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Mabry S, Bradshaw JL, Gardner JJ, Wilson EN, Cunningham RL. Sex-dependent effects of chronic intermittent hypoxia: implication for obstructive sleep apnea. Biol Sex Differ 2024; 15:38. [PMID: 38664845 PMCID: PMC11044342 DOI: 10.1186/s13293-024-00613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) affects 10-26% of adults in the United States with known sex differences in prevalence and severity. OSA is characterized by elevated inflammation, oxidative stress (OS), and cognitive dysfunction. However, there is a paucity of data regarding the role of sex in the OSA phenotype. Prior findings suggest women exhibit different OSA phenotypes than men, which could result in under-reported OSA prevalence in women. To examine the relationship between OSA and sex, we used chronic intermittent hypoxia (CIH) to model OSA in rats. We hypothesized that CIH would produce sex-dependent phenotypes of inflammation, OS, and cognitive dysfunction, and these sex differences would be dependent on mitochondrial oxidative stress (mtOS). METHODS Adult male and female Sprague Dawley rats were exposed to CIH or normoxia for 14 days to examine the impact of sex on CIH-associated circulating inflammation (IL-1β, IL-6, IL-10, TNF-α), circulating steroid hormones, circulating OS, and behavior (recollective and spatial memory; gross and fine motor function; anxiety-like behaviors; and compulsive behaviors). Rats were implanted with osmotic minipumps containing either a mitochondria-targeting antioxidant (MitoTEMPOL) or saline vehicle 1 week prior to CIH initiation to examine how inhibiting mtOS would affect the CIH phenotype. RESULTS Sex-specific differences in CIH-induced inflammation, OS, motor function, and compulsive behavior were observed. In female rats, CIH increased inflammation (plasma IL-6 and IL-6/IL-10 ratio) and impaired fine motor function. Conversely, CIH elevated circulating OS and compulsivity in males. These sex-dependent effects of CIH were blocked by inhibiting mtOS. Interestingly, CIH impaired recollective memory in both sexes but these effects were not mediated by mtOS. No effects of CIH were observed on spatial memory, gross motor function, or anxiety-like behavior, regardless of sex. CONCLUSIONS Our results indicate that the impact of CIH is dependent on sex, such as an inflammatory response and OS response in females and males, respectively, that are mediated by mtOS. Interestingly, there was no effect of sex or mtOS in CIH-induced impairment of recollective memory. These results indicate that mtOS is involved in the sex differences observed in CIH, but a different mechanism underlies CIH-induced memory impairments.
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Affiliation(s)
- Steve Mabry
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - Jessica L Bradshaw
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - Jennifer J Gardner
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - E Nicole Wilson
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA.
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Zanini L, Picano C, Spitoni GF. The Iowa Gambling Task: Men and Women Perform Differently. A Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09637-3. [PMID: 38462590 DOI: 10.1007/s11065-024-09637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
The Iowa Gambling Task (IGT) was designed to assess decision-making under conditions of complexity and uncertainty; it is currently one of the most widely used tests to assess decision-making in both experimental and clinical settings. In the original version of the task, participants are given a loan of play money and four decks of cards and are asked to maximize profits. Although any single card unpredictably yields wins/losses, variations in frequency and size of gains/losses ultimately make two decks more advantageous in the long term. Several studies have previously suggested that there may be a sex-related difference in IGT performance. Thus, the present study aimed to explore and quantify sex differences in IGT performance by pooling the results of 110 studies. The meta-analysis revealed that males tend to perform better than females on the classic 100-trial IGT (UMD = 3.381; p < 0.001). Furthermore, the significant heterogeneity observed suggests high variability in the results obtained by individual studies. Results were not affected by publication bias or other moderators. Factors that may contribute to differences in male and female performance are discussed, such as functional sex-related asymmetries in the ventromedial prefrontal cortex and amygdala, as well as differences in sensitivity to wins/losses.
