Artículos de revistas sobre el tema "Overnight oxygen saturation"
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Lario, Bonifacio Alvarez, José Luis Alonso Valdivielso, Javier Alegre López, Carlos Martel Soteres, José Luis Viejo Bañuelos y Angel Marañón Cabello. "Fibromyalgia Syndrome: Overnight Falls in Arterial Oxygen Saturation". American Journal of Medicine 101, n.º 1 (julio de 1996): 54–60. http://dx.doi.org/10.1016/s0002-9343(96)00067-8.
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Kobayashi, Tadaharu, Akinori Funayama, Daichi Hasebe, Yusuke Kato, Michiko Yoshizawa y Chikara Saito. "Changes in overnight arterial oxygen saturation after mandibular setback". British Journal of Oral and Maxillofacial Surgery 51, n.º 4 (junio de 2013): 312–18. http://dx.doi.org/10.1016/j.bjoms.2012.07.004.
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van Geyzel, Lisa, Michele Arigliani, Baba Inusa, Bethany Singh, Wanda Kozlowska, Subarna Chakravorty, Cara J. Bossley, Gary Ruiz, David Rees y Atul Gupta. "Higher oxygen saturation with hydroxyurea in paediatric sickle cell disease". Archives of Disease in Childhood 105, n.º 6 (23 de diciembre de 2019): 575–79. http://dx.doi.org/10.1136/archdischild-2019-317862.
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IntroductionSickle cell disease (SCD) is one of the most common inherited diseases worldwide. It is associated with lifelong morbidity and reduced life expectancy. Hydroxyurea (HU) has been shown to reduce the frequency and severity of vaso-occlusive episodes in SCD. Hypoxaemia and intermittent nocturnal oxygen desaturations occur frequently in children with SCD and contribute to the associated morbidity, including risk of cerebrovascular disease.ObjectiveTo evaluate the effect of HU on oxygen saturation (SpO2) overnight and on daytime SpO2 spot checks in children with SCD.MethodsA retrospective review of children with SCD and respiratory problems who attended two UK tertiary sickle respiratory clinics and were treated with HU. Longitudinal data were collected from 2 years prior and up to 3 years after the commencement of HU.ResultsForty-three children, 23 males (53%) with a median age of 9 (range 1.8–18) years were included. In the 21 children who had comparable sleep studies before and after starting HU, mean SpO2 was higher (95.2% from 93.5%, p=0.01) and nadir SpO2 was higher (87.2% from 84.3%, p=0.009) when taking HU. In 32 of the children, spot daytime oxygen saturations were also higher (96.3% from 93.5%, p=0.001).ConclusionChildren with SCD had higher oxygen saturation overnight and on daytime spot checks after starting HU. These data suggest HU may be helpful for treating persistent hypoxaemia in children with SCD pending more evidence from a randomised clinical trial.
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Johnson, Mark C., Fenella J. Kirkham, Susan Redline, Carol L. Rosen, Yan Yan, Irene Roberts, Jeanine Gruenwald, Jan Marek y Michael R. DeBaun. "Left ventricular hypertrophy and diastolic dysfunction in children with sickle cell disease are related to asleep and waking oxygen desaturation". Blood 116, n.º 1 (8 de julio de 2010): 16–21. http://dx.doi.org/10.1182/blood-2009-06-227447.
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Abstract Premature death and cardiac abnormalities are described in individuals with sickle cell disease (SCD), but the mechanisms are not well characterized. We tested the hypothesis that cardiac abnormalities in children with SCD are related to sleep-disordered breathing. We enrolled 44 children with SCD (mean age, 10.1 years; range, 4-18 years) in an observational study. Standard and tissue Doppler echocardiography, waking oxygen saturation averaged over 5 minutes, and overnight polysomnography were obtained in participants, each within 7 days. Eccentric left ventricular (LV) hypertrophy was present in 46% of our cohort. After multivariable adjustment, LV mass index was inversely related to average asleep and waking oxygen saturation. For every 1% drop in the average asleep oxygen saturation, there was a 2.1 g/m2.7 increase in LV mass index. LV diastolic dysfunction, as measured by the E/E′ ratio, was present in our subjects and was also associated with low oxygen saturation (sleep or waking). Elevated tricuspid regurgitant velocity (≥ 2.5 m/sec), a measure of pulmonary hypertension, was not predicted by either oxygen saturation or sleep variables with multivariable logistic regression analysis. These data provide evidence that low asleep and waking oxygen saturations are associated with LV abnormalities in children with SCD.
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Clark, M., B. Cooper, S. Singh, M. Cooper, A. Carr y R. Hubbard. "A survey of nocturnal hypoxaemia and health related quality of life in patients with cryptogenic fibrosing alveolitis". Thorax 56, n.º 6 (1 de junio de 2001): 482–86. http://dx.doi.org/10.1136/thx.56.6.482.
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BACKGROUNDA survey of overnight oximetry was conducted to estimate the prevalence of nocturnal hypoxaemia in patients with cryptogenic fibrosing alveolitis and to establish whether nocturnal hypoxaemia is related to quality of life.METHODSAll patients with cryptogenic fibrosing alveolitis attending Nottingham City Hospital were invited to enter the study. Spirometric measurements and capillary blood gas tensions were obtained and overnight oxygen saturation was recorded at home. Quality of life was assessed using the Short Form-36, Chronic Respiratory Questionnaire, Hospital Anxiety Depression Scale, and Epworth Sleepiness Score questionnaires.RESULTSSixty seven eligible patients were identified and 50 agreed to enter the study, although two were subsequently excluded because they already used oxygen overnight. In the remaining 48 the mean (SD) overnight oxygen saturation (Sao2) was 92.5 (4.3)% and the median number of dips greater than 4% per hour was 2.3 (interquartile range 1.5–5.3). Daytime oxygen level predicted mean overnight Sao2 (1.94%/kPa, 95% CI 1.22 to 2.66, p<0.001) but percentage predicted forced vital capacity (FVC) did not (0.018%/% predicted FVC, 95% CI –0.04 to 0.08, p=0.5). Nocturnal hypoxaemia was associated with decreased energy levels and impaired daytime social and physical functioning, and these effects were independent of FVC.CONCLUSIONSNocturnal hypoxaemia is common in patients with cryptogenic fibrosing alveolitis and may have an impact on health related quality of life.
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Al Rajeh, Ahmed M., Yousef Saad Aldabayan, Abdulelah Aldhahir, Elisha Pickett, Shumonta Quaderi, Jaber S. Alqahtani, Swapna Mandal, Marc CI Lipman y John R. Hurst. "Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial". JMIR mHealth and uHealth 8, n.º 11 (13 de noviembre de 2020): e17597. http://dx.doi.org/10.2196/17597.
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Background Earlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations. Objective This study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations. Methods A total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline. Results The mean age of the patients was 70.6 (SD 8.1) years, 52% (43/83) were female, and the mean FEV1 was 53.0% (SD 18.5%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2%. However, this was not statistically better than examining changes in symptoms alone. Conclusions Overnight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations. Trial Registration ClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702
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Dillon, Richard, Patrick Murphy, Craig Davidson, Adrian Williams, Kate Brignall, Sean Higgins, Dawn Evans, Nicholas Hart y Jo Howard. "Prevalence of Nocturnal Hypoxia and Its Association with Disease Severity in Adults with Sickle Cell Disease." Blood 114, n.º 22 (20 de noviembre de 2009): 261. http://dx.doi.org/10.1182/blood.v114.22.261.261.
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Abstract Abstract 261 Introduction: In children with sickle cell disease (SCD), obstructive sleep apnoea (OSA) is common and the degree of overnight hypoxia is closely correlated with disease severity, particularly frequency of painful crises, risk of stroke and presence of pulmonary hypertension. No studies have examined the prevalence or effects of OSA in adults with SCD. Methods: All adults with SCD attending routine sickle cell out-patient clinics were offered screening for OSA using the Epworth Sleepiness Score (ESS) questionnaire. All of those in whom the score was >10 or in whom there was a high clinical suspicion of OSA were offered overnight domiciliary oximetry. Oximetry traces were both analysed by computer and manually. Computerised analysis was used to quantify night time hypoxic load (mean nocturnal SpO2 and sleep time with SpO2 below 90%) and frequency of desaturation (number of times per hour the SpO2 dropped by >4%, or Overnight Desaturation Index, ODI). Manual analysis of each trace was performed by four independent sleep physicians who assigned a diagnosis of normal, OSA, non-OSA nocturnal hypoxia or inadequate based on the pattern of the oxygen saturation and heart rate traces. These parameters were then correlated with measures of disease severity and presence of complications taken from the patient's medical record. Statistical analysis was performed using the t-test and linear regression. Results: 93 patients completed the ESS, with 34 patients identified for subsequent oximetry (26 ESS>10, 8 clinical suspicion). 22 patients went on to have subsequent oximetry. 17/22 of recordings (77%) were abnormal of which 11 showed OSA (65%) and 6 showed nocturnal hypoxia without OSA (35%). Nocturnal hypoxic load, measured as mean overnight oxygen saturation, was correlated with glomerular filtration rate (r=0.5; p=0.0008) and pulmonary artery systolic pressure estimated by echocardiography (r=0.71; p=0.0001). Furthermore, urine protein level correlated with ODI (r=0.5 p=0.0007) and mean overnight oxygen saturation (r=0.35; p=0.02). In addition, mean overnight oxygen saturation was 87% in male patients that experienced priapism and 94% in those who did not (p=0.004). Mean ODI was 10/hr in patients with priapism and 4 in those without (p=0.008). There were no correlations demonstrated between either hypoxic load or ODI with the frequency of painful crises, frequency of hospital admissions or avascular necrosis. Lung function test parameters, history of chest syndrome, hydroxyurea therapy and Epworth score did not predict either hypoxic load or ODI. However, daytime SpO2 were highly predictive of nocturnal hypoxic load (r=0.69 p=0.0000007) but not ODI. Conclusion: OSA and non-OSA nocturnal hypoxia are common in adults with sickle cell disease. The degree of nocturnal hypoxia is associated with impaired renal function, proteinuria, priapism and pulmonary hypertension. Daytime SpO2 appears to be a better predictor of night time hypoxic load than daytime somnolence. Further work is needed to investigate the effect of interventions such as nocturnal oxygen therapy or continuous positive airway pressure on the associations reported. Disclosures: No relevant conflicts of interest to declare.
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Terrill, Philip Ian, Carolyn Dakin, Ian Hughes, Maggie Yuill y Chloe Parsley. "Nocturnal oxygen saturation profiles of healthy term infants". Archives of Disease in Childhood 100, n.º 1 (25 de julio de 2014): 18–23. http://dx.doi.org/10.1136/archdischild-2013-305708.
