Ambulatory Device Research Articles

Patient preferences for ambulatory blood pressure monitoring devices: Wrist-type or arm-type?

BackgroundAmbulatory blood pressure monitoring (ABPM) is important in evaluating average 24-hour blood pressure (BP) levels, circadian rhythm, sleeping BP and BP variability but many patients are reluctant to use standard ABPM devices.MethodsWe compared two validated ABPM devices, the BPro tonometric wrist monitor and the A&D TM-2430 oscillometric upper arm monitor, for agreement of recordings and acceptability in 37 hypertensive patients (aged 55±9 years).ResultsSuccessful BP measurements were less frequent with the wrist-type than the arm-type device during the sleeping (66.3% vs. 92.9%, P <0.01) and awake periods (56.2% vs. 86.5%, P <0.01). Comparable paired readings showed no significant difference in systolic BP but diastolic BP (DBP) values were higher with the wrist compared to the arm monitor (24-hour 89±13 vs. 85±14 mmHg, P <0.01) with similar differences awake and sleeping. Bland-Altman analysis showed some large discrepancies between individual arm and wrist monitor measurements. More patients found the wrist monitor more comfortable to use than the arm monitor.ConclusionsDespite the difference in individual BP measurements and the systematic overestimation of DBP values with the BPro device, wrist monitors with good patient acceptability may be useful to facilitate ABPM in some patients to provide additional information about cardiovascular risk and response to antihypertensive therapies.

Deep learning analysis of resting electrocardiograms for the detection of myocardial dysfunction, hypertrophy, and ischaemia: a systematic review.

The aim of this review was to assess the evidence for deep learning (DL) analysis of resting electrocardiograms (ECGs) to predict structural cardiac pathologies such as left ventricular (LV) systolic dysfunction, myocardial hypertrophy, and ischaemic heart disease. A systematic literature search was conducted to identify published original articles on end-to-end DL analysis of resting ECG signals for the detection of structural cardiac pathologies. Studies were excluded if the ECG was acquired by ambulatory, stress, intracardiac, or implantable devices, and if the pathology of interest was arrhythmic in nature. After duplicate reviewers screened search results, 12 articles met the inclusion criteria and were included. Three articles used DL to detect LV systolic dysfunction, achieving an area under the curve (AUC) of 0.89–0.93 and an accuracy of 98%. One study used DL to detect LV hypertrophy, achieving an AUC of 0.87 and an accuracy of 87%. Six articles used DL to detect acute myocardial infarction, achieving an AUC of 0.88–1.00 and an accuracy of 83–99.9%. Two articles used DL to detect stable ischaemic heart disease, achieving an accuracy of 95–99.9%. Deep learning models, particularly those that used convolutional neural networks, outperformed rules-based models and other machine learning models. Deep learning is a promising technique to analyse resting ECG signals for the detection of structural cardiac pathologies, which has clinical applicability for more effective screening of asymptomatic populations and expedited diagnostic work-up of symptomatic patients at risk for cardiovascular disease.

Microbial Interventions to Control and Reduce Blood Pressure in Australia (MICRoBIA): rationale and design of a double-blinded randomised cross-over placebo controlled trial

BackgroundHypertension is a prevalent chronic disease worldwide that remains poorly controlled. Recent studies support the concept that the gut microbiota is involved in the development of hypertension and that dietary fibre intake may act through the gut microbiota to lower blood pressure (BP). Resistant starch is a type of prebiotic fibre which is metabolised by commensal bacteria in the colon to produce short-chain fatty acids (SCFAs), including acetate, propionate, and butyrate. Previous work in pre-clinical models provides strong evidence that both prebiotic fibre as well as SCFAs (i.e. postbiotics) can prevent the development of hypertension. The aim of this clinical trial is to determine if acetylated and butyrylated modified resistant starch can decrease BP of hypertensive individuals via the modulation of the gut microbiota and release of high levels of SCFAs.MethodsThis is a phase IIa double-blinded, randomised, cross-over, placebo controlled trial. Participants are randomly allocated to receive either a diet containing 40 g/day of the modified resistant starch or placebo (corn starch or regular flour) for 3 weeks on each diet, with a 3-week washout period between the two diets. BP is measured in the office, at home, and using a 24-h ambulatory device. Arterial stiffness is measured using carotid-to-femoral pulse wave velocity. Our primary endpoint is a reduction in ambulatory daytime systolic BP. Secondary endpoints include changes to circulating cytokines, immune markers, and modulation to the gut microbiome.DiscussionThe findings of this study will provide the first evidence for the use of a combination of pre- and postbiotics to lower BP in humans. The results are expected at the end of 2021.Trial registrationAustralia and New Zealand Clinical Trial Registry ACTRN12619000916145. Registered on 1 July 2019.

