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Kawamura LRDSM, Sarmet M, de Campos PS, Takehara S, Kumei Y, Zeredo JLL. Apnea behavior in early- and late-stage mouse models of Parkinson's disease: Cineradiographic analysis of spontaneous breathing, acute stress, and swallowing. Respir Physiol Neurobiol 2024; 323:104239. [PMID: 38395210 DOI: 10.1016/j.resp.2024.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
This study aimed to evaluate the timing and frequency of spontaneous apneas during breathing and swallowing by using cineradiography on mouse models of early/initial or late/advanced Parkinson's disease (PD). C57BL/6 J mice received either 6-OHDA or vehicle injections into their right striatum, followed by respiratory movement recordings during spontaneous breathing and swallowing, and a stress challenge, two weeks later. Experimental group animals showed a significantly lower respiratory rate (158.66 ± 32.88 breaths/minute in late PD, 173.16 ± 25.19 in early PD versus 185.27 ± 25.36 in controls; p<0.001) and a significantly higher frequency of apneas (median 1 apnea/minute in both groups versus 0 in controls; p<0.001). Other changes included reduced food intake and the absence of swallow apneas in experimental mice. 6-OHDA-induced nigrostriatal degeneration in mice disrupted respiratory control, swallowing, stress responsiveness, and feeding behaviors, potentially hindering airway protection and elevating the risk of aspiration.
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Affiliation(s)
| | - Max Sarmet
- Graduate Program in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
| | | | - Sachiko Takehara
- Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yasuhiro Kumei
- Department of Pathological Biochemistry, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jorge Luis Lopes Zeredo
- Graduate Program in Health Sciences, University of Brasilia, Brasilia, Brazil; Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA.
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Umezu HL, Bittencourt-Silva PG, Mourão FAG, Moreira FA, Moraes MFD, Santos VR, da Silva GSF. Respiratory activity during seizures induced by pentylenetetrazole. Respir Physiol Neurobiol 2024; 323:104229. [PMID: 38307440 DOI: 10.1016/j.resp.2024.104229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
This study investigated the respiratory activity in adult Wistar rats across different behavioral seizure severity induced by pentylenetetrazole (PTZ). Animals underwent surgery for electrodes implantation, allowing simultaneous EEG and diaphragm EMG (DIAEMG) recordings and the respiratory frequency and DIAEMG amplitude were measured. Seizures were acutely induced through PTZ injection and classified based on a pre-established score, with absence-like seizures (spike wave discharge (SWD) events on EEG) representing the lowest score. The respiratory activity was grouped into the different seizure severities. During absence-like and myoclonic jerk seizures, the breathing frequency decreased significantly (∼50% decrease) compared to pre- and post-ictal periods. Pronounced changes occurred with more severe seizures (clonic and tonic) with periods of apnea, especially during tonic seizures. Apnea duration was significantly higher in tonic compared to clonic seizures. Notably, during PTZ-induced tonic seizures the apnea events were marked by tonic DIAEMG contraction (tonic-phase apnea). In the majority of animals (5 out of 7) this was a fatal event in which the seizure-induced respiratory arrest preceded the asystole. In conclusion, we provide an assessment of the respiratory activity in the PTZ-induced acute seizures and showed that breathing dysfunction is more pronounced in seizures with higher severity.
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Affiliation(s)
- Hanna L Umezu
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil
| | - Paloma G Bittencourt-Silva
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil
| | - Flávio A G Mourão
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil; Graduate Program in Neuroscience, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil
| | - Fabrício A Moreira
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil
| | - Márcio Flávio D Moraes
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil; Graduate Program in Neuroscience, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil
| | - Victor R Santos
- Department of Morphology, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil
| | - Glauber S F da Silva
- Department of Physiology and Biophysics, Institute of Biological Science, Federal University of Minas Gerais (ICB/UFMG), Belo Horizonte, Brazil.
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Francisco GR, Simões JLB, de Carvalho Braga G, Guerra PH, Bagatini MD. The outcomes of growth hormone therapy in the obstructive sleep apnea parameters of Prader-Willi syndrome patients: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:2235-2242. [PMID: 38133808 DOI: 10.1007/s00405-023-08406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Prader-Willi syndrome is a serious genetic condition, capable of causing endocrinological imbalance, which has as one of its main treatments the growth hormone therapy. However, this therapy still causes some uncertainty concerning its effects on the respiratory parameters of those patients, especially in cases of obstructive sleep apnea, therefore, presenting a need for the analysis of the relationship between the therapy and the otolaryngologic condition. METHODS A systematic review following the PRISMA model was developed, with searches for keywords made in the databases PubMed (MEDLINE), Scopus, and Web of Science and registration in the PROSPERO platform (CRD42023404250). RESULTS Three randomized controlled trials were considered eligible for inclusion in the review. None of the studies demonstrated statistically significant modifications in the obstructive sleep apnea parameters of Prader-Willi patients related to the growth hormone administration. CONCLUSIONS Growth hormone therapy is safe for Prader-Willi syndrome patients when analyzing their obstructive sleep apnea parameters.
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Zanusso F, De Benedictis GM, Bellini L. Exploring oxygen reserve index for timely detection of deoxygenation in canine patients recovering from anesthesia. Res Vet Sci 2024; 173:105268. [PMID: 38631076 DOI: 10.1016/j.rvsc.2024.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
Pulse oximetry (SpO2) identifies a decrease in the partial pressure of oxygen (PaO2) when it falls below 80 mmHg, while oxygen reserve index (ORi), a dimensionless index ranging from 0 to 1, detects PaO2 changes between 100 and 200 mmHg. This study investigates the usefulness of ORi in detecting impending deoxygenation before traditional SpO2. Fifty-one dogs undergoing anesthesia were mechanically ventilated maintaining a fraction of inspired oxygen of 0.50 and an ORi of 1. Animals were classified according to their body condition score (BCS) as normal-fit (BCS 4-5/9), overweight (BCS 6-7/9), or obese (BCS 8-9/9). At the end of the procedure, dogs were placed in sternal recumbency, and after 10 min disconnected from the ventilator and maintained in apnea. ORi added warning time was determined at various ORi values as the time difference in reaching SpO2 of 95% from ORi of 0.9 and 0.5, compared to the SpO2 warning time from SpO2 of 98%. During apnea, ORi decreased before noticeable SpO2 changes. An ORi of 0.9 anticipated an SpO2 of 95% in normal-fit dogs by 87 (33-212) [median (range)] seconds or in those with a BCS ≥ 6/9 by 49 (7-161) seconds. Regardless of the BCS class, the median time from ORi of 0.5 to SpO2 of 95% was 30-35 s. ORi declined from 0.9 to 0.0 in 68 compared to 33 s between normal-fit and obese dogs (p < 0.05). In dogs, ORi added warning time could facilitate timely intervention, particularly in obese patients.
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Affiliation(s)
- Francesca Zanusso
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy
| | - Giulia Maria De Benedictis
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy
| | - Luca Bellini
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy.
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Emara TA, Elmonem MSAA, Khaled AM, Genedy HAH, Youssef RS. Anterolateral advancement pharyngoplasty versus barbed reposition pharyngoplasty in patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2024; 281:1991-2000. [PMID: 38170209 PMCID: PMC10943148 DOI: 10.1007/s00405-023-08402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare functional outcomes and complication rates of anterolateral advancement pharyngoplasty (ALA) versus barbed reposition pharyngoplasty (BRP) in the treatment of obstructive sleep apnea patients with palatal and lateral pharyngeal wall collapse. STUDY DESIGN Prospective study. SETTING University hospitals. SUBJECTS AND METHODS Forty-six patients were included in this study. Patients were divided into two groups randomly, group 1 (23 cases) underwent anterolateral advancement pharyngoplasty and group 2 (23 cases) underwent barbed relocation pharyngoplasty. According to the following criteria: both sex, age between 18 and 65 years, body mass index ≤ 32 kg/m2, Friedman stage II or III, type I Fujita, nocturnal polysomnography study diagnostic for OSA, retropalatal and lateral pharyngeal wall collapse, diagnosis with flexible nasoendoscopy during a Muller's maneuver based on a 5-point scale and drug-induced sleep endoscopy. Patients who suffered from retroglossal airway collapse were rolled out. RESULTS Apnea-hypopnea index decreased from 27.50 ± 11.56 to 11.22 ± 7.63 (P ≤ .001) in group 1 and from 33.18 ± 10.94 to 12.38 ± 6.77 (P ≤ .001) in group 2. Retropalatal posterior airway space increased from 9.84 ± 1.29 mm to 21.48 ± 2.8 mm (P ≤ .001) in group 1 and increased from 10.26 ± 1.2 mm to 22.86 ± 2.62 mm (P ≤ .001) in group 2. Retropalatal space volume increased from 1.9 ± 0.68 cm3 to 2.75 ± 0.7 cm3 (P ≤ .001) in group 1 and increased from 1.96 ± 0.88 cm3 to 2.82 ± 0.83 cm3 (P ≤ .001) in group 2. Surgical success was 86.95% in group 1 compared to 82.6% in group 2. CONCLUSIONS Both techniques appear to be effective with a high surgical success rate in the treatment of OSA patients with retropalatal and lateral pharyngeal wall collapse.
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Affiliation(s)
| | | | | | - Hisham Ahmed Hasan Genedy
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
- Faculty of Medicine, ENT Department, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Sayed Youssef
- Faculty of Medicine, ENT Department, Beni-Suef University, Beni Suef, Egypt.
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Malhotra A, Bednarik J, Chakladar S, Dunn JP, Weaver T, Grunstein R, Fietze I, Redline S, Azarbarzin A, Sands SA, Schwab RJ, Bunck MC. Tirzepatide for the treatment of obstructive sleep apnea: Rationale, design, and sample baseline characteristics of the SURMOUNT -OSA phase 3 trial. Contemp Clin Trials 2024; 141:107516. [PMID: 38547961 DOI: 10.1016/j.cct.2024.107516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Weight reduction is a standard recommendation for obstructive sleep apnea (OSA) treatment in people with obesity or overweight; however, weight loss can be challenging to achieve and maintain without bariatric surgery. Currently, no approved anti-obesity medication has demonstrated effectiveness in OSA management. This study is evaluating the efficacy and safety of tirzepatide for treatment of moderate to severe OSA in people with obesity. METHODS SURMOUNT-OSA, a randomized, placebo -controlled, 52-week phase 3 trial, is investigating the efficacy and safety of tirzepatide for treatment of moderate to severe OSA (apnea hypopnea- index ≥15 events/h) in participants with obesity (body mass index ≥30 kg/m2) and an established OSA diagnosis. SURMOUNT-OSA is made of 2 intervention-specific appendices (ISAs): ISA-1 includes participants with no current OSA treatment, and ISA-2 includes participants using positive airway pressure therapy. Overall, 469 participants have been randomized 1:1 to receive tirzepatide or placebo across the master protocol (ISA-1, n = 234; ISA-2, n = 235). All participants are also receiving lifestyle intervention for weight reduction. RESULTS The primary endpoint for the individual ISAs is the difference in apnea hypopnea- index response, as measured by polysomnography, between tirzepatide and placebo arms at week 52. Secondary endpoints include sleep apnea-specific hypoxic burden, functional outcomes, and cardiometabolic biomarkers. The trial employs digital wearables, including home sleep testing to capture time to improvement and accelerometry for daily physical activity assessment, to evaluate exploratory outcomes. CONCLUSION SURMOUNT-OSA brings a novel design to investigate if tirzepatide provides clinically meaningful improvement in obesity-related OSA by targeting the underlying etiology. TRIAL REGISTRATION ClinicalTrials.gov, NCT05412004.
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Affiliation(s)
- Atul Malhotra
- University of California San Diego, La Jolla, CA, USA.
| | | | | | | | - Terri Weaver
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA; University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ron Grunstein
- Woolcock Institute of Medical Research and Royal Prince Alfred Hospital, Sydney, Australia
| | - Ingo Fietze
- Centre of Sleep Medicine, Charité University Hospital Berlin, Berlin, Germany
| | | | | | | | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Varol Y, Uçar ZZ, Oktay Arslan B, Karasu I. Apnea-hypopnea index and the polysomnographic risk factors for predicting 5- to 8-year mortality in patients with OSA. Sleep Breath 2024; 28:103-112. [PMID: 37422579 DOI: 10.1007/s11325-023-02868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the long-term mortality rates of patients with obstructive sleep apnea (OSA) who received an overnight polysomnogram (PSG) for obtaining the diagnosis and to determine the relationship between PSG parameters and overall mortality. METHODS Between 2007 and 2013, patients who had overnight PSG and were diagnosed with OSA were included in the study. Factors which are thought to influence mortality were assessed for 5-year and overall survival using the log rank test and Kaplan-Meier survival curves. Using multivariable Cox regression analysis, a model was constructed for factors influencing 5-year and overall survival. RESULTS A total of 762 patients with a mean age of 52.7 (±10.8) and a dominance of men (74.7%) were studied. Gender, OSA severity subgroups, and apnea hypopnea index (AHI) were not statistically significantly associated with either 5-year or overall mortality (p<0.05 for both). Age, having a cardiovascular comorbidity, proportion of rapid eye movement (%REM), and total sleep time with an oxyhemoglobin saturation of less than 90% (T90) all showed a significant correlation with overall all-cause mortality in the model. For 5-year mortality and overall mortality, the hazard ration (HR) for T90 was 3.6 (95% CI (1.6-8.0) p=0.001) and 3 (95% CI (1.6-5.7) p=0.001), respectively. CONCLUSION The study findings suggest that not AHI but PSG parameters of hypoxia, mainly T90, having cardiovascular comorbidity, and %REM sleep were significant risk factors for all-cause mortality in patients with OSA. The association of OSA, hypoxia, and mortality is an area that deserves further study.
