Pregnancy With Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) Patients Screening System To Improve And Efficacy Evaluation Of CPAP

Background and Significance:Obstructive sleep apnea syndrome (Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS) is characterized by its clinical state in patients with sleep apnea repeated short and/or low ventilation, with oxygen desaturation. Can cause heart, brain, kidney, endocrine and other clinical syndrome of multiple organ damage. Currently, the disease at home and abroad in research in the general population more, according to epidemiological investigation Tip:obstructive sleep apnea hypopnea syndrome (OSAHS) in the general population prevalence rate of about 4%.According to the relevant information abroad:general female population with obstructive sleep apnea hypopnea syndrome (OSAHS) occur in approximately 2 to 5%, while the prevalence rate of pregnant women rose significantly, up 11.4% and may thus lead to gestational hypertension, preeclampsia, intrauterine growth retardation, prematurity, congestive heart failure and a series of complications, a serious threat to the mother, infant safety. However, with this appropriate, the domestic and on pregnancy diagnosis and intervention in screening OSAHS treatment of correlation is still at a blank stage. For the diagnosis of OSAHS pregnancy, at home and abroad mainly by overnight polysomnography (Polysomnograhy; PSG) confirmed. However, because the examination requires patients overnight sleep monitoring, and the necessary instruments, equipment is expensive (Shushi million/unit), and the need for sleep monitoring sites with specialized and professional and technical personnel; So the grass roots, or even a in general, small hospitals are difficult to be universal; and that the inspection cost is high (900-1100 yuan/time), so that people can not afford to carry out clinical extremely difficult.As the pregnancy diagnosis and treatment OSAHS has not been well developed and popular, leading to OSAHS every year due to pregnancy with pregnancy induced hypertension (Hypertensive Disorder Complicating Pregnancy, HDCP) of the patients and premature children, children with low birth weight high incidence; has extended the mother of baby’s ICU stay; can directly affect the perinatal mothers, infant health and prognosis; also increases the social and financial burden, the state spent a lot of health care health resources. Therefore, from the perspective of disease prevention, so that high risk pregnancy with OSAHS receive appropriate and effective prenatal screening will not only improve pregnancy outcomes; relationship between costs and benefits from the point of view:very high cost of prenatal care.To this end, for the majority of pregnant women groups, to provide efficient, specialist of OSAHS-related screening programs and intervention for the treatment of dynamic quantitative assessment tools to prepare an urgent need to improve and enhance medical and health management issues of great social and economic value. Some scholars put forward:neck circumference, and BMI of the OS AHS’s condition has some screening value; and in young and aged compared to the former BMI and neck circumference, predict the severity of the OSAHS more valuable, can be used as screening check one of the means. Currently, commonly used outside the "Epworth" Sleepiness Scale (Epworth Sleepiness Scale; ESS) of the common assessment of high-risk groups, could play a screening role of OSAHS. However, the sensitivity (79.2%) and specificity (60.9) are not high. Moreover, the domestic research also found that due to the formulation of ESS information from abroad, without adjustment to their national conditions, the overall screening results can have a greater deviation. Such as:the number of domestic self-drive small cars, less maternal. So most people can not be screening "is dozing off when driving a red light" to effectively answer this one; while not reflected by the survey items and other special causes of maternal restriction. Epworth score currently expect the application form on the pregnancy at high risk for OSAHS efficient screening may not be realistic.Therefore, how to proceed with self-developed as soon as possible compatible with the local culture, and Zhuanmenzhendui pregnancy合并OSAHS Huanzhe screening Yiji right intervention Jin Xing Zhi Liao’s effectiveness could be dynamic assessment of Gongju, to fill the domestic-related Lingyukongbai of Ren Wu imminent. The ultimate goal is the screening tool widely available in pregnancy and efficacy evaluation of health