Treatment and prevention of inflammatory responses and oxidative stress in patients with obstructive sleep apnea hypopnea syndrome using Chinese herbal medicines

Chen,Qin; Lin,Rong  Jing; Hong,Xuchu; Ye,Lin; Lin,Qichang

doi:10.3892/etm.2016.3484

Treatment and prevention of inflammatory responses and oxidative stress in patients with obstructive sleep apnea hypopnea syndrome using Chinese herbal medicines

Authors:
- Qin Chen
- Rong Jing Lin
- Xuchu Hong
- Lin Ye
- Qichang Lin
View Affiliations

Affiliations: Department of Pulmonary Disease, Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350004, P.R. China, Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
Published online on: June 27, 2016 https://doi.org/10.3892/etm.2016.3484
Pages: 1572-1578

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to investigate the therapeutic effects of Chinese herbal medicines for the treatment and prevention of inflammatory responses and oxidative stress in obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 60 patients with OSAHS were randomly divided into two groups (n=30/group): The experimental group, who received the conventional treatment + oral administration of the traditional Chinese herbal formula, Jiawei Di Tan Tang; and the control group, who received the conventional treatment only. OSAHS patients were included in the current study if they presented with snoring and had an apnea‑hypopnea index (AHI) of >30 in a polysomnography study, without comorbidities. The therapeutic course lasted 12 weeks in both groups. Alterations to the mean clinical symptom score, Epworth sleepiness scale (ESS) and AHI scores, lowest nocturnal blood oxygen saturation (SaO2) and the serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin (IL)‑6, tumor necrosis factor (TNF)‑α and C‑reactive protein (CRP) prior to and following treatment were observed. The mean clinical symptom score was significantly decreased in the experimental group post‑treatment compared with the control group (P<0.05). In addition, the clinical symptoms in the experimental group were significantly improved following treatment compared with pre‑treatment symptoms (P<0.05). Furthermore, the ESS and AHI scores, lowest nocturnal SaO2 and serum levels of SOD, MDA, IL‑6, TNF‑α and CRP were significantly improved in the experimental group post‑treatment compared with the control group (P<0.05). These parameters in the experimental group were also significantly improved post‑treatment compared with those pre‑treatment (P<0.05). The results of the present study suggested that oral administration of the traditional Chinese herbal formula Jiawei Di Tan Tang was able to attenuate oxidative stress and inflammatory responses in patients with OSAHS, and thus may relieve their clinical symptoms.