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Affiliation(s)
- Yelda Varol
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey.
| | - Zeynep Zeren Uçar
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Burcu Oktay Arslan
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Işıl Karasu
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, Izmir, Turkey
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Ribeiro LDJA, Bastos VHDV, Coertjens M. Breath-holding as model for the evaluation of EEG signal during respiratory distress. Eur J Appl Physiol 2024; 124:753-760. [PMID: 38105311 DOI: 10.1007/s00421-023-05379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Research describes the existence of a relationship between cortical activity and the regulation of bulbar respiratory centers through the evaluation of the electroencephalographic (EEG) signal during respiratory challenges. For example, we found evidences of a reduction in the frequency of the EEG (alpha band) in both divers and non-divers during apnea tests. For instance, this reduction was more prominent in divers due to the greater physiological disturbance resulting from longer apnea time. However, little is known about EEG adaptations during tests of maximal apnea, a test that voluntarily stops breathing and induces dyspnea. RESULTS Through this mini-review, we verified that a protocol of successive apneas triggers a significant increase in the maximum apnea time and we hypothesized that successive maximal apnea test could be a powerful model for the study of cortical activity during respiratory distress. CONCLUSION Dyspnea is a multifactorial symptom and we believe that performing a successive maximal apnea protocol is possible to understand some factors that determine the sensation of dyspnea through the EEG signal, especially in people not trained in apnea.
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Affiliation(s)
- Lucas de Jesus Alves Ribeiro
- Physiotherapy Department, Universidade Federal do Delta do Parnaíba, Av. São Sebastião, CEP: 64.202-020, Parnaíba, PI, 2819, Brazil
- Brain Mapping and Functionality Laboratory, Universidade Federal do Delta do Parnaíba, Piauí, Brazil
| | - Victor Hugo do Vale Bastos
- Physiotherapy Department, Universidade Federal do Delta do Parnaíba, Av. São Sebastião, CEP: 64.202-020, Parnaíba, PI, 2819, Brazil
- Postgraduate Program in Biomedical Sciences, Universidade Federal do Delta do Parnaíba, Piauí, Brazil
- Brain Mapping and Functionality Laboratory, Universidade Federal do Delta do Parnaíba, Piauí, Brazil
| | - Marcelo Coertjens
- Physiotherapy Department, Universidade Federal do Delta do Parnaíba, Av. São Sebastião, CEP: 64.202-020, Parnaíba, PI, 2819, Brazil.
- Postgraduate Program in Biomedical Sciences, Universidade Federal do Delta do Parnaíba, Piauí, Brazil.
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De Weerdt S, Schotte C, Barbé K, Verbanck S, Verbraecken J. The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea. Sleep Breath 2024; 28:69-78. [PMID: 37418222 DOI: 10.1007/s11325-023-02859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Little is known about type D personality in patients with obstructive sleep apnea (OSA). The DS-14 questionnaire is the standard tool to assess this personality type, but it has not been properly validated in patients with OSA, nor has it been correlated with clinical features in these patients. PURPOSE To determine the internal consistency and test-retest reliability of the DS-14 questionnaire, as well as the prevalence of type D personality in the overall OSA sample and subgroups. We assessed the influence of type D on perceived symptoms and its congruence with self-reported measures of personality, depression, fatigue, anxiety, quality of life, and quality of sleep. METHODS Patients with OSA completed the DS-14 questionnaire, Big Five Inventory-2 questionnaire, Hospital Anxiety and Depression Scale, SF-36 Health Survey Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index, Fatigue Assessment Scale, and Checklist Individual Strength. After 1 month, the DS-14 questionnaire was repeated. RESULTS The overall prevalence of type D personality was 32%. Internal consistency (negative affectivity: α = 0.880, social inhibition: α = 0.851) and diagnostic test-retest reliability (kappa value = 0.664) of the DS-14 questionnaire were high. Significantly more symptoms of anxiety, depression, poor sleep quality, fatigue, and a worse health perception were found in OSA with type D. Neither OSA severity nor REM predominance altered these observations. CONCLUSION The DS-14 questionnaire showed excellent psychometric properties in patients with OSA. The prevalence of type D personality in patients with OSA was higher than in the general population. The presence of type D personality was associated with higher symptom burden.
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Affiliation(s)
- Sonia De Weerdt
- Sleep Laboratory, UZ Brussels, Laarbeeklaan 101, 1090, Jette, Belgium.
| | - Christiaan Schotte
- Faculty of Psychology and al Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kurt Barbé
- Research Group Biostatistics and Medical Informatics (BISI), Free University of Brussels (VUB), Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Dupont A, Ciener D, Monteilh C, Bharath A, Thomas A, Wolpert K, Pearce J. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric Sedation Complications. MedEdPORTAL 2024; 20:11384. [PMID: 38352651 PMCID: PMC10861802 DOI: 10.15766/mep_2374-8265.11384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 02/16/2024]
Abstract
Introduction Ketamine and propofol are commonly used agents for sedation in the pediatric emergency department (PED). While these medications routinely provide safe sedations, there are side effects providers should be able to recognize and manage. Currently, no pediatric sedation simulations exist in the literature. Methods We created two sedation simulation cases for learners, including pediatric emergency medicine (PEM) fellows, working in the PED: case 1, a 12-year-old male with a shoulder dislocation requiring reduction under propofol sedation, and case 2, a forearm fracture requiring reduction under ketamine sedation. Learner actions included setting up equipment for sedations, dosing medications correctly, and managing complications. Additionally, in case 2, learners assigned an American Society of Anesthesiologists classification and selected the appropriate candidate for PED sedation from amongst three patients. A debrief followed the cases. Next, a didactic presentation reinforced concepts discussed in the debrief. Participants then completed an evaluation of the simulation. Results Fifty-eight emergency medicine residents and PEM fellows across four sites at three institutions participated. Participants scored the simulations and the debriefing session on a 5-point Likert scale. Learners rated the scenario as clinically relevant (M = 4.37) and effective at improving their comfort level in caring for critically ill patients (M = 4.36). Learners felt the debrief provided valuable learning (M = 4.40) and was a safe learning environment (M = 4.50). Discussion These cases can be utilized as resources for learners in any emergency department and can be tailored to any training background of learner providing sedation.
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Affiliation(s)
- Amanda Dupont
- Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin
| | - Daisy Ciener
- Assistant Professor, Division of Emergency Medicine, Department of Pediatrics, Vanderbilt University Medical Center
| | - Cecilia Monteilh
- Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Phoenix Children's
| | - Anita Bharath
- Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Phoenix Children's
| | - Anita Thomas
- Associate Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Seattle Children's
| | - Katherine Wolpert
- Assistant Professor, Section of Pediatric Emergency Medicine, Department of Pediatrics, Seattle Children's
| | - Jean Pearce
- Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin
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Parthasarathy S, Hyman D, Doherty J, Saad R, Zhang J, Morris S, Eldemir L, Fox B, Ying Vang MK, Schroeder J, Marshall NJ, Parks GS. A real-world observational study assessing relationships between excessive daytime sleepiness and patient satisfaction in obstructive sleep apnea. Sleep Med 2024; 114:42-48. [PMID: 38154148 PMCID: PMC10961719 DOI: 10.1016/j.sleep.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES/BACKGROUND To estimate prevalence and severity of excessive daytime sleepiness among patients with obstructive sleep apnea (OSA) who were prescribed treatment; assess perception and satisfaction of OSA-related care; describe relationships between excessive daytime sleepiness, treatment adherence, and patient satisfaction. PATIENTS/METHODS A national population-based cross-sectional sample of US adults with clinician-diagnosed OSA was surveyed in January 2021 via Evidation Health's Achievement App. Patients completed the Epworth Sleepiness Scale, rated satisfaction with healthcare provider and overall OSA care, and reported treatment adherence. Covariates affecting excessive daytime sleepiness (average weekly sleep duration, treatment adherence, sleepiness-inducing medications, age, sex, body mass index, nasal congestion, smoking status, and comorbidities) were adjusted in multivariate regression models. RESULTS In 2289 participants (50.3 % women; 44.8 ± 11.1 years), EDS was highly prevalent (42 %), and was experienced by 36 % of patients with high positive airway pressure (PAP) therapy adherence. Each additional hour of nightly PAP use was associated with improved sleepiness (a 0.28-point lower Epworth score; p < 0.001). Excessive daytime sleepiness was associated with lower patient satisfaction with healthcare providers and overall care (OR [95 % CI] 0.62 [0.48-0.80] and 0.50 [0.39-0.64], respectively; p < 0.0001), whereas PAP adherence was associated with higher patient satisfaction (OR [95 % CI] 2.37 [1.64-3.43] and 2.91 [2.03-4.17]; p < 0.0001), after adjusting for confounders. CONCLUSIONS In a real-world population-based study of patients with OSA, excessive daytime sleepiness was highly prevalent and associated with poor patient satisfaction ratings. Better patient-centered care among patients with OSA may require interventions aimed at addressing excessive daytime sleepiness and treatment adherence.
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Affiliation(s)
| | | | | | - Ragy Saad
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | - Gregory S Parks
- Jazz Pharmaceuticals, Palo Alto, CA, USA; Axsome Therapeutics, Inc., New York, NY, USA
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12
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Kausch SL, Lake DE, Di Fiore JM, Weese-Mayer DE, Claure N, Ambalavanan N, Vesoulis ZA, Fairchild KD, Dennery PA, Hibbs AM, Martin RJ, Indic P, Travers CP, Bancalari E, Hamvas A, Kemp JS, Carroll JL, Moorman JR, Sullivan BA. Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Extremely Preterm Infants. medRxiv 2024:2024.01.26.24301820. [PMID: 38343825 PMCID: PMC10854335 DOI: 10.1101/2024.01.26.24301820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Objectives Detection of changes in cardiorespiratory events, including apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia, may facilitate earlier detection of sepsis. Our objective was to examine the association of cardiorespiratory events with late-onset sepsis for extremely preterm infants (<29 weeks' gestational age (GA)) on versus off invasive mechanical ventilation. Study Design Retrospective analysis of data from infants enrolled in Pre-Vent (ClinicalTrials.gov identifier NCT03174301), an observational study in five level IV neonatal intensive care units. Clinical data were analyzed for 737 infants (mean GA 26.4w, SD 1.71). Monitoring data were available and analyzed for 719 infants (47,512 patient-days), of whom 109 had 123 sepsis events. Using continuous monitoring data, we quantified apnea, periodic breathing, bradycardia, and IH. We analyzed the relationships between these daily measures and late-onset sepsis (positive blood culture >72h after birth and ≥5d antibiotics). Results For infants not on a ventilator, apnea, periodic breathing, and bradycardia increased before sepsis diagnosis. During times on a ventilator, increased sepsis risk was associated with longer IH80 events and more bradycardia events before sepsis. IH events were associated with higher sepsis risk, but did not dynamically increase before sepsis, regardless of ventilator status. A multivariable model predicted sepsis with an AUC of 0.783. Conclusion We identified cardiorespiratory signatures of late-onset sepsis. Longer IH events were associated with increased sepsis risk but did not change temporally near diagnosis. Increases in bradycardia, apnea, and periodic breathing preceded the clinical diagnosis of sepsis.
