[Sleep quality and sleep disturbances in Chinese pregnant women: a multicenter cross-sectional study]

Objective: This study aims to investigate the sleep quality of pregnant women in Xuhui District, Shanghai, and the related factors of sleep disturbances during pregnancy. Methods: From February 2019 to February 2021, we used online integrated sleep questionnaire (including PSQI, BQ, ESS, AIS) in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, The International Peace Maternity and Child Health Hospitals of China Welfare Institution, and Shanghai Eighth People's Hospital, to investigate the sleep quality across pregnancy. We also collected maternal physical examination results, childbearing history, sociodemographic, and other clinical data. The prevalences and related factors of various sleep disturbances in pregnant women were analyzed, including insufficient/excessive nighttime sleep, low sleep efficiency, difficulty falling asleep, poor sleep quality, insomnia, daytime sleepiness, and high risk of sleep-disordered breathing (SDB). Results: This study includes 1 898 cases in the first trimester (T1), 3 099 cases in the second trimester (T2), and 1 539 cases in the third trimester (T3). Poor sleep quality (38.6%), daytime sleepiness (mild 41.9%, moderate 17.7%, severe 2.1%), and suspicious insomnia (32.3%) are most prevalent among women in T1 (P<0.01). In comparison, short sleep time (2.7%), long sleep time (8.6%), difficulty falling asleep (12.2%), poor sleep efficiency (35.4%), very poor sleep quality (6.7%), clinical insomnia (21.8%), and high-risk SDB (6.4%) are most prevalent among women in T3 (P<0.05). During pregnancy, late gestation (OR=1.016, 95%CI: 1.006-1.025) and multiple induced/drug abortions (OR=1.329, 95%CI: 1.043-1.692) are risk factors for poor sleep quality (PSQI>5), while multiple full-term deliveries (OR=0.800, 95%CI: 0.675-0.949) is its protective factor. Advanced maternal age (OR=0.976, 95%CI: 0.956-0.997), multiple full-term deliveries (OR=0.808, 95%CI: 0.680-0.959), late gestation (OR=0.983, 95%CI: 0.974-0.992) and hypertension (OR=0.572, 95%CI: 0.401-0.814) are protective factors for daytime sleepiness (ESS>6). The high-risk pregnancy category (OR=9.312, 95%CI: 1.156-74.978) is a risk factor for insomnia (AIS≥4), while multiple full-term deliveries (OR=0.815, 95%CI: 0.691-0.961) is its protective factor. High BMI (OR=1.334, 95%CI: 1.270-1.402) and hypertension (OR=4.427, 95%CI: 2.539-7.719) are risk factors for high-risk SDB in pregnant women. Conclusions: The prevalences of various sleep disturbances are high throughout pregnancy. Noticeably, symptoms of maternal SDB develop along with pregnancy. Different types of sleep disturbances are associated with different factors. Women of high-risk pregnancy category, in late gestation, with high BMI, hypertension, a history of induced/drug abortion, or without a history of full-term delivery can be at high risk of sleep disturbances during pregnancy.

[Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database]

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m²,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(T_oxygen=7.1), minimum blood oxygen(T_minimum=56.3), blood oxygen saturation below 90% cumulative time ratio (T_CT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

[Relationship between smoking and the severity of OSA]

Objective:To explore the relationship between smoking and the severity of OSA. Method:There were 719 patients included in the study, who were accompanied by snoring, daytime sleepiness and other symptoms. Laboratory-based polysomnographic variables （including AHI, oxygen desaturation index and microarousal index, etc.）, and anthropometric measurements （including weight, neck circumference, waist circumference, hip circumference etc.） were collected for all participants. The severity of OSA was determined by AHI. No OSA was defined as AHI<5, mild OSA as AHI of 5 to 15，moderate OSA as AHI of >15 to 30, and severe OSA as AHI of >30. Smoking severity was determined by the smoking index （SI）. Light smoke was defined as SI<200, moderate smoke was as SI 200 to 400, and severe smoke as SI>400. Result:There were 138 cases of non-OSA and 581 cases of OSA. There were 381 non-smokers, 279 smokers and 59 quit smokers. The smoking rate of OSA group was significantly higher than that of non-OSA group （41.5% vs. 27.5%,P<0.01）. After excluding 59 quit smokers, the remaining 660 subjects were divided into four groups according to the severity of smoking, then each group was further divided into four groups according to OSA severity. Unadjusted analysis showed that OSA severity positively correlated with smoking severity （r=0.203,P<0.01）. The positive correlation remained significant after further adjustment for age, BMI and waist-hip ratio. In addition, logistic regression analysis showed that compared to non-smokers, the odd ratios for OSA in moderate smokers were 1.72 （95%CI 1.08-2.75） and in severe smokers were 2.68 （95%CI 1.61-4.46）, after adjustment for age, BMI and waist-hip ratio. Conclusion:The severity of smoking significantly correlated with the severity of OSA. There was increased risk of OSA in patients with severe smoke. The correlation was independent of some confounders such as age and obesity.

[Clinical characteristics and management of cervical necrotizing fasciitis]

Objective:To investigate the clinical characteristics and treatment of cervical necrotizing fasciitis. Method:Clinical data of 61 patients were analyzed retrospectively. All patients were underwent surgical debridement and treated with broad-spectrum antibiotics after diagnose. Result:Complications occurred in 14 patients. Fifty-nine patients were cured while 2 patients died. After 3 months or more follow-up, 3 patients accompanied with sequelae of vocal hoarseness, and no patient recurred or died. Conclusion:Early surgical debridement and the use of antibiotics should be taken as soon as possible after diagnosis of cervical necrotizing fasciitis, as well as control of comorbidities and systemic support treatment in order to prevent complications and deaths.

