Objective:To investigate the incidence of collateral circulation in high-risk patients with sleep apnea and stroke treated by continuous positive airway pressure （CPAP） ventilation and to analyze the influencing factors. Methods:A total of 152 patients diagnosed with obstructive sleep apnea-hypopnea syndrome （OSAHS） combined with acute ischemic stroke （AIS） who were admitted to our hospital from January 2020 to June 2022 were selected for this study. Based on the apnea-hypopnea index （AHI）, the patients were divided into three groups: mild （n=44）, moderate （n=72）, and severe （n=36）. After treatment, the patients were further classified into a group without collateral circulation （n=30） and a group with collateral circulation （n=26）, which included those with moderate collateral circulation （n=69） and good collateral circulation （n=27）. Clinical data across the different groups were compared, and multiple factor analysis was performed to identify factors affecting the occurrence of collateral circulation. Results:The AHI and IL-6 levels in the severe group were significantly higher than those in the mild and moderate groups, while the levels of NO and PO2 were significantly lower in the severe group compared to the mild and moderate groups, with statistically significant differences among the three groups （P<0.05）. After treatment, all groups showed improvement, and the proportion of patients with collateral circulation was 84.09% in the mild group, 81.94% in the moderate group, and 72.22% in the severe group. Significant differences in age, AHI, NIHSS, NO, MoCA, and MMSE scores were observed between the groups with and without collateral circulation （P<0.05）. In the group with collateral circulation, the scores for age, AHI, and NIHSS in the good collateral circulation subgroup were significantly lower than those in the poor collateral circulation and moderate collateral circulation subgroups, while the scores for NO, MoCA, and MMSE were significantly higher in the good collateral circulation subgroup. Multi-factor analysis revealed that age, AHI, and NIHSS were independent risk factors for collateral circulation, whereas NO, MoCA, and MMSE served as protective factors that were negatively correlated with collateral circulation. Classification tree model results indicated that AHI had the greatest influence on the occurrence of collateral circulation among the five influencing factors, demonstrating good predictive capability. Conclusion:Most high-risk patients with sleep apnea and stroke are likely to develop collateral circulation following continuous positive airway pressure ventilation. Factors such as age, AHI, NIHSS, NO, MoCA, and MMSE are important determinants affecting the occurrence of collateral circulation.
Humans ; Collateral Circulation ; Continuous Positive Airway Pressure ; Stroke/physiopathology* ; Sleep Apnea, Obstructive/physiopathology* ; Risk Factors ; Male ; Incidence ; Female ; Middle Aged ; Aged ; Sleep Apnea Syndromes/physiopathology* ; Interleukin-6/blood*

INTRODUCTIONPatients with obstructive sleep apnoea (OSA) often present with excessive daytime sleepiness (EDS) as measured by the Epworth Sleepiness Scale (ESS). However, the relationship between EDS and OSA severity as measured by the apnoea-hypopnoea index (AHI) remains inconsistent. We hypothesise that this may be due to the usage and equal weightage of apnoea and hypopnoea events used in determining AHI and that apnoea and hypopnoea load as measured by their total durations may be a better metric to use. We sought to investigate if apnoea or hypopnoea load can display better correlation with ESS.

MATERIALS AND METHODSRetrospective analysis of 821 patients with AHI ≥5, who underwent in-laboratory polysomnogram for suspected OSA from January 2015-December 2015, was performed. Objective factors on polysomnogram were correlated with ESS.

RESULTSESS was correlated with age (r = -0.148, <0.001), number of apnoeas (r = 0.096, = 0.006), apnoea load (r = 0.102, = 0.003), apnoea index (r = 0.075, = 0.032), number of desaturations (r = 0.081, = 0.020), minimum SpO (r = -0.071, = 0.041), time SpO <85% (r = 0.075, = 0.031) and REM sleep duration (r = 0.099, = 0.004). Linear regression analysis found age ( <0.001), apnoea load ( = 0.005), REM ( = 0.021) and stage 1 sleep duration ( = 0.042) as independent factors correlated to ESS. The apnoea load calculated using duration in apnoea correlate with ESS in patients with severe OSA by AHI criteria compared to the mild category.