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Affiliation(s)
- Sherry L Kausch
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA
| | - Douglas E Lake
- Department of Medicine, Division of Cardiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Juliann M Di Fiore
- Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Debra E Weese-Mayer
- Department of Pediatrics, Division of Autonomic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nelson Claure
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Miami, FL
| | - Namasivayam Ambalavanan
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Zachary A Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO
| | - Karen D Fairchild
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA
| | - Phyllis A Dennery
- Department of Pediatrics, Brown University School of Medicine, Department of Pediatrics, Providence, RI
| | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Richard J Martin
- Department of Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Premananda Indic
- Department of Electrical Engineering, University of Texas at Tyler, Tyler, TX
| | - Colm P Travers
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Eduardo Bancalari
- Department of Pediatrics, Division of Neonatology, University of Miami Miller School of Medicine, Miami, FL
| | - Aaron Hamvas
- Department of Pediatrics, Division of Neonatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James S Kemp
- Department of Pediatrics, Division of Pediatric Pulmonology, Washington University School of Medicine, St. Louis, MO
| | - John L Carroll
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AK
| | - J Randall Moorman
- Department of Medicine, Division of Cardiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Brynne A Sullivan
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA
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13
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Delhez Q, Bairy L, Mitchell J, Maseri A. Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material. BMC Anesthesiol 2024; 24:6. [PMID: 38166574 PMCID: PMC10759333 DOI: 10.1186/s12871-023-02375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/08/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND To perform step-by-step analysis of the different factors (material, anesthesia technique, human, and location) that led to major pneumothorax during an infrequent pediatric cardiac MRI and to prevent its occurrence in the future. Anesthesia equipment used in a remote location is often different than those in operating rooms. For magnetic resonance imaging (MRI), ventilation devices and monitors must be compatible with the magnetic fields. During cardiac MRI numerous apneas are required and, visual contact with the patient is limited for clinical evaluation. Anesthesia-related barotrauma and pneumothorax are rare in children and the first symptoms can be masked. CASE PRESENTATION A 3-year-old boy with atrial septal defect (ASD) and suspicious partial anomalous pulmonary venous return was anesthetized and intubated to perform a follow up with MRI. Sevoflurane maintenance and ventilation were performed using a circular CO2 absorber device, co-axial circuit, and 500 mL pediatric silicone balloon. Apneas were facilitated by Alfentanyl boluses and hyperventilation. A few moderated desaturations occurred during the imaging sequences without hemodynamic changes. At the end of the MRI, facial subcutaneous emphysema was observed by swollen eyelids and crackling snow neck palpation. A complete left pneumothorax was diagnosed by auscultation, sonography examination, and chest radiograph. Pneumo-mediastinum, -pericardium and -peritoneum were present. A chest drain was placed, and the child was extubated and transferred to the pediatric intensive care unit (PICU). Despite the anesthesiologist's belief that PEEP was minimal, critical analysis revealed that PEEP was maintained at a high level throughout anesthesia. After the initial barotrauma, repeated exposure to high pressure led to the diffusion of air from the pleura to subcutaneous tissues and mediastinal and peritoneal cavities. Equipment check revealed a functional circular circuit; however, the plastic adjustable pressure-limiting valve (APL) closed within the last 30° rotation. The balloon was found to be more rigid and demonstrated significantly reduced compliance. CONCLUSIONS Anesthetists require proficiency is using equipment in non-OR locations and this equipment must be properly maintained and checked for malfunctions. Controlling the human factor risks by implementing checklists, formations, and alarms allows us to reduce errors. The number of pediatric anesthesia performed routinely appeared to be essential for limiting risks and reporting our mistakes will be a benefit for all who care about patients.
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Affiliation(s)
- Quentin Delhez
- Department of Anesthesiology, Université Catholique de Louvain, Centre Hospitalier Universitaire UCL Namur site Godinne, Yvoir, Belgium.
| | - Laurent Bairy
- Department of Anesthesiology, Université Catholique de Louvain, Centre Hospitalier Universitaire UCL Namur site Godinne, Yvoir, Belgium
| | - John Mitchell
- Department of Anesthesiology, Université Catholique de Louvain, Centre Hospitalier Universitaire UCL Namur site Godinne, Yvoir, Belgium
| | - Adrien Maseri
- Department of Anesthesiology, Université Catholique de Louvain, Centre Hospitalier Universitaire UCL Namur site Godinne, Yvoir, Belgium
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Thamby J, Prange L, Boggs A, Subei MO, Myers C, Uchitel J, ElMallah M, Bartlett-Lee B, Riviello JJ, Mikati MA. Characteristics of non-sleep related apneas in children with alternating hemiplegia of childhood. Eur J Paediatr Neurol 2024; 48:101-108. [PMID: 38096596 DOI: 10.1016/j.ejpn.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/17/2023] [Accepted: 12/03/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Non-sleep related apnea (NSA) has been observed in alternating hemiplegia of childhood (AHC) but has yet to be characterized. GOALS Investigate the following hypotheses: 1) AHC patients manifest NSA that is often severe. 2) NSA is usually triggered by precipitating events. 3) NSA is more likely in patients with ATP1A3 mutations. METHODS Retrospective review of 51 consecutive AHC patients (ages 2-45 years) enrolled in our AHC registry. NSAs were classified as mild (not needing intervention), moderate (needing intervention but not perceived as life threatening), or severe (needing intervention and perceived as life threatening). RESULTS 19/51 patients (37 %) had 52 NSA events (6 mild, 11 moderate, 35 severe). Mean age of onset of NSA (± Standard Error of the Mean (SEM)): 3.8 ± 1.5 (range 0-24) years, frequency during follow up was higher at younger ages as compared to adulthood (year 1: 2.2/year, adulthood: 0.060/year). NSAs were associated with triggering factors, bradycardia and with younger age (p < 0.008 in all) but not with mutation status (p = 0.360). Triggers, observed in 17 patients, most commonly included epileptic seizures in 9 (47 %), anesthesia, AHC spells and intercurrent, stressful, conditions. Management included use of pulse oximeter at home in nine patients, home oxygen in seven, intubation/ventilatory support in seven, and basic CPR in six. An additional patient required tracheostomy. There were no deaths or permanent sequalae. CONCLUSIONS AHC patients experience NSAs that are often severe. These events are usually triggered by seizures or other stressful events and can be successfully managed with interventions tailored to the severity of the NSA.
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Affiliation(s)
- Julie Thamby
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Lyndsey Prange
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - April Boggs
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - M Omar Subei
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Duke University School of Medicine, Durham, NC, United States
| | - Cory Myers
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Duke University School of Medicine, Durham, NC, United States
| | - Julie Uchitel
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States; Stanford University Medical School, Palo Alto, CA, United States
| | - Mai ElMallah
- Department of Pediatrics, Division of Pulmonary Medicine, Duke University School of Medicine, United States
| | | | - James J Riviello
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Mohamad A Mikati
- Department of Pediatrics, Division of Neurology and Developmental Pediatrics, Duke University School of Medicine, Durham, NC, United States.
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15
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Kim F, Bateman DA, Garey D, Goldshtrom N, Isler JR, Sahni R, Wallman-Stokes A. Association between intermittent hypoxemia and neurodevelopmental outcomes in extremely premature infants: A single-center experience. Early Hum Dev 2024; 188:105919. [PMID: 38118389 DOI: 10.1016/j.earlhumdev.2023.105919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/03/2023] [Accepted: 12/07/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE To describe the association between intermittent hypoxemic events (IHEs) and severe neurodevelopmental impairment (SNDI) or death in extremely premature infants. STUDY DESIGN Retrospective study of extremely premature infants 230/7-276/7 weeks gestational age (GA) and birthweight (BW) ≤1250 grams (g) admitted to a level IV neonatal intensive care unit (NICU) from 2013 to 2017. IHEs, defined as events with SpO2 ≤ 80 % lasting 10 s to 5 min, were algorithmically identified using data extracted from bedside monitors at 2 s intervals (0.5 Hz). The primary outcome was SNDI at 18-24 months corrected age (CA), defined as a Bayley-III motor, language or cognitive composite score ≤69, or death before discharge while the secondary outcome was SNDI alone. We used mixed-effects regression models to evaluate the relationship between mean daily IHE rate per postnatal week of life for the first 12 weeks and the outcomes, and logistic regression models to assess the association between outcomes and summary measures of hypoxic burden for the entire NICU hospitalization. RESULTS The mortality rate was 7 % (18/249) during NICU hospitalization. Of 249 infants born during this time period, IHE and neurodevelopmental outcome data were fully available for 65 infants (mean GA 26 ± 1.4 weeks, mean birth weight (BW) 738 ± 199 g. The outcome of SNDI alone occurred in 34 % (22/65) with a majority demonstrating motor or language delay on the Bayley-III. Although mean daily IHE rate/week was not associated with SNDI or death, total IHE duration was associated with increased odds of SNDI (OR (95 % CI) 1.03 (1.01, 1.05), p = 0.008) in models adjusted for GA. CONCLUSIONS In a cohort of extremely premature infants 23-27 weeks GA, each hour of total IHE duration (SpO2 ≤ 80 %) was associated with a 2.7 % (0.7 %, 4.8 %) increase in the odds of SNDI at 18-24 months CA.
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Affiliation(s)
- Faith Kim
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America.
| | - David A Bateman
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Donna Garey
- Department of Pediatrics, Phoenix Children's Medical Group, Phoenix, AZ, United States of America
| | - Nimrod Goldshtrom
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Joseph R Isler
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Rakesh Sahni
- Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Aaron Wallman-Stokes
- Department of Pediatrics, University of Vermont Children's Hospital, Burlington, VT, United States of America
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Sbrollini A, Morettini M, Gambi E, Burattini L. Identification of Respiration Types Through Respiratory Signal Derived From Clinical and Wearable Electrocardiograms. IEEE Open J Eng Med Biol 2023; 4:268-274. [PMID: 38196981 PMCID: PMC10776097 DOI: 10.1109/ojemb.2023.3343557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
GOAL To evaluate suitability of respiratory signals derived from clinical 12-lead electrocardiograms (ECGs) and wearable 1-lead ECG to identify different respiration types. METHODS ECGs were simultaneously acquired through the M12R ECG Holter by Global Instrumentation and the chest strap BioHarness 3.0 by Zephyr from 42 healthy subjects alternating normal breathing, breath holding, and deep breathing. Respiration signals were derived from the ECGs through the Segmented-Beat Modulation Method (SBMM)-based algorithm and the algorithms by Van Gent, Charlton, Soni and Sarkar, and characterized in terms of breathing rate and amplitude. Respiration classification was performed through a linear support vector machine and evaluated by F1 score. RESULTS Best F1 scores were 86.59%(lead V2) and 80.57%, when considering 12-lead and 1-lead ECGs, respectively, and using SBMM-based algorithm. CONCLUSION ECG-derived respiratory signals allow reliable identification of different respiration types even when acquired through wearable sensors, if associated to appropriate processing algorithms, such as the SBMM-based algorithm.
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Affiliation(s)
- Agnese Sbrollini
- Department of Information EngineeringUniversità Politecnica delle Marche60121AnconaItaly
| | - Micaela Morettini
- Department of Information EngineeringUniversità Politecnica delle Marche60121AnconaItaly
| | - Ennio Gambi
- Department of Information EngineeringUniversità Politecnica delle Marche60121AnconaItaly
| | - Laura Burattini
- Department of Information EngineeringUniversità Politecnica delle Marche60121AnconaItaly
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17
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Alsaqobi A. Obstructive sleep apnoea triggering autonomic dysreflexia: Isn't it time for sleep studies to be routine in SCI? Brain Spine 2023; 4:102725. [PMID: 38510615 PMCID: PMC10951708 DOI: 10.1016/j.bas.2023.102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/11/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Abstract
Autonomic dysreflexia is a known complication after spinal cord injury. It is defined as a reflexive increase in blood pressure as a result of a painful or irritating stimulus below the level of the lesion. Although commonly caused by stimuli from the bladder, other rare triggers are still being described. Herein, we present a case with autonomic dysreflexia triggered by obstructive sleep apnoea. A 43-year-old smoker suffered a spinal cord injury after a road traffic accident secondary to multiple cervical spine vertebrae fractures. He presented to our rehabilitation centre 6 months post-injury as a case of complete spinal cord injury with C4 neurological level. Autonomic dysfunction in the form of autonomic dysreflexia was occurring on a daily basis. After exclusion of known inciting factors, it was noticed that early morning episodes of autonomic dysreflexia were persistent. He was also reporting daytime fatigue and sleepiness and multiple night-time awakenings. Therefore, work up for sleep apnoea was done. A diagnosis of moderate obstructive sleep apnoea was made. With continuous positive airway pressure treatment, his daily early morning episodes of autonomic dysreflexia settled. This case illustrates the importance of the pattern of blood pressure elevation to pinpoint specific triggers of autonomic dysreflexia.
