1
|
Maghsoudipour M, Bosompra N, Jen R, Li Y, Moore S, DeYoung P, Fine J, Edwards B, Gilbertson D, Owens R, Morgan T, Malhotra A. 0690 An Evaluation Of Genioglossus Strengthening On Obstructive Sleep Apnea Treatment Outcomes. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal collapse. The genioglossus is a major upper airway dilator muscle thought to be important in OSA pathogenesis. Upper airway (UA) muscle training has reported benefits in some OSA patients. Our goal was to assess the effect of upper airway muscle training on OSA outcomes.
Methods
Sixty five patients with OSA (AHI>10/h) were divided in three subgroups: 1) Treated with auto-CPAP (n=21), 2) Previously failed or refused CPAP therapy (no treatment), (n=24), 3) Currently treated with an oral appliance who still have residual OSA (AHI>10/h), (n=20). All subjects were given a custom-made tongue strengthening device. Within each group we conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to UA muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with 1:1 ratio over 6 weeks of treatment (twice daily for 20 min/session). In the baseline and the final visit, subjects completed home sleep testing, questionnaires (ESS, PSQI), acoustic pharynogometry, Iowa Oral Performance Instrument (IOPI), and Psychomotor Vigilance Test (PVT).
Results
Results remain blinded; 33 patients received treatment Y and 32 patients received treatment Z. To date, we have not observed a main effect of treatment group on several measures of OSA severity. Some changes in subjective measures over time were observed but difficult to interpret until unblinding occurs.
Conclusion
Treatment of OSA using upper airway muscle training exercises requires further study. Whether muscle training is a viable approach for a definable subset of OSA patients remains unclear.
Support
R01HL085188-05A1 (U.S. NIH Grant/Contract)
Collapse
Affiliation(s)
| | - N Bosompra
- University of California San Diego, La Jolla, CA
| | - R Jen
- University of California San Diego, La Jolla, CA
| | - Y Li
- University of California San Diego, La Jolla, CA
| | - S Moore
- University of California San Diego, La Jolla, CA
| | - P DeYoung
- University of California San Diego, La Jolla, CA
| | - J Fine
- University of California San Diego, La Jolla, CA
| | - B Edwards
- University of California San Diego, La Jolla, CA
| | - D Gilbertson
- University of California San Diego, La Jolla, CA
| | - R Owens
- University of California San Diego, La Jolla, CA
| | - T Morgan
- University of California San Diego, La Jolla, CA
| | - A Malhotra
- University of California San Diego, La Jolla, CA
| |
Collapse
|
2
|
Jen R, Orr JE, Li Y, DeYoung P, Smales E, Malhotra A, Owens RL. Accuracy of WatchPAT for the Diagnosis of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:34-39. [PMID: 31965862 DOI: 10.1080/15412555.2019.1707789] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), termed the overlap syndrome (OVS), is associated with adverse outcomes that may be reversed with treatment. However, diagnosis is limited by the apparent need for in-laboratory polysomnography (PSG). WatchPAT is a portable diagnostic device that is validated for the diagnosis of OSA that might represent an attractive tool for the diagnosis of OVS.Subjects with established COPD were recruited from a general population. Subjects underwent PSG and simultaneous recording with WatchPAT. Pulmonary function testing and questionnaires were also performed.A total of 36 subjects were recruited and valid data was obtained on 33 (age 63 ± 7, BMI 28 ± 7, 61% male, FEV1 56 ± 20% predicted). There was no significant difference in the apnea-hypopnea index (AHI) between PSG and WatchPAT (19 ± 20 versus 20 ± 15 events/h; mean difference 2(-2, 5) events/h; p = 0.381). The AHI was not significantly different in rapid eye movement (REM) and non-rapid eye movement (NREM) determined by PSG versus REM and NREM determined by WatchPAT. WatchPAT slightly overestimated total and REM sleep time, and sleep efficiency. The sensitivity of WatchPAT at an AHI cut-off of ≥5, ≥15, and ≥30 events/h for corresponding PSG AHI cut-offs was 95.8, 92.3, and 88.9, respectively; specificity was 55, 65.0, and 95.8, respectively.WatchPAT is able to determine OSA reliably in patients with COPD. The availability of this additional diagnostic modality may lead to improved detection of OVS, which may in turn lead to improved outcomes for a group of COPD patients at high risk of poor outcomes.
