Study Of Leptin Expression In Serum Of Patients With Obstructive Sleep Apnea

Objective:By detecting the expression levels of leptin(Lp)in peripheral blood of patients with Obstructive sleep apnea(OSA)of different severity and the normal control group,we analyzed and compared the expression differences of Lp in each group,and preliminarily clarified whether Lp can be used as a predictor of OSA risk.Meanwhile,differences in scores of the Epworth sleepiness scale(ESS)and Pittsburgh sleep quality index(PSQI)in patients with different degrees of severity were compared to analyze the diagnostic efficacy of the two scales for OSA.To provide guidance for clinical diagnosis prediction and severity assessment of OSA.Methods:Patients with OSA risk factors or related symptoms who were admitted to the outpatient department and inpatient department of the second ward of the Second Affiliated Hospital of Kunming Medical University from April 2018 to September 2019 were diagnosed with polysomnography(Polysomnography,PSG)results,and finally selected 13 cases in the non-OSA group and 35 patients with a simple diagnosis of OSA for the first time,including the mild group(9 cases),the moderate group(13 cases),and the severe group(13 cases).The diagnostic criteria for OSA patients refer to the "Guidelines for the Diagnosis and Treatment of Adult Obstructive Sleep Apnea at the Primary Level(2018)" issued by the Sleep Apnea Group of the Chinese Medical Association Respiratory Branch.Record the general information and PSG monitoring indicators of the research subjects,collect the ESS and PSQI questionnaire information for the research subjects,use the enzyme-linked immunosorbent assay to determine serum Lp levels,compare and analyze the differences in Lp levels,ESS scores,and PSQI scores between the groups and analyze them Correlation with PSG monitoring indicators to assess whether it has diagnostic efficacy for OSA.Result1.Comparison of basic data and sleep monitoring indicators between the groups:There were no significant differences in gender,age,and BMI between the four groups of subjects;moderate(P<0.001)and severe(P<0.001)OSA groups had significantly higher AHI than non-OSA group;AHI in severe OSA group was significantly higher than that in mild OSA group(P<0.001);LSaO2 in moderate(P=0.005)and severe(P<0.001)OSA group was significantly lower than that in non-OSA group;LSaO2 was significantly lower than mild OSA group(P<0.001);MSaO2 in severe OSA group was significantly lower than moderate OSA group(P=0.007)and non-OSA group(P<0.001);LAT in severe OSA group was significantly lower than non-OSA group OSA group(P<0.001).2.The expression level of Lp in the severe OSA group was significantly higher than that in the non-OSA group,mild and moderate OSA group,and there was no significant difference in Lp expression level among the non-OSA group,mild OSA group and moderate OSA group.3.Correlation analysis of serum Lp levels:There was no correlation between serum Lp expression levels and the sex and age of the subjects;serum Lp expression levels were not related to the subjects’ BMI(r=0.382,P=0.007),AHI(r=0.477,P=0.001),LAT(r=0.356,P=0.013)were positively correlated with LSaO2(r=-0.361,P=0.012),MSaO2(r=-0.534,P<0.001);negatively correlated with serum Lp expression levels Among the related factors,the degree of correlation was MSaO2>AHI>BMI>LSaO2>LAT from high to low.4.Serum Lp level is the dependent variable,and the possible influencing factor is the independent variable.Stepwise multiple regression analysis was performed.MSaO2 was selected into the equation(regression equation:Lp=25.52 1-0.234MSaO2).5.There were no significant differences in PSQI scores between the four groups of subjects(P=0.127),and there was no correlation between PSQI scores and the monitoring indicators of gender,age,BMI and PSG.Moderate(P<0.001)and severe(P<0.001)ESS scores in the OS A group were significantly higher than those in the non-OSA group.The ESS scores were positive with AHI(r=0.432,P＝0.002)and LAT(r=0.511,P<0.001).Correlation was negatively correlated with LSaO2(r=-0.310,P=0.032)and MSaO2(r=-0.325,P=0.024).6.Using the severity of the disease(severe and non-severe)as the state variable and Lp expression level as the test variable to draw the ROC curve,area under the curve(AUC)=0.846,P<0.001<0.05,≥3.895ng/ml,the sensitivity for diagnosing severe OSA was 92.3%,and the specificity was 62.9%.Using the severity of the disease(severe and non-severe)as the state variable and the ESS score as the test variable,the ROC curve was plotted.AUC=0.751,P=0.008<0.05.When the ESS score was≥7.5,the sensitivity for diagnosing severe OSA was 76.9%The specificity is 68.6%.The accuracy of serum Lp combined with ESS score in diagnosis of severe OSA(86.6%)was higher than that of single diagnosis.Conclusion1.Serum Lp level in severe OSA group was significantly higher than that in normal control group,mild and moderate OSA group.Serum Lp level increased with the increase of BMI,OSA severity and LAT.The lower the LSaO2 and MSaO2,the higher the serum Lp level.Among the factors related to serum Lp level,the correlation was MSaO2>AHI>BMI>LSaO2>LAT.Therefore,Lp is considered to be involved in the occurrence and development of OSA disease and can be used as a risk predictor of OSA.2.MSaO2 is an independent influencing factor of Lp.3.The ESS scores of patients with moderate and severe OSA were significantly higher than those of the normal control group.The higher the ESS score,the greater the severity of OSA disease and the longer the LAT;the lower the LSaO2 and MSaO2.4.The PSQI score cannot reflect the severity of OSA and cannot be used as a reference indicator for assessing OSA risk.The subject’s daytime sleepiness was not related to nighttime sleep quality.5.The diagnostic accuracy of serum Lp level in diagnosis of severe OSA is 84.6%.When the serum Lp level is greater than 3.895ng/ml,considering that the patient may be a severe OSA patient,the corresponding sensitivity is 92.3%,the specificity is 62.9%,and the serum Lp Level can be used as an indicator to predict the risk of severe OSA.6.ESS score was 75.1%in diagnosing severe OSA.When the ESS score is>7.5,consider that the patient may be severe OSA,the corresponding sensitivity is 76.9%,and the specificity is 68.6%.The ESS score can be used as an indicator to predict the risk of severe OSA,and its diagnostic accuracy is lower than the serum Lp level.The diagnostic accuracy of serum Lp level combined with ESS score in the diagnosis of severe OSA(86.6%),the accuracy of the combined diagnosis is higher than the accuracy of single diagnosis of Lp and ESS scores.