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Background: Pulmonary fibrosis can develop after acute respiratory distress syndrome (ARDS). The hypothesis is we are able to measure phenotypes that lie at the origin of ARDS severity and fibrosis development. The aim is an accuracy study of prognostic circulating biomarkers., Methods: A longitudinal study followed COVID-related ARDS patients with medical imaging, pulmonary function tests and biomarker analysis, generating 444 laboratory data. Comparison to controls used non-parametrical statistics; p < 0·05 was considered significant. Cut-offs were obtained through receiver operating curve. Contingency tables revealed predictive values. Odds ratio was calculated through logistic regression., Results: Angiotensin 1-7 beneath 138 pg/mL defined Angiotensin imbalance phenotype. Hyper-inflammatory phenotype showed a composite index test above 34, based on high Angiotensin 1-7, C-Reactive Protein, Ferritin and Transforming Growth Factor-β. Analytical study showed conformity to predefined goals. Clinical performance gave a positive predictive value of 95 % (95 % confidence interval, 82 %-99 %), and a negative predictive value of 100 % (95 % confidence interval, 65 %-100 %). Those severe ARDS phenotypes represented 34 (Odds 95 % confidence interval, 3-355) times higher risk for pulmonary fibrosis development (p < 0·001)., Conclusions: Angiotensin 1-7 composite index is an early and objective predictor of ARDS evolving to pulmonary fibrosis. It may guide therapeutic decisions in targeted phenotypes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. NDV and FC declare International Patent PCT/EP2023/051954 - WIPO WO2023144281A1 (European Patent Office EP22153733.5)., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The onset of narcolepsy type 1 (NT1) occurs after 50 years of age in less than 2% of the cases. In older adults, the diagnosis is often delayed due to the presence of neurological degenerative and inflammatory comorbidities and overlapping sleep disorders. We report the case of a 63-year-old man with a 5-year history of excessive daytime sleepiness (EDS) and a 2-year diagnosis of obstructive sleep apnea syndrome (OSAS), which. OSAS was confirmed by respiratory polygraphy that showed an apnea-hypopnea index (AHI) of 71 events/hour of sleep associated with significant nocturnal hypoxemia (lowest oxygen saturation: 53%), which lead to the initiation of continuous positive airway pressure (CPAP) treatment. Cognitive complaints, unexplained spells of dizziness, and lack of improvement in EDS with CPAP led to further diagnostic investigation of infectious, inflammatory, and neurodegenerative disorders. Low hypocretin levels in the cerebrospinal fluid (CSF) confirmed the diagnosis of NT1, and the patient's symptoms improved with the treatment with pitolisant. Though exceptional in older adults, NT1 should be suspected in the presence of atypical EDS with neurological complaints, unexplained dizzy spells, or OSAS that resists the CPAP treatment. Low levels of hypocretin in the CSF are highly specific and rule out other neurological and sleep disorders., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m 2 , age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients., Competing Interests: The authors have no competing interests to declare for this work., (© 2024 Demaeyer and Bruyneel.)

Background: In COVID-19 intensive care unit (ICU)-admitted patients, multiorgan acute complications lead to long-lasting sequelae. The aim of this study was to assess (1) changes in chest CT, pulmonary function test (PFT), functional capacity (6-minute walking distance test (6MWT)), and health-related quality of life (HR-QoL) among ICU COVID-19 survivors at 3, 6, and 12 months after ICU discharge and (2) predictors of persistent impairment/improvement in 6MWT and HR-QoL., Methods: ICU COVID-19 survivors were prospectively included. Outcomes at 3, 6, and 12 months included PFT, 6MWT, respiratory muscle strength (RMS), HR-QoL (SF-36), Medical Research Council dyspnea scale (mMRC), and post-COVID Functional Status scale., Results: Eighty-seven survivors were included, from June 3, 2020, to September 2, 2021. At 12 months, 50% of PFT were normal, 46% were restrictive, and 22% showed reduced diffusing capacity for carbon monoxide (DLCO). Impaired DLCO was associated with ICU length of stay and age. In mixed linear model analysis, improvements in RMS and mMRC persisted over time regardless of the adjustments applied ( P  ≤ .050). SF-36 improved in parallel with FEV1 and 6MWT between 3 and 12 months ( P  ≤ .044), while increment in DLCO correlated with changes in FEV1 and total lung capacity (TLC) ( p  ≤ 0.026)., Conclusions: This longitudinal study demonstrated that improvements in SF-36 occur in parallel with improvements in FEV1 and 6MWT between 3 and 12 months post-ICU discharge in a sample of critically ill COVID-19 patients. However, PFT remained, however, abnormal in 50% of patients. Based on continued improvements observed from 3 to 12 months, it is anticipated that COVID-19 ICU patients will continue to recover similarly to ARDS patients., Competing Interests: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (© 2023 The Authors.)

Chronic insomnia is reported by up to 50% of chronic obstructive pulmonary disease (COPD) patients. This may be attributable to several factors including nocturnal dyspnea, reduced physical activity, and less time outside. Pulmonary rehabilitation (PR) is recommended in COPD to improve both physical and psychological conditioning. The aim of this study was to assess the effect of PR on sleep efficiency (SE, measured by actigraphy) in COPD patients. COPD eligible for PR were prospectively included. Baseline and post PR (30 sessions) assessments included incremental and maximal exercise testing, 6-min walking distance test (6MWT), actigraphy, and questionnaires [Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety Depression scale, St George Respiratory, and modified Medical Research Council dyspnea scale]. Sixty-one patients were included, and 31 patients completed the study protocol (68% of males, age 63 ± 9 y, FEV1 44.2 ± 12.3%). After PR, SE remained unchanged, p = 0.07, as well as PSQI score (p = 0.22), despite improvements in exercise capacity (incremental exercise test, 6MWT) and dyspnea. However, SE improved significantly in the poor sleeper subgroup (SE < 85%, n = 24, p = 0.02), whereas the PSQI remained unchanged. The present study shows, in COPD patients included in a PR program, that improvement in exercise capacity was disappointingly not associated with a better SE assessed by actigraphy. Subjective sleep quality was also unchanged at the end of PR program. However, SE improved significantly in the poor sleeper subgroup (SE < 85%). Further studies are required to better characterize the origin of sleep disturbances in COPD and the potential benefit of some (non-)pharmacologic interventions., (© 2023. The Author(s).)

