| Objective: Obstructive sleep apnea hypopnea syndrome(OSAHS)is a very common respiratory disorder which characterized by intermittent hypoxia(IH)during sleep,while a persistent IH state activates inflammatory factors The persistent IH state activates inflammatory factors,triggering an inflammatory response that produces a series of physiological pathological changes such as oxidative stress that damage endothelial cells leading to vascular endothelial dysfunction.It has been found that endothelial dysfunction is one of the causes of OSAHS-related atherosclerosis and is closely associated with the development of OSAHS-related cardiovascular system diseases.Recently,serum Adropin,endothelial cell-specific molecule-1(ESM-1),and intercellular adhesion molecule-1(ICAM-1)have been found to be biomarkers for early assessment of endothelial dysfunction in patients with OSAHS and correlated with the severity of OSAHS,among which Adropin is a novel endothelial function modulator with potential endothelial protective effects.It is a novel serum marker for the assessment of endothelial function.There is a lack of comprehensive analysis of serum Adropin,ESM-1,ICAM-1 levels and sleep parameters,glycolipid metabolism,inflammatory factors and Carotid Intima-Media Thickness(CIMT)in OSAHS patients.Therefore,the objectives of our study were:(1)to study the changes of serum Adropin,ESM-1 and ICAM-1 levels in patients with OSAHS of different severity;(2)to investigate the correlation between serum Adropin,ESM-1 and ICAM-1 levels and sleep parameters,inflammatory factors,glycolipid metabolism and CIMT in patients with OSAHS;(3)to analyze the correlation between OSAHS with CIMT thickening in patients with OSAHS,and to investigate the predictive role of serum Adropin,ESM-1 and ICAM-1 in patients with OSAHS with CIMT thickening.Methods: 149 patients with sleep snoring,daytime sleepiness and other symptoms admitted to the Department of Respiratory and Critical Care Medicine of Affiliated Hospital of Yangzhou University from September 2021 to December 2022 were collected,and general clinical data were recorded.All patients were divided into severe OSAHS group(38 patients),moderate OSAHS group(35 patients),mild OSAHS group(36patients),and control group(40 patients)according to the results of AHI,and the following indexes were recorded: apnea hypopnea index(AHI),oxygen desaturation index(ODI),mean oxygen saturation(MSa02),and lowest oxygen saturation(LSa02).After PSG monitoring,venous blood was drawn on an empty stomach on the following morning for white blood cell(WBC),neutrophil(NEUT),lymphocyte(LY),platelet(PLT),hypersensitive C-reactive protein(hs-CRP),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood-glucose(FBG),glycosylated hemoglobin,type A1-c(Hb A1c).Enzyme-linked immunosorbent assay(ELISA)was used to detect serum Adropin,ESM-1 and ICAM-1levels;CIMT thickness was measured by color ultrasonography,and the data were statistically analyzed using spss24.0 statistical software.Results:1.Comparison of general clinical data between groups: among the above indexes,patients in moderate and severe OSAHS groups has a higher level of BMI,neck circumference,waist circumference,systolic blood pressure and the amount of patients with hyperlipidaemia than in the control group(all P < 0.05).BMI,neck circumference were higher in the moderate and severe OSAHS groups than mild OSAHS group(all P <0.05).Compared with the control group,Waist circumference and BMI were higher in the OSAHS groups(all P < 0.01),the waist circumference of severe OSAHS group was higher than mild and moderate OSAHS groups(all P < 0.05),ESS scores were higher in severe OSAHS group than mild OSAHS group and control group(all P < 0.01).2.Comparison of sleep monitoring indicators,inflammation indicators,glucose and lipid metabolism indicators