Search

INTRODUCTION: The neuroanatomical changes driving both cognitive and mobility impairments, an emerging preclinical dementia syndrome, are not fully understood. We examined gray‐matter volumes (GMVs) and structural covariance networks (SCNs) abnormalities in community‐based older people preceding the conversion to physio‐cognitive decline syndrome (PCDS). METHODS: Voxel‐wise brain GMV and established SCNs were compared between PCDS and non‐PCDS converters. RESULTS: The study included 343 individuals (60.2 ± 6.9 years, 49.6% men) with intact cognitive and mobility functions. Over an average 5.6‐year follow‐up, 116 transitioned to PCDS. Identified regions with abnormal GMVs in PCDS converters were over cerebellum and caudate, which served as seeds for SCNs establishment. Significant differences in cerebellum‐based (to right frontal pole and left middle frontal gyrus) and caudate‐based SCNs (to right caudate putamen, right planum temporale, left precentral gyrus, right postcentral gyrus, and left parietal operculum) between converters and nonconverters were observed. DISCUSSION: This study reveals early neuroanatomic changes, emphasizing the cerebellum's role, in dual cognitive and mobility impairments. Highlights: Neuroanatomic precursors of dual cognitive and mobility impairments are identified.Cerebellar GMV reductions and increased right caudate GMV precede the onset of PCDS.Altered cerebellum‐ and caudate‐based SCNs drive PCDS transformation.This research establishes a foundation for understanding PCDS as a specific dementia syndrome. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify characteristics in image‐based computational fluid dynamics (CFD) in children with obstructive sleep apnea (OSA). Design: Diagnostic study. Setting: Hospital‐based cohort. Participants: Children with symptoms suggestive of OSA were recruited and underwent polysomnography. Main outcome measures: Three‐dimensional models of computational fluid dynamics were derived from cone‐beam computed tomography. Results: A total of 68 children participated in the study (44 boys; mean age: 7.8 years), including 34 participants having moderate‐to‐severe OSA (apnea‐hypopnea index [AHI] greater than 5 events/h), and 34 age, gender, and body mass index percentile matched participants having primary snoring (AHI less than 1). Children with moderate‐to‐severe OSA had a significantly higher total airway pressure (166.3 vs. 39.1 Pa, p =.009), total airway resistance (9851 vs. 2060 Newton‐metre, p =.004) and velocity at a minimal cross‐sectional area (65.7 vs. 8.8 metre per second, p =.017) than those with primary snoring. The optimal cut‐off points for moderate‐to‐severe OSA were 46.2 Pa in the total airway pressure (area under the curve [AUC] = 73.2%), 2373 Newton‐metre in the total airway resistance (AUC = 72.5%) and 12.6 metres per second in the velocity at a minimal cross‐sectional area (AUC = 70.5%). The conditional logistic regression model revealed that total airway pressure, total airway resistance and velocity at minimal cross‐sectional area were significantly associated with an increased risk of moderate‐to‐severe OSA. Conclusions: This study demonstrates that CFD could be a useful tool for evaluating upper airway patency in children with OSA. [ABSTRACT FROM AUTHOR]

Background and aims Atherosclerosis preferentially develops in arterial branches and curvatures where vascular endothelium is exposed to disturbed flow. In this study, the effects of disturbed flow on the regulation of vascular endothelial phosphoproteins and their contribution to therapeutic application in atherogenesis were elucidated. Methods Porcine models, large-scale phosphoproteomics, transgenic mice, and clinical specimens were used to discover novel site-specific phosphorylation alterations induced by disturbed flow in endothelial cells (ECs). Results A large-scale phosphoproteomics analysis of native endothelium from disturbed (athero-susceptible) vs. pulsatile flow (athero-resistant) regions of porcine aortas led to the identification of a novel atherosclerosis-related phosphoprotein vinculin (VCL) with disturbed flow-induced phosphorylation at serine 721 (VCLS721p). The induction of VCLS721p was mediated by G-protein-coupled receptor kinase 2 (GRK2)S29p and resulted in an inactive form of VCL with a closed conformation, leading to the VE-cadherin/catenin complex disruption to enhance endothelial permeability and atherogenesis. The generation of novel apolipoprotein E-deficient (ApoE−/−) mice overexpressing S721-non-phosphorylatable VCL mutant in ECs confirmed the critical role of VCLS721p in promoting atherosclerosis. The administration of a GRK2 inhibitor to ApoE−/− mice suppressed plaque formation by inhibiting endothelial VCLS721p. Studies on clinical specimens from patients with coronary artery disease (CAD) revealed that endothelial VCLS721p is a critical clinicopathological biomarker for atherosclerosis progression and that serum VCLS721p level is a promising biomarker for CAD diagnosis. Conclusions The findings of this study indicate that endothelial VCLS721p is a valuable hemodynamic-based target for clinical assessment and treatment of vascular disorders resulting from atherosclerosis. [ABSTRACT FROM AUTHOR]

