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Rationale: Obstructive sleep apnea (OSA) is associated with increased cardiovascular disease (CVD) risk. Conversely, OSA has not been shown to increase recurrent cardiovascular events in patients w...

STUDY OBJECTIVES: Mandibular advancement devices (MADs) constitute an alternative treatment in selected patients with OSA. A mandibular advanced position has been suggested to be beneficial, whereas its combination with an increased bite-raise may increase its adverse effects. The objective of this study was to assess upper airway (UA) volume and inspiratory pressure gradient variations in a group of 17 patients with OSA. The study was performed under 3 mandibular positions: intercuspal position (P1), MAD position in closed mouth (P2), and MAD position with an increased bite-raise (P3). METHODS: We conducted a 3-dimensional reconstruction of the pharynx using the finite element method via a computed tomography scan and the subsequent calculation using fluid-dynamic analysis. RESULTS: One hundred percent of the patients showed an increase in UA volume in both P2 and the MAD position with an increased bite-raise, P2 being the position where 76.47% of the patients showed the largest UA volume. P2/velopharynx was the position/region where the largest UA volume increase was achieved (4.73 mm(3)). A better gradient in P2 (mean = 0.62) in 58.82% of the patients and a better gradient in P3 (mean = 0.74) in 41.18% of patients respect P1 was observed. In 82.35% of patients, a better volume-pressure gradient match was also found. CONCLUSIONS: The best efficiency scores for both volume increase and better inspiratory pressure gradient were obtained in P2. This study findings suggest that in a MAD, the minimal bite opening position necessary for mandibular protrusion is more effective in increasing airway volume and inspiratory gradient compared to a larger bite-raising (15 mm). CITATION: Barbero M, Flores-Mir C, Blanco JC, et al. Tridimensional upper airway assessment in male patients with OSA using oral advancement devices modifying their vertical dimension. J Clin Sleep Med 2020;16(10):1721–1729.

To carry out both an objective and subjective assessment of the facial esthetics, clinical outcome, and quality of life evaluation in 25 OSAS patients treated with telegnathic surgery. Patients wer...

Introduction: DMD affects 1/3500 males. The most frequent cause of death is ventilatory failure.90% of patients who do not use MV die before 20 years. Aim: To describe the characteristics of patients with DMD treated in our hospital in the last 20 years Methods: Retrospective study. We collected:age, cardiopathy, date of death, use of MV and starting age, elective or after an exacerbation, ventilatory mode, use of Cough Assist, gastrostomy and scoliosis surgery. Functional tests and polygraphy previous starting respiratory theraphy were analyzed. Results: 19 DMD males.57,8% has MV and is controlled by Pulmonologists.52,3% require Cough Assist and 10,5% gastrostomy. Cardiac affectation in 57,8% and 36,8% has scoliosis surgery. During this time 5 patients died at the age of 26 +/- 6,52 years. MV was initiated in 11 patients at 19y(15-25) and mean time with MV was 6 y(1-9).90.9% non-invasive/1 Invasive.45.4% MV was initiated acutely during an admission. Characteristics of MV are shown in Table1. A combined Pediatric-Pneumology assestment has been started since 2017. Conclusions: DMD is a rare disease in our area.57,8% of patients require MV and Cough assist and are controlled by pulmonologists Mainly MV starts in the adolescence and in 45,4% of cases after an acute process. Recently, a process coordination between Pediatrics and Pulmonologists has begun to improve the care of these patients.

Sleep-Disordered Breathing in MD-1 patients are common:obstructive sleep apnea (OSA), central apneas and nocturnal hypoventilacion Aim: To determine whether there is a relationship between sleep breathing disorders and clinical parameters such as symptoms of OSA, pulmonary function and degree of neuromuscular impairment Methods: Retrospective descriptive study of MD-1patients. We collected:symptoms of OSA and/or nocturnal hypoventilation, spirometry, arterial blood gases and muscle pressures and sleep test results. We analyzed the factors related to the presence of moderate OSA (AHI >15) Results: Patient´s characteristics in figure1.47patients(51%men /49%women), mean age 47.8 with BMI ≥30 in 27.7%. Only 36% reported any symptoms of OSA and/or nocturnal hypoventilation. 87% presented an AHI>5, with central apnea predominance in 44%. Factors related to AHI>15 are presented in figure2. A low nocturnal SATO2, with a CT90>10% was related to have an AHI >15. No differences were found in age, sex, obesity, OSA symptoms, pCO2 levels or functional parameters (FVC, MIP, MEP). Conclusions: 1)OSA is very common in MD1, with a high number of central apneas.2)It cannot be predicted on the symptoms, functional respiratory test or diurnal hypercapnia.3)Having a low nocturnal SATO2 and a CT 90> 10% are related to an IAH>15.4)So, we believe that nocturnal oximetry can have an important role in determining when to perform a sleep test, which will be preferably a PSG with capnography

Melanoma is a highly prevalent cancer that is associated with substantial mortality. Although clinical staging procedures can serve as relatively robust prognostic indicators, we aimed to determine whether assessments of the abundance of hypoxia inducible factor-1α (HIF-1α) or vascular endothelial growth factor (VEGF) in postexcisional melanoma tumor tissues may enable more accurate determination of tumor aggressiveness. We carried out a multicenter prospective study, in which we systematically evaluated 376 consecutive patients diagnosed with melanoma, and performed histochemical assessments for both HIF-1α and VEGF immunoreactivity in the tumor biopsies. Multivariate analyses showed that higher HIF-1α expression, but not high VEGF, were associated significantly and independently with increased tumor aggressiveness as derived from several well-established aggressiveness criteria. A limitation of this study was that this was a descriptive prospective study lacking a post-hoc verification arm. Thus, the presence of increased numbers of positively labeled HIF-1α cells in melanoma tumors may potentially serve as an indicator of tumor phenotype and prognosis, and accordingly guide therapy.