Clinical Study About Serum Indicators Related With Moderate To Severe Obstructive Sleep Apnea Hypopnea Syndrome And Treatment Of N-acetylcysteine On OSAHS

Obstructive sleep apnea hypopnea syndrome is a common sleep breathing disorder.Because of complete or incomplete upper airway obstruction,recurrent sleep apnea and hypopnea may lead to sleep breathing disorder with intermittent hypoxia and hypercapnia.Part 1 Clinical study about serum indicators related with moderate to severe Obstructive Sleep Apnea Hypopnea SyndromeObjective:To analyse the correlation of height,weight,BMI,neck circumference,chest circumference,abdominal circumference with AHI,La SO2,ESS,the difference of FPG,TG,Chol,LDL,HDL,Fins,D-dimer,CRP with different severity OSAHS and the predictive ability of D-dimer,CRP,HOMA-IR for severe OSAHS,we collected height,weight,BMI,neck circumference,chest circumference,abdominal circumference,ESS score,C-reactive protein,D-dimer,fasting plasma glucose,fasting plasma insulin, triglyceride,cholesterol,low density lipoprotein,high density lipoprotein,HOMA-IR.Methods:Moderate group and severe group:40 moderate OSAHS patients and 40 severe OSAHS patients admitted in the Affiliated Hospital of Chengde Medical College between 2014 September to 2015 April were recruited. All the patients underwent an overnight polysomnography(PSG) were diagnosed according to the obstructive sleep apnea hypopnea syndrome diagnosis and treatment guidelines(2011 Edition) drafted by sleep respiratory disorder group of Chinese medical association respiratory disease branch.Healthycontrol group:40 healthy subjects without OSAHS were diagnosed by PSG(AHI < 5/h).The general information(height,weight,BMI,neck circumference,chest circumference,abdominal circumference),ESS score,serum C-reactive protein(CRP),D-dimer,fasting plasma glucose(FPG),fasting plasma insulin(Fins),triglyceride(TG),cholesterol(Chol),low density lipoprotein(LDL),high density lipoprotein(HDL) levels were detected in 80 OSAHS patients as well as in 40 healthy controls.Their HOMA-IR index was calculated afterwards.Then,we analysed the correlation of height, weight,BMI,neck circumference,chest circumference,abdominal circumference with AHI,La SO2,ESS,the difference of FPG, TG, Chol, LDL, HDL, Fins,D-dimer,CRP with different severity OSAHS and the predictive ability of D-dimer,CRP,HOMA-IR for severe OSAHS.Results:1.AHI and ESS were associated positively with age, weight, BMI, NC,CC,WC(P<0.05),La SO2 positively with age(P<0.05),negatively with BMI,NC,CC(P<0.05).2.CRP,FPG,Fins,TG,Chol,LDL,D-dimer,HOMA-IR levels were significantly higher in OSAHS group than those in the control group(P <0.05),and became higher in the severe OSA group than those in the moderate group(P<0.05). HDL were significantly lower in OSAHS group than those in the control group(P<0.05),and became lower in the severe OSAHS group than those in the moderate group(P<0.05).3. The area under the receiver operating characteristic curve(ROC) of D-dimer,CRP and HOMA-IR were 0.724(95%CI 0.605~0.843), 0.839(95%CI0.748~0.930),0.747(95%CI0.630~0.864),respectively.The diagnostic threshold value for severe OSA of D-dimer was > 0.493 ug/ml, the specificity was 80%, and the sensitivity was 60%. The diagnostic threshold of CRP was >9.34ug/ml, the specificity was 80%, and the sensitivity was 74.3%. The diagnostic threshold of HOMA-IR was > 4.99, the specificity was 85.7%, and the sensitivity was 60%.Concerning the predictive value of mortality,CRP showed ideal predictive accuracy. Concerning the predictive value of mortality,CRP showed ideal predictive accuracy.Conclusions:1.Age and obesity are the risk factors of OSAHS.The severity of OSAHS increases with the increase of age,weigh,BMI, neck circumference,abdominal circumference, chest circumference.2. Blood glucose, blood lipid, insulin resistance,C-reactive protein are related positively with the severity of OSAHS.The severity of mutiply system disorders correlates with the severity of OSAHS.3. In consideration of the inconvenience of OSAHS patients diagnosed by PSG in underdeveloped area, CRP, HOMA-IR and D-dimer have a certain predictive