Objective To evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，Plt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，Pgt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
OBJECTIVE: To study the effects of jaw advancement in treating micromandibular deformity associated with obstructive sleep apnea syndrome (OSAS) by ramus osteotomy and genioplasty. METHODS: From April 1998 to February 2002, 12 patients with micromandibular deformity associated with OSAS (aged 14-36 years, 7 females and 5 males) were treated. Invert "L" shape ramus osteotomy and inverted replantation of posterior segment of ramus were performed to reconstruct the TMJ with the jaw advancement and genioplasty at the same time in 7 cases; mandibular angle osteotomy, bone grafts and genioplasty in 3 cases; and the jaw advancement by ramus sagittal osteotomy and genioplasty in 2 cases of the first branchial arch syndrome. RESULTS: The follow-up period was 6 months to 4 years. All the patients gained good appearance and had the distance of opening movement over 3.0 cm. Micromandible and facial asymmetries were corrected satisfactorily. The ratio of SaO2 was ascended from 82%-92% (preoperation) to 97%-99% (postoperation). OSAS was relieved. CONCLUSION: The jaw advancement by ramus osteotomy and genioplasty for treating micromandibular deformity associated with OSAS can correct the maxillofacial deformities and enlarge the upper airway space to relieve OSAS. This method has achieved satisfactory result.
Objective To assess the effectiveness of the auto-continuous positive airway pressure (Auto-CPAP) versus the fixed-continuous positive airway pressure (Fixed-CPAP) in patients with obstructive sleep Apnea syndrome (OSAS). Methods Such databases as PubMed (1990 to 2010), SpringerLink (1995 to 2010), CNKI (1990 to 2010), WanFang Data (1995 to 2010), and Google academic (1994 to 2010) were searched, the relevant conference theses were retrieved, and the experts in this field were enquired to collect the randomized controlled trials (RCTs) on Auto-CPAP versus Fixed-CPAP for patients with OSAS. Two reviewers independently screened the trials according to inclusion and exclusion criteria, abstracted the data, and assessed the methodology quality. Meta-analyes was performed using RevMan 5.0 software. Results A total of 11 RCTs involving 327 patients were included. The results of meta-analyses showed that, compared with the Fixed-CPAP group after treatment, the Auto-CPAP group significantly reduced the mean effective therapeutic pressure (WMD=-1.79, 95%CI -3.39 to -0.20), won much better treatment adherence (WMD=0.43, 95%CI 0.30 to 0.56), but got much higher scores of the Apnea-hypopnea index (AHI) (WMD=1.17, 95%CI 0.25 to 2.08) and Epworth Sleepiness Scale (ESS) (WMD=0.88, 95%CI 0.42 to 1.33) as well. There was no significant difference between those two groups in patients’ subjective preference for treatment (OR=2.06, 95%CI 0.46 to 9.10). Conclusion Compared to the Fixed-CPAP, the Auto-CPAP significantly reduces the mean effective therapeutic pressure and improves the treatment adherence of the patients, but is inferior in decreasing AHI and ESS. However, more high-quality and large-scale RCTs are required to verify the above conclusion because of the limitation of research quality and sample at present.
Sleep apnea syndrome (SAS) is a kind of harmful systemic sleep disorder with high incidence, and the pathological mechanism of it is complicated and the diagnosis and treatment are difficult. Mining the characteristic information of SAS from the single or small physiological signal is a hot topic in the research of sleep disorders in recent years. In our study shown in this paper, the detrended fluctuation analysis (DFA) was used to analyze sleep electroencephalogram (EEG) of SAS patients and normal healthy persons based on the non-stationary and nonlinear characteristics. It was found that in both groups, the scaling exponents increased gradually with the deepening of sleep, and in the rapid eye movement (REM) stage, the scaling exponents decreased. The scaling exponents of SAS group were significantly higher than those of the healthy group. The performance of SAS diagnosis based on scaling exponents was evaluated with receiver operator characteristic (ROC) curve. The optimal threshold value 0.81 for the SAS and normal control were obtained, corresponding to the sensitivity 94.4%, specificity 99.2%, and area under curve (AUC) was 0.994. The results show that DFA scaling exponents have a good discrimination power and accuracy for the SAS, which provide a new theoretical basis for SAS diagnosis.
