Possibility Relationship And Mechanism Between Sleep Apnea Hypopnea Syndrom And Preeclampsia

BackgroundAlong with the deeply study in sleep medicine,people not only know the importance of sleep,but also gradually understand the unhealthy influence of abnormal sleep.As we know one to three time of our lifetime in sleep,there are many events happened in this time,for instance dream,sleepwalking,insomnia,and so on, that events have caused the doctors’attention. But they did not see it seriously, and even know lessly about the other influence of abnormal sleep. In our life we can see many such evidence such as a friend who have a strong body dead suddenly in sleep;and some people who have primary hypertation will take medicine every day;All these phenomenia maybe correlated with the commen things——snore or sleep apnea.With the further study of sleep and the development of sense recouding,sleep disorder breathing as a disease studied seriously from 1970s. Sleep disorder breathing include simple snoring,sleep apnea hypopnea syndrom, upper airway resistance syndrome.Sleep apnea hypopnea syndrom(SAHS) include obstructive sleep apnea hypopnea syndrom(OSAHS),central sleep apnea hypopnea syndrom(CSAHS),mixed sleep apnea hypopnea syndrom(MSAHS).SAHS as a disease studied in our country have 20 years history,and studied authentically these years.With the increase of sleep laboratory,more people were diagnosed SAHS.and some researh works were evolved,such as basic and clinical study,epidemiology et al.Nowadays scholars have confirmed that SAHS is one of the dangerous factors to cause hypertension. The main clinical appearance of SAHS is snoring with apnea-hypopnea, repeatedly hypoxia, hypercapnia and sleep disordered et al.All that will cause people to somnolence in day time, work decrement,and complicating other diseases.Affect life quality. Researchers found that people with SAHS have higher inflammatory factor level,and the reason may be repeatedly hypoxia and reperfusion.Pregnancy induced hypertension is a disease that developped in gestation period,and the main clinical situation is hypertension and proteinuria.The morbility is to 10.5%. Preeclampsia is a severe stage that if diagnosed must be in hospital to treat,and is the main reason of death of gravida and fetus. Obstetrical doctors explore the reason constantly,but there are only many doctrine,such as placento-ischemia, blood vessel endothelium damaged,immune doctrine et al.Many reaserchers found that the inflammatory factor level of gravida with preeclampsia is more higher than normal gravida. Williams et al found that inflammatory factor level is raising up before clinical appearance.But the reason is unknown.IL-6 and TNF-a was found these years,they have wide biological activity. They should be maintained in low level to regulate the normal growth and function,and have many important functions.But if IL-6 and TNF-a raising persistently,they will have more adverse influence,such as promote endothelial cell to adhere leucocyte, stimulate endothelial cell excrete inflammatory factor, activate clotting mechanism etal.These years many overseas scholars via questionaire found that SAHS is correlated with preeclampsia, prematurity and so on,and if gave them nasal CPAP treatment the blood pressure will decrease and delivery normal fetus.We found that there are many conduplicate factors,such as higher level of inflammatory factor and oxidative stress,narrowe up airway, abdominal obesity, hypertension,sleep disorder, somnolence et al.In view of these basic data and the approved means——PSG, we select the right gravida,all of them should be diagnosed if they have SASH by PSQthe gravida who have SAHS will be treated by Auto CPAP.and we will investigate the possible mechanism of it in inflammatory factor level.Chapter 1.The correlation between SAHS and preeclampsia in inflammatory factor levelObjectiveTo observe and investigate the correlation between SAHS and preeclampsia in inflammatory factor level.Methods1.Cases and groups Select the right preeclampsia and the normal gravida that have the same age and gestational age from July 2008 to June 2009.All the gravida should be monitorred by PSG,of the total normal gravida is 25 cases,preeclampsia gravida with no SAHS is 43 cases, preeclampsia gravida with SAHS is 27 cases.All these cases should be monocyesis,not have hypertension, cardiac disease, nephrosis, diabetes mellitus,choronic pneumonosis and so on to cause hypoxia.2.Somni-monitoring All the gravida should be under 7 hours PSG,the item include electroencephalogram, electro-oculogram, electro-mandibular gram, electrocardiogram,nasal flow,snore,body position, thoracoabdominal movement and saturation of blood oxygen.The data was analysed by machine and artificial.The