Explainable Artificial Intelligence (xAI) is a rapidly growing field that focuses on making deep learning models interpretable and understandable to human decision-makers. In this study, we introduce xAAEnet, a novel xAI model applied to the assessment of Obstructive Sleep Apnea (OSA) severity. OSA is a prevalent sleep disorder that can lead to numerous medical conditions and is currently assessed using the Apnea-Hypopnea Index (AHI). However, AHI has been criticized for its inability to accurately estimate the effect of OSAs on related medical conditions. To address this issue, we propose a human-centric xAI approach that emphasizes similarity between apneic events as a whole and reduces subjectivity in diagnosis by examining how the model makes its decisions. Our model was trained and tested on a dataset of 60 patients' Polysomnographic (PSG) recordings. Our results demonstrate that the proposed model, xAAEnet, outperforms models with traditional architectures such as convolutional regressor, autoencoder (AE), and variational autoencoder (VAE). This study highlights the potential of xAI in providing an objective OSA severity scoring method.Clinical relevance- This study provides an objective OSA severity scoring technique which could improve the management of apneic patients in clinical practice.

Introduction: Despite improved management of patients with COVID-19, we still ignore whether pharmacologic treatments and improved respiratory support have modified outcomes for intensive care unit (ICU) surviving patients of the three first consecutive waves (w) of the pandemic. The aim of this study was to evaluate whether developments in the management of ICU COVID-19 patients have positively impacted respiratory functional outcomes, quality of life (QoL), and chest CT scan patterns in ICU COVID-19 surviving patients at 3 months, according to pandemic waves., Methods: We prospectively included all patients admitted to the ICU of two university hospitals with acute respiratory distress syndrome (ARDS) related to COVID-19. Data related to hospitalization (disease severity, complications), demographics, and medical history were collected. Patients were assessed 3 months post-ICU discharge using a 6 min walking distance test (6MWT), a pulmonary function test (PFT), a respiratory muscle strength (RMS) test, a chest CT scan, and a Short Form 36 (SF-36) questionnaire., Results: We included 84 ARDS COVID-19 surviving patients. Disease severity, complications, demographics, and comorbidities were similar between groups, but there were more women in wave 3 (w3). Length of stay at the hospital was shorter during w3 vs. during wave 1 (w1) (23.4 ± 14.2 days vs. 34.7 ± 20.8 days, p = 0.0304). Fewer patients required mechanical ventilation (MV) during the second wave (w2) vs. during w1 (33.3% vs. 63.9%, p = 0.0038). Assessment at 3 months after ICU discharge revealed that PFTs and 6MWTs scores were worse for w3 > w2 > w1. QoL (SF-36) deteriorated (vitality and mental health) more for patients in w1 vs. in w3 (64.7 ± 16.3 vs. 49.2 ± 23.2, p = 0.0169). Mechanical ventilation was associated with reduced forced expiratory volume (FEV1), total lung capacity (TLC), diffusing capacity for carbon monoxide (DLCO), and respiratory muscle strength (RMS) (w1,2,3, p < 0.0500) on linear/logistic regression analysis. The use of glucocorticoids, as well as tocilizumab, was associated with improvements in the number of affected segments in chest CT, FEV1, TLC, and DLCO ( p < 0.01)., Conclusions: With better understanding and management of COVID-19, there was an improvement in PFT, 6MWT, and RMS in ICU survivors 3 months after ICU discharge, regardless of the pandemic wave during which they were hospitalized. However, immunomodulation and improved best practices for the management of COVID-19 do not appear to be sufficient to prevent significant morbidity in critically ill patients.

Purpose: Diabetic retinopathy (DR) is the most common ocular complication of type 2 diabetes mellitus (T2D) and is associated with diabetes duration, glycemic control, and hypertension (HTN). Obstructive sleep apnea (OSA) is frequent in T2D and is associated with poor glycemic control. However, it is unclear if there is an association between OSA and DR. This study aimed to assess whether or not the presence of OSA in patients with T2D was associated with DR., Methods: In this prospective case-control study, consecutive patients with DM attending the ophthalmology clinics were recruited to include patients with DR (cases) and without DR (controls). OSA was diagnosed by attended polysomnography (PSG). Blood pressure and a fasting morning blood sample, including glycosylated hemoglobin (HbA1c), were recorded. Patients were matched for age, body mass index (BMI), gender, and T2D duration., Results: Thirty diabetic patients with DR were matched with 30 controls. In all patients, the prevalence of moderate-to-severe OSA was 57%. In the logistic regression analysis, DR was associated with increased HbA1c (OR 2.63, 95% CI 1.35-5.16, p = 0.004) but not with any PSG parameter. In the DR group, PSG parameters were not associated with the severity of ocular disease (non-proliferative, proliferative, presence/absence of macular edema). The proliferative aspect of DR was correlated with age (p = 0.017). DR occurred more frequently in uncontrolled diabetes compared to well-controlled diabetes (80% vs 38%, p = 0.029)., Conclusions: In patients with T2D, the presence of DR is not associated with OSA, but with poorly controlled T2D., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare.

Obstructive sleep apnoea (OSA) is a common disorder characterized by recurrent episodes of apnoea or hypopnea due to total or partial pharyngeal collapse and temporary upper airway obstruction during sleep. The prevalence of OSA is increasing and currently affects about 30% of men and 13% of women in Europe. Intermittent hypoxia, oxidative stress, systemic inflammation, and sleep fragmentation resulting from OSA can provoke subsequent cardiometabolic disorders. The relationships between endocrine disorders and OSA are complex and bidirectional. Indeed, several endocrine disorders are risk factors for OSA. Compared with the general population, the prevalence of OSA is increased in patients with obesity, hypothyroidism, acromegaly, Cushing syndrome, and type 1 and 2 diabetes. In some cases, treatment of the underlying endocrine disorder can improve, and occasionally cure, OSA. On the other hand, OSA can also induce endocrine disorders, particularly glucose metabolism abnormalities. Whether continuous positive airway pressure (CPAP) treatment for OSA can improve these endocrine disturbances remains unclear due to the presence of several confounding factors. In this review, we discuss the current state-of-the-art based on the review of the current medical literature for key articles focusing on the bidirectional relationship between endocrine disorders and OSA and the effects of treatment. Screening of OSA in endocrine patients is also discussed, as it remains a subject of debate., (© 2022 John Wiley & Sons Ltd.)

