Effects of continuous positive airway pressure on blood pressure in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES)

[Changes of carotid artery elasticity before and after CPAP in patients with obstructive sleep apnea by ultrasonic ultrafast pulse wave velocity technique]

Objective:To examine the changes of carotid artery elasticity in patients with obstructive sleep apnea（OSA） before and after continuous positive airway pressure（CPAP） treatment by ultrafast pulse wave velocity（UFPWV） technique，and to explore the influencing factors of carotid artery elasticity in OSA patients，and to provide guidance for clinical prevention and treatment of cardiovascular complications. Methods：Fifty cases of moderate and severe OSA patients diagnosed with PSG monitoring from January 2020 to December 2020 were collected as the OSA group，at the same time，40 healthy subjects who participated in physical examination and matched with OSA group in age and gender were selected as the control group.The OSA group was treated with CPAP for 12 weeks.Clinical indicators，carotid intima-media thickness（IMT），and pulse wave velocity at the beginning of systole（PWVBS） and pulse wave velocity at the end of systole（PWVES） were recorded in the control group，and the above data were collected in the OSA group before and after treatment.The changes of various indicators between the control group and the OSA group，and between the OSA group before and after treatment were compared.The correlative factors and influencing factors of PWVBS and PWVES are analyzed. Results：The serum lipid indexes，IMT，PWVBS and PWVES in OSA group were higher than those in control group（P<0.05）.Comparison between post-treatment and pre-treatment with CPAP in OSA group：PWVBS，PWVES，apnea hypopnea index（AHI），blood oxygen saturation（SaO₂） less than 90% of the time，the percentage of monitoring time when SaO₂ was less than 90%（T90），low density lipoprotein cholesterol（LDL-C）and triglyceride（TG） were decreased（P<0.05）.Lowest blood oxygen saturation（LSaO₂） and high density lipoprotein cholesterol（HDL-C） increased（P<0.05）.Age，systolic blood pressure，IMT，AHI，T90 and time of oxygen saturation below 90% were positively correlated with PWVBS and PWVES，while HDL-C and LSaO₂ were negatively correlated with them（P<0.05）.The risk factors of PWVBS and PWVES included systolic blood pressure，AHI，TC，T90.Conclusion：Moderate and severe OSA can reduce arterial elasticity.CPAP can improve carotid artery elasticity function in patients with OSA.UFPWV technique is more sensitive to quantitatively evaluate the changes of arterial elasticity in patients with OSA than traditional two-dimensional ultrasound.

Contemporary Concise Review 2020: Sleep

Obstructive sleep apnoea (OSA) now affects one-seventh of the world's population. Treatment of even mild OSA can improve daytime sleepiness and quality of life. Recent modifications to uvulopalatopharyngoplasty may make it a more widely applicable treatment option in selected patients with OSA. Diet and exercise have effects on sleep apnoea severity independent of weight loss. Insomnia has become increasingly common during the coronavirus disease 2019 (COVID-19) pandemic.

Recent approaches in clinical applications of 3D printing in neonates and pediatrics

Neonates and pediatric populations are vulnerable subjects in terms of health. Proper screening and early optimal treatment would reduce infant and child mortality, improving the quality of life. Researchers and clinicians all over the world are in pursuit of innovations to improve the medical care delivery system. Infant morphometrics changes drastically due to the rapid somatic growth in infancy and childhood, demanding for patient-specific customization of treatment intervention accordingly. 3D printing is a radical technology that allows the generation of physical 3D products from digital images and addresses the patient-specific requirement. The combination of cost-effective and on-demand customization offers a boundless opportunity for the enhancement of neonates and pediatric health.Conclusion: The advanced technology of 3D printing proposes a pioneering breakthrough in bringing physiologically and anatomically appropriate treatment strategies addressing the unmet needs of child health problems. What is Known: • The potential application of 3D printing is observed across a multitude of fields within medicine and surgery. • The unprecedented effect of this technology on pediatric healthcare is still very much a work in progress. What is New: • The recent clinical applications of 3D printing provide better treatment modalities to infants and children. • The review provides an overview of the comparison between conventional treatment methods and 3DP regarding specific applications.

Sleep Apnea and Heart

Scientific investigations in the past few decades have supported the important role of sleep in various domains of health. Sleep apnea is a highly prevalent yet underdiagnosed sleep disorder representing a valid cardiovascular risk factor, particularly for hypertension. While several studies have demonstrated the benefits of sleep apnea treatment on subclinical cardiovascular measures, there is a paucity of studies proving reduction of cardiovascular events and mortality. Sufficient and high-quality sleep is also important in the maintenance of cardiovascular health. Future investigations should focus on improving identification of patients at greatest risk of adverse cardiovascular s sequalae of sleep apnea and testing the therapeutic benefit of sleep apnea treatment in this vulnerable group.