder OSAS group versus elder control group, BMI was significantly higher (P<0. 01), while both lowest pulse oxygen saturation (LSpO_2 ) and mean series pulse oximeter ( MeanSpO_2 ) were significantly lower (P< 0.01 and P<0. 05, respectively). Multiple logistic regression analysis showed that impaired fasting plasma glucose was the primary injury factor for FMD (OR=1. 83, 95% CI:1. 11～3.03), and LSpO_2 was the secondary injury factor (OR = 0.92, 95% CI: 0. 85～1. 00). (3) The incidence of cardiovascular events in the 3 groups: the incidence of cardiovascular events was significantly higher in elder OSAS group than in the other 2 groups (χ~2= 7. 339, P<0. 05). Multiple logistic regression analysis showed that FMD (OR=1. 33, 95% CI:1. 06～1. 66)and hs-CRP (OR = 0.51, 95% CI: 0. 34～0.76) were closely related with prognosis. Conclusions Compared with non-elder OSAS group and elder control group, vascular endothelial function impairment is more serious and the incidence of cardiovascular events is higher in elder OSAS group. So OSAS may influence the prognosis of the patients by injuring the vascular endothelial function.

OBJECTIVETo explore the relationship between nonalcoholic fatty liver disease (NAFLD) and the incidence of type 2 diabetes mellitus (T2DM) in Chinese adults.

METHODSA total of 4847 Chinese adults were enrolled in this prospective study. All participants underwent physical examination at one of three hospitals in Nanjing during 2008. According to results from B ultrasound, the participants were grouped according to NAFLD diagnosis, with 1468 in the NAFLD group and 3379 in the control group.Participants were followed up until diagnosis of T2DM or for 4 years. The cumulative incidence rates of T2DM were calculated for and compared between the NAFLD group and the control group. The relationship between NAFLD and risk of T2DM was examined by Cox proportional hazards modeling.

RESULTSDuring the 4-year follow-up,387 (8.0%) of the patients were diagnosed with T2DM. The cumulative incidence rates of T2DM in the NAFLD group and the control group were 17.2% and 4.0%, respectively. After adjusting for age,sex,body mass index,blood pressure,triglyceride level and alanine aminotransferase level, NAFLD was found to be closely related to the incidence of T2DM (relative risk:3.465,95% confidence interval:2.755-4.358).

CONCLUSIONNAFLD is associated with elevated risk of T2DM in adult patients in Nanjing,China. The general population of this region may benefit from focused public health intervention and treatment strategies targeting to prevent development of T2DM in conjunction with NAFLD.

Adult ; Asian Continental Ancestry Group ; China ; epidemiology ; Diabetes Mellitus, Type 2 ; epidemiology ; Humans ; Incidence ; Non-alcoholic Fatty Liver Disease ; epidemiology ; Prospective Studies ; Risk Factors

Objective To investigate the correlations of plasma homocysteine(Hcy)levels with cerebral white matter lesion(WML)severity and cognitive impairment in elderly hypertension patients.Methods A retrospective case-control study was conducted.Ninty-eight elderly patients with hypertension were enrolled.Based on the presence or absence of hyperhomocysteinemia(hypertension with plasma Hcy levels ≥10μmol/L was defined as H-type hypertension),patients were divided into two groups:a control group(n =48) and an H-type hypertension group(n =50).The degree of WML was rated by the Fazekas scale using magnetic resonance imaging(MRI)analysis.Neuropsychological examinations including mini-mental state examination(MMSE)and Montreal cognitive assessment (MoCA)were taken to assess cognitive function.The degree of WML and cognitive impairment were compared between the two groups.Correlations of plasma Hcy levels with the degree of WML and cognitive impairment were analyzed.Results Compared with the control group,scores of the Fazekas scale(3.2 ± 1.0 vs.2.5 ± 1.0,P ＜0.05) and deep white matter hyperintensity on MRI(1.7 ± 0.8 vs.1.3±0.7,P＜0.05)increased,and scores of MMSE(24.9±3.3 vs.27.7±1.8,P＜0.05)and MoCA(18.6±3.9 vs.25.0±3.0,P＜0.05)decreased in the H-type hypertension group.Plasma Hcy levels were positively correlated with the degree of WML (r =0.430,P ＜ 0.01) and negatively correlated with cognitive function(r=-0.406 in MMSE and-0.663 in MoCA,P＜0.01).Multivariate logistic regression showed that Hcy,fasting blood-glucose,deep WML,low-density lipoprotein cholesterolin,age and systolic pressure were influencing factors for cognitive impairment (P ＜ 0.01).Conclusions WML and cognitive function are worse in elderly H-type hypertension patients than in hypertension patients with normal Hcy levels.WML and cognitive impairment are aggravated with increased plasma Hcy levels.The plasma Hcy level may be an effective clinical indicator of cognitive function in elderly people with hypertension.