Various phenotypes of obstructive sleep apnea (OSA) have been recently described and are poorly assessed by the commonly used polysomnographic indices, such as the apnea-hypopnea index and oxygen desaturation index. Nocturnal hypoxemia is the hallmark of OSA and new quantitative markers, as hypoxic burden or desaturation severity, have been shown to be associated with cardiovascular (CV) mortality. The purpose of this overview is to review the endophenotypical and clinical characteristics of OSA, the current metrics, and to analyze different measurements of hypoxemia in OSA to predict the cardiovascular impact (eg hypoxic burden). Potential interest of multidimensional models to classify OSA, such as BAVENO classification, is also discussed, with the goal of focusing on specific endophenotypes that are likely to develop CV comorbidities, in order to guide clinicians to more aggressive management of OSA in these individuals., Competing Interests: The authors declare no conflicts of interest in this work., (© 2022 Blekic et al.)

Objectives: Continuous positive airway pressure (CPAP) is the 'gold standard' treatment for moderate-to-severe obstructive sleep apnea (OSA); adherence is an important issue. The aim of this paper is to review Belgian data on CPAP users and their adherence over a period of 11 years., Methods: Data delivered annually by the CPAP centers to the Belgian National Institute for Health Insurance (RIZIV/INAMI) were studied. Comments on these results were embedded in a narrative review., Results: On 1 January 2008 27.266 Belgian patients were treated with CPAP, at the end of 2018 this number increased to 121.605. In 2018, the short-term adherence (≤3 months) to CPAP was at least twice as high compared to the United States: the CPAP termination rate in Belgium (mainly due to stop of reimbursement because adherence <4 h/night) was estimated to be 12.4%, considerably lower than the 31.1% of patients on CPAP in the United States using the device <4 h., Conclusion: We speculate that this good adherence might be attributed to a stringent Belgian diagnostic and treatment convention model. This model uses 'gold standard' techniques (including in-hospital polysomnography), imposes a minimum capacity of medical doctors and paramedical collaborators, a strict follow-up of the patients, multidisciplinary care and proof of competency. Taking into account the increasing number of patients, a change in the Belgian care strategy is under consideration focusing on more out-of-centre patient's management; we propose a step-by step approach with careful monitoring of the impact of changing policy on adherence.

Background: Chronic insomnia disorder (CI) is a prevalent sleep disorder that can lead to disturbed daytime functioning and is closely associated with anxiety and depression. First-choice treatment is cognitive behavioral therapy (CBT-I). Other mind-body interventions, such as Tai-chi and Yoga, have demonstrated subjective improvements in sleep quality. The purpose of this study was to assess the efficacy of Yoga for improvement of subjective and objective sleep quality as well as measures of anxiety, depression, sleepiness, and fatigue in patients with CI., Methods: Adults with CI were prospectively included in this single group pre-post study. Baseline assessments included home polysomnography (PSG), 7-day actigraphy, and questionnaires (Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression scale (HADS), Epworth Sleepiness Scale (ESS), Pichot fatigue scale (PS)). Patients practiced Viniyoga, an individualised Yoga practice with daily self-administered exercises, for 14 weeks. Assessments were repeated at the end of Yoga practice., Results: Twenty-one patients completed the study. Objective sleep measurements revealed no change in PSG parameters after Yoga practice, but a decrease in arousals on actigraphy (p < 0.001). Subjective symptoms improved for all questionnaires (PSQI, p < 0.001; HAD-A, p = 0.020, HAD-D, p = 0.001, ESS, p = 0.041, PS, p = 0.010). In univariate correlations, decrease in PSQI was associated with increase in sleep stage N3 (p < 0.001) on PSG., Conclusions: We have demonstrated a positive impact of individualized Yoga practice on subjective parameters related to sleep and daytime symptoms in CI, resulting in fewer arousals on actigraphy. Yoga could be proposed as a potentially useful alternative to CBT-I in CI, as it is easy to practice autonomously over the long-term. However, given the design of the present study, future prospective controlled studies should first confirm our results., Trial Registration: ClinicalTrials.gov identifier: NCT03314441 , date of registration: 19/10/2017., (© 2022. The Author(s).)

Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies.

Purpose: Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment., Methods: All patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient's request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected., Results: Between May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m 2 , mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = -0.23 and -0.18, p = 0.016 and 0.002), and CPAP compliance. During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021., Conclusion: Pressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Traditional healthcare is centred around providing in-hospital services using hospital owned medical instruments. The COVID-19 pandemic has shown that this approach lacks flexibility to insure follow-up and treatment of common medical problems. In an alternative setting adapted to this problem, participatory healthcare can be considered centred around data provided by patients owning and operating medical data collection equipment in their homes., Objective: In order to trigger such a shift reliable and price attractive devices need to become available. Snoring, as a human sound production during sleep, can reflect sleeping behaviour and indicate sleep problems as an element of the overall health condition of a person., Methods: The use of off-the-shelf hardware from Internet of Things platforms and standard audio components allows the development of such devices. A prototype of a snoring sound detector with this purpose is developed., Results: The device, controlled by the patient and with specific snoring recording and analysing functions is demonstrated as a model for future participatory healthcare., Conclusions: Design of monitoring devices following this model could allow market introduction of new equipment for participatory healthcare, bringing a care complementary to traditional healthcare to the reach of patients, and could result in benefits from enhanced patient participation.

Objective: Several clinical obstructive sleep apnea syndrome (OSAS) phenotypes associated with heterogeneous cardiovascular risk profiles have been recently identified. The purpose of this study was to identify clusters amongst these profiles that allow for the differentiation of patients., Methods: This retrospective study included all moderate-to-severe OSAS patients referred to the sleep unit over a 5-year period. Demographic, symptom, comorbidity, polysomnographic, and continuous positive airway pressure (CPAP) adherence data were collected. Statistical analyses were performed to identify clusters of patients., Results: A total of 567 patients were included (67% men, 54±13 years, body mass index: 32±7 kg/m 2 , 65% Caucasian, 32% European African). Five clusters were identified: less severe OSAS (n=172); healthier severe OSAS (n=160); poorly sleeping OSAS patients with cardiometabolic comorbidities (n=87); younger obese men with sleepiness at the wheel (n=94); sleepy obese men with very severe desaturating OSAS and cardiometabolic comorbidities (n=54). Patients in clusters 3 and 5 were older than those in clusters 2 and 4 (P=0.034). Patients in clusters 4 and 5 were significantly more obese than those in the other clusters (P=0.04). No significant differences were detected in terms of symptoms and comorbidities. Polysomnographic profiles were very discriminating between clusters. CPAP adherence was similar in all clusters but, among adherent patients, daily usage was more important in cluster 1 (less severe patients) than in cluster 5., Conclusion: This study highlights that the typical sleepy obese middle-aged men with desaturating events represent only a minority of patients in our multi-ethnic moderate-to-severe OSAS cohort of 33% females., (© 2021. Huazhong University of Science and Technology.)

