The relationship of baseline fasting plasma glucose and cardiovascular morbidity and mortality

Effect of continuous positive airway pressure on cardiometabolic risk factors in patients with obstructive sleep apnea: A systematic review and meta-analysis

OBJECTIVE

Cardiometabolic risk factors (CMRFs) play a crucial role in the occurrence and development of cardiovascular diseases. Obstructive sleep apnea (OSA) causes abnormalities of CMRFs. Continuous positive airway pressure (CPAP) is a widely used treatment for OSA. This systematic review and meta-analysis aimed to investigate the effect of CPAP on CMRFs in patients with OSA.

METHODS

A search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase was conducted to find randomized controlled trials up to December 3, 2023. The quality of the studies included was evaluated using the Cochrane Bias Risk Tool 2.0, and a meta-analysis was carried out using Stata15.1 software. The effect sizes for this meta-analysis were represented as the weighted mean difference (WMD) and 95 % confidence interval (CI).

RESULTS

A total of 52 studies with 10,104 participants were analyzed. The results showed that CPAP significantly lowered systolic blood pressure (WMD: -2.04 mmHg; 95%CI: -3.56 to -0.51), diastolic blood pressure (WMD: -1.40 mmHg; 95%CI: -2.36 to -0.44), total cholesterol (WMD: -0.27 mmol/L; 95%CI: -0.51 to -0.04), triglycerides (WMD: -0.02 mmol/L; 95%CI: -0.03 to -0.01), and fasting blood glucose (WMD: -0.15 mmol/L; 95%CI: -0.16 to -0.13) in patients with OSA. However, there was no significant change in low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, waist circumference, or body mass index after CPAP.

CONCLUSION

In summary, this meta-analysis demonstrated that CPAP effectively reduced certain CMRFs in patients with OSA, offering new insights for cardiovascular disease prevention.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42023456380.

Anthropometry did not approach adequate predictive accuracies for detecting elevated fasting plasma glucose or hemoglobin A1c levels among Chinese children aged 7-9 years

AIMS/INTRODUCTION

Elevated concentrations of fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c) are well-established independent risk factors for progression to diabetes, cardiovascular comorbidities and mortality. Most previous studies on the relationships of anthropometric measures with hyperglycemia were carried out among adults and adolescents, but few data are available for the performance predication of the predictors for diagnosing elevated FPG or HbA1c among young children.

MATERIALS AND METHODS

Involving 5,556 students of aged 7-9 years, a school-based cross-sectional survey was carried out between March and June 2019 in Shenzhen, China. Receiver operating characteristic curve analysis was utilized.

RESULTS

The median was 4.6 (interquartile range [IQR] 4.3-4.8) mmol/L for FPG and 5.3% (IQR 5.1-5.5%) for HbA1c levels for all participants. For detecting elevated FPG, weight (0.651, IQR 0.583-0.719) and waist circumference (0.650, IQR 0.584-0.717) showed the highest area under the curve and 95% confidence interval, followed by body mass index and the z-score of body mass index (both 0.635, IQR 0.567-0.703); other anthropometric measures showed poorer diagnostic efficiencies or no ability. For detecting elevated HbA1c, lower efficiencies for the Conicity Index (0.651, IQR 0.583-0.719), waist-to-height ratio, waist-to-hip ratio and waist-to-chest ratio were shown. The correlations of FPG and HbA1c levels with anthropometric indices were weak (Spearman's r ≤ 0.179).

CONCLUSIONS

None of the evaluated anthropometric indicators approached an adequate predictive accuracy for the detection of elevated FPG or HbA1c levels in Shenzhen children aged 7-9 years. The current study did not recommend anthropometry screening for prediabetes in young children.

Brain Histopathology of Adult Decedents After Extracorporeal Membrane Oxygenation

OBJECTIVE

To test the hypothesis that brain injury is more common and varied in patients receiving extracorporeal membrane oxygenation (ECMO) than radiographically observed, we described neuropathology findings of ECMO decedents and associated clinical factors from 3 institutions.

METHODS

We conducted a retrospective multicenter observational study of brain autopsies from adult ECMO recipients. Pathology findings were examined for correlation with demographics, clinical data, ECMO characteristics, and outcomes.

RESULTS

Forty-three decedents (n = 13 female, median age 47 years) received autopsies after undergoing ECMO for acute respiratory distress syndrome (n = 14), cardiogenic shock (n = 14), and cardiac arrest (n = 15). Median duration of ECMO was 140 hours, most decedents (n = 40) received anticoagulants; 60% (n = 26) underwent venoarterial ECMO, and 40% (n = 17) underwent venovenous ECMO. Neuropathology was found in 35 decedents (81%), including microhemorrhages (37%), macrohemorrhages (35%), infarctions (47%), and hypoxic-ischemic brain injury (n = 17, 40%). Most pathology occurred in frontal neocortices (n = 43 occurrences), basal ganglia (n = 33), and cerebellum (n = 26). Decedents with hemorrhage were older (median age 57 vs 38 years, p = 0.01); those with hypoxic brain injury had higher Sequential Organ Failure Assessment scores (8.0 vs 2.0, p = 0.04); and those with infarction had lower peak Paco₂ (53 vs 61 mm Hg, p = 0.04). Six of 9 patients with normal neuroimaging results were found to have pathology on autopsy. The majority underwent withdrawal of life-sustaining therapy (n = 32, 74%), and 2 of 8 patients with normal brain autopsy underwent withdrawal of life-sustaining therapy for suspected neurologic injury.

CONCLUSION

Neuropathological findings after ECMO are common, varied, and associated with various clinical factors. Further study on underlying mechanisms is warranted and may guide ECMO management.