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Management of non-alcoholic fatty liver disease patients with sleep apnea syndrome

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World Journal of Gastroenterology 2022年第43期28卷 6099-6108页

作者： Wei Sheng Guang Ji Li Zhang Institute of Digestive Diseases Longhua HospitalShanghai University of Traditional Chinese MedicineShanghai 200032China

Nonalcoholic fatty liver disease(NAFLD)is strongly associated with sleep apnea syndrome(SAS).Many NAFLD patients have SAS,and obstructive sleep apnea hypopnea syndrome is also considered to be an independent risk factor for NAFLD,as it contributes to the progression of NAFLD via oxidative stress,lipid peroxidation,inflammation,and insulin *** review aims to provide some recommendations for the management of NAFLD patients with SAS,including diet,exercise,weight loss,and continuous positive airway *** review also highlights the importance of effective strategies in NAFLD prevention and treatment.

关键词： Nonalcoholic fatty liver disease sleep apnea syndrome Obesity Obstructive sleep apnea hypopnea syndrome Continuous positive airway pressure Management

Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with sleep apnea syndrome Before and After Treatment

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Chinese Medical Sciences Journal 2011年第1期26卷 9-13页

作者： Hai-ling Wang Yu Wang Ying Zhang Yun-dai Chen Xin-chun Wang Zhi-xuan Liu Guo-li Jing Hai-feng Tong Yuan Tian Qing-zeng Liu Department of Heart and Circulation 263 Clinical Department of Beijing PLA General Hospital Beijing 101149 China Department of Otolaryngology-Head and Neck Surgery 263 Clinical Department of Beijing PLA General Hospital Beijing 101149 China Department of Cardiology Chinese PLA General Hospital Beijing 100853 China Department of Emergency the 2nd Affiliated Hospital of Harbin Medical University Harbin 150001 China

Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SA

关键词： hypertension sleep apnea syndrome circadian rhythm of blood pressure angiotensin Ⅱ continuous positive airway pressure surgery

Character of diaphragm compound muscle action potential and phrenic nerve conduction time in patients with obstructive sleep apnea-hypopnea syndrome

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Neural Regeneration Research 2008年第5期3卷 533-537页

作者： Yuhong HOU Rongchang Chen Jinbing Pan Yuanming Luo Nanshan Zhong Department of Emergency the First Affiliated Hospital Zhengzhou University Zhengzhou 450052 Henan Province China Guangzhou Institute of Respiratory Disease First Affiliated Hospital Guangzhou Medical College Guangzhou 510120 Guangdong Province China Department of Respiratory Medicine Henan Provincial Hospital Zhengzhou 450003 Henan Province China

BACKGROUND： Both hypoxia *** dioxide retention can damage phrenic nerve and muscle conduction, as well as diaphragm function. Diaphragm compound muscle action potential and phrenic nerve conduction time are reliable indicators for measuring phrenic nerve and diaphragm function. OBJECTIVES： To verify the hypothesis that changes of phrenic nerve conduction time （PNCT） and diaphragm compound muscle action potential （CMAP） in obstructive sleep apnea-hypopnea syndrome （OSAHS） patients might contribute to the decline of phrenic nerve and diaphragm function. PNCT and CMAP were measured with multipair esophageal electrodes combined with unilateral magnetic stimulation. DESIGN, TIME AND SETTING： Case controlled study. The experiment was carried out in Guangzhou Institute of Respiratory Disease, Guangzhou MediCal College, from June 2005 to April 2006. PARTICIPANTS： Twenty seven OSAHS patients and eight primary snoring subjects from Guangzhou Institute of Respiratory Disease, Guangzhou Medical College were recruited and all subjects were diagnosed by polysomnography （PSG）. Sixteen healthy, non-snoring subjects in the hospital for medical examination during the same time period were selected as the control group. METHODS： Esophageal electrodes, made by Guangzhou Institute of Respiratory Disease, combined with unilateral magnetic stimulation, were used to measure PNCT and CMAP of all subjects. PNCT was defined as the time from stimulation artifact to the onset of CMAP and diaphragm CMAP amplitude was measured from peak to peak. Oxygen desaturation index and apnea-hypopnea index were measured using PSG, and their relevance to PNCT and CMAP were analyzed. PNCT and CMAP in five OSAHS patients were repeatedly measured after effective nasal continuous positive airway pressure treatment for more than 2 months. MAIN OUTCOME MEASURES：（1） PNCT and diaphragm CMAP of subjects in each group. （2） Relevance of oxygen desaturation index and apnea-hypopnea index to PNCT and CMAP. （3） Ch

关键词： sleep apnea syndrome action potentials phrenic nerve

Chronic intermittent hypoxia from pedo-stage decreases glucose transporter 4 expression in adipose tissue and causes insulin resistance

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Chinese Medical Journal 2010年第4期123卷 463-470页

作者： CHEN Lin CAO Zhao-long HAN Fang GAO Zhan-cheng HE Quan-ying Department of Pneumology Peking University People's Hospital Beijing 100044 China

