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Obstructive sleep apnea (OSA) is a common sleep disorder, and continuous positive airways pressure (CPAP) is the most effective treatment. Poor adherence is one of the major challenges in CPAP therapy. The recent boom of wearable optical sensors measuring oxygen saturation makes the at-home multiple-night CPAP titrations possible, which may essentially improve the adherence of CPAP therapy by optimizing its pressure in a real-life setting economically. We tested whether the oxygen desaturations (OD) measured in the arm muscle (arm_OD) by gold-standard frequency-domain multi-distance near-infrared spectroscopy (FDMD-NIRS) changes with titrated CPAP pressures in OSA patients together with polysomnography. We found that the arm_OD (2.08 ± 1.23%, mean ± standard deviation) was significantly smaller (P-value

Introduction With a 2% increase in sleep referrals and impact from COVID-19, a safer and more effective way of working was required. Historically CPAP is issued face-to-face (F2F), DTCC was introduced to increase patient capacity. The aim is to compare compliance and efficacy between DTCC and F2F appointments. Method Between 12/11/20 & 18/3/21 N=58 (44m & 14f) patients with confirmed Obstructive Sleep Apnoea (OSA) attended DTCC. Average Oxygen Desaturation Index (ODI) 15.45 (4.47-46), age 52.1yrs (29-86), BMI 31.92 (21-55), Mean SpO2 93.81% (81.68-96.69). Prior to DTCC patients watched demonstration video, paperwork was completed and machines pre-assigned. 10 minute appointment, patients were consented to AirView, mask size measured and post CPAP questionnaire plus brief instructions were given. First review at ~4 weeks, (use of ≥ 4 hrs/p/n.1 Weaver, TE) indicated compliance. Post ESS obtained and absolute Δ in ESS calculated to identify clinical outcomes. Data was analysis using Microsoft Excel. Results Compliance of 50% was achieved, N=29 (22m 7f), 29 patients either returned the machine, did not use or were non-compliant; (22m & 7f). ESS reduced by 5.36 (50.93%), however only 35 post CPAP questionnaires/ESS were returned. Average time for F2F appointment (~45 mins.) compared to DTCC (~15 mins.). (Table 1). Discussion DTCC shows small reduction in compliance when compared to 61% from data previous local study.2 Therefore DTCC is a time efficient alternative to F2F appointments with average reduction of ~30 minutes per patient. The DTCC will aid recovery post COVID, allowing increased outpatient capacity while reducing footfall. References Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy, proceedings of the american thoracic society 2008;5:173–178. EJ Oakham, M Unstead, AD McGown. CPAP compliance and symptomatic benefit: a comparison of patients established on CPAP from GP or preoperative screening. Thorax2017;2018:A1–A220.

Several recent studies have reported that a few patients had positive SARS-CoV-2 RNA tests after hospital discharge. The high-risk factors associated with these patients remain to be identified. A total of 463 patients with COVID-19 discharged from Leishenshan Hospital in Wuhan, China, between February 8 and March 8, 2020 were initially enrolled, and 351 patients with at least 2 weeks of follow-up were finally included. Seventeen of the 351 discharged patients had positive tests for SARS-CoV-2 RNA. Based on clinical characteristics and mathematical modeling, patients with shorter hospital stays and less oxygen desaturation were at higher risk of SARS-CoV-2 RNA reoccurrence after discharge. Notably, traditional Chinese medicine treatment offered extensive benefits to reduce risk. Particular attention should be paid to those patients with high risk, and traditional Chinese medicine should be advocated. Published version

