Influencing Factors of Daytime Sleepiness in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Its Correlation with Pulse Oxygen Decline Rate

Objective. To explore the influencing factors of daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the correlation between daytime sleepiness and pulse oxygen decline rate in patients with severe OSAHS. Methods. From January 2018 to April 2021, 246 consecutive patients with OSAHS diagnosed by polysomnography (PSG) in our hospital were selected. All patients were grouped according to the minimum nocturnal oxygen saturation and apnea hypopnea index (AHI). There were 33 cases in the no sleep hypoxia group, 34 cases in the mild hypoxia group, 119 cases in the moderate hypoxia group, and 60 cases in the severe hypoxia group. There were 30 cases in the simple snoring group, 55 cases in the mild OSAHS group, 48 cases in the moderate OSAHS group, and 113 cases in the severe OSAHS group. The Epworth Sleepiness Scale (ESS) scores of each group were compared. All patients were grouped according to ESS score. Those with score ≥9 were included in the lethargy group (n = 118), and those with score ≤10 were included in the no lethargy group (n = 128). Univariate and multivariate logistic regression analyses were used to explore the influencing factors of daytime sleepiness in OSAHS patients. Pearson correlation analysis showed the correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS. Results. The ESS score of the severe hypoxia group > the moderate hypoxia group > the mild hypoxia group > the no sleep hypoxia group. There was significant difference among the groups (F = 19.700, P < 0.0001 ). There were significant differences between the severe hypoxia group and other groups and between the moderate hypoxia group and the no sleep hypoxia group and the mild hypoxia group ( P < 0.05 ). The ESS score of the severe OSAHS group > the moderate OSAHS group > the mild OSAHS group > the simple snoring group. There was significant difference among the groups (F = 19.000, P < 0.0001 ). There were significant differences between the severe OSAHS group and other groups and between the moderate OSAHS group and the simple snoring group ( P < 0.05 ). Univariate analysis showed that BMI, neck circumference, snoring degree, total apnea hypopnea time, AHI, micro arousal index (MAI), oxygen saturation (CT90%), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) were the influencing factors of daytime sleepiness in OSAHS patients ( P < 0.05 ). Multiple logistic regression analysis showed that AHI and CT90% were independent risk factors for daytime sleepiness in OSAHS patients ( P < 0.05 ). Pearson correlation analysis showed that there was a positive correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS (r = 0.765, P < 0.0001 ). Conclusion. OSAHS patients may be accompanied by daytime sleepiness in varying degrees, which may be independently related to AHI and CT90%. The degree of daytime sleepiness in patients with severe OSAHS may be closely related to the decline rate of pulse oxygen, which should be paid great attention in clinic.

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Integration of hypoxic dilation signaling pathways for skeletal muscle resistance arteries

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00741.2001 ◽

2002 ◽

Vol 283 (2) ◽

pp. R309-R319 ◽

Cited By ~ 26

Author(s):

Jefferson C. Frisbee ◽

Kristopher G. Maier ◽

John R. Falck ◽

Richard J. Roman ◽

Julian H. Lombard

Keyword(s):

Nitric Oxide ◽

Vascular Reactivity ◽

No Synthase ◽

Gracilis Muscle ◽

Severe Hypoxia ◽

No Production ◽

Resistance Arteries ◽

Moderate Hypoxia ◽

Progressive Hypoxia ◽

Mild Hypoxia

Mediator contributions to hypoxic dilation of rat gracilis muscle resistance arteries were determined by measuring dilation, vascular smooth muscle hyperpolarization, and metabolite production after incremental hypoxia. Nitric oxide (NO) synthase inhibition abolished responses to mild hypoxia, whereas COX inhibition impaired responses to more severe hypoxia by 77%. Blocking 20-hydroxyeicosatetraenoic acid (20-HETE) impaired responses to moderate hypoxia. With only NO systems intact, responses were maintained with mild hypoxia (88% normal) mediated via KCachannels. When only COX pathways were intact, responses to moderate-severe hypoxia were largely retained (79% of normal) mediated via KATP channels. Vessel responses to moderate hypoxia were retained with only 20-HETE systems intact mediated via KCa channels. NO production increased 5.6-fold with mild hypoxia; greater hypoxia was without further effect. With increased hypoxia, 20-HETE levels fell to 40% of control values. 6-keto-PGF1α levels were not altered with mild hypoxia, but increased 4.6-fold with severe hypoxia. These results suggest vascular reactivity to progressive hypoxia represents an integration of NO production (mild hypoxia), PGI2 production (severe hypoxia), and reduced 20-HETE levels (moderate hypoxia).