promotion. The only way to make better use of limited medical resources; reduce unnecessary human and financial resources to waste. Only improve the quality of perinatal medicine screening, to better benefit the vast majority of family and maternal.In addition, some scholars have proposed for:OSAHS patients during pregnancy is pregnancy induced hypertension (Hypertensive Disorder Complicating Pregnancy, HDCP) high risk, and may result in pregnancy induced hypertension, preeclampsia and intrauterine growth retardation and other related diseases occurrence, and even affect the safety of mother and child. As the current treatment interventions for HDCP no major breakthrough, only confined to the traditional rest, sedation, spasm, and blood pressure of symptomatic treatment, the effect is unsatisfactory, the clinic also need an effective means of intervention.Our clinical work, once diagnosed OSAHS patients, should be appropriate intervention measures. Currently, the most widely recognized definitive treatment efficacy are:continuous positive airway pressure at night (Continuous Positive Airway Pressure, CPAP). Overseas, there have been individual through the use of CPAP treatment for pregnancy in patients with OSAHS, success stories. Based on current information:CPAP OSAHS patients by improving the inflammation and oxidative stress can significantly change the relevant prognosis. Therefore, we need to conduct relevant feasibility studies, specifically the point in pregnancy is feasible in patients with OSAHS, and to evaluate its associated pathophysiology.Therefore, this study has the following three purposes:1, without changing the original purpose of Epworth score sheet under the premise of the original in accordance with their national conditions, habits and characteristics of maternal appropriate modifications. With the local situation so that it can adapt to specific OSAHS患者pregnancy screening, and was able to curative effect of intervention dynamic assessment tools-modified Epworth score table to fill the relevant fields blank; the same time, tested through its clinical value in the field of obstetrics and feasibility analysis.2, around the body during pregnancy in patients with OSAHS inflammation and oxidative stress-related indicators related research started with the intention of pregnancy in patients with OSAHS disease and inflammation and oxidative stress related, and its possible mechanism. For the next step to provide a theoretical basis for intervention and related monitoring indicators and ultimately improve the treatment of patients with pregnancy levels of OSAHS.3, through the one-week continuous positive airway pressure (CPAP) treatment interventions, monitor pregnancy OSAHS patients before and after the intervention in the blood levels of inflammation and oxidative stress changes, and changes in clinical indicators, obtained short-term CPAP therapy if you can reduce the body’s inflammatory response and oxidative stress, and thus to some extent to improve the condition of pregnancy in patients with OSAHS conclusions. Eventually find a non-drug treatment interventions.PartⅠOSAHS patients during pregnancy improved screening systemFirst, research methodsSelect from February 2008 to March 2009 in our hospital for check-and hospital delivery of obstructive sleep apnea hypopnea syndrome (OSAHS) maternal 64 (pregnancy with OSAHS group), mean age (28.41±5.67) years, height (1.58±0.09) m, gestational age (31.58±3.37) weeks; normal control mothers and 22 (normal pregnancy group), mean age (27.59±6.09) years, height (1.57±0.08) m, gestational age (32.32±2.95) weeks. General comparison of the two groups were not significantly different (p> 0.05), comparable. Sleep monitoring in patients within 24 hours before taking prohibited:sleeping pills, tobacco, alcohol, tea and coffee; while not oxygen, oral VitC, VitE other antioxidants.All officers are selected to accept both scoring and improved Epworth Epworth scoring questionnaire survey. Epworth Epworth score table and improved scoring a total of 8 questions related to each question in accordance with the never (0 points), rarely (1 point), sometimes (2 points), often (3 points), scoring a total of 4 levels. EP score from the scores of the maximum score of 24 points. Epworth score table which includes the following whether the possibility of falling asleep:①sat reading;②watching TV;③sitting in public places, not activities (such as theater or meeting);④the middle of a long ride do not break;⑤sat talking with people;⑥meal breaks (not alcohol);⑦driving through traffic lights;⑧repose at rest. Modified