diagnostic standard of SAHS consult the protocol established by Chinese Medical Associaition.AHI is the main diagnostic standard,lowest saturation of blood oxygen is the aided index.3.Blood pressure measurement Gravidas’blood pressure should be measured after PSG,and be quiet 10 minute,in order to be convenient,we calculate the mean arterial pressure according to the systolic pressure and diastolic pressure,the formula is diastolic pressure+1/3(systolic pressure-diastolic pressure).4.24-hour urinary protein The urine should be gathered from 7Am to next 7Am,and be measured by coomassie brilliant blue G2504.5.Serum IL-6 and TNF-a messurement The 5ml blood was take after PSG,and was put in 4℃refrigerator,then centrifuge it by 3000r/min,10min, then put it in three EP tubes, store it at-80℃. IL-6 and TNF-a was messured by Enzyme-Linked Immunosorbnent Assay(ELISA),and the operate procedure is according to the direction strictly.6.Statistical analysis Uses statistical software SPSS13.0 to deal with the data. The data are presented as mean±SD for continuous variables, Differences between groups were assessed using One-way ANOVA LSD, The correlation was analyzed with Pearson’s correlation coefficient if homoscedasticity. A probability less than 0.05 was considered to indicate significance.Result1.Basic data There is no significant difference among the three groups in age and gestational age(P>0.05)2.Clinical and liboratory data analysis There is a significant difference among groups in body mass index(BMI),mean arterial blood pressure(MAP),24-hour urine protein,apnea hypopnea index(AHI),lowest saturation of blood oxygen(LSaO2),IL-6 and TNF-a(P<0.01).But there is no marked difference in BMI between normal gravida and gravida with preeclampsia(P=0.083),and there is also no significant difference in AHI and LSaO2 between normal gravida and gravida with preeclampsia (P=0.797,0.862).The two important indexes——blood pressure and 24-hour urine protein were correlated significantly with the severity degree of SAHS(P<0.01),and were positively correlated with IL-6 and TNF-a, IL-6 and TNF-a were positively correlated with AHI,negatively correlated with LSaO2.And we also found that MAP and 24h urine protein were positively with BMI,but the coefficient is small.Conclusion1. The rate of AHI happened in gravida with SAHS is more than normal gravida.2. IL-6 and TNF-a may have an important function between SAHS and preeclampsia.3. SAHS possibly be one dangerous factor of preeclampsia.Chapter 2 Assessment of Auto CPAP treatment on SAHSObjectiveTo assess the effect of AutoCPAP treatment on SAHS and further more to confirm the relationship between SAHS and preeclampsia.Methord1.Cases 27 cases who have SAHS were selected via PSG,and record their age,gestational age,weight and height.2.AutoCPAP treatment In order to make the right gravida who have SAHS to go with our work,we have to give them more knowledge about SAHS,and how to treat it.All of them should know how to use AutoCPAP.All the gravida who agree to be treated by AutoCPAP will sign the informed consent.Every gravida should be under AutoCPAP treatment at least 4 hours.To comfort the treatment we set up the pressure to be increased gradualy in 30 minutes.3.Blood pressure measurement Gravidas’blood pressure should be measured after PSQand be quiet 10 minute,in order to be convenient,we calculate the mean arterial pressure according to the systolic pressure and diastolic pressure,the formula is diastolic pressure+l/3(systolic pressure-diastolic pressure).4.24-hour urinary protein The urine should be gathered from 7Am to next 7Am,and be measured by coomassie brilliant blue G2504.5.Serum IL-6 and TNF-a messurement The 5ml blood was take after PSG,and was put in 4℃refrigerator,then centrifuge it by 3000r/min,10min, then put it in three EP tubes, store it at -80℃. IL-6 and TNF-a was messured by Enzyme-Linked Immunosorbnent Assay(ELISA),and the operate procedure is according to the direction strictly.6.Statistical analysis Uses statistical software SPSS13.0 to deal with the data. The data are presented as mean±SD for continuous variables, Differences between before and after treatment were assessed using maching T test. A probability less than 0.05 was considered to indicate significance.ResultThe gravida who accepted AutoCPAP treatment said that they feel well and have a good sleep in night.We found that the level of IL-6 and TNF-a were down significantly after treatment,and blood presure and 24h urinary protein were also down significantly(P＜0.01).Conclusion 1.From the treatment effect that the indexes were down we can confirm that SAHS may be a dangerous factor of preeclampsia.2.Should give the gravida who may have SAHS AutoCPAP treatment to avoid preeclampsia that may be caused by SAHS.