ObjectiveTo evaluate the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) vs. nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS). MethodsThe PubMed, EMbase, The Cochrane Library (Issue 3, 2017), CBM, VIP, WanFang Data and CNKI were searched up to March 27th, 2017 to collect randomized controlled trials (RCTs) of HHHFNC vs. NCPAP for NRDS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 104 patients were included. The results of meta-analysis showed that: 1) The HHHFNC group reduced the rate of reintubation (OR=0.56, 95%CI 0.32 to 0.98, P=0.04), shortened the time of assisted ventilation (MD=–11.12, 95%CI –13.31 to –8.93, P<0.000 01), hospitalization time (MD=–2.99, 95%CI –3.54 to –2.44, P<0.000 01) and neonatal aspiration of milk (MD=–17.82, 95%CI –21.19 to –14.45, P<0.000 01), shortened partial pressure of carbon dioxide at 48 hours (MD=–4.86, 95%CI –5.94 to –3.78, P<0.000 01), reduced the rate of frequent hemorrhoid (OR=0.32, 95%CI 0.12 to 0.90, P=0.03), the rate of abdominal distension (OR=0.17, 95%CI 0.09 to 0.30, P<0.000 01), the rate of injury of nose (OR=0.08, 95%CI 0.03 to 0.20, P<0.000 01), and the rate of head shape change (OR=0.03, 95%CI 0.00 to 0.23, P=0.000 7). 2) There were no significant differences between two groups in mortality rate, nosocomial infection rate, oxygen exposure time, arterial oxygen pressure and oxygen saturation at 48 hours, intraventricular hemorrhage, patent ductus arteriosus, retinopathy of prematurity, bronchopulmonary dysplasia and neonatal necrotizing enterocolitis, respectively. ConclusionCurrent evidence indicates that HHHFNC can reduce the rate of reintubation, shorten the time of assisted ventilation, length of hospital day and neonatal aspiration of milk, reduce the rate of frequent hemorrhoid, abdominal distension, injury of nose, head shape change. Due to the limitation of quantity and quality of included studies, the long-term follow-up results of HHHFNC for NRDS are needed to analyze with large-scale and multicenter RCTs.
Objective To study the changes of receptor activator of nuclear factor-κB ligand (RANKL, an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG, the decoy receptor for RANKL), oxidative stress and bone turnover markers in obstructive sleep apnea-hypopnea syndrome (OSAHS), in order to understand the potential mechanisms underlying bone loss in OSAHS patients. Methods Ninety-eight male patients with OSAHS, confirmed by polysomnography (PSG) study, were enrolled. The patients were divided into mild-moderate groups and severe groups. Forty-two male subjects who were confirmed as not having OSAHS served as the controls. The subjects’ bone mineral density (BMD) and T-score were assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry. Blood samples were collected from all subjects for measurement of RANKL, OPG, the bone formation marker bone-specific alkaline phosphatase (BAP), the bone resorption marker tartrate-resistant acid phosphatase-5b (TRAP-5b), total antioxidant capacity (TAOC). Twenty-eight severe OSAHS patients accepted continuous positive airway pressure (CPAP) treatment voluntarily. After 6 months, PSG was conducted, and serum RANKL, OPG, TAOC, TRAP-5b, BAP was measured after six months treatment. Results The BMD, T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group. The level of BAP was significantly decreased in the OSAHS group as compared to the control group, and there was no significant difference in TRAP-5b level between two groups. As compared with the control group, levels of OPG, TAOC and the OPG/RANKL ratio decreased significantly. None of these parameters (BMD, T-score, RANKL, OPG, TRAP-5b, BAP) showed significant difference between patients with mild-moderate and severe OSAHS group. Correlation analysis showed that the apnea hypopnea index and oxygen desaturation index were correlated with TAOC. BAP level was positively correlated with TAOC and lowest pulse oxygen saturation. The serum level of TAOC was lower in the OSAHS group after CPAP therapy, but the levels of RANKL, OPG, TRAP-5b, BAP were not different. As compared with the OSAHS group before CPAP therapy, the BMD of the femoral neck and the lumbar spine were not significant difference. Conclusions In patients with OSAHS, the oxidative stress response is enhanced, and imbalance of OPG/RANKL is shifted, which participates in the occurrence of osteoporosis. The oxidative stress injury of severe OSAHS patients was relieved after non-invasive ventilation treatment, but the effect of oxidative stress response on bone metabolism still needs further evaluation.