Background The persistence of sleep disordered breathing （SDB） symptoms after tonsil and/or adenoid （T＆A） surgery are common in children with obstructive sleep apnea （OSA）. We tested the hypothesis that disturbances of glucose transporters （GLUTs） in intraabdominal adipose tissue caused by chronic intermittent hypoxia （CIH） from the pedo-period could facilitate the appearance of periphery insulin resistance in Sprague-Dawley （SD） rats. We tested the hypothesis that the changes of GLUTs in adipose tissue may be one of the reasons for persistent SDB among clinical OSA children after T＆A surgery. Methods Thirty 21-day-old SD rats were randomly divided into a CIH group, a chronic continuous hypoxia （CCH） group and a normal oxygen group （control group） and exposed for 40 days. The changes of weight, fasting blood glucose and fasting blood insulin levels were measured. Hyperinsulinemic-euglycemic clamp techniques were used to measure insulin resistance in each animal. Real-time quantitative PCR and Western blotting were used to measure GLUT mRNA and proteins in intraabdominal adipose tissue. Additional intraabdomial white adipose tissue （WAT） was also processed into paraffin sections and directly observed for GLUTs1-4 expression. Results When compared with control group, CIH increased blood fasting insulin levels, （245.07±53.89） pg/ml vs. （168.63±38.70） pg/ml, P=-0.038, and decreased the mean glucose infusion rate （GIR）, （7.25±1.29） mg·kg^-1·min^-1 vs. （13.34±1.54） mg·kg^-1·min^-1, P 〈0.001. GLUT-4 mRNA and protein expression was significantly reduced after CIH compared with CCH or normal oxygen rats, 0.002±0.002 vs. 0.039±0.009, P 〈0.001; 0.642±0.073 vs. 1.000±0.103, P=0.035. Conclusions CIH in young rats could induce insulin resistance via adverse effects on glycometabolism. These findings emphasize the importance of early detection and treatment of insulin insensitivity in obese childhood OSA.

关键词： sleep apnea syndrome insulin resistance glucose transporters hypoxia childhood

Effect of chronic intermittent hypoxia on theophylline metabolism in mouse liver

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Chinese Medical Journal 2013年第1期126卷 118-123页

作者： CHEN Xiao-yang ZENG Yi-ming ZHANG Yi-xiang WANG Wan-yu WU Run-hua Department of Pulmonary Medicine Second Clinical MedicalCollege of Fujian Medical University Quanzhou Fujian 362000China

Background Chronic intermittent hypoxia （CIH） has been associated with abnormalities in the liver, which is the most important organ for drug metabolism. This study aimed to investigate the effect of CIH on theophylline metabolism in mouse liver. Methods Eight C57BL/6J mice were exposed to CIH for 12 weeks. Eight C57BL/6J mice were exposed to room air as a control group. Serum levels of alanine aminotransferase and aspartate aminotransferase were measured. Liver histology was observed by light and electron microscopy. Total hepatic cytochrome P450 concentration was measured. Hepatocytes were isolated and incubated with 15 mg/ml theophylline for four hours. After incubation, the theophylline concentration in the supernatant was measured and the theophylline metabolism rate was calculated. Results CIH did not affect the serum transaminase levels. Livers from mice exposed to CIH showed hepatocellular edema, and liver cells had fuzzy rough endoplasmic reticulum under the electron microscope. The theophylline metabolism rate was significantly inhibited by CIH compared with controls; （16.60±2.43）% vs. （21.58±4.52）% （P=0.02）. The total liver cytochrome P450 concentration in the CIH group was significantly lower than in the control group; （0.83±0.08） vs. （1.13±0.21）mol/mg microsomal protein （P=0.004）. Conclusion CIH decreases theophylline metabolism by mouse hepatocytes, which may correlate with the downregulation of cytochrome P450 expression by CIH.

关键词： hypoxia liver metabolism sleep apnea syndrome theophylline

Intermittent hypoxia and isoniazid plus rifampicin affect hepatic ultrastructure in mice

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Chinese Medical Journal 2011年第23期124卷 4034-4038页

作者： WU Run-hua ZENG Yi-ming CHEN Xiao-yang Department of Pulmonary Medicine Second Affiliated Hospital ol Fujian Medical University Quanzhou Fujian 362000 China