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ObjectivePulse oximetry is used extensively in hospital and home settings to measure arterial oxygen saturation (SpO2). Interpretation of the trend and range of SpO2values observed in infants is currently limited by a lack of reference ranges using current devices, and may be augmented by development of cumulative frequency (CF) reference-curves. This study aims to provide reference oxygen saturation values from a prospective longitudinal cohort of healthy infants.DesignProspective longitudinal cohort study.SettingSleep-laboratory.Patients34 healthy term infants were enrolled, and studied at 2 weeks, 3, 6, 12 and 24 months of age (N=30, 25, 27, 26, 20, respectively).InterventionsFull overnight polysomnography, including 2 s averaging pulse oximetry (Masimo Radical).Main outcome measurementsSummary SpO2statistics (mean, median, 5th and 10th percentiles) and SpO2CF plots were calculated for each recording. CF reference-curves were then generated for each study age. Analyses were repeated with sleep-state stratifications and inclusion of manual artefact removal.ResultsMedian nocturnal SpO2values ranged between 98% and 99% over the first 2 years of life and the CF reference-curves shift right by 1% between 2 weeks and 3 months. CF reference-curves did not change with manual artefact removal during sleep and did not vary between rapid eye movement (REM) and non-REM sleep. Manual artefact removal did significantly change summary statistics and CF reference-curves during wake.ConclusionsSpO2CF curves provide an intuitive visual tool for evaluating whether an individual's nocturnal SpO2distribution falls within the range of healthy age-matched infants, thereby complementing summary statistics in the interpretation of extended oximetry recordings in infants.
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Hollocks, Matthew J., Tessa B. Kok, Fenella J. Kirkham, Johanna Gavlak, Baba P. Inusa, Michael R. DeBaun y Michelle de Haan. "Nocturnal Oxygen Desaturation and Disordered Sleep as a Potential Factor in Executive Dysfunction in Sickle Cell Anemia". Journal of the International Neuropsychological Society 18, n.º 1 (24 de noviembre de 2011): 168–73. http://dx.doi.org/10.1017/s1355617711001469.
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AbstractPrevious research has identified cognitive impairment in children with sickle cell anemia (SCA, Hemoglobin SS) compared with controls, partly accounted for by overt neuropathology after clinical stroke, “covert” (“silent”) infarction, and severity of anemia. However, cognitive deficits have also been identified in children with SCA with no history of stroke and a normal T2-weighted magnetic resonance imaging (MRI) scan. Our aim was to investigate whether nocturnal hemoglobin oxygen desaturation and sleep fragmentation could be associated with cognitive impairment in children with SCA. We assessed 10 children with SCA (9 with normal MRI) using neuropsychological measures of executive function. Cognitive assessment was immediately followed by overnight polysomnography to record nocturnal hemoglobin oxygen saturation and sleep arousals. Decreases in hemoglobin oxygen saturation and/or increased sleep arousals were associated with reduced performance on cognitive assessment. Nocturnal hemoglobin oxygen desaturation and sleep fragmentation may be a contributing factor to executive dysfunction in SCA. (JINS, 2012, 18, 168–173)
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Liguoro, Ilaria, Michele Arigliani, Bethany Singh, Lisa Van Geyzel, Subarna Chakravorty, Cara Bossley, Maria Pelidis, David Rees, Baba P. D. Inusa y Atul Gupta. "Beneficial effects of adenotonsillectomy in children with sickle cell disease". ERJ Open Research 6, n.º 4 (octubre de 2020): 00071–2020. http://dx.doi.org/10.1183/23120541.00071-2020.
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Tonsillectomy and adenoidectomy (T&A) is frequently performed in children with sickle cell disease (SCD). Our aim was to evaluate the impact of this surgery on overnight oxygenation and rates of complications in these patients.Children with SCD who underwent T&A between 2008 and 2014 in two tertiary hospitals were retrospectively evaluated. Overnight oximetry and admission rates due to vaso-occlusive pain episodes (VOEs) and acute chest syndrome (ACS) in the year preceding and following the surgery were compared.19 patients (10 males, 53%) with a median age of 6 years (range 3.5–8) were included. A significant increase of mean overnight arterial oxygen saturation measured by pulse oximetry (SpO2) (from 93±3.6% to 95.3±2.8%, p=0.001), nadir SpO2 (from 83.0±7.1% to 88±4.1%, p=0.004) and a reduction of 3% oxygen desaturation index (from a median value of 5.7 to 1.8, p=0.003) were shown. The mean annual rate of ACS decreased from 0.6±1.22 to 0.1±0.2 events per patient-year (p=0.003), while the mean cumulative rate of hospitalisations for all causes and the incidence of VOEs were not affected.T&A improved nocturnal oxygenation and was also associated with a reduction in the incidence of ACS at 1-year follow-up after surgery.
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Morillo, Daniel S., Juan L. Rojas, Luis F. Crespo, Antonio León y Nicole Gross. "Poincaré analysis of an overnight arterial oxygen saturation signal applied to the diagnosis of sleep apnea hypopnea syndrome". Physiological Measurement 30, n.º 4 (31 de marzo de 2009): 405–20. http://dx.doi.org/10.1088/0967-3334/30/4/005.
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Kopitovic, Ivan, Marija Kojicic, Mirjana Drvenica y Miroslav Ilic. "LABA in patients with stage I COPD and mild sleep apnea syndrome: a pilot study". Open Medicine 6, n.º 1 (1 de febrero de 2011): 26–30. http://dx.doi.org/10.2478/s11536-010-0053-2.
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AbstractPatients suffering from both sleep apnea-hypopnea syndrome (SAHS) and chronic obstructive pulmonary disease (COPD) have a more severe form of sleep apnea. Knowing all pathophysiological aspects that mutually interact in sleep disorders and COPD, we aimed to investigate if the introduction of long-acting β2 agonists (LABA) during the night could improve overnight oxygenation and the ability to perform daily activities in stage I COPD patients with mild SAHS. We conducted a prospective study of 22 patients with stage I COPD and SAHS confirmed by overnight polygraph screening, without nocturnal CPAP treatment. During twelve weeks, all patients used LABA (salmeterol 50 mcg) with a metered dose inhaler before bedtime. The levels of apnea hypopnea index, oxygen saturation, heart rate, and Epworth daytime sleepiness scale (ESS) were recorded before and after the treatment. There was a significant improvement of lowest and average overnight oxygenation compared to baseline (mean difference 2.1±0.42, p<0.0001; 1.7±0.3, p<0.0001, respectively). In addition, patients reported reduction in daytime sleepiness according to ESS (mean difference 1.23±0.51; p=0.03). Fewer patients exhibited tachycardia when on salmeterol (68 vs. 41%; p=0.01). Use of inhaled salmeterol improves overnight oxygenation in patients with stage I COPD and SAHS. Future prospective studies are warranted to confirm this potentially beneficial effect of long-acting β2 agonists.
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Madenjian, Charles P., Gary L. Rogers y Arlo W. Fast. "Estimation of Whole Pond Respiration Rate". Canadian Journal of Fisheries and Aquatic Sciences 47, n.º 4 (1 de abril de 1990): 682–86. http://dx.doi.org/10.1139/f90-075.
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A regression application of the whole pond respiration–diffusion (WPRD) model to overnight observations of dissolved oxygen concentration (DO) was introduced as a new method to estimate whole pond respiration rate. A new modification of the Welch procedure was also presented. These two techniques were compared with the tangent method for whole pond respiration rate estimation. The tangent method required fitting a quadratic curve to observed DO; and then calculating the slope of the tangent line to the curve at the time the curve reached 100% saturation of DO. When the quadratic was fitted to DO observed during both day and light, the tangent method often yielded inaccurate estimates of whole pond respiration rate. Estimates by the tangent method were sensitive to the time at which 100% saturation of DO occurred. The WPRD model regression and the modified Welch procedure were recommended to estimate whole pond respiration rate.
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Kenny, P. Pang, G. Gourin Christine y J. Terris David. "A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea". Otolaryngology–Head and Neck Surgery 137, n.º 4 (octubre de 2007): 665–68. http://dx.doi.org/10.1016/j.otohns.2007.03.015.
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Objective Our goal was to validate the WatchPAT in the diagnosis of obstructive sleep apnea. Study Design We conducted a prospective, blinded, nonrandomized clinical trial. Methods Patients with suspected obstructive sleep apnea scheduled for an overnight level I polysomnogram were offered enrollment in a study to compare the WatchPAT (Itamar Ltd, Israel) device with polysomnography. Patients wore the WatchPAT device simultaneously while undergoing polysomnography during evaluation in the sleep lab. Results Thirty-seven patients participated in the study. They had a mean age of 50.1 years (range, 31–73 years) and mean body mass index of 34.6 kg/m 2 (range, 21.2–46.8 kg/m 2 ). There was high correlation between the polysomnogram and WatchPAT apnea-hypopnea index ( r = 0.9288; 95% confidence interval = 0.8579–0.9650, P < 0.0001). The lowest oxygen saturation also showed high correlation ( r = 0.989; 95% confidence interval = 0.9773–0.9947, P < 0.0001). The overall polysomnogram and WatchPAT sleep times revealed a correlation of r = 0.5815 ( P = 0.005). Conclusion The WatchPAT showed a high correlation with the polysomnogram in apnea-hypopnea index, lowest oxygen saturation, and sleep time. Significance It's use as a reliable tool in the diagnosis of Obstructive Sleep Apnea.
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Roffe, Christine, Tracy Nevatte, Jon Bishop, Julius Sim, Cristina Penaloza, Susan Jowett, Natalie Ives, Richard Gray, Phillip Ferdinand y Girish Muddegowda. "Routine low-dose continuous or nocturnal oxygen for people with acute stroke: three-arm Stroke Oxygen Supplementation RCT". Health Technology Assessment 22, n.º 14 (marzo de 2018): 1–88. http://dx.doi.org/10.3310/hta22140.
