Purpose The diagnosis and severity of obstructive sleep apnea (OSA) are commonly based on the apnea hypopnea index (AHI). However, patients with similar severity AHIs may show widely varying comorbidities and risks for cardiovascular disease, which may be associated with different severities of nocturnal hypoxia. The percentage of cumulative time with oxygen saturation below 90% in total sleep time (T90) is receiving increasing attention in OSA research because it describes the duration and degree of hypoxia during the whole sleep. This study aimed to explore the distribution of T90 in OSA patients with similar severity and to evaluate the relationship between T90 and hypertension. Patients and Methods A total of 775 patients with OSA were enrolled in this study, all participants were divided into groups according to the T90 value: light hypoxia (T90≤5%), mild hypoxia (T90 accounted for 5–10%), moderate hypoxia (T90 accounted for 10–25%), and severe hypoxia (T90>25%). Multivariate logistic regression analysis was performed to assess the association between T90 and hypertension. Results Of the patients with mild OSA, 94.33% had light hypoxia, and 88.64% of moderate OSA patients had light hypoxia. The proportions of light, mild, moderate, and severe hypoxia among patients with severe OSA were 28.60%, 17.69%, 21.40%, and 32.31%, respectively. After adjustment for potential confounders, the risk of hypertension in patients with severe OSA increased according to the severity categories of T90. The odds ratio for T90 accounting for 10–25% relative to T90≤5% was 2.544 (95%confidence interval, 1.254–5.164; P=0.010) and as high as 2.692 (95%confidence interval, 1.403–5.166; P=0.003) in patients with T90>25%. Conclusion OSA patients with similar degree of AHI may have different T90 values, especially in severe OSA. A higher T90 was independently associated with the risk of hypertension after adjustment for traditional risk factors in patients with severe OSA. Our findings highlight the potential role for T90 in predicting hypertension in patients severe OSA.

Pulmonary sarcomatoid carcinoma (PSC), a rare subtype of non-small cell lung cancer (NSCLC) characterized by poor differentiated, highly invasive, and early systemic metastases, accounts for only 0.4% of all pulmonary malignancies. The overall prognosis is worse than other subtypes of NSCLC. 1 The rapid development of molecular detection and deep understanding of tumor (U.S. vs. U.K spelling) biology highlight the important role of targeted drugs in NSCLC. Some patients with NSCLC harboring specific driver mutations could benefit from targeted therapies. 2,3 Until now, due to its rarity, high aggressiveness, and difficulty in diagnosis, no large-scale prospective studies of PSC are available. Thus, the efficacy of some targeted options in the treatment of PSC is not clear. We report here a novel PSC case, with mutation of

BackgroundHypothyroidism could cause obstructive sleep apnea (OSA), however, the specific association of them remained unclear. This cross-sectional study aimed to determine the prevalence of hypothyroidism among patients with OSA, and the characteristics and predictors of hypothyroidism associated with OSA.MethodsA total of 573 patients with OSA were included in the study. Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were measured in all participants. Univariate and binary logistic regression analysis were performed to assess the association of OSA with hypothyroidism while controlling for potential confounders. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the OSA effect in the distinction between euthyroid and hypothyroidism.ResultsThe prevalence of hypothyroidism was 6.75%、5.12%、10.38% in the total, men, and women cohort, respectively, and the prevalence rate in women OSA patients was significantly higher than that in men OSA patients (P=0.018). The men OSA patients with hypothyroidism had a higher Epworth sleepiness scale (ESS) than women OSA patients with hypothyroidism (P=0.022). Additionally, the ESS was significantly higher in men OSA patients with hypothyroidism than those with euthyroid (P=0.042), while women OSA patients had no such difference (P=0.822). In men patients with OSA, ROC curve analyses revealed that the risk of hypothyroidism increased in accordance with increasing ESS after adjustment for potential confounders, and the optimal cutoff value was 10 score. Higher ESS category was significantly associated with a higher risk of prevalent hypothyroidism in men patients with OSA [odds ratio (OR) = 4.898 for ESS≥10 relative to ESS <10, 95% confidence interval (CI) 1.628-14.731, P = 0.005].ConclusionsThe prevalence of hypothyroidism in OSA patients was relatively higher, especially in women OSA patients. ESS was significantly and positively associated with hypothyroidism in men patients with OSA, suggesting that ESS may have a potential role in identification and diagnosis of men OSA patients complicated with hypothyroidism.

Obstructive sleep apnea (OSA) plays an important role in the pathogenesis of hypertension. The aim of this cross-sectional study was to explore the clinical and polysomnographic characteristics of OSA patients with hypertension and to explore the gender differences in the relationship between rapid eye movement (REM) OSA and hypertension. Patients and Methods: A total of 808 patients with OSA at a tertiary hospital were enrolled in this study, and OSA patients were divided into groups presenting with or without hypertension. The clinical and polysomnographic characteristics were compared between the groups. Multivariate binary logistic analysis was performed to assess the association between REM OSA and hypertension.Results: After adjustment for potential confounders, the risk of hypertension in patients with OSA increased with severity categories of apnea hypopnea index during rapid eye movement sleep stage (REM AHI) (OR = 1.61 for REM AHI ≥58.87 events/h relative to REM AHI <30.50 events/h, 95% CI 1.07-2.42, P = 0.022). Consistent with this, when taken as a continuous variable, this association still remains significant (OR = 1.007, 95% CI 1.001-1.014, P < 0.05). This effect was more pronounced in women patients, the OR for REM AHI ≥57.24 events/h relative to REM AHI <30.36 events/h was 2.79 (95% CI, 1.16-6.73; P = 0.022); however, there was no significant difference in male patients. Conclusion: REM AHI was significantly and positively associated with hypertension in patients with OSA, and the effect was more pronounced in female patients.

Introduction:Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare biphasic tumor characterized by a mixture of malignant epithelial and mesenchymal cells. Owing to the rarity, as well as the lack of typical manifestations and imaging signs, the rate of misdiagnosis is high. Herein, we present a case of PSC misdiagnosed as pleural mesothelioma in a 59-year-old man.Patient concerns:A 59-year-old man presented with recurrent coughing, fever, and chest pain.Diagnosis:Chest computed tomography showed 2 large and dense masses involving the inferior lobes of right lung, along with slight irregular pleural thickening and a small amount of effusion.Interventions:Chest computed tomography-guided tumor biopsy was performed. PSC was confirmed based on histopathology and immunohistochemistry. The patient refused treatment due to economic reasons.Outcomes:The patient developed adrenal, multiple lung and brain metastasis. The overall survival time was 11 months.Conclusions:PSC, despite its rarity, should be considered in the differential diagnosis of lung cancer. Besides, biopsy, histopathology, and specific immunohistochemical staining of larger tissue specimens can be contributing to the accurate diagnosis of PSC.