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Ratneswaran C, Steier J, Reed K, Khong TK. Electronic Cigarette Advertising Impacts Adversely on Smoking Behaviour Within a London Student Cohort: A Cross-Sectional Structured Survey. Lung 2019; 197:533-540. [PMID: 31463548 PMCID: PMC6778585 DOI: 10.1007/s00408-019-00262-z] [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: 12/30/2018] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Introduction In contrast to tobacco smoking, electronic cigarette (“vaping”) advertisement had been approved in the United Kingdom (UK) in January 2013. Currently, there are an estimated 3.2 million UK e-cigarette users. The impact of e-cigarette advertisement on tobacco use has not been studied in detail. We hypothesised that e-cigarette advertisement impacts on conventional smoking behaviour. Methods A cross-sectional structured survey assessed the impact of e-cigarette advertising on the perceived social acceptability of cigarette and e-cigarette smoking and on using either cigarettes or e-cigarettes (on a scale of 1 to 5/‘not at all’ to ‘a lot’). The survey was administered between January to March 2015 to London university students, before and after viewing 5 UK adverts including a TV commercial. Results Data were collected from 106 participants (22 ± 2 years, 66% male), comprising cigarette smokers (32%), non-smokers (54%) and ex-smokers (14%). This included vapers (16%), non-vapers (77%) and ex-vapers (7%). After viewing the adverts, smokers (2.6 ± 1.0 vs. 3.8 ± 1.1, p = 0.001) and non-smokers (3.2 ± 0.7 vs. 3.7 ± 0.8, p = 0.007) felt smoking was more socially acceptable, compared to before viewing them. Participants were more likely to try both e-cigarettes (1.90 ± 1.03 to 3.09 ± 1.11, p < 0.001) and conventional cigarettes (1.73 ± 0.83 to 2.27 ± 1.13, p < 0.001) after viewing the adverts compared to before. Vapers were less likely to smoke both an e-cigarette, and a conventional cigarette after viewing the adverts. Conclusion E-cigarette advertising encourages both e-cigarette and conventional cigarette use in young smokers and non-smokers. The adverts increase the social acceptability of smoking without regarding the importance of public health campaigns that champion smoking cessation. Electronic supplementary material The online version of this article (10.1007/s00408-019-00262-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Ratneswaran
- Lane Fox Unit/ Sleep Disorders Centre, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Road, London, SE1 7EH, UK. .,Faculty of Life Sciences and Medicine, Centre for Human & Applied Physiological Sciences, King's College London, London, UK. .,Institute of Medical and Biomedical Education, St George's, University of London, London, UK.
| | - J Steier
- Lane Fox Unit/ Sleep Disorders Centre, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Road, London, SE1 7EH, UK.,Faculty of Life Sciences and Medicine, Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - K Reed
- Faculty of Life Sciences and Medicine, Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - T K Khong
- Institute of Medical and Biomedical Education, St George's, University of London, London, UK
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He B, Al-Sherif M, Nido M, Tas R, Beach M, Schwarz EI, Cheng M, Ishak A, Lee K, Shah N, Kent B, Eze-John P, Ratneswaran C, Rafferty G, Williams AJ, Hart N, Luo Y, Moxham J, Pengo M, Steier J. Domiciliary use of transcutaneous electrical stimulation for patients with obstructive sleep apnoea: a conceptual framework for the TESLA home programme. J Thorac Dis 2019; 11:2153-2164. [PMID: 31285910 DOI: 10.21037/jtd.2019.05.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obstructive sleep apnoea (OSA) is a global health problem of increasing prevalence. Effective treatments are available with continuous positive airway pressure (CPAP) therapy and mandibular advancement devices (MAD). However, there is limited long-term adherence to therapy, as CPAP and MAD require permanent usage to avoid recurrence of the symptoms and adverse ill health. Alternative treatments would aid in the treatment cascade to manage OSA effectively whenever standard therapy has been trialled and failed. Hypoglossal nerve stimulation (HNS), an invasive approach to stimulate the pharyngeal dilator muscles of the upper airway during sleep, has been approved for the treatment of OSA by several healthcare systems in recent years. In parallel to the development of HNS, a non-invasive approach has been developed to deliver electrical stimulation. Transcutaneous electrical stimulation in obstructive sleep apnoea (TESLA) uses non-invasive electrical stimulation to increase neuromuscular tone of the upper airway dilator muscles of patients with OSA during sleep. Data from previous feasibility studies and randomised controlled trials have helped to identify a subgroup of patients who are "responders" to this treatment. However, further investigations are required to assess usability, functionality and task accomplishment of this novel treatment. Consideration of these factors in the study design of future clinical trials will strengthen research methodology and protocols, improve patient related outcome measures and assessments, to optimise this emerging therapeutical option. In this review, we will introduce a conceptual framework for the TESLA home programme highlighting qualitative aspects and outcomes.