Sleep apnea syndrome (SAS) is a kind of common and harmful systemic sleep disorder. SAS patients have significant iconography changes in brain structure and function, and electroencephalogram (EEG) is the most intuitive parameter to describe the sleep process which can reflect the electrical activity and function of brain tissues. Based on the non-stationary and nonlinear characteristics of EEG, this paper analyzes the correlation dimension of sleep EEG in patients with SAS. Six SAS patients were classed as SAS group and six healthy persons were classified into a control group. The results showed that the correlation dimension of sleep EEG in the SAS group and the control group decreased gradually with the deepening of sleep, and then increased to the level of awake and light sleep stage with rapid eye movement (REM). The correlation dimension of SAS group was significantly lower than that of control group (P<0.01) throughout all the stages. The results suggested that there were significant nonlinear dynamic differences between the EEG signals of SAS patients and of healthy people, which provided a new direction for the study of the physiological mechanism and automatic detection of SAS.
ObjectiveTo systematically review the association between obstructive sleep apnea syndrome and levels of thyroid hormone.MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 6, 2016), Web of Science, VIP, CNKI, WanFang Data, CBM and the relevant conference abstracts and unpublished literatures from inception to June, 2016 to collect the case-control studies about the levels of thyroid hormones with OSAS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software.ResultsA total of 8 RCTs involving 1 519 patients were included. The results of meta-analysis showed that: there were no significant differences of levels of FT3 between OSAS group and control group (mild: SMD=–0.01, 95%CI –0.21 to 0.20, P=0.93; moderate: SMD=0.15, 95%CI –0.34 to 0.64, P=0.55; severe: SMD=0.12, 95%CI –0.32 to 1.25, P=0.08). There were significant differences of levels of FT4 between mild and moderate OSAS groups with control group (mild: SMD=–0.49, 95%CI –0.74 to –0.25, P<0.000 1; moderate: SMD=–0.86, 95%CI –1.69 to –0.02, P=0.04), but no significant difference in severe group (SMD=–1.06, 95%CI –2.16 to 0.03, P=0.06). There were no significant differences of levels of TSH between OSAS group and control group (mild: SMD=–0.03, 95%CI –0.13 to 0.20, P=0.69; moderate: SMD=–0.09, 95%CI –0.27 to –0.10, P=0.35; severe: SMD=–0.02, 95%CI –0.26 to –0.22, P=0.88).ConclusionsThe current evidence shows that, OSAS is associated with lower levels of FT4. Due to the limited quality and quantity of included studies, the above results are needed to validate by more studies.
ObjectiveTo systematically review the prevalence of obstructive sleep apnea syndrome (OSAS) in China. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data, and VIP databases were electronically searched to collect cross-sectional studies of the prevalence of OSAS in China from inception to October 30th, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software. ResultsA total of 27 studies were included, with a total sample size of 97 746 cases and 10 853 confirmed OSAS patients. Meta-analysis results showed that the prevalence of OSAS in China was 11% (95%CI 5% to 17%), of which females was 12% (95%CI 5% to 19%) and males was 12% (95%CI 5% to 20%). OSAS cases grouped by regions were as follows: Central China 4% (95%CI 2.7% to 4.5%), South China 5% (95%CI 2.7% to 6.7%), North China 7% (95%CI 4.6% to 9.3%), Northeast China 22% (95%CI 17.7% to 61.2%), Southwest China 4% (95%CI 3.2% to 5%), Northwest China 16% (95%CI 14.5% to 17.7%), and East China 17% (95%CI 2.8% to 30.6%). OSAS patients grouped by ages were as follows: 4% (95%CI 3% to 5%) for ≤14 years old, 5% (95%CI 2% to 7%) for 15-44 years old, 13% (95%CI 6% to 20%) for 45-59 years old, 16% (95%CI 6% to 25%) for 60-74 years old, 13% (95%CI 4% to 23%) for 75-89 years old, and 11% (95%CI 2% to 21%) for ≥ 90 years old. A subgroup analysis based on the year of publication found that the prevalence of OSAS fluctuated between 6% and 9% from 2005 to 2020, and the prevalence was the highest from 2000 to 2005 accouted with 21% (95%CI 0.8% to 40.5%). ConclusionsThe prevalence of OSAS in China is relatively high, and there are differences in the prevalence among individuals of different ages and regions. The 60-year-old groups in addition to the Northeast and East China regions have a high incidence. The prevalence of OSAS is substantially consistent between males and females. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Sleep disorder is related to many comorbidities, such as diabetes, obesity, cardiovascular diseases, and hypertension. Because of its increasing prevalence rate, it has become a global problem that seriously threatens people’s health. Various forms of sleep disorder can cause increased insulin resistance and/or decreased sensitivity, thus affecting the occurrence, development and prognosis of diabetes. However, sleep health has not been paid attention to in recent years. Therefore, this article summarizes the findings of the correlation between sleep disorder and diabetes mellitus in recent years, by elaborating the relationship between various types of sleep disorder (including sleep apnea syndrome) and diabetes mellitus, as well as their mechanisms and intervention measures, in order to enhance the attention of clinical workers to sleep health, and to provide basis for reducing the risk of diabetes.