The role that oxygen desaturation plays in exercise tolerance and its rehabilitative implications in patients with Parkinson’s disease (PD) are unclear. We aimed to test exercise tolerance and oxygen saturation levels both during exercise and at night in PD patients to better define their rehabilitative needs. In clinically stable PD patients, undergoing inpatient rehabilitation, and in “ON” phase, we prospectively assessed clinical data, sleepiness, comorbidities, PD severity (Hoehn&Yahr, HY), motor function (ADLs, UPDRSII and UPDRSIII, Barthel Index, Functional Independence Measure), balance, spirometry, respiratory muscles (MIP/MEP), peak cough expiratory flow (PCEF), continuous night oxygen monitoring, and meters at 6MWT. Of 55 patients analyzed (28 with moderate–severe PD, HY ≥ 2.5), 37% and 23% showed moderate–severe impairment on UPDRSII and UPDRSIII, respectively; 96% had reduced exercise tolerance and severe respiratory muscles impairment (MIP/MEP < 45% pred.); 21.8% showed desaturations during exercise; and 12.7% showed nocturnal desaturations. At multiple regression, low exercise tolerance and low mean nocturnal and exercise-induced saturation correlated with several respiratory and motor function and disability indices (all p < 0.03). Exercise tolerance, exercise-induced desaturations, and nocturnal desaturations were extremely frequent in PD patients and were worse in more severe PD patients. This suggests considering a combined role for motor and respiratory rehabilitation in these patients.

Objective: The primary objective of the present cross-sectional study is to evaluate the semantic language abilities of patients with Obstructive Sleep Apnea Syndrome (OSAS) compared to normative data. Secondary objectives are to examine the effects of OSAS comorbidities on language test performance.Method: 118 adult patients suffering from OSAS were assessed using standardized tests (Boston Naming Test, the Peabody Picture Vocabulary Test and the Verbal Fluency Test).Results: Compared to normative standards, the OSAS group (age and education adjusted mean) scored significantly lower on all tests (p < 0.01). The OSAS group also included a significantly higher percentage of persons scoring below the 5th percentile of the normative distribution on the four tests (p < 0.01). The Apnea/Hypopnea Index, O2 Desaturation index, SaO2 2 p < 0.05). Moreover, higher Apnea–Hypopnea Index score and night-time oxygen desaturation were associated with reduced phonemic and semantic fluency performance only among patients with a history of hypertension and hypercholesterolemia (p < 0.05). The moderating effect of diabetes and cardiovascular disease on the association between OSAS severity indices and test scores did not reach significance (p > 0.6).Conclusions: Results suggest that the severity of semantic language impairments in patients with OSAS is associated with the severity of the disease and intensified by common medical comorbidities (hypertension and hypercholesterolemia).

Aim of the study: To study presence of nocturnal oxygen desaturation with pulmonary hypertension. Results: The mean age of patients was 69.51 years. The mean duration of COPD was 4.14 years. The mean smoking index of study population was 401.32. Mean baseline SPO2. The mean BMI was 26.32 kg/m2. The mean hemoglobin level was 11.21 g/dL. The partial pressure of oxygen and carbon dioxide in desaturators and nondesaturators was 61.54 mmHg and 70.65 mmHg respectively. The presence of nocturnal hypoxemia has been postulated as the etiopathological factor resulting in the development of pulmonary hypertension in COPD patients. Conclusion: From the results of the present study, this can be concluded that 29 % of the normoxemic patients had significant nocturnal desaturation. The significant predictors of nocturnal desaturation are PaO2 and PaCO2.

BackgroundOlder adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care.Materials and methodsWe analyzed patients ≥50y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs.ResultsAmong 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry

Congenital cyanogenic heart disease (CCHD) is a malformation of the heart and large vessels characterized by an oxygen desaturation in the arterial blood, responsible for cyanosis. The general objective was to study the profile of CCHD in Senegalese hospitals. This is a retrospective study carried out over a period of 8 years (January 1, 2010 - December 31, 2017) and including all children aged 0 to 16 years followed for a CCHD. The hospital prevalence was 0.87% for 420 cases collected. The sex ratio was 1.44 and the average age at diagnosis was 16 months. First degree parental consanguinity was noted in 36 cases (30.78%). The main reasons for consultation were breathing difficulty in 242 cases (57.62%) and fever in 136 patients (32.36%). Apart from cyanosis, the clinical signs were dominated by the heart murmur in 313 cases (74.7%), tachycardia in 283 cases (67.38%) and digital hippocratism in 162 cases (38.57%). Cardiomegaly was found in 239 patients (83.36%). The main types of CCHD were tetralogy of Fallot and transposition of the large vessels. In biology, 206 patients (49.05%) presented polyglobulia. A complete surgical cure was carried out in 22 patients (5.24%). Complications were anoxic crisis (52 cases) and hemorrhagic syndrome (17 cases). There were 97 deaths (28.28%) during hospitalization. The diagnosis of CCHD is late in our country and surgical management is poor explaining the high mortality.