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Affiliation(s)
- Ameerah Alsaqobi
- Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Hospital, Andalous, Kuwait
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18
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Brodovskaya A, Sun H, Adotevi N, Wenker IC, Mitchell KE, Clements RT, Kapur J. Neuronal plasticity contributes to postictal death. Prog Neurobiol 2023; 231:102531. [PMID: 37778436 PMCID: PMC10842614 DOI: 10.1016/j.pneurobio.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/07/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Repeated generalized tonic-clonic seizures (GTCSs) are the most critical risk factor for sudden unexpected death in epilepsy (SUDEP). GTCSs can cause fatal apnea. We investigated neuronal plasticity mechanisms that precipitate postictal apnea and seizure-induced death. Repeated seizures worsened behavior, precipitated apnea, and enlarged active neuronal circuits, recruiting more neurons in such brainstem nuclei as periaqueductal gray (PAG) and dorsal raphe, indicative of brainstem plasticity. Seizure-activated neurons are more excitable and have enhanced AMPA-mediated excitatory transmission after a seizure. Global deletion of the GluA1 subunit of AMPA receptors abolishes postictal apnea and seizure-induced death. Treatment with a drug that blocks Ca2+-permeable AMPA receptors also renders mice apnea-free with five-fold better survival than untreated mice. Repeated seizures traffic the GluA1 subunit-containing AMPA receptors to synapses, and blocking this mechanism decreases the probability of postictal apnea and seizure-induced death.
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Affiliation(s)
| | - Huayu Sun
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Nadia Adotevi
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Ian C Wenker
- Department of Anesthesiology, University of Virginia, Charlottesville, VA 22908, USA
| | - Keri E Mitchell
- Department of Chemistry, University of Virginia, Charlottesville, VA 22908, USA
| | - Rachel T Clements
- Department of Neuroscience, University of Virginia, Charlottesville, VA 22908, USA
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA; UVA Brain Institute, University of Virginia, Charlottesville, VA 22908, USA.
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Bobin F, Lechien JR. Association between oropharyngeal ph-monitoring, pepsin saliva concentration and degree of apnea-hypopnea index of obstructive sleep apnea. J Otolaryngol Head Neck Surg 2023; 52:68. [PMID: 37838710 PMCID: PMC10576889 DOI: 10.1186/s40463-023-00675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 10/06/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE To investigate the association between obstructive sleep apnea (OSA) and laryngopharyngeal reflux (LPR) through oropharyngeal pH-monitoring and pepsin saliva measurements. DESIGN Prospective uncontrolled study. METHODS Patients with sleep disturbances and reflux symptoms underwent polysomnography, 24-h oropharyngeal pH-monitoring and saliva pepsin collections. The prevalence of LPR was investigated in OSA patients according to oropharyngeal pH-monitoring and pepsin measurements. A correlation analysis was performed between pH-monitoring findings, pepsin saliva levels, reflux symptom score-12 (RSS-12), reflux sign assessment (RSA), Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale, Pichot and arousal findings. RESULTS Thirty-seven patients completed the evaluations. LPR was detected in 34/37 (92%) and 29/34 (85%) patients at the oropharyngeal-pH monitoring and pepsin test, respectively. OSA was detected in 30 patients (81%). Among them, LPR was detected in 28/30 (93%) cases. Pharyngeal reflux events mainly occurred nighttime/supine in OSA patients. Both Ryan score and supine reflux time at pH < 6.5 were significantly associated with BMI and the RSA sub- and total scores (p < 0.02). Tongue-base hypertrophy score was positively associated with the number of micro-arousals (p = 0.027); the supine percent of pH < 6.5 (p = 0.030); morning (p = 0.030) and bedtime pepsin saliva measurements (p = 0.037). The bedtime pepsin saliva level was significantly associated with Ryan Score (p = 0.047); AHI (p = 0.017) and the sleep saturation < 90% time (p = 0.040). The saliva level of the morning pepsin was associated with a shortest paradoxical sleep phase (p = 0.013). CONCLUSION OSA patients may have high prevalence of pharyngeal reflux events at the oropharyngeal pH-monitoring and high pepsin saliva measurements. Oropharyngeal pH-monitoring should be useful for the correlation between reflux and sleep findings in OSA patients. Future large cohort controlled studies are needed to determine the prevalence of LPR in OSA and healthy individuals.
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Affiliation(s)
- Francois Bobin
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France
| | - Jérôme R Lechien
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Department of Otolaryngology-Head & Neck Surgery, Laryngoloy and Bronchoesophagology Division, EpiCURA Hospital, University of Mons, Mons, Belgium.
- Department of Otolaryngology, Foch Hospital, Paris Saclay University, Suresnes, France.
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Doufas AG, Laporta ML, Driver CN, Di Piazza F, Scardapane M, Bergese SD, Urman RD, Khanna AK, Weingarten TN. Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial. BMC Anesthesiol 2023; 23:332. [PMID: 37794334 PMCID: PMC10548743 DOI: 10.1186/s12871-023-02291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Supplemental oxygen (SO) potentiates opioid-induced respiratory depression (OIRD) in experiments on healthy volunteers. Our objective was to examine the relationship between SO and OIRD in patients on surgical units. METHODS This post-hoc analysis utilized a portion of the observational PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial dataset (202 patients, two trial sites), which involved blinded continuous pulse oximetry and capnography monitoring of postsurgical patients on surgical units. OIRD incidence was determined for patients receiving room air (RA), intermittent SO, or continuous SO. Generalized estimating equation (GEE) models, with a Poisson distribution, a log-link function and time of exposure as offset, were used to compare the incidence of OIRD when patients were receiving SO vs RA. RESULTS Within the analysis cohort, 74 patients were always on RA, 88 on intermittent and 40 on continuous SO. Compared with when on RA, when receiving SO patients had a higher risk for all OIRD episodes (incidence rate ratio [IRR] 2.7, 95% confidence interval [CI] 1.4-5.1), apnea episodes (IRR 2.8, 95% CI 1.5-5.2), and bradypnea episodes (IRR 3.0, 95% CI 1.2-7.9). Patients with high or intermediate PRODIGY scores had higher IRRs of OIRD episodes when receiving SO, compared with RA (IRR 4.5, 95% CI 2.2-9.6 and IRR 2.3, 95% CI 1.1-4.9, for high and intermediate scores, respectively). CONCLUSIONS Despite oxygen desaturation events not differing between SO and RA, SO may clinically promote OIRD. Clinicians should be aware that postoperative patients receiving SO therapy remain at increased risk for apnea and bradypnea. TRIAL REGISTRATION Clinicaltrials.gov: NCT02811302, registered June 23, 2016.
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Affiliation(s)
- Anthony G Doufas
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Sleep and Circadian Sciences, Stanford University School of Medicine, 300 Pasteur Drive, H3580, Stanford, San Francisco, CA, 94305-5640, USA.
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Noelle Driver
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy
| | - Marco Scardapane
- Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy
| | - Sergio D Bergese
- Department of Anesthesiology and Neurological Surgery, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, OH, USA
| | - Ashish K Khanna
- Section On Critical Care Medicine, Department of Anesthesiology, Wake Forest Center for Biomedical Informatics, Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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21
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Hateruma Y, Nozaki-Taguchi N, Son K, Tarao K, Kawakami S, Sato Y, Isono S. Assessments of perioperative respiratory pattern with non-contact vital sign monitor in children undergoing minor surgery: a prospective observational study. J Anesth 2023; 37:714-725. [PMID: 37584687 DOI: 10.1007/s00540-023-03223-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/01/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Nurses routinely assess respiration of hospitalized children; however, respiratory rate measurements are technically difficult due to rapid and small chest wall movements. The aim of this study is to reveal the respiratory status of small children undergoing minor surgery with load cells placed under the bed legs, and to test the hypothesis that respiratory rate (primary variable) is slower immediately after arrival to the ward and recovers in 2 h. METHODS Continuous recordings of the load cell signals were performed and stable respiratory waves within the 10 discriminative perioperative timepoints were used for respiratory rate measurements. Apnea frequencies were calculated at pre and postoperative nights and 2 h immediately after returning to the ward after surgery. RESULTS Continuous recordings of the load cell signals were successfully performed in 18 children (13 to 119 months). Respiratory waves were appraisable for more than 70% of nighttime period and 40% of immediate postoperative period. There were no statistically significant differences of respiratory rate in any timepoint comparisons (p = 0.448), thereby not supporting the study hypothesis. Respiratory rates changed more than 5 breaths per minute postoperatively in 5 out of 18 children (28%) while doses of fentanyl alone did not explain the changes. Apnea frequencies significantly decreased 2 h immediately after returning to the ward and during the operative night compared to the preoperative night. CONCLUSION Respiratory signal extracted from load cell sensors under the bed legs successfully revealed various postoperative respiratory pattern change in small children undergoing minor surgery. CLINICAL TRAIL REGISTRATION UMIN (University Hospital Information Network) Clinical Registry: UMIN000045579 ( https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052039 ).
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Affiliation(s)
- Yuki Hateruma
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-Cho, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Natsuko Nozaki-Taguchi
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kyongsuk Son
- Department of Anesthesiology, Chiba University Hospital, Chiba, Japan
| | - Kentaroh Tarao
- Department of Anesthesiology, Chiba University Hospital, Chiba, Japan
| | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Shiroh Isono
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Maeda M, Yoshikawa Y, Oura S, Takahashi K, Ohno S, Hirata N, Yamakage M. Apnea management during WATCHMAN device deployment with apneic oxygenation: A case report of three cases. Ann Card Anaesth 2023; 26:458-460. [PMID: 37861586 PMCID: PMC10691579 DOI: 10.4103/aca.aca_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 10/21/2023] Open
Abstract
WATCHMAN is a percutaneous left atrial appendage closure device that is implanted in patients who are unsuitable for anticoagulation therapy for atrial fibrillation. During WATCHMAN implantation, inducing apnea in the patient is preferable to allow stable deployment. We present three cases in which apneic oxygenation was employed to maintain oxygenation during apnea, and oxygen reserve index (ORiTM) was measured to evaluate its safety and efficacy. Oxygen was administered continuously via the endotracheal tube during apnea. During all four apneic events in three patients (mean duration of 356 seconds), the ORi values maintained above 0.24, which is generally considered the threshold of partial pressure of arterial oxygen (PaO2) > 100 mmHg. Transcutaneous oxygen saturation and PaO2 remained above 99% and 300 mmHg, respectively. There were no respiratory or circulatory complications during or after the surgery.
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Affiliation(s)
- Makishi Maeda
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shunsuke Oura
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kanako Takahashi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sho Ohno
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Hirata
- Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Ibrahim S, Mehra R, Tantibhedhyangkul J, Bena J, Flyckt RL. Sleep and obstructive sleep apnea in women with infertility. Sleep Breath 2023; 27:1733-1742. [PMID: 36609819 DOI: 10.1007/s11325-022-02770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with polycystic ovarian syndrome (PCOS), a common cause of infertility. Understanding predictors and outcomes of OSA in women with infertility may guide treatment. METHODS A descriptive cross-sectional survey was performed to assess OSA in women presenting to an infertility clinic using validated sleep questionnaires to assess sleep and fertility outcomes. An Infertile-C group (controls with male or tubal factors) and an Infertile-S group (unknown/other infertile causes) were analyzed to assess OSA risk and other sleep disorders (e.g., restless legs syndrome (RLS) and insomnia) with fertility outcomes (time to pregnancy, PCOS, irregular menstruation, and miscarriage). RESULTS In 258 women, occurrences of OSA diagnosis (6%) and RLS (10%) were reported similar to women of child-bearing age in the general population. PCOS was unassociated with OSA risk. Predictors of OSA risk were BMI, insomnia symptoms, and sleep aid use. Obese women with high OSA risk were more likely to have other comorbidities (e.g., depression). In adjusted models, prior clinical OSA diagnosis was associated with miscarriage (odds ratio: 6.17 (1.24, 30.62), p = 0.026). RLS was associated with irregular menstruation (odds ratio: 3.73 (1.21, 11.53), p = 0.022). CONCLUSIONS Similar to other populations, women with infertility and OSA risk have more health comorbidities and higher BMI and may present with insomnia symptoms. While the data are limited, this study supports the potential associations of OSA and miscarriage. Further work is needed to evaluate OSA in female infertility.