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Affiliation(s)
- Ludovica Zanini
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy.
| | - Chiara Picano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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Mabry S, Bradshaw JL, Gardner JJ, Wilson EN, Cunningham R. Sex-dependent effects of chronic intermittent hypoxia: Implication for obstructive sleep apnea. RESEARCH SQUARE 2024:rs.3.rs-3898670. [PMID: 38352622 PMCID: PMC10862974 DOI: 10.21203/rs.3.rs-3898670/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background Obstructive sleep apnea (OSA) affects 10-26% of adults in the United States with known sex differences in prevalence and severity. OSA is characterized by elevated inflammation, oxidative stress (OS), and cognitive dysfunction. However, there is a paucity of data regarding the role of sex in the OSA phenotype. Prior findings suggest women exhibit different OSA phenotypes than men, which could result in under-reported OSA prevalence in women. To examine the relationship between OSA and sex, we used chronic intermittent hypoxia (CIH) to model OSA in rats. We hypothesized that CIH would produce sex-dependent phenotypes of inflammation, OS, and cognitive dysfunction, and these sex differences would be dependent on mitochondrial oxidative stress (mtOS). Methods Adult male and female Sprague Dawley rats were exposed to CIH or normoxia for 14 days to examine the impact of sex on CIH-associated circulating inflammation (IL-1β, IL-4, IL-6, IL-10, TNF-α), circulating OS, and behavior (recollective and spatial memory; gross and fine motor function; anxiety-like behaviors; and compulsive behaviors). A subset of rats was implanted with osmotic minipumps containing either a mitochondria-targeting antioxidant (MitoTEMPOL) or saline vehicle 1 week prior to CIH initiation to examine how inhibiting mtOS would affect the CIH phenotype. Results Sex-specific differences in CIH-induced inflammation, OS, motor function, and compulsive behavior were observed. In female rats, CIH increased inflammation (plasma IL-6 and IL-6/IL-10 ratio) and impaired fine motor function. Conversely, CIH elevated circulating OS and compulsivity in males. These sex-dependent effects of CIH were blocked by inhibiting mtOS. Interestingly, CIH impaired recollective memory in both sexes but these effects were not mediated by mtOS. No effects of CIH were observed on spatial memory, gross motor function, or anxiety-like behavior, regardless of sex. Conclusions Our results indicate that the impact of CIH is dependent on sex, such as an inflammatory response and OS response in females and males, respectively, that are mediated by mtOS. Interestingly, there was no effect of sex or mtOS in CIH-induced impairment of recollective memory. These results indicate that mtOS is involved in the sex differences observed in CIH, but a different mechanism underlies CIH-induced memory impairments.
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Blinder H, Narang I, Chaput JP, Katz SL. Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea. J Clin Sleep Med 2023; 19:511-518. [PMID: 36468645 PMCID: PMC9978425 DOI: 10.5664/jcsm.10376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES The association between obstructive sleep apnea (OSA) and lifestyle habits in children with obesity is largely unknown. This study aimed to determine whether there was an association between lifestyle patterns (sleep quality, physical activity, recreational screen time, and substance use) and OSA presence and severity in children with obesity. METHODS This cross-sectional study recruited children with obesity, aged 8-17 years, who were referred to undergo polysomnography. Children completed questionnaires on sleep quality, physical activity, recreational screen time, and substance use. Children also had a diagnostic polysomnography. The association between questionnaire scores and OSA severity, after adjusting for body mass index z-score, age, and sex, was evaluated using negative binomial multiple regression. Correlations were conducted between sleep quality, physical activity, screen time, substance use, and OSA severity. RESULTS A total of 100 children were included in the analysis (mean age: 14.3 ± 2.6 years; 44% female; mean body mass index z-score: 2.5 ± 0.4; 65% with OSA). In the adjusted regression analysis, each additional substance-use behavior was associated with a 17% (95% confidence interval: 1%, 36%) increase in OSA severity. Correlations were identified between poorer sleep quality and lower physical activity (r = -.42), poorer sleep quality and more substance-use behaviors (r = .40), and greater physical activity and less substance-use behaviors (r = -.26). CONCLUSIONS In children with obesity, more substance-use behaviors were independently associated with greater OSA severity. As there are complex, bidirectional relationships between lifestyle behaviors and OSA severity, interventions need to be comprehensive and multifactorial to ensure successful treatment of OSA and its sequelae in children. CITATION Blinder H, Narang I, Chaput J-P, Katz SL; on behalf of the Canadian Sleep and Circadian Network. Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(3):511-518.