Summary: Until now, no study has directly network meta‐analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in patients with obstructive sleep apnea. This study aimed to meta‐analyse the impact of three kinds of nasal interfaces with both network meta‐analysis and pairwise comparison. PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to December 2020 for studies that compared the three types of nasal interfaces for treating obstructive sleep apnea with continuous positive airway pressure. The outcomes were residual apnea–hypopnea index, continuous positive airway pressure, and nightly average usage. The network meta‐analysis was conducted using multivariate random‐effects in a frequentist framework where three interfaces were ranked with the surface under the cumulative ranking probabilities. The pairwise comparison was conducted using random‐effects meta‐analysis. Twenty‐nine articles comprising 6378 participants were included. The pairwise comparison showed both nasal masks and nasal pillows were associated with lower residual apnea–hypopnea index, lower continuous positive airway pressure, and higher continuous positive airway pressure adherence compared with oronasal masks. The surface under the cumulative ranking confirmed that nasal masks were associated with the lowest residual apnea–hypopnea index and highest adherence, while pillows were associated with the lowest continuous positive airway pressure. The meta‐regression identified that lower pretreatment apnea–hypopnea index and continuous positive airway pressure determined during continuous positive airway pressure titration (versus determined during continuous positive airway pressure therapy) was associated with lower continuous positive airway pressure with nasal masks and nasal pillows. In conclusion, compared with oronasal masks, nasal masks and nasal pillows are better interfaces, especially in patients with lower pretreatment apnea–hypopnea index and those with the therapeutic pressure determined during continuous positive airway pressure titration. [ABSTRACT FROM AUTHOR]

Automatic assessment of sleep apnea/ hypopnea syndrome (SAHS) based on fewer physiological signals is critical for the success of healthcare at home. However, previous studies that use such settings only achieve a lower assessment accuracy, causing fewer syndromes to be separated for effective diagnosis. This paper presents a 3-stage support vector machines (SVM)-based algorithm for SAHS assessment using a single-channel nasal pressure (NP) signal. In this work, NP signal is utilized for feature extraction. Amplitude features, as well as those extracted using discrete Fourier transform and discrete wavelet transform, are used for machine learning. A total of 58 sets of polysomnography recordings, each with approximately 7 h in duration, were analyzed. This work achieves a sensitivity of 95.7% and a positive predictive value of 90.9%, outperforming previous works using NP signal. Compared with prior studies using only SpO2 signal, this work still achieves better performance and supports more classification levels. Thanks to the low-complexity settings based only on the NP signal, the proposed approach provides a promising solution to SAHS assessment for remote healthcare. [ABSTRACT FROM AUTHOR]

Objective: To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA).Study Design: Case series study.Methods: Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability.Results: A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status.Conclusions: OSA in children is associated with increased BP and BP variability.Level Of Evidence: 4 Laryngoscope, 131:2126-2132, 2021. [ABSTRACT FROM AUTHOR]