ability for severe OSAHS.Part 2 Clinical study about treatment of N-acetylcysteine on obstructive sleep apnea hypopnea syndromeObjective:Through the application of N- acetylcysteine antioxidant therapy on patients with moderate to severe OSAHS, to explore its role in the treatment of OSAHS and metabolic injury combined with OSAHS.Methods:35 patients with OSAHS admitted in the Affiliated Hospital of Chengde Medical College between 2014 September to 2015 April were recruited.All the patients underwent an overnight polysomnography(PSG) were diagnosed according to the obstructive sleep apnea hypopnea syndrome diagnosis and treatment guidelines(2011 Edition) drafted by sleep respiratory disorder group of Chinese medical association respiratory disease branch. 35 patients with moderate to severe OSAHS were divided into N-acetylcysteine group(NAC group) and placebo control group(placebo group) according to the principle of stratified randomization.NAC group had 15 cases,placebo group had 20 cases(4 cases abscised,16 cases remained).Patients in the NAC group were orally administered with 600 mg N-acetylcysteine 1 tablet, 2 times daily;Others in the placebo group were orally administered with placebo which wassimilar to NAC in characteristics and packaging 1 tablet,2 times daily.Serum C-reactive protein(CRP), D-dimer, fasting plasma glucose(FPG),fasting plasma insulin(Fins),triglyceride(TG),cholesterol(Chol),low density lipoprotein(LDL),high density lipoprotein(HDL) levels were detected in 35 OSAHS patients before treatment and after treatment 6 months.Their HOMA-IR index was calculated afterwards.PSG and Epworth sleepiness scale(ESS) were also implemented.We compared all the indexs between the two groups before and after treatment in order to discuss the effect of NAC on AHI, La SO2,ESS sores and metabolic damage.Results:1.AHI:before treatment,AHI in NAC group and placebo group has no statistically significant difference(t=0.745,P=0.463);After treatment,AHI in NAC group and placebo group has statistically significant difference(t=-2.511,P=0.018).OSAHS patients in NAC group after treatment than before treatment,AHI decreased,the difference was statistically significant(t=2.261,P=0.040);OSAHS patients in placebo group after treatment than before treatment,AHI increased,the difference was statistically significant(t=-3.090,P=0.007).2.La SO2:before treatment, La SO2 in NAC group and placebo group has no statistically significant difference(t=0.263,P=0.795);After treatment,La SO2 in NAC group and placebo group has no statistically significant difference(t=0.224,P=0.832).OSAHS patients in NAC group after treatment than before treatment, La SO2 increased,the difference was not statistically significant(t=-1.375,P=0.191);OSAHS patients in placebo group after treatment than before treatment, La SO2 increased, but the difference was not statistically significant(t=-1.085,P=0.295).3.Sleep score results: before treatment, ESS score in NAC group and placebo group has no statistically significant difference(t=0.253,P=0.802);After treatment, ESS score in NAC group and placebo group has statistically significant difference(t=-0.775,P=0.045).ESS score of patients with OSAHS in NAC are lower after treatment statistically significant(t=2.477,P=0.027);Placebo group patients’ score have no obvious drop(t=0.618,P=0.546).4.Metabolic index and CRP: CRP,FPG,TG,Chol,LDL,HDL, Fins,HOMA-IR has no significant difference in NAC group and placebo groupbefore treatment(P>0.05); FPG,Fins,HOMA-IR of patients with OSAHSafter treatment in NAC group were lower statistically significantly thanplacebo group(P < 0.05),but CRP,TG,Chol,LDL,HDL had no statisticallysignificance(P>0.05).Conclusions:1. After N-acetylcysteine antioxidant treatment, clinical symptoms and sleep score of OSAHS patients are improved,with the fewer AHI during sleep in night and fewer ESS score daytime.2. After N-acetylcysteine antioxidant treatment, the lowest oxygen saturation during sleep in night of OSAHS patients had no significance compared with before treatment.3. N-acetylcysteine can reduce the fast glucose and insuilin resistance in OSASH patients.