Epworth Epworth score sheet score sheet in the original:the first③is replaced with "queue waiting time for check-call number"; first④is replaced "by bus congestion at the"; first⑥is replaced with "quiet after dinner sit time "; first⑦is replaced with" Waiting on public transport"; first⑧is replaced with" repose again after lunch break. " The end of the survey was conducted after the PSG (polysomnography, PSG) examination (the most Less 7h). OSAHS diagnostic criteria (1) apnea:in the mouth during sleep, complete cessation of nasal airflow for more than 10 seconds; (2) low ventilation:respiratory airflow during sleep, reduced strength was based on≥50% airflow accompanied by oxygen saturation decline than the basic≥4%; (3) apnea hypopnea index (Apnea Hypopnea Index, AHI):within an hour of sleep apnea with hypopnea frequency; (4) OSAHS patients with apnea are still with thoracic and abdominal respiratory movement; (5) OSAHS severity of illness according to Chinese Society of Respiratory Diseases of credit will be sleep apnea group established in 2002 "OSAHS treatment guidelines" classification.Second, the resultsWeight (WT), body mass index (BMI), neck circumference in Pregnancy OSAHS group were (64.71±7.63; 25.88±1.82; 38.37±2.48) compared with normal pregnancy group (58.93±7.37; 23.95±1.57; 36.08±2.48) The significantly increased, there was significant statistical difference in p values were:(0.003; 0.000; 0.000). Apnea hypopnea index (AHI), lowest oxygen saturation (LSaO2) in pregnancy with OSAHS group were (31.38±18.90; 0.81±0.07) compared with normal pregnancy group (4.17±0.92; 0.93±0.02) between the sleep monitoring indicators of more significant statistical difference (p<0.001). Epworth Sleepiness Scale score improved scores (modified EP), Epworth sleepiness scale score points (EP) in pregnancy with OSAHS group were (10.89±2.63; 9.55±2.99) than normal pregnancy group (6.73±2.07; 6.23±2.11) compared scores between the existence of significant statistical difference (p<0.001). Normal pregnancy group’s EP value and improve the EP values were (6.23±2.11; 6.73±2.07), no significant difference between the two (p= 0.457); pregnancy with OSAHS group and the improvement of EP value of EP values were respectively (9.55±2.99; 10.89±2.63), there was significant difference between the two (p<0.001). Apnea hypopnea index (AHI) value and the improvement of Epworth sleepiness score scale scores (modified EP), Epworth sleepiness scale score points (EP), neck circumference (NC), body mass index (BMI) values showed a positive correlation, correlation coefficient (r), respectively (0.876,0.748,0.671,0.670), (p<0.001); apnea hypopnea index (AHI) correlated with age, gestational age, height no correlation, correlation coefficient (r) is (0.009,-0.047,-0.013), p values were (1.000,0.669,0.905). Minimum oxygen saturation (LSaO2) and modified Epworth Sleepiness Scale score score (modified EP), Epworth sleepiness scale score points (EP), neck circumference (NC), body mass index (BMI) value of a negative correlation coefficient (r), respectively (-0.874,-0.745,-0.660,-0.657), (p<0.001); minimum oxygen saturation (LSaO2) correlated with age, gestational age, height no correlation, correlation coefficient (r) is (-0.024,0.063,-0.006), p values were (0.826,0.563,0.954). Epworth Sleepiness Scale score improved scores (modified EP), Epworth sleepiness scale score points (EP), neck circumference (NC), body mass index (BMI) of the ROC curve for the following points (0.901,0.819,0.750,0.779), p values were (0.000,0.000,0.001,0.000).Third, the conclusions1, modified Epworth sleepiness scale score (modified ESS) without changing the original purpose of the Epworth Sleepiness Scale score under the premise of the appropriate modifications and amendments to better reflect China’s national conditions, habits and maternal characteristics.2, modified Epworth sleepiness score scale scores (modified EP) more accurately reflects the sleepiness in patients with OSAHS pregnancy status and degree of respiratory disorders and with severe hypoxemia related to the degree.3, corresponding to other screening measures (neck circumference, BMI, and the Epworth sleepiness scale score), modified Epworth Sleepiness Scale score (modified EP) has a higher sensitivity (84.4%) and specificity (90.9%).4, for clinical intervention (such as CPAP) efficacy in patients with OSAHS pregnancy provides a more objective observation of dynamic assessment tools.PartⅡPregnancy in patients with OSAHS AOPP and IL-6, TNF-a correlationFirst, research methodsFrom February 2008 to May 2009 to hospital for check-in