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Affiliation(s)
- Sally Ibrahim
- Division of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children's Hospital of University Hospitals, Cleveland, OH, USA.
| | - Reena Mehra
- Neurological Institute, Cleveland Clinic Sleep Disorders Center, Cleveland, OH, USA
| | - Julierut Tantibhedhyangkul
- Division of Reproductive Endocrinology and Infertility, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca L Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Raj A, Bansal S, Dhooria S, Jain D, Virk RS, Panda NK. Drug-induced sleep endoscopy-continuous positive airway pressure (DISE-CPAP), a newer modality to choose the right candidates for CPAP. Sleep Breath 2023; 27:1787-1794. [PMID: 36753005 DOI: 10.1007/s11325-023-02787-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is recommended for moderate-to-severe obstructive sleep apnea (OSA). We aimed to investigate whether or not combining drug-induced sleep endoscopy (DISE) with CPAP titration may inform more appropriate pressure settings. MATERIALS AND METHODS A sleep CPAP titration study and DISE-CPAP treatment were performed on consecutive subjects with moderate-to-severe OSA under controlled sedation using bispectral monitoring. Video recordings of dynamic changes in UA with CPAP pressure ranges of 5 to 25 cm were assessed in accordance with the VOTE classification. The 95th percentile (95th PC) pressure of the CPAP titration trial was compared to optimal pressure for alleviating UA blockage. RESULTS We included 30 subjects (mean age 37.5, 17% women). All showed UA collapse at more than one level, with more than 80% of them collapsing completely at the levels of the velum and oropharynx. At the velum, 90% of subjects experienced improvement with CPAP. At the oropharynx, 75% of subjects experienced improvement with CPAP. The mean pressure and standard deviation (SD) of the 95th PC of the CPAP titration was 14.3 (3.5) cmH2O, while the pressure required to partially or fully open the airway (best possible pressure) was 16.1 (3.9) cmH2O; mean (SD) difference, 1.9 (2.2); P ≤ 0.001. The limits of agreement between the CPAP 95th pressure and the ideal pressure were - 6.32 to + 2.52. CONCLUSIONS The palate and lateral pharynx were more affected by CPAP than the hypopharynx. Most of the time, the mean 95th PC CPAP titration pressure was lower than the mean optimal pressure needed to alleviate the collapse.
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Affiliation(s)
- Arun Raj
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, India
| | - Sandeep Bansal
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, India.
| | | | - Divya Jain
- Department of Anesthesia and Critical Care, PGIMER, Chandigarh, India
| | - Ramandeep S Virk
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, India
| | - Naresh Kumar Panda
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, India
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25
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Aubertin G, Akkari M, Andrieux A, Colas des Francs C, Fauroux B, Franco P, Gagnadoux F, de Santerre OG, Grollemund B, Hartley S, Jaffuel D, Lafond L, Schröder CM, Schweitzer C, Charley-Monaca C. Management of obstructive sleep apnea syndrome type 1 in children and adolescents - A French consensus. Arch Pediatr 2023; 30:510-516. [PMID: 37537084 DOI: 10.1016/j.arcped.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/23/2023] [Accepted: 06/04/2023] [Indexed: 08/05/2023]
Abstract
This document is the outcome of a group of experts brought together at the request of the French Society of Sleep Research and Medicine to provide recommendations for the management of obstructive sleep apnea syndrome type 1 (OSA1) in children. The recommendations are based on shared experience and published literature. OSA1 is suspected when several nighttime respiratory symptoms related to upper airway obstruction are identified on clinical history taking. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. A sleep study for OSA1 is not mandatory when at least two nighttime symptoms (including snoring) are noted. Therapeutic management must be individualized according to the location of the obstruction. Ear, nose, and throat (ENT) surgery is often required, as hypertrophy of the lymphoid tissues is the main cause of OSA1 in children. According to clinical findings, orthodontic treatment generally associated with specialized orofacial-myofunctional therapy might also be indicated. Whatever treatment is chosen, follow-up must be continuous and multidisciplinary, in a network of trained specialists.
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Affiliation(s)
- G Aubertin
- Pediatric Pulmonology, Armand Trousseau Hospital, AP-HP Hospital, Sorbonne University, Paris, 75012, France; Centre de recherche Saint Antoine (CRSA), INSERM UMR-S 938, Paris, 75012, France; Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Boulogne-Billancourt, 92100, France.
| | - M Akkari
- Ear, Nose and Throat & Head and Neck Surgery, University Hospital Gui de Chauliac, University of Montpellier, Montpellier, 34000, France
| | - A Andrieux
- Cabinet de pneumo-pédiatrie et somnologie pédiatrique, Mérignac, 33700, France; Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel Air, Bordeaux, 33200, France; Pediatric Pulmonology Unit, University Hospital Pellegrin - Enfants, University of Bordeaux, Bordeaux, 33000, France
| | - C Colas des Francs
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Réseau Morphée, Garches, 92380, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, 75015, France; VIFASOM, University of Paris Cité, Paris, 75004, France
| | - P Franco
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292 University of Lyon 1, Bron, 69675, France
| | - F Gagnadoux
- Department of Pulmonary and Sleep Medicine, University Hospital of Angers, Angers, 49000, France; INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, 49000, France
| | | | - B Grollemund
- Department of Dental-Facial Orthopedics, Pole of Bucco Dentaries' Medicine and Surgery, Cleft Competence Center, Strasbourg University Hospital, Strasbourg, 67000, France
| | - S Hartley
- Réseau Morphée, Garches, 92380, France; Sleep Unit, Department of Physiology, Raymond Poincaré Hospital, AP-HP, Garches, 92380, France
| | - D Jaffuel
- Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, 34000, France; PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, 34000, France
| | - L Lafond
- Oro-myofunctional Therapy Office, Bordeaux, 33000, France
| | - C M Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University and Strasbourg University Hospitals, Strasbourg, 67000, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, 67000, France; Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), Strasbourg University Hospitals, Strasbourg, 67000, France
| | - C Schweitzer
- Children's Medicine, Department of Pediatric Lung Function Testing, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, 54501, France; EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Vandoeuvre les Nancy, 54505, France
| | - C Charley-Monaca
- Department of Clinical Neurophysiology-Sleep Disorders Unit, University of Lille, University Hospital of Lille, and U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, 59000, France
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Honda J, Murakawa M, Inoue S. Effect of averaging time and respiratory pause time on the measurement of acoustic respiration rate monitoring. JA Clin Rep 2023; 9:61. [PMID: 37773551 PMCID: PMC10541352 DOI: 10.1186/s40981-023-00654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Acoustic respiration rate (RRa) monitoring is a method of continuously measuring respiratory rate using a signal from an acoustic transducer placed over the airway. The purpose of the present study is to examine how the averaging time and respiratory pause time settings of an RRa monitor affect the detection time of sudden respiratory rate changes. METHODS A total of 40 healthy adult volunteers were included in the study. First, we measured the apnea detection time (apnea test) by dividing them into two groups (N = 20 each), one with a respiratory pause time setting of 20 s and the other with 40 s. Each group performed two apnea tests with an averaging time setting of 10 and 30 s. Next, we measured the tachypnea detection time (tachypnea test) for half of the subjects (N = 20) with two averaging time settings of 10 and 30 s. For each test, three measurements were taken, and the average of the three measurements was recorded. RESULTS There was no significant difference in the apnea detection time between the averaging time set at 10 and 30 s regardless of whether the respiratory pause time was set at 20 or 40 s. However, the apnea detection time was significantly shorter with the respiratory pause time of 20 s than 40 s, regardless of whether the averaging time was set at 10 or 30 s (p < 0.001). The tachypnea detection time was shorter with the averaging time of 10 s than 30 s (p < 0.001). Furthermore, the apnea detection time and tachypnea detection time were much longer than the actual settings. CONCLUSIONS The results of the current study show that in the measurement of RRa, the apnea detection time is more affected by the respiratory pause time setting than the averaging time setting; however, the tachypnea detection time is significantly affected by the averaging time setting.
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Affiliation(s)
- Jun Honda
- Department of Anesthesiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Masahiro Murakawa
- Department of Anesthesiology, Iwase General Hospital, 20, Kitamachi, Sukagawa City, Fukushima, 962-8503, Japan
| | - Satoki Inoue
- Department of Anesthesiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
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Dahan P, de Oliveira PMN, Brum AR, Ribeiro ACP, Figueiredo AA, de Bessa J, Murillo B. J. Treating asthma in patients with enuresis: repercussions on urinary symptoms. Int Braz J Urol 2023; 49:590-598. [PMID: 37450772 PMCID: PMC10482458 DOI: 10.1590/s1677-5538.ibju.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. OBJECTIVE This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. MATERIALS AND METHODS Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. RESULTS At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. DISCUSSION Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. CONCLUSION Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.
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Affiliation(s)
- Patricia Dahan
- Faculdade de Medicina da Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de PediatriaJuiz de ForaMGBrasilDepartamento de Pediatria, Faculdade de Medicina da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG, Brasil
| | - Pricila Mara Novais de Oliveira
- Universidade Federal de Juiz de ForaHospital UniversitárioDepartamento de Fisioterapia PediátricaJuiz de ForaMGBrasilDepartamento de Fisioterapia Pediátrica do Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Aparecida Regina Brum
- Hospital Evandro RibeiroJuiz de ForaMGBrasilServiço de Otorrinolaringologia do Hospital Evandro Ribeiro, Juiz de Fora, MG, Brasil
| | - André Costa Pinto Ribeiro
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia do Hospital UniversitárioDepartamento de OtorrinolaringologiaJuiz de ForaMGBrasilDepartamento de Otorrinolaringologia, Departamento de Cirurgia do Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - André Avarese Figueiredo
- Universidade Federal de Juiz de ForaDepartamento de CirurgiaDivisão de UrologiaJuiz de ForaMGBrasilDepartamento de Cirurgia- Divisão de Urologia, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de CirurgiaDivisão de UrologiaFeira de SantanaBahiaBrasilDepartamento de Cirurgia - Divisão de Urologia, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brasil
| | - José Murillo B.
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de CirurgiaJuiz de ForaMGBrasilDepartamento de Cirurgia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG, Brasil
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Wetsch WA, Schroeder DC, Herff SJ, Böttiger BW, Wenzel V, Herff H. The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation. BMC Anesthesiol 2023; 23:273. [PMID: 37580678 PMCID: PMC10424410 DOI: 10.1186/s12871-023-02234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Recently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side. Actually, it is unclear at which point of this blade the oxygen supply line should end to facilitate the best possible oxygen supply for apneic oxygenation. METHODS In this simulation study using a standardized human airway manikin, the efficacy of apneic oxygenation by oxygen insufflation using standard and modified Macintosh blades was compared: a standard Macintosh blade without oxygen supply line as control, one with an additional oxygen supply line ending proximal near the handle, one with the line ending at the middle of the blade, and one with the line ending near the tip. A preoxygenated test lung was connected to an oximeter with a flow rate of 200ml/min, simulating oxygen consumption of a male adult, and to the trachea of an anatomically correctly shaped airway manikin. Apneic oxygenation was performed and oxygen content was measured over a 20-minutes observation period. Experiments were repeated five times for each laryngoscope blade. RESULTS Oxygen percentage in the test lung dropped from 100 ± 0% at the start of the experiment to 53 ± 1.5% in the room air control group (p < 0.001 compared to all other groups), and to 74 ± 2.5% in the proximal oxygen line group, whereas oxygen percentage remained at 100% in both the medium and distal oxygen line groups (p = 1 between these groups; p < 0.001 between all other groups). CONCLUSIONS In this simulation study with a preoxygenated airway manikin, the use of a modified Macintosh laryngoscope blade with oxygen line attached at the tip or at the middle were able to maintain apneic oxygenation without measurable drop of oxygen content over 20 min. Proximal placement of the oxygen supply line still showed an advantage against room air, however it did not completely prevent room air from entering the airway. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Wolfgang A Wetsch
- Faculty of Medicine, University of Cologne, Albertus-Magnus-Platz 1, 50931, Cologne, Germany.
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Daniel C Schroeder
- Faculty of Medicine, University of Cologne, Albertus-Magnus-Platz 1, 50931, Cologne, Germany
- Department of Anaesthesiology and Intensive Care, German Armed Forces Central Hospital, Koblenz, Germany
| | - Susanne J Herff
- Faculty of Medicine, University of Cologne, Albertus-Magnus-Platz 1, 50931, Cologne, Germany
| | - Bernd W Böttiger
- Faculty of Medicine, University of Cologne, Albertus-Magnus-Platz 1, 50931, Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Volker Wenzel
- Department of Anesthesiology, Friedrichshafen Regional Medical Center, Friedrichshafen, Germany
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Holger Herff
- Faculty of Medicine, University of Cologne, Albertus-Magnus-Platz 1, 50931, Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Anesthesiology, PAN Clinic, Cologne, Germany
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Yap AU, Tan MWY, Tan SHX, Chua AP. Sleep bruxism events: an epiphenomenon of severe obstructive sleep apnea? Clin Oral Investig 2023; 27:4633-4642. [PMID: 37256429 DOI: 10.1007/s00784-023-05089-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study investigated the temporal relationships between apnea-hypopnea (AH) and sleep bruxism (SB) events and correlated SB to various respiratory/sleep indexes in adult patients with concomitant obstructive sleep apnea (OSA) and SB. MATERIALS AND METHODS Nocturnal PSG data of 147 consecutive OSA patients were examined for comorbid SB. Among the 49 subjects with coexisting OSA and SB, 26 were randomly selected for in-depth appraisal of temporal patterns which were classified as T1 (unrelated activities), T2 (AH events occur before SB events), T3 (SB events occur before AH events), and T4 (AH and SB events occur simultaneously). Data were analyzed using Mann-Whitney U tests and Spearman's correlation (α = 0.05). RESULTS The majority (84.5%) of AH events were unrelated to SB events. Of the 15.5% of related activities, T2 and T3 patterns occurred in 14.1% and 1.4%, respectively. SB events/index, the percentage of unrelated/related AH-SB events, and T2-T3 episodes were not associated with gender, age, body mass (BMI), and apnea-hypopnea (AHI) index. SB events were related to total sleep time (rs = 0.44), but no significant associations were discerned between SB and AH index. CONCLUSIONS As most AH events were unrelated to SB events, OSA and SB are probably epiphenomena in adult patients with concomitant conditions. Where AH-SB events were related, the T2 temporal pattern, where SB events were subsequent to AH events, featured predominantly alluding to a specific form of secondary SB triggered by sleep micro-arousals. CLINICAL RELEVANCE AH and SB events are probably epiphenomena in adult patients with coexisting OSA and SB. Even so, OSA patients should be routinely screened for SB and vice versa considering their frequent comorbidity.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Madeleine Wan Yong Tan
- Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Sharon Hui Xuan Tan
- Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ai Ping Chua
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
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Abstract
The climate crisis is a major public health threat for children, disproportionately affecting the most vulnerable populations. Climate change causes a myriad of health issues for children, including respiratory illness, heat stress, infectious disease, the effects of weather-related disasters, and psychological sequelae. Pediatric clinicians must identify and address these issues in the clinical setting. Strong advocacy from pediatric clinicians is needed to help prevent the worst effects of the climate crisis and to support the elimination of use of fossil fuels and enactment of climate-friendly policies.