and CIMT indicators among groups:(1)AHI and ODI levels increased for the mild to moderate OSAHS group(P < 0.01),MSa O2 and LSa O2 levels decreased for the mild to moderate OSAHS group(P < 0.01);(2)NLR indicators were higher in mild OSAHS group than in control group(P < 0.05);(3)FBG and Hb A1 c levels were higher in severe OSAHS group compared to control group(P < 0.05),Hb A1 c levels were higher in severe OSAHS group compared to mild and moderate OSAHS(both P <0.01);(4)HDL-C levels were lower in all OSAHS groups compared to the control group(P< 0.01),severe TG levels were higher in OSAHS group compared with control group(P <0.05).(5)CIMT levels were higher in moderate and severe OSAHS groups compared to the mild OSAHS and the control group(all P < 0.01).3.Comparison of serum Adropin,ESM-1 and ICAM-1 between groups: Adropin levels were significantly lower in the severe OSAHS group compared to the mild OSAHS group and the control group(all P < 0.01),ESM-1 was significantly higher in the severe OSAHS group compared to the control group(P < 0.05),and ICAM-1 levels were significantly higher in all OSAHS groups compared to the control group(all P < 0.01).4.Comparison of sleep monitoring indicators and serum Adropin,ESM-1 and ICAM-1levels between subgroups with and without CIMT thickening in OSAHS:(1)The AHI and ODI levels gradually increased in the OSAHS with CIMT thickening group compared with the control group and the OSAHS without CIMT thickening group(all P < 0.05),while MSa O2 and LSa O2 levels gradually decreased(all P < 0.05).(2)Serum Adropin levels were significantly lower in the OSAHS with CIMT thickening group compared to the control group(P < 0.05),while ESM-1 and ICAM-1 levels were significantly higher(both P < 0.05).5.Correlation analysis of AHI,Adropin,ESM-1,ICAM-1 with CIMT and other indicators: AHI was positively correlated with ODI,ESM-1,ICAM-1,CIMT,BMI,TG,FBG and Hb A1c(all P < 0.05),negatively correlated with MSa O2,LSa O2,Adropin and HDL-C(all P < 0.01);Adropin was positively correlated with MSa O2,LSa O2 and HDL-C(all P < 0.05),negatively correlated with AHI,ODI,ESM-1,ICAM-1,CIMT and BMI(all P < 0.01);ESM-1 was positively correlated with AHI,ODI,ICAM-1 and CIMT(all P <0.01),negatively correlated with MSa O2,LSa O2,Adropin and HDL-C(all P < 0.01);ICAM-1 was positively correlated with AHI,ODI,ESM-1,CIMT,BMI,TG and Hb A1c(all P < 0.05),negatively correlated with MSa O2,LSa O2,Adropin and HDL-C(all P <0.01).6.Analysis of factors affecting patients with OSAHS with CIMT thickening and ROC curves:(1)Binary logistic regression analysis revealed that increased age(OR=1.051,95%CI 1.009-1.095,P=0.016),increased BMI(OR=1.840,95% CI 1.347-2.514,P=0.000),increased ICAM-1(OR=1.008,95% CI 1.002-1.014,P=0.033)as independent risk factors for patients with OSAHS with CIMT thickening and increased Adropin(OR=0.990,95% CI 0.981-0.999,P=0.022)as independent protective factor.(2)The sensitivity of serum Adropin at 318.20 pg/m L was 69.5% and the specificity was 62.7%;the optimal threshold value of ICAM-1 for OSAHS with CIMT thickening was 335.33ng/m L(sensitivity 82.1%,specificity 54.9%);ESM-1 for OSAHS with CIMT thickening The optimal threshold value for OSAHS with CIMT thickening was 35.78ng/m L(sensitivity 50.7%,specificity 75.6%).Conclusions:(1)Patients with OSAHS are prone to disorders of glucolipid metabolism,thickened CIMT,decreased serum Adropin and increased ESM-1 and ICAM-1,and this correlates with the severity of OSAHS.(2)Adropin was negatively correlated with CIMT,while ESM-1 and ICAM-1 were positively correlated with CIMT.(3)Serum Adropin,ESM-1 and ICAM-1 can be used as predictors for patients with OSAHS with CIMT thickening,to provide a reference for assessing the degree of endothelial dysfunction in patients with OSAHS. |
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