Alcohol is one of the most commonly used psychoactive substances in the community. Many individuals use alcohol for its sleep-promoting effects. Nonetheless, alcohol disrupts sleep through multiple mechanisms, such as disrupting electrophysiologic sleep architecture, triggering insomnia, and contributing to abnormalities of circadian rhythms and short sleep duration (SSD) in cross-sectional studies. Alcohol also increases breathing-related sleep events such as snoring and oxygen desaturation, especially in those with pre-existing problems. Emerging data demonstrate that insomnia may co-exist with SSD and circadian abnormalities. Future studies should unravel these tentative associations in individuals who misuse alcohol.

Screening instruments are poor predictors of the severity of pediatric obstructive sleep apnea (OSA). We hypothesized that their performance could be improved by identifying and eliminating redundant features. Baseline scores from three screening questionnaires for pediatric OSA were obtained from the Childhood Adenotonsillectomy Trial (CHAT). The questionnaires included the (i) modified Epworth sleepiness scale (ESS), (ii) the sleep-related breathing disorders subscale of the pediatric sleep questionnaire (PSQ), and the (iii) obstructive sleep apnea-18 (OSA-18) scale. Key features from each questionnaire were identified using variable selection methods. These selected features (SF) were then assessed for their ability to predict the severity of OSA, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). In addition, prediction performance of SF was also calculated for AHI > 5 and > 10 and ODI > 5 and > 10, respectively. Four hundred fifty-three children aged 5–10 years were included. The majority of the pairwise correlations among the items within the 3 screening questionnaires were statistically significant. The prediction of AHI and ODI by overall questionnaire scores was poor. Four-item SF, comprising apneic pauses, growth problems, mouth breathing, and obesity predicted AHI and ODI significantly better than each of the individual questionnaires. Furthermore, SF also predicted AHI > 5 and > 10, as well as ODI > 5 and > 10 significantly better than the original questionnaires. Elimination of redundant items in screening questionnaires improves their prediction performance for OSA severity in children with high pre-test probability for the condition.

Obstructive sleep apnoea syndrome (OSAS) increases the risk cardiovascular events regardless of the presence of previous cardiovascular disease. As both OSAS and coronary heart disease (CHD) have same risk factors it�s often difficult to quantify the proportion of each risk factor in developing cardiac events. The aim of this study was to evaluate the 10-year risk of developing a coronary heart disease (CHD) event or stroke in newly diagnosed OSAS patients. 65 patients diagnosed with OSAS over a period of four months in Oradea Sleep Laboratory were included. Demographic characteristics, anthropometric parameters, clinical and biochemical data, sleep disorder and daytime sleepiness assessment, results of polysomnography were collected in all patients. In 55 selected patients by age range from 34 to 74 years old, cardiovascular risk was assessed using Framingham score calculator. Statistical analysis was performed using SPSS-PC version 7.5 and Stata 10.The estimated 10-years risk of a CHD event was 18.97% (� 9.67) in all cases. It was higher in men (22.17% � 9.24) compare to women (12.39% � 6.92) and it was not significantly different by stages of OSAS severity (20.58% �9.41 in patients with severe OSAS versus 15.4% in mild OSAS), suggesting that apnea hypopnea index is not a major confounding factor. Desaturation of oxygen is a better outcome to define the relation between OSAS and cardiovascular diseases. OSAS and cardiovascular risk factors increased risk for future adverse cardiovascular events related to the severity of oxygen desaturation.

Study Objectives:The association between obstructive sleep apnea (OSA) and hypertension in prior studies has been determined using a definition of hypopnea requiring a 4% O2 desaturation. However, ...

Aims/objectives: To examine the effects of surgery for unilateral sinonasal lesions on sleep-disordered breathing (SDB).Material and methods: Oxygen desaturation index (3%ODI) as a marker o...

