OSAHS And Metabolic Disorders And Two Diagnositic Method's Validation

Background:Previous studies showed that obstructive sleep apnea-hypopnea syndrome?OSAHS?had intimate relationship with lipid disorders and insulin resistance.Overall assessment of metabolic disorders in OSAHS still is lacked in current study.Metabolic disorders,perticularly lipid metabolism disorder,are recognized to be associated with OSAHS;however,inconsistent results have been reported.Meanwhile,how Roux-en-Y gastric bypass?RYGB?affects obesity indices and metabolic outcomes in OSAHS remains unknown.Besides,a potentially cost-effective,reliable alternative for the diagnosis of OSAHS is lacked,thus we assessed the validity of the micro-movement sensitive mattress?MSM?and snoring analysis.Methods:a metabolomics approach was also performed to identify altered urinary metabolites in 60 and 120 suspected OSAHS,respectively.In addition,subjects were recruited.Data for overnight polysomnography?PSG?parameters,serum lipids,fasting blood glucose,insulin levels,and anthropometric measurements were collected.Multivariable logistic regression analyses were used to determine the correlation between lipid profile and OSAHS.Sixty-four RYGB candidates with OSAHS symptoms were consecutively approached.A sleep questionnaire was conducted and medical histories were taken.Full-night polysomnography?PSG?,anthropometric variables,and blood samples were collected.The MSM sleep-monitoring system,snoring sounds records,and PSG were performed simultaneously overnight in each subject.The rhythm and frequency domain of the snoring signal were analyzed based on frequency energy endpoint detection?FEP?and the Earth mover's distance?EMD?,for each subject to harvest the EMD-calculated Apnea-Hypopnea Index(AHI_EMD)and MSM-calculated AHI(AHI_MSM).Finally,we compared the AHI_EMD,AHI_MSM with the PSG-monitored AHI(AHI_PSG).Results:Amino acids and metabolites of carbohydrate metabolism were mainly participanted in the patholology of padiatric OSAHS.A total of 21 and 31 metabolites were differentially expressed in the simple snoners?SS?and OSAHS groups,respectively,compared with those in the normal controls.Patients with OSAHS had 18 metabolites different from those in patients with SS.Of the 56 metabolites detected among the 3 groups,24 were consistently higher or lower.Large-cross-sectioal study showed that only LDL-C?OR=1.430,95%CI=1.221-1.675?was found to be an independent risk factor for OSA in further multivariable logistic regression analyses.Thirty-five consecutive patients with OSA who underwent laparoscopic RYGB surgery were prospectively examined for at least 6 months were included in the study.Significant improvements?p<0.01?in sleep parameters?except for micro-arousal?,obesity indices,and metabolic outcomes[except low-density lipoprotein in men and high-density lipoprotein?HDL?in women]were obtained in men and women with OSAHS.The area under the receiver operating characteristic?ROC?curves,which was used to differentiate AHI_PSG?5,AHI_PSG?15,and AHI_PSG?30 events/hour clinically diagnosed OSA,was 0.984,0.982,and 0.980,respectively.The area under ROC curve for OSA detection was0.974,0.957,and 0.997 for AHI_EMD thresholds of 5,15,and 30 events/h,respectively.Conclusions:The metabolomics approach identified several metabolites?mainly includes glucose and amino acids?associated with patients with padiatric and adult OSAHS.Patients with OSAHS had a higher percentage of dyslipidemia than subjects without OSAHS.Of the various components in serum lipid,only LDL-C was independently associated with OSAHS.Sleep parameters,obesity indices,and metabolic outcomes after RYGB surgery were significantly improved.Finally,the MSM sleep-monitoring system and snoring analysis can accurately diagnose OSAHS in the Chinese Han population.