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Background Stroke is a major cause of death and disability worldwide. Hypoxia is common after stroke and is associated with worse outcomes. Oxygen supplementation could prevent hypoxia and secondary brain damage. Objectives (1) To assess whether or not routine low-dose oxygen supplementation in patients with acute stroke improves outcome compared with no oxygen; and (2) to assess whether or not oxygen given at night only, when oxygen saturation is most likely to be low, is more effective than continuous supplementation. Design Multicentre, prospective, randomised, open, blinded-end point trial. Setting Secondary care hospitals with acute stroke wards. Participants Adult stroke patients within 24 hours of hospital admission and 48 hours of stroke onset, without definite indications for or contraindications to oxygen or a life-threatening condition other than stroke. Interventions Allocated by web-based minimised randomisation to: (1) continuous oxygen: oxygen via nasal cannula continuously (day and night) for 72 hours after randomisation at a flow rate of 3 l/minute if baseline oxygen saturation was ≤ 93% or 2 l/minute if > 93%; (2) nocturnal oxygen: oxygen via nasal cannula overnight (21:00–07:00) for three consecutive nights. The flow rate was the same as the continuous oxygen group; and (3) control: no routine oxygen supplementation unless required for reasons other than stroke. Main outcome measures Primary outcome: disability assessed by the modified Rankin Scale (mRS) at 3 months by postal questionnaire (participant aware, assessor blinded). Secondary outcomes at 7 days: neurological improvement, National Institutes of Health Stroke Scale (NIHSS), mortality, and the highest and lowest oxygen saturations within the first 72 hours. Secondary outcomes at 3, 6, and 12 months: mortality, independence, current living arrangements, Barthel Index, quality of life (European Quality of Life-5 Dimensions, three levels) and Nottingham Extended Activities of Daily Living scale by postal questionnaire. Results In total, 8003 patients were recruited between 24 April 2008 and 17 June 2013 from 136 hospitals in the UK [continuous, n = 2668; nocturnal, n = 2667; control, n = 2668; mean age 72 years (standard deviation 13 years); 4398 (55%) males]. All prognostic factors and baseline characteristics were well matched across the groups. Eighty-two per cent had ischaemic strokes. At baseline the median Glasgow Coma Scale score was 15 (interquartile range 15–15) and the mean and median NIHSS scores were 7 and 5 (range 0–34), respectively. The mean oxygen saturation at randomisation was 96.6% in the continuous and nocturnal oxygen groups and 96.7% in the control group. Primary outcome: oxygen supplementation did not reduce disability in either the continuous or the nocturnal oxygen groups. The unadjusted odds ratio for a better outcome (lower mRS) was 0.97 [95% confidence interval (CI) 0.89 to 1.05; p = 0.5] for the combined oxygen groups (both continuous and nocturnal together) (n = 5152) versus the control (n = 2567) and 1.03 (95% CI 0.93 to 1.13; p = 0.6) for continuous versus nocturnal oxygen. Secondary outcomes: oxygen supplementation significantly increased oxygen saturation, but did not affect any of the other secondary outcomes. Limitations Severely hypoxic patients were not included. Conclusions Routine low-dose oxygen supplementation in stroke patients who are not severely hypoxic is safe, but does not improve outcome after stroke. Future work To investigate the causes of hypoxia and develop methods of prevention. Trial registration Current Controlled Trials ISRCTN52416964 and European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2006-003479-11. Funding details This project was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit and Health Technology Assessment programmes and will be published in full in Health Technology Assessment; Vol. 22, No. 14. See the NIHR Journals Library website for further project information.
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V., Suresh, Gowri Shankar M., Prabhu D. y Natarajan S. "The correlation of the severity of polysomnography with clinical assessment in cases of adult OSA in a tertiary hospital". International Journal of Otorhinolaryngology and Head and Neck Surgery 4, n.º 4 (23 de junio de 2018): 1076. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20182717.
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<p class="abstract"><strong>Background:</strong> Now days increasing number of people with sleep related breathing disorders especially obstructive sleep apnea are reporting every day in our institute, which is a tertiary referral centre. The objective was to correlate between clinical assessment andpolysomnographic features in an obstructive sleep apnea patient.</p><p class="abstract"><strong>Methods:</strong> A total number of 60 cases were analyzed retrospectively and those who were already clinically assessed and diagnosed as OSA by AHI>5/h in overnight PSG study. The clinical history, body mass index, Epworth sleepiness scale score and full night polysomnograpic data were obtained for all 60 cases. The age and gender differences in OSA cases were analyzed. The correlations between the BMI, ESS score, AHI, oxygen saturation sleep apnea, Epworth sleeps scale and apnea hypopnea index were explored. </p><p class="abstract"><strong>Results:</strong> Of the 60 cases OSA were analyzed, the mean (SD) age was 36.62 (±11.90) years and the men was mostly affected 96.7% than women only 3.3%. Of 60 cases, 30% of patients having mild form, 25% of patients moderate form, 45% of patients having severe form. The obese patients affected more 83.3% (50/60) than normal only 10% (6/60). The clinical symptom were analyzed by ESS score the normal 18.3%, mild 18.3%, moderate 28.3% and severe 35%. The mean oxygen saturation and heart rate of OSA patients were 72.35 (±11.47) and 69.90 (±15.26) respectively.</p><p><strong>Conclusions:</strong> The BMI and ESS score were positively correlated with severity of OSA. The oxygen saturation and heart rate were negatively correlated with OSA. </p>
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Dlamini, Nomazulu, Dawn E. Saunders, Michael Bynevelt, Sara Trompeter, Timothy C. Cox, Romola S. Bucks y Fenella J. Kirkham. "Nocturnal oxyhemoglobin desaturation and arteriopathy in a pediatric sickle cell disease cohort". Neurology 89, n.º 24 (8 de noviembre de 2017): 2406–12. http://dx.doi.org/10.1212/wnl.0000000000004728.
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Objective:The purpose of this study of sickle cell disease (SCD) was to determine whether arteriopathy, measurable as intracranial vessel signal loss on magnetic resonance angiography (MRA), was associated with low nocturnal hemoglobin oxygen saturation (SpO2) or hemolytic rate, measurable as reticulocytosis or unconjugated hyperbilirubinemia.Methods:Ninety-five East London children with SCD without prior stroke had overnight pulse oximetry, of whom 47 (26 boys, 39 hemoglobin SS; mean age 9.1 ± 3.1 years) also had MRA, transcranial Doppler (TCD), steady-state hemoglobin, and reticulocytes within 34 months. Two radiologists blinded to the other data graded arteriopathy on MRA as 0 (none) or as increasing severity grades 1, 2, or 3.Results:Grades 2 or 3 arteriopathy (n = 24; 2 with abnormal TCD) predicted stroke/TIA compared with grades 0 and 1 (log-rank χ2 [1, n = 47] = 8.1, p = 0.004). Mean overnight SpO2 correlated negatively with reticulocyte percentage (r = −0.387; p = 0.007). Despite no significant differences across the degrees of arteriopathy in genotype, mean overnight SpO2 was higher (p < 0.01) in those with grade 0 (97.0% ± 1.6%) than those with grades 2 (93.9 ± 3.7%) or 3 (93.5% ± 3.0%) arteriopathy. Unconjugated bilirubin was not associated but reticulocyte percentage was lower (p < 0.001) in those with grade 0 than those with grades 2 and 3 arteriopathy. In multivariable logistic regression, lower mean overnight SpO2 (odds ratio 0.50, 95% confidence interval 0.26–0.96; p < 0.01) predicted arteriopathy independent of reticulocyte percentage (odds ratio 1.47, 95% confidence interval 1.15–1.87; p = 0.003).Conclusion:Low nocturnal SpO2 and reticulocytosis are associated with intracranial arteriopathy in children with SCD. Preventative strategies might reduce stroke risk.
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George, Efremidis, Varela Katerina, Spyropoulou Maria, Beroukas Lambros, Nikoloutsou Konstantina y Georgopoulos Dimitrios. "Clinical Features and Polysomnographic Findings in Greek Male Patients with Obstructive Sleep Apnea Syndrome: Differences Regarding the Age". Sleep Disorders 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/324635.
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Background-Aim. Although sleep disturbance is a common complaint among patients of all ages, research suggests that older adults are particularly vulnerable. The aim of this retrospective study was to elucidate the influence of age on clinical characteristics and polysomnographic findings of obstructive sleep apnea syndrome (OSAS) between elderly and younger male patients in a Greek population.Methods. 697 male patients with OSAS were examined from December 2001 to August 2011. All subjects underwent an attended overnight polysomnography (PSG). They were divided into two groups: young and middle-aged (<65 years old) and elderly (≥65 years old). We evaluated the severity of OSAS, based on apnea-hypopnea index (AHI), and the duration of apnea-hypopnea events, the duration of hypoxemia during total sleep time (TST) and during REM and NREM sleep, and the oxygen saturation in REM and in NREM sleep.Results. PSG studies showed that elderly group had significant higher duration of apnea-hypopnea events, longer hypoxemia in TST and in NREM sleep, as well as lower oxygen saturation in REM and NREM sleep than the younger group. Otherwise, significant correlation between BMI and neck circumference with AHI was observed in both groups.Conclusions. The higher percentages of hypoxemia during sleep and longer duration of apnea-hypopnea events that were observed in the elderly group might be explained by increased propensity for pharyngeal collapse and increased deposition of parapharyngeal fat, which are associated with aging. Another factor that could explain these findings might be a decreased partial arterial pressure of oxygen (PaO2) due to age-related changes in the respiratory system.
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Álvarez, Daniel, Roberto Hornero, María García, Félix del Campo y Carlos Zamarrón. "Improving diagnostic ability of blood oxygen saturation from overnight pulse oximetry in obstructive sleep apnea detection by means of central tendency measure". Artificial Intelligence in Medicine 41, n.º 1 (septiembre de 2007): 13–24. http://dx.doi.org/10.1016/j.artmed.2007.06.002.
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Suzuki, Masaaki, Hanako Saigusa, Ryoko Kurogi, Shigeho Morita y Yoichi Ishizuka. "Postoperative Monitoring of Esophageal Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome Who Have Undergone Tonsillectomy with Uvulopalatopharyngoplasty". Annals of Otology, Rhinology & Laryngology 117, n.º 11 (noviembre de 2008): 849–53. http://dx.doi.org/10.1177/000348940811701110.
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Objectives: To realize better postoperative management in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), we elucidated the need for the postoperative monitoring of esophageal pressure (Pes). Methods: A prospective randomized controlled study was performed. Adult patients with OSAHS were divided into 2 groups: Those administered autoadjusted continuous positive airway pressure (CPAP) before, on, and after the first postoperative night (CPAP group) and those not administered CPAP before or after the surgery (non-CPAP group). Tonsillectomy with uvulopalatopharyngoplasty (UPPP) under general anesthesia was performed on all of the patients. On the first postoperative night, continuous overnight monitoring of Pes and oxygen saturation level was carried out simultaneously with oxygen supplementation in both groups in the patient's room in the general ward. Results: The CPAP group showed a significantly improved mean inspiratory maximal end-apneic Pes swing on the first postoperative night as compared with the non-CPAP group, although there was no significant difference in oxygen desaturation index on the first postoperative night between the 2 groups. Conclusions: Continuous Pes monitoring and CPAP administration were beneficial in the detection and minimization of respiratory disturbances in patients with OSAHS who underwent tonsillectomy with UPPP under general anesthesia.
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Gliklich, Richard E., Farhan Taghizadeh y John W. Winkelman. "Health status in patients with disturbed sleep and obstructive sleep apnea". Otolaryngology–Head and Neck Surgery 122, n.º 4 (abril de 2000): 542–46. http://dx.doi.org/10.1067/mhn.2000.102579.
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The health status of 435 consecutive patients with sleep disturbances necessitating polysomnography was investigated. Patients underwent overnight polysomnography and health status assessment, including the Medical Outcomes Study SF-36 Health Survey and the Pittsburgh Sleep Quality Index. Based on a respiratory distress index (RDI) greater than 10 to define apnea, patients with apnea were significantly ( P < 0.05) more likely to be male, be older, and have higher body mass index and lower oxygen saturation levels than patients without apnea. Multiple domains of the SF-36 Health Survey and the Pittsburgh Sleep Quality Index were significantly worse ( P < 0.05) for this population when normative data were compared. Although few differences were observed between the apneic and nonapneic patients when a cutoff point for apnea was defined as an RDI greater than 10 or 20, increasing RDI was significantly associated with worsening physical functioning scores. Overall, decrements in health status measures were more strongly correlated with the number of oxygen desaturations below 85% than with increasing RDI. We conclude that patients with sleep disturbances demonstrate significant decrements in general and sleep-specific health status, but these decrements are more closely associated with oxygen desaturation than RDI.