Study Objectives: To assess the diagnostic performance of a nonintrusive device placed under the mattress to detect sleep apnea syndrome., Methods: One hundred eighteen patients suspected to have obstructive sleep apnea syndrome completed a night at a sleep clinic with a simultaneous polysomnography (PSG) and recording with the Withings Sleep Analyzers. PSG nights were scored twice: first as simple polygraphy, then as PSG., Results: Average (standard deviation) apnea-hypopnea index from PSG was 31.2 events/h (25.0) and 32.8 events/h (29.9) according to the Withings Sleep Analyzers. The mean absolute error was 9.5 events/h. The sensitivity, specificity, and area under the receiver operating characteristic curve at thresholds of apnea-hypopnea index ≥ 15 events/h were, respectively, sensitivity (Se) 15 = 88.0%, specificity (Sp) 15 = 88.6%, and area under the receiver operating characteristic curve (AUROC) 15 = 0.926. At the threshold of apnea-hypopnea index ≥ 30 events/h, results included Se 30 = 86.0%, Sp 30 = 91.2%, AUROC 30 = 0.954. The average total sleep time from PSG and the Withings Sleep Analyzers was 366.6 (61.2) and 392.4 (67.2) minutes, sleep efficiency was 82.5% (11.6) and 82.6% (11.6), and wake after sleep onset was 62.7 (48.0) and 45.2 (37.3) minutes, respectively., Conclusions: Withings Sleep Analyzers accurately detect moderate-severe sleep apnea syndrome in patients suspected of sleep apnea syndrome. This simple and automated approach could be of great clinical value given the high prevalence of sleep apnea syndrome in the general population., Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Validation of Withings Sleep for the Detection of Sleep Apnea Syndrome; URL: https://clinicaltrials.gov/ct2/show/NCT04234828; Identifier: NCT04234828., (© 2021 American Academy of Sleep Medicine.)

This article presents an overview of the advancements that have been made in the use of photoplethysmography (PPG) for unobtrusive sleep studies. PPG is included in the quickly evolving and very popular landscape of wearables but has specific interesting properties, particularly the ability to capture the modulation of the autonomic nervous system during sleep. Recent advances have been made in PPG signal acquisition and processing, including coupling it with accelerometry in order to construct hypnograms in normal and pathologic sleep and also to detect sleep-disordered breathing (SDB). The limitations of PPG (e.g., oxymetry signal failure, motion artefacts, signal processing) are reviewed as well as technical solutions to overcome these issues. The potential medical applications of PPG are numerous, including home-based detection of SDB (for triage purposes), and long-term monitoring of insomnia, circadian rhythm sleep disorders (to assess treatment effects), and treated SDB (to ensure disease control). New contact sensor combinations to improve future wearables seem promising, particularly tools that allow for the assessment of brain activity. In this way, in-ear EEG combined with PPG and actigraphy could be an interesting focus for future research.

Among 359 healthcare workers (HCW) employed in Panzi General Referral Hospital located in Bukavu in the Democratic Republic of Congo, 148 (41.2%) tested positive for SARS-CoV-2 antibodies. Thirty-three (22.3%) of the 148 personnel with positive serology reported symptoms evoking a prior COVID-19 illness. None of the infected HCWs reported COVID-related hospitalization, and all of them recovered. Our findings indicate high and underestimated circulation of SARS-CoV-2 within the Bukavu area.

Purpose: Overweight and obesity are major causal factors for obstructive sleep apnea syndrome (OSAS), providing insight into why one third of patients with OSAS suffer from diabetes mellitus and another third from glucose intolerance. However, a significant proportion of the general population remains undiagnosed for glucose metabolism disorders. The primary aim of this study was to establish the prevalence of known and newly diagnosed glucose metabolism disorders in patients with moderate and severe OSAS referred to the sleep lab for continuous positive airway pressure (CPAP) therapy., Methods: We prospectively included consecutive patients with moderate or severe OSAS referred for CPAP therapy. A fasting blood sample was collected to determine glycosylated hemoglobin (HbA1c), glucose, and homeostatic model assessment (HOMA) index. Baseline demographic data and medication intake were recorded., Results: Of 280 consecutive patients (70% men, mean ± SD body mass index 33 ± 7 kg/m 2 , apnea-hypopnea index 49 ± 25), 22% exhibited diabetes and 44% glucose intolerance. Undiagnosed diabetes and glucose intolerance was found in 79 of 280 patients (28%). Insulin resistance was associated with OSAS severity in multivariate linear regression analysis (regression coefficient 2.40 [95% CI 0.07-4.72]; p = 0.04)., Conclusion: In this population of overweight and obese patients with moderate and severe OSAS, 66% of patients had diabetes or glucose intolerance and 28% were newly diagnosed. Diabetes and glucose intolerance were not related to OSAS severity, contrary to insulin resistance. These data suggest that there is value in systematic screening for glucose metabolism disorders in all patients with moderate and severe OSAS.