[Preliminary study on the relationship between OSA and renal function]

Objective:To explore the relationship between obstructive sleep apnea(OSA) and renal function. Method:We collected the clinical data of 487 patients who underwent sleep monitoring in our hospital from January 2013 to December 2017 and excluded history of chronic heart disease, acute and chronic glomerulonephritis, and pyelonephritis. Among the 487 patients, 54 were in nonOSA control group and 433 were in OSA group, including 64 patients with mild OSA, 77 patients with moderate OSA, 108 patients with severe OSA, and 188 patients with extremly severe OSA. The eGFR was calculated using an equation combined serum creatinine and cystatin C. Then propensity score matching(PSM) was used to reduce differences in confounders among groups. The differences of creatinine, cystatin and eGFR between the control group and different degrees of OSA were compared, and the relationship between OSA severity and renal dysfunction was analyzed.Result:There was no statistically significant difference in creatinine between the OSA group and the control group. Serum cystatin C levels in the moderate OSA group and the extremly severe OSA group were higher compared with the control group(0.90±0.18)mg/L, (0.82±0.21) mg/L,P=0.026;(0.92±0.22) mg/L,(0.82±0.21) mg/L,P=0.006,there was no statistically significant difference in cystatin C level of mild OSA group or severe OSA group compared with the control group.The eGFR levels in the moderate OSA group and extremly severe OSA group were lower than that in the control group, 100.64±16.09, 108.57±19.31,P=0.012; 102.03±18.39, 108.57±19.31, P=0.024.After matching with the PSM, the serum cystatin C levels in the moderate OSA group and in the extremely severe OSA group were higher compared with the control group, (0.91±0.19) mg/L,P=0.028;(0.91±0.23) mg/L,P=0.031;(0.82±0.21) mg/L, but only in moderate OSA group, eGFR was lower than the control group,100.86±17.31,108.57±19.31,P<0.05. Conclusion: The renal function of OSA patients has different degrees of impairment. Renal function impairment and the severity of OSA do not show a single linear relationship.

[Advances in the application of cloud platform in diagnosis and treatment of OSA]

Obstructive sleep apnea(OSA) has been a major public health problem due to a surge in the number of patients with OSA, which can create a heavy socio-economic burden. How to effectively carry out mass screening and prevention is an important link in China's health management and chronic disease prevention.The development of cloud computing and Internet of things technology has brought new directions and new solutions.For the sake of diagnosis and treatment of disease involving multiple disciplines, cross cooperation problems, we can use the Internet of things, a cloud platform and the database as the core architecture to establish the network which contains family-primary hospitals-tertiary hospitals-specialized subject and sleep medicine laboratory.With the help of handsets, we are able to realize the effectiveness and convenience of remote cooperation and eventually form the cloud platform diagnosis and treatment system of sleep-related breathing disease based on the large sample data.

[Advances in postoperative thyroid-stimulating hormone suppression therapy in females with thyroid cancer]

Differentiated thyroid cancer is the most common malignant carcinoma in female population.Postoperative long-term thyroid-stimulating hormone(TSH) suppression therapy can reduce the risk of recurrence for differentiated thyroid cancer and control the progress of the disease, but it also induces simultaneously subclinical hypothyroidism and imposes negative effect on female. In addition to cardiovascular disease, TSH suppression therapy can lead to the alteration of sex hormone metabolism, menstrual disorder, poor influence on pregnancy and osteoporosis. This article reviews the recent studies on postoperative TSH suppression therapy in women with thyroid cancer.

[Progress of dopamine in obstructive sleep apnea hypopnea syndrome]

The etiology and pathogenesis of sleep obstructive apnea hypopnea syndrome (OSAHS) is not yet definitive, evidence shows that the dysfunction of pharyngeal nerve and the atonia of the muscle innervated by these nerve could play an important role in the progress of OSAHS. Dopamine is a neurotransmitter in the central nervous system which significantly affects the sleep-awake regulation. So far mounting evidence shows that dopamine has a potential role in the modulation of hypoglossal nucleus. The progress of dopamine in obstructive sleep apnea hypopnea syndrome is reviewed in this article.

[Advances of the treatments for thyroid carcinoma patients with laryngotracheal invasion]

Thyroid carcinoma is one of the most common cancer in the head and neck and its incidence shows an increasing tendency. Due to the special anatomical location of thyroid carcinoma, patients will have a bad prognosis outcome when cancer invades larynx and trachea. Surgical treatment is still a preferred therapy for thyroid carcinoma with laryngotracheal invasion, because it has the advantages such as high survival rate, low recurrence rate, relieving of airway obstruction, improving of postoperative quality of life. Other therapies including radiotherapy, chemotherapy, ¹³¹I and molecular targeted therapy can also be used for treatments of thyroid carcinoma. This article reviews the current treatments for thyroid carcinoma with laryngotracheal invasion.

Extraordinary ductility in Al-bearing δ-TRIP steel

An iron-based alloy system has been developed that exhibits impressive combinations of tensile strength and elongation that are not available with current steels used in the manufacture of automobiles. Furthermore, the heat treatments required to achieve these properties are consistent with practical production processes. The alloys rely on significant concentrations of ferrite-stabilizing solutes so that δ-ferrite which forms during solidification is retained in the microstructure.