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Purpose: The objective of this research was to examine changes in the neural networks of both gray and white matter in individuals with obstructive sleep apnea (OSA) in comparison to those without the condition, employing a comprehensive multilayer network analysis. Methods: Patients meeting the criteria for OSA were recruited through polysomnography, while a control group of healthy individuals matched for age and sex was also assembled. Utilizing T1-weighted imaging, a morphometric similarity network was crafted to represent gray matter, while diffusion tensor imaging provided structural connectivity for constructing a white matter network. A multilayer network analysis was then performed, employing graph theory methodologies. Results: We included 40 individuals diagnosed with OSA and 40 healthy participants in our study. Analysis revealed significant differences in various global network metrics between the two groups. Specifically, patients with OSA exhibited higher average degree overlap and average multilayer clustering coefficient (28.081 vs. 23.407, p < 0.001; 0.459 vs. 0.412, p = 0.004), but lower multilayer modularity (0.150 vs. 0.175, p = 0.001) compared to healthy controls. However, no significant differences were observed in average multiplex participation, average overlapping strength, or average weighted multiplex participation between the patients with OSA and healthy controls. Moreover, several brain regions displayed notable differences in degree overlap at the nodal level between patients with OSA and healthy controls. Conclusion: Remarkable alterations in the multilayer network, indicating shifts in both gray and white matter, were detected in patients with OSA in contrast to their healthy counterparts. Further examination at the nodal level unveiled notable changes in regions associated with cognition, underscoring the effectiveness of multilayer network analysis in exploring interactions across brain layers. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA. Methods: A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with confirmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development. Results: 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446–0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764–0.886] when the prediction model with seven parameters – comorbidities (dyslipidemia, cerebrovascular disease, sleep apnea syndrome [SAS]), systolic blood pressure (SBP), plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI – was used. In patients without comorbidities, hypokalemia, SBP > 160 mmHg, PAC > 40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP < 140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%). Conclusion: A combination of high PAC, SBP > 160 mmHg, low serum potassium, a unilateral adrenal nodule>1 cm and no comorbidities could predict a UPA with a 98.5% accuracy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the efficacy of uvulopalatopharyngoplasty (UPPP) and the corresponding postoperative morphometrical changes. Methods: Patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Pre- and postoperative tests, including CTs, pharyngeal volume (PV), cross-sectional area (CSA), and six-category morphometrical studies, were performed. Results: Of 11 patients included, 10 showed improvement of symptoms. BMI correlated with the respiratory event index (REI). In terms of PV, there was a significantly wider postoperative area. The rate of change between preoperative REI and postoperative REI (ΔREI) correlated with the amount of change of PV between preoperative PV and postoperative PV (ΔPV). CSA increased postoperatively and correlated with REI. Uvula space (UV) and distance between the hyoid bone and the base of the tongue (HB) increased postoperatively, and posterior airway space (PAS) and epiglottic space (Epi) decreased postoperatively. UV and PAS were significant (p = 0.046, 0.014). UV was related to REI. Conclusion: Widening the PV, increasing CSA, and the posterior movement of the tongue base after UPPP surgery were found. The improvement of REI did not depend only on volume. These results suggest that it was important not only to widen the PV but also to improve the shape of the pharynx. [ABSTRACT FROM AUTHOR]

This retrospective study aims to further investigate the effects of rapid maxillary expansion (RME) treatment on respiratory function in growing patients with contracted upper airways, by assessing nasal resistance using active anterior rhinomanometry (AAR). Methods: At T0 (pre-RME), 122 orthodontic patients aged 5 to 12 years, exhibiting oral breathing and/or snoring along with maxillary contraction, underwent AAR with a mask using the ATMOS Rhino 31 rhinomanometer. Additionally, the SRDB or PSQ-SRDB Questionnaire was utilized to validate the orthodontic history of obstructive sleep apnea syndrome (OSAS). If AAR results at T0 were clinically significant, they were repeated at T1, corresponding to a period of three months after screw fixation, to evaluate changes in nasal resistance values between pre- and post-treatment. Results: The study group comprised 42 oral respiratory patients with a mean age of 7.71 years, suspected of pediatric OSAS. Although the questionnaires did not yield statistically significant results, the therapy induced an overall reduction in airflow resistance values from both nostrils (−24.63% in the right nostril; −26.65% in the left nostril). Conclusions: This study demonstrates the beneficial effects of orthodontic treatment with RME on nasal function in terms of airflow resistance in cases of maxillary contraction. [ABSTRACT FROM AUTHOR]

Summary: Excessive fragmentary myoclonus (EFM) is a frequent finding during routine video‐polysomnography (VPSG). We aimed to automatically measure the prevalence of EFM according to current American Academy of Sleep Medicine (AASM) criteria, and the fragmentary myoclonus index (FMI) in sleep stage N1, N2, N3, rapid eye movement (REM) sleep and wake in a large patient population. A total of 500 VPSG recordings of patients admitted to the Sleep Laboratory, Department of Neurology, Medical University of Innsbruck, Austria, between May 1, 2022 and February 28, 2023, were included. EFM according to AASM criteria and FMI were computed by applying a previously validated algorithm. EFM was automatically detected in 121 of the 500 Sleep Laboratory patients (24.2%, 95% confidence interval 20.1%–28.9%). FMI increased with age, male gender, apnea–hypopnea‐index (AHI), oxygen desaturation index (ODI), and periodic leg movements of sleep (PLMS) index. FMI was highest in REM sleep behaviour disorder (RBD), followed by neurodegenerative and internal medicine diseases, but the increase in the FMI was not explained by the disease itself but rather by the age and sex of the patients. Almost a quarter of our patient population had EFM. However, the prevalence of EFM does not allow the drawing of any conclusions about the pathophysiology of EFM or even the determination of a pathological FMI cut‐off value. Associations of the FMI with age, sex, AHI, ODI and PLMS are in line with previous studies, but the FMI needs to be evaluated in different disease entities to learn more about its pathophysiology. [ABSTRACT FROM AUTHOR]