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Affiliation(s)
- Baiting He
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK.,Key National Laboratory for Respiratory Disease, Guangzhou Medical University, Guangzhou 510000, China
| | - Miral Al-Sherif
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK.,Department of Respiratory Medicine, University of Minia, Minia, Egypt
| | - Miriam Nido
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Institute for Work Research and Organizational Consultancy, Switzerland
| | - Rukiye Tas
- Faculty of Life Sciences and Medicine, King's College London, UK
| | - Marianne Beach
- Faculty of Life Sciences and Medicine, King's College London, UK
| | - Esther I Schwarz
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK.,Department of Respiratory Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Cheng
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK.,Department of Respiratory Medicine, University of Sydney, Sydney, Australia
| | - Athanasius Ishak
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | - Kai Lee
- Faculty of Life Sciences and Medicine, King's College London, UK.,Department of Respiratory Medicine, King's College Hospital, London, UK
| | - Nimish Shah
- Jaslok Hospital and Research Centre, Mumbai, India
| | - Brian Kent
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | - Paul Eze-John
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Culadeeban Ratneswaran
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | - Gerrard Rafferty
- Faculty of Life Sciences and Medicine, King's College London, UK
| | - Adrian J Williams
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | - Nicholas Hart
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
| | - Yuanming Luo
- Faculty of Life Sciences and Medicine, King's College London, UK.,Key National Laboratory for Respiratory Disease, Guangzhou Medical University, Guangzhou 510000, China
| | - John Moxham
- Faculty of Life Sciences and Medicine, King's College London, UK
| | - Martino Pengo
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK.,Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - Joerg Steier
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
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Ratneswaran C, Pengo MF, Xiao S, Luo Y, Rossi GP, Polkey MI, Moxham J, Steier J. The acute effect of continuous positive airway pressure titration on blood pressure in awake overweight/obese patients with obstructive sleep apnoea. Blood Press 2018; 27:206-214. [PMID: 29473760 DOI: 10.1080/08037051.2018.1443391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/18/2022]
Abstract
OBJECTIVES Continuous positive airway pressure (CPAP) improves upper airway obstruction in patients with obstructive sleep apnoea (OSA), who often are overweight-obese. Although it is thought that CPAP improves long-term blood pressure control (BP), the impact of acute and short-term CPAP use on the cardiovascular system in obese patients has not been described in detail. METHODS Obese patients (body mass index, BMI > 25 kg/m2) with OSA were studied awake, supine during incremental CPAP titration (4-20 cmH2O, +2 cmH2O/3 mins). BP was measured continuously with a beat-to-beat BP monitor (Ohmeda 2300, Finapres Medical Systems, Amsterdam/NL), BP variability (BPV) was calculated as the standard deviation of BP at each CPAP level, the 95% confidence interval (95%CI) was calculated and changes in BP and BPV were reported. RESULTS 15 patients (12 male, 48 ± 10) years, BMI 38.9 ± 5.8 kg/m2) were studied; the baseline BP was 131.0 ± 10.2/85.1 ± 9.1 mmHg. BP and BPV increased linearly with CPAP titration (systolic BP r = 0.960, p < .001; diastolic BP r = 0.961, p < .001; systolic BPV r = 0.662, p = .026; diastolic BPV r = 0.886, p < .001). The systolic BP increased by +17% (+23.15 (7.9, 38.4) mmHg; p = .011) and the diastolic BP by +23% (+18.27 (2.33, 34.21) mmHg; p = .009), when titrating CPAP to 20 cmH2O. Systolic BPV increased by +96% (+5.10 (0.67, 9.53) mmHg; p < .001) and was maximal at 14 cmH2O, and diastolic BPV by +97% (+3.02 (0.26, 5.78) mmHg; p < .001) at 16 cmH2O. CONCLUSION Short-term incremental CPAP leads to significant increases in BP and BPV in obese patients with OSA while awake. Careful titration of pressures is required to minimise the risk of nocturnal awakenings while improving BP control.