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Affiliation(s)
| | - Ruth A Etzel
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Northwest, Washington, DC 20052, USA.
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Alvente S, Matteoli G, Miglioranza E, Zoccoli G, Bastianini S. How to study sleep apneas in mouse models of human pathology. J Neurosci Methods 2023; 395:109923. [PMID: 37459897 DOI: 10.1016/j.jneumeth.2023.109923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
Sleep apnea, the most widespread sleep-related breathing disorder (SBD), consists of recurrent episodes of breathing cessation during sleep. This condition can be classified as either central (CSA) or obstructive (OSA) sleep apnea, with the latest being the most common and toxic. Due to the complexity of living organisms, animal models and, particularly, mice still represent an essential tool for the study of SBD. In the present review we first discuss the methodological pros and cons in the use of whole-body plethysmography to coupling respiratory and sleep measurements and to characterize CSA and OSA in mice; then, we draw an updated and objective picture of the methods used so far in the study of sleep apnea in mice. Most of the studies present in the literature used intermittent hypoxia to mimic OSA in mice and to investigate consequent pathological correlates. On the contrary, few studies using genetic manipulation or high-fat diets investigated the pathogenesis or potential treatments of sleep apnea. To date, mice lacking orexins, hemeoxygenase-2, monoamine oxidase A, Phox2b or Cdkl5 can be considered validated mouse models of sleep apnea. Moreover, genetically- or diet-induced obese mice, and mice recapitulating Down syndrome were proposed as OSA models. In conclusion, our review shows that despite the growing interest in the field and the need of new therapeutical approaches, technical complexity and inter-study variability strongly limit the availability of validated mouse of sleep apnea, which are essential in biomedical research.
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Affiliation(s)
- Sara Alvente
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gabriele Matteoli
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Miglioranza
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Zoccoli
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Bastianini
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Olaithe M, Hagen EW, Barnet JH, Eastwood PR, Bucks RS. OSA-Onset: An algorithm for predicting the age of OSA onset. Sleep Med 2023; 108:100-104. [PMID: 37348284 DOI: 10.1016/j.sleep.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/29/2023] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/24/2023]
Abstract
STUDY OBJECTIVES There is currently no way to estimate the period of time a person has had obstructive sleep apnoea (OSA). Such information would allow identification of people who have had an extended exposure period and are therefore at greater risk of other medical disorders; and enable consideration of disease chronicity in the study of OSA pathogenesis/treatment. METHOD The 'age of OSA Onset' algorithm was developed in the Wisconsin Sleep Cohort (WSC), in participants who had ≥2 sleep studies and not using continuous positive airway pressure (n = 696). The algorithm was tested in a participant subset from the WSC (n = 154) and the Sleep Heart Health Study (SHHS; n = 705), those with an initial sleep study showing no significant OSA (apnea-hypopnea index (AHI) < 15 events/hr) and later sleep study showing moderate to severe OSA (AHI≥15 events/hr). RESULTS Regression analyses were performed to identify variables that predicted change in AHI over time (BMI, sex, and AHI; beta weights and intercept used in the algorithm). In the WSC and SHHS subsamples, the observed years with OSA was 3.6 ± 2.6 and 2.7 ± 0.6 years, the algorithm estimated years with OSA was 10.6 ± 8.2 and 9.0 ± 6.2 years. CONCLUSIONS The OSA-Onset algorithm estimated years of exposure to OSA with an accuracy of between 6.6 and 7.8 years (mean absolute error). Future studies are needed to determine whether the years of exposure derived from the OSA-Onset algorithm is related to worse prognosis, poorer cognitive outcomes, and/or poorer response to treatment.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Australia.
| | - Erica W Hagen
- School of Population Health Science, University of Wisconsin School of Medicine and Public Health, Wisconsin-Madison, USA
| | - Jodi H Barnet
- School of Population Health Science, University of Wisconsin School of Medicine and Public Health, Wisconsin-Madison, USA
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Australia
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Bucklin AA, Ganglberger W, Quadri SA, Tesh RA, Adra N, Da Silva Cardoso M, Leone MJ, Krishnamurthy PV, Hemmige A, Rajan S, Panneerselvam E, Paixao L, Higgins J, Ayub MA, Shao YP, Ye EM, Coughlin B, Sun H, Cash SS, Thompson BT, Akeju O, Kuller D, Thomas RJ, Westover MB. High prevalence of sleep-disordered breathing in the intensive care unit - a cross-sectional study. Sleep Breath 2023; 27:1013-1026. [PMID: 35971023 PMCID: PMC9931933 DOI: 10.1007/s11325-022-02698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Sleep-disordered breathing may be induced by, exacerbate, or complicate recovery from critical illness. Disordered breathing during sleep, which itself is often fragmented, can go unrecognized in the intensive care unit (ICU). The objective of this study was to investigate the prevalence, severity, and risk factors of sleep-disordered breathing in ICU patients using a single respiratory belt and oxygen saturation signals. METHODS Patients in three ICUs at Massachusetts General Hospital wore a thoracic respiratory effort belt as part of a clinical trial for up to 7 days and nights. Using a previously developed machine learning algorithm, we processed respiratory and oximetry signals to measure the 3% apnea-hypopnea index (AHI) and estimate AH-specific hypoxic burden and periodic breathing. We trained models to predict AHI categories for 12-h segments from risk factors, including admission variables and bio-signals data, available at the start of these segments. RESULTS Of 129 patients, 68% had an AHI ≥ 5; 40% an AHI > 15, and 19% had an AHI > 30 while critically ill. Median [interquartile range] hypoxic burden was 2.8 [0.5, 9.8] at night and 4.2 [1.0, 13.7] %min/h during the day. Of patients with AHI ≥ 5, 26% had periodic breathing. Performance of predicting AHI-categories from risk factors was poor. CONCLUSIONS Sleep-disordered breathing and sleep apnea events while in the ICU are common and are associated with substantial burden of hypoxia and periodic breathing. Detection is feasible using limited bio-signals, such as respiratory effort and SpO2 signals, while risk factors were insufficient to predict AHI severity.
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Affiliation(s)
- Abigail A Bucklin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Wolfgang Ganglberger
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Syed A Quadri
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Noor Adra
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Madalena Da Silva Cardoso
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Parimala Velpula Krishnamurthy
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Aashritha Hemmige
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Subapriya Rajan
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ezhil Panneerselvam
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Jasmine Higgins
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Muhammad Abubakar Ayub
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Elissa M Ye
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Brian Coughlin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | | | - Oluwaseun Akeju
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, MGH, Boston, MA, USA
| | | | - Robert J Thomas
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA.
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA.
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA.
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Kurnool S, McCowen KC, Bernstein NA, Malhotra A. Sleep Apnea, Obesity, and Diabetes - an Intertwined Trio. Curr Diab Rep 2023:10.1007/s11892-023-01510-6. [PMID: 37148488 DOI: 10.1007/s11892-023-01510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE OF REVIEW To synthesize the existing literature regarding the complex interplay between sleep disturbance, obesity, and diabetes. The review emphasizes the three pillars of health being diet, exercise, and sleep, with the notion that if one is ignored, then the other two could suffer. RECENT FINDINGS Sleep deprivation is associated with incident obesity, perhaps mediated by dysregulation in leptin and ghrelin - hormones important in regulation of appetite. Sleep apnea is very common particularly among obese people with type 2 diabetes mellitus. Treatment of sleep apnea has clear symptomatic benefits although its impact on long-term cardiometabolic health is less clear. Sleep disturbance may be an important modifiable risk for patients at risk of cardiometabolic disease. An assessment of sleep health may be an important component of the comprehensive care of patients with obesity and diabetes mellitus.
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Affiliation(s)
- Soumya Kurnool
- UC San Diego Department of Medicine, 9500 Gilman Drive, UC San Diego, La Jolla, CA, 92037, USA
| | - Karen C McCowen
- UC San Diego Department of Medicine, 9500 Gilman Drive, UC San Diego, La Jolla, CA, 92037, USA
| | - Nicole A Bernstein
- UC San Diego Department of Medicine, 9500 Gilman Drive, UC San Diego, La Jolla, CA, 92037, USA
| | - Atul Malhotra
- UC San Diego Department of Medicine, 9500 Gilman Drive, UC San Diego, La Jolla, CA, 92037, USA.
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Gadoth A, Devine MF, Pittock SJ, McKeon A, Tobin WO, Gossard TR, Cattaneo EFD, McCarter SJ, St Louis EK. Sleep disturbances associated with DPPX autoantibodies: a case series. J Neurol 2023:10.1007/s00415-023-11698-y. [PMID: 37024733 DOI: 10.1007/s00415-023-11698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
STUDY OBJECTIVES To describe a case series of patients with prominent sleep disturbances and their polysomnography findings in six patients with dipeptidyl-peptidase-like protein-6 (DPPX) autoimmunity syndrome. METHODS Of 13 patients with DPPX autoimmunity evaluated at Mayo Clinic, 6 were seen by Sleep Medicine with polysomnography and were assessed with blood and cerebrospinal fluid, neuroimaging, neuropsychological testing, and evaluation tailored to clinical presentation. RESULTS Median age of our six DPPX autoimmunity patients was 57 (range 27-70) years, with one woman. All patients had prominent gastrointestinal disturbances, most with prominent and early weight loss, and a spectrum of neuropsychiatric disturbances including cognitive impairment, myoclonus, exaggerated startle, and dysautonomia. Sleep disturbances included insomnia and obstructive sleep apnea in six patients, periodic leg movements of sleep in four, and REM sleep behavior disorder in two. Polysomnography demonstrated REM sleep-atonia loss in four patients, and ambiguous sleep with status dissociatus (mixed features of wakefulness, non-rapid eye movement [NREM], and REM sleep) appeared in one patient. Five of six patients showed neurological improvement with immunotherapy, including three with at least partial improvement in sleep disturbances. CONCLUSION Our patients with DPPX autoimmunity syndrome had prominent sleep disturbances including sleep-disordered breathing, REM sleep behavior disorder, and abnormal NREM sleep architecture with highly variable clinical presentations. DPPX autoimmunity should be considered in cases with a triad of sleep disturbance, neurological features of hyperexcitability, and systemic symptoms of gastrointestinal disturbance and weight loss. Future prospective studies of DPPX autoimmunity syndrome including detailed sleep evaluation and follow-up are necessary.
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Affiliation(s)
- Avi Gadoth
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Michelle F Devine
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- Olmsted Medical Center, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Thomas R Gossard
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- St. Olaf College, Northfield, MN, USA
| | - Elena F D Cattaneo
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- The University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Stuart J McCarter
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Paolin C, Zanetto L, Frison S, Boscolo Mela F, Tessari A, Amigoni A, Daverio M, Bonardi CM. Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review. Eur J Pediatr 2023; 182:2089-2094. [PMID: 36912961 PMCID: PMC10009862 DOI: 10.1007/s00431-023-04856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants ≤ 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery. Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients. What is Known: • Although the course of COVID-19 in infants is usually mild, some of them may develop a more severe disease needing intensive care support. Apneas may be a clinical sign in COVID-19. What is New: • Infants with apneas during COVID-19 may require intensive care support, but they usually show a benign course of the disease and full recovery.
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Affiliation(s)
- Chiara Paolin
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Lorenzo Zanetto
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Sara Frison
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Federica Boscolo Mela
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Anna Tessari
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy.
