Antioxidant Carbocysteine Treatment in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial

<div><p>Objective</p><p>This study aimed to examine the effects of carbocysteine in OSAS patients.</p><p>Methods</p><p>A total of 40 patients with moderate to severe obstructive sleep apnea syndrome (OSAS) were randomly divided into two groups. One group was treated with 1500 mg carbocysteine daily, and the other was treated with continuous positive airway pressure (CPAP) at night. Before treatment and after 6 weeks of treatment, all patients underwent polysomnography and completed questionnaires. Treatment compliance was compared between the two groups. Plasma was collected for various biochemical analyses. Endothelial function was assessed with ultrasound in the carbocysteine group.</p><p>Results</p><p>The proportion of patients who fulfilled the criteria for good compliance was higher in the carbocysteine group (n = 17) than in the CPAP group (n = 11; 100% vs. 64.7%). Compared with baseline values, the carbocysteine group showed significant improvement in their Epworth Sleepiness Scale score (10.18±4.28 vs. 6.82±3.66; P≤0.01), apnea-hypopnea index (55.34±25.03 vs. 47.56±27.32; P≤0.01), time and percentage of 90% oxygen desaturation (12.66 (2.81; 50.01) vs. 8.9 (1.41; 39.71); P≤0.01), and lowest oxygen saturation level (65.88±14.86 vs. 70.41±14.34; P≤0.01). Similar changes were also observed in the CPAP group. The CPAP group also showed a decreased oxygen desaturation index and a significant increase in the mean oxygen saturation after treatment, but these increases were not observed in the carbocysteine group. Snoring volume parameters, such as the power spectral density, were significantly reduced in both groups after the treatments. The plasma malondialdehyde level decreased and the superoxide dismutase and nitric oxide levels increased in both groups. The endothelin-1 level decreased in the CPAP group but did not significantly change in the carbocysteine group. Ultrasonography showed that the intima-media thickness decreased (0.71±0.15 vs. 0.66±0.15; P≤0.05) but that flow-mediated dilation did not significantly change in the carbocysteine group.</p><p>Conclusions</p><p>Oral carbocysteine slightly improves sleep disorders by attenuating oxidative stress in patients with moderate to severe OSAS. Carbocysteine may have a role in the treatment of OSAS patients with poor compliance with CPAP treatment. However, the efficiency and feasibility of carbocysteine treatment for OSAS needs further evaluation.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://www.clinicaltrials.gov/ct2/show/NCT02015598?term=NCT02015598&rank=1" target="_blank">NCT02015598</a></p></div

Characteristics of the study subjects.

<p>ESS = Epworth sleeping scale, AHI = Apnea-hypopnea index, ODI = Oxygen desaturation index, MSaO2 = Mean oxygen saturation, LSaO2 = Lowest oxygen saturation, T90% = Time percentage of 90% oxygen desaturation, Fpeak = Peak frequency. Data are given as means±SEM unless otherwise indicated</p

Correlation between intima-media thickness (IMT) and PSG Parameters in OSAS patients at baseline.

<p>(A) Pearson correlation analysis between lowest oxygen saturation (LSaO₂) and baseline IMT. (B) Spearman correlation analysis between Mean oxygen saturation (MSaO2) and baseline IMT. (C) Spearman correlation analysis between time percentage of 90% oxygen desaturation (T90%) and baseline IMT. (D) Spearman correlation analysis between nitric oxide (NO) and baseline IMT.</p

Polysomnography parameters in patients with OSAS before and after treatment.

<p>No significant difference of the baseline and the after treatment value between carbocysteine group and CPAP group.</p

Consort diagram.

<p>OSAS = sleep apnea syndrome; CPAP = continuous positive airway pressure.</p

Study plan.