Brain age is an imaging-based biomarker with excellent feasibility for characterizing individual brain health and may serve as a single quantitative index for clinical and domain-specific usage. Brain age has been successfully estimated using extensive neuroimaging data from healthy participants with various feature extraction and conventional machine learning (ML) approaches. Recently, several end-to-end deep learning (DL) analytical frameworks have been proposed as alternative approaches to predict individual brain age with higher accuracy. However, the optimal approach to select and assemble appropriate input feature sets for DL analytical frameworks remains to be determined. In the Predictive Analytics Competition 2019, we proposed a hierarchical analytical framework which first used ML algorithms to investigate the potential contribution of different input features for predicting individual brain age. The obtained information then served as a priori knowledge for determining the input feature sets of the final ensemble DL prediction model. Systematic evaluation revealed that ML approaches with multiple concurrent input features, including tissue volume and density, achieved higher prediction accuracy when compared with approaches with a single input feature set [Ridge regression: mean absolute error (MAE) = 4.51 years, R 2 = 0.88; support vector regression, MAE = 4.42 years, R 2 = 0.88]. Based on this evaluation, a final ensemble DL brain age prediction model integrating multiple feature sets was constructed with reasonable computation capacity and achieved higher prediction accuracy when compared with ML approaches in the training dataset (MAE = 3.77 years; R 2 = 0.90). Furthermore, the proposed ensemble DL brain age prediction model also demonstrated sufficient generalizability in the testing dataset (MAE = 3.33 years). In summary, this study provides initial evidence of how-to efficiency for integrating ML and advanced DL approaches into a unified analytical framework for predicting individual brain age with higher accuracy. With the increase in large open multiple-modality neuroimaging datasets, ensemble DL strategies with appropriate input feature sets serve as a candidate approach for predicting individual brain age in the future. [ABSTRACT FROM AUTHOR]

Objective: Cone‐beam computed tomography (CBCT) offers three‐dimensional structures in assessing upper airway of patients. This study aims to compare the cone‐beam computerized tomography scan measurements between children with obstructive sleep apnea (OSA) and primary snoring. Study Design: Case–control study. Methods: This prospective study was conducted in a tertiary referral center. Thirty‐six children with moderate‐to‐severe OSA (with apnea‐hypopnea index [AHI] > 5 events/hour) and 36 age‐, gender‐, and obesity‐matched children with primary snoring (AHI <1) were enrolled. The measurements in CBCT parameters were compared between children with moderate‐to‐severe OSA and primary snorers by conditional logistic regression model. Results: A total of 72 children (mean age, 7.9 ± 2.8 years; 64% male) were included. Children with moderate‐to‐severe OSA had a significantly smaller nasopharyngeal (2900 ± 1400 vs. 3800 ± 1800 mm3, P =.017) and oropharyngeal airway volume (5600 ± 2700 vs. 7400 ± 4000 mm3, P =.026) than those with primary snoring. Children with moderate‐to‐severe OSA, as compared to primary snorers, also had a significantly smaller minimal airway area in nasopharynx (77.4 ± 37.7 vs. 107.7 ± 52.0 mm2, P =.006) and oropharynx (66.6 ± 61.9 vs. 101.6 ± 65.8 mm2, P =.023). Moreover, the airway length was not significantly different between children with moderate‐to‐severe OSA and primary snoring. Conclusions: The three‐dimensional CBCT airway analysis could be used as a useful tool to evaluate upper airway in children with OSA. Level of Evidence: 3 Laryngoscope, 131:680–685, 2021 [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by the accumulation of toxic misfolded proteins, which are believed to have propagated from disease-specific epicenters through their corresponding large-scale structural networks in the brain. Although previous cross-sectional studies have identified potential AD-associated epicenters and corresponding brain networks, it is unclear whether these networks are associated with disease progression. Hence, this study aims to identify the most vulnerable epicenters and corresponding large-scale structural networks involved in the early stages of AD and to evaluate its associations with multiple cognitive domains using longitudinal study design. Annual neuropsychological and MRI assessments were obtained from 23 patients with AD, 37 patients with amnestic mild cognitive impairment (MCI), and 33 healthy controls (HC) for 3 years. Candidate epicenters were identified as regions with faster decline rate in the gray matter volume (GMV) in patients with MCI who progressed to AD as compared to those regions in patients without progression. These epicenters were then further used as pre-defined regions of interest to map the synchronized degeneration network (SDN) in HCs. Spatial similarity, network preference and clinical association analyses were used to evaluate the specific roles of the identified SDNs. Our results demonstrated that the hippocampus and posterior cingulate cortex (PCC) were the most vulnerable AD-associated epicenters. The corresponding PCC-SDN showed significant spatial association with the patterns of GMV atrophy rate in each patient group and the overlap of these patterns was more evident in the advanced stages of the disease. Furthermore, individuals with a higher GMV atrophy rate of the PCC-SDN also showed faster decline in multiple cognitive domains. In conclusion, our findings suggest the PCC and hippocampus are two vulnerable regions involved early in AD pathophysiology. However, the PCC-SDN, but not hippocampus-SDN, was more closely associated with AD progression. These results may provide insight into the pathophysiology of AD from large-scale network perspective. [ABSTRACT FROM AUTHOR]