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Baddock, Sally A., David Tipene-Leach, Sheila M. Williams, Angeline Tangiora, Raymond Jones, Aleksandra K. Mącznik y Barry J. Taylor. "Physiological stability in an indigenous sleep device: a randomised controlled trial". Archives of Disease in Childhood 103, n.º 4 (13 de octubre de 2017): 377–82. http://dx.doi.org/10.1136/archdischild-2017-313512.
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ObjectiveTo compare overnight oxygen saturation, heart rate and the thermal environment of infants sleeping in an indigenous sleep device (wahakura) or bassinet to identify potential risks and benefits.DesignRandomised controlled trial.SettingFamily homes in low socio-economic areas in New Zealand.Patients200 mainly Māori mothers and their infants.InterventionsParticipants received a wahakura or bassinet from birth.Main outcome measuresOvernight oximetry, heart rate and temperature at 1 month.ResultsIntention-to-treat analysis for 83 bassinet and 84 wahakura infants showed no significant differences between groups for the mean time oxygen saturation (SpO2) was less than 94% (0.54 min, 95% CI -1.36 to 2.45) or less than 90% (0.22 min, 95% CI -0.56 to 1.00), the mean number of SpO2 dips per hour >5% (-0.19, 95% CI -3.07 to 2.69) or >10% (-0.41, 95% CI -1.63 to 0.81), mean heart rate (1.99 beats/min, 95% CI -1.02 to 4.99), or time shin temperature >36°C (risk ratio (RR): 0.63, 95% CI 0.13 to 2.99) or <34°C (RR: 0.89, 95% CI 0.61 to 1.30). A per-protocol analysis of 45 bassinet and 26 wahakura infants and an as-used analysis of 104 infants in a bassinet and 48 in a wahakura found no significant differences between groups for all outcome measures.ConclusionsThis indigenous sleep device is at least as safe as the currently recommended bassinet, which supports its use as a sleep environment that offers an alternative way of bed-sharing.Trial registration numberAustralian New Zealand Clinical Trials Registry: ACTRN12610000993099.
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Festic, Nura, Muhammad Zuberi, Vikas Bansal, Paul Fredrickson y Emir Festic. "Correlation Between Oxygen Saturation and Pulse Tracing Patterns on Overnight Oximetry With Normal Desaturation Index Is an Independent Predictor of Obstructive Sleep Apnea". Journal of Clinical Sleep Medicine 15, n.º 02 (15 de febrero de 2019): 195–200. http://dx.doi.org/10.5664/jcsm.7614.
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Duenas-Meza, Elida, María A. Bazurto-Zapata, David Gozal, Mauricio González-García, Joaquín Durán-Cantolla y Carlos A. Torres-Duque. "Overnight Polysomnographic Characteristics and Oxygen Saturation of Healthy Infants, 1 to 18 Months of Age, Born and Residing At High Altitude (2,640 Meters)". Chest 148, n.º 1 (julio de 2015): 120–27. http://dx.doi.org/10.1378/chest.14-3207.
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Hatch, Guy M., Liza Ashbrook, Aric A. Prather y Andrew D. Krystal. "Is cellular energy monitoring more responsive to hypoxia than pulse oximetry?" Sleep and Breathing 24, n.º 4 (26 de mayo de 2020): 1633–43. http://dx.doi.org/10.1007/s11325-020-02104-2.
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Abstract Purpose Pulse oximetry is the current standard for detecting drops in arterial blood oxygen saturation (SpO2) associated with obstructive sleep apnea and hypopnea events in polysomnographic (PSG) testing. However, cellular energy monitoring (CE monitoring), a measure related to cellular hypoxia in the skin, is likely to be more responsive to inadequate breathing during sleep because during hypoxic challenge, such as occurs during apneic events, regulatory mechanisms restrict blood flow to the skin to preferentially maintain SpO2 for more vital organs. We carried out initial proof of concept testing to determine if CE monitoring has promise for being more responsive to hypoxic challenge occurring during sleep-disordered breathing (SDB) than pulse oximetry. Methods We assessed both CE monitoring and pulse oximetry in a series of conditions which affect oxygen supply: (1) breathing nitrogen or 100% oxygen, (2) physical exertion, and (3) studying a night of sleep in an individual known to be a loud snorer. We also present the results of a preliminary study comparing CE monitoring to pulse oximetry in eight individuals undergoing standard clinical overnight polysomnography for suspected SDB. Results CE monitoring is responsive to changes in cellular oxygen supply to the skin and detects hypoxia during SDB events that is not detected by pulse oximetry. Conclusion CE monitoring is a promising tool for identifying pathology at the mild end of the SDB spectrum.
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Urbano, Jéssica Julioti, Lilian Nanami Uchiyama, Anderson Soares Silva, Roger André Oliveira Peixoto, Sergio Roberto Nacif y Luis Vicente Franco Oliveira. "Nocturnal oxyhemoglobin desaturation during sleep in congestive heart failure patients". Fisioterapia em Movimento 29, n.º 3 (septiembre de 2016): 597–606. http://dx.doi.org/10.1590/1980-5918.029.003.ao18.
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Abstract Introduction: Sleep breathing disorders occur in 45% of patients with heart failure, with 36%-50% manifesting Cheyne-Stokes respiration with central sleep apnea and 12% exhibiting obstructive sleep apnea. Several studies have shown that sleep pathophysiology may negatively affect the cardiovascular system and that cardiac dysfunction alters sleep and respiration. Objective: The aim of this study was to examine oxyhemoglobin desaturation during sleep in patients with congestive heart failure (CHF) using overnight pulse oximetry. Methods: Overnight pulse oximetry was conducted in the patients' homes with wrist pulse oximeters and finger probes that were placed around the forefingers of 15 patients with CHF and ejection fractions less than 50%, who were classified as New York Heart Association functional classes II and III. Results: The patients were divided into two groups. The first group consisted of seven patients with oxyhemoglobin desaturation indices of over 5 events/h, and the second group contained eight patients with oxyhemoglobin desaturation indices of 5 or less events/h. Student's t-tests did not show any significant differences between the groups. The patients' body mass indices correlated positively with the total desaturation episodes and desaturation time less than 90% and correlated negatively with the arterial oxygen saturation nadir. Conclusion: Pulse oximetry monitoring during sleep can be used to detect sleep breathing disorders in stable patients with CHF.
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L'Esperance, VS, T. Ekong, SE Cox, J. Makani, CR Newton, D. Soka, A. Komba, FJ Kirkham y CM Hill. "Nocturnal haemoglobin oxygen desaturation in urban and rural East African paediatric cohorts with and without sickle cell anaemia: a cross-sectional study". Archives of Disease in Childhood 101, n.º 4 (23 de diciembre de 2015): 352–55. http://dx.doi.org/10.1136/archdischild-2014-306468.
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Low haemoglobin oxygen saturation (SpO2) predicts complications in children with sickle cell anaemia (SCA) in the North but there are few data from Africa, where the majority of the patients reside. We measured daytime and overnight SpO2 in children with SCA in routine follow-up clinic, and controls without symptoms of SCA, comparing rural (Kilifi, Kenya) and urban (Dar-es-Salaam, Tanzania) cohorts. Daytime SpO2 was lower in 65 Tanzanian children with SCA (TS; median 97 (IQR 94–100)%); p<0.0001) than in 113 Kenyan children with SCA (KS; 99 (98–100)%) and 20 Tanzanian controls (TC; 100 (98–100)%). Compared with 95 Kenyan children with SCA, in 54 Tanzanian children with SCA and 19 TC who returned for overnight oximetry, mean (KS 99.0 (96.7–99.8)%; TS 97.9 (95.4–99.3)%; TC 98.4 (97.5–99.1)%; p=0.01) and minimum nocturnal SpO2 (92 (86–95)%; 87 (78.5–91)%; 90 (83.5–93)% p=0.0001) were lower. The difference between children with SCA persisted after adjustment for haemoglobin (p=0.004). Urban Tanzanian children, with and without SCA, experience greater exposure to low daytime and night-time SpO2 compared with rural Kenyan children with SCA. Possible explanations include differences in the prevalence of obstructive sleep apnoea or asthma, alterations in the oxyhaemoglobin desaturation curve or cardiovascular compromise, for example, to shunting at atrial or pulmonary level secondary to increased pulmonary artery pressure. The fact that non-SCA siblings in the urban area are also affected suggests that environmental exposures, for example, air pollution, nutrition or physical exercise, may play a role. Further studies should determine aetiology and clinical relevance for the SCA phenotype in children resident in Africa.
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LAU, ESTHER YUET YING, GAIL A. ESKES, DEBRA L. MORRISON, MALGORZATA RAJDA y KATHLEEN F. SPURR. "Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure". Journal of the International Neuropsychological Society 16, n.º 6 (25 de agosto de 2010): 1077–88. http://dx.doi.org/10.1017/s1355617710000901.
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AbstractObstructive sleep apnea (OSA) is characterized by disrupted breathing and hypoxemia during sleep, daytime sleepiness, and changes in cognition and mood. One important question is regarding the reversibility of cognitive deficits after treatment with continuous positive airway pressure (CPAP). Here, we report the outcomes of CPAP treatment as measured by tests of attention and executive function. Thirty-seven individuals with moderate to severe OSA and compliant on CPAP treatment were studied with working memory tasks, neuropsychological testing, and overnight polysomnographic sleep study and compared to 27 healthy controls. CPAP improved the respiratory disturbance index, minimum and mean oxygen saturation (SpO2), subjective sleep quality, and daytime sleepiness ratings compared to pre-treatment values. In terms of current neurocognitive function, treated individuals with OSA performed at a comparable level to controls on basic working memory storage functions but still showed a significant reduction on tests of working memory requiring the central executive. The OSA group also performed worse on neuropsychological measures of complex attention, executive function, and psychomotor speed. While CPAP is an effective treatment for OSA in terms of ameliorating breathing disruption and oxygen desaturation during sleep, as well as daytime sleepiness, some cognitive deficits may be more resistant to treatment. (JINS, 2010,16, 1077–1088.)
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ÁLVAREZ, DANIEL, ROBERTO HORNERO, J. VÍCTOR MARCOS, NIELS WESSEL, THOMAS PENZEL, MARTIN GLOS y FÉLIX DEL CAMPO. "ASSESSMENT OF FEATURE SELECTION AND CLASSIFICATION APPROACHES TO ENHANCE INFORMATION FROM OVERNIGHT OXIMETRY IN THE CONTEXT OF APNEA DIAGNOSIS". International Journal of Neural Systems 23, n.º 05 (7 de agosto de 2013): 1350020. http://dx.doi.org/10.1142/s0129065713500202.
