Apoptosis And Denervation Changes Of Dilator Muscles In The Upper Airway In Obstructive Sleep Apnea Hypopnea Syndrome

Objective To explore apoptosis and denervation changes of dilator muscles in the upper airway in patients suffered from Obstructive Sleep Apnea Hypopnea Syndrome by determining the expression of Bax,Bcl-2,Calpain-Ⅰ,NCAM in tensor veil palatini in patients with OSAHS.Methods Study group consisted of 30 OSAHS as test group and 10 chronic tonsillitis without OSAHS as control group.The test group were divided into 3 groups:mild group(n=6,AHI 5-20 times / hour);moderate group(n=8,AHI 21-40 times / hour) and severe group(n=16,AHI＞40 times / hour) according to the severity of OSAHS. The test group were also divided into PDC group(n = 14) and non-PDC group(n = 16) according to the diagnositic standard of phlegm damp constitution in TCM.All patients in the test group were performed with polysomnography(PSG) monitoring for at least seven hours in sleep monitoring room and were diagnosed with OSAHS.And the obstructive area were located in the oral pharynx mainly through electronic nasopharyngeal laryngoscope and muller'test.The test group were performed with UPPP surgery and the control group were performed with tonsillectomy.Tensor muscles of velum palatini were removed intraoperatively as a specimen for studies.Immunohistochemistry method was used to determine Bax,Bcl-2,Calpain-Ⅰ,NCAM expression in specimens.Results(1) The expression levels of Bax,Bcl-2,Calpain-Ⅰ,NCAM in the test group increased significantly compared to control group(P＜0.05),but there were no significant differences of Bcl-2 expression between two groups,and the ratio of Bax/Bcl-2 increased significantly(P＜0.05).(2) The expression levels of Bax and Calpain-Ⅰwere increased significantly in severe group compared to mild group and moderate group(P＜0.05),and the results in the moderate group increased significantly than mild group(P＜0.05);the expression levels of NCAM were increased in severe group compared to mild group and moderate group(P＜0.05),and the results showed no distinct difference between mild group and moderate group(P＞0.05).The ratio of Bax/Bcl-2 increased significantly in severe group compared to moderate group(P＜0.01),but the results showed no distinct difference between mild group and moderate group(P＞0.05) as well as moderate group and severe group.(3) The expression levels of Bax,Calpain-Ⅰand NCAM increased significantly in PDC OSAHS group compared to non-PDC group(P＜0.05).The ratio of Bax/Bcl-2 increased significantly in PDC OSAHS group compared to non-PDC group(P＜0.05).(4) There were positive correlations between AHI and the expression levels of Bax(r=0.697, P=0.000),Calpain-Ⅰ(r=0.811,P=0.000),NCAM(r=0.692,P=0.000) respectively in the test group.There were positive correlations between the expression level of Bax and NCAM (r=0.635,P=0.000),Bax and Calpain-Ⅰ(r=0.720,P=0.000).There were positive correlations between the expression levels of NCAM and Calpain-Ⅰ(r=0.583,P=0.001).Conclusions(1) The expression level of Bax,Calpain-Ⅰ,NCAM and the ratio of Bax/Bcl-2 increased significantly in test group compared to control group.And the expression level of Bax,Calpain-Ⅰ,NCAM correlated with AHI positively.These results indicate that there were apoptosis and denervation changes of dilator muscles in the upper airway in patients suffered from Obstructive Sleep Apnea Hypopnea Syndrome,and severity of OSAHS were relevant with apoptosis and denervation as well as the more denervate and poptosis,the more severity of OSAHS.(2) The expression level of Bax,Calpain-Ⅰ,NCAM and the ratio of Bax/Bcl-2 are increased significantly in PDC OSAHS group compared to non-PDC group.The results showed that phlegm damp constitution in TCM play an important role in the pathogenic mechanisms of OSAHS.