The Effects Of One-month CPAP On Sleep Architecture, Therapy Pressure And Blood Glucose Of Patients With Obstructive Sleep Apnea Hypopnea Syndrome

BackgroundObstructive sleep apnea hypopnea syndrome is internationally recognized as one of the major public health problem. OSAHS is a clinical syndrome with a series of pathological physiology change caused by intermittent hypoxia, sleep fragmentation, hypercapnia and so on, due to repeated apnea and (or) lower ventilation as throat collapse, pharyngeal cavity stenosis repeatedly. Symptoms of OSAHS are sleeping snoring and apnea, dry mouth and fatigue next morning, daytime sleepiness, nocturia and so on. OSAHS may cause autonomic nerve and endocrine disorder, inflammation, damage of tissue and multiple organs, which is associated with multiple system disease, such hypertension, stroke, cardiac arrhythmia, angina and so on, and seriously affects people’s physical and mental health. It will be life-threatening if OSAHS is not timely treated. It is common in patients with OSAHS and the prevalence of OSAHS is as high as 4% for men,2% for female in adults.It is reported that the average medical expense of patients with OSAHS was significantly higher than those in healthy group. What is more, the medical costs was positively correlated with the severity of OSAHS. In addition to the medical expenses, the economic losses caused by OSAHS include the cost of occupational injury, motor vehicle traffic accident and the decrease of the production and so on. The risk of occupational injury in patients with OSAHS was 2.2 times, and the risk of motor vehicle traffic accident was 3 to 7 times of control group.People spend a third time on sleep. The growth and physical recovery mainly complete during sleep. Poor sleep for a long time will make the person inattention, grumpy, aggressive, mental fatigue, memory loss, immunity drop and endocrine disorder, which also may induce coronary heart disease, hypertesion, stroke, menstrual disorders and so on. Sleep quality is closely related to people’s health and quality of life. OSAHS is one kind of sleep disorder. Patients with OSAHS may appear arousal increase, sleep fragmentation and daytime sleepiness. While age is one of other factors that affect sleep. The sleep quality of different ages is different. The older are more likely to have trouble in falling asleep, lack sleep time, easy to wake up and wake up early. Age is associated with the development of OSAHS. However, it is lack of studies on the effects of age or OSAHS on sleep architecture respectively. Most researches on the effects of OSAHS on sleep architecture neglect the effects of age and researches on the effects of age on sleep architecture neglect the effects of OSAHS.The timely and accurate diagnosis and treatment for OSAHS can not only prevent or control diseases such as cardiovascular diseases, metabolic diseases and so on, but also can reduce the consumption of health resources, improve the quality of life and promote happiness index in patients with OSAHS. Polysomnography (PSG) is the gold standard for diagnosis of OSAHS and the preferred treatment is nasal continuous positive airway pressure (CPAP). Appropriate therapy pressure is one of the key factors of successful CPAP treatment, and the standard method for determination of optimal therapy pressure is artificial airway pressure titration test. Set appropriate CPAP therapy pressure can improve the comfort and effectiveness of the treatment, improve patients’ compliance. While if the therapy pressure and sleep architecture alter after long-term CPAP treatment is not clear, and it is lack of relevant research, especially after the publication of the new AASM manual in 2007. Most existing literature only study on the change of sleep architecture and hypoxemia after initial CPAP in patients with OSAHS, but not on the treatment effects and the change of pressure after long-term CPAP treatment.Diabetes is also one of the major public health problems, and the prevalence of diabetes was 9.7% and pre-diabetes was 15.5% in Chinese. According to researches, The direct and indirect medical costs due to diabetes was up to $174 billion each year.What is more, diabetes killed nearly 250000 people each year. But only 23.66% of patients will be awared of their diabetes. Cardiovascular