We postulate that using a simple pulse oximetry monitor (POM) to detect the severity of OSA will help clinical staff confirm the need for early treatment. Hence, we compared the POM-derived oxygen desaturation index (ODI) (events/h) with the polysomnography (PSG)-derived apnea–hypopnea index (AHI) (events/h). Our study is intended to validate the SpO2 measurements and related ODI4% and ODI3% (events/h) calculations from POM associated with AHI and ODI from PSG based on 2007 and 2012 criteria. All 73 participants (mean age: 51.04 ± 13.14 years old) underwent an overnight PSG test and wore wristwatch POMs (PULSOX 300i) to automatically collect POM oxygen saturation (SpO2) data. Pearson correlation and the Bland and Altman method were used to verify the correlation between POM and PSG. We found that the POM SpO2 and the PSG2007 and PSG2012 scores were significantly highly correlated (total record time [TRT] and lowest SpO2, R2 = 0.815 and 0.817; ODI4%, R2 = 0.912 and 0.863 and ODI3%, R2 = 0.930 and 0.914). AHI was significantly correlated with ODI4% and ODI3%, but ODI3% was nonsignificantly higher (ODI4%, r = 0.955–0.929; ODI3%, r = 0.965–0.956). Both the ODI3% and the ODI4% were highly diagnostically sensitive and specific. The ODI3% score with the AHI 15 events/h cutoff was nonsignificantly higher (area under the curve [AUC] = 0.99, AHI 15 events/h; AUC = 0.95, AHI 5 events/h). We conclude that the ODI3% score is a feasible early screening alternative for patients with moderate-to-severe OSA.

Background Preterm very low birth weight (VLBW) infants experience physiologic maturation and transitions off therapies from 32–35 weeks postmenstrual age (PMA), which may impact episodic bradycardia and oxygen desaturation. We sought to characterize bradycardias and desaturations from 32–35 weeks PMA and test whether events at 32 weeks PMA are associated with NICU length of stay. Methods For 265 VLBW infants from 32–35 weeks PMA, we quantified the number and duration of bradycardias (HR

Overnight pulse oximetry allows the relatively non-invasive estimation of peripheral blood haemoglobin oxygen saturations (SpO2 ), and forms part of the typical polysomnogram (PSG) for investigation of obstructive sleep apnoea (OSA). While the raw SpO2 signal can provide detailed information about OSA-related pathophysiology, this information is typically summarized with simple statistics such as the oxygen desaturation index (ODI, number of desaturations per hour). As such, this study reviews the technical methods for quantifying OSA-related patterns in oximetry data. The technical methods described in literature can be broadly grouped into four categories: (i) Describing the detailed characteristics of desaturations events; (ii) Time series statistics; (iii) Analysis of power spectral distribution (i.e. frequency domain analysis); and (d) Non-linear analysis. These are described and illustrated with examples of oximetry traces. The utilization of these techniques is then described in two applications. First, the application of detailed oximetry analysis allows the accurate automated classification of PSG-defined OSA. Second, quantifications which better characterize the severity of desaturation events are better predictors of OSA-related epidemiological outcomes than standard clinical metrics. Finally, methodological considerations and further applications and opportunities are considered.

Intermittent hypoxaemia is a risk factor for numerous diseases. However, the reverse pathway remains unclear. Therefore, we investigated whether pre-existing hypertension, diabetes or cardiovascular diseases are associated with the worsening of intermittent hypoxaemia. Among the included 2,535 Sleep Heart Health Study participants, hypertension (n = 1,164), diabetes (n = 170) and cardiovascular diseases (n = 265) were frequently present at baseline. All participants had undergone two polysomnographic recordings approximately 5.2 years apart. Covariate-adjusted linear regression analyses were utilized to investigate the difference in the severity of intermittent hypoxaemia at baseline between each comorbidity group and the group of participants free from all comorbidities (n = 1,264). Similarly, we investigated whether the pre-existing comorbidities are associated with the progression of intermittent hypoxaemia. Significantly higher oxygen desaturation index (β = 1.77 [95% confidence interval: 0.41–3.13], p = 0.011), desaturation severity (β = 0.07 [95% confidence interval: 0.00–0.14], p = 0.048) and desaturation duration (β = 1.50 [95% confidence interval: 0.31–2.69], p = 0.013) were observed in participants with pre-existing cardiovascular diseases at baseline. Furthermore, the increase in oxygen desaturation index (β = 3.59 [95% confidence interval: 1.78–5.39], p