Purpose: Obstructive sleep apnea (OSA) syndrome is a well-recognized independent risk factor for cardiovascular disease and its prevalence is increasing. OSA symptomology, polysomnographic features, and comorbidities are heterogeneous among patients. Ethnicity is thought to influence OSA phenotypes, but extensive knowledge of OSA ethnic patterns is lacking. The primary aim of the present study was to compare comorbidities in Caucasian and African OSA. Secondary aims were to observe OSA symptomatology, polysomnographic characteristics, and CPAP adherence in these two ethnic groups., Methods: In this retrospective study, 1717 patients suffering from moderate/severe OSA were included between 2013 and 2017. Data on demographics, symptomatology, comorbidities, polysomnographic characteristics, and CPAP adherence were collected. Data were analyzed to identify potential differences between Caucasians and Africans., Results: Despite healthier lifestyles and lower BMI, a higher prevalence of diabetes but less cardiac comorbidities and dyslipidemia was observed in the African population. Younger African patients (< 56 years) suffered more from cognitive impairment than Caucasians and both younger and older Africans complained more of nighttime choking than Caucasians. In analysis of polysomnographic data, Africans had higher apnea-hypopnea index (AHI) in REM sleep, lower supine AHI, lower desaturation time, and lower periodic leg movements index., Conclusions: Compared with Caucasians, African OSA showed a particular comorbidity profile. There are younger patients who exhibit more diabetes but less cardiac comorbidities than the Caucasians. African diabetics should be more promptly referred for OSA testing. Moreover, as they suffer more often from choking and cognitive impairment, OSA treatment could positively impact their quality of life.

Background: Immunotherapy represents a recent milestone in the treatment of lung cancer, particularly with the rapidly expanding development of monoclonal antibodies targeting checkpoint inhibitors in the programmed cell death-1 (PD-1) pathway, such as nivolumab and pembrolizumab. Classical auto-immune side effects of these treatments, often called immune-related adverse events (irAEs), can affect multiple organs, including the lungs in which potentially life-threatening pneumonitis may require rapid treatment with high doses of corticosteroids. Nevertheless, the occurrence of severe infections in cancer patients treated with nivolumab, outside the context of immunosuppressive therapy, is a complication that has rarely been reported in the literature., Clinical Cases: We report two cases of severe pulmonary infection with unusual microbes, Mycobacterium tuberculosis and Aspergillus fumigatus, in patients treated with nivolumab for non-small cell lung cancer., Conclusion: Ruling out pulmonary infections may require extensive investigation, as these may have an atypical presentation due to immunomodulation. Furthermore, treating the patient with corticosteroids for immune-related pneumonia could lead to a fatal outcome in this context. This report highlights the importance of excluding the presence of opportunistic infections and tuberculosis before considering immune-related pulmonary toxicity with or without a history of prior corticosteroid use. These cases also emphasize the potential value of tuberculosis screening in patients treated with PD-1 checkpoint inhibitors.

Background: Obstructive sleep apnea syndrome (OSA) is currently recognized as an independent risk factor for hypertension, arrhythmia, coronary heart disease, stroke, and metabolic disorders (e.g. diabetes, dyslipidemia). In clinical practice, apnea-hypopnea index (AHI) is the marker used to classify disease severity and guide treatment. However, AHI alone does not sufficiently identify OSA patients at risk for cardiometabolic comorbidities. With this in mind, the aim of this retrospective study was to determine whether some polysomnographic parameters (e.g. apnea-hypopnea duration, sleep structure, nocturnal hypoxemia) are specifically associated with cardiometabolic comorbidities in OSA., Methods: In this retrospective study, 1717 patients suffering from moderate/severe OSA were included between 2013 and 2017. Data on demographics, comorbidities, and polysomnographic characteristics were collected and analyzed to identify factors associated with cardiometabolic complications., Results: The medical files of 1717 patients (68% male) were reviewed. The mean AHI was 43.1 +/- 27.7 with 57.3% of patients suffering from severe OSA, and 52% from at least one cardiovascular comorbidity (CVCo). Diabetes affected 22% of the patients and 27% exhibited dyslipidemia. Patients affected by CVCos were older, and more often women and non-smokers. These patients also had worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. With regard to diabetes, diabetics were older, more often non-smoker, non-drinker women, and were more obese. These patients also exhibited more severe OSA, especially in non-REM (NREM) sleep, worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. Dyslipidemia was more frequent in the absence of alcohol consumption, and was associated with OSA severity, decreased sleep quality, and longer AH in REM sleep., Conclusions: This study identifies demographic and polysomnographic factors associated with cardiometabolic comorbidities. Patients (especially women) suffering from more severe OSA, longer sleep apneas and hypopneas, worse sleep quality, and marked intermittent/global nocturnal hypoxemia are more likely to develop cardiometabolic comorbidities. This should stimulate clinicians to obtain adequate treatment in this population.

Background: Hypothyroidism can directly cause obstructive sleep apnea (OSA) but may also contribute to it through its impact on the metabolic syndrome. The purpose of this study was to establish the prevalence of known and newly diagnosed overt and subclinical hypothyroidism (SCH) among patients with OSA., Methods: We prospectively included all consecutive moderate or severe OSA patients referred for CPAP therapy. A fasting blood sample was collected to determine thyroid-stimulating hormone (TSH) and free T4 (FT4) levels., Results: A total of 280 patients were included (70% male). Mean ± SD body mass index (BMI) and apnea-hypopnea index (AHI) were 33 ± 7 kg/m 2 and 49 ± 25, respectively. Median (range) serum TSH levels and mean ± SD FT4 levels were comparable between severe and moderate OSA (1.7 (1.3-2.6) vs 2.1 (1.2-2.8); p = 0.378 and 15.3 ± 2.3 vs 15.3 ± 2.3; p = 0.981). TSH and FT4 levels were not correlated with AHI (p = 0.297 and p = 0.370, respectively), but TSH was correlated with BMI (p = 0.049).Of all patients, 8.9% had increased serum TSH levels (severe and moderate OSA patients had similar levels (p = 0.711)) and 8.2% were newly diagnosed patients (no differences were observed between severe and moderate OSA (p = 0.450)). A total of 16.4% of patients had some type of thyroid disorder. Thyroid function parameters were associated with BMI but not with the severity of OSA., Conclusion: In our population of moderate or severe OSA, 16% of patients had a thyroid problem and 8% of these were newly diagnosed with SCH.