Background: Nasal airway obstruction (NAO) is characterised by high resistance in the nasal cavity with a collapsible and narrowed upper airway and is an integral part of OSA pathophysiology. The literature demonstrates that the identification of high-risk OSA in the young adult population leads to the prevention of later health consequences. A nasoorospirometer is a prototype device that measures nasal capacity during inspiration. The basis for measurement is a Wheatstone bridge and a thermal anemometer. The parameters are recorded via hot wire anemometry (HTA) with velocity measurements in the airflow field. Therefore, this pilot study aimed to test the feasibility of the device by examining a young adult sample. The secondary aim was to determine whether subjective NAO correlates with nasal capacity and whether NAO corresponds with anthropometric parameters and individual risk of OSA. Methods: A group of 31 participants (mean age 24.9 years) underwent a thorough laryngological examination. The nasoorospirometer was used to measure objective NAO (nasal capacity), the NOSE scale was used to gain subjective NAO evaluation, and the Berlin Questionnaire for the risk of OSA. Results: A correlation analysis confirmed no significant associations between the subjective and objective measures (p > 0.05). Higher BMI and neck circumference are associated with lower NAO and higher nasal patency in the population of young adults (r: 0.32–0.45; p < 0.05). The risk of OSA showed no statistically significant association (p > 0.05). Conclusions: We presented three methods of NAO assessment: subjective participant evaluation, objective nasoosopirometry, and objective laryngological assessment. However, the use of a nasoorospirometer with anthropometric measures in young adults needs to be verified in future studies. [ABSTRACT FROM AUTHOR]

Introduction Lateral pharyngoplasty (LP) has shown promising results. Craniofacial deformity reduces the pharyngeal space, contributing to the etiopathogenesis. The analysis of craniofacial features can be performed using cephalometry. Objective To verify if craniofacial deformity is associated with worse polysomnographic data in patients with obstructive sleep apnea (OSA), and to verify if the preoperative cephalometric parameters can interfere with the surgical success of the LP. Methods The study included 21 patients with OSA aged between 18 and 65 years who underwent LP in a university hospital from 2015 to 2019. Polysomnography was performed postoperatively, after a minimum period of 6 months from the surgical procedure. In addition, a cephalometric evaluation was performed to assess craniofacial deformity, and to correlate it with the polysomnographic results. Results The mean and median of all polysomnographic respiratory parameters improved postoperatively, especially the apnea-hypopnea index (AHI), which went from 40.15 to 16.60 events per hour (p = 0.001). Of the 21 patients, 15 showed improvements in the AHI postoperatively. As for the cephalometric evaluations, we found that the longer the distance between the hyoid bone and the mandibular plane, the greater the patient's preoperative AHI (p = 0.011). When assessing whether cephalometric changes related to craniofacial deformities influence the surgical outcome of LP, no correlation was found for any cephalometric measurement. Conclusion The longer the distance between the hyoid bone and the mandibular plane, the greater the preoperative AHI, and LP was an effective OSA treatment. Cephalometric variables are not able to modify or determine the success of LP in apneic patients in the population assessed. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating how facial biotypes affect the therapeutic response of mandibular advancement devices (MADs) in patients with sleep apnea syndrome (SAHS). Topics include categorizing patients into different facial biotype subgroups, analyzing the reduction in respiratory disturbance index (RDI) and oxygen desaturation index (ODI) among these subgroups, and discussing the implications of these findings on MAD therapy efficacy.

Background: The prevalence of obstructive sleep apnea (OSA) is suggested to differ according to different age groups. While its prevalence has been extensively investigated among middle-aged and old individuals, very few studies have summarized its prevalence among young adults. The present study aimed to conduct a systematic review and meta-analysis of OSA prevalence among healthy adults aged 18–30 years in the general population. Methods: A search of Embase, Medline, and Web of Science databases for articles reporting the prevalence of OSA among young adults confirmed by objective diagnostic methods was completed by two reviewers. Studies identified and included in the review were summarized qualitatively. Additionally, a meta-analysis of prevalence rates was conducted using a random effects model. Results: 11 articles out of 5898 met the inclusion criteria and were included in the meta-analysis. The diagnostic thresholds, scoring criteria, and the type of used device varied substantially among all the studies. We found that the pooled prevalence of OSA among young adults was 16% (CI 95%, 8–29%, I2 = 92%, τ2 = 1.47). Conclusion: The prevalence of OSA among young adults was found to be ~16%. However, a few factors diverged prevalence between the studies, such as hypopnea definition, AHI threshold, and type of device. Most of the studies included examined healthy volunteers, suggesting that the disease burden may be underestimated. Findings from our review highlight the need to include OSA-related assessment and intervention in the overall health care of young adults. By early detection and offered treatment, further complications related to comorbidities may be omitted. [ABSTRACT FROM AUTHOR]

Summary: Obstructive sleep apnea (OSA) is caused by temporary partial or complete constriction of the upper airway during sleep which leads to reduced blood oxygen and cardiovascular risks. Main symptoms vary between adults and children leading to misdiagnosis or delayed patient identification. To improve early diagnosis, lateral cephalograms can provide craniofacial measurements associated with a higher risk of OSA. In order to identify the most relevant craniofacial measurements, a systematic literature review with meta‐analysis was conducted combining the terms 'orthodontic*', 'craniofacial', 'cephalometr*', 'cephalogram', 'OSA*', 'UARS', 'SDB', 'sleep disordered breathing', 'sleep apnea' and 'sleep apnoea'. Of 3016 publications, 19 were included in the systematic review and meta‐analysis, 15 with adult patients and four with children. A total of 16 measurements (six angles, 10 distances) were compared, nine showed a possible influence in patients with OSA compared to controls: NSBa angle (−0.28°), ANB angle (+0.33°), ML‐NSL angle (+0.34°), Me‐Go‐Ar angle (+0.33°), SN distance (−0.70 mm), N–ANS distance (−0.36 mm), MP–H distance (+1.18 mm), uvula length (+1.07 mm) and thickness (+0.96 mm). Posterior airway measurements were not sufficiently described or comparably measured to be statistically analysed. There is some evidence for altered craniofacial anatomy in patients with OSA compared to controls. Lateral cephalograms should be screened for these aspects routinely to improve early diagnosis of OSA and craniofacial orthopaedics should complement the interdisciplinary treatment plan for young patients with OSA. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS) exposes cells throughout the body to intermittent hypoxia (IH). Intermittent hypoxia is a risk factor not only for hypertension and insulin resistance but also for vascular dysfunction. We have reported correlations between IH, insulin resistance and hypertension. However, the details of why IH leads to vascular dysfunction remain unclear. In this study, we investigated inflammation‐related transcripts in vascular endothelial cells (human HUEhT‐1 and mouse UV2) exposed to IH by real‐time RT‐PCR and found that intercellular adhesion molecule‐1 (ICAM‐1) and endothelial cell‐specific molecule‐1 (ESM1) mRNAs were significantly increased. ELISA confirmed that, in the UV2 cell medium, ICAM‐1 and ESM1 were significantly increased by IH. However, the promoter activities of ICAM‐1 and ESM1 were not upregulated. On the other hand, IH treatment significantly decreased microRNA (miR)‐181a1 in IH‐treated cells. The introduction of miR‐181a1 mimic but not miR‐181a1 mimic NC abolished the IH‐induced upregulation of Ican‐1 and ESM1. These results indicated that ICAM‐1 and ESM1 were upregulated by IH via the IH‐induced downregulation of miR‐181a1 in vascular endothelial cells and suggested that SAS patients developed atherosclerosis via the IH‐induced upregulation of ICAM‐1 and ESM1. [ABSTRACT FROM AUTHOR]