Obstructive Sleep Apnea (OSA) is a syndrome characterized by episodes of airway obstruction, which causes oxygen desaturation events. These events can be identified by oximetry analysis and are used as one of the parameters to diagnose OSA. However, desaturation events have an inaccurate definition in manuals and in most of the literature. Thus, this work aims to evaluate whether different methodologies for the calculation of desaturation events impact the Oxygen Desaturation Index (ODI) and the diagnosis of OSA. The results indicated that the ODI values are significantly different from each other (p

Background Persistence of breathlessness after recovery from SARS-CoV-2 pneumonia is frequent. Recovery from acute respiratory failure (ARF) is usually determined by normalized arterial blood gases (ABGs), but the prevalence of persistent exercise-induced desaturation (EID) and dyspnea is still unknown. Methods We investigated the prevalence of EID in 70 patients with normal arterial oxygen at rest after recovery from ARF due to COVID-19 pneumonia. Patients underwent a 6-min walking test (6MWT) before discharge from hospital. We recorded dyspnea score and heart rate during 6MWT. We also investigated the possible role of lung ultrasound (LU) in predicting EID. Patients underwent a LU scan and scores for each explored area were summed to give a total LU score. Results In 30 patients (43%), oxygen desaturation was >4% during 6MWT. These patients had significantly higher dyspnea and heart rate compared to non-desaturators. LU score >8.5 was significantly able to discriminate patients with EID. Conclusion In SARS-CoV-2 pneumonia, ABGs at discharge cannot predict the persistence of EID, which is frequent. LU may be useful to identify patients at risk who could benefit from a rehabilitation program.

Altered cerebral perfusion has been reported in obstructive sleep apnea (OSA). Using dynamic susceptibility contrast MRI, we compared cerebral perfusion between male OSA patients and male healthy reference subjects and assessed correlations of perfusion abnormalities of OSA patients with sleep parameters and neuropsychological deficits at 3 T MRI, polysomnography and neuropsychological tests in 68 patients with OSA and 21 reference subjects. We found lower global and regional cerebral blood flow and cerebral blood volume, localized mainly in bilateral parietal and prefrontal cortices, as well as multiple focal cortical and deep structures related to the default mode network and attention network. In the correlation analysis between regional hypoperfusion and parameters of polysomnography, different patterns of regional hypoperfusion were distinctively associated with parameters of intermittent hypoxia and sleep fragmentation, which involved mainly parietal and orbitofrontal cortices, respectively. There was no association between brain perfusion and cognition in OSA patients in areas where significant association was observed in reference subjects, largely overlapping with nodes of the default mode network and attention network. Our results suggest that impaired cerebral perfusion in important areas of functional networks could be an important pathomechanism of neurocognitive deficits in OSA.

Introduction: Obstructive sleep apnoea (OSA) is defined and graded by thresholds of obstructive respiratory events and cyclic oxygen desaturations per hour while asleep. The aim of this study was to assess night-to-night variability of the oxygen desaturation index (ODI ≥4% dips) in a sleep clinic population. Methods: Adults referred for OSA evaluation who underwent two consecutive nocturnal pulse oximetries were eligible. Based on the mean ODI over two nights, participants were grouped into “no” (l5/h), “mild” (5-14.9/h), “moderate” (15-29.9/h), and “severe” (g30h) OSA. Outcomes were the change in ODI and coefficient of variation (CV) between repeated studies in different OSA severity categories, and changes in ODI ≥10/h, ≥15/h, and in severity. Data are reported as mean±SD. Results: 623 of 900 included adults (58±13 years) had OSA (ODI 21.8±21.4/h). The change in ODI between nights was 6.7±7.6/h and increased with OSA severity (table 1). A CV of 27±3% indicated a high night-to-night-variability. Within the group of mild OSA, 27% changed between “no OSA” and “mild OSA”. A change in ODI ≥10/h and ≥15/h was found in up to 43% and 29%, respectively, and increased with severity as well. A severity category change was found in 35% with OSA and was most likely in moderate OSA. Conclusion: The night-to-night variability in OSA severity, as measured by the ODI, is high and more than 1/3 of patients changed severity class within two nights. Sleep studies recorded during a single night need to be interpreted with caution and in conjunction with symptoms as part of a comprehensive sleep evaluation to allow informed treatment recommendations.