Telemedicine (TM) is a current tool in the landscape of medicine. It helps to address public health challenges such as increases in chronic disease in an ageing society and the associated burden in healthcare costs. Sleep TM refers to patient data exchange with the purpose of enhancing disease management. Obstructive sleep apnoea (OSA) syndrome is a chronic disorder associated with a significant morbidity, mainly cardiometabolic, and mortality. Obtaining adequate compliance to continuous positive airway pressure (CPAP) remains the greatest challenge related to OSA treatment, and the adoption of TM to support OSA management makes sense. In addition, the prevalence of OSA is growing and OSA is associated with increased healthcare costs that could be streamlined by the application of TM. In OSA, multiple modalities of TM are utilised, such as telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with CPAP. In the present article, I aim to provide an overview of current practice and the recent developments in TM for OSA management. Concerns related to TM use will also be addressed., Competing Interests: Conflict of interest: M. Bruyneel has received lecture fees from Chiesi, Novartis and Philips, travel fees from GSK, Chiesi, Novartis, Boehringer Ingelheim and AstraZeneca, and fees for educational presentations from Linde and Visisol, outside the submitted work., (Copyright ©ERS 2019.)

Objective: The use of activity and sleep trackers that operate through dedicated smartphone applications has become popular in the general population. However, the validity of the data they provide has been disappointing and only Total Sleep Time (TST) is reliably recorded in healthy individuals for any of the devices tested. The purpose of this study was to evaluate the ability of two sleep trackers (Withings pulse 02 (W) and Jawbone Up (U)) to measure sleep parameters in patients suffering from obstructive sleep apnea (OSA)., Methods: All patients evaluated for OSA in our sleep laboratory underwent overnight polysomnography (PSG). PSG was conducted simultaneously with three other devices: two consumer-level sleep monitors (U and W) and one actigraph (Bodymedia SenseWear Pro Armband (SWA))., Results: Of 36 patients evaluated, 22 (17 men) were diagnosed with OSA (mean apnea-hypopnea index of 37+ 23/h). Single comparisons of sleep trackers (U and W) and actigraph (SWA) were performed. Compared to PSG, SWA correctly assessed TST and Wake After Sleep Onset (WASO), and U and W correctly assessed Time In Bed (TIB) and light sleep. Intraclass correlations (ICC) revealed poor validity for all parameters and devices, except for WASO assessed by SWA., Conclusions: This is the first study assessing the validity of sleep trackers in OSA patients. In this series, we have confirmed the limited performance of wearable sleep monitors that has been previously observed in healthy subjects. In OSA patients, wearable app-based health technologies provide a good estimation of TIB and light sleep but with very poor ICC., Competing Interests: The authors have declared that no competing interests exist.

Rationale and Objectives: Computed tomography (CT) airways measurements can be used as surrogates to spirometric measurements for assessing bronchodilation in a particular patient with chronic obstructive pulmonary disease. Although spirometric measurements show variations within the opening hours of a hospital department, we aimed to compare the variability of CT airways measurements between morning and afternoon in patients with chronic obstructive pulmonary disease to that of spirometric measurements., Materials and Methods: Twenty patients had pulmonary function tests and CT around 8 am and 4 pm. Luminal area (LA) and wall thickness (WT) of third and fourth generation airways were measured twice by three readers. The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of examination time, reader, and measurement session on CT airways measurements were assessed, and the variability of these measurements was compared to that of spirometric measurements., Results: Variability of LA 3rd and LA 4th was greater than that of spirometric measurements (P values ranging from <.001 to .033). There was no examination time effect on √WAPi10, WT 3rd , LA 4th , or WA% 4th (P values ranging from .102 to .712). There was a reader effect on all CT airways measurements (P values ranging from <.001 to .028), except in WT 3rd (P> .999). There was no effect of measurement session on any CT airway measurement (P values ranging from .535 to >.999)., Conclusion: As the variability of LA 3rd and LA 4th is greater than that of spirometric measurements, clinical studies should include cohorts with larger numbers of patients when considering LA than when considering spirometric measurements as end points., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Sleep-wake disturbances are common in liver cirrhosis and associated with impaired quality of life. The most common abnormalities are insomnia (difficulties falling asleep and maintaining sleep, or unrefreshing sleep), excessive daytime sleepiness, and sleep-wake inversion (disturbances of circadian rhythmicity). The underlying pathophysiological mechanisms for sleep disturbances in cirrhosis are complex and may include disturbed metabolism of melatonin and glucose, alterations in thermoregulation, and altered ghrelin secretion profiles. Sleep-wake abnormalities are related to the presence of hepatic encephalopathy (HE) and improvement in sleep parameters can be observed when HE is properly managed. A few non-specific treatments for sleep-wake abnormalities have been tried with encouraging results for hydroxyzine and modafinil. However, due to the potential for medication toxicity in these disabled patients, further studies are needed to address the potential role of non-drug therapies in this population (eg, cognitive behavioral therapy, mindfulness, yoga) that have demonstrated usefulness in insomnia disorders., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Competing interests: None declared.

Objective: Telemonitoring (TM) has been used in continuous positive airway pressure (CPAP)-treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome., Methods: Patients diagnosed with moderate to severe obstructive sleep apnea syndrome were prospectively included and randomized to receive usual care (UC) or TM. In both arms, an educational session was scheduled 1 month after CPAP initiation, and medical visits were planned after 1.5 and 3 months. In the TM arm, we added a universal TM unit (T4P) to the CPAP device., Results: Delay to first intervention was significantly shorter in the TM group (29 ± 25 vs 47 ± 30 days, p = 0.02). The first intervention in the TM group was motivated by detection of problems by the TM system in 39% of patients. Compliance at 3 months was significantly better in the TM group (5.7 ± 1.6 vs 4.2 ± 1.9 h/night, p = 0.018)., Conclusion: This is the first randomized study showing that TM reduces delay to first technical intervention in CPAP-treated patients. This early activation of troubleshooting was associated with improved compliance at 3 months. Since CPAP side effects at 1 month have been shown to predict lower 12-month CPAP compliance, TM seems to be an excellent tool for improvement of long-term CPAP acceptance., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: In asthma patients, the assessment of activity limitation is based on questions evaluating how limited the patient feels in their activities. However, the lack of functional data complicates the interpretation of the answers. We aimed to evaluate the intensity of relationships between the patient's perception of activity limitation and the results of several functional tests., Methods: Twenty patients complaining of asthma exacerbation were invited to complete three scores (Chronic Respiratory Disease questionnaire, Asthma Control Questionnaire, Hospital Anxiety and Depression scale). They also underwent lung function measurements, a 6-minute walk test and a cardio-pulmonary exercise test. In addition, physical activity was studied by actigraphy. Spearman's rank correlation coefficients between the patient's perception of activity limitation and each of the other parameters were analysed., Results: Five parameters were significantly correlated with the perception of activity limitation: ACQ question 4, related to dyspnea (rs 0.74, p < 0.001); Emotion domain of the Chronic Respiratory Disease questionnaire (rs -0.57, p = 0.02); HAD anxiety (rs 0.48, p = 0.032); HAD depression (rs 0.46, p = 0.041); ACQ question 6, related to reliever use (rs 0.46, p = 0.046). No parameters from the lung function test, 6MWT, CPET or actigraphy, were significantly correlated with the perception of activity limitation., Conclusions: In response to questions about limitation of activity, patients do not specifically answer mentioning physical limitation but rather the psychological burden associated with this constraint.