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This study is aimed at assessing the usefulness of different feature selection and classification methodologies in the context of sleep apnea hypopnea syndrome (SAHS) detection. Feature extraction, selection and classification stages were applied to analyze blood oxygen saturation (SaO2) recordings in order to simplify polysomnography (PSG), the gold standard diagnostic methodology for SAHS. Statistical, spectral and nonlinear measures were computed to compose the initial feature set. Principal component analysis (PCA), forward stepwise feature selection (FSFS) and genetic algorithms (GAs) were applied to select feature subsets. Fisher's linear discriminant (FLD), logistic regression (LR) and support vector machines (SVMs) were applied in the classification stage. Optimum classification algorithms from each combination of these feature selection and classification approaches were prospectively validated on datasets from two independent sleep units. FSFS + LR achieved the highest diagnostic performance using a small feature subset (4 features), reaching 83.2% accuracy in the validation set and 88.7% accuracy in the test set. Similarly, GAs + SVM also achieved high generalization capability using a small number of input features (7 features), with 84.2% accuracy on the validation set and 84.5% accuracy in the test set. Our results suggest that reduced subsets of complementary features (25% to 50% of total features) and classifiers with high generalization ability could provide high-performance screening tools in the context of SAHS.
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Yan, Lu, Qin Luo, Zhihui Zhao, Qing Zhao, Qi Jin, Yi Zhang y Zhihong Liu. "Nocturnal hypoxia in patients with idiopathic pulmonary arterial hypertension". Pulmonary Circulation 10, n.º 3 (julio de 2020): 204589401988536. http://dx.doi.org/10.1177/2045894019885364.
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Background Sleep-disordered breathing causes a variety of cardiovascular complications and increases the risk of a poor prognosis in patients. There is still some controversy regarding the clinical diagnosis and treatment of sleep-disordered breathing in patients with pulmonary hypertension. The aim of this study was to determine the incidence of desaturation in idiopathic pulmonary arterial hypertension (IPAH) patients, evaluate the effect of desaturation on the clinical status of patients with IPAH, and identify possible influencing factors. Methods Patients with IPAH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from January 2018 to July 2019 were enrolled. Nocturnal hypoxic time was defined as the time that oxygen saturation remained below 90%. Desaturation was defined as a nocturnal oxygen saturation level less than 90% for more than 10% of the total recording time. Baseline clinical characteristics and parameters were collected to compare IPAH patients with and without desaturation. In addition, logistic regression was performed to identify possible factors associated with desaturation in IPAH patients. Results Fifty patients with IPAH were included. Among them, 17 patients presented desaturation. Patients with desaturation were older, had a shorter six-min walking distance (6MWD), had a higher mean right atrial pressure, and had a lower daytime arterial oxygen partial pressure than patients without desaturation, and there were significant differences in the VE/VCO2 and VE/VCO2 slope ( P < 0.05). The multivariate logistic regression analysis indicated that the 6 MWD (OR = 0.971, 95% CI: 0.948–0.994, P = 0.013) and; VE/VCO2 slope (OR = 1.095, 95% CI: 1.010–1.307, P = 0.032) were independently associated with desaturation after adjusting for age, sex, and body mass index. Conclusion Nocturnal hypoxia is common in IPAH patients. Desaturation may aggravate the clinical situation of patients with IPAH. In IPAH patients, a poor exercise capacity (6 MWD) and the VE/VCO2 slope can predict desaturation after adjusting for age, sex, and body mass index.
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Burtscher, Martin, Klemens Mairer, Maria Wille y Gregor Broessner. "Risk factors for high-altitude headache in mountaineers". Cephalalgia 31, n.º 6 (10 de enero de 2011): 706–11. http://dx.doi.org/10.1177/0333102410394678.
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Aim: The aim was to identify most relevant risk factors of high-altitude headache within a broad mountaineering population through a prospective, observational, rater-blinded study. Methods: A total of 506 mountaineers were enrolled after their first overnight stay in one of seven alpine huts between 2200–3817 m. Structured interview including information on mountaineering histories, caffeine intake, smoking habits, alcohol consumption, intake of medication, rate of ascent, physical fitness, the level of exertion and the amount of fluids intake at the day of ascent were recorded along with a standardized medical examination. Results: High-altitude headache occurred in 31% of study participants. Logistic regression analysis revealed a migraine history, low arterial oxygen saturation, high ratings of perceived exertion and fluid intake below 2 l to be independent risk factors for the development of high-altitude headache. Conclusion: Given the high prevalence, high-altitude headache is a relevant medical condition and a better understanding of risk factors has important impact and may facilitate patient behaviour and future study design.
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Elwali, Ahmed y Zahra Moussavi. "Predicting Polysomnography Parameters from Anthropometric Features and Breathing Sounds Recorded during Wakefulness". Diagnostics 11, n.º 5 (19 de mayo de 2021): 905. http://dx.doi.org/10.3390/diagnostics11050905.
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Background: The apnea/hypopnea index (AHI) is the primary outcome of a polysomnography assessment (PSG) for determining obstructive sleep apnea (OSA) severity. However, other OSA severity parameters (i.e., total arousal index, mean oxygen saturation (SpO2%), etc.) are crucial for a full diagnosis of OSA and deciding on a treatment option. PSG assessments and home sleep tests measure these parameters, but there is no screening tool to estimate or predict the OSA severity parameters other than the AHI. In this study, we investigated whether a combination of breathing sounds recorded during wakefulness and anthropometric features could be predictive of PSG parameters. Methods: Anthropometric information and five tracheal breathing sound cycles were recorded during wakefulness from 145 individuals referred to an overnight PSG study. The dataset was divided into training, validation, and blind testing datasets. Spectral and bispectral features of the sounds were evaluated to run correlation and classification analyses with the PSG parameters collected from the PSG sleep reports. Results: Many sound and anthropometric features had significant correlations (up to 0.56) with PSG parameters. Using combinations of sound and anthropometric features in a bilinear model for each PSG parameter resulted in correlation coefficients up to 0.84. Using the evaluated models for classification with a two-class random-forest classifier resulted in a blind testing classification accuracy up to 88.8% for predicting the key PSG parameters such as arousal index. Conclusions: These results add new value to the current OSA screening tools and provide a new promising possibility for predicting PSG parameters using only a few seconds of breathing sounds recorded during wakefulness without conducting an overnight PSG study.
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Kapus, Jernej, Igor Mekjavic, Adam McDonnell, Anton Ušaj, Janez Vodičar, Peter Najdenov, Miroljub Jakovljević, Polona Jaki Mekjavić, Milan Žvan y Tadej Debevec. "Cardiorespiratory Responses of Adults and Children during Normoxic and Hypoxic Exercise". International Journal of Sports Medicine 38, n.º 08 (31 de mayo de 2017): 627–36. http://dx.doi.org/10.1055/s-0043-109376.
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AbstractWe aimed to elucidate potential differential effects of hypoxia on cardiorespiratory responses during submaximal cycling and simulated skiing exercise between adults and pre-pubertal children. Healthy, low-altitude residents (adults, N=13, Age=40±4yrs.; children, N=13, age=8±2yrs.) were tested in normoxia (Nor: PiO2=134±0.4 mmHg; 940 m) and normobaric hypoxia (Hyp: PiO2=105±0.6 mmHg; ~3 000 m) following an overnight hypoxic acclimation (≥12-hrs). On both days, the participants underwent a graded cycling test and a simulated skiing protocol. Minute ventilation (VE), oxygen uptake (VO2), heart rate (HR) and capillary-oxygen saturation (SpO2) were measured throughout both tests. The cycling data were interpolated for 2 relative workload levels (1 W·kg−1 & 2 W·kg−1). Higher resting HR in hypoxia, compared to normoxia was only noted in children (Nor:78±17; Hyp:89±17 beats·min−1; p<0.05), while SpO2 was significantly lower in hypoxia (Nor:97±1%; Hyp:91±2%; p<0.01) with no between-group differences. The VE, VO2 and HR responses were higher during hypoxic compared to normoxic cycling test in both groups (p<0.05). Except for greater HR during hypoxic compared to normoxic skiing in children (Nor:155±19; Hyp:167±13 (beats·min−1); p<0.05), no other significant between-group differences were noted during the cycling and skiing protocols. In summary, these data suggest similar cardiorespiratory responses to submaximal hypoxic cycling and simulated skiing in adults and children.
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Singh, Ravinder, Brian E. Louie, William F. Bennett, Christopher Allen, Tom Kelly y Christine H. Lee. "Overwhelming Pulmonary Infection after a Tobogganing Accident". Canadian Journal of Infectious Diseases and Medical Microbiology 16, n.º 4 (2005): 253–54. http://dx.doi.org/10.1155/2005/162957.
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A 17-year-old male patient presented to St Joseph's Healthcare (Hamilton, Ontario) with a radiologically opacified left hemithorax. Three days earlier, the patient had injured his left lower chest while tobogganing on his farm. He developed dyspnea and felt unwell, but only sought medical attention from his family doctor a few days after the injury, when fever and pleuritic chest pain ensued. He was treated with a nonsteroidal anti-inflammatory agent, but his chest radiograph revealed an opacified hemithorax, for which he was referred to the hospital. In the emergency department, the patient looked ill and was in distress. His heart rate was 125 beats/min, and he had a blood pressure of 103/61 mmHg, a respiratory rate of 20 breaths/min, a temperature of 38.5°C and an oxygen saturation of 94% on ambient air. Laboratory results showed a white blood cell count of 40×109/L with a left shift. Chest radiography showed a left pleural effusion. A #28 Fr chest tube was inserted into the left hemithorax, and foul-smelling serosanguineous fluid was drained. There was a transient improvement of tachypnea and hypoxemia despite minimal radiographic change. He was admitted and subsequently started on intravenous levofloxacin. Overnight, he deteriorated and required an increase in supplemental oxygen. A computed tomography (CT) scan of his chest revealed multiple loculated fluid collections and bilateral pulmonary parenchymal infiltrates consistent with a pneumonia and empyema.
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Pang, K. P. "Identifying patients who need close monitoring during and after upper airway surgery for obstructive sleep apnoea". Journal of Laryngology & Otology 120, n.º 8 (2 de junio de 2006): 655–60. http://dx.doi.org/10.1017/s0022215106001617.
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Potentially serious complications have been documented in patients undergoing upper airway surgery for obstructive sleep apnoea (OSA). Consensus is lacking regarding peri- and post-operative monitoring and identification of those patients likely to suffer post-operative complications.This retrospective review of 118 patients treated and 152 surgical procedures undertaken, from January 1998 to December 2003, addresses this issue. The overall peri- and post-operative complication rate was 13.8 per cent, with one patient experiencing upper airway compromise, five patients experiencing post-operative oxygen desaturation within 150 minutes of extubation, six patients experiencing persistent hypertension and four patients suffering secondary haemorrhage. All patients were treated accordingly and recovered well, with no mortality. From these results, it is concluded that patients with severe OSA (apnoea–hypopnoea index > 60 and lowest oxygen saturation <80 per cent) are at higher risk of post-operative oxygen desaturation. Post-operative hypertension is more likely in patients with a prior history of hypertension. Routine post-operative admission to an intensive care unit for all OSA patients is unnecessary (including patients with severe OSA). However, all patients with OSA should be closely monitored in the post-anaesthesia care area for at least three hours after surgery; based on the outcome of this period and the clinical judgment of the clinician, the patient can then be observed overnight in either the high dependency unit or on a general ward. Patients with mild OSA may be admitted to the 23-hour ambulatory unit post-operatively. Use of continuous positive airway pressure in the immediate post-operative period can reduce the incidence of post-operative respiratory compromise and complications and is strongly recommended.