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
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González-Gordillo CI, Orozco-Soto LE, Osegueda-Mayen JR, Nava-Tapia A, Martinez-Monreal D. Joubert syndrome: a case report of neonatal presentation and early diagnosis. Bol Med Hosp Infant Mex 2023; 80:23-27. [PMID: 37490694 DOI: 10.24875/bmhim.22000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/07/2022] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Joubert syndrome is a rare genetic condition with a prevalence of 1:80,000-1:100,000. In most cases, it shows an autosomal autosomal recessive hereditary pattern, although X-linked and autosomal dominant cases have been described. The distinctive characteristic of this syndrome is the malformation at cerebral and cerebellar levels, known as the "molar tooth sign," hypotonia, and delayed neurodevelopment. CASE REPORT We describe the case of a newborn with transient tachypnea. However, during hospital stay, he showed other clinical signs not corresponding to the admission diagnosis, such as bradycardia, apneas, hypotonia, and alteration in swallowing mechanics. To rule out etiologies of central origin, we conducted a magnetic resonance of the brain and identified the "molar tooth sign," where the pathognomonic sign of Joubert syndrome. CONCLUSIONS Rare genetic diseases may manifest as early as the neonatal period with non-specific signs. The early diagnosis of Joubert syndrome is reflected in better pediatric follow-up, which impacts its prognosis and the possibility of improving the patient's quality of life with a multidisciplinary management and genetic counseling.
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Affiliation(s)
| | | | | | | | - Dario Martinez-Monreal
- Unidad de Imagenología, Hospital General Regional No. 270, Instituto Mexicano del Seguro Social, Reynosa, Tamaulipas. Mexico
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Siegler BH, Dudek M, Müller T, Kessler M, Günther P, Hochreiter M, Weigand MA. Impact of supplemental anesthesia in preterm infants undergoing inguinal hernia repair under spinal anesthesia : A retrospective analysis. Anaesthesiologie 2023; 72:175-182. [PMID: 36121460 PMCID: PMC9974706 DOI: 10.1007/s00101-022-01199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In preterm infants, spinal anesthesia (SpA) is recognized as an alternative to general anesthesia for inguinal hernia repair (IHR); however, some patients require supplemental anesthesia during surgery. The purpose of this study was to investigate the frequency and impact of supplemental anesthesia on perioperative care and adverse respiratory and hemodynamic events. METHODS A retrospective study of preterm infants undergoing IHR at Heidelberg University Hospital within the first year of life between 2009 and 2018 was carried out. RESULTS In total, 230 patients (255 surgeries) were investigated. Among 189 procedures completed using SpA 24 patients received supplemental anesthesia. Reasons for supplemental anesthesia included loss of anesthetic effect, returning motor response, and respiratory complications. Compared to SpA alone, no differences were found concerning hemodynamic parameters; however, patients requiring supplemental anesthesia displayed higher rates of postoperative oxygen supplementation and unexpected admission to the intensive care unit. The rate of perioperative apnea was 2.7%. Apneic events exclusively occurred after supplemental anesthesia. Bilateral IHR and duration of surgery were associated with the need for supplemental anesthesia. CONCLUSION Whereas SpA might be favorable when compared to general anesthesia for IHR, the data indicate that particular caution is required in patients receiving supplemental anesthesia due to the possible risk for adverse respiratory events.
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Affiliation(s)
- Benedikt Hermann Siegler
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Martha Dudek
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Thomas Müller
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Markus Kessler
- Division of Pediatric Surgery, Department of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Patrick Günther
- Division of Pediatric Surgery, Department of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Marcel Hochreiter
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany
| | - Markus Alexander Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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Bheemavarapu B, Singh A, Ranjini NJ, Abhilash Meda VS, Patil D. Recurrent Acute on Chronic Respiratory Failure in Stiff Person Syndrome. Case Rep Neurol 2023; 15:187-191. [PMID: 37901129 PMCID: PMC10601654 DOI: 10.1159/000532093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/10/2023] [Indexed: 10/31/2023] Open
Abstract
Stiff person syndrome (SPS) is an extremely rare disease that presents with episodic painful muscle spasms and progressive muscle rigidity. Recent evidence suggests that SPS can rarely manifest with life-threatening respiratory complications. However, the pathophysiology behind respiratory failure in SPS is still not clearly understood. Here, we explored an extremely rare case of a 36-year-old African-American female with SPS presenting with multiple episodes of respiratory failure events for the past 9 years. She had an in-situ tracheostomy and was admitted to the hospital for tracheostomy evaluation and decannulation. 11 years ago she initially presented with gait abnormalities, stiffness, and spastic episodes. She was diagnosed 1 year later with SPS after detecting elevated anti-glutamic acid decarboxylase antibody levels in her blood. Through this report, we were able to follow a very rare case of SPS that presented with multiple episodes of respiratory failure. We pointed out the importance of early start and regular administration of diazepam, baclofen, and IVIg in not only controlling the symptoms and progression of the disease but also in preventing further respiratory failure and possible sudden death.
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Affiliation(s)
- Bhumika Bheemavarapu
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Arkaja Singh
- Mahatma Gandhi Medical College and Hospital, Riico Industrial Area, Jaipur, India
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Mahale AR, Rao P, Ullal S, Fernandes M, Prabhu S. Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome. Indian J Otolaryngol Head Neck Surg 2022; 74:5134-5143. [PMID: 36742538 PMCID: PMC9895697 DOI: 10.1007/s12070-021-02980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6 mm and in the OSAS group it was 11.2 mm. The mean length of the soft palate was 36.4 mm in the controls, 39.5 mm in the mild/moderate OSAS and 41.2 mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.
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Affiliation(s)
- Ajit R. Mahale
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Pallavi Rao
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Sonali Ullal
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Merwyn Fernandes
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
| | - Sonali Prabhu
- Department of Radiodiagnosis, Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India, Mangalore, Karnataka India
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Walsh P, Chaigneau FRC, Lebedev M, Mutua V, McEligot H, Lam SHF, Hwang B, Bang H, Gershwin LJ. Lung ultrasound allows for earlier diagnosis of bronchiolitis than auscultation: an animal experiment and human case series. J Ultrasound 2022; 25:877-886. [PMID: 35179715 PMCID: PMC9705680 DOI: 10.1007/s40477-021-00648-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/11/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Early diagnosis of bronchiolitis in infants allows for risk stratification for central apnea, and, when available, the timely initiation of antiviral treatment. An animal model could demonstrate if earlier diagnosis is possible with ultrasound than with clinical exam. Even if possible, translating this to pediatrics would require observations from undifferentiated human infants. METHODS We used serial daily clinical and lung ultrasound exams in a bovine calf model (Bos taurus) of respiratory syncytial virus bronchiolitis. Ultrasound and clinical examiners were blinded to each other's findings and the treatments used in 24 calves. Time to diagnosis was compared using Kaplan-Meier curves. A case series of human infants with upper respiratory tract infections, without clinical signs of bronchiolitis, and in whom lung ultrasound was performed, was extracted from hospital records. RESULTS In the bovine model, lung ultrasound findings emerged earlier and lasted later than auscultatory findings. Relying on auscultation, 5/24 (21%) of animals were diagnosed by post-inoculation day 5 whereas 24/24 (100%) were diagnosed by ultrasound. We identified seven infants in whom lung ultrasound was used to diagnose bronchiolitis before adventitial lung sounds emerged. Three of these subsequently developed typical clinical findings of bronchiolitis in the hospital. Two had alternative explanations for their abnormal lung ultrasounds (both required surgical intervention). Two were discharged and required no further medical attention. CONCLUSION Lung ultrasound allowed earlier diagnosis of bronchiolitis than clinical exam in the bovine model. In the human case series this was also true, but alternative causes of abnormal ultrasound were frequent.
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Affiliation(s)
- Paul Walsh
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, 95816, USA.
| | - Francisco R Carvallo Chaigneau
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
- California Animal Health and Food Safety Laboratory, San Bernardino branch, 105 W Central Ave, San Bernardino, CA, 92408, USA
- Division of Veterinary Pathology. Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, VA, 24060, USA
| | - Maxim Lebedev
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Victoria Mutua
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Heather McEligot
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Samuel H F Lam
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, 95816, USA
| | - Benjamin Hwang
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, 95616, USA
| | - Laurel J Gershwin
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, 95616, USA.
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Silu M, Gupta G, Chand D, Patidar M. Evaluation of Cognitive and Social Behavior After Adenotonsillectomy in Children. Indian J Otolaryngol Head Neck Surg 2022; 74:6444-6447. [PMID: 36742553 PMCID: PMC9895664 DOI: 10.1007/s12070-020-02287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
To evaluate improvement in cognitive and social behavior of children after adenotonsillectomy. This prospective, observational study was done on 50 patients between November 2016 to September 2019 with clinical features suggestive of adenoid and palatine tonsillar hypertrophy (grade 3, 4) at department of otorhinolaryngology in our institute. We used 10 questions of Glasgow Children's Benefit Inventory (GCBI), to evaluate the cognitive and social behavior of children after adenotonsillectomy. After surgery, we evaluated cognitive functions (distractibility, learning, concentration and irritability) and social behavior (Progress and development, liveliness, family harmony, fun with friends, happiness and leisure) of children. p value of comparison at 1 month and 6 months postoperative was significant (< 0.05) for all questions of GCBI. Adenotonsillectomy definitely have positive impact on cognitive and social behavior of children. So early surgical intervention in form of adenotonsillectomy is recommended in children having clinical symptoms of adenotonsillar hypertrophy and sleep disordered breathing.
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Affiliation(s)
- Manju Silu
- Department of Otorhinolaryngology, Ravindra Nath Medical College, Udaipur, Rajasthan 313001 India
| | - Gaurav Gupta
- Department of Otorhinolaryngology, Sardar Patel Medical College, Bikaner, Rajasthan India
| | - Deep Chand
- Department of Otorhinolaryngology, Sardar Patel Medical College, Bikaner, Rajasthan India
| | - Monika Patidar
- Department of Otorhinolaryngology, Sardar Patel Medical College, Bikaner, Rajasthan India
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Ioan I, Weick D, Sevin F, Sanlaville D, De Fréminville B, Schweitzer C, Akkari M, Coutier L, Putois B, Plancoulaine S, Thieux M, Franco P. Neurocognitive evaluation of children with down syndrome and obstructive sleep apnea syndrome. Sleep Med 2022; 100:542-549. [PMID: 36308912 DOI: 10.1016/j.sleep.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/08/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) treatment has been shown to improve cardiac behavioral and cognitive functions in typically developing children. Early OSAS diagnosis in children with Down syndrome (DS) would be important to prevent its complications, especially cognitive ones, but remains overlooked. The main objective of our study was to assess the cognitive function of children with DS, with and without OSAS. The second objective was to determine the impact of the therapeutic intervention on the cognitive function of children with OSAS. This study included 41 children with DS who underwent polysomnography for OSAS diagnosis and a cognitive evaluation. They were aged between 3.4 and 17.3 years and 24 (59%) were boys. Their median OAHI was 2.6 (0-31)/h of sleep, 30 (73%) were diagnosed with OSAS (15 had mild OSAS, and 15 had moderate/severe OSAS). Some scores of the Raven's colored progressive matrices were negatively correlated with the respiratory arousal index, OAHI tended to be positively correlated with Reiss behavioral problems. 24 (59%) patients received a treatment. Even if we were unable to demonstrate this formally due that only 16 children (39%) accepted a follow-up visit, some displayed improvement in their neuropsychological scores, especially those with moderate/severe OSAS after treatment. Children with DS have low intellectual abilities and more risk of developing OSAS compared to the general population, which may lead to further neurocognitive impairment. Early screening and management are important in this population to prevent any further neurocognitive delay in their development.
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Affiliation(s)
- Iulia Ioan
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, DevAH, F-54000 Nancy, France
| | - Diane Weick
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - François Sevin
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Damien Sanlaville
- Département de génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte De Fréminville
- Service de Génétique, CHU de St Etienne, Centre de Référence Maladies Rares des Anomalies du Développement et des Syndromes Malformatifs de l'Inter région Centre Est (Rhône Alpes Auvergne), France
| | - Cyril Schweitzer
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, DevAH, F-54000 Nancy, France
| | - Mohamed Akkari
- Hopital Gui de Chauliac, 58 Avenue Augustin Fliche, 34295, France
| | - Laurianne Coutier
- Service de pneumologie infantile, allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Benjamin Putois
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; U1028, Lyon Neuroscience Research Center (CNRL), University Lyon 1, Lyon, France
| | | | - Marine Thieux
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; U1028, Lyon Neuroscience Research Center (CNRL), University Lyon 1, Lyon, France
| | - Patricia Franco
- Service d'épileptologie clinique, des troubles du sommeil et de neurologie fonctionnelle de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; U1028, Lyon Neuroscience Research Center (CNRL), University Lyon 1, Lyon, France.