Introduction: Wearable health devices have become trendy among consumers, but it is not known whether they accurately measure sleep and physical activity parameters. To address this question, we have studied the measured data of two consumer-level activity monitors (Up Move Jawbone ® (U) and Withings Pulse 02 ® (W)) and compared it with reference methods for sleep and activity recordings, namely the Bodymedia SenseWear Pro Armband ® actigraph (SWA) and home-polysomnography (H-PSG)., Methods: Twenty healthy patients were assessed at home, during sleep, with the four devices. An additional 24-h period of recording was then planned during which they wore the 2 trackers and the SWA. Physical activity and sleep parameters obtained with the 4 devices were analyzed., Results: Significant correlations with H-PSG were obtained for total sleep time (TST) for all the devices: r=0.48 for W (p=0.04), r=0.63 for U (p=0.002), r=0.7 for SWA (p=0.0003). The best coefficient was obtained with SWA. Significant correlations were also obtained for time in bed (TIB) for U and SWA vs PSG (r=0.79 and r=0.76, p<0.0001 for both) but not for W (r=0.45, p=0.07). No significant correlations were obtained for deep sleep, light sleep, and sleep efficiency (SE) measurements with W, U and SWA. Sleep latency (SL) correlated with H-PSG only when measured against SWA (r=0.5, p=0.02). Physical activity assessment revealed significant correlations for U and W with SWA for step count (both r=0.95 and p<0.0001) and active energy expenditure (EE) (r=0.65 and 0.54; p=0.0006 and p<0.0001). Total EE was also correctly estimated (r=0.75 and 0.52; p<0.0001 and p=0.001)., Conclusion: Sleep and activity monitors are only able to produce a limited set of reliable measurements, such as TST, step count, and active EE, with a preference for U which performs globally better. Despite the manual activation to sleep mode, U and W were not suitable for giving correct data such as sleep architecture, SE, and SL. In the future, to enhance accuracy of such monitors, researchers and providers have to collaborate to write algorithms based reliably on sleep physiology. It could avoid misleading the consumer., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background and Aim: Sleep disorders are frequently reported in patients with cirrhosis and hepatic encephalopathy (HE). This study assessed the effect of rifaximin on sleep architecture parameters in patients with recurrent HE., Patients and Methods: This sequential, prospective, and exploratory study involved all patients with cirrhosis and recurrent HE admitted between June 2014 and September 2015. HE was assessed according to the West-Haven Classification. Patients underwent 24-h polysomnography (PSG) and 7-day actigraphy. Rapid eye movement (REM) sleep was considered to be an indicator of good sleep quality. Patients completed questionnaires assessing the quality of sleep and sleepiness. After a 28-day course of rifaximin, the same assessment was repeated., Results: Fifteen patients were included (nine men, mean age: 57±11 years). Child-Pugh scores ranged from B7 to C15. Before rifaximin, the mean HE score was 2.7±0.7. Data from PSG analysis indicated long total sleep time (TST): 571±288 min, and limited REM sleep: 2.5% TST (0-19). Seven-day actigraphy showed an impaired number of steps: 1690/24 h (176-6945). Questionnaires indicated that patients experienced impaired sleep quality and excessive daytime sleepiness. After rifaximin, HE scores decreased to 1.7±0.6 (P<0.001). REM sleep increased to 8.5% TST (0-25) (P=0.003). No changes were observed for TST, number of steps, and on questionnaires., Conclusion: Patients with recurrent HE suffer from poor sleep quality and excessive daytime sleepiness. On 24-h PSG, rifaximin improves objective sleep architecture parameters with no changes in the subjective quality of sleep and sleepiness.

The use of assistive technology and telemedicine is likely to continue to shape our medical practice in the future, notably in the field of sleep medicine, especially within developed countries. Currently, the number of people suffering from obstructive sleep apnea syndrome (OSAS) is increasing. Telemedicine (TM) can be used in a variety of ways in sleep medicine: telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with positive pressure devices. In this review, we aim to summarize the recent scientific progresses of these techniques and their potential clinical applications and give consideration to the remaining problems related to TM application., Competing Interests: The author declares no conflict of interest.

Acromegaly is a rare hormonal disease related to excessive growth hormone secretion. It can result in a range of complications, including cardiovascular, respiratory, metabolic, articular and neoplastic disorders. Among patients with the condition, obstructive sleep apnea syndrome occurs frequently and the effect of treatment is inconstant: improvement, statu quo or deterioration can be observed. We here report three clinical cases, which illustrate the unpredictable evolution of this condition., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Respiratory tract infections remain one of the most frequently encountered acute illnesses in the primary care. Atypical germs along with Streptococcus pneumoniae are an important cause of community-acquired pneumonia. Most infections caused by atypical germs are mild or moderate but some of them might cause a severe disease with important morbidity and mortality. Diagnosis of community-acquired pneumonia remains a challenge in the primary care. On the other hand some of them are reported to be associated with chronic cough which is a common problem in the general practice. The aim of this mini-review is to give a short overview of some data on local prevalence, presentation and scoring systems, with stress on feasibility of current diagnostic methods in the primary care practice and therapeutic considerations for the general practitioners.