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Ulrich, Silvia, Stéphanie Saxer, Elisabeth D. Hasler, Esther I. Schwarz, Simon R. Schneider, Michael Furian, Patrick R. Bader, Mona Lichtblau y Konrad E. Bloch. "Effect of domiciliary oxygen therapy on exercise capacity and quality of life in patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension: a randomised, placebo-controlled trial". European Respiratory Journal 54, n.º 2 (9 de mayo de 2019): 1900276. http://dx.doi.org/10.1183/13993003.002762019.
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Study questionWe investigated whether domiciliary oxygen therapy (DOXT) increases exercise capacity and quality of life in patients with pulmonary arterial or distal chronic thromboembolic pulmonary hypertension (PAH/CTEPH) presenting with mild resting hypoxaemia and exercise-induced oxygen desaturation.Materials and methods30 patients with PAH/CTEPH, mean±sdage 60±15 years, pulmonary artery pressure 39±11 mmHg, resting arterial oxygen saturation measured by pulse oximetry (SpO2) ≥90%,SpO2drop during a 6-min walk test ≥4%, on pulmonary hypertension-targeted medication, were randomised in a double-blind crossover protocol to DOXT and placebo (ambient air) treatment, each over 5 weeks, at 3 L·min−1vianasal cannula overnight and when resting during the day. Treatment periods were separated by 2 weeks of washout. Co-primary outcomes were changes in 6-min walk distance (6MWD, breathing ambient air) and physical functioning scale of the 36-item short-form medical outcome questionnaire during treatment periods.ResultsDOXT increased the 6MWD from baseline 478±113 m by a mean (95% CI) of 19 (6–32) m, and physical functioning from 52±29 by 4 (0–8) points. Corresponding changes with placebo were 1 (−11–13) m in 6MWD and −2 (−6–2) points in physical functioning. Between-treatment differences in changes were 6MWD 18 (1–35) m (p=0.042) and physical functioning 6 (1–11) points (p=0.029). DOXT significantly improved the New York Heart Association functional classversusplacebo.Answer to the questionThis first randomised trial in PAH/CTEPH patients with exercise-induced hypoxaemia demonstrates that DOXT improves exercise capacity, quality of life and functional class. The results support large long-term randomised trials of DOXT in PAH/CTEPH.
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Eckert, Danny J., Robert L. Owens, Geoffrey B. Kehlmann, Andrew Wellman, Shilpa Rahangdale, Susie Yim-Yeh, David P. White y Atul Malhotra. "Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold". Clinical Science 120, n.º 12 (7 de marzo de 2011): 505–14. http://dx.doi.org/10.1042/cs20100588.
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Recent insights into sleep apnoea pathogenesis reveal that a low respiratory arousal threshold (awaken easily) is important for many patients. As most patients experience stable breathing periods mediated by upper-airway dilator muscle activation via accumulation of respiratory stimuli, premature awakening may prevent respiratory stimuli build up as well as the resulting stabilization of sleep and breathing. The aim of the present physiological study was to determine the effects of a non-benzodiazepine sedative, eszopiclone, on the arousal threshold and the AHI (apnoea/hypopnoea index) in obstructive sleep apnoea patients. We hypothesized that eszopiclone would increase the arousal threshold and lower the AHI in patients with a low arousal threshold (0 to −15 cmH2O). Following a baseline overnight polysomnogram with an epiglottic pressure catheter to quantify the arousal threshold, 17 obstructive sleep apnoea patients, without major hypoxaemia [nadir SaO2 (arterial blood oxygen saturation) >70%], returned on two additional nights and received 3 mg of eszopiclone or placebo immediately prior to each study. Compared with placebo, eszopiclone significantly increased the arousal threshold [−14.0 (−19.9 to −10.9) compared with −18.0 (−22.2 to −15.1) cmH2O; P<0.01], and sleep duration, improved sleep quality and lowered the AHI without respiratory event prolongation or worsening hypoxaemia. Among the eight patients identified as having a low arousal threshold, reductions in the AHI occurred invariably and were most pronounced (25±6 compared with 14±4 events/h of sleep; P<0.01). In conclusion, eszopiclone increases the arousal threshold and lowers the AHI in obstructive sleep apnoea patients that do not have marked overnight hypoxaemia. The greatest reductions in the AHI occurred in those with a low arousal threshold. The results of this single night physiological study suggest that certain sedatives may be of therapeutic benefit for a definable subgroup of patients. However, additional treatment strategies are probably required to achieve elimination of apnoea.
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Ankita, A., B. Mehta, N. Dutt y P. Sharma. "0555 The Relationship Between Sleep Efficiency and Apnoea Hypopnoea Index (AHI) in Adult Obese Males". Sleep 43, Supplement_1 (abril de 2020): A213. http://dx.doi.org/10.1093/sleep/zsaa056.552.
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Abstract Introduction Prevalence of obesity is increasing worldwide. According to OECD 2017, the prevalence of obesity is 19.5% worldwide. Obesity leads to disturbed sleep due to complete or partial obstruction of upper airways i.e. obstructive sleep apnoea. This disturbed sleep leads to increased sympathetic discharge & further obesity and thus forms a vicious cycle of obesity disturbing sleep and sleep disturbance increasing obesity. The purpose of the present study was to correlate the sleep efficiency with apnoea hypopnea index (AHI) in adult obese males. Methods Nineteen adult obese males (26 years- 60 years), non-smokers were recruited for this cross-sectional study. The obesity criteria was taken as BMI ≥ 25 kg/m2. They underwent an overnight polysomnographic examination with total 68 channels and 32 EEG inputs. The episodes of apnea were defined as complete cessation of airflow for ≥10 s, and hypopnea consisted of a ≥30% reduction in oronasal airflow accompanied by a reduction in oxygen saturation measured by pulse oximetry of at least 4%. AHI was determined by the frequency of these events per hour during sleep time based on the results of the overnight polysomnography. Sleep efficiency index was calculated by dividing total duration of sleep stages (N1+ N2+ N3+ REM) by total time in bed. Results We tested for normality through Shapiro Wilk test and our data was found to be non-parametric. Hence Spearman correlation between sleep efficiency and AHI was performed. The correlation was non- significant with p value 0.1245 and r = - 0.365. The correlation of BMI with sleep efficiency was significant (p= 0.0195) with r value= -0.5303. Conclusion The results conclude that the sleep efficiency worsens with obesity. Although the correlation between AHI and sleep efficiency was not found significant, a negative r value indicates that the sleep efficiency decreases with increased obstructive events during sleep. Support All India Institute of Medical Sciences Jodhpur
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Keshavamurthy, Venkatesha Belur, Munish Kambathatti Shekharappa, Yogeesha Beesanahalli, Nagaraj Maradi y Priya Rani Kori. "Does Nasal Obstruction Increase Heart Rate?" Bengal Journal of Otolaryngology and Head Neck Surgery 25, n.º 3 (29 de diciembre de 2017): 124–29. http://dx.doi.org/10.47210/bjohns.2017.v25i3.132.
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Introduction
Nasal obstruction is implicated in the etiopathogenesis of Obstructive Sleep Apnea (OSA). OSA is associated with mean heart rate (HR) variations in wakefulness and in sleep. Early intervention has proven to reduce cardiovascular morbidity in OSA patients. In spite of various confounding factors HR measurement has been utilised as an independent predictor of mortality. The influence of severity of nasal obstruction on HR has not been studied in the literature. This study aims to clarify the influence of severity of nasal obstruction on HR.
Materials and Methods
We examined 55 patients aged less than 50 years with no previous cardiac complaints, who underwent overnight oxygen saturation and HR monitoring. The patients were divided into Mild, Moderate and Severe Nasal Obstruction group depending on NOSE scale grading.
Results
There was no statistically significant difference in the Mean HR, Min HR, Max HR, and Max-Min HR in mild, moderate or severe nasal obstruction groups.
Discussion
The role of nasal obstruction in Obstructive Sleep Apnoea and the importance of HR as predictor of cardiovascular morbidity have been discussed. The studies on the heart rate in nasal obstruction and OSA were reviewed.
Conclusion
Nasal obstruction does not influence the heart rate.
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Barry, P. W., N. P. Mason, M. Riordan y C. O'Callaghan. "Cough Frequency and Cough-Receptor Sensitivity are Increased in Man at Altitude". Clinical Science 93, n.º 2 (1 de agosto de 1997): 181–86. http://dx.doi.org/10.1042/cs0930181.
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1. Travellers to high altitude often complain of paroxysmal cough, which has not been previously investigated. We recorded overnight cough frequency and cough-receptor sensitivity to inhaled citric acid in a group of climbers travelling to 5300 m or higher. 2. Cough frequency, monitored in ten subjects, increased from a median of 0 coughs at sea level (range 0–1) to 5 coughs at 5000 m (range 0–13) and to over 60 coughs in subjects ascending to 7000 m. Citric acid cough threshold, measured in 42 subjects, was unchanged on arrival at 5300 m compared with sea level (geometric mean difference 1.26, 95% confidence intervals 0.84–1.89, P = 0.25), but was significantly reduced after 6 days, or more, at altitude compared with sea level (geometric mean difference 2.2, 95% confidence intervals 1.54–3.15, P = 0.0002). Cough threshold was not related to symptoms of acute mountain sickness, oxygen saturation, carbon dioxide tension or lung function. 3. These results indicate an increase in cough and cough-receptor sensitivity after some days at altitude. This may be due to respiratory tract damage from breathing cold dry air at increased ventilatory rates. Other explanations, such as sub-clinical pulmonary oedema or an effect on the cough centre of acclimatization to altitude, cannot be excluded.
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Xue, P., Y. Gao, J. Zhou y X. Tang. "0735 Hyperglycemia Is Associated With An Altered Sleep Structure In Patients With Obstructive Sleep Apnea". Sleep 43, Supplement_1 (abril de 2020): A279—A280. http://dx.doi.org/10.1093/sleep/zsaa056.731.
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Abstract Introduction Although obstructive sleep apnea (OSA) is associated with abnormal glycometabolism, current evidence on the association between hyperglycemia and abnormal sleep structure is still limited among patients with OSA. We sought to evaluate whether hyperglycemia was associated with abnormal sleep architecture. Methods A total of 452 patients with OSA, who were free of previously diagnosed diabetes mellitus, were consecutively recruited. All participants underwent overnight polysomnography and 75-g oral glucose tolerance test. Patients were divided into normal glucose tolerance (NGT) and hyperglycemia (i.e. prediabetes and type 2 diabetes) according to the ADA criteria. The association between hyperglycemia and sleep architecture was examined using logistic regression model. Results Of 452 patients, 283 (63%) had hyperglycemia (age 43.9 ± 11.1) and 169 (37%) had NGT (age 40.1 ± 11.1). Compared to the NGT group, the hyperglycemia group had older age (P < 0.05), higher body mass index (27.5 ± 4.1 vs. 26.33 ± 4.4; P < 0.05) and higher AHI (apnea-hypopnea index) (57.41 ± 28.6 vs. 48.3 ± 28.2; P < 0.05). There were no differences in total sleep time, the percentage of time spent in rapid eye movement (REM) or non-rapid eye movement (NREM) sleep between groups. However, patients with hyperglycemia had more microarousal events, especially during the NREM sleep (214 (range 19-662) events/h vs. 148 (range 37-600) events/h; P < 0.05). In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤80%, were significantly greater during the REM sleep in patients with hyperglycemia (1.4 (total range 0-91.1) % vs. 1.1(0-78.6) %; P < 0.05). After adjusting potential confounders, logistic regression analyses showed that the presence of hyperglycemia was independently associated with the number of microarousals in NREM sleep (OR = 1.01, 95% CI = 1.00-1.02, P = 0.02). Conclusion Hyperglycemia is independently associated with abnormal sleep architecture among patients with OSA. Patients with hyperglycemia have significantly increased sleep fragmentation in NREM sleep and significantly increased hypoxia in REM sleep. Support This work was supported by the National Natural Science Foundation of China (81700087).