disease is the main lethal factors of type 2 diabetes. In addition, diabetes can damage the eyes, kidneys and nervous system, etc.The relationship between OSAHS and diabetes has become a hot research topic. According to statisticsin, the prevalence of type 2 diabetes in OSAHS patients is between 15% and 30%, and pre-diabetes between 20% and 67%. However, other studies did not found the independent association between OSAHS and glucose metabolic disorder. Chronic intermittent hypoxemia and sleep fragmentation are two main characteristic of OSAHS, and its association with glucose metabolism is still lack of comprehensive study.Nasal continuous positive airway pressure (CPAP) can reduce apnea hypoventilation index, improve hypoxemia effectively, improve the sleep quality of patients, lethargy, and cognitive dysfunction, and then improve the quality of life. It is reported that CPAP can reduce the blood pressure of patients with hypertension and OSAHS, reduce the risk of cardiovascular and cerebrovascular diseases, improve cardiac arrhythmias and enhance heart function. But whether glucose metabolism be improve after CPAP treatment in patients with OSAHS remains controversial, and the study on the effects of one-month CPAP on glucose metabolism is lack in ChinaFollowing, we will study the characteristics of sleep architecture, therapy pressure and glucose metabolism before and after one-month Auto-CPAP in patients with OSAHS.Chapter 1:The characteristics of sleep architecture and therapy pressure before and after one-month CPAP in patients with obstructive sleep apnea hypopnea syndromeObjective:To observe the effects of obstructive sleep apnea hypopnea syndrome (OSAHS) and age on sleep architecture respectively.Then observe the effects of continuous positive airway pressure (CPAP) for one month on sleep architecture and therapy pressure in patients with OSAHS.Methods:According to standard, selecting 222. adults who had accepted a polysomnography (PSG) due to snore and analyzing their sleep architecture. The sleep architecture of subjects in different age groups and in groups with different severity of OSAHS was analyzed before and after adjustment for AHI or age. Then, from the 222. adults, selecting 139 patients who were diagnosed with OSAHS by a full polysomnography, received Auto-CPAP for one month and twice artificial airway pressure titration test before and after one month. Sleep architecture, ventilation function and therapy pressure before and after one month-CPAP were analyzed.Results:1. N3 sleep was most correlated with AHI (r=-0.361, P< 0.001). REM sleep and wake after sleep onset (WASO) were most correlated with age (REM sleep: r=-0.211, P= 0.002; WASO:r=0.216, P= 0.001).2. In four age groups, as AHI was not significantly different, sleep efficiency, N1, N2 and REM sleeps, and WASO were significantly different (F= 7.558,3.565, 3.669,3.050,5.456; P< 0.001, P= 0.015,0.013,0.030,0.001), but not was N3 sleep (F= 1.518, P=0.211). REM sleep decreased and WASO increased with the increase of age.3. In four groups with different severity of OSAHS, N1, N2 and REM sleeps were significantly different after adjustment for age (F= 3.389,3.490,5.800; P= 0.011,0.017,0.001), but not was REM sleep (F= 0.232, P=0.874). The N3 sleep of patients with moderate or severe OSAHS increased with the increase of AHI.4. In the results of twice artificial airway pressure titration test before and after one-month Auto-CPAP, the light sleep (N1 and N2 sleeps) of patients with OSAHS significantly decreased, the slow-wave sleep (N3 sleep) and REM sleep significantly increased (All P< 0.001), and after one-month Auto-CPAP sleep efficiency significantly increased (P= 0.018) and wake time after sleep onset significantly decreased (P= 0.035), compared to those before CPAP. The N2 sleep significantly increased after one-month CPAP (P= 0.010), and latency to sleep onset significantly decreased (P= 0.022), compared to that of the first artificial airway pressure titration test.5. The optimal therapy pressure of Auto-CPAP increased with the increase of the severity of OSAHS (CPAP-1d:F= 28.812, P< 0.001; CPAP-lm:F= 19.366, P< 0.001). The optimal therapy pressure of patients with severe OSAHS decreased after one-month Auto-CPAP (CPAP-1d:CPAP-lm= (9.73 ± 2.6) cmH20:(9.10 ± 2.5) cmH2O,P= 