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Impact of Violent Experiences and Social Support on R-NSSI Behavior among Middle School Students in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073347 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3347

Author(s):

Kun Liu ◽

Xueyan Yang ◽

Moye Xin

Keyword(s):

Social Support ◽

Influencing Factors ◽

Empirical Support ◽

Female Students ◽

Male Students ◽

Male And Female ◽

Self Injury ◽

Significant Difference ◽

Main Effect ◽

Nonsuicidal Self Injury

Repetitive nonsuicidal self-injury (R-NSSI) is an extreme manifestation of nonsuicidal self-injury (NSSI) behavior that causes bodily harm and emotional and personality disorders. It is a growing concern, especially among adolescents; therefore, this study aims to provide empirical support for effective interventions on R-NSSI behavior among adolescents in China. We used data of about 1180 students from a survey conducted in seven middle schools in Xi’an, China, and applied multiple logistic regression to analyze NSSI and R-NSSI among male and female students, including their influencing factors. We found no significant difference between male and female students’ R-NSSI; however, regarding influencing factors, male students had more violent experiences and less social support than female students. Parental and familial factors played the most prominent role in social support. Social support was found to be a main-effect mechanism in the effect of violent experiences on R-NSSI among male students, whereas the mechanism had both a main effect and a certain buffer effect among female students. R-NSSI was found to be more prevalent among younger children, children with siblings, and those with romantic relationship experiences. We also found that healthy adolescent development involves the participation of families and schools. Health education should be conducted according to the students’ sex and characteristics.

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Interaction of hypoxia and hypercapnia on cerebral hemodynamics and brain electrical activity in dogs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1987.253.4.h890 ◽

1987 ◽

Vol 253 (4) ◽

pp. H890-H897 ◽

Cited By ~ 2

Author(s):

R. W. McPherson ◽

D. Eimerl ◽

R. J. Traystman

Keyword(s):

Partial Pressure ◽

Elevated Level ◽

Severe Hypoxia ◽

O2 Uptake ◽

Animal Group ◽

Moderate Hypoxia ◽

Co2 Partial Pressure ◽

Arterial Blood ◽

O2 Partial Pressure ◽

O2 Delivery

The interaction of hypoxic hypoxia, hypercapnia, and mean arterial blood pressure (MABP) was studied in 15 pentobarbital-anesthetized ventilated dogs. In one group of animals (n = 5) hypercapnia [arterial CO2 partial pressure (PaCO2) approximately 50 Torr] was added to both moderate hypoxia and severe hypoxia. Moderate hypoxia [arterial O2 partial pressure (PaO2) = 36 mmHg] increased MABP and cerebral blood flow (CBF) without changes in cerebral O2 uptake (CMRO2). Superimposed hypercapnia increased CBF and MABP further with no change in CMRO2. In another group of animals (n = 5), a MABP increase of approximately 40 mmHg during moderate hypoxia without hypercapnia did not further increase CBF, suggesting intact autoregulation. Thus, during moderate hypoxia, hypercapnia is capable of increasing CBF. Severe hypoxia (PaO2 = 22 mmHg) increased CBF, but MABP and CMRO2 declined. Superimposed hypercapnia further decreased MABP and decreased CBF from its elevated level and further decreased CMRO2. Raising MABP under these circumstances in another animal group (n = 5) increased CBF above the level present during severe hypoxia alone and increased CMRO2. The change in CBF and CMRO2 during severe hypoxia plus hypercapnia with MABP elevation were not different from that severe hypoxia alone. We conclude that, during hypoxia sufficiently severe to impair CMRO2, superimposed hypercapnia has a detrimental influence due to decreased MABP, which causes a decrease in CBF and cerebral O2 delivery.