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Rowsell, Luke, Keith K. H. Wong, Brendon J. Yee, Danny J. Eckert, Andrew A. Somogyi, James Duffin, Ronald R. Grunstein y David Wang. "The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial". Thorax 74, n.º 2 (30 de agosto de 2018): 177–84. http://dx.doi.org/10.1136/thoraxjnl-2018-211675.
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ObjectiveAnaesthesiology guidelines suggest that opioids worsen obstructive sleep apnoea (OSA) despite no randomised controlled trial evidence. We therefore conducted a randomised controlled trial to evaluate the effects of a common clinical dose of morphine on OSA, and to identify clinical phenotype and genotype vulnerability to opioid-respiratory depression.MethodsUnder a double-blind, randomised, crossover design, 60 male patients with OSA attended two visits to the hospital sleep laboratory, at least 1 week apart. Either 40 mg controlled-release oral morphine or placebo was administered. Awake ventilatory chemoreflex tests were performed post dose and prior to overnight polysomnography monitoring. Blood was sampled before sleep and the next morning for toxicology and genotype analyses. Sleep time with oxygen saturation (SpO2) <90% (T90) was the primary outcome.ResultsDespite a large inter-individual variability, 40 mg morphine did not worsen T90 and apnoea–hypopnoea index, and only decreased the SpO2 nadir by 1.3%. In patients with severe OSA, a lower baseline CO2ventilatory response threshold correlated with the worsening of T90, apnoea–hypopnoea index and oxygen desaturation index with morphine use. Patients with OSA and the A118G OPRM1 polymorphism of A/A and A/G had a significantly different morphine effect on awake ventilatory chemosensitivity and T90 during sleep.Conclusions40 mg oral controlled-release morphine did not worsen OSA in men, challenging traditional thinking that OSA will be worsened by opioids. Individual opioid response in patients with OSA may relate to baseline CO2 response threshold and OPRM1 genotype. Our study findings may pave the way for a precision medicine approach to avoid opioid-related risks.Trial registration numberThe Australian and New Zealand Clinical Trial Registry, ACTRN12613000858796.
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Kölbel, Melanie, Fenella J. Kirkham y Dagmara Dimitriou. "Developmental Profile of Sleep and Its Potential Impact on Daytime Functioning from Childhood to Adulthood in Sickle Cell Anaemia". Brain Sciences 10, n.º 12 (14 de diciembre de 2020): 981. http://dx.doi.org/10.3390/brainsci10120981.
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Young individuals with sickle cell anaemia (SCA) experience sleep disturbances and often experience daytime tiredness, which in turn may impact on their daytime functioning and academic attainment, but there are few longitudinal data. Methods: Data on sleep habits and behaviour were taken on the same day as an in-hospital polysomnography. This study assesses the developmental sleep profiles of children and young adults aged 4–23 years old with SCA. We examined retrospective polysomnography (PSG) and questionnaire data. Results: A total of 256 children with a median age of 10.67 years (130 male) were recruited and 179 returned for PSG 1.80–6.72 years later. Later bedtimes and a decrease in total sleep time (TST) were observed. Sleep disturbances, e.g., parasomnias and night waking, were highest in preschool children and young adults at their first visit. Participants with lower sleep quality, more movement during the night and increased night waking experienced daytime sleepiness, potentially an indicator of lower daytime functioning. Factors influencing sleep quantity included age, hydroxyurea prescription, mean overnight oxygen saturation, sleep onset latency, periodic limb movement, socioeconomic status and night waking. Conclusion: Sleep serves an important role for daytime functioning in SCA; hence, quantitative (i.e., PSG for clinical symptoms, e.g., sleep-disordered breathing, nocturnal limb movement) and qualitative (i.e., questionnaires for habitual sleep behaviour) assessments of sleep should be mutually considered to guide interventions.
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Perrine, Susan P., Oluwakemi Owoyemi, Elizabeth S. Klings, Mehdi Nouraie, Angela Rock, Patricia A. Oneal, Thomas Mellman et al. "A Pilot Study of Sleep Disordered Breathing (SDB) and Nocturnal Hypoxemia in Young Adults with Sickle Cell Disease". Blood 126, n.º 23 (3 de diciembre de 2015): 3414. http://dx.doi.org/10.1182/blood.v126.23.3414.3414.
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Abstract Sleep disordered breathing including transient hypoxemia and hypercarbia are reported in 60-80% of adolescents and children with sickle cell disease (SCD); oxygen desaturation <93% is associated with exercise intolerance. Longer duration of oxygen desaturation, lower nadirs of oxygenation, and end-tidal carbon dioxide levels >50 mm Hg during sleep are associated with increased frequency of acute vaso-occlusion events and are suspected of contributing to microvasculature alterations. To assess the prevalence and degree of sleep-related hypoxemia and potential associations with cardiovascular functions in young adults with SCD, we performed overnight sleep studies using a Type II sleep monitor NOX-T3 (Carefusion, Inc), 6-minute walk tests, echocardiograms, hematologic and chemistry panels, and PSQI questionnaires in 17 adults with SCD, ages 21-30 years. Subjects were attending a sickle cell clinic solely for routine care with no expressed complaints of SDB. Exclusion criteria included acute clinical events, hospitalizations, or red cell transfusions within 4 weeks, and chronic transfusions. AHI>5 (significant apnea/hypopnea hypoxemic episodes) during sleep occurred in 7/17 (41%) of subjects, and these subjects had a higher median number of hypopneas (34 vs 12, p=0.005), and oxygen desaturation indices (ODI, 5.9 vs 2.0, p<0.001) than occurred in subjects with AHI scores ≤5, with a trend to lower oxygen saturation during sleep (lowest saturation of 78% vs 88%, P = 0.1). Patient-reported symptoms of SDB on the PSQI questionnaire were strongly associated with nocturnal hypoxemia (Sensitivity = 86%). All subjects had 6-minute walk distances below normal for healthy subjects, (mean 384 vs normal adult 876 meters). Left ventricular diastolic function was more affected in patients with AHI>5 (median MV EA ratio of 2.0 vs. 1.5, p = 0.08). TR jet velocity >2.5 was found in 2/17 asymptomatic subjects; (both were in the AHI>5 group). General quality of life was lower in patients with AHI>5 (mean score of 38 vs. 48, p = 0.012). As prolonged and frequent hypoxemic episodes may increase risks for vaso-occlusive, cardiovascular, and neurologic events, these common findings of significant nocturnal hypoxemia in young adult sickle cell subjects strongly suggest that SDB should be investigated further in larger patient populations, and interventions initiated. The observations, in addition to prior reports, also strongly suggest that screening of young adult SCD patients for SDB should be performed on a routine basis. Research reported in this publication was supported by the NHLBI under Award Number P50HL118006. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Disclosures Klings: Actelion Pharmaceuticals: Research Funding; Pfizer: Consultancy.
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Lastra, Alejandra, Veronica Esmero, James Herdegen y Colleen Durkin. "728 Sleep Apnea Screening in Inpatients Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A feasibility study". Sleep 44, Supplement_2 (1 de mayo de 2021): A284. http://dx.doi.org/10.1093/sleep/zsab072.725.
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Abstract Introduction Obstructive sleep apnea (OSA) and Chronic obstructive airway disease (COPD) affect millions of Americans. The combination (overlap syndrome) results in increased morbidity, mortality and associated healthcare costs. Type III sleep testing via portable monitoring (PM) is not recommended for patients with COPD, and there is little guidance in regards to inpatient testing. We aim to determine the feasibility of inpatient PM for diagnosing OSA in patients admitted with acute exacerbation of COPD (AECOPD) and hypercapnic respiratory failure requiring noninvasive positive pressure ventilation (NIPPV). Methods This is a retrospective review of prospectively collected data. Inpatients 40 year-old and older admitted with AECOPD and PaCO2≥52mmHg on arterial blood gas (ABG) testing requiring NIPPV were included for analysis. One patient died and one withdrew consent. The remaining patients underwent overnight PM (ApneaLink Airtm by ResMed®) once clinically stable, off NIPPV, on oxygen when needed to sustain oxygen saturation at or above 88%. Patients were discharged on volume-assured pressure support ventilation (VAPS) for nightly use at home and followed for 6 months. Results Five patients were included. Average age was 60 years, majority were African-American males, former smokers (average 31.2 pack-years), with moderate to severe airflow obstruction (FEV1 24–52 %Pred). Except for one (BMI 17 kg/m2), patients had concomitant morbid obesity (average BMI 39.7 kg/m2). Four out of 5 patients had overlap syndrome (AHI 19.4/h -75/h). Follow-up objective download data demonstrated AHI <10 in all patients with available data (3/5 at 6 months). One patient required in-sleep center VAPS titration. Conclusion This pilot study suggests portable monitoring is feasible in diagnosing OSA in this complex patient population admitted for AECOPD, despite concomitant oxygen use during PM testing. Despite the small number of patients, 4/5 were diagnosed with moderate to severe OSA and objective data on VAPS demonstrated effective treatment. Further studies using PM for screening of OSA in inpatients with COPD and obesity and impact on patient-centric outcomes are needed. Support (if any):
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Maris, Mieke, Stijn Verhulst, Marek Wojciechowski, Paul Van de Heyning y An Boudewyns. "Outcome of adenotonsillectomy in children with Down syndrome and obstructive sleep apnoea". Archives of Disease in Childhood 102, n.º 4 (2 de agosto de 2016): 331–36. http://dx.doi.org/10.1136/archdischild-2015-310351.
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ObjectiveTo evaluate the outcome of adenotonsillectomy (AT) in a cohort of children with Down syndrome (DS) and obstructive sleep apnoea (OSA).DesignRetrospective, cross-sectional study.SettingTertiary care centre.PatientsChildren with DS and OSA, without previous upper airway (UA) surgery.InterventionsAT and full overnight polysomnography.Main outcome resultsA significant improvement of the obstructive apnoea-hypopnoea index (oAHI) after AT was obtained. No differences in sleep efficiency or sleep fragmentation were found postoperatively. Almost half of the children had persistent OSA (oAHI ≥5/hour).ResultsData are presented as median (lower–upper quartile). Thirty-four children were included, median age 4.0 years (2.7–5.8), body mass index (BMI) z-score 0.81 (−0.46–1.76), and oAHI 11.4/hour (6.5–22.7). The majority presented with severe OSA (58.9%). AT was performed in 22 children, tonsillectomy in 10 and adenoidectomy in two. Postoperatively, a significant improvement of the oAHI was measured from 11.4/hour (6.5–22.7) to 3.6/hour (2.1–9.5) (p=0.001), with a parallel increase of the minimum oxygen saturation (p=0.008). Children with initially more severe OSA had significantly more improvement after UA surgery (p=0.001). Persistent OSA was found in 47.1% of the children.ConclusionsAT results in a significant improvement of OSA in children with DS without a change in sleep efficiency or sleep stage distribution. Severe OSA was associated with a larger reduction of OSA severity. Almost half of the children had persistent OSA, which was not correlated to age, gender or BMI z-score.