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Affiliation(s)
- Culadeeban Ratneswaran
- a Faculty of Life Sciences and Medicine , King's College London , London , UK.,b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK
| | - Martino F Pengo
- b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK.,c Clinica dell'Ipertensione Arteriosa - Department of Medicine (DIMED) , University of Padua , Padova , Italy
| | - Sichang Xiao
- b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK.,d State Key Laboratory of Respiratory Disease , The First Affiliated Hospital of Guangzhou Medical School , Guangzhou , China
| | - Yuanming Luo
- d State Key Laboratory of Respiratory Disease , The First Affiliated Hospital of Guangzhou Medical School , Guangzhou , China
| | - Gian Paolo Rossi
- c Clinica dell'Ipertensione Arteriosa - Department of Medicine (DIMED) , University of Padua , Padova , Italy
| | - Michael I Polkey
- e NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute , London , UK
| | - John Moxham
- a Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Joerg Steier
- a Faculty of Life Sciences and Medicine , King's College London , London , UK.,b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK
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Ratneswaran C, Sagoo MK, Steier J. Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review. J Thorac Dis 2018; 10:S1-S23. [PMID: 29445524 PMCID: PMC5803052 DOI: 10.21037/jtd.2017.10.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Manpreet K Sagoo
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Pengo M, Sichang X, Ratneswaran C, Shah N, Reed K, Chen T, Douiri A, Hart N, Luo Y, Rafferty G, Rossi GP, Williams A, Polkey MI, Moxham J, Steier J. T6 Randomised sham-controlled trial of transcutaneous electrical stimulation in obstructive sleep apnoea. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reed KI, Pengo MF, Xiao S, Ratneswaran C, Shah N, Chen T, Douiri A, Hart N, Luo Y, Rafferty GF, Rossi GP, Williams A, Polkey MI, Moxham J, Steier J. S26 Feasibility and patient tolerability of transcutaneous electrical stimulation in obstructive sleep apnoea. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVES We compared 2 sociocultural cohorts with different duration of exposure to graphic health warning labels (GHWL), to investigate a possible desensitisation to their use. We further studied how a differing awareness and emotional impact of smoking-associated risks could be used to prevent this. SETTING Structured interviews of patients from the general respiratory department were undertaken between 2012 and 2013 in 2 tertiary hospitals in Singapore and London. PARTICIPANTS 266 participants were studied, 163 Londoners (35% smokers, 54% male, age 52±18 years) and 103 Singaporeans (53% smokers, p=0.003; 78% male, p<0.001; age 58±15 years, p=0.012). MAIN OUTCOMES AND MEASURES 50 items assessed demographics, smoking history, knowledge and the deterring impact of smoking-associated risks. After showing 10 GHWL, the impact on emotional response, cognitive processing and intended smoking behaviour was recorded. RESULTS Singaporeans scored lower than the Londoners across all label processing constructs, and this was consistent for the smoking and non-smoking groups. Londoners experienced more 'disgust' and felt GHWL were more effective at preventing initiation of, or quitting, smoking. Singaporeans had a lower awareness of lung cancer (82% vs 96%, p<0.001), despite ranking it as the most deterring consequence of smoking. Overall, 'blindness' was the least known potential risk (28%), despite being ranked as more deterring than 'stroke' and 'oral cancer' in all participants. CONCLUSIONS The length of exposure to GHWL impacts on the effectiveness. However, acknowledging the different levels of awareness and emotional impact of smoking-associated risks within different sociocultural cohorts could be used to maintain their impact.