and hospital delivery of obstructive sleep apnea hypopnea syndrome (OSAHS) 56 Maternity (pregnancy with OSAHS group), mean age (28.38±5.58) years, height (1.59±0.07) m, gestational age (30.99±4.44) weeks; normal maternal 24 (normal pregnancy group), mean age (27.58±6.01) years, height (1.58±0.06) m, gestational age (30.19±4.28) weeks. General comparison of the two groups were not significantly different (p> 0.05), comparable. Sleep monitoring in patients within 24 hours before taking prohibited:antihypertensive drugs, sleeping pills, tobacco, alcohol, tea and coffee; the same time can not be oxygen inhalation, oral VitC, VitE and other antioxidants.All officers Embletta X-100 PSG monitoring system (polysomnography, PSG) for the night of PSG monitoring, diagnosis or exclusion of the OSAHS patients. The patients who had no hypertension, heart disease, kidney disease, diabetes and chronic lung diseases. Diagnosis of OSAHS based China credits the Chinese Society of Respiratory Diseases Study Group will sleep respiratory disease developed in 2002, "obstructive sleep apnea syndrome diagnosis and treatment guidelines" confirmed. Measurement of blood pressure:blood pressure measurement standards consistent with vertical mercury column type sphygmomanometer cuff, measurement time line polysomnography unified end morning; take the mean arterial pressure (mean arterial pressure, MAP) as an evaluation index; mean arterial pressure= diastolic pressure+1/3 (systolic-diastolic pressure). Samples should be taken:in the polysomnography apparatus at the end of fasting blood samples were immediately placed in non-anticoagulant tube 6ml, low centrifugal serum markers were stored at-800C environment, equipment seized. Was detected according to the instructions: Plasma advanced oxidation protein products (AOPP); Interleukin-6 (IL-6); tumor necrosis factor-a (TNF-a).24-hour urine protein:participating in the experiment was collected from pregnant women to the next 7Am 7Am after a total of 24 hours before the urine, quantitative detection of maternal 24-hour urine protein, and the related records.Second, the resultsMean arterial blood pressure (MBP), body mass index (BMI) apnea hypopnea index (AHI), lowest oxygen saturation (LSaO2) in pregnancy with OSAHS group were (106.52±19.87,25.94±1.84,0.81±0.07,26.96±15.01) compared with normal pregnancy group (87.57±9.09,23.89±1.51,0.92±0.02,3.50±0.98) was statistically significant between the difference (p<0.001).24-hour urine protein, advanced oxidation protein products (AOPP), tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) in pregnancy with OSAHS group were (488.59±527.89,304.06±51.22,22.64±7.40,188.39±46.40) compared with normal pregnant group (154.52±68.50,171.35±45.33,12.04±4.02,119.80±40.89) was statistically significant between the difference, p values were (0.003,0.000,0.000,0.000). Apnea hypopnea index (AHI) and no correlation between age and gestational age, the correlation coefficient (r) are (0.089,0.096), p values were (0.435,0.399); and mean arterial pressure (MBP), urinary protein, Advanced oxidation protein products (AOPP), tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) there is a significant correlation coefficient (r) are (0.745,0.765,0.798,0.668,0.707), (p<0.001). Minimum oxygen saturation (LSaO2) age and gestational age with no correlation, correlation coefficient (r) are (-0.115,-0.079), p values were (0.309,0.485); and mean arterial pressure (MBP), urine protein, advanced oxidation protein products (AOPP), tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) there is a significant correlation coefficient (r) are (-0.866,-0.872,-0.775,-0.684,-0.739), (p<0.001). Advanced oxidation protein products (AOPP) and no correlation between age and gestational age, the correlation coefficient (r) are (0.124,0.090), p values were (0.275,0.428); and mean arterial pressure (MBP), urinary protein, Tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) there is a significant correlation coefficient (r), respectively (0.626,0.619,0.518,0.596), (p<0.001). Tumor necrosis factor-a (TNF-a) and no correlation between age and gestational age, the correlation coefficient (r) are (0.115,-0,078), p values were (0.309,0.491); and mean arterial pressure (MBP), urine protein, interleukin-6 (IL-6) there is a significant correlation coefficient (r), respectively (0.592,0.627,0.697), (p<0.001). Number of interleukin-6 (IL-6) and no correlation between age and gestational age, the correlation coefficient (r) are (0.096,0.106), p values were (0.398,0.349); and the mean arterial pressure (MBP), urinary protein