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Carlson, Barbara Waag, Virginia J. Neelon, John R. Carlson, Marilyn Hartman y Sunil Dogra. "Cerebrovascular Disease and Patterns of Cerebral Oxygenation During Sleep in Elders". Biological Research For Nursing 10, n.º 4 (26 de febrero de 2009): 307–17. http://dx.doi.org/10.1177/1099800408330396.
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Purpose: The aim of this descriptive exploratory study was to describe patterns of cerebral oxygen reserves during sleep and their association with cerebrovascular risk factors in elders. Method: Participants—115 elders, age 70 + years—were monitored overnight using standard polysomnography. Measures included arterial oxyhemoglobin (SaO2) and regional measures of percentage of cerebral oxyhemoglobin saturation (rcSO2) via cerebral oximetry. Participants were classified based on the magnitude of change in rcSO2 from resting baseline to the end of the first nonrapideye-movement (NREM) period. One-way ANOVA and Chi-square were used to test group differences in SaO2 and the prevalence of cerebrovascular risk factors. Findings: 20 participants (Group 1) experienced an increase in rcSO2 during sleep along with sleeping rcSO2 levels !55%; 95 participants experienced a decline in rcSO2; 72 participants (Group 2) had sleeping rcSO2 levels !55%; and 23 participants had sleeping rcSO2 levels <55% (Group 3). Although all three groups had equivalent declines in SaO2 levels during sleep, Group 3 had more cardiovascular comorbidity than Groups 1 and 2. Conclusions: Although SaO2 levels decline in most people during sleep, compensatory vascular responses to these drops in SaO2 are important for preventing rcSO2 from falling during sleep. Those entering sleep with lower baseline rcSO2 levels and those with greater declines in cerebral oxygenation during sleep may have greater cardiovascular burden and be at greater risk for stroke and other forms of disabling cerebrovascular disease.
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Santer, Peter, Anne McGahey, Matthew C. Frise, Nayia Petousi, Nick P. Talbot, Richard Baskerville, Mona Bafadhel, Annabel H. Nickol y Peter A. Robbins. "Intravenous iron and chronic obstructive pulmonary disease: a randomised controlled trial". BMJ Open Respiratory Research 7, n.º 1 (junio de 2020): e000577. http://dx.doi.org/10.1136/bmjresp-2020-000577.
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BackgroundIncreased iron availability modifies cardiorespiratory function in healthy volunteers and improves exercise capacity and quality of life in patients with heart failure or pulmonary hypertension. We hypothesised that intravenous iron would produce improvements in oxygenation, exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD).MethodsWe performed a randomised, placebo-controlled, double-blind trial in 48 participants with COPD (mean±SD: age 69±8 years, haemoglobin 144.8±13.2 g/L, ferritin 97.1±70.0 µg/L, transferrin saturation 31.3%±15.2%; GOLD grades II–IV), each of whom received a single dose of intravenous ferric carboxymaltose (FCM; 15 mg/kg bodyweight) or saline placebo. The primary endpoint was peripheral oxygen saturation (SpO2) at rest after 1 week. The secondary endpoints included daily SpO2, overnight SpO2, exercise SpO2, 6 min walk distance, symptom and quality of life scores, serum iron indices, spirometry, echocardiographic measures, and exacerbation frequency.ResultsSpO2 was unchanged 1 week after FCM administration (difference between groups 0.8%, 95% CI −0.2% to 1.7%). However, in secondary analyses, exercise capacity increased significantly after FCM administration, compared with placebo, with a mean difference in 6 min walk distance of 12.6 m (95% CI 1.6 to 23.5 m). Improvements of ≥40 m were observed in 29.2% of iron-treated and 0% of placebo-treated participants after 1 week (p=0.009). Modified MRC Dyspnoea Scale score was also significantly lower after FCM, and fewer participants reported scores ≥2 in the FCM group, compared with placebo (33.3% vs 66.7%, p=0.02). No significant differences were observed in other secondary endpoints. Adverse event rates were similar between groups, except for hypophosphataemia, which occurred more frequently after FCM (91.7% vs 8.3%, p<0.001).ConclusionsFCM did not improve oxygenation over 8 weeks in patients with COPD. However, this treatment was well tolerated and produced improvements in exercise capacity and functional limitation caused by breathlessness. These effects on secondary endpoints require confirmation in future studies.Trial registration numberISRCTN09143837.
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Inusa, Baba, SallyAnn Wakeford y Fenella Kirkham. "Overnight Respiratory Support for Prevention of Morbidity in Sickle Cell Disease (POMS 2a) - Parent and Child Preferences". Blood 126, n.º 23 (3 de diciembre de 2015): 4457. http://dx.doi.org/10.1182/blood.v126.23.4457.4457.
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Abstract PURPOSE: Obstructive sleep apnea and nocturnal hypoxemia are common in children with sickle cell disease (SCD) and some degree of improvement has been reported following adenotonsillectomy(Finch et al., 2013). NOT and continuous positive airways pressure (CPAP) have shown some benefits in children and adolescent patients(Hargrave, 2003). While NOT and CPAP are offered to children with or without co-morbidities, there are concerns about acceptability and safety(Makani et al., 2009). The data on patient preference is limited in childhood and more so for those with SCD. To achieve optimal adherence to therapy in SCD, Auto-Adjusting Positive Airways Pressure (APAP), where airway pressure is delivered only when obstruction occurs, may be a more acceptable option than CPAP(Marshall et al., 2009). Therefore prior to designing Phase II and III trials that are adequately powered, this study sought to: i) identify parent/caregiver and child treatment preference; ii) assess whether parent/caregiver or child should manage the electronic pain diary; iii) assess any treatment effect on Health Related Quality of Life (HRQOL) in children; and iv) explore the relationship of treatment adherence to: a) experience of pain, and b) overall clinical benefit from the intervention. HYPOTHESES: 1. Treatment adherence of children or adults with would be directly related a) HRQOL quantitative measures, and b) improvement in symptoms reported through semi-structured interviews of patients; 2. Children >8 years would be able to record their experience of pain in an appropriate electronic pain diary; 3. Treatment adherence would be predictive of effect on pain frequency. METHOD: We utilised mixed-methods to explore the primary endpoint of patient experience of treatment intervention, and the secondary endpoint of pain, in a sample of 11 children (aged >8 years) with homozygous SCD. The statistician was blinded to order of intervention. Two interventions NOT and APAP were conducted for one week each in randomized order, with a washout week between interventions. Qualitative data was obtained through in-depth interviews with children and their parents/caregivers conducted by a research psychologist using content method of analysis; quantitative measures were explored employing the Pediatric Quality of Life InventoryTM (PedsQL)(Panepinto et al., 2013) including the sickle module. All analyses were preliminary, exploratory and mainly descriptive. The secondary endpoint of pain was captured utilizing a pain rating scale and symptom assessment on smart technology via an iPad(Jacob et al., 2012). Other secondary outcomes included adverse events, daytime oxygen saturation, and lung function.. All variables were reported for three time points: baseline, post-intervention 1 and post-intervention 2. RESULTS: Analysis of interviews between children and parents/caregivers revealed similarities in expectations prior to treatment, and variations in post-study perception of treatment. Parents/caregivers and children emphasised impact on other family members, practical concerns and challenges as objective criteria for treatment preference, while children additionally emphasized night time positive/negative sensory experiences: e.g. airflow, dreams, breathing, sound, as influences for treatment preference. Belief that treatment is beneficial only for children with breathing difficulties emerged as an influence on both expectation and perception of positive benefits. In 7 children for whom APAP adherence data were available, pain was noted after 3 nights with a median adherence of 5.23 (range 4.0-6.1) hours and was not noted after 38 nights with a median adherence of 8.03 (range 3.21-10.19) hours (p=0.2). For 4 children with pain recorded on 2, 2, 2 and 4 days in the pre-treatment week, 3 recorded no pain on APAP and the child with 4 days pre-treatment recorded 2 days on APAP. CONCLUSIONS: These data reveal some variation in approaches toward treatment preferences between parents/caregivers and children, and supports an inclusive approach to facilitate appropriate treatment choice. Adherence data are not available for oxygen but there is some evidence for reduction in pain in relation to APAP adherence. This trial will contribute to understanding in participant feasibility and acceptability for therapeutic intervention. Research results will be used to inform design of the Phase II and III trials. Disclosures No relevant conflicts of interest to declare.
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Eckert, Danny J., R. Doug McEvoy, Kate E. George, Kieron J. Thomson y Peter G. Catcheside. "Effects of hypoxia on genioglossus and scalene reflex responses to brief pulses of negative upper-airway pressure during wakefulness and sleep in healthy men". Journal of Applied Physiology 104, n.º 5 (mayo de 2008): 1426–35. http://dx.doi.org/10.1152/japplphysiol.01056.2007.
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Hypoxia can depress ventilation, respiratory load sensation, and the cough reflex, and potentially other protective respiratory reflexes such as respiratory muscle responses to increased respiratory load. In sleep-disordered breathing, increased respiratory load and hypoxia frequently coexist. This study aimed to examine the effects of hypoxia on the reflex responses of 1) the genioglossus (the largest upper airway dilator muscle) and 2) the scalene muscle (an obligatory inspiratory muscle) to negative-pressure pulse stimuli during wakefulness and sleep. We hypothesized that hypoxia would impair these reflex responses. Fourteen healthy men, 19–42 yr old, were studied on two separate occasions, ∼1 wk apart. Bipolar fine-wire electrodes were inserted orally into the genioglossus muscle, and surface electrodes were placed overlying the left scalene muscle to record EMG activity. In random order, participants were exposed to mild overnight hypoxia (arterial oxygen saturation ∼85%) or medical air. Respiratory muscle reflex responses were elicited via negative-pressure pulse stimuli (approximately −10 cmH2O at the mask, 250-ms duration) delivered in early inspiration during wakefulness and sleep. Negative-pressure pulse stimuli resulted in a short-latency activation followed by a suppression of the genioglossus EMG that did not alter with hypoxia. Conversely, the predominant response of the scalene EMG to negative-pressure pulse stimuli was suppression followed by activation with more pronounced suppression during hypoxia compared with normoxia (mean ± SE suppression duration 64 ± 6 vs. 38 ± 6 ms, P = 0.006). These results indicate differential sensitivity to the depressive effects of hypoxia in the reflex responsiveness to sudden respiratory loads to breathing between these two respiratory muscles.