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A Comparative study between Dexmedetomidine versus Propofol for sedation in upper GI endoscopy procedure considering effect on intraoperative vital data, patient amnesia and onset of recovery after the procedure

QJM ◽

10.1093/qjmed/hcab086.025 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eslam Ahmed Mohamed Elsamahi ◽

Bassem P Ghobrail ◽

Ghada Mohamed Samir ◽

Hany Victor Zaki

Keyword(s):

Heart Rate ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Day Case ◽

Upper Gi ◽

Significant Difference ◽

Upper Gi Endoscopy ◽

Upper Gastrointestinal

Abstract Background In the modern medicine, upper gastrointestinal endoscopy has become a definitive tool for diagnosis and management of many diseases. It is usually preformed in separate unit as day-case procedure and for outpatient clinic. The search of a safe and effective sedation for these patients is still an open topic. Objective The aim of the study is to compare the use of propofol and dexmedetomedine in upper GI endoscopy regarding the hemodynamics, sedative effect and the patient satisfaction. Methods Double – blinded, randomized controlled trial with allocation ratio 1:1 arranged in two parallel groups. This study was conducted in the endoscopy unit of Ainshams University Hospital, Cairo, Egypt within a period of 6 months started from April 2019. All recruited patients were adults undergoing upper gastrointestinal endoscopy. They were included in the study according to the following criteria: Age 21-60 years; elective procedures under general anesthesia with patients who completed eight hours of fasting; and physical Status: ASA I and II Patients after taking written and informed consent. Results Concerning the results of the study, there was no statistically significant difference considering the heart rate in relation to base line readings. The changes of heart rate between the two groups were significantly different with dexmedetomidine associated with lower readings. Respiratory rate and oxygen saturation were insignificantly different in both groups. Time of induction was significantly shorter in propofol than dexmedetomidine (P < 0.001) and time to reach full recovery identified by modified Alderete’s score 10/10 was significantly shorter in dexmedetomidine than propofol (P < 0.014). There was a significant difference between the two dugs concerning the patients and endoscopists satisfaction. The patients were more satisfied with propofol (P 0.047), while the endoscopists were more satisfied with dexmedetomidine (P 0.034). Conclusion Dexmedetomidine and propofol are equally effective and safe to provide enough sedation for upper gastrointestinal endoscopy in a day-case manner. Advantages of dexmedetomidine were providing analgesic effect, rapid recovery from sedation and stability of respiratory rate and oxygen saturation. However, there were some disadvantages such as the bradycardia and patient dissatisfaction although the bradycardia can be utilized in cardiac patients as a safety factor against myocardial ischemia. Other point noticed that using dexmedetomidine for sedation was more costly than propofol and requires the usage of a syringe pump for accurate dosing. On the contrary, propofol is cheap and available in all centers with rabid onset of induction but it causes hypotension and respiratory depression which might be risky in cardiac patients.

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Effects of hypoxia and hypercapnia on geniohyoid contractility and endurance

Journal of Applied Physiology ◽

10.1152/jappl.1991.71.2.709 ◽

1991 ◽

Vol 71 (2) ◽

pp. 709-715 ◽

Cited By ~ 25

Author(s):

R. J. Salmone ◽

E. Van Lunteren

Keyword(s):