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intermittent hypoxia (IH) is a central characteristic of sleep apnea syndrome (SAS), and it subjects cells in the body to repetitive apnea, chronic hypoxia, oxygen desaturation, and hypercapnia. Since SAS is linked to various serious cardiovascular complications, especially hypertension, many studies have been conducted to elucidate the mechanism of hypertension induced by SAS/IH. Hypertension in SAS is associated with numerous cardiovascular disorders. As hypertension is the most common complication of SAS, cell and animal models to study SAS/IH have developed and provided lots of hints for elucidating the molecular mechanisms of hypertension induced by IH. However, the detailed mechanisms are obscure and under investigation. This review outlines the molecular mechanisms of hypertension in IH, which include the regulation systems of reactive oxygen species (ROS) that activate the renin–angiotensin system (RAS) and catecholamine biosynthesis in the sympathetic nervous system, resulting in hypertension. And hypoxia-inducible factors (HIFs), Endotheline 1 (ET-1), and inflammatory factors are also mentioned. In addition, we will discuss the influences of SAS/IH in cardiovascular dysfunction and the relationship of microRNA (miRNA)s to regulate the key molecules in each mechanism, which has become more apparent in recent years. These findings provide insight into the pathogenesis of SAS and help in the development of future treatments. [ABSTRACT FROM AUTHOR]

Purpose : Obstructive sleep apnoea (OSA) and cardiac conduction disorders are pathologies with a rising prevalence due to increased life expectancy. Upper airway patency is affected by environmental factors that may be associated with seasonal periods. The ability to record the degree of nocturnal apnoea on a daily basis may provide a more accurate picture of seasonal variability. Methods: This study used an observational, cross-sectional design recruiting consecutive patients with Sorin/Livanova/Microport® pacemakers. The study assessed the seasonal influence on the daily degree of nocturnal apnoea over a minimum period of 180 days. The respiratory events were recorded using a pacemaker-integrated detection algorithm based on transthoracic impedance variation. A generalised linear repeated measure mixed model was used to study the seasonal effect. Results: A sample of 101 subjects with a mean of 227 valid nights was compiled. Summer was associated with higher RDI (respiratory disturbance index) values and winter with lower values. The mean daily RDI ratio in summer was 1.099 times higher than in winter. Conclusions: Slight seasonal influences on the degree of nocturnal apnoea were detected through the daily observation of an unselected sample of pacemaker wearers. The degree of apnoea is higher in warmer months and lower in colder months. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is associated with an increased risk of amyloid-β (Aβ) burden, the hallmark of Alzheimer's disease, and cognitive decline. Objective: To determine the differential impacts of hypoxemia and slow-wave sleep disruption on brain amyloid burden, and to explore the effects of hypoxemia, slow-wave sleep disruption, and amyloid burden on cognition in individuals with and without OSA. Methods: Thirty-four individuals with confirmed OSA (mean±SD age 57.5±4.1 years; 19 males) and 12 healthy controls (58.5±4.2 years; 6 males) underwent a clinical polysomnogram, a NAV4694 positron emission tomography (PET) scan for Aβ burden, assessment of APOEɛ status and cognitive assessments. Linear hierarchical regressions were conducted to determine the contributions of demographic and sleep variables on amyloid burden and cognition. Results: Aβ burden was associated with nocturnal hypoxemia, and impaired verbal episodic memory, autobiographical memory and set shifting. Hypoxemia was correlated with impaired autobiographical memory, and only set shifting performance remained significantly associated with Aβ burden when controlling for sleep variables. Conclusions: Nocturnal hypoxemia was related to brain Aβ burden in this sample of OSA participants. Aβ burden and hypoxemia had differential impacts on cognition. This study reveals aspects of sleep disturbance in OSA that are most strongly associated with brain Aβ burden and poor cognition, which are markers of early Alzheimer's disease. These findings add weight to the possibility that hypoxemia may be causally related to the development of dementia; however, whether it may be a therapeutic target for dementia prevention in OSA is yet to be determined. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to investigate the differences in chronobiology and prevention between patients with acute type-A aortic dissection (ATAAD) complicated with sleep apnea syndrome (SAS) and without sleep apnea syndrome (non-SAS). Methods: We retrospectively analyzed the clinical information of ATAAD patients using hospital medical records and regional meteorological and chronological information between January 2013 and December 2019. Results: An early mortality rate of 16.9% (196 out of 1160 cases) was observed, comprising 95 cases of aortic rupture before surgery and 101 surgery-related deaths. Eighty-one of the 964 survivors were screened for SAS using complete morphological characteristics. Of these patients, 291 (33.0%) suffered from SAS, while 590 (67.0%) had no SAS. Based on a Circular Von Mises distribution analysis, the non-SAS patients experienced a significant morning peak in the occurrence of ATAAD at 10:04 (r1 = 0.148, p < 0.01). In contrast, the SAS patients experienced a significantly different (non-SAS vs. SAS, U2 = 0.947, p < 0.001) nighttime peak at 23:48 (r2 = 0.489, p < 0.01). Moreover, both non-SAS (Z = 39.770, P < 0.001) and SAS (Z = 55.663, P < 0.001) patients showed a comparable peak during January (non-SAS vs. SAS, U2 = 0.173, p > 0.05). Furthermore, SAS patients experienced a peak on Fridays (χ2 = 36.419, p < 0.001), whereas there was no significant difference in the weekly distribution in non-SAS patients (χ2 = 11.315, p = 0.079). Conclusions: The analyses showed that both SAS and non-SAS patients showed distinct rhythmicity in ATAAD onset. These findings highlight the chronobiological triggers within different ATAAD subpopulations and may contribute to the prevention of this potentially fatal occurrence. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the association of sleep apnea syndrome (SAS) with methadone dose and timing of administration in patients receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD). Methods: This retrospective cross-sectional study was conducted on adult patients receiving MMT who had a nocturnal respiratory polygraphy between November 2015 and December 2021. Data on methadone treatment and polygraph recording, including the apnea-hypopnea index (AHI) were collected. Findings: A total of 40 patients, mostly male (72.5%), with a mean age of 35 ± 6.7 years and a mean body mass index (BMI) of 25.1 ± 4.5 kg/m² were included. The daily dose of methadone was significantly associated with an AHI = 15 events/h as well as an AHI = 30 events/h, even after adjustment for age, gender, BMI, and benzodiazepine use. However, these associations were not preserved when the time of administration (day vs evening) was considered, while the evening administration was significantly associated with an AHI = 15 events/h. The best sensitivity and specificity for the prediction of AHI = 15 events/h and AHI = 30 events/h were obtained with daily methadone doses of = 72.5 mg and 77.5 mg, respectively. Conclusion: In this sample of MMT patients, methadone doses of 72.5 mg and 77.5 mg were the best cut-off values for predicting AHI = 15 and = 30 events/h, respectively, especially when taken in the evening. These results should draw clinicians' attention to the importance of SAS screening, and further studies are needed, notably comparisons with buprenorphine. [ABSTRACT FROM AUTHOR]