The prevalence rate of obstructive sleep apnea (OSA) in the community Down syndrome (DS) children is not clear. Moreover, the impact of OSA and sleep structure on the cognitive function is inconclusive. The present study aimed to investigate 1) the prevalence rate of OSA in the community DS children and 2) the impact of OSA and sleep structure on cognitive performance. Thirty DS children aged 6–18 years were recruited and evaluated with the performance of the language domain and sensorimotor domain, combining neuropsychological tests and parent-rated behavior. The outcomes were the age-adjusted scores, of which the lower the score was, the better was the patient's ability. The association of score with OSA and sleep structures was determined by linear regression. To diminish the age-related difference, all analyses were conducted separately for all subjects and 6–12-year-old subjects. The median age was 11.3 years and median Full-Scale Intelligence Quotient (FSIQ) was 44. The prevalence of OSA (apnea–hypopnea index ≥ 1/h) was 80% and 62.5% in all subjects and 6–12-year-old subjects, respectively. For 6–12-year-old subjects, after adjustment for age and FSIQ, both %REM and OSA were associated with lower score of the subtest of language domain, WPPSI-R Vocabulary, while %REM was also associated with lower score of VABS-II Communication – Expressive. In contrary, % slow wave sleep was not associated with any subtest. This study identified that OSA may be highly prevalent in community DS children. Among 6–12-year-old DS children, OSA and % REM were associated with their language function. [ABSTRACT FROM AUTHOR]

Background: Whether the weaning outcome of solid cancer patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) is comparable to that in non-cancer patients is unknown. The aim of this study was to compare the weaning outcomes between non-cancer patients and patients with different types of cancer.Methods: We studied patients requiring MV during ICU stay for medical reasons between 2012 and 2014. Cancer patients were grouped into those with lung cancer (LC), head and neck cancer (HNC), hepatocellular carcinoma (HCC), and other cancers (OC). The primary endpoint was successful weaning at day 90 after the initiation of MV, and the main secondary endpoints were 28-day and 90-day mortality after ICU admission.Results: Five hundred and eighteen patients with solid cancers and 1362 non-cancer patients were recruited. The rate of successful weaning at day 90 was 57.9% in cancer patients, which was lower than 68.9% in non-cancer patients (p < 0.001). Compared to non-cancer patients, LC was associated with a lower probability of weaning at day 90 (hazard ratio 0.565, 95% CI 0.446 to 0.715), while HNC, HCC, and OC had similar probabilities. The 28-day and 90-day mortality rates were higher in cancer patients than in non-cancer patients (45.2% vs. 29.4%, and 65.6% vs. 37.7%, respectively, both p < 0.001).Conclusion: Among mechanically ventilated patients in the ICU, those with LC were associated with a lower probability of weaning at day 90 compared to non-cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea.Study Design: Prospective interventional study.Setting: Tertiary medical hospital.Subjects and Methods: Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight. The 24-hour ambulatory blood pressure was measured before and 6 months after surgery.Results: The study cohort enrolled 124 children: mean (SD) age, 7.3 (3.1) years; 73% boys. After surgery, the apnea-hypopnea index significantly decreased from 13.3 (18.1) to 3.3 (7.2) events per hour ( P < .001). Overall systolic blood pressure and diastolic blood pressure were not significantly different following surgery, while daytime systolic blood pressure was slightly increased (114.3 to 117.3 mm Hg, P < .01) postoperatively. The hypertensive group (n = 43) exhibited significantly decreased levels of overall diastolic, nighttime systolic, and nighttime diastolic blood pressure ( P < .05), and 54% of hypertensive children became nonhypertensive after surgery. The nonhypertensive group (n = 81) showed slightly increased levels of nocturnal overall systolic, daytime systolic, and nighttime systolic blood pressure. A generalized linear mixed model revealed that children with hypertension had a greater decrease in systolic and diastolic ambulatory blood pressure during the daytime and nighttime (all P < .05) than those without hypertension.Conclusions: Ambulatory blood pressure changes after adenotonsillectomy among children with obstructive sleep apnea are minimal. The decrease in ambulatory blood pressure after surgery is more prominent for hypertensive children than nonhypertensive children. [ABSTRACT FROM AUTHOR]