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Wang YL, Lan GR, Zou X, Wang EQ, Dai RP, Chen YX. Apnea caused by retrobulbar anesthesia: A case report. World J Clin Cases 2022; 10:11646-11651. [PMID: 36387800 PMCID: PMC9649527 DOI: 10.12998/wjcc.v10.i31.11646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery.
CASE SUMMARY We report a rare case of apnea caused by retrobulbar anesthesia, and emergency resuscitation was used. A 74-year-old female patient was diagnosed with rhegmatogenous retinal detachment in the right eye and planned to undergo vitrectomy under retrobulbar anesthesia. After the retrobulbar anesthesia in her right eye, she became unconscious and apneic. It was suggested that she had developed brainstem anesthesia. Assisted ventilation was initiated. Atropine 0.5 mg, epinephrine 1 mg, ephedrine 30 mg, and lipid emulsion were given. Five minutes later, her consciousness and breathing gradually returned, but with uncertain light perception in her right eye. Alprostadil 20 µg was given, and after 2 h her visual acuity resumed to the preoperative level.
CONCLUSION Brainstem anesthesia is a serious complication secondary to retrobulbar anesthesia. Medical staff should pay attention to the identification of brainstem anesthesia and be familiar with the emergency treatment for this complication.
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Affiliation(s)
- Yue-Lin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Guo-Ru Lan
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xuan Zou
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Er-Qian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Rong-Ping Dai
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
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Calvo-Henriquez C, Boronat-Catala B, Rivero-Fernández I, Cammaroto G, Ibrahim B, Lechien JR, Martínez-Capoccioni G, Carrasco-Llatas M, Capasso R, Martin-Martin C. Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:384-393. [PMID: 36404101 DOI: 10.1016/j.otoeng.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults. DATA SOURCES PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database. REVIEW METHODS Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique. RESULTS 20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample. CONCLUSION The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation.
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Affiliation(s)
| | - Borja Boronat-Catala
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Service of Otolaryngology, Rhinology Department, Hospital Complex of Santiago de Compostela,Spain
| | - Irene Rivero-Fernández
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Service of Otolaryngology, Hospital 12 de Octubre, Madrid,Spain
| | - Giovanni Cammaroto
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Department of Head-Neck Surgery, AUSL Romagna,Italy; Ear Nose Throat (ENT) Unit of Forlì and Faenza, University of Ferrara and Bologna, Morgagni-Pierantoni Hospital,Forlì,Italy
| | - Badr Ibrahim
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Department of Otolaryngology-Head and Neck Surgery, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, CA,USA
| | - Jerome R Lechien
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris,France
| | - Gabriel Martínez-Capoccioni
- Sleep Apnea Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris,France; Service of Otolaryngology, Rhinology Department, Hospital Complex of Santiago de Compostela,Spain
| | | | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, CA,USA
| | - Carlos Martin-Martin
- Service of Otolaryngology, Rhinology Department, Hospital Complex of Santiago de Compostela,Spain
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Setoue T, Yatsuga S, Ito K, Kodera T, Onda Y, Kawano H, Niimi T, Miyamoto T, Ohta E, Nagamitsu S. An exploratory study to identify neonatal arterial ischemic stroke: A single-center study. Brain Dev 2022; 44:672-80. [PMID: 36058756 DOI: 10.1016/j.braindev.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/03/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neonatal arterial ischemic stroke (NAIS) presents as seizures, including convulsions, subtle seizures, and apnea, and most patients experience neurological sequelae. Diagnosis is often delayed owing to low test sensitivity. The present study aimed to identify the early clinical diagnostic factors for NAIS in neonates with seizures. METHODS The present study included 54 patients born at ≥36 weeks of gestation during the last 15 years who presented to the neonatal intensive care unit with neonatal seizures and underwent brain magnetic resonance imaging (MRI), 6 of whom were diagnosed with NAIS. Maternal background, clinical characteristics, and transcranial pulsed Doppler sonography results were retrospectively reviewed. RESULTS Of the 24 patients who presented with convulsions or subtle seizures, 3 (13%) were diagnosed with NAIS and 3 of 30 patients (10%) presented with apnea. Maternal premature ventricular contraction complications were higher in the NAIS group than in the non-NAIS group (p = 0.01). NAIS group showed lower mean middle cerebral artery (MCA) resistance index (RI) was lower the non-NAIS group (p = 0.009), while the left-right RI difference (p = 0.019), mean MCA blood velocity (MnV; p = 0.04), and left-right MnV difference (p < 0.001) in cerebral blood flow velocities (CBFVs) were higher in the NAIS group. CONCLUSIONS Our results revealed that maternal arrhythmia may be a diagnostic factor for NAIS in neonates with seizures. Early brain MRI is essential in neonates with seizures and findings of low MCA-RI, high MCA-MnV, or high left-right difference in CBFVs to distinguish between NAIS and non-NAIS.
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Tunçel D, Bilgin LK, İnce Z, Çoban A. Apnea as an isolated finding in neonatal COVID-19. Proc AMIA Symp 2022; 36:73-74. [PMID: 36578617 PMCID: PMC9762778 DOI: 10.1080/08998280.2022.2131184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/31/2022] Open
Abstract
COVID-19 continues to mutate and spread rapidly. However, case reports about newborns remain rare. A male baby, born at 840 g at gestational week 28, was diagnosed with respiratory distress syndrome, sepsis, patent ductus arteriosus, and bronchopulmonary dysplasia in the neonatal intensive care unit. Refractory apnea developed on postnatal day 58, and an upper respiratory tract SARS-nCoV-2 polymerase chain reaction test was positive. A COVID test was also positive in an asymptomatic nurse who cared for the baby. This case shows that SARS-CoV-2 can cause symptoms of only apnea in newborns and that those who care for newborns should strictly comply with hygiene rules.
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Affiliation(s)
- Duygu Tunçel
- Department of Neonatology, University of Health Sciences Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey,Corresponding author: Duygu Tunçel, Department of Neonatology, Istanbul Faculty of Medicine, Istanbul University, Talaytepe District, Urfa Road, 21090Diyarbakır, Turkey (e-mail: )
| | - Leyla Karadeniz Bilgin
- Department of Neonatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep İnce
- Department of Neonatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Asuman Çoban
- Department of Neonatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Chiang TL, Tam KW, Chen JT, Wong CS, Yeh CT, Huang TY, Ong JR. Non-invasive ventilation for preoxygenation before general anesthesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2022; 22:306. [PMID: 36180822 DOI: 10.1186/s12871-022-01842-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background and objectives Preoxygenation is crucial for providing sufficient oxygen reservoir to a patient before intubation and enables the extension of the period between breathing termination and critical desaturation (safe apnoea time). Conventionally, face mask ventilation is used for preoxygenation. Non-invasive ventilation is a new preoxygenation method. The study objective was to compare the outcomes of non-invasive ventilation and face mask ventilation for preoxygenation. Method PubMed, Embase, Cochrane Library, and the ClinicalTrials.gov registry were searched for eligible studies published from database inception to September 2021. Individual effect sizes were standardized, and a meta-analysis was conducted using random effects models to calculate the pooled effect size. Inclusion criteria were randomised controlled trials of comparing the outcomes of non-invasive ventilation or face mask ventilation for preoxygenation in patients scheduled for surgeries. The primary outcome was safe apnea time, and the secondary outcomes were post-operative complications, number of patients who achieved the expired O2 fraction (FeO2) after 3 min of preoxygenation, minimal SpO2 during tracheal intubation, partial pressure of oxygen in the arterial blood (PaO2) and partial pressure of carbon dioxide (PaCO2) after preoxygenation, and PaO2 and PaCO2 after tracheal intubation. Results 13 trials were eligible for inclusion in this study. Significant differences were observed in safe apnoea time, number of patients who achieved FeO2 90% after preoxygenation for 3 min, and PaO2 and PaCO2 after preoxygenation and tracheal intubation. Only in the non-obese subgroup, no significant difference was observed in safe apnoea time (mean difference: 125.38, 95% confidence interval: − 12.26 to 263.03). Conclusion Non-invasive ventilation appeared to be more effective than conventional methods for preoxygenation. We recommend non-invasive ventilation based on our results. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01842-y.
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Yaslıkaya S, Geçkil AA, Birişik Z. Is There a Relationship between Voice Quality and Obstructive Sleep Apnea Severity and Cumulative Percentage of Time Spent at Saturations below Ninety Percent: Voice Analysis in Obstructive Sleep Apnea Patients. Medicina (Kaunas) 2022; 58:medicina58101336. [PMID: 36295497 PMCID: PMC9608866 DOI: 10.3390/medicina58101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Apnea hypopnea index is the most important criterion in determining the severity of obstructive sleep apnea (OSA), while the percentage of the total number of times which oxygen saturation is measured below 90% during polysomnography (CT90%) is important in determining the severity of hypoxemia. As hypoxemia increases, inflammation will also increase in OSA. Inflammation in the respiratory tract may affect phonation. We aimed to determine the effects of the degree of OSA and CT90% on phonation. Materials and Methods: The patients were between the ages of 18−60 years and were divided into four groups: normal, mild, moderate, and severe OSA. Patients were asked to say the vowels /α:/ and /i:/ for 5 s for voice recording. Maximum phonation time (MPT) was recorded. Using the Praat voice analysis program, Jitter%, Shimmer%, harmonics-to-noise ratio (HNR), and f0 values were obtained. Results: Seventy-two patients were included. Vowel sound /α:/; there was a significant difference for Jitter%, Shimmer%, and HNR measurements between the 1st and the 4th group (p < 0.001, p < 0.001, and p < 0.001, respectively) and a correlation between CT90% and Shimmer% and HNR values (p < 0.001 and p < 0.021, respectively). Vowel sound /i:/; there was a significant difference in f0 values between the 1st group and 2nd and 4th groups (p < 0.028 and p < 0.015, respectively), and for Jitter%, Shimmer%, and HNR measurements between the 1st and 4th group (p < 0.04, p < 0.000, and p < 0.000, respectively), and a correlation between CT90% and Shimmer% and HNR values (p < 0.016 and p < 0.003, respectively). The difference was significant in MPT between the 1st group and 3rd and 4th groups (p < 0.03 and p < 0.003, respectively). Conclusions: Glottic phonation can be affected, especially in patients whose AHI scores are ≥15. Voice quality can decrease as the degree of OSA increases. The increase in CT90% can be associated with the worsening of voice and can be used as a predictor in the evaluation of voice disorders in the future.
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Affiliation(s)
- Serhat Yaslıkaya
- Department of Otorhinolaryngology, Faculty of Medicine, Adıyaman University, Adıyaman 02100, Turkey
- Correspondence: ; Tel.: +90-4162161015
| | - Ayşegül Altıntop Geçkil
- Department of Chest Diseases, Faculty of Medicine, Malatya Turgut Özal University, Malatya 44210, Turkey
| | - Zehra Birişik
- Department of Speech and Language Therapy, Malatya Training and Research Hospital, Malatya 44000, Turkey
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Song JS, Sloychuk J, El-Hakim H, Isaac A. A novel sleep oximetry scoring tool for pediatric laryngomalacia. Int J Pediatr Otorhinolaryngol 2022; 160:111220. [PMID: 35816969 DOI: 10.1016/j.ijporl.2022.111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Despite being a more accessible and less resource intensive modality than polysomnography, the utility of sleep oximetry (SO) in pediatric laryngomalacia (LM) is not well understood or validated. We aimed to retrospectively evaluate the utility of overnight home based SO in children with LM by developing and internally validating the Modified Laryngomalacia Oximetry Score (MLOS) scoring system to triage severity and guide clinical decision making. METHODS We evaluated pediatric patients with a diagnosis of LM at our tertiary referral centre. Data from initial and post-treatment SO including mean oxygen saturation (spO2) nadir and mean oxygen desaturation index (ODI) were aggregated. The MLOS ranging from I-VI (inconclusive to severe) was created by two otolaryngologists to incorporate bradycardia associated desaturation events during SO. Corresponding McGill Oximetry Score (MOS) was also determined. RESULTS 172 patients were included in final analysis. The average age was 9.2 ± 14.3 months. 98 (57%) of patients were identified as Thompson severity score 1, and 87 (50.6%) of patients underwent supraglottoplasty. The surgical cohort had a significantly higher MLOS and MOS scores of 4 and 2 respectively, and higher mean ODI and spO2 nadir metrics. When evaluating post-supraglottoplasty SO tracings, all parameters improved significantly, including median MLOS score from 4 to 1. Only the mean ODI improved in the non-surgical cohort. Patients with Thompson severity score 2/3 had significantly higher MLOS. CONCLUSION We present a simple scoring system based on overnight SO, the MLOS, to help triage severity of pediatric LM and guide decision-making. MLOS is associated with worse clinical severity and a need for surgery, and shows significant improvement after surgery.
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