Background: One of the most common sleep disorders is sleep apnea syndrome. To diagnose sleep apnea syndrome, polysomnography is typically used, but it has limitations in terms of labor, cost, and time. Therefore, studies have been conducted to develop automated detection algorithms using limited biological signals that can be more easily diagnosed. However, the lack of information from limited signals can result in uncertainty from artificial intelligence judgments. Therefore, we performed selective prediction by using estimated respiratory signals from electrocardiogram and oxygen saturation signals based on confidence scores to classify only those sleep apnea occurrence samples with high confidence. In addition, for samples with high uncertainty, this algorithm rejected them, providing a second opinion to the clinician. Method: Our developed model utilized polysomnography data from 994 subjects obtained from Massachusetts General Hospital. We performed feature extraction from the latent vector using the autoencoder. Then, one dimensional convolutional neural network—long short-term memory (1D CNN-LSTM) was designed and trained to measure confidence scores for input, with an additional selection function. We set a confidence score threshold called the target coverage and performed optimization only on samples with confidence scores higher than the target coverage. As a result, we demonstrated that the empirical coverage trained in the model converged to the target coverage. Result: To confirm whether the model has been optimized according to the objectives, the coverage violation was used to measure the difference between the target coverage and the empirical coverage. As a result, the value of coverage violation was found to be an average of 0.067. Based on the model, we evaluated the classification performance of sleep apnea and confirmed that it achieved 90.26% accuracy, 91.29% sensitivity, and 89.21% specificity. This represents an improvement of approximately 7.03% in all metrics compared to the performance achieved without using a selective prediction. Conclusion: This algorithm based on selective prediction utilizes confidence measurement method to minimize the problem caused by limited biological information. Based on this approach, this algorithm is applicable to wearable devices despite low signal quality and can be used as a simple detection method that determine the need for polysomnography or complement it. [ABSTRACT FROM AUTHOR]

Differential privacy is a powerful technique that protects the privacy of individuals in a dataset by adding controlled randomness. With the increasing developments in smart sensors, the use of various biometric database is expanding. If privacy protections coexist with advanced use of the biometric database, wider utilization is expected. One of the promising approaches is to apply differential privacy to biometric information, which is attracting attention in use cases such as Google. By adding Laplace noise to biometric information, differential privacy can be added. Our aim is to focus on peak to peak interval of electrocardiogram. It is useful bio-information because it is possible to know not only heart disease but also various physical conditions such as exercise amount, activity amount, fatigue, sleep based on it. In this study, we demonstrated that differential privacy can be applied to obtain the sleep apnea index from PPIs with Laplace noise. The observed correlations were 0.96 to 0.99 for the corresponding PPIs with Laplace noise. [ABSTRACT FROM AUTHOR]

Deep neck infections are serious conditions and can present with acute upper airway obstruction. Our priority in the treatment is to ensure airway safety, and tracheotomy may be needed to overcome the upper airway obstruction. Unceasing dyspnea after tracheotomy should suggest serious pulmonary pathologies in patients with upper airway obstruction due to deep neck infection. Acute/chronic obstruction resolved after tracheotomy or upper respiratory tract surgical procedures of obstructive sleep apnea patients can turn into severe dyspnea with pulmonary edema. In this report, we present a 46-year-old male patient with negative pressure pulmonary edema as a complication of tracheotomy. The tracheotomy was performed due to severe upper airway obstruction secondary to a deep neck infection. The importance of early diagnosis and prompt treatment of this rare entity after unceasing dyspnea despite tracheotomy is discussed in the light of the current literature. [ABSTRACT FROM AUTHOR]

Deep neck infections are serious conditions and can present with acute upper airway obstruction. Our priority in the treatment is to ensure airway safety, and tracheotomy may be needed to overcome the upper airway obstruction. Unceasing dyspnea after tracheotomy should suggest serious pulmonary pathologies in patients with upper airway obstruction due to deep neck infection. Acute/chronic obstruction resolved after tracheotomy or upper respiratory tract surgical procedures of obstructive sleep apnea patients can turn into severe dyspnea with pulmonary edema. In this report, we present a 46-year-old male patient with negative pressure pulmonary edema as a complication of tracheotomy. The tracheotomy was performed due to severe upper airway obstruction secondary to a deep neck infection. The importance of early diagnosis and prompt treatment of this rare entity after unceasing dyspnea despite tracheotomy is discussed in the light of the current literature. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSAS) is the most common breathing-related sleep disorder. It is characterized by recurrent episodes of partial or complete airway obstruction during sleep, resulting in a reduction in or the total cessation of airflow, despite ongoing respiratory efforts, leading to oxygen desaturation and arousal. The purpose of this literature review is to evaluate the most common characteristics of this pathology, as well as to investigate the most effective treatment options, providing an update on the management of OSA patients. [ABSTRACT FROM AUTHOR]

In this observational cohort study, sleep quality in post-COVID-19 patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. This study aimed to examine aspects of sleep quality in patients who have undergone SARS-CoV-2 infection and if there is a pattern of progression or regression over time (6 months). We also observed and analyzed the results in order to identify any possible links between the severity of COVID-19 and sleep quality as measured by the PSQI questionnaire. The study group consisted of 65 adult patients with confirmed SARS-CoV-2 infection who were referred to a pulmonologist for evaluation. Sleep quality was impacted at a high rate in post-COVID-19 patients, quantified by a PSQI score ≥5. Out of 65 patients, 51% of them had scores greater than or equal to 5. Sleep was subjectively reported as unsatisfactory predominantly in mild and moderate COVID-19 patients. According to the PSQI score and a 6-month follow-up, many patients presented persistency in poor sleep quality. Investigation and individualized treatment of sleep disorders in post-COVID-19 patients should be part of the routine pneumological control, as improvement in sleep quality has an impact not only on the health but also on the psychological state of patients. Educating patients about the importance of sleep and sleep quality impairment should be a primary concern. [ABSTRACT FROM AUTHOR]