0.001).Conclusion:OSAHS and age are associated with sleep architecture. REM sleep and WTSO are greater influenced by age, while N3 sleep is greater influenced by OSAHS. Besides, both initial and one-month Auto-CPAP can improve sleep of patients with OSAHS and the therapy pressure needed of patients with severe OSAHS will decrease after one-month Auto-CPAP.Chapter 2:The characteristics of glucose metabolism before and after one-month CPAP in patients with obstructive sleep apnea hypopnea syndromeSection 1:The association between OSAHS and glucose metabolism before CPAP treatmentObjective:To study the effects of obstructive sleep apnea hypopnea syndrome (OSAHS) on glucose metabolism and comprehensively analyze its influencing factors.Methods:Retrospectively reviewed data of 180 subjects who snored and underwent both a full polysomnography (PSG) and plasma glucose measure, including fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). To test if FPG, OGTT-lh or OGTT-2h glucose is associated with apnea hypoventilation index (AHI), oxygen saturation, sleep architecture or obesity index, and then to test the differences of FPG, OGTT-lh and OGTT-2h glucose of patients with different apnea hypopnea index (AHI) or hypoxia.Results:Prevalence of glucose metabolism disorder was higher in subjects with OSAHS than those without OSAHS (diabetes:21.4% vs.5%; prediabetes:34.3% vs. 25%). Blood glucose was significantly associated with AHI, blood oxygen saturation, obesity indexes, but not was sleep architecture or sleep efficiency. The FPG, OGTT-1h and OGTT-2h glucose of participants with different severity of OSAHS was significantly different (F= 77.728, P< 0.001; F= 9.003, P< 0.001; F= 5.078, P= 0.002), so as participants with different degree of the lowest oxygen (F= 75.655, P= 0.004; F= 5.517, P= 0.001; F= 76.346, P= 0.014). Post-load glucose were still significantly different after adjustment for neck circumference (OGTT-1h:F= 4.679, P= 0.004; OGTT-2h:F= 2.683, P= 0.048). While glucose was not significantly associated with sleep architecture or sleep efficiency.Conclusion:The risk of glucose metabolism disorder increases with the increasing severity of OSAHS. Compared to fasting glucose, post-load glucose is more affected by OSAHS independent of obesity. Glucose metabolism disorder may be more associated with hypoxia due to OSAHS, compared to sleep architecture or sleep efficiency.Section 2:The effects of one-month CPAP on glucose metabolism of patients with OSAHSObjective:To test the hypothesis that one-month Auto-CPAP improves the glucose metabolism of patients with OSAHS.Methods:According to standard, selecting 53 men from the Sleep Medical Centre between January 1,2013 to May 30,2014. They accepted a polysomnography (PSG) due to snore, artificial airway pressure titration test and one-month Auto-CPAP at home. Then dividing the subjects into three groups:normal glucose, pre-diabetes (pre-DM) and diabetes, or three groups:mild, moderate and severe OSAHS or two groups:obese and non-obese. To compare the differences of fasting, OGTT-lh and OGTT-2h glucose in patients with OSAHS before and after one-month Auto-CPAP treatment.Results:1. After one-month Auto-CPAP, the fasting and OGTT-lh glucose significantly decrease in patients with OSAHS and pre-DM (FPG:t= 4.160, P< 0.001; OGTT-1h:t= 2.306, P= 0.031). OGTT-lh and OGTT-2h glucose significantly decrease in patients with OSAHS and diabetes (OGTT-1h:t= 2.731, P= 0.039; OGTT-2h:t= 2.766, P= 0.025). The fasting OGTT-lh and OGTT-2h glucose were not significantly different in patients with OSAHS and normal glucose.2. After one-month Auto-CPAP, OGTT-1h and OGTT-2h glucose significantly decrease in patients with severe OSAHS (OGTT-1h:t= 3.367:P= 0.002; OGTT-2h 血糖:t= 2.664, P= 0.011), and the fasting OGTT-lh and OGTT-2h glucose were not significantly different in patients with mild-moderate OSAHS.3. After one-month Auto-CPAP, OGTT-lh glucose significantly decrease in obese patients with OSAHS (t= 3.195, P= 0.003), but not did OGTT-2h glucose (t= 1.919, P= 0.064). The fasting OGTT-lh and OGTT-2h glucose were not significantly different in non-obese patients with OSAHS;Conclusion:One-month Auto-CPAP improves the glucose metabolism of patients with OSAHS and glucose metabolism disorder, especially for the patients with severe OSAHS or obesity.