Recent studies indicate that ambient temperature may modulate obstructive sleep apnoea (OSA) severity. However, study results are contradictory warranting more investigation in this field. We analysed 19,293 patients of the European Sleep Apnoea Database (ESADA) cohort with restriction to the three predominant climate zones according to the Koppen-Geiger climate classification: Cfb (warm temperature, fully humid, warm summer), Csa (warm temperature, summer dry, hot summer), and Dfb (snow, fully humid, warm summer). Average outside temperature values were obtained and several hierarchical regression analyses were performed to investigate the impact of temperature on the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), time of oxygen saturation, Fundacao para a Ciencia e a Tecnologia (FCT), Portugal; European Union; ResMed Foundation; Philips Respironics Foundation; European Respiratory Society (ERS), RS received financial support by the Fundacao para a Ciencia e a Tecnologia (FCT), Portugal. We would like to thank the members of the Pneumology Department of the University Hospital Lisbon, in particular to Andreia Colaco (RN), Claudia Pereira (RN), Dina Fernandes (RN), and Cristina Barbara (MD, Professor) for their support. The ESADA network was founded during the COST action B26 supported by the European Union and is one of the Clinical Research Collaborations (CRC) funded by the European Respiratory Society (ERS). Unrestricted seeding grants from the ResMed Foundation and the Philips Respironics Foundation for establishment of the database in 2007 and 2011 are gratefully acknowledged. Non--financial support was provided by the European Sleep Research Society (ESRS) and the European Respiratory Society (ERS) in terms of logistics for communication, meetings, and data presentations for the ESADA collaborators.

Background Preoxygenation and application of apneic oxygenation are standard to prevent patients from desaturation e.g. during emergency intubation. The time before desaturation occurs can be prolonged by applying high flow oxygen into the airway. Aim of this study was to scientifically assess the flow that is necessary to avoid nitrogen entering the airway of a manikin model during application of pure oxygen via high flow nasal oxygen. Methods We measured oxygen content over a 20-min observation period for each method in a preoxygenated test lung applied to a human manikin, allowing either room air entering the airway in control group, or applying pure oxygen via high flow nasal oxygen at flows of 10, 20, 40, 60 and 80 L/min via nasal cannula in the other groups. Our formal hypothesis was that there would be no difference in oxygen fraction decrease between the groups. Results Oxygen content in the test lung dropped from 97 ± 1% at baseline in all groups to 43 ± 1% in the control group (p p = .715) and 10/L/min vs. 40 L/min group (p = .018), p was Conclusions Simulating apneic oxygenation in a preoxygenated manikin connected to a test lung over 20 min by applying high flow nasal oxygen resulted in the highest oxygen content at a flow of 10 L/min; higher flows resulted in slightly decreased oxygen percentages in the test lung.

IntroductionThe craniofacial abnormalities found in infants with cleft palate (CP) decrease their airway patency and increase their risk of obstructive sleep apnoea (OSA). We hypothesise that optimising sleep position in infants with CP may improve airway patency and offer a ‘low-cost, high-impact’ intervention to prevent the negative impacts of OSA. Because cleft centres give inconsistent advice about sleep position: some recommend back-lying and others side-lying, we will compare these in a randomised controlled trial.Methods and analysisThe aim is to determine the clinical effectiveness of side-lying as compared with back-lying sleep positioning in terms of reducing oxygen desaturation resulting from OSA in 244 infants aged 3–5 weeks of age, diagnosed with an isolated CP in/by UK cleft centres. Primary outcome is the 4% Oxygen Desaturation Index measured using pulse oximetry during sleep.Research plan1. Multicentre randomised controlled trial of side-lying compared with back-lying sleep positioning in reducing oxygen desaturation resulting from OSA in infants with CP at one month of age. 2. Internal pilot questionnaire-based study to support parents and clinicians regarding study participation, seeking to identify and address any barriers to recruitment. Monitoring data from the internal pilot will be used in the final analysis. 3. Co-development of new UK recommendations with Cleft Lip and Palate Association (CLAPA) regarding sleep position for infants with CP.Ethics and disseminationThe study protocol has received the favourable opinion of the West Midlands-South Birmingham Research Ethics Committee. Study results will be published on affiliated webpages and in peer-reviewed publications and conference contributions.Trial registration numberNCT04478201.