Collapse
Affiliation(s)
- R Jen
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - J E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Y Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - P DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - E Smales
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - A Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - R L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
3
|
Peres B, Allen AH, Fox N, Laher I, Almeida F, Jen R, Ayas N. Obstructive sleep apnea (OSA) as a predictor of oxidative stress. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
4
|
Jen R, Puusepp-Benazzouz H, Nanan R. Oxygen Saturation in Infants With Retinopathy of Prematurity. JAMA Ophthalmol 2019; 137:1092. [DOI: 10.1001/jamaophthalmol.2019.2555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Roger Jen
- Paediatric Department, Nepean Hospital, Sydney, New South Wales, Australia
| | | | - Ralph Nanan
- Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Jen R, Li Y, DeYoung P, Smales E, Orr JE, Moore A, Malhotra A, Robert OL. 0475 COMPARISON OF PERIPHERAL ARTERIAL TONOMETRY AND POLYSOMNOGRAPHY FOR THE DIAGNOSIS OF OSA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
6
|
Ngoh EN, Weisser SB, Lo Y, Kozicky LK, Jen R, Brugger HK, Menzies SC, McLarren KW, Nackiewicz D, van Rooijen N, Jacobson K, Ehses JA, Turvey SE, Sly LM. Activity of SHIP, Which Prevents Expression of Interleukin 1β, Is Reduced in Patients With Crohn's Disease. Gastroenterology 2016; 150:465-76. [PMID: 26481854 DOI: 10.1053/j.gastro.2015.09.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Crohn's disease (CD) is associated with a dysregulated immune response to commensal micro-organisms in the intestine. Mice deficient in inositol polyphosphate 5'-phosphatase D (INPP5D, also known as SHIP) develop intestinal inflammation resembling that of patients with CD. SHIP is a negative regulator of PI3Kp110α activity. We investigated mechanisms of intestinal inflammation in Inpp5d(-/-) mice (SHIP-null mice), and SHIP levels and activity in intestinal tissues of subjects with CD. METHODS We collected intestines from SHIP-null mice, as well as Inpp5d(+/+) mice (controls), and measured levels of cytokines of the interleukin 1 (IL1) family (IL1α, IL1β, IL1ra, and IL6) by enzyme-linked immunosorbent assay. Macrophages were isolated from lamina propria cells of mice, IL1β production was measured, and mechanisms of increased IL1β production were investigated. Macrophages were incubated with pan-phosphatidylinositol 3-kinase inhibitors or PI3Kp110α-specific inhibitors. Some mice were given an antagonist of the IL1 receptor; macrophages were depleted from ilea of mice using clodronate-containing liposomes. We obtained ileal biopsies from sites of inflammation and peripheral blood mononuclear cells (PBMCs) from treatment-naïve subjects with CD or without CD (controls), and measured SHIP levels and activity. PBMCs were incubated with lipopolysaccharide and adenosine triphosphate, and levels of IL1β production were measured. RESULTS Inflamed intestinal tissues and intestinal macrophages from SHIP-null mice produced higher levels of IL1B and IL18 than intestinal tissues from control mice. We found PI3Kp110α to be required for macrophage transcription of Il1b. Macrophage depletion or injection of an IL1 receptor antagonist reduced ileal inflammation in SHIP-null mice. Inflamed ileal tissues and PBMCs from patients with CD had lower levels of SHIP protein than controls (P < .0001 and P < .0002, respectively). There was an inverse correlation between levels of SHIP activity in PBMCs and induction of IL1β production by lipopolysaccharide and adenosine triphosphate (R(2) = .88). CONCLUSIONS Macrophages from SHIP-deficient mice have increased PI3Kp110α-mediated transcription of Il1b, which contributes to spontaneous ileal inflammation. SHIP levels and activity are lower in intestinal tissues and peripheral blood samples from patients with CD than controls. There is an inverse correlation between SHIP activity and induction of IL1β production by lipopolysaccharide and adenosine triphosphate in PBMCs. Strategies to reduce IL1B might be developed to treat patients with CD found to have low SHIP activity.
Collapse
Affiliation(s)
- Eyler N Ngoh
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelley B Weisser
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Young Lo
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa K Kozicky
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Jen
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hayley K Brugger
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan C Menzies
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith W McLarren
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominika Nackiewicz
- Department of Surgery, Child & Family Research Institute, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nico van Rooijen
- Department of Molecular Cell Biology, Vrije Universiteit, Amsterdam, Netherlands
| | - Kevan Jacobson
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jan A Ehses
- Department of Surgery, Child & Family Research Institute, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart E Turvey
- Division of Allergy and Immunology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura M Sly
- Division of Gastroenterology, Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
7
|
Sharma AA, Jen R, Kan B, Sharma A, Marchant E, Tang A, Gadawski I, Senger C, Skoll A, Turvey SE, Sly LM, Côté HCF, Lavoie PM. Impaired NLRP3 inflammasome activity during fetal development regulates IL-1β production in human monocytes. Eur J Immunol 2014; 45:238-49. [PMID: 25311115 DOI: 10.1002/eji.201444707] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/04/2014] [Accepted: 10/08/2014] [Indexed: 02/06/2023]
Abstract
Interleukin-1β (IL-1β) production is impaired in cord blood monocytes. However, the mechanism underlying this developmental attenuation remains unclear. Here, we analyzed the extent of variability within the Toll-like receptor (TLR)/NLRP3 inflammasome pathways in human neonates. We show that immature low CD14 expressing/CD16(pos) monocytes predominate before 33 weeks of gestation, and that these cells lack production of the pro-IL-1β precursor protein upon LPS stimulation. In contrast, high levels of pro-IL-1β are produced within high CD14 expressing monocytes, although these cells are unable to secrete mature IL-1β. The lack of secreted IL-1β in these monocytes parallels a reduction of NLRP3 induction following TLR stimulation resulting in a lack of caspase-1 activity before 29 weeks of gestation, whereas expression of the apoptosis-associated speck-like protein containing a CARD and function of the P2×7 receptor are preserved. Our analyses also reveal a strong inhibitory effect of placental infection on LPS/ATP-induced caspase-1 activity in cord blood monocytes. Lastly, secretion of IL-1β in preterm neonates is restored to adult levels during the neonatal period, indicating rapid maturation of these responses after birth. Collectively, our data highlight important developmental mechanisms regulating IL-1β responses early in gestation, in part due to a downregulation of TLR-mediated NLRP3 expression. Such mechanisms may serve to limit potentially damaging inflammatory responses in a developing fetus.