The aim of this paper is to perform an observational descriptive study of the Obstructive Sleep Apnea Syndrome (OSAS) in a population of children by evaluating the prevalence and role of sex and age variables. The 22-item Pediatric Sleep Questionnaire (PSQ) was administered to parents of children aged 3 to 12 years. The questionnaire is a very simple tool since it allows for the indication of patients with possible OSAS diagnosis through a cut-off of 0.33. The anonymous diagnostic questionnaire, available in digital format, was administered to the population under study by a link or QR code. Only the questionnaires completed in all their parts were recorded and analyzed. Eight hundred and thirty-two questionnaires were collected. One hundred and fifty-four subjects obtained a PSQ score > 0.33 and the prevalence of OSAS was 18.51%. The Chi-square test showed a statistically significant association between the PSQ score > 0.33 and male sex. The higher prevalence of subjects with a value of PSQ > 0.33 (n = 277) are aged 3–4–5 years, followed by the 6–7–8 range in the group with PSQ score > 0.33, p < 0.05. The prevalence of OSAS was 18.51% in children aged 3 to 12 years. The variables male biological sex and the age group 3–8 year were statistically significant for subjects with OSAS diagnosis. This study underlines the use of the 22-item Pediatric Sleep Questionnaire as a first screening tool to identify children at risk of OSAS. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Distraction osteogenesis (DO) of the mandible is often performed at a young age, and there are few reports after age 30, as in this case. The Hybrid MMF used in this case was useful in that it allowed correction of fine directionality. DO is often performed in young patients with a high capability of osteogenesis. We performed distraction surgery for a 35‐year‐old man who had severe micrognathia with serious sleep apnea syndrome. Four years postoperatively, suitable occlusion and improvement of apnea were observed. [ABSTRACT FROM AUTHOR]

Copyright of Belügyi Szemle / Academic Journal of Internal Affairs is the property of Ministry of Interior of Hungary and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sleep apnea syndrome (SAS) is a common but underdiagnosed health problem related to impaired quality of life and increased cardiovascular risk. In order to solve the problem of complicated and expensive operation procedures for clinical diagnosis of sleep apnea, here we propose a small and low-cost wearable apnea diagnostic system. The system uses a photoplethysmography (PPG) optical sensor to collect human pulse wave signals and blood oxygen saturation synchronously. Then multiscale entropy and random forest algorithms are used to process the PPG signal for analysis and diagnosis of sleep apnea. The SAS determination is based on the comprehensive diagnosis of the PPG signal and blood oxygen saturation signal, and the blood oxygen is used to exclude the error induced by non-pathological factors. The performance of the system is compared with the Compumedics Grael PSG (Polysomnography) sleep monitoring system. This simple diagnostic system provides a feasible technical solution for portable and low-cost screening and diagnosis of SAS patients with a high accuracy of over 85%. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea syndrome (OSA) is increasingly reported in patients with chronic obstructive pulmonary disease (COPD). Our research aimed to analyze the clinical characteristics of patients with overlap syndrome (OS) and develop a nomogram for predicting OSA in patients with COPD. Methods: We retroactively collected data on 330 patients with COPD treated at Wuhan Union Hospital (Wuhan, China) from March 2017 to March 2022. Multivariate logistic regression was used to select predictors applied to develop a simple nomogram. The area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to assess the value of the model. Results: A total of 330 consecutive patients with COPD were enrolled in this study, with 96 patients (29.1%) confirmed with OSA. Patients were randomly divided into the training group (70%, n=230) and the validation group (30%, n=100). Age [odds ratio (OR): 1.062, 1.003-1.124], type 2 diabetes (OR: 3.166, 1.263-7.939), neck circumference (NC) (OR: 1.370, 1.098-1,709), modified Medical Research Council (mMRC) dyspnea scale (OR: 0.503, 0.325-0.777), Sleep Apnea Clinical Score (SACS) (OR: 1.083, 1.004-1.168), and C-reactive protein (CRP) (OR: 0.977, 0.962-0.993) were identified as valuable predictors used for developing a nomogram. The prediction model performed good discrimination [AUC: 0.928, 95% confidence interval (CI): 0.873-0.984] and calibration in the validation group. The DCA showed excellent clinical practicability. Conclusion: We established a concise and practical nomogram that will benefit the advanced diagnosis of OSA in patients with COPD. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy of uvulopalatopharyngoplasty and the corresponding postoperative airflow. Eleven patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Computational fluid dynamics (CFD) was implemented. CFD could be accomplished in nine cases. Airflow analysis was not possible in cases with a high respiratory event index (REI) score. Before surgery, stenosis was identified in the oropharynx and epiglottic area. And the airflow velocity and pressure were found to have significantly decreased in the oropharynx postoperatively, while in the epiglottic area, those data had increased postoperatively in some cases. The velocity and pressure of the oropharynx are related to REI score. From the CFD analysis, airflow analysis is important for evaluating the apnea state. It is suggested that the postoperative function can now be predicted preoperatively. [ABSTRACT FROM AUTHOR]

It is essential to estimate the sleep quality and diagnose the clinical stages in time and at home, because they are closely related to and important causes of chronic diseases and daily life dysfunctions. However, the existing "gold-standard" sensing machine for diagnosis (Polysomnography (PSG) with Electroencephalogram (EEG) measurements) is almost infeasible to deploy at home in a "ubiquitous" manner. In addition, it is costly to train clinicians for the diagnosis of sleep conditions. In this paper, we proposed a novel technical and systematic attempt to tackle the previous barriers: first, we proposed to monitor and sense the sleep conditions using the infrared (IR) camera videos synchronized with the EEG signal; second, we proposed a novel cross-modal retrieval system termed as Cross-modal Contrastive Hashing Retrieval (CCHR) to build the relationship between EEG and IR videos, retrieving the most relevant EEG signal given an infrared video. Specifically, the CCHR is novel in the following two perspectives. Firstly, to eliminate the large cross-modal semantic gap between EEG and IR data, we designed a novel joint cross-modal representation learning strategy using a memory-enhanced hard-negative mining design under the framework of contrastive learning. Secondly, as the sleep monitoring data are large-scale (8 h long for each subject), a novel contrastive hashing module is proposed to transform the joint cross-modal features to the discriminative binary hash codes, enabling the efficient storage and inference. Extensive experiments on our collected cross-modal sleep condition dataset validated that the proposed CCHR achieves superior performances compared with existing cross-modal hashing methods. [ABSTRACT FROM AUTHOR]

Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents. [ABSTRACT FROM AUTHOR]