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Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Ben Chisnall
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Mingyue Li
- Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sarah Tan
- Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abdel Douiri
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
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Pengo MF, Xiao S, Ratneswaran C, Reed K, Shah N, Chen T, Douiri A, Hart N, Luo Y, Rafferty GF, Rossi GP, Williams A, Polkey MI, Moxham J, Steier J. Randomised sham-controlled trial of transcutaneous electrical stimulation in obstructive sleep apnoea. Thorax 2016; 71:923-31. [PMID: 27435610 PMCID: PMC5036236 DOI: 10.1136/thoraxjnl-2016-208691] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/23/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is characterised by a loss of neuromuscular tone of the upper airway dilator muscles while asleep. This study investigated the effectiveness of transcutaneous electrical stimulation in patients with OSA. PATIENTS AND METHODS This was a randomised, sham-controlled crossover trial using transcutaneous electrical stimulation of the upper airway dilator muscles in patients with confirmed OSA. Patients were randomly assigned to one night of sham stimulation and one night of active treatment. The primary outcome was the 4% oxygen desaturation index, responders were defined as patients with a reduction >25% in the oxygen desaturation index when compared with sham stimulation and/or with an index <5/hour in the active treatment night. RESULTS In 36 patients (age mean 50.8 (SD 11.2) years, male/female 30/6, body mass index median 29.6 (IQR 26.9-34.9) kg/m(2), Epworth Sleepiness Scale 10.5 (4.6) points, oxygen desaturation index median 25.7 (16.0-49.1)/hour, apnoea-hypopnoea index median 28.1 (19.0-57.0)/hour) the primary outcome measure improved when comparing sham stimulation (median 26.9 (17.5-39.5)/hour) with active treatment (median 19.5 (11.6-40.0)/hour; p=0.026), a modest reduction of the mean by 4.1 (95% CI -0.6 to 8.9)/hour. Secondary outcome parameters of patients' perception indicated that stimulation was well tolerated. Responders (47.2%) were predominantly from the mild-to-moderate OSA category. In this subgroup, the oxygen desaturation index was reduced by 10.0 (95% CI 3.9 to 16.0)/hour (p<0.001) and the apnoea-hypopnoea index was reduced by 9.1 (95% CI 2.0 to 16.2)/hour (p=0.004). CONCLUSION Transcutaneous electrical stimulation of the pharyngeal dilators during a single night in patients with OSA improves upper airway obstruction and is well tolerated. TRIAL REGISTRATION NUMBER NCT01661712.
