Search

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

The American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year's sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.

We assessed the effects of consuming a U.S.-style healthy dietary pattern (HDP) with lean, unprocessed beef (BEEF) compared to a U.S.-style HDP without meat (vegetarian, VEG) on short-term changes in cardiometabolic disease (CMD) risk factors in adults classified as overweight or obese. Forty-one adults (22 females, 19 males; age 39.9 ± 8.0 y; BMI 29.6 ± 3.3 kg/m2; mean ± SD) completed two 5-week controlled feeding periods (randomized, crossover, controlled trial). For the BEEF HDP, two 3-oz (168-g) servings/d of lean, unprocessed beef were predominately substituted for some starchy vegetables and refined grains in the VEG HDP. Baseline and post-intervention measurements were fasting CMD risk factors, with serum low-density lipoprotein (LDL), total cholesterol (TC), and total apolipoprotein B as primary outcomes. VEG reduced LDL, insulin, and glucose compared to BEEF. Reductions did not differ between VEG vs. BEEF for TC, high-density lipoprotein (HDL), apolipoprotein A1, small, dense LDL IV, buoyant HDL2b, TC-to-HDL ratio, and systolic blood pressure. Total apolipoprotein B and all other CMD risk factors measured were not influenced by HDP type nor changed over time. Adopting a U.S.-style HDP that is either vegetarian or omnivorous with beef improved multiple cardiometabolic disease risk factors among adults classified as overweight or obese. [ABSTRACT FROM AUTHOR]

Perfluorosulfonic acid (PFSA) ionomer nanocomposites are a promising solution to address the poor ion selectivity of current membranes utilized in vanadium redox flow batteries. Herein, we investigate the impact of a casting substrate on the nanostructure and vanadium ion transport in bulk ionomer and ionomer nanocomposite membranes (i.e., films with thicknesses of ∼100 μm). Specifically, solution-cast ionomer nanocomposite membranes, containing either unfunctionalized (hydroxyl groups), amine-functionalized, or sulfonic acid-functionalized silica nanoparticles (SiNPs), were fabricated by casting on either a polished quartz or polytetrafluoroethylene (PTFE) substrates. Surprisingly, the choice of the casting substrate was seen to affect the bulk morphology of the PFSA ionomers, resulting in substrate-specific vanadium ion transport, where suppressed ion transport was observed for membranes cast on the polished quartz, when compared to their PTFE-cast counterparts. Additionally, the chemical composition of the substrate-adjacent surface was a function of both the substrate and the surface functionality of the SiNPs. Moreover, it was observed that both the chemical composition of the membrane surface and the substrate-induced changes to the bulk ionomer morphology governed vanadyl ion transport through the PFSA ionomers. Results from this work have direct implications for the design of next-generation ionomer nanocomposites, as the casting substrate used to fabricate these materials, and the orientation of these membranes inside the operating flow battery, can significantly influence transport of vanadium ions. [ABSTRACT FROM AUTHOR]

The article presents a case study of Exploding Head Syndrome (EHS) associated with central hypoventilatory hypopnea. Topics include the neurological mechanisms involved in the regulation of sleep-associated ventilation, the impact of opioid use, specifically chronic methadone use, on respiratory function and the development of EHS.