Expression Of Toll-like Receptor 4 In Patients With Obstructive Sleep Apnea

Objective:This study detected the expression of Toll-like receptor4(TLR4)in the serum of patients with the obstructive sleep apnea(OSA)and compared with the non-OSA control group.It evaluated the relationship between the serum expression of TLR4 in patients with different severity of OSA.The relationship between TLR4 and apnea hypopnea index(AHI),nocturnal lowest oxygen saturation(LSaO2),mean oxygen saturation(MSaO2)and the longest apnea time(LAT)were analyzed.To exp-lore whether TLR4 can be used as an indicator to assess the severity of OSA and as an indicator of OSA follow-up.Methods:Patients with excessive daytime sleepiness and snoring at night from November 2017 to November 2018 were selected to perform polysomnography(PSG)in the respiratory monitoring room of the Second Affiliated Hospital of Kunming Medical University.The mild OSA was selected according to the PSG results.Accor-ding to the PSG results,13 cases in the mild OSA group,12 cases in the moderate OSA group,12 cases in the severe OSA group were selected as the experimenta]group,and 8 cases in the non-osa group as the control group.Diagnosis and grouping of OSA patients are based on the 2012 guidelines for the diagnosis and treatment of obstructive sleep apnea by the professional committee of sleep medicine of Chinese medical doctors association.An enzyme-linked immunosorbentassay kit was used to measure concentration of TLR4 in serum.To analyze the difference of the expression of TLR4 in mild group,moderate group,severe group and non-OSA control group.And analyze the relationship between these factors and apnea hypopnea index(AHI).the lowest oxygen saturation(LSaO2).mean oxygen saturation(MSaO2)and the longest apnea time(LAT).Results:1 The comparison of levels of serum TLR4 in four groups:There were significant differences in TLR4 expression levels between the four groups(P<0.001),and TIR4 expression level increased with increased OSA severity.Compared with the normal control group,the expression of TLR4 in the moderate and severe OSA group was significantly different(P<0.008),and there was no significant difference in the mild group.Compared with the mild OSA group,there was a significant difference in the expression of TLR4 in the severe OSA group(P<0.008),and there was no significant difference in the moderate group.There was no significant difference in TLR4 level between moderate OSA group and severe OSA group.2 The correlation analysis of serum levels of TLR4 with general data and PSG monitoring index:The correlation analysis results,there was no significant correlation between the expression of TLR4 and gender,age,BMI.Shows serum TLR4 expression level was positively correlated with AHI(r=0.588,P<0.001)and LAT(r=0.412.P=0.005).The more severe obstructive sleep apnea,and the longer the longest apnea time,the higher the serum TLR4 expression.And negatively correlated with LSaO2(r=-0.311,P=0.038)and MSaO2(r=-0.342,P=0.021).The lower the lowest and mean oxygen saturation,the higher the serum TLR4 expression.3 Stepwise multiple regression analysis was performed to determine gender,age,BMI,LSaO2,MSaO2,longest apnea time,and TLR4 prediction of OSA severity.AHI was the dependent variable and the above factors were independent variables.Among all the factors,TLR4 and MSaO2 were selected into the equation,and the regression equation was(AHI=155.180+5.93TLR4-1.703MSaO2).suggesting that TLR4 and MSaO2 are predictors of OSA severity,positively correlated with TLR4,and negatively correlated with MSaO2.4 The ROC curve of TLR4 predicts the non-OSA and severe OSA,using AHI value as the "gold standard" for diagnosis and classification,1-specificity as the abscissa and sensitivity as the ordinate to draw the ROC curve of TLR4 index.Taking the maximum of the Jordan index(sensitivity+specificity-1)as the optimal boundary value,the optimal value was 3.315ng/mL,the sensitivity was 91.7%,and the specificity was 87.5%,indicating that TLR≥3.315ng/mL,consider that the patients may be severe OSA.5 Two-class logistic regression analysis of factors affecting OSA:OSA as the dependent variable,gender,age,BMI,TLR4 as independent variables.TLR4 inclusion equation,X2=14.87,P<0.001,the fitting equation is considered meaningful.Therefore,TLR4 are the influencing factors of OSA.TLR4 is positively correlated with OSA.The odds ratio is 3.977Conclusions:1 Serum TLR4 level in patients with obstructive sleep apnea was significantl y higher than that in the normal control group,and serum TLR4 level increase d with the more severe obstructive sleep apnea,the longer the longest apnea ti me,he lower the minimum and average oxygen saturation.Therefore,TLR4 is considered to be involved in the inflammatory process of OSA,and is closely related to the degree of hypoxia and apnea time of OSA patients.2 TLR4 and MSaO2 are predictors of OSA severity,positively correlated wit h TLR4 and negatively correlated with MSaO2.TLR4 can be used as a predict ive indicator for clinical interpretation of OSA severity3 When TLR4 is used to distinguish between non-osa and severe OSA,patie nts with serum TLR4 3.315ng/mL are likely to have severe obstructive sleep a pnea and moderate hypoxia.The sensitivity is 91.7%and the specificity is 87.5%.Therefore,TLR4 can be considered as an evaluation index of the degree of hypoxia in OSA patients.4 TLR4 is a factor affecting OSA,and the higher the level of TLR4 expres sion,the higher the risk of OSA.