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Affiliation(s)
- Martino F Pengo
- Faculty of Life Sciences and Medicine, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Sichang Xiao
- Faculty of Life Sciences and Medicine, King's College London, London, UK State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Kate Reed
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nimish Shah
- Faculty of Life Sciences and Medicine, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Tao Chen
- Division of Health and Social Care, King's College London, London, UK
| | - Abdel Douiri
- Division of Health and Social Care, King's College London, London, UK
| | - Nicholas Hart
- Faculty of Life Sciences and Medicine, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Yuanming Luo
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Gerrard F Rafferty
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Gian Paolo Rossi
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Adrian Williams
- Faculty of Life Sciences and Medicine, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - John Moxham
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
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Pengo MF, Ratneswaran C, Berry M, Kent BD, Kohler M, Rossi GP, Steier J. Effect of Continuous Positive Airway Pressure on Blood Pressure Variability in Patients With Obstructive Sleep Apnea. J Clin Hypertens (Greenwich) 2016; 18:1180-1184. [PMID: 27251875 DOI: 10.1111/jch.12845] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
Abstract
Obstructive sleep apnea (OSA) is a common risk factor for cardiovascular disease. Continuous positive airway pressure (CPAP) improves OSA symptoms and blood pressure (BP) control. The effect of CPAP on BP variability (BPV) in patients with and without hypertension treated with autotitrating CPAP (APAP) for 2 weeks was studied. A total of 78 participants (76.9% men, 49% hypertensive, mean body mass index 36.2 [6.9] kg/m2 , age 49.0 [12.9] years) underwent 2 weeks of APAP therapy. Office BP, BPV (standard deviation of three BP measurements), and pulse rate were measured before and after treatment. Systolic BPV (5.3±4.9 vs 4.2±3.4 mm Hg, P=.047) and pulse rate (78.0±14.5 vs 75.5±15.8 beats per minute, P=.032) decreased after treatment, particularly in hypertensive participants. Mask leak was independently associated with reduced changes in systolic BPV (r=-0.237, P=.048). Short-term APAP treatment reduced BPV and pulse rate, particularly in hypertensive patients with OSA.
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Affiliation(s)
- Martino F Pengo
- Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK. .,Department of Medicine (DIMED), University of Padua, Padova, Italy. .,King's College London, Faculty of Life Sciences and Medicine, London, UK.
| | - Culadeeban Ratneswaran
- Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Marc Berry
- Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Brian D Kent
- Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Malcolm Kohler
- Department of Pneumology, University Hospital of Zurich and Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Gian Paolo Rossi
- Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Joerg Steier
- Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK.,King's College London, Faculty of Life Sciences and Medicine, London, UK
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10
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Xiao S, Bastianpillai J, Ratneswaran C, Pengo MF, Luo Y, Jolley CJ, Moxham J, Steier J. Continuous Positive Airway Pressure and Breathlessness in Obese Patients with Obstructive Sleep Apnea: A Pilot Study. Sleep 2016; 39:1201-10. [PMID: 27091534 DOI: 10.5665/sleep.5832] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/16/2015] [Accepted: 03/04/2016] [Indexed: 12/28/2022] Open
Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). However, long-term compliance with CPAP is limited. We tested the hypothesis that CPAP levels routinely used during sleep increase neural respiratory drive (NRD) and breathlessness, which may discourage compliance. METHODS This was an observational physiological cohort study in a respiratory physiology and sleep unit, University Hospital. Patients with a body mass index (BMI) > 25 kg/m(2) and confirmed OSA were studied supine and awake on CPAP (4-20 cm H2O, increments of 2 cm H2O/3 min). We measured NRD during awake CPAP titration in obese subjects to quantify the response to the load of the respiratory system and compared it to the CPAP used for nocturnal treatment, with the modified Borg Scale (mBorg) for dyspnea recorded (from 0 to 10 points, with higher numbers indicating more breathlessness). RESULTS Fifteen patients (age 48 ± 10 years, 12 male, BMI 38.9 ± 5.8 kg/m(2)) with OSA (AHI 32.2 ± 21.1/h, 95(th) percentile of CPAP 14.1 ± 3.8 cm H2O) were studied and NRD (electromyogram of the parasternal intercostals, EMGpara; EMG of the external oblique, EMGabdomen) was recorded (awake, supine). Awake, EMGpara declined from baseline to 70.2% ± 17.1% when CPAP of 10.7 ± 3.4 cm H2O (P = 0.026) was applied. Further increase in CPAP led to a rise in EMGpara and increased breathlessness (P = 0.02). CPAP compliance (nights used) correlated negatively with mBorg scores (r = -0.738, P = 0.006). CONCLUSIONS Awake, the respiratory system is maximally offloaded with lower than therapeutic CPAP levels in obese patients with OSA. Levels of NRD observed at effective CPAP levels while asleep are associated with breathlessness which may limit long-term CPAP compliance.