Force Production ◽

Upper Airway ◽

Muscle Performance ◽

Severe Hypoxia ◽

Force Frequency ◽

Force Output ◽

Frequency Curve ◽

Dilator Muscle ◽

Index Ratio ◽

Mild Hypoxia

Sleep apnea and other respiratory diseases produce hypoxemia and hypercapnia, factors that adversely affect skeletal muscle performance. To examine the effects of these chemical alterations on force production by an upper airway dilator muscle, the contractile and endurance characteristics of the geniohyoid muscle were examined in situ during severe hypoxia (arterial PO2 less than 40 Torr), mild hypoxia (PO2 45–65 Torr), and hypercapnia (PCO2 55–80 Torr) and compared with hyperoxic-normocapnic conditions in anesthetized cats. Muscles were studied at optimal length, and contractile force was assessed in response to supramaximal electrical stimulation of the hypoglossal nerve (n = 7 cats) or geniohyoid muscle (n = 2 cats). There were no significant changes in the twitch kinetics or force-frequency curve of the geniohyoid muscle during hypoxia or hypercapnia. However, the endurance of the geniohyoid, as reflected in the fatigue index (ratio of force at 2 min to initial force in response to 40-Hz stimulation at a duty cycle 0.33), was significantly reduced by severe hypoxia but not by hypercapnia or mild hypoxia. In addition, the downward shift in the force-frequency curve after the repetitive stimulation protocol was greater during hypoxia than hyperoxia, especially at higher frequencies. In conclusion, the ability of the geniohyoid muscle to maintain force output during high levels of activation is adversely affected by severe hypoxia but not mild hypoxia or hypercapnia. However, none of these chemical perturbations affected muscle contractility acutely.

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Investigation of Cardiovascular Endurance Levels of Sedentary High School Students

Journal of Education and Training Studies ◽

10.11114/jets.v6i5.3039 ◽

2018 ◽

Vol 6 (5) ◽

pp. 144

Author(s):

Betül Akyol ◽

Kayhan Söğüt

Keyword(s):

High School ◽

Heart Rate ◽

High School Students ◽

Oxygen Saturation ◽

Recovery Period ◽

Step Test ◽

School Students ◽

Walking Test ◽

Cardiovascular Endurance ◽

Significant Difference

The aim of our study is to examine the cardiovascular endurance systems of sedentary high school students. The 112 sedentary individual was taken to the 1600 meter walking test run, and the 120 sedentary individual Harward step test. While both individuals were participating in the same test, weight, height, oxygen saturation, and heart rate of participants were measured before starting the test. As soon as the test is finished (recovery period), oxygen saturation and heart rate variability of individuals are measured at 1, 3, 5 minutes. All measured variables were analyzed and compared. Analysis of the data was done according to the SPSS statistical program and the significance level was accepted as p <0.05. In the 1600-meter walking test, it was observed that there was a significant difference in mean heart rate between males and females p<0.05. There was a significant difference between the mean values of the time of completion of the 1600 m running test by males and females (p < 0.05). During the 1600-meter walking and Harward step test recovery period, there was no difference in the participants' parameters. There was no significant difference between oxygen saturations at beginning, recovery 1st, 3rd, and 5th minutes in both tests. Significant differences were found between heart rate and oxygen saturation values (beginning, recovery 1st, 3rd, and 5th minutes) in the intra-group comparisons of both groups. Participants' heart rates began to increase with exercise, but remained above the initial heart rate level during recovery. Participants' body mass indexes were observed to be within normal values. We think that can be increased cardio respiratory and cardiovascular fitness levels and can been created lifelong exercise habits by regular exercise programs are given to Sedentary high school students. Thus, we believe that the young population can be prevented from getting sick by providing healthier, social, active individuals.

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Differential Profile of OSA in Obese Kashmiri Patients of Northern India

JMS SKIMS ◽

10.33883/jms.v19i2.291 ◽

2016 ◽

Vol 19 (2) ◽

pp. 65-74

Author(s):

Javid Ahmad Malik ◽

Sheikh Shoib ◽

Bashir Ahmad Naikoo ◽

Shabir Ahmad Lone ◽

Ramees Mohi Ud Din Mir ◽

...

Keyword(s):