This paper proposes a robust method to screen patients with sleep apnea syndrome (SAS) using a single-lead electrocardiogram (ECG). This method consists of minute-by-minute abnormal breathing detection and apnea-hypopnea index (AHI) estimation. Heartbeat interval and ECG-derived respiration (EDR) are calculated using the single-lead ECG and used to train the models, including ResNet18, ResNet34, and ResNet50. The proposed method, using data from 1232 subjects, was developed with two open datasets and experimental data and evaluated using two additional open datasets and data acquired from an abdomen-attached wearable device (in total, data from 189 subjects). ResNet18 showed the best results, having an average Cohen's kappa coefficient of 0.57, in the abnormal breathing detection. Moreover, SAS patient classification, with 15 as the AHI threshold, yielded an average Cohen's kappa coefficient of 0.71. The results of patient classification were biased toward data from the wearable patch-type device, which may be influenced by different ECG waveforms. The proposed method is tuned with a sample of the data from the device, and the performance result of Cohen's kappa increased from 0.54 to 0.91 for SAS patient classification. Our method, proposed in this paper, achieved equivalent performance results with data recorded using an abdomen-attached wearable device and two open datasets used in previous studies, although the method had not used those data during model training. The proposed method could reduce the development costs of commercial software, as it was developed using open datasets, has robust performance throughout all datasets. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS) is characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia [IH]), and is a risk factor for cardiovascular disease (CVD) and insulin resistance/Type 2 diabetes. However, the mechanisms linking IH stress and CVD remain elusive. We exposed rat H9c2 and mouse P19.CL6 cardiomyocytes to experimental IH or normoxia for 24 h to analyze the mRNA expression of several cardiomyokines. We found that the mRNA levels of regenerating gene IV (Reg IV) and hepatocyte growth factor (Hgf) in H9c2 and P19.CL6 cardiomyocytes were significantly increased by IH, whereas the promoter activities of the genes were not increased. A target mRNA search of microRNA (miR)s revealed that rat and mouse mRNAs have a potential target sequence for miR-499. The miR-499 level of IH-treated cells was significantly decreased compared to normoxia-treated cells. MiR-499 mimic and non-specific control RNA (miR-499 mimic NC) were introduced into P19.CL6 cells, and the IH-induced upregulation of the genes was abolished by introduction of the miR-499 mimic, but not by the miR-499 mimic NC. These results indicate that IH stress downregulates the miR-499 in cardiomyocytes, resulting in increased levels of Reg IV and Hgf mRNAs, leading to the protection of cardiomyocytes in SAS patients. [ABSTRACT FROM AUTHOR]

Introduction: This study's purpose is to compare obstructive sleep apnea (OSA) patients over 65 with those under 65 using polysomnography tests. Materials and Method: The polysomnography tests performed on 108 patients (54 study and 54 control group) from January 1, 2018 to January 1, 2022 were examined retrospectively at the ear, nose and throat clinic in the Adana City Training and Research Hospital. Results: The study group and the control group shared the same body mass index (BMI) median, apnea-hypopnea index (AHI) median value, the mean oxygen saturation median value, the minimum oxygen saturation median value, the oxygen saturation < 90% (SAT90) median value, the oxygen desaturation index (ODI) median value, the average apnea duration value and the arousal index value. (p>0.01) Conclusion: In conclusion, being a male above 65 years of age may be a risk factor for obstructive sleep apnea. However, getting older does not increase obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Silk is the property of Zhejiang Sci-Tech University Magazines and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sleep apnea syndrome (SAS) is characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia, IH), and it is a risk factor for cardiovascular disease (CVD) and insulin resistance/type 2 diabetes. However, the mechanisms linking IH stress and CVD remain elusive. We exposed rat H9c2 and mouse P19.CL6 cardiomyocytes to experimental IH or normoxia for 24 h to analyze the mRNA expression of the components of Cd38-cyclic ADP-ribose (cADPR) signaling. We found that the mRNA levels of cluster of differentiation 38 (Cd38), type 2 ryanodine receptor (Ryr2), and FK506-binding protein 12.6 (Fkbp12.6) in H9c2 and P19.CL6 cardiomyocytes were significantly decreased by IH, whereas the promoter activities of these genes were not decreased. By contrast, the expression of phosphatase and tensin homolog deleted from chromosome 10 (Pten) was upregulated in IH-treated cells. The small interfering RNA for Pten (siPten) and a non-specific control RNA were introduced into the H9c2 cells. The IH-induced downregulation of Cd38, Ryr2, and Fkbp12.6 was abolished by the introduction of the siPten, but not by the control RNA. These results indicate that IH stress upregulated the Pten in cardiomyocytes, resulting in the decreased mRNA levels of Cd38, Ryr2, and Fkbp12.6, leading to the inhibition of cardiomyocyte functions in SAS patients. [ABSTRACT FROM AUTHOR]

Background: Patients suffering from aortic dissection (AD) often experience sleep apnea syndrome (SAS), which aggravates their respiratory function and aortic false lumen expansion.Methods: We analyzed the peri-operative data of Stanford A AD patients, with or without SAS, between January 2017 and June 2019. Subjects were separated into SAS positive (SAS+) and SAS negative (SAS-) cohorts, based on the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). We next analyzed variables between the SAS+ and SAS- groups.Results: 155, out of 198 AAD patients, were enlisted for this study. SAS+ patients exhibited higher rates of pneumonia (p < 0.001), heart failure (HF, p = 0.038), acute kidney injury (AKI, p = 0.001), ventilation time (p = 0.009), and hospitalization duration (p < 0.001). According to subsequent follow-ups, the unstented aorta false lumen dilatation (FLD) rate increased markedly, with increasing degree of SAS (p < 0.001, according to AHI and ODI). The SAS+ patients exhibited worse cumulative survival rate (p = 0.025). The significant risk factors (RF) for poor survival were: severe (p = 0.002) or moderate SAS (p = 0.008), prolonged ventilation time (p = 0.018), AKI (p = 0.015), HF New York Heart Association (NYHA) IV (p = 0.005) or III (p = 0.015), pneumonia (p = 0.005), Marfan syndrome (p = 0.010), systolic blood pressure (BP) upon arrival (p = 0.009), and BMI ≥ 30 (p = 0.004).Conclusions: SAS+ Stanford A AD patients primarily exhibited higher rates of complications and low survival rates in the mid-time follow-up. Hence, the RFs associated with poor survival must be monitored carefully in SAS patients. Moreover, the FLD rate is related to the degree of SAS, thus treating SAS may mitigate FLD. [ABSTRACT FROM AUTHOR]