Objectives: Migraine and restless legs syndrome (RLS) are often comorbid and share elements of pathology; however, their neuroanatomical underpinnings are poorly understood. This study aimed to identify patterns of gray matter volume (GMV) alteration specific to and common among patients with RLS, migraine, and comorbid migraine and RLS. Methods: High‐resolution T1‐weighted images were acquired from 116 subjects: 27 RLS patients, 22 migraine patients, 22 patients with comorbid migraine and RLS, and 45 healthy controls. Direct group comparisons and conjunction analysis were first used to localize the distinct and shared neural signatures of migraine and RLS. We also investigated whether the shared neural signature could be replicated in an additional comorbid migraine/RLS group. Results: Compared with healthy controls, migraine patients showed GMV changes in the lateral occipital cortex, cerebellum, frontal pole, and middle frontal gyrus (MFG), and RLS patients showed GMV changes in the thalamus, middle temporal gyrus, anterior cingulate cortex, insular cortex, and MFG. In migraine, compared with RLS, GMV differences were found in the precuneus, lateral occipital and occipital fusiform cortex, superior frontal and precentral gyri, and cerebellum. Conjunction analyses for these disorders showed altered GMV in the MFG, also found in patients with comorbid migraine and RLS. The GMV of the MFG also correlated with sleep quality in patients with comorbid migraine and RLS. Interpretation: Migraine and RLS are characterized by shared and distinctive neuroanatomical characteristics, with a specific role of the MFG. These findings may be related to shared pathophysiology of these two distinct disorders. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the association between snoring, sleep quality, quantity, and blood pressure in third‐trimester normotensive pregnant women. Design: This study was a cross‐sectional analysis of two cohorts of healthy pregnant women recruited from a prenatal clinic in a medical center in Northern Taiwan. Methods: A total of 322 women reported sociodemographic and health characteristics in a structured interview and wore a wrist actigraph on their nondominant wrist for 7 consecutive days to assess objective sleep patterns. The women's resting blood pressures were measured while seated in the clinic by trained personnel using an electronic sphygmomanometer. Findings: One hundred thirty‐three (41.3%) women reported snoring. Ninety‐three women (28.9%) had <6 hr of nighttime sleep, with only 95 (29.5%) women averaging 7 or more hours of nighttime sleep. In the univariate analyses, snoring was positively associated with systolic and diastolic blood pressure as well as mean arterial pressure levels (p < .05). In the multivariate analyses, snoring remained as a significant predictor of higher diastolic blood pressure (β = 2.07, p < .05) and mean arterial pressure levels (β = 2.00, p < .05), after adjustment for age, parity, gestational age, body mass index before pregnancy, and sleep quantity and quality by actigraphy. Conclusions: Snoring is a highly prevalent condition experienced by healthy third‐trimester pregnant women and is associated with elevated blood pressure. Clinical Relevance: Clinical assessment and screening of snoring are of utmost importance in obstetric nursing practice to potentially prevent or reduce the associated adverse cardiovascular consequences in women during pregnancy. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort. Methods: We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model. Results: The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.037~1.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.265~3.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP). Conclusion: The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events. [ABSTRACT FROM AUTHOR]