To introduce the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) with Repose bone screw system and to evaluate the treating effect.Thirty-two patients with severe OSAHS (Friedman classification II, III) were treated with tongue ablation + uvulopalatopharyngoplasty + hard palate shortening + Repose suspension. All patients were followed-up for 6 months. Apnea hypopnea index (AHI), lowest oxygen percent saturation (LSaO₂), body mass index (BMI), vallecula epiglottic-lateral pharyngeal wall (V-LPW) and pharyngeal airway space (PAS) were used for the diagnosis and evaluation.The AHI in 32 patients reduced from (78.3 +/- 11.6)/h to (18.4 +/- 12.5)/h (x(-) +/- s), t = 13.5, P = 0.000. The LSaO₂ increased from (0.632 +/- 0.007) to (0.794 +/- 0.006), t = 4.1, P = 0.000. The BMI was statistical indiscriminate. The V-LPW increased from (12.1 +/- 3.2) mm to (16.9 +/- 2.6) mm (t = 2.5, P = 0.014). PAS increased from (9.2 +/- 3.3) mm to (15.6 +/- 2.4) mm (t = 7.6, P = 0.000). The total effective rate was 93.8%. Three genioglossus stabilization patients complained about foreign body sensation in the mouth floor 3 - 7 days after procedures, which disappeared in 6 months. One genioglossus stabilization patients complained about mandibular osteomyelitis 3 months after procedures, which recovered after anti-inflammatory treatment for 5 days. One genioglossus stabilization patients appeared hypoglossia bleeding, which stopped after compression. One hyoid suspension patients showed haematoma of submandibular region and cured after incision and drainage.Repose system was an effective method, safe, simple, with few complications.
To investigate the relationship between plasma neopterin and high sensitivity C-reactive protein (hsCRP) levels and circadian rhythm of blood pressure in hypertensive patients with obstructive sleep apnea syndrome (OSAS). A total of 367 hospitalized hypertensive patients were recruited. They were divided into three groups according to polysomnography (PSG): hypertension alone (group A, n=212), hypertension with mild OSAS (group B, n=107) and hypertension with moderate to severe OSAS (group C, n=48). Plasma neopterin and hsCRP concentrations were measured on or after the day of PSG, and ambulatory blood pressure (ABPM) was monitored in the first week of admission. Plasma neopterin and hsCRP levels were significantly higher in group B and C compared to group A (P<0.05). Incidence of non-dippers was significantly lower in group A (44.5%) compared to group B (67.7%) and C (84.2%) (P<0.05). Nocturnal and diurnal blood pressures were negatively correlated with plasma neopterin and hsCRP. Multiple stepwise regression analysis showed that apnea hypopnea index (AHI), drop rate of systolic blood pressure, mean oxygen saturation (MSaO2), minimum oxygen saturation (SaO2 min) were the main factors for neopterin levels while AHI and MSaO2 were the major factors affecting hsCRP levels. Plasma neopterin and hsCRP levels are increased in hypertensive patients with OSAS and positively correlated with severity of OSAS.
To investigate the change of circadian blood pressure variability (BPV) and plasma neopterin before and after surgery (uvulopalatopharyngoplasty) for patients with obstructive sleep apnea syndrome (OSAS).A total of 382 OSAS patients underwent uvulopalatopharyngoplasty were divided into three groups based on polysomnography (PSG) results: mild OSAS (n = 206), moderate OSAS (n = 108) and severe OSAS (n = 68). Plasma neopterin, 24-hour ambulatory blood pressure monitoring (ABPM), PSG were measured before and 3 months after surgery.Plasma neopterin increased in proportion to severity of OSAS before surgery (15.08 nmol/L, 27.68 nmol/L and 37.32 nmol/L in patients with mild to severe OSAS) which were significantly reduced post surgery (9.92 ng/ml, 15.07 ng/ml and 18.54 ng/ml, all P < 0.05 vs. pre-surgery). The incidence of non-dipper curve in three OSAS groups were 50.2%, 72.7% and 86.5%, respectively before surgery and the values decreased to 34.8%, 48.2% and 49.2% after surgery (all P < 0.05 vs. pre-surgery). Relevance analysis indicates that D-value of nocturnal and diurnal blood pressure was negatively correlated with plasma neopterin.Our findings indicated that plasma neopterin and the incidence of non-dipper could reliably reflect OSAS severity and could thus be used to evaluate the surgery efficacy. Plasma neopterin might be an important player in the pathophysiology of OSAS via modulating blood pressure variability.
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