Introduction: This study's purpose is to compare obstructive sleep apnea (OSA) patients over 65 with those under 65 using polysomnography tests. Materials and Method: The polysomnography tests performed on 108 patients (54 study and 54 control group) from January 1, 2018 to January 1, 2022 were examined retrospectively at the ear, nose and throat clinic in the Adana City Training and Research Hospital. Results: The study group and the control group shared the same body mass index (BMI) median, apnea-hypopnea index (AHI) median value, the mean oxygen saturation median value, the minimum oxygen saturation median value, the oxygen saturation < 90% (SAT90) median value, the oxygen desaturation index (ODI) median value, the average apnea duration value and the arousal index value. (p>0.01). Conclusion: In conclusion, being a male above 65 years of age may be a risk factor for obstructive sleep apnea. However, getting older does not increase obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Aim: To construct neural models to predict the progression of glaucoma in patients with sleep apnea. Materials and Methods: Modeling the use of neural networks was performed using the Neurosolutions commercial simulator. The built databases gather information on a group of patients with primitive open-angle glaucoma and normal-tension glaucoma, who have been associated with sleep apnea syndrome and various stages of disease severity. The data within the database were divided as follows: 65 were used in the neural network training stage and 8 were kept for the validation stage. In total, 21 parameters were selected as input parameters for neural models including: age of patients, BMI (body mass index), systolic and diastolic blood pressure, intraocular pressure, central corneal thickness, corneal biomechanical parameters (IOPcc, HC, CRF), AHI, desaturation index, nocturnal oxygen saturation, remaining AHI, type of apnea, and associated general conditions (diabetes, hypertension, obesity, COPD). The selected output parameters are: c/d ratio, modified visual field parameters (MD, PSD), ganglion cell layer thickness. Forward-propagation neural networks (multilayer perceptron) were constructed with a layer of hidden neurons. The constructed neural models generated the output values for these data. The obtained results were then compared with the experimental values. Results: The best results were obtained during the training stage with the ANN network (21:35:4). If we consider a 25% confidence interval, we find that very good results are obtained during the validation stage, except for the average GCL thickness, for which the errors are slightly higher. Conclusions: Excellent results were obtained during the validation stage, which support the results obtained in other studies in the literature that strengthen the connection between sleep apnea syndrome and glaucoma changes. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS), characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia (IH)), is a risk factor for hypertension and insulin resistance. We report a correlation between IH and insulin resistance/diabetes. However, the reason why hypertension is induced by IH is elusive. Here, we investigated the effect of IH on the expression of catecholamine-metabolizing enzymes using an in vitro IH system. Human and mouse neuroblastoma cells (NB-1 and Neuro-2a) were exposed to IH or normoxia for 24 h. Real-time RT-PCR revealed that IH significantly increased the mRNA levels of dopamine β-hydroxylase (DBH) and phenylethanolamine N-methyltransferase (PNMT) in both NB-1 and Neuro-2a. Western blot showed that the expression of DBH and PNMT in the NB-1 cells was significantly increased by IH. Reporter assays revealed that promoter activities of DBH and PNMT were not increased by IH. The miR-375 level of IH-treated cells was significantly decreased relative to that of normoxia-treated cells. The IH-induced up-regulation of DBH and PNMT was abolished by the introduction of the miR-375 mimic, but not by the control RNA. These results indicate that IH stress increases levels of DBH and PNMT via the inhibition of miR-375-mediated mRNA degradation, potentially playing a role in the emergence of hypertension in SAS patients. [ABSTRACT FROM AUTHOR]

Objective: The NoSAS score is a new tool widely used in recent years to screen for obstructive sleep apnea. A number of studies have shown that the NoSAS score is more accurate than previous tools, such as the Berlin, STOP-Bang, and STOP questionnaires. Therefore, this meta-analysis assessed the diagnostic value of the NoSAS score for sleep apnea syndrome in comparison to polysomnography. Methods: Two researchers searched the PubMed, EMBASE, Cochrane, and Web of Science databases through November 13, 2020. This paper used Endnote9.3 software to manage the literature and RevMan 5.3 and STATA12.0 software to perform the meta-analysis. Results: A total of 10 studies were included in this meta-analysis, including 14,510 patients. The meta-analysis showed that the pooled sensitivity was 0.798 (95% CI 0.757, 0.833), the pooled specificity was 0.582 (95% CI 0.510, 0.651), the positive likelihood ratio was 1.909 (95% CI 1.652, 2.206), the negative likelihood ratio was 0.347 (95% CI 0.300, 0.403), the diagnostic OR was 5.495 (95% CI 4.348, 6.945), and the area under the SROC curve was 0.77 (95% CI 0.73, 0.80). The NoSAS score has good efficacy in identifying patients likely to have obstructive sleep apnea. Conclusion: The NoSAS score can accurately identify patients likely to have obstructive sleep apnea. Therefore, in the absence of polysomnography, one should use the NoSAS score to evaluate patients with suspected sleep apnea syndrome. [ABSTRACT FROM AUTHOR]

AIM Whether obstructive sleep apnea (OSA) actually represents an independent risk factor for aortic dilation in the general population is unclear. We investigated this issue through a review and a meta-analysis of cardiac imaging studies that provided data on this vascular phenotype measured at the root or ascending tract level. DESIGN A computerized search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 30 November 2021. Studies were identified by using the following search terms: "aortic root," "ascending aorta," "vascular damage," "echocardiography," "computed tomography," "magnetic resonance imaging," "obstructive sleep apnea," "sleep disordered breathing." RESULTS Eleven studies including a total of 1,860 patients with OSA (without aortic aneurysms and connective tissue diseases) and 233 non-OSA controls were considered. Aortic diameter was significantly higher in patients with OSA than in non-OSA controls (standard means difference [SMD] = 0.73 ± 0.08, confidence interval [CI]: 0.57–0.88, P < 0.0001). This was also the case for patients with severe OSA as compared with their counterparts with mild OSA (SMD = 0.42 ± 0.07, CI: 0.28–0.56, P < 0.0001). CONCLUSIONS Our findings suggest an association between OSA and aortic enlargement and particularly in the severe OSA setting. However, this conclusion must be taken with caution in relation to 2 types of factors: (i) the paucity of available data, and (ii) the limits deriving from the methodological differences of the various studies. Larger prospective and carefully designed studies are needed to shed light on this relevant public health topic. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study is to identify sleep disorders in adults with sickle cell disease and to examine the effects of accompanying sleep disorders on the prognosis of sickle cell disease. MATERIAL AND METHODS: Twenty-eight patients followed up with a diagnosis of sickle cell disease and 22 healthy volunteers were included in our study. RESULTS: Both groups had similar characteristics in terms of age, gender, and body mass index. More obstructive sleep apnea syndrome was detected in the sickle cell group than in healthy volunteers. Statistically, the sickle cell patient group had higher apnea-hypopnea index and lower nighttime oxygen desaturation. As the degree of obstructive sleep apnea syndrome increased in the sickle cell group, it was found that there were more emergency admissions and hospitalization due to painful crises and/or acute chest syndrome in the last 1 year. Also, lower sleep efficiency was found in the sickle cell disease patient group. In the sickle cell group, it was found that the restless leg syndrome severity was statistically significantly more. CONCLUSION: As hypoxia deepens in sickle cell patients, mortality and morbidity due to the disease increase significantly. Comorbid sleep disturbances in sickle cell patients exacerbate nocturnal hypoxia and negatively affect the prognosis of the disease. Therefore, patients with sickle cell disease should be questioned in detail in terms of obstructive sleep apnea syndrome and, if necessary, polysomnographic evaluation should be performed to provide treatment for sleep disorders in the early period. [ABSTRACT FROM AUTHOR]

