Application Of Ischemia Modified Albumin In The Diagnosis And Treatment Of Obstructive Sleep Apnea Syndrome

Background and Objective:Obstructive sleep apnea syndrome(OSAHS)is a respiratory disorder characterized by apnea during sleep.Mainly due to the nasal septum curvature,tonsil hypertrophy,soft palate,resulting in partial or complete upper respiratory obstruction,also known as hypoventilation or apnea syndrome.The overall incidence of.OSAHS is 1-2%[1-3],particularly in older men,with women at half the prevalence of males[4-5].OSAHS patients have been disrupted by the process of normal sleep,while the body is in lack of oxygen,oxidative stress can lead to increased inflammation,daytime sleepiness,inability to concentrate,decreased learning efficiency[6].Continuous positive airway pressure(CPAP)is the treatment of moderate and severe OSAHS patients and clinical symptoms in patients with mild OSAHS preferred treatment methods[7].At present,the diagnosis of OSAHS mainly depends on the polysomnography(polysomnography,PSG)on the snoring people screening,PSG generally only three hospitals or specialized respiratory hospitals will monitor configuration,and tedious process(a machine for one night only monitoring a patient,and the patient must stay for a night in the hospital[8]).Due to the above limitations,PSG surveillance seems to be a drop in the eye for a large population of snoring(20%to 40%of our snoring population is reported)[9].Ischemia modified albumin(IMA)is a variant albumin formed by the change of N-terminal region of serum albumin under the condition of ischemia.It is a serum marker for sensitive myocardial ischemia,which has been approved by the US Food and Drug Administration(FDA).Studies have shown that serum IMA levels in patients with OSAHS are increased.The purpose of this study was to investigate the clinical significance of ischemic modified albumin(IMA),C-reactive protein(CRP)in the diagnosis,disease assessment and evaluation of therapeutic efficiency of obstructive sleep apnea hypopnea syndrome(OSAHS).MethodsFrom January 2016 to October 2016,97 patients with OSAHS admitted in the pneumology Department of Nanjing First Hospital Affiliated to Nanjing Medical University were enrolled.The 97 patients were divided into mild OSAHS group 46 cases,moderate OSAHS group 31 cases and severe OSAHS group 20 cases mainly according to polysomnography(PSG).At the same time,30 cases of simple snorers were selected as control group.Serum levels of IMA and CRP were measured before receiving any treatment in all 97 OSAHS patients and 30 simple snorers.Serum levels of IMA and CRP were measured repeatedly after receiving one month standard continuous positive airway pressure(CPAP)treatment in 97 OSAHS patients.Results1.The serum IMA of OSAHS light,medium and heavy groups before receiving CPAP treatment were 65.5± 10.8U/nil,74.6±11.7,83.5±12.9 U/ml,which were significantly higher than the control group(49.2 + 8.2 U/ml,P<0.05);CRP.concentrations were 6.6±3.1mg/L,7.9±2.7,10.3±2.4 mg/L,significantly higher than the control group(1.6 + 0.7 P,<0.05),the more serious condition,the change of serum IMA and CRP concentration.2.Serum IMA level in OSAHS group was significantly correlated with the severity of OSAHS(P<0.05).3.After 1 month of CPAP standardized treatment,The serum IMA of OSAHS light,medium and heavy groups were:55.1 ± 14 U/ml、61.5±15.6 U/ml,、69.4±16.9 U/ml,compared with before treatment groups,IMA levels were significantly decreased(P<0.05).The levels of CRP were 5.1±2.3mg/L,6.3±2.5m±/L and 6.9±2.6mg/L,respectively,CRP levels were significantly decreased,compared with those before treatment(P<0.05).4.Regarded 66.5U/L as the cut-off value,the sensitivity of serum IMA in OSAHS diagnosis was 82.5%,the specificity was 86.7%,the positive predictive value was 95.2%,and the negative predictive.value was 60.5%.Conclusion1.The research indicated that serum IMA was an independent predictor of OSAHS,and its level was closely related to the severity of OSAHS.2.The level of serum IMA has some clinical significance in the diagnosis,disease assessment and evaluation of therapeutic efficiency of obstructive sleep apnea hypopnea syndrome(OSAHS).3.By the way,in the present study elevated CRP in patients with OSAHS indicated that inflammatory response was involved in the pathological development of OSAHS.