Oxygen Saturation ◽

Daytime Sleepiness ◽

Sleep Latency ◽

Obese Patients ◽

Nocturnal Sleep ◽

Presenting Symptoms ◽

Northern India ◽

Obstructive Sleep ◽

The Mean ◽

Nonobese Patients

Obstructive sleep apnea (OSA) and obesity are two interacting global epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that majority of patients with obesity also have OSA and untreated OSA in these patients results in significant cardiovascular and metabolic complications.Objectives: To evaluate the profile of OSAin obese patients of Kashmir.Methods: We performed polysomnography studies in obese patients that were referred from various sub-specialty clinics from July 2011 to August 2013.Results: Out of 182 patients who underwent polysomnography (PSG), 11O (60.4%) were obese (BMI > 30 kg/m2). In 110 obese patients, 104 (94.5%) had OSA. Hypertension, diabetes and dyslipidemia were more prevalent among obese (p<0.05). The mean neck circumference and mean BMI of obese patients was significantly more than that of non-obese (33.9 kg/m2 vs. 26.8 kg/m2) (p <0.000). Presenting symptoms of obese were snoring (97.3%), daytime sleepiness (87.3%) with a mean ESS of 15.3, disturbed nocturnal sleep (70.0%), nocturia (62.7%) and witnessed apneas (45.5%). OSA was significantly (p=0.002) more common among obese compared to non-obese (93% vs 76%). Most were clinically suspected to have OSAby internists (29%), cardiologists (20%), endocrinologists (15%) and psychiatrists (13%). Sleep efficiency was significantly less (p< 0.03) in obese patients but sleep latency and REM sleep latency did not significantly differ between obese and non-obese. Unlike awake oxygen saturation the average nocturnal oxygen saturation of obese patients was significantly less [p=0.001] than that of nonobese patients (84.7% vs. 88.1%). The mean AHI of obese patients was significantly more than non-obese i.e 24.3 vs. 18.0 (p = 0.001) and so was the mean ODI i.e 24.6 vs. 17.2 (p = 0.001). Variables that significantly correlated with presence of OSA include age, gender, BMI, hypertension, diabetes and cardiovascular disease (p< 0.05), however on logistic regression only BMI, hypertension, and nocturia correlated with OSA. CPAPtherapy improved snoring, nocturia, nocturnal sleep and daytime sleepiness more in obese than non-obese OSApatients.Conclusions: OSA which is highly prevalent among obese Kashmiri patients, is largely unrecognized in the primary care setting. It is associated with significant comorbidities and most of these improve with CPAPtherapy. JMS 2016; 19(2):65-74.

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Metabolic, Cardiac, and Hemorheological Responses to Submaximal Exercise under Light and Moderate Hypobaric Hypoxia in Healthy Men

Biology ◽

10.3390/biology11010144 ◽

2022 ◽

Vol 11 (1) ◽

pp. 144

Author(s):

Hun-Young Park ◽

Jeong-Weon Kim ◽

Sang-Seok Nam

Keyword(s):

Oxygen Uptake ◽

Blood Lactate ◽

Minute Ventilation ◽

Random Order ◽

Cycle Ergometer ◽

Submaximal Exercise ◽

Erythrocyte Deformability ◽

Moderate Hypoxia ◽

Healthy Men ◽

Significant Difference

We compared the effects of metabolic, cardiac, and hemorheological responses to submaximal exercise under light hypoxia (LH) and moderate hypoxia (MH) versus normoxia (N). Ten healthy men (aged 21.3 ± 1.0 years) completed 30 min submaximal exercise corresponding to 60% maximal oxygen uptake at normoxia on a cycle ergometer under normoxia (760 mmHg), light hypoxia (596 mmHg, simulated 2000 m altitude), and moderate hypoxia (526 mmHg, simulated 3000 m altitude) after a 30 min exposure in the respective environments on different days, in a random order. Metabolic parameters (oxygen saturation (SPO2), minute ventilation, oxygen uptake, carbon dioxide excretion, respiratory exchange ratio, and blood lactate), cardiac function (heart rate (HR), stroke volume, cardiac output, and ejection fraction), and hemorheological properties (erythrocyte deformability and aggregation) were measured at rest and 5, 10, 15, and 30 min after exercise. SPO2 significantly reduced as hypoxia became more severe (MH > LH > N), and blood lactate was significantly higher in the MH than in the LH and N groups. HR significantly increased in the MH and LH groups compared to the N group. There was no significant difference in hemorheological properties, including erythrocyte deformability and aggregation. Thus, submaximal exercise under light/moderate hypoxia induced greater metabolic and cardiac responses but did not affect hemorheological properties.