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Affiliation(s)
- Henrietta Blinder
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Indra Narang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jean-Philippe Chaput
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sherri Lynne Katz
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - on behalf of the Canadian Sleep and Circadian Network
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Jóhannsdóttir KR, Ferretti D, Árnadóttir BS, Jónsdóttir MK. Objective Measures of Cognitive Performance in Sleep Disorder Research. Sleep Med Clin 2021; 16:575-593. [PMID: 34711383 DOI: 10.1016/j.jsmc.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neurocognitive tests offer objective and reliable assessment of patients' status and progress. However, there is no consensus on how to use neurocognitive assessment in sleep disorder research. An effective use of neurocognitive assessment must be based on standardized practices and have a firm theoretic basis. The aim of this review is to offer an overview of how different tests have been used in the field, mapping each test onto a corresponding cognitive domain and propose how to move forward with a suggested cognitive battery of tests covering all major cognitive domains.
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Affiliation(s)
- Kamilla Rún Jóhannsdóttir
- Department of Psychology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland; Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland.
| | - Dimitri Ferretti
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland
| | - Birta Sóley Árnadóttir
- Department of Psychology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland; Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland
| | - María Kristín Jónsdóttir
- Department of Psychology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland; Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Menntavegur 1, Reykjavik 102, Iceland; Landspitali University Hospital, Reykjavik, Iceland
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Zhang CQ, Yi S, Chen BB, Cui PP, Wang Y, Li YZ. mTOR/NF-κB signaling pathway protects hippocampal neurons from injury induced by intermittent hypoxia in rats. Int J Neurosci 2020; 131:994-1003. [PMID: 32378972 DOI: 10.1080/00207454.2020.1766460] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To expound the roles of mTOR and NF-kB signaling pathway in intermittent hypoxia (IH)-induced damage of hippocampal neurons. METHODS For rat experiments, mTOR inhibitor (Rapamycin, Rapa) and NF-κB signaling inhibitor (ammonium pyrrolidine dithiocarbamate, PDTC) were applied to inhibit mTOR and NF-κB signaling, respectively. For neuron experiments, hippocampal neurons from rat were successfully cultured. Different concentrations of Rapa and PDTC were added to the cultured hippocampal neurons. Rat or primary hippocampal neurons were exposed to normoxic or IH conditions after administration of Rapa and PDTC. The effects of Rapa and PDTC administration on learning and memory ability of rats and hippocampal injury after IH exposure were assayed by Morris water maze and H&E staining. Electron microscope was utilized to examine primary hippocampal neuron ultrastructure changes after IH exposure and Rapa or PDTC administration. The expressions of NF-κB-p65, IκBα, IKKβ, BDNF, TNF-α, IL-1β, PSD-95 and SYN in hippocampal neurons were examined. RESULTS Compared with normal control rats or neurons, IH-treated group had elevated expression levels of NF-kB, TNF-α and IL-1β and suppressed expression level of BDNF, PSD-95 and SYN. These results were reversed upon pre-treatment with Rapa and PDTC. Furthermore, IκBα and IKKβ expressions were down-regulated in IH group. No notable difference was manifested in PDTC pre-treatment group, while a prominent increase was shown after Rapa pre-administration. CONCLUSION The administration of PDTC and Rapa could prevent IH-induced hippocampal neuron impairment, indicating that inhibition of the mTOR and NF-κB pathway may likely act as a therapeutic target for obstructive sleep apnea.