We aimed to determine whether bone-conducted acoustic stimulation could prematurely terminate sleep apnea events, thereby decreasing amplitude and duration of subsequent oxygen desaturation. As oxygen desaturation has been linked to cardiovascular consequences, we postulate this could be a viable therapy in some cases. Eight patients with severe Obstructive Sleep Apnea (2 women, 45 [20-68] y.o. Apnea-Hypopnea Index: 77.7 ± 22.3/h) underwent polysomnography at the Lausanne University Sleep Center. Short acoustic stimulations were administered by bone conduction every second event of sleep apnea. Sounds were remotely administered using a Dreem® headband worn by patients while undergoing nocturnal polysomnography. Amplitude (%) and duration(s) of oxygen desaturations following terminated apneas were compared to that of non-stimulated previous and subsequent events. 549 stimulations (68.6 ± 38 sounds per patient) in N1 (16.2%), N2 (69.9%), N3 (4.2%), and REM(9.6%) were conducted. Compared to the previous and subsequent non-stimulated apnea, stimulations reduced event duration by 21.4% (-3.4 ± 7.2 s, p < 0.0001) while oxygen desaturation amplitude and duration were reduced by 30.4% (mean absolute difference ± SD: -1.9 ± 2.8%, p < 0.0001), and 39.6% (-5.7 ± 9.2 s, p < 0.0001) respectively. For these variables, each patient showed a significant improvement following acoustic stimulation. Sound-associated discomfort was rated 1.14 ± 1.53 on an 8 points scale (8 = worst) and only 6.8% of emitted sounds were perceived by the patients, suggesting a well-tolerated intervention. Bone-conducted sound stimuli decreased apnea events duration as well as duration and amplitude of associated oxygen desaturations. Stimulations were well tolerated and rarely perceived by patients. This therapeutic approach deserves further investigation, with monitoring of effects on sleep quality, daytime function/sleepiness and cardiovascular parameters.

Producción Científica, This study focused on the automatic analysis of the airflow signal (AF) to aid in the diagnosis of pediatric obstructive sleep apnea (OSA). Thus, our aims were: (i) to characterize the overnight AF characteristics using discrete wavelet transform (DWT) approach, (ii) to evaluate its diagnostic utility, and (iii) to assess its complementarity with the 3% oxygen desaturation index (ODI3). In order to reach these goals, we analyzed 946 overnight pediatric AF recordings in three stages: (i) DWT-derived feature extraction, (ii) feature selection, and (iii) pattern recognition. AF recordings from OSA patients showed both lower detail coefficients and decreased activity associated with the normal breathing band. Wavelet analysis also revealed that OSA disturbed the frequency and energy distribution of the AF signal, increasing its irregularity. Moreover, the information obtained from the wavelet analysis was complementary to ODI3. In this regard, the combination of both wavelet information and ODI3 achieved high diagnostic accuracy using the common OSA-positive cutoffs: 77.97%, 81.91%, and 90.99% (AdaBoost.M2), and 81.96%, 82.14%, and 90.69% (Bayesian multi-layer perceptron) for 1, 5, and 10 apneic events/hour, respectively. Hence, these findings suggest that DWT properly characterizes OSA-related severity as embedded in nocturnal AF, and could simplify the diagnosis of pediatric OSA., Ministerio de Ciencia, Innovación y Universidades, Agencia Estatal de Investigación y Fondo Europeo de Desarrollo Regional (FEDER) - (Projects DPI2017-84280-R and RTC-2017-6516-1), Comisión Europea y Fondo Europeo de Desarrollo Regional (FEDER) - (POCTEP 0702_MIGRAINEE_2_E), Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER) - (CIBER-BBN), Ministerio de Ciencia e Innovación, Agencia Estatal de Investigación y Fondo Social Europeo - (grant RYC2019- 028566-I), Ministerio de Educación, Cultura y Deporte - (grant FPU16/02938), Institutes of Health - (grants HL130984, HL140548, and AG061824)