Background: To explore the clinical efficacy and safety of modified electroconvulsive therapy (MECT) in the treatment of elderly patients with refractory depression. Methods : A total of 43 older patients (18 male and 25 female) with refractory depression were enrolled in our study from March 2014 to February 2015, with the average age of 65±4.8 years old. Modified electroconvulsive therapy (MECT) was performed in these patients after physical examinations and anesthesia procedures. Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to assess the efficacy of MECT, and Wechsler Memory Scale (WMS) and mini mental state examination (MMSE) were used to evaluate the memory ability and cognitive function. The preoperative, intraoperative and postoperative care were conducted in patients accompanied by physical diseases. Results: The rate of efficacy was calculated as 67.44% after 4 weeks of MECT treatment. Our results showed HAMA and HAMD scores after 2 weeks of MECT treatment were significantly lower than that before treatment (P<0.05), and the differences were more significant after 4 weeks of MECT treatment (P<0.01). Compared with before treatment, the scores of memory quotient and immediate memory of WMS decreased significantly after 1 week of treatment (P<0.05). However, these events were not be presented with the progress of treatment, except for after 2 weeks of treatment. Our results demonstrated that compared with before treatment, the scores of MMSE significantly increased significantly after 4 weeks of treatment (P<0.05). There were no serious adverse events in all patients, including cardiovascular and cerebrovascular events. Among them, 7 patients had transient blood pressure rise and slight headache, which were relieved spontaneously after resting. Conclusion: MECT is an effective, well tolerated and safe method for the treatment of older patients with refractory depression, which is temporary and reversible for cognitive impairment. MECT can be recommended for the treatment of these patients after conducting effective risk control of comorbid somatic diseases.

Objective This study aimed to examine the association between slow-wave sleep ([SWS] N3 stage) and the risk of hypertension in patients with obstructive sleep apnea (OSA) or primary snorers. Methods A retrospective cross-sectional study of 1145 participants who were evaluated for suspected OSA at our Sleep Medical Center were included. Among these participants, 1022 had OSA and 123 were primary snorers. Logistic regression modeling was performed to evaluate the association between the prevalence of hypertension and combined OSA and SWS based on polysomnographic measurements. Results Patients with OSA in the lowest SWS quartile (quartile 1,  < 2.0%) showed a two-fold increased risk of hypertension after adjustment for confounding factors compared with primary snorers (odds ratio, 2.13 [95% confidence interval 1.54–2.06]). In logistic analysis stratified according to SWS quartiles, there was no significant difference in the risk of hypertension between patients with OSA and primary snorers in quartile 1. However, in the highest quartile (quartile 4), SWS was significantly associated with incident hypertension in patients with OSA rather than primary snorers. Conclusion SWS is associated with prevalent hypertension in patients with OSA. Notably, a low proportion of SWS confers a stronger association with incident hypertension than OSA.

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