<p>PSG <b>=</b> Polysomnography; CPAP = continuous positive airway pressure; t.i.d. = three times a day.</p

Efficacy and Safety of Indacaterol/Glycopyrronium (IND/GLY) Versus Salmeterol/Fluticasone in Chinese Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease: The Chinese Cohort from the LANTERN Study

<p>Inhaled indacaterol/glycopyrronium fixed-dose combination (IND/GLY) is approved in over 80 countries, including the EU, Japan, Australia and Switzerland and the US. The LANTERN study evaluated the efficacy of IND/GLY compared with inhaled long-acting β₂-agonist (LABA)/inhaled corticosteroid (ICS) or salmeterol/fluticasone (SFC) in patients with moderate-to-severe COPD with a history of ≤1 exacerbation in the previous year. Here we present the efficacy and safety of IND/GLY versus SFC in the Chinese cohort from the LANTERN study. LANTERN was a 26-week, multicenter, randomized, double-blind, double-dummy, parallel-group study conducted in patients with moderate-to-severe COPD with a history of ≤1 exacerbation in the previous year. The patients were randomized (1:1) to once-daily IND/GLY (110/50 μg) or twice-daily SFC (50/500 μg). The primary endpoint was non-inferiority of IND/GLY versus SFC in terms of trough FEV₁. Of the total 744 patients randomized in the LANTERN study, 598 (80.4%) were from Mainland China and randomized to IND/GLY (n = 298) or SFC (n = 300), and 553 (92.5%) completed the study. IND/GLY showed superiority over SFC with a statistically significant and clinically meaningful improvement in trough FEV₁, FEV₁ AUC_0–4h, peak FEV₁ and trough forced vital capacity (FVC) change from the baseline. Annualized rate of moderate or severe COPD exacerbations was significantly lower (43%) with IND/GLY compared with SFC (rate ratio: 0.57, <i>p</i> = 0.015). Overall, adverse events were lower for IND/GLY (34.6%) versus SFC (43.1%). IND/GLY was superior in achieving bronchodilation versus SFC in a Chinese subgroup of patients from this study.</p> <p><b>Clinicaltrials.gov identifier</b>: NCT01709903</p

Efficacy of the COVID-19 vaccination in patients with asymptomatic or mild illness during the Omicron epidemic in Guangzhou: a multi-centre retrospective cohort study

Despite the widespread administration of coronavirus disease 2019 (COVID-19) vaccines, the impact on patients with asymptomatic to mild illness remains unclear. Here, we aimed to assess the efficacy of various vaccine doses and types on the duration of isolation duration and discharge rates, the viral shedding duration, and negative rates in asymptomatic to mild COVID-19 patients. We included adult patients at the Fangcang isolation centres in Pazhou or Yongning between November and December 2022. We analysed data on basic demographics, admission details, laboratory indicators and vaccination information. A total of 6560 infected patients were included (3584 from Pazhou and 2976 from Yongning). Of these, 90.6% received inactivated vaccines, 3.66% received recombinant SARS-CoV-2 spike protein subunit vaccines and 0.91% received adenovirus vaccines. Among the 6173 vaccinated individuals, 71.9% received a booster dose. By day 9, the isolation rate reached 50% among vaccinated patients. On day 7.5, the positive rate among vaccinated individuals reached 50%. Full vaccination was effective, with heterologous vaccines showing greater efficacy than inactivated vaccines alone. However, there was no significant difference in the vaccine protective effect 12 months after vaccination.</p

Additional file 1 of Genome-wide association analyses identified novel susceptibility loci for pulmonary embolism among Han Chinese population

Additional file 1: Fig. S1. Regional association plot at genome-wide association study (GWAS) genome-wide significant loci. Fig. S2. Principal component analysis (PCA) plot of Han Chinese PE cohort. Fig. S3. FUMA Manhattan plot and QQ plot of genome-wide association study (GWAS) meta-analysis. Fig. S4. The transfection efficiency of cellular experiments for FABP2. Fig. S5. Low-density lipoprotein cholesterol (LDL-C) levels of patients with different genotypes of rs1799883. Fig. S6. Forest plot for the association of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) with PE. Fig. S7. Ancestry-specific polygenic risk score (PRS) ROC plot. Fig. S8. Performance of different PRSVTE in the CURES testing set

Additional file 2 of Genome-wide association analyses identified novel susceptibility loci for pulmonary embolism among Han Chinese population

Additional file 2: Table S1. Independent genome-wide significant lead SNPs associated with pulmonary embolism (PE) in the discovery stage and replication stage. Table S2. The allele frequency of identified loci in 1000Genomes. Table S3. Replication of associations for the known loci in our cohort. Table S4. Association results for genes that were significant in FUMA gene-based analysis. Table S5. Polygenic risk score variants. Table S6. Polygenic risk score (PRS) quantile and odds ratio (OR)