Summary: The aims of the present prospective clinical study were to determine objective, sensor‐measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner‐specific adherence‐related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non‐adherent to continuous positive airway pressure (mean age 56.2 years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow‐up was 8.3 (3.4–16.5) months. The mean apnea–hypopnea index (AHI) was 26.6 events/hr at baseline and 12.5 events/hr at the 8‐month follow‐up (both p < 0.001). The mean sensor‐measured adherence at the 8‐month follow‐up was 60.1% for ≥4 hr/night of appliance use for ≥5 days/week. Average usage was 6.4 hr/night, when worn. The mean reduction in the AHI was significantly greater in the "good adherence" (Δ 17.4) than the "poor adherence" group (Δ11.0; p < 0.05). From the partner's perspective, the appliance had a positive effect on sharing a bedroom in the good‐ (55%) compared to the poor‐adherence group (25%; p < 0.05) and on their relationship (51.7% versus 17.9%, respectively; p < 0.05). Regression analyses identified the partner's snoring and apneas to be the most significant factor predicting good adherence to MAD (odds ratio 4.4, 95% confidence interval 1.4–14.0). In conclusion, social factors, like partner perceptions, were positively associated with adherence, which indicate that partner's attitudes and support may be a resource that can be utilised to improve adherence in oral appliance treatment of OSA. [ABSTRACT FROM AUTHOR]

Introduction: We previously identified UDP‐N‐acetylglucosamine 2‐epimerase (GNE) myopathy patients with sleep apnea and a past history of thrombocytopenia, but without disease‐specific cardiac involvement. This study aimed to clarify the occurrence, severity, and serial changes of these complications. Methods: Thirty‐three genetically confirmed GNE myopathy patients who participated in a 5‐y longitudinal observational history study underwent platelet count and platelet‐associated immunoglobulin G (PA‐IgG) measurements, a sleep study, and electrocardiography (ECG), Holter ECG, and echocardiogram examinations. Results: Among the 33 patients, three had low platelet counts and 17 out of 26 were PA‐IgG positive. No patient exhibited bleeding tendencies, and 3 out of 28 had low platelet counts. Muscle weakness was more pronounced, and summed MMT and grip power significantly lower, in PA‐IgG‐positive patients than in PA‐IgG‐negative patients. Of 19 patients, 7, 4, and 3 who underwent a sleep study had mild, moderate, and severe sleep apnea, respectively, and three started continuous positive airway pressure (CPAP). The respiratory disturbance index was not significantly correlated with physical evaluation items or forced vital capacity. All patients underwent ECG, 32 underwent cardiac ultrasound, and 25 underwent Holter ECG. No disease‐specific cardiac involvement was noted, no serial changes during the follow‐up period were observed for ECG and echocardiography, and none of the patients required therapy for cardiac abnormalities. Discussion: PA‐IgG is a potential disease biomarker in GNE myopathy patients, although its significance needs to be clarified. While none of the patients in this study experienced cardiomyopathy or arrythmia due to myopathy, sleep apnea was identified as a frequent complication. See editorial on pages 263–265 in this issue. [ABSTRACT FROM AUTHOR]

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Obstructive sleep apnea syndrome (OSAS) is characterized with interruption of sleep with apnea attacks and is associated with various diseases such as metabolic syndrome. GDF-15 (Growth differentiation factor 15) is a cytokine belonging to the transforming growth factor - β superfamily and it has been found to be associated with chronic heart failure, acute pulmonary embolism, and acute attacks of chronic obstructive pulmonary disease (COPD). It was aimed to evaluate the relationship between disease severity and mean GDF-15 in patients diagnosed with OSAS. Our study was carried out with 75 patients with OSAS. GDF-15 levels were checked by in the morning fasting blood test. Among the 75 patients, 27 constituted the mild, 22 constituted the moderate and 26 constituted the severe OSAS groups. The mean ages of the patients were not significantly different between groups (53.17±10, 54.61±10.2 and 53.5±11.6 respectively; p>0,05). GDF-15 levels were not significantly different between groups separately (p>0.05). There was only a weak positive relationship between GDF-15 and NREM and REM (p<0.05). In our study, it was revealed that there was no significant relationship between the OSAS severity groups and GDF-15. Our determination of a positive relationship with NREM and REM may have been related to reduction of minute ventilation experienced in OSAS-diagnosed patients, tachycardic fluctuations, their more severe nature and increased right ventricular pressure. Consequently, our current knowledge indicates that GDF-15 is not much guiding in the prediction and monitoring of OSAS severity. [ABSTRACT FROM AUTHOR]

Copyright of Minas Gerais Medical Journal / Revista Médica de Minas Gerais is the property of Associacao Medica de Minas Gerais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Sleep apnea syndrome (SAS) is a prevalent sleep disorder in which apnea and hypopnea occur frequently during sleep and result in increase of the risk of lifestyle-related disease development as well as daytime sleepiness. Although SAS is a common sleep disorder, most patients remain undiagnosed because the gold standard test polysomnography (PSG), is high-cost and unavailable in many hospitals. Thus, an SAS screening system that can be used easily at home is needed. Methods: Apnea during sleep affects changes in the autonomic nervous function, which causes fluctuation of the heart rate. In this study, we propose a new SAS screening method that combines heart rate measurement and long short-term memory (LSTM) which is a type of recurrent neural network (RNN). We analyzed the data of intervals between adjacent R waves (R-R interval; RRI) on the electrocardiogram (ECG) records, and used an LSTM model whose inputs are the RRI data is trained to discriminate the respiratory condition during sleep. Results: The application of the proposed method to clinical data showed that it distinguished between patients with moderate-to-severe SAS with a sensitivity of 100% and specificity of 100%, results which are superior to any other existing SAS screening methods. Conclusion: Since the RRI data can be easily measured by means of wearable heart rate sensors, our method may prove to be useful as an SAS screening system at home. [ABSTRACT FROM AUTHOR]