Objective To investigate the effect of continuous positive airway pressure (CPAP) on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease (AD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of forty-two early AD patients with OSAHS were randomly divided into a CPAP combined treatment group (20 cases) and a simple medicine treatment group (22 cases). The changes of neurocognitive function were assessed by Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE) and Hopkins Verbal Learning Test-revised (HVLT). Patient Health Questionnaire-9 (PHQ9) was used to evaluate the depression mood changes. The sleep characteristics and respiratory parameters were evaluated by polysomnography. The changes of the patients’ sleep status were assessed by Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The changes of sleep status, cognitive function and mood in the CPAP combined treatment group were compared before and three months after CPAP treatment, and with the simple medicine treatment group. Results After three months of CPAP treatment, the ESS, PSQI and PHQ9 scores in the CPAP combined treatment group were significantly decreased compared with those before treatment, whereas MoCA, MMSE and HVLT (total scores and recall ) in the CPAP combined treatment group were increased compared with those before treatment (P<0.05). After CPAP treatment, the respiratory parameters apnea hypopnea index in the CPAP combined treatment group was significantly lower than that before treatment (P<0.05), and the minimum blood oxygen saturation was significantly higher than that before treatment (P<0.05). However, the sleep characteristics and parameters did not show statistically significant changes compared with those before treatment (P>0.05). The ESS, PSQI and PHQ9 scores were significantly reduced in the CPAP combined treatment group compared with the simple medicine treatment group (P<0.05), while there was no statistically significant changes of cognitive scores between the two groups (P>0.05). Conclusions The degree of low ventilation and hypoxia is alleviated, and the daytime sleepiness and depression is improved in early AD patients with OSAHS after three-month continuous CPAP treatment. Cognitive function is significantly improved, whereas there is no significant change in sleep structure disorder.
Objective To evaluate the correlation of vascular endothelial growth factor (VEGF) and vascular endothelial cadherin (VE-Cadherin) in serum with the severity of obstructive sleep apnea (OSA) and explore their clinical value in OSA. Methods A total of 90 patients with OSA admitted to the Sleep Monitoring Center of the Affiliated Hospital of Xuzhou Medical University from April 2023 to June 2024 were prospectively selected. Based on the apnea-hypopnea index (AHI), the patients were divided into a mild group (5 - 15 times/hour, n=30), a moderate group (>15 - 30 times/hour, n=28), and a severe group (>30 times/hour, n=32). Thirty healthy individuals who underwent physical examinations during the same period were included as a control group. The levels of serum VEGF and soluble VE-Cadherin (sVE) in all subjects were detected by enzyme-linked immunosorbent assay. The differences in serum VEGF and sVE levels among the groups were compared, and the correlations between serum VEGF and sVE levels and sleep parameters were explored. The moderate and severe OSA patients were given 3 months of continuous positive airway pressure (CPAP) treatment, and the changes in sleep parameters and serum VEGF and sVE levels before and after treatment were compared. Results The levels of serum VEGF and sVE in the OSA patients increased with the severity of the disease; the levels of serum VEGF and sVE in the moderate and severe OSA groups were significantly higher than those in the healthy control group and the mild OSA group (P<0.05). The levels of serum VEGF and sVE in the severe OSA group were significantly higher than those in the moderate OSA group (P<0.05). There was no significant difference in the expression levels of serum VEGF or sVE between the mild OSA group and the healthy control group (P>0.05). The sensitivity and specificity of serum VEGF in diagnosing OSA were 65.6% and 93.3%, respectively, with an area under curve (AUC) value of 0.845. The sensitivity and specificity of serum VE-Cadherin in diagnosing OSA were 64.4% and 96.7%, respectively, with an AUC value of 0.835. After 3 months of CPAP treatment, AHI, longest apnea time, serum VEGF and sVE levels in the moderate and severe OSA groups decreased significantly, mean arterial oxygen saturation and lowest arterial oxygen saturation increased significantly (P<0.05). Conclusions The levels of VEGF and VE-Cadherin in serum of OSA patients are significantly elevated and positively correlated with the severity of OSA. Monitoring the changes in the levels of VEGF and VE-Cadherin in serum of OSA patients is helpful for evaluating the therapeutic effect of CPAP.
ObjectiveTo analyze the application and efficacy of continuous positive airway pressure (CPAP) as an initial support measure for respiratory diseases in premature infants. MethodsWe retrospectively studied the clinical data of 160 premature infants hospitalized in the Neonatal Intensive Care Unit from January to December 2014. These infants accepted CPAP as the initial respiratory support. ResultsThe average birth weight and the average gestational age of the 160 premature infants were (1 581±440) g and (31.6±1.9) weeks, respectively. The main diagnosis of the primary diseases in these infants included neonatal pneumonia (81.3%), neonatal respiratory distress syndrome (57.5%), neonatal apnea (53.8%) and neonatal asphyxia (22.5%). The CPAP success rate in those infants whose birth weight was less than 1 000 g was significantly lower than those whose birth weight was equal or greater than 1 000 g (χ2=4.882, P=0.027). The perinatal period analysis showed that premature rupture of membranes, intrauterine fetal distress and maternal pregnancy complications were factors correlating with the effect of CPAP. CPAP treatment analysis showed that early application of CPAP within 24 hours after birth had a success rate of 82.4% (108/131), and initial inhaled oxygen concentration and oxygen pressure were the primary factors affecting CPAP efficacy. ConclusionApplication of CPAP is effective in respiratory support for premature infants and has a high success rate. Early application can reduce the use of mechanical ventilation and intubation. Regulating appropriate parameters helps raise the efficacy of CPAP therapy. Clinically, the standardized application of CPAP and monitoring the failure of CPAP are important for the improvement of the treatment efficacy.
