title: Exhaled nitric oxide from the central airway and alveoli in OSAHS patients: the potential correlations and clinical implications.
abstract: BACKGROUND
  The aim of the study was to evaluate exhaled nitric oxide (eNO) derived from different areas of airway in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with NO exchange model and investigate the potential application and interpretation of eNO in clinical setting.
  
  
  METHODS
  This study was divided into two parts. Firstly, we performed a case control study in 32 OSAHS patients and 27 non-OSAHS participants. Fractional eNO (FeNO) and eNO from the central airway (J'awNO) and from alveoli (CANO) were compared in OSAHS and control groups. Also, correlation of eNO to severity of OSAHS was analyzed. Secondly, a prospective study was conducted in 30 severe OSAHS patients who received a short-term nasal continuous positive airway pressure (nCPAP) treatment. We evaluated eNO, plasma ET-1 concentration, and echocardiography during the treatment process and explored the potential relationship among them.
  
  
  RESULTS
  FeNO and J'awNO were higher in OSAHS and associated with disease severity, while CANO was relatively lower. After nCPAP treatment in severe OSAHS patients, FeNO and J'awNO decreased and CANO increased significantly. Substantial agreement was shown between the elevation of CANO and the decrease of plasma ET-1 concentration after nCPAP by Kappa analysis for consistency. Tei index, which is considered indicative of global right ventricular function, might be predicted by plasma ET-1 levels in severe OSAHS patients.
  
  
  CONCLUSIONS
  NO exchange model provides us with more information of eNO derived from different areas. eNO is not only confirmed to be an effective method for airway inflammation evaluation in the follow-up of OSAHS, CANO may also serve as a useful marker in monitoring endothelial function, resistance of pulmonary circulation, and right ventricular function for clinical implication.
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Zilong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Fen
authors.initials: F
authors.lastname: Zhu
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Yuanlin
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Respiratory Research Institute, Shanghai, China.
authors.forename: Shanqun
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032. bai.chunxue@zs-hospital.sh.cn.|Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China. bai.chunxue@zs-hospital.sh.cn.|Shanghai Respiratory Research Institute, Shanghai, China. bai.chunxue@zs-hospital.sh.cn.
authors.forename: Chunxue
authors.initials: C
authors.lastname: Bai
mesh_terms: D001944:Breath Tests; D001980:Bronchi / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000503:physiopathology; D016022:Case-Control Studies; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D019332:Endothelin-1 / Q000097:blood*; D004727:Endothelium / Q000502:physiology; D045853:Exhalation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000502:physiology*; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D012016:Reference Values; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013223:Statistics as Topic; D016278:Ventricular Function, Right / Q000502:physiology
chemical_list: D019332:Endothelin-1; D009569:Nitric Oxide
keywords: Endothelial function; Exhaled nitric oxide; Obstructive sleep apnea hypopnea syndrome; Right cardiac function