View Figures

View References

1	Tatsumi K, Kasahara Y, Kurosu K, Tanabe N, Takiguchi Y and Kuriyama T: Sleep oxygen desaturation and circulating leptin in obstructive sleep apnea-hypopnea syndrome. Chest. 127:716–721. 2005. View Article : Google Scholar : PubMed/NCBI
2	Bounhoure JP, Galinier M, Didier A and Leophonte P: Sleep apnea syndromes and cardiovascular disease. Bull Acad Natl Med. 189:445–459; discussion 460–464. 2005.(In French). PubMed/NCBI
3	Deng HT, Huang Y and Li SL: The epidemiologic survey of OSAHS among children and adolescents in Dongguan district. Zhong Guo Yi Xue Chuang Xin. 12:61–63. 2015.(In Chinese).
4	Hu QL, Yang Y and Zhou H: Epidemiological study on children with obstructive sleep apnea hypopnea syndrome aged from 4 to 7 years in Putuo District of Shanghai. Yan Shi Guang Xue Za Zhi. 14:316–319. 2014.(In Chinese).
5	Ma YL, Wang X and Bao PP: Taiyuan area epidemiological studies of sleep apnea syndrome. Zhong Guo Yi Yao Zhi Dao. 9:108–110. 2011.(In Chinese).
6	Ma GQ, Dai G and Li JP: East Inner Mongolia black flag pastoral area population aged over 20 obstructive sleep apnea hypopnea syndrom epidemiological investigation. Zhong Hua Lin Chuang Yi Shi Za Zhi. 4:1070–1073. 2010.(In Chinese).
7	Nanduri J, Yuan G, Kumar GK, Semenza GL and Prabhakar NR: Transcriptional responses to intermittent hypoxia. Respir Physiol Neurobiol. 164:277–281. 2008. View Article : Google Scholar : PubMed/NCBI
8	Takahashi Y, Ganster RW, Gambotto A, Shao L, Kaizu T, Wu T, Yagnik GP, Nakao A, Tsoulfas G, Ishikawa T, et al: Role of NF-kappaB on liver cold ischemia-reperfusion injury. Am J Physiol Gastrointest Liver Physiol. 283:G1175–G1184. 2002. View Article : Google Scholar : PubMed/NCBI
9	Baeuerie PA and Baltimore D: NF-kappaB: Ten years after. Cell. 87:13–20. 1996. View Article : Google Scholar : PubMed/NCBI
10	McNicholas WT and Bonsigore MR: Management Committee of EU COST ACTION B26: Sleep apnoea as an independent risk factor for cardiovascular disease: Current evidence, basic mechanisms and research priorities. Eur Respir J. 29:156–178. 2007. View Article : Google Scholar : PubMed/NCBI
11	Del Ben M, Loffredo L, Violi F and Angelico F: Strong interplay between metabolic syndrome, obstructive sleep apnoea, oxidative stress and arterial dysfunction. Sleep Breath. 18:223–224. 2014.PubMed/NCBI
12	Wysocka E, Cofta S, Cymerys M, Gozdzik J, Torlinski L and Batura-Gabryel H: The impact of the sleep apnea syndrome on oxidant-antioxidant balance in the blood of overweight and obese patients. J Physiol Pharmacol. 59(Suppl 6): 761–769. 2008.PubMed/NCBI
13	Lavie L, Vishnevsky A and Lavie P: Evidence for lipid peroxidation in obstructive sleep apnea. Sleep. 27:123–128. 2004.PubMed/NCBI
14	Yamauchi M, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Suzuki T and Kimura H: Oxidative stress in obstructive sleep apnea. Chest. 127:1674–1679. 2005. View Article : Google Scholar : PubMed/NCBI
15	The Chinese Medical Association Respiratory Neurology, Sleep Respiratory Disease Group: Obstructive sleep apnea hypopnea syndrom diagnosis and treatment guidelines (draft). Zhong Hua Jie He he Hu Xi Za Zhi. 25:195–198. 2002.(In Chinese).
16	Platt AB, Kuna ST, Field SH, Chen Z, Gupta R, Roche DF, Christie JD and Asch DA: Adherence to sleep apnea therapy and use of lipid-lowering drugs: A study of the healthy-user effect. Chest. 137:102–108. 2010. View Article : Google Scholar : PubMed/NCBI
17	Villar I, Izuel M, Carrizo S, Vicente E and Marin JM: Medication adherence and persistence in severe obstructive sleep apnea. Sleep. 32:623–628. 2009.PubMed/NCBI
18	Hobson JC, Robinson S, Antic NA, McEvoy RD, Windler S, Mackay S and Carney AS: What is ‘success’ following surgery for obstructive sleep apnea? The effect of different polysomnographic scoring systems. Laryngoscope. 122:1878–1881. 2012. View Article : Google Scholar : PubMed/NCBI
19	Certal V, Nishino N, Camacho M and Capasso R: Reviewing the systematic reviews in OSA surgery. Head Neck Surg. 149:817–829. 2013. View Article : Google Scholar
20	Xia R, Chen JZ and Shao GM: Exploration of the correlation between the phlegm dampness constitution and the pathogenesis of OSAHS. Chin J Tradit Chin Med. 21:465–469. 2006.
21	Kang J and Wang ZF: Inflammation, oxidative stress and obstructive sleep apnea hypopnea syndrome. Zhong Hua Jie He He Hu Xi Za Zhi. 29:226–227. 2006.(In Chinese).
22	Liu YH, Wang HY and Yue J: TCM exploration of OSHAS. Liaoning Da Xue Xue Bao. 25:13–15. 2010.(In Chinese).