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Affiliation(s)
- Sichang Xiao
- King's College London, Faculty of Life Sciences and Medicine, London, UK.,Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Johan Bastianpillai
- King's College London, Faculty of Life Sciences and Medicine, London, UK.,Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Culadeeban Ratneswaran
- King's College London, Faculty of Life Sciences and Medicine, London, UK.,Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK
| | - Martino F Pengo
- King's College London, Faculty of Life Sciences and Medicine, London, UK.,University of Padua, Italy
| | | | - Caroline J Jolley
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - John Moxham
- King's College London, Faculty of Life Sciences and Medicine, London, UK.,King's Health Partners, London, UK
| | - Joerg Steier
- King's College London, Faculty of Life Sciences and Medicine, London, UK.,Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK.,King's Health Partners, London, UK
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11
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Affiliation(s)
- Culadeeban Ratneswaran
- 1 Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK ; 2 Faculty of Life Sciences and Medicine, King's College London, London, UK ; 3 St George's, University of London, Institute of Medical and Biomedical Education, London, UK ; 4 Department of Medicine, University of Padova, Padova, Italy
| | - Murtaza Kadhum
- 1 Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK ; 2 Faculty of Life Sciences and Medicine, King's College London, London, UK ; 3 St George's, University of London, Institute of Medical and Biomedical Education, London, UK ; 4 Department of Medicine, University of Padova, Padova, Italy
| | - Martino F Pengo
- 1 Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK ; 2 Faculty of Life Sciences and Medicine, King's College London, London, UK ; 3 St George's, University of London, Institute of Medical and Biomedical Education, London, UK ; 4 Department of Medicine, University of Padova, Padova, Italy
| | - Joerg Steier
- 1 Guy's and St Thomas' NHS Foundation Trust, Lane Fox Respiratory Unit/Sleep Disorders Centre, London, UK ; 2 Faculty of Life Sciences and Medicine, King's College London, London, UK ; 3 St George's, University of London, Institute of Medical and Biomedical Education, London, UK ; 4 Department of Medicine, University of Padova, Padova, Italy
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Ratneswaran C, Mushtaq J, Steier J. Clinical update sleep: year in review 2015-2016. J Thorac Dis 2016; 8:207-12. [PMID: 26904261 PMCID: PMC4739959 DOI: 10.3978/j.issn.2072-1439.2015.12.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ratneswaran C, Dodd K, Enright K, Dasan S. A multi-faceted approach to increase appropriate analgesia prescribing in the emergency department. BMJ Qual Improv Rep 2016; 4:bmjquality_uu204091.w3774. [PMID: 26734441 PMCID: PMC4693099 DOI: 10.1136/bmjquality.u204091.w3774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/13/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Abstract
Pain is the most common presenting complaint within the emergency department. Whilst national RCEM guidelines exist, there tends to be low compliance with its use. A retrospective, cross-sectional audit, over a 24 hour period, was carried out in the emergency department of a tertiary hospital in London on all patients with abdominal pain. Pain score documentation was checked as well as: whether analgesia prescribed was compliant with guidelines, time to prescription, and if pain scores were rechecked within an hour. Cycle 1 (21 patients) showed that only 29% of patients were prescribed analgesia in accordance with guidelines, 38% of pain scores were documented at triage, and only 19% of scores were rechecked at any time. 22% of patients in severe pain were prescribed analgesia within the recommended duration from presentation (20 minutes). New guidelines, adapted from RCEM, were departmentally approved and disseminated to reflect local medication use. Monthly doctor and nurse teaching sessions were established to improve guideline compliance, objective pain score documentation, and encourage results driven performance. A nurse prescriber champion was established to encourage analgesia prescribing competence in addressing delayed administration. Finally, plans to integrate electronic pain scoring with timer prompts for rechecking are in place to help streamline the process. Following these interventions, cycle 2 (n=23) showed 87% of pain scores were documented at triage, 52% were prescribed guideline concordant analgesia, and 40% of severe pain scores were acted upon in time. Cycle 3 (n=33) demonstrated the need for monthly educational intervention to maintain high standards; as in its absence, any improvement returned to baseline.