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Affiliation(s)
- Chu-Qin Zhang
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China.,Department of Otorhinolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Song Yi
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Bo-Bei Chen
- Department of Otorhinolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Pan-Pan Cui
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Yan Wang
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
| | - Yan-Zhong Li
- Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China
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Wali SO, Abaalkhail B, AlQassas I, Alhejaili F, Spence DW, Pandi-Perumal SR. The correlation between oxygen saturation indices and the standard obstructive sleep apnea severity. Ann Thorac Med 2020; 15:70-75. [PMID: 32489441 PMCID: PMC7259396 DOI: 10.4103/atm.atm_215_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE: Currently accepted guidelines categorize obstructive sleep apnea (OSA) severity according to the Apnea–Hypopnea Index (AHI). However, it is unclear how to best define OSA severity. The present study sought to evaluate the concurrent validity of the widely accepted AHI by correlating it with various oxygen saturation (SpO2) and polysomnographic parameters. METHODS: The study utilized the data of a previous survey concerning the prevalence of OSA among a middle-aged Saudi population (n = 2682). Among the 346 individuals who underwent polysomnography, 178 had total sleep times of at least 240 min with rapid eye movement (REM) sleep and were included in the study. The standard classification of OSA severity was compared with different SpO2 and polysomnographic parameters. RESULTS: The study found that there were correlations between the standard OSA severity based on AHI severity classification and different SpO2 and polysomnographic parameters, including the desaturation index (DI), the sum of all desaturations, desaturation below 90%, the average duration of respiratory events, and indices of total arousals and respiratory arousals. All of these parameters correlated directly with OSA severity classification (P < 0.001 for each). However, REM sleep duration and SpO2 nadir were inversely correlated with OSA severity (P < 0.003 and < 0.001, respectively). In addition, only the DI, SpO2 nadir, and respiratory arousal index were predictors of OSA severity, as determined through a multiple logistic regression analysis. CONCLUSION: Our findings support the clinical reliability of the currently used standard classification of OSA severity based on the AHI.
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Affiliation(s)
- Siraj Omar Wali
- Sleep Medicine Research Group, Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Bahaa Abaalkhail
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Faris Alhejaili
- Sleep Medicine Research Group, Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Mu L, Peng L, Zhang Z, Jie J, Jia S, Yuan H. Memory and Executive Screening for the Detection of Cognitive Impairment in Obstructive Sleep Apnea. Am J Med Sci 2017; 354:399-407. [PMID: 29078845 DOI: 10.1016/j.amjms.2017.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/09/2017] [Accepted: 04/24/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is commonly associated with cognitive dysfunction, which is more apparent in severe OSA and impairs quality of life. However, the clinical screening methods for these impairments in OSA are still limited. In this study, we evaluated the feasibility of using the Memory and Executive Screening (MES) for assessing cognitive performance in OSA. MATERIALS AND METHODS Twenty-four patients with nonsevere OSA and 36 patients with severe OSA participated in this study. All participants underwent comprehensive, laboratory-based polysomnography and completed assessments of cognitive function, which included both the MES and the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ). RESULTS Both the total MES scores and 5 recall scores of the MES (MES-5R) were significantly lower in the severe OSA group than those in the nonsevere OSA group. The patients with severe OSA performed worse on the memory subtests of the MES-5R, especially on immediate recall. The sensitivity and specificity of the MES for identifying cognitive impairment in patients with OSA were 63.89% and 66.67%, respectively, for a cutoff value of <92 out of 100 points. An optimal cutoff between nonsevere and severe OSA was also set at 45 points (MES-5R) and at 0.94 points (MES ratio). Compared with the MES, the MoCA-BJ had similar sensitivity (61.11%) and specificity (66.67%). CONCLUSIONS The MES is an acceptable tool for detecting cognitive dysfunction in patients with OSA. The sensitivity and specificity of the MES were similar to those of the MoCA-BJ. The MES-5R and total MES scores can assess the presence and severity of cognitive impairment in patients with severe OSA.
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Affiliation(s)
- Li Mu
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China; Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
| | - Liping Peng
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China
| | - Zhengjiao Zhang
- Department of Neurology & Sleep Center, The People׳s Hospital of Jilin Province, Changchun, China
| | - Jing Jie
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China
| | - Siqi Jia
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China
| | - Haibo Yuan
- Department of Respiratory Medicine & Sleep Center, The First Hospital of Jilin University, Changchun, China.
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