were significantly correlated correlation coefficients (r) are (0.667,0.697), (p<0.001),24-hour urine protein and no correlation between age and gestational age, the correlation coefficient (r) are (0.106,0.068), p value was (0.349,0.550); and average arterial pressure (MBP) significantly correlated correlation coefficient (r) is (0.830), (p<0.001).Third, the conclusions1 pregnancy in patients with OSAHS obvious inflammatory response (IL-6, TNF-a) and oxidative stress (AOPP) state, and its related indicators (IL-6, TNF-a, AOPP) and the severity of OSAHS significant correlation.2, pregnancy OSAHS patients vulnerable to blood pressure, proteinuria, and the phenomenon of significant increase in body weight, and with the severity of OSAHS with a statistical correlation; of these three clinical manifestations and pregnancy induced hypertension (HDCP) The three major characteristics:hypertension, proteinuria and edema consistent with each other, so we have reason to conclude:OSAHS pregnancy may be pregnancy induced hypertension (HDCP) is an important risk factor.3, through the use of pregnant women can reduce the inflammatory response in patients with OSAHS and oxidative stress treatment of clinical interventions can achieve the goal of treatment HDCP, to be the third part of the clinical observation.PartⅢThe AOPP and IL-6, TNF-a changes in the Pregnancy patients with OSAHS after CPAP treatmentFirst, research methodsFrom February 2008 to May 2009 to hospital for check-in and delivery in pregnant women-mothers and 23 severe OSAHS, mean gestational age 31.13±3.99 weeks; average age of 27.57±5.01 years; height 1.58±0.07m; weight 66.73±7.20kg; and calculate BMI (Body Mass Index, BMI) was 26.63±1.71. Selected eligible patients-severe OSAHS diagnostic criteria. CPAP patients before and after treatment are not taking blood pressure medicine, sleeping pills, tobacco, alcohol, tea and coffee; the same time can not be oxygen, oral VitC, VitE and other antioxidants.Measurement of blood pressure:blood pressure measurement standards consistent with vertical mercury column type sphygmomanometer cuff, measurement time line polysomnography unified end morning; take the mean arterial pressure (mean arterial pressure, MAP) as an evaluation index; mean arterial pressure= diastolic pressure+1/3 (systolic-diastolic pressure).Samples should be taken:in the PSG and CPAP end of the fasting blood samples were immediately placed in non-anticoagulant tube 6ml, low centrifugal serum markers were stored at-800C environment, equipment seized. Samples Was detected according to the instructions:Plasma advanced oxidation protein products (AOPP); Interleukin-6 (IL-6); tumor necrosis factor-a (TNF-a).24-hour urine protein collection from pregnant women participating in the experiment is to the next 7Am 7Am after a total of 24 hours before the urine, quantitative detection of maternal 24-hour urine protein, and the related records.Continuous positive airway pressure:CPAP use DEVILBISS-Sleepcube autoadjust a continuous positive airway pressure ventilation, CPAP treatment night at least 6h, treatment time for 7 days.Second, the resultsPregnancy CPAP treatment in OSAHS patients after 7 days of the clinical indicators, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MBP), apnea hypopnea index (AHI), lowest oxygen saturation (LSaO2) were (158.70±13.24,91.52±10.27,113.91±10.95,7.82±3.68,0.90±0.03) and the index before treatment (163.35±16.57,94.78±13.01,116.96±14.54,38.97±11.54,0.78±0.07) were significantly improved compared, t values were (5.04,4.04,2.76,12.76,-7.14), (p<0.05).Pregnancy CPAP treatment in patients with OSAHS of the laboratory indicators, including 24-hour urine protein, advanced oxidation protein products (AOPP), interleukin several-6 (IL-6), tumor necrosis factor-a (TNF-a) were was (442.28±421.46,205.92±55.90,191.72±39.05,22.43±5.16) and the index before treatment (613.89±647.17,319.79±48.97,211.57±34.43,24.84±6.53) were significantly improved compared, t values were (3.53,8.13,4.86,4.47), (p<0.001).Third, the conclusionsSeven days of CPAP treatment can reduce the body during pregnancy in patients with OSAHS apnea and hypoxia, so as to achieve significant reduction in the imbalance of oxidative stress and the degree of inflammation.2, while CPAP treatment can be achieved to some extent to improve the condition of patients with OSAHS pregnancy; to play to prevent further patients with severe HDCP goal.3, the side effects, since CPAP is a non-drug treatment of non-invasive interventions for maternal and fetal absence of any adverse effects, with higher clinical safety.