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The influence of intra-aortic balloon counter pulsation on central venous blood oxygen saturation

Perfusion ◽

10.1177/02676591211055968 ◽

2021 ◽

pp. 026765912110559

Author(s):

Ayman Mohamed ◽

Sameh Aboulnaga ◽

Fayez Hamwi ◽

Amr S Omar ◽

Abdulrasheed Pattath ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Oxygen Saturation ◽

Venous Blood ◽

Blood Gases ◽

Left Ventricular ◽

Arterial Oxygen ◽

Secondary Outcome ◽

Central Venous ◽

Significant Difference

Objectives We aim at identifying the changes in venous blood saturation values that associates intra-aortic balloon pump (IABP) in cardiac surgery patients with reduced left ventricular function (LVF). Methods A retrospective observational study was conducted in a cardiothoracic intensive care unit (CTICU) in a tertiary cardiac center over 5 years in Qatar. A total of 114 patients with at least moderate impairment of LVF with ejection fraction (EF) less than 40% were enrolled. According to the association of IABP, patients were segregated into two groups with and without IABP (groups 1, 40 patients and group 2, 74 patients). Sequential arterial and venous blood gases were analyzed. The primary outcome was to analyze the changes in the central venous saturation (ScvO2) in both groups and the secondary outcome was to analyze whether these changes affect the overall outcome in terms of intensive care unit (ICU) length of stay. Results There was no significant difference between both groups with regard to age, preoperative EF, hemoglobin, and arterial oxygen saturation (SaO2) in blood gases. Patients with IABP have a higher cScvO2 when compared to the other group (71.5 ± 12.5 vs 63.5 ± 9.3, 68.3 ± 12.6 vs 60.1 ± 9.5, 62.7 ± 10.8 vs 55.63 ± 8.1, and 60.6 ± 7.6 vs 54.9 ± 8.1; p = 0.04, 0.05, 0.03, and 0.5, respectively). However, generalized estimating equations (GEE) analysis showed that compared with the participants showing that there is a decreasing trend in mean levels within the groups during follow-ups, overall difference between both groups’ mean levels was not statistically significant. Conclusions In this study, we observed that after cardiac surgeries, patients with IABP had non-significant higher ScvO2 when compared with a corresponding group with moderate impairment of LVF. Further prospective studies are required to validate these findings.

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Urban Ecological Efficiency and Its Influencing Factors—A Case Study in Henan Province, China

Sustainability ◽

10.3390/su11185048 ◽

2019 ◽

Vol 11 (18) ◽

pp. 5048 ◽

Cited By ~ 7

Author(s):

Tao Liu ◽

Jixia Li ◽

Juan Chen ◽

Shaolei Yang

Keyword(s):

Economic Development ◽

Influencing Factors ◽

Efficiency Analysis ◽

Henan Province ◽

Measure Data ◽

Ecological Efficiency ◽

Ecological Civilization ◽

Growth Trend ◽

Static And Dynamic Analysis ◽

Significant Difference

The urban ecological civilization construction relates to welfare of the people and the national future. It is an important field of the high-quality economic development to improve the urban ecological efficiency level. The purpose of this research is to provide a new perspective and method for the quantitative study of the urban sustainable development, and also to provide some decision-making references for the improvement of the urban ecological efficiency in Henan province. This paper uses the slacks-based measure-data envelopment analysis (SBM-DEA) model containing the undesirable output and the Malmquist index model to fully evaluate the urban ecological efficiency level in Henan province during the period of 2005–2016, via both the static and dynamic analysis. Based on this, the bootstrap regression model is applied in analyzing the influencing factors of the urban ecological efficiency. The research shows three findings. First, according to the static efficiency analysis, the urban ecological efficiency in Henan province is low as a whole and has a big promotion space. Moreover, there is a significant difference in the urban ecological efficiency level among the five regions because of the different geographical locations and social and economic development situations of the cities. Second, according to the dynamic efficiency analysis, in the last 12 years, the urban ecological efficiency in Henan province has shown an overall growth trend, and the technological progress has played a major role in promoting the urban ecological efficiency in Henan province. Third, according to the influencing factor analysis, the governmental financial support hinders the improvement of the urban ecological efficiency in Henan province, while the level of opening to the outside world, the urban population density, and the urban greening level promote it.

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