CONCLUSIONAHI does not correlate with ESS. Younger age, longer apnoea, stage 1 and REM sleep were independently related to higher ESS though the correlations were weak. Apnoea load should be taken into account when determining OSA severity.

Adult ; Age Factors ; Disorders of Excessive Somnolence ; diagnosis ; etiology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Sleep Apnea Syndromes ; physiopathology ; Sleep Apnea, Obstructive ; complications ; diagnosis ; physiopathology ; Sleep, REM ; physiology ; Statistics as Topic

Adolescent ; Arousal ; physiology ; Child ; Child, Preschool ; Electroencephalography ; methods ; Female ; Humans ; Male ; Polysomnography ; Sleep Apnea Syndromes ; physiopathology ; Sleep Apnea, Obstructive ; physiopathology ; Sleep Stages ; physiology

OBJECTIVEThe aim of this study is to investigate the occurrence and mechanism of Cheyne-Stokes breathing pattern in patients with heart failure.

METHODSFifty-six patients who performed polusomnography sleep testing at National Center of Cardiovascular Diseases Fuwai Hospital from March to May in 2015. We divided them into chronic heart failure (CHF) group and non-CHF group.

RESULTSThe occurrences of sleep apnea in two groups were high. In CHF group (n = 11) , there were 10 patients with apnea hypopnea index (AHI) > 5; and their AHI was 23.93 ±14.63. In non-CHF group (n = 45), there were 33 patients whose AHI > 5; and their AHI was 16.20 ± 18.76. The ratio of center sleep apnea to all gross sleep apnea ratio in CHF group was higher than that in non-CHF group (80.21% ± 30.55% vs 27.16% ± 35.71%, P < 0.01 ).

CONCLUSIONBased upon the new theory of holistic integrative physiology and medicine, we explain the mechanism of circulatory dysfunction induce the oscillation breathing in patients with CHF. The sleep apnea and C-S respiration in CHF should be called circulatory sleep apnea, rather than central sleep apnea.

Cheyne-Stokes Respiration ; Chronic Disease ; Heart Failure ; physiopathology ; Humans ; Polysomnography ; Sleep Apnea Syndromes ; physiopathology ; Sleep Apnea, Central

Child ; Child Behavior Disorders ; etiology ; Cognition Disorders ; physiopathology ; Humans ; Sleep Apnea Syndromes ; psychology

Peripheral chemoreceptors in the carotid body play important roles in the transduction of chemical stimuli in the arterial blood to the central for eliciting the chemoreflex, which mediates the ventilatory and circulatory responses to hypoxia. The activity of carotid chemoreceptor is modulated and significantly contributes to the ventilatory acclimatization at high altitude. In addition, the carotid chemoreceptor activity is augmented in patients with sleep-disordered breathing, notably in central or obstructive sleep apnea, and also in experimental animals. Thus, the carotid body functions to maintain the oxygen homeostasis, whereas anomalous carotid chemoreceptor activities could be both adaptive and pathogenic in sleep apnea. This review aims to summarize the cellular and molecular mechanisms that could mediate the augmented chemoreceptor activity induced by intermittent hypoxia. Our recent findings suggest a pathogenic role of inflammation mediated by an upregulation of renin-angiotensin system in the carotid body in the over-activity of the chemoreflex. These locally regulated mechanisms are proposed to be a significant part of the hypoxia-mediated maladaptive changes of the carotid body function, which could play a role in the pathophysiology of sleep apnea.
Acclimatization ; Animals ; Carotid Body ; cytology ; Chemoreceptor Cells ; pathology ; Humans ; Hypoxia ; physiopathology ; Renin-Angiotensin System ; Sleep Apnea Syndromes ; physiopathology

BACKGROUNDRecent 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.