23	Liu W: TCM syndromes of OSAHAS: Analysis of 300 cases. Zhong Guo Zhong Xi Yao Jie He Za Zhi. 29:22010.(In Chinese).
24	Chua KK, Wong A, Kwan PW, Song JX, Chen LL, Chan AL, Lu JH, Mok V and Li M: The efficacy and safety of the Chinese herbal medicine Di-Tan decoction for treating Alzheimer's disease: Protocol for a randomized controlled trial. Trials. 16:1992015. View Article : Google Scholar : PubMed/NCBI
25	Guo SH and Zhang LJ: Influence of ditan decoction on lipid metabolism, oxidant stress and inflammatory cytokines in atherosclerosis rabbits. Hu Bei Zhong Yi Yao Da Xue Xue Bao. 18:8–11. 2016.(In Chinese).
26	Zheng XY: Chinese Traditional Meditional New Medicine Clinical Research Guiding Principles. (4th). Zhong Guo Yi Yao Ke Ji Chu Ban She. 42–45. 2002.
27	Johns MW: A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 14:540–545. 1991.PubMed/NCBI
28	Schulz H: Phasic or transient? Comment on the terminology of the AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 3:7522007.PubMed/NCBI
29	American academy of sleep medicine: International classification of sleep disorders: Diagnostic and coding manual. American academy of sleep medicine. Westchester, Ill, USA: 2005.
30	Meng Y, Zheng WF and Liu WR: Treatment of obstructive sleep apnea hypopnea syndrom. Zhong Guo Shi Yan Fang Ji Xue Za Zhi. 17:281–283. 2011.(In Chinese).
31	Luo XF, Wang HR and Cai YY: Please describe the syndrome differentiation and treatment of sleep apnea syndrome. Zhe Jiang Zhong Yi Za Zhi. 38:490–491. 2003.(In Chinese).
32	Sun GR: The higher colleges and universities of Chinese medicine for teaching. Diagnostics of Traditional Chinese Medicine (5th). Zhong Guo Zhong Yi Yao Chu Ban She. 33–36. 2007.
33	Zhu WF: The higher colleges and universities of Chinese medicine for teaching. Diagnostics of Traditional Chinese Medicine (5th). Zhong Guo Zhong Xi Yao Jie He Za Zhi. 37–41. 2007.
34	Zhou ZY: The higher colleges and universities of Chinese medicine for teaching. Internal Medicine of Traditional Chinese Medicine (5th). Zhong Guo Zhong Yi Yao Chu Ban She. 21–25. 2007.
35	Ohga E, Tomita T, Wada H, Yamamoto H, Nagase T and Ouchi Y: Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1. J Appl Physiol. 94:179–184. 2003. View Article : Google Scholar : PubMed/NCBI
36	Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K and Chrousos GP: Elevation of plasma cytokines in disorders of excessive daytime sleepiness: Role of sleep disturbance and obesity. J Clin Endoerinol Metab. 82:1313–1316. 1997. View Article : Google Scholar
37	Guven SF, Turkkani MH, Ciftci B, Ciftci TU and Erdogan Y: The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. Sleep Breath. 16:217–221. 2012. View Article : Google Scholar : PubMed/NCBI
38	Constantinidis J, Ereliadis S, Angouridakis N, Konstantinidis I, Vital V and Angouridaki C: Cytokine changes after surgical treatment of obstructive sleep apnoea syndrome. Eur Arch Otorhinolaryngol. 265:1275–1279. 2008. View Article : Google Scholar : PubMed/NCBI
39	Wysocka E, Cofta S, Piorunek T, Dziegielewska-Gesiak S, Bryl W and Torlinski L: Blood antioxidant status, dysglycemia and obstructive sleep apnea. Adv Exp Med Biol. 756:121–129. 2013. View Article : Google Scholar : PubMed/NCBI
40	Priou P, Gagnadoux F, Tesse A, Mastronardi ML, Agouni A, Meslier N, Racineux JL, Martinez MC, Trzepizur W and Andriantsitohaina R: Endothelial dysfunction and circulating microparticles from patients with obstructive sleep apnea. Am J Pathol. 177:974–983. 2010. View Article : Google Scholar : PubMed/NCBI
41	Chen L, Einbinder E, Zhang Q, Hasday J, Balke CW and Scharf SM: Oxidative stress and left ventricular function with chronic intermittent hypoxia in rats. Am J Respir Crit Care Med. 172:915–920. 2005. View Article : Google Scholar : PubMed/NCBI
42	Zhang Kun and Xie Chun Guang: Effects of shenqi compound recipe on oxidative stress in GK rats with type II diabetes mellitus macrovascular complications. CJTCMP. 4:1084–1085. 2012.
43	Xu XM, Chen XJ and Chen R: Effect of buyang huanwu decoction on blood viscosity, TXB2, LPO and SOD in rats. J Shanxi Med Univ. 33:212–214. 2002.
44	Ru J, Chen MQ and Geng YX: Effect of qi benefiting stasis removing method on systemic inflammatory response and coagulation function in MODS patients. Zhong Guo Zhong Xi Yao Jie He Za Zhi 34. 34:365–338. 2014.(In Chinese).
45	Zeng X: Observation of the therapeutic effect of Chinese traditional medicines on OSAHS. Chin Foreign Med Treat. 27:490–491. 2012.