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Affiliation(s)
| | - Kevin Dodd
- St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Kevin Enright
- St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Sunil Dasan
- St George's University Hospitals NHS Foundation Trust, United Kingdom
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Ratneswaran C, Chisnall B, Li MY, Tan S, Devanand A, Steier J. S77 Processing of Cigarette Graphic Health Warning Labels Decrease with Prolonged Exposure: Abstract S77 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Xiao S, Bastianpillai J, Ratneswaran C, Pengo M, Luo YM, Jolley CJ, Moxham J, Steier J. S48 Continuous positive airway pressure titration in awake obese subjects with obstructive sleep apnoea and its impact on neural respiratory drive and breathlessness. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ratneswaran C, Judge R, Colquhoun M, Steier J, Khong TK. S78 Electronic cigarette advertising impacts adversely on smoking behaviour within a London student cohort: a cross-sectional survey. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ratneswaran C, Mushtaq J, Steier J. A model for medical school application courses: widening access to student preparation. Med Educ 2015; 49:1139. [PMID: 26494067 DOI: 10.1111/medu.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Ratneswaran C, Chisnall B, Drakatos P, Sivakumar S, Sivakumar B, Barrecheguren M, Douiri A, Steier J. A cross-sectional survey investigating the desensitisation of graphic health warning labels and their impact on smokers, non-smokers and patients with COPD in a London cohort. BMJ Open 2014; 4:e004782. [PMID: 24996914 PMCID: PMC4091396 DOI: 10.1136/bmjopen-2013-004782] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES There is a lack of evidence regarding the effectiveness of graphic health warning labels (GHWL) in different individuals, including patients with chronic obstructive pulmonary disease (COPD). Investigating knowledge and attitudes may allow better implementation of future public health policies. We hypothesised that differences in the impact of GHWL exist between non-smokers, smokers and patients with COPD, with decreased efficacy in those groups who are longer and more frequently exposed to them. PARTICIPANTS AND SETTING 163 participants (54% male, aged 21-80) including 60 non-smokers, 53 smokers and 50 patients with COPD (Gold stage II-IV), attending London respiratory outpatient clinics, participated in case-controlled surveys (50 items). OUTCOME MEASURES Ten different GHWL were shown and demographics, smoking history, plans to quit, smoking-risk awareness, emotional response, processing and impact of GHWL on behaviour were recorded. Patients were further asked to prioritise the hypothetical treatment or prevention of five specific smoking-related diseases. RESULTS Smokers, in particular those with COPD, were less susceptible to GHWL than non-smokers; 53.4% of all participants expressed fear when looking at GHWL, non-smokers (71.9%) more so than smokers (39.8%, p<0.001). COPD participants were less aware of the consequences than non-COPD participants (p<0.001), including an awareness of lung cancer (p=0.001). Lung cancer (95%), oral cancer (90.2%), heart disease (84.7%) and stroke (71.2%) were correctly associated with smoking, whereas blindness was least associated (23.9%). However, blindness was prioritised over oral cancer, stroke and in patients with COPD also over heart disease when participants were asked about hypothetical treatment or prevention. CONCLUSIONS GHWL are most effective in non-smokers and a desensitisation effect was observed in smokers and patients with COPD. As a consequence, a tailored and concerted public health approach to use such messages is required and 'blindness' deserves to be mentioned in this context because of an unexpectedly high-deterring impact.
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Affiliation(s)
- Culadeeban Ratneswaran
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Ben Chisnall
- King's College London School of Medicine, London, UK
| | - Panagis Drakatos
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | | | | | - Miriam Barrecheguren
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Abdel Douiri
- Department of Public Health Sciences, King's College London & NIHR Biomedical Research Centre, London, UK
| | - Joerg Steier
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's & St Thomas’ NHS Foundation Trust, London, UK
- King's College London School of Medicine, London, UK
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