METHODSA 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.

RESULTSThe 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).

CONCLUSIONSThe 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.

Animals ; Male ; Rats ; Rats, Sprague-Dawley ; Sleep Apnea Syndromes ; metabolism ; physiopathology ; Sleep, REM ; physiology ; Sodium-Hydrogen Exchanger 3 ; Sodium-Hydrogen Exchangers ; antagonists & inhibitors ; metabolism

OBJECTIVE: To explore the change of nasal ventilation function in a group of SDB patients and its relationship to PSG parameters. METHOD: One hundred twenty-eight controls, 11 habitual snorers, 33 cases of mild-moderate OSAHS and 33 cases of severe OSAHS were examined. NN1 Rhinospirometer was used to measure unilateral nasal respiratory capacity (NC(un)) and bilateral nasal respiratory capacity (NC(bi)), and the nasal partitioning ratio (NPR) can be calculated. NR6 Rhinomanometry was used to measure total nasal inspiratory and expiratory resistance (TNRi, TNRe). A1 acoustic rhinometry was used to measure distances of the two notches to the nostril (MD1, MD2), cross-sectional areas of the two notches (MCA1, MCA2) and nasal volume from 0-5 cm (NV(0-5)). Moreover, make the correlational analysis on different index of nasal functional tests and PSG. RESULT: (1) Significant group differences were shown in NPR (P < 0.01). (2) TNRi and TNRe were statistical different among the groups (P < 0.01 or P < 0.05). (3) There are significant difference on MD1, MCA1, MCA2, NV(0-5) in male, but just on MD1 in female. (4) There was no correlation between PSG parameters and nasal functional parameters in SDB patients. But for certain subgroup analysis in female patients with a body mass index below 25, minimum oxygen saturation correlated significantly with MCA2 (r = 0.688, P < 0.05), arousal index correlated significantly with MCA1 (r = 0.543, P < 0.05). CONCLUSION The nasal anatomical structure and physiological function contribute to the pathogenesis of OSAHS, which may play a larger role in non-obese female patients.
Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Nose ; physiopathology ; Rhinomanometry ; Rhinometry, Acoustic ; Sleep Apnea Syndromes ; physiopathology ; Young Adult

Child ; Humans ; Polysomnography ; Sleep Apnea Syndromes ; physiopathology ; surgery ; Tonsillectomy ; methods

PURPOSE: This study aimed to evaluate the correlation between associating factors of moderate to severe asthma with obstructive sleep apnea (OSA). MATERIALS AND METHODS: One hundred and sixty-seven patients who visited the pulmonary and sleep clinic in Severance Hospital presenting with symptoms of sleep-disordered breathing were evaluated. All subjects were screened with ApneaLink. Thirty-two subjects with a high likelihood of having OSA were assessed with full polysomnography (PSG). RESULTS: The mean age was 58.8+/-12.0 years and 58.7% of subjects were male. The mean ApneaLink apnea-hypopnea index (AHI) was 12.7+/-13.0/hr. The mean ApneaLink AHI for the 32 selected high risk patients of OSA was 22.3+/-13.2/hr, which was lower than the sleep laboratory-based PSG AHI of 39.1+/-20.5/hr. When OSA was defined at an ApneaLink AHI > or =5/hr, the positive correlating factors for OSA were age, male gender, and moderate to severe asthma. CONCLUSION: Moderate to severe asthma showed strong correlation with OSA when defined at an ApneaLink AHI > or =5/hr.
Aged ; Asthma/complications/epidemiology/*etiology ; Comorbidity ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Polysomnography/instrumentation ; Severity of Illness Index ; Sleep Apnea Syndromes/epidemiology/etiology ; Sleep Apnea, Obstructive/complications/epidemiology/*physiopathology