46	Ma X, Zhang K, Li H, Han S, Ma Z and Tu P: Extracts from astragalus membranaceus limit myocardial cell death and improve cardiac function in a rat model of myocardial ischemia. J Ethnopharmacol. 149:720–728. 2013. View Article : Google Scholar : PubMed/NCBI
47	Song J, Li J, Zheng SR, Jin Y and Huang Y: Anti-inflammatory and immunoregulatory effects of Yupingfeng powder on chronic bronchitis rats. Chin J Integr Med. 19:353–359. 2013. View Article : Google Scholar : PubMed/NCBI
48	Lv ZK, Liu YZ and Wu Z: Inhibitory effects of different doses of Astragalus membranaceus on oxidative stress in the kidneys of diabetic rats. Shang Hai Zhong Yi Yao Za Zhi. 49:68–71. 2015.(In Chinese).
49	Yu DH, Bao YM, Wei CL and An LJ: Studies of chemical constituents and their antioxidant activities from Astragalus mongholicus Bunge. Biomed Environ Sci. 18:297–301. 2005.PubMed/NCBI
50	Li J, Han L and Ma YF: Inhibiting effects of three components of Astragalus membranaceus on oxidative stress in Chang Liver cells. Zhong Guo Zhong Yao Za Zhi. 40:318–323. 2015.(In Chinese).
51	Cao LL, Li WZ and Si XL: Astragalus armour glycosides on glomerular mesangial cell protective effect and its mechanism of oxidative stress damage. Zhong Guo Zhong Yao Za Zhi. 38:725–727. 2013.(In Chinese).
52	Gao LS, Zeng FP and Ning LX: Researcheson effects of magnetized codonopsis Pilosula (Franch) nannf. Medicinal solution on carbon expurgatory function of small white rats. Biomagnetism. 4:1–4. 2004.
53	Gao LS, Zeng FP and Ning LX: Researches on effects of magnetized codonopsis Pilosula (Franch) nannf. Medicinal solution on blood function of small rats. Biomagnetism. 5:14–16. 2005.
54	Chen KN, Peng WH, Hou CW, et al: Codonopsis javanica root extracts attenuate hyperinsulinemia and lipid peroxidation in fructose-fed insulin resistant rats. Journal of Food and Drug Analysis. 4:347–355. 2013. View Article : Google Scholar
55	Zhou GJ, Wang W, Xie XM, Qin MJ, Kuai BK and Zhou TS: Post-harvest induced production of salvianolic acids and significant promotion of antioxidant properties in roots of Salvia miltiorrhiza (Danshen). Molecules. 19:7207–7222. 2014. View Article : Google Scholar : PubMed/NCBI
56	Wang N, Yang JY, Lu JG, Qiao Q, Wu T, Du X, Bao G and He X: A polysaccharide from Salvia miltiorrhiza Bunge improves immune function in gastric cancer rats. Carbohydr Polym. 111:47–55. 2014. View Article : Google Scholar : PubMed/NCBI
57	Li CM, Guo YQ, Dong XL, Li H, Wang B, Wu JH, Wong MS and Chan SW: Ethanolic extract of rhizome of ligusticum chuanxiong hort. (chuanxiong) enhances endothelium-dependent vascular reactivity in ovariectomized rats fed with high-fat diet. Food Funct. 5:2475–2485. 2014. View Article : Google Scholar : PubMed/NCBI
58	Huang J, Lu XQ, Zhang C, Lu J, Li GY, Lin RC and Wang JH: Anti-inflammatory ligustilides from ligusticum chuanxiong hort. Fitoterapia. 91:21–27. 2013. View Article : Google Scholar : PubMed/NCBI
59	Huang X, Lv B, Zhang S, Dai Q, Chen BB and Meng LN: Effects of radix curcumae-derived diterpenoid C on Helicobacter pylori-induced inflammation and nuclear factor kappa B signal pathways. World J Gastroenterol. 19:5085–5093. 2013. View Article : Google Scholar : PubMed/NCBI
60	Li YY, Wang MR, Zhang QQ, et al: Chemical differentiation of Da-Cheng-Qi decoction and its three analogous decoctions using UFLC-ITTOF/MS-based chemomic and chemometric approach. Analytical Methods. 6:1720–1727. 2014. View Article : Google Scholar
61	Jin MH, Lu Y, Yang JH, Jo TH, Park YI, Lee CK, Park SJ, Son KH and Chang HW: Anti-inflammatory activity of 6-hydroxy-2,7-dimethoxy-1,4-henanthraquinone from tuberous roots of yam (Dioscorea batatas) through inhibition of prostaglandin D-2 and leukotriene C-4 production in mouse bone marrow-derived mast cells. Arch Pharm Res. 34:1495–1501. 2011. View Article : Google Scholar : PubMed/NCBI
62	Zeng S, Wang L, Zhang L, Qu H and Gong X: Multi-criteria optimization for ultrasonic-assisted extraction of antioxidants from Pericarpium Citri Reticulataeusing response surface methodology, an activity-based approach. J Sep Sci. 36:1861–1868. 2013. View Article : Google Scholar : PubMed/NCBI
63	Svatikova A, Wolk R, Lerman LO, Juncos LA, Greene EL, McConnell JP and Somers VK: Oxidative stress in obstructive sleep apnoea. Eur Heart J. 26:2435–2439. 2005. View Article : Google Scholar : PubMed/NCBI
64	Alzoghaibi MA and Bahammam AS: Lipid peroxides, superoxide dismutase and circulating IL-8 and GCP-2 in patients with severe obstructive sleep apnea: A pilot study. Sleep Breath. 9:119–126. 2005. View Article : Google Scholar : PubMed/NCBI