Objective To evaluate the changes of right ventricular function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after continuous positive airway pressure (CPAP) treatment by two-dimensional speckle tracking imaging (2D-STI). Methods Fifty patients with moderate and severe OSAHS were selected for CPAP treatment, and another 40 healthy volunteers were selected as a control group. 2D-STI and traditional echocardiography were conducted in the study group before treatment, after 3 months of continuous treatment and after 6 months of continuous treatment and in the control group. Results The differences between the control subjects and the OSAHS patients were statistically significant in right ventricular global longitudinal strain (RVGLS), right ventricular free lateral wall longitudinal strain (RVLLS), apical segment of the right ventricular free wall longitudinal strain (Apical RV-SL), basal segment of the right ventricular free wall longitudinal strain (Basal RV-SL), and media segment of the right ventricular free wall longitudinal strain (Media RV-SL) (all P<0.05). RVGLS, RVLLS and Apical RV-SL were significantly improved after 3 months of CPAP treatment (all P<0.05). Basal RV-SL was significantly improved after 6 months of CPAP treatment (P<0.05). Conclusions The right ventricular function of patients with OSAHS is abnormal. CPAP treatment can improve the right ventricular function of OSAHS patients. 2D-STI can accurately assess the changes of right ventricular function.
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 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.
ObjectiveTo investigate the pathogenesis and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) by detecting the changes of serum interleukin-23 (IL-23) and C-reactive protein (CRP) levels of the OSAHS patients before and after treatment with continuous positive airway pressure (CPAP).MethodsFifty-eight patients with moderate to severe OSAHS diagnosed by polysomnography were recruited as an experimental group, 57 out-patient healthy subjects with matched age, sex and body mass index of the experimental group were enrolled as a control group. The serum concentrations of IL-23 and CRP in the experimental group were detected and compared before and after CPAP application for 3 months. The serum concentrations of IL-23 and CRP in the control group were also measured.ResultsThe serum levels of IL-23 and CRP in the OSAHS patients were significantly higher than those in the normal control subjects (P<0.05). The serum levels of IL-23 and CRP in the OSAHS patients after CPAP treatment were significantly lower than those before CPAP treatment (P<0.05). The serum concentrations of IL-23 and CRP were positively correlated with apnea hypopnea index (r=0.756, r=0.345, P<0.05, respectively), and negatively correlated with mean oxygen saturation (r=–0.715, r=–0.334, P<0.05, respectively).ConclusionsThe serum levels of IL-23 and CRP are positively correlated with the severity of OSAHS. After CPAP treatment, the levels of IL-23 and CRP decrease, which indicates that CPAP treatment may reduce the inflammatory reaction and correct anoxia of OSAHS patients.
Objective To assess the effect of continuous positive airway pressure treatment (CPAP) on subjective and objective sleepiness in patients with obstructive sleep apnea-hypopnea syndrom (OSAHS). Methods We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSAHS. We use computer to search Pubmed (1990-2008.5), CNKI (1994-2008.5), google (1995-2008.5), Springer Link (1997-2008)、 and many meeting articals. We chose the literatures that divided patients randomly into two groups as CPAP group and subtheraputic CPAP or drug group. Meta-analysis were performed to access the effect and bias. Results A total of 15 trials involving 1 052 patients were included. A Meta-analysis showed that (1) The total effect was that compared with the control group, CPAP treatment group significantly depressed the degree of sleepiness in ESS [WMD= – 2.61, 95%CI (– 3.92, – 1.29)] and in MWT/ MSLT [WMD= 1.42, 95%CI (– 0.01, 2.85)]. (2) Results of subgroups on ESS were that: 1. CPAP vs CT: there was a significant effect on CPAP therapy [WMD= – 3.15, 95%CI (– 4.84, – 1.47)]. 2. CPAP vs sham CPAP: there was no significant difference between the two groups. 3. CPAP vs drugs: CPAP was more efficient than drugs. CPAP may be more efficient in improving patients’ life quality. Conclusion CPAP is a valuable treatment for OSAHS no matter in subjective or objective sleepiness .But more attention should be paid to the lone-time treatment of CPAP.
Objective To investigate the antihypertensive effects of continuous airway positive pressure( CPAP) plus antihypertensive drugs on patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) and hypertension.Methods 82 OSAHS patients with hypertension were enrolled in this study. They were randomly divided into a CPAP treatment group( 44 patients, treated with antihypertensive drugs and CPAP) , and a control group( 38 patients, treated with antihypertensive drugs only) . All the patients were performed polysomnography and 24-hour blood pressure monitoring before and 12 weeks after the treatment. Results After 12 weeks treatment, except the systolic pressure in night time( nSBP) , all the parameters of 24-hour blood monitoring improved better in the CPAP group than in the control group( all P lt; 0. 05) . The blood pressure dropped to normal in 75. 0% ( 33/44) CPAP patients and in 52. 6% ( 20 /38) control patients. In the CPAP group, 8( 18. 2% ) cases were withdrawn from antihypertensive drugs, 13( 29. 5% )cases required single agents, and 9( 20. 5% ) cases required three agents to achieve blood pressure control.But in the control group, all the patients needed two or more antihypertensive agents, in which 23( 60. 6% )patients needed three agents to achieve blood pressure control. After the treatment, the patients with dipping pattern blood pressure increased from10 to 29( 22. 7% -65. 9% , P lt;0. 05) in the CPAP group, and from10to 14( 26. 3% -36. 8%, P gt;0. 05) in the control group. Conclusions Combination therapy with CPAP and antihypertensive drugs controls blood pressure better than antihypertensive medication only for OSAHS patients with hypertension with fewer types of antihypertensive agents or even withdrawal from antihypertensive medication in some patients.