Background: Hypoxemia is a frequent adverse event occurring during flexible bronchoscopy and is usually prevented by close monitoring and, if needed, oxygen supplementation by nasal cannula., Objective: We aim to demonstrate that tracheal oxygen supplementation during flexible bronchoscopy is a feasible, safe and effective method to restore oxygen saturation levels after oxygen desaturation., Methods: In a first phase, we compare oxygen supplementation by the tracheal or nasal route in a single blinded cross-over design in healthy volunteers. In a second phase, we study patients referred for diagnostic flexible bronchoscopy, who desaturate despite oxygen supplementation by nasal cannula, in order to assess the ability to correct hypoxemia through tracheal oxygen supplementation., Results: In the first phase, the mean capillary partial pressure of oxygen was 181 mm Hg when oxygen at a flow rate of 4 liters/min was administered by the tracheal route, compared to 125 mm Hg by the nasal route (p < 0.001). The capillary partial pressure of carbon dioxide was not significantly different. During 950 bronchoscopic procedures in the second phase of the trial, 30 patients desaturated below 90% despite oxygen supplementation by nasal cannula. In 22 out of these 30 patients, switching to the tracheal route resulted in a correction of the saturation within 120 s. In the remaining 8 patients, saturation levels were corrected after increasing the oxygen flow rate to 4 liters/min. After restoring saturation levels, the bronchoscopy could be completed in 25 of 30 patients., Conclusions: Tracheal oxygen supplementation is safe, feasible and an effective way to restore oxygen saturation levels during flexible bronchoscopy., (© 2016 S. Karger AG, Basel.)

Purpose: To determine the effect of bronchodilation on airway indexes reflecting airway disease in patients with chronic obstructive pulmonary disease (COPD) and to determine the minimum number of segmental and subsegmental airways required., Materials and Methods: This study was approved by the local ethical committee, and written informed consent was obtained from all subjects. Twenty patients with COPD who had undergone pre- and postbronchodilator pulmonary function tests and computed tomographic (CT) examinations were prospectively included. Eight healthy volunteers underwent two CT examinations. Luminal area and wall thickness (WT) of third- and fourth-generation airways were measured twice by three readers. The percentage of total airway area occupied by the wall and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of pathologic status, session, reader, bronchodilation, and CT examination were assessed by using mixed linear model analyses. The number of airways to measure for a definite percentage error of √WAPi10 was computed by using a bootstrap method., Results: There were no significant session, reader, or bronchodilation effects on WT in third-generation airways and √WAPi10 in patients with COPD (P values ranging from .187 to >.999). WT in third-generation airways and √WAPi10 were significantly different in patients with COPD and control subjects (P = .018 and <.001, respectively). Measuring 12 third- or fourth-generation airways ensured a maximal 10% error of √WAPi10., Conclusion: WT in third-generation airways and √WAPi10 are not significantly different before and after bronchodilation and are different in patients with COPD and control subjects. Twelve is the minimum number of third- or fourth-generation airways required to ensure a maximal 10% error of √WAPi10. (©) RSNA, 2015 Clinical trial registration no. NCT01142531 Online supplemental material is available for this article.

Background: Unattended home-based polysomnography (H-PSG) is a reliable tool for the diagnosis of obstructive sleep apnoea (OSA). The quality of the recording can be influenced by several factors including the set-up location - at home versus in the sleep laboratory. Previous studies have suggested that the failure rate is higher when H-PSG is fitted in hospital. The aim of this study was to determine the influence of hook-up location on H-PSG recording quality. Feasibility and repeatability of H-PSG were also assessed., Methods: Consecutive patients suspected of OSA were selected. Each patient underwent two H-PSGs within two weeks, one fitted at home and one fitted in the sleep laboratory. The order of H-PSG was randomly assigned., Results: Among the 102 included patients, 95 completed the study. Ninety-three per cent of the 190 H-PSGs were satisfactory. The failure rate of H-PSG was similar for both the home set-up and the sleep laboratory set-up (p = 0.33). Seventy-nine per cent of patients opted to be fitted at home. OSA was diagnosed in 59%. The apnoea-hypopnoea index was similar for home and sleep laboratory set-up, resulting in a very good reproducibility (intraclass correlation coefficient of 0.85). No differences in total sleep time and sleep architecture were observed in both set-up protocols. Except for sleep duration, which was longer in the first H-PSG test, we did not observe any first-night effect during the first H-PSG., Conclusion: The present study demonstrates that hospital hook-up is as effective as home hook-up for home-unattended polysomnography, and that feasibility and repeatability of H-PSG are very good., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Sleep deteriorates with age. The menopause is often a turning point for women's sleep, as complaints of insomnia increase significantly thereafter. Insomnia can occur as a secondary disorder to hot flashes, mood disorders, medical conditions, psychosocial factors, underlying intrinsic sleep disorders, such as obstructive sleep apnoea (OSA) or restless legs syndrome (RLS), or it can be a primary disorder. Since unrecognized OSA can have dramatic health-related consequences, menopausal women complaining of persisting sleep disturbances suggesting primary insomnia or intrinsic sleep disorders should be referred to a sleep specialist for a comprehensive sleep assessment. Patients suffering from primary insomnia will be preferentially treated with non-benzodiazepine hypnotics or melatonin, or with cognitive behavioural therapy. Insomnia related to vasomotor symptoms can be improved with hormone replacement therapy. Gabapentin and isoflavones have also shown efficacy in small series but their precise role has yet to be established. In patients suffering from OSA, non-pharmacological therapy will be applied: continuous positive airway pressure or an oral appliance, according to the severity of the disorder. In the case of RLS, triggering factors must be avoided; dopaminergic agonists are the first-line treatment for moderate to severe disease. In conclusion, persisting sleep complaints should be addressed in menopausal women, in order to correctly diagnose the specific causal disorder and to prescribe treatments that have been shown to improve sleep quality, quality of life and long-term health status., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS., Methods: All consecutive patients admitted to the coronary care unit (CCU) for ACS without acute heart failure underwent one overnight-attended polysomnography (PSG) within 72 h after admission. A telemonitoring (TM) system was set up to remotely monitor the signals and repair faulty sensors. The 27 recordings were analyzed as respiratory polygraphy (RP) and as PSG, and the results were compared., Results: The TM system allowed successful intervention in 48% of recordings, resulting in excellent quality PSG for 89% of cases. The prevalence of SDB [apnea-hypopnea index (AHI) ≥ 15/h] was 82% and mainly consisted of central SDB and periodic breathing, except three patients with OSA. Compared with PSG, RP underestimated AHI, probably due to the poor sleep efficiency, reduction of slow-wave sleep, and alteration of rapid eye movement sleep., Conclusion: An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact., (Copyright © 2014 Elsevier B.V. All rights reserved.)