Background Chronic intermittent hypoxia is the most important pathophysiologic feature of sleep apnea syndrome. The present study aimed to determine whether chronic intermittent hypoxia, which is associated with sleep apnea syndrome, can cause or increase damage to liver cell ultrastructure induced by isoniazid and rifampicin in mice. Methods Based on a 2x2 full factorial design consisting of two factors of chronic intermittent hypoxia and isoniazid plus rifampicin, 32 male C57B6J mice were randomized into the control group, the chronic intermittent hypoxia group, the isoniazid plus rifampicin group, and the chronic intermittent hypoxia ＋ isoniazid plus rifampicin group. Twelve weeks after treatment, we examined the ultrastructure of liver cells and quantitatively analyzed mitochondrial morphology in C57B6J mice. Results Chronic intermittent hypoxia did not significantly affect the ultrastructure of liver cells. The main effect of chronic intermittent hypoxia did not lead to an increase of mean profile area or mean perimeter of mitochondria, and a decrease of numerical density on area of mitochondria （all P 〉0.05）. Isoniazid plus rifampicin significantly affected liver cell ultrastructure. The main effect of isoniazid plus rifampicin resulted in an increase of mean profile area and mean perimeter of mitochondria, and a decrease of numerical density on area of mitochondria （all P 〈0.05）. Moreover, there was a positive interaction among the chronic intermittent hypoxia and the isoniazid plus rifampicin groups for mean profile area, mean perimeter, and numerical density on area of mitochondria （all P〈0.05）. Conclusion Chronic intermittent hypoxia and isoniazid plus rifampicin treatment lead to synergistic liver cell ultrastructural injury.

关键词： sleep apnea syndrome chronic intermittent hypoxia ultrastructure

Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 378-387页

作者： Mizuho Aikawa Masaya Uesato Ryuma Urahama Koichi Hayano Reiko Kunii Yohei Kawasaki Shiroh Isono Hisahiro Matsubara Department of Frontier Surgery Chiba University Graduate School of MedicineChiba 260-8670Japan Staff of Clinical Laboratory Seirei Sakura Citizen HospitalChiba 285-8765Japan Biostatistics Section Clinical Research CenterChiba University HospitalChiba 260-8677Japan Department of Anesthesiology Chiba University Graduate School of MedicineChiba 260-8670Japan

BACKGROUND Sedation is commonly performed for the endoscopic submucosal dissection(ESD)of early gastric *** hypoxemia occasionally occurs due to the respiratory depression during *** To establish predictive models for respiratory depression during sedation for *** Thirty-five adult patients undergoing sedation using propofol and pentazocine for gastric ESDs participated in this prospective observational ***,a portable sleep monitor and STOP questionnaires,which are the established screening tools for sleep apnea syndrome,were *** during sedation was assessed by a standard polysomnography technique including the pulse oximeter,nasal pressure sensor,nasal thermistor sensor,and chest and abdominal respiratory motion *** apnea-hypopnea index(AHI)was obtained using a preoperative portable sleep monitor and polysomnography during ESD.A predictive model for the AHI during sedation was developed using either the preoperative AHI or STOP questionnaire *** All ESDs were completed successfully and without *** patients(49%)had a preoperative AHI greater than 5/*** intraoperative AHI was significantly greater than the preoperative AHI(12.8±7.6 events/h vs 9.35±11.0 events/h,P=0.049).Among the potential predictive variables,age,body mass index,STOP questionnaire score,and preoperative AHI were significantly correlated with AHI during *** linear regression analysis determined either STOP questionnaire score or preoperative AHI as independent predictors for intraoperative AHI≥30/h(area under the curve[AUC]:0.707 and 0.833,respectively)and AHI between 15 and 30/h(AUC:0.761 and 0.778,respectively).CONCLUSION The cost-effective STOP questionnaire shows performance for predicting abnormal breathing during sedation for ESD that was equivalent to that of preoperative portable sleep monitoring.

关键词： Deep sedation Respiratory depression Polysomnography Endoscopic submucosal dissection sleep apnea syndrome STOP questionnaire

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健康教育对重叠综合征患者生活方式的影响

中国实用护理杂志 2008年第8期24卷 22-23页

作者：谢瑛徐锡凤孙维敏王玉宇南京医科大学附属无锡第五医院肺移植中心

近年来,睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)作为一种常见病、多发病,正日益受到重视。有文献报道,1985年Flenley首先提出了将OSAS合并慢性阻塞性肺疾病(COPD)称为"重叠综合征"的概念,并认为此类患者较单纯OSAS... 详细信息

近年来,睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)作为一种常见病、多发病,正日益受到重视。有文献报道,1985年Flenley首先提出了将OSAS合并慢性阻塞性肺疾病(COPD)称为"重叠综合征"的概念,并认为此类患者较单纯OSAS或COPD有更严重的与睡眠有关的低氧血症,易导致肺动脉高压,从而进一步发展成慢性肺源性

关键词：健康教育重叠患者生活方式 sleep apnea syndrome 睡眠呼吸暂停综合慢性阻塞性肺疾病慢性肺源性心脏病肺动脉高压低氧血症多发病常见病文献概念

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OSAS患者颈椎手术的围手术期护理

中国实用护理杂志 2007年第3期23卷 31-31页

作者：武权桑旭明娄翠华大连市骨科医院

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea syndrome,OSAS)是一种常见的睡眠性疾病,除睡眠打鼾外,均伴有不同程度的阻塞性呼吸暂停、缺氧、憋气、头痛,记忆力下降,入睡困难及恐惧的心理。

关键词：患者颈椎手术围手术期护理 cervical vertebrae 阻塞性睡眠呼吸暂停低通气 sleep apnea syndrome 睡眠打鼾性疾病记忆力心理头痛缺氧程度