Collapse
Affiliation(s)
- Ashish A Sharma
- Child & Family Research Institute, Vancouver, BC, Canada; Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Weisser SB, Kozicky LK, Brugger HK, Ngoh EN, Cheung B, Jen R, Menzies SC, Samarakoon A, Murray PJ, Lim CJ, Johnson P, Boucher JL, van Rooijen N, Sly LM. Arginase activity in alternatively activated macrophages protects PI3Kp110δ deficient mice from dextran sodium sulfate induced intestinal inflammation. Eur J Immunol 2014; 44:3353-67. [DOI: 10.1002/eji.201343981] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 07/25/2014] [Accepted: 08/12/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Shelley B. Weisser
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Lisa K. Kozicky
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Hayley K. Brugger
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Eyler N. Ngoh
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Bonnie Cheung
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Roger Jen
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Susan C. Menzies
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| | - Asanga Samarakoon
- Department of Microbiology and Immunology; University of British Columbia; Vancouver British Columbia Canada
| | - Peter J. Murray
- Departments of Infectious Diseases and Immunology; St Jude's Children's Research Hospital; Memphis TN USA
| | - C. James Lim
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
- Division of Hematology, Oncology, BMT, Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
| | - Pauline Johnson
- Department of Microbiology and Immunology; University of British Columbia; Vancouver British Columbia Canada
| | | | - Nico van Rooijen
- Department of Molecular Cell Biology; Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - Laura M. Sly
- Division of Gastroenterology; Department of Pediatrics; University of British Columbia; Vancouver British Columbia Canada
- Child & Family Research Institute, BC Children's Hospital; Vancouver British Columbia Canada
| |
Collapse
|
9
|
Sharma AA, Jen R, Brant R, Ladd M, Huang Q, Skoll A, Senger C, Turvey SE, Marr N, Lavoie PM. Hierarchical maturation of innate immune defences in very preterm neonates. Neonatology 2014; 106:1-9. [PMID: 24603545 PMCID: PMC4556450 DOI: 10.1159/000358550] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/13/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preterm neonates are highly vulnerable to infection. OBJECTIVES To investigate the developmental contribution of prematurity, chorioamnionitis and antenatal corticosteroids (ANS) on the maturation of neonatal microbial pathogen recognition responses. METHODS Using standardized protocols, we assayed multiple inflammatory cytokine responses (IL-1β, IL-6, TNF-α and IL-12/23p40) to three prototypic Toll-like receptor (TLR) agonists, i.e. TLR4 (lipopolysaccharide), TLR5 (flagellin) and TLR7/8 (R848), and to the non-TLR retinoic acid-inducible gene I (RIG-I)-like receptor agonist, in cord blood mononuclear cells from neonates born before 33 weeks of gestation and at term. RESULTS TLR responses develop asynchronously in preterm neonates, whereby responses to TLR7/8 were more mature and were followed by the development of TLR4 responses, which were also heterogeneous. Responses to TLR5 were weakest and most immature. Maturity in TLR responses was not influenced by sex. Overall, we detected no significant contribution of ANS and chorioamnionitis to the developmental attenuation of either TLR or RIG-I responses. CONCLUSIONS The maturation of anti-microbial responses in neonates born early in gestation follows an asynchronous developmental hierarchy independently of an exposure to chorioamnionitis and ANS. Our data provide an immunological basis for the predominance of specific microbial infections in this age group.
Collapse
|
10
|
Sharma AA, Jen R, Butler A, Lavoie PM. The developing human preterm neonatal immune system: a case for more research in this area. Clin Immunol 2012; 145:61-8. [PMID: 22926079 DOI: 10.1016/j.clim.2012.08.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/07/2012] [Accepted: 08/08/2012] [Indexed: 12/23/2022]
Abstract
Neonates, particularly those born prematurely, are among the most vulnerable age group for morbidity and mortality due to infections. Immaturity of the innate immune system and a high need for invasive medical procedures in the context of a preterm birth make these infants highly susceptible to common neonatal pathogens. Preterm infants who survive may also suffer permanent disabilities due to organ damage resulting from either the infection itself or from the inflammatory response generated under an oxidative stress. Infections in preterm infants continue to pose important healthcare challenges. Yet, developmental maturation events in the innate immune system that underlie their excessively high vulnerability to infection remain largely understudied. In this review article, we identify pertinent knowledge gaps that must be filled in order to orient future translational research.
Collapse
|