Effect of Antihypertensive Drugs on Circadian Variation of Blood Pressure Measured by Ambulatory Blood Pressure Monitoring in Controlled Hypertensive Individuals

Background: Rewinding back a 100 years ago, Riva Rocci introduced the meticulous way of measuring blood pressure (BP) in clinical practice. With recent years, ambulatory BP monitoring came into existence which is still not used routinely in the management of hypertension. This thought led to the commencement of our study to analyze the variations in ambulatory BP recording over a 24-h cycle. Objectives: The objectives of the study are to determine the BP differences throughout the circadian cycle and to analyze the variations in circadian rhythm due to various antihypertensive drugs. Methods: On the first visit to the Medicine Outpatient Department, patient's medical history was recorded. Three readings of office BP were recorded using a sphygmomanometer. The patient was then provided with the ambulatory BP monitoring device, sent home and asked to follow-up after 24 h and the report was recorded. Results: On comparing the nocturnal pattern among candidates taking single versus combination drug, the dip was found to be in 31.7% in patients on single drug compared to 38.6% combination therapy. The surge in BP was seen in 56.8% of patients on single-drug therapy compared to 43.3% patients on combination drug therapy. Conclusion: Single-drug therapy for hypertension did not show a significant nocturnal pattern compared to the combination drug therapy for hypertension. The presence of the risk factors such as obesity smoking, dyslipidemia, diabetes mellitus, hypothyroidism, family history, and chronic kidney disease showed a presence of dipping and nondipping pattern in BP.

Real-Time High-Level Acute Pain Detection Using a Smartphone and a Wrist-Worn Electrodermal Activity Sensor.

The subjectiveness of pain can lead to inaccurate prescribing of pain medication, which can exacerbate drug addiction and overdose. Given that pain is often experienced in patients’ homes, there is an urgent need for ambulatory devices that can quantify pain in real-time. We implemented three time- and frequency-domain electrodermal activity (EDA) indices in our smartphone application that collects EDA signals using a wrist-worn device. We then evaluated our computational algorithms using thermal grill data from ten subjects. The thermal grill delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). Furthermore, we simulated the real-time processing of the smartphone application using a dataset pre-collected from another group of fifteen subjects who underwent pain stimulation using electrical pulses, which elicited a VAS pain score level 7 out of 10. All EDA features showed significant difference between painless and pain segments, termed for the 5-s segments before and after each pain stimulus. Random forest showed the highest accuracy in detecting pain, 81.5%, with 78.9% sensitivity and 84.2% specificity with leave-one-subject-out cross-validation approach. Our results show the potential of a smartphone application to provide near real-time objective pain detection.

Patch versus traditional ambulatory ECG monitoring in children

BackgroundPatch ambulatory electrocardiogram (ECG) monitors may provide an advantage over traditional wired ambulatory ECG devices, such as Holter and event monitors, but there is limited data comparing their clinical impact in the pediatric population. ObjectiveThis study sought to directly compare traditional wired ambulatory ECG devices to a patch ambulatory monitor in terms of clinical impact and ability to detect significant arrhythmias. MethodsThis retrospective cohort study included outpatients 0–18 years old who received ambulatory ECG monitoring at our institution. A cohort consisting of all patients evaluated with a Holter or event monitor between 5/2011–2/2013 (prior to patch ECG use) was compared with a time-matched cohort from 2015 to 2017 when patch monitors (Zio) were the sole ambulatory ECG devices used in our practice. Chart review was conducted to determine the clinical impact of all monitor results. ResultsCardiologists prescribed patch monitors more frequently than traditional monitors (1 per 11.5 vs 21.8 clinical encounters, p < 0.0001). The primary indication for monitoring differed, with patch monitors being used more often for patient-reported symptoms including palpitations, pre-syncope, or syncope (38.6% vs 23.8%, p < 0.01). Detection rates of serious arrhythmias were similar, when assessing results that led to new intervention (6.2% versus 7.7%, p = 0.55) or increased clinical surveillance (5.0% vs 4.2%, p = 0.82). Yet, patch monitoring more frequently yielded results that allowed patients to be discharged from cardiology follow-up (46.8% vs 36.8%, p = 0.01). ConclusionsIn terms of diagnosing serious arrhythmias that escalated clinical management, patch ambulatory ECG monitors provided similar clinical impact as traditional monitors, but they more often provided results that allowed discharge from cardiology care.

Ambulatory management of primary spontaneous pneumothorax.

Ambulatory pneumothorax management in primary spontaneous pneumothorax is safe and feasible https://bit.ly/39w3EfD

Serum Uric Acid, Lipid Profile and Atherogenic Index of Plasma in Dipper and Non-dipper Normotensive Subjects

The cardiovascular risk evidentially found to have an association with disparities of the dipper and non-dipper hypertension. There is less celerity with regard to mechanism of diurnal blood pressure variations and related disorders. The serum uric acid and AIP are considered as cardiovascular risk factors. The current study aims to determine and compare serum uric acid level and atherogenic index of plasma (AIP) in dipper and non-dipper normotensive subjects. The study population is 64 healthy normotensive subjects (32 dippers and 32 non-dippers), age between 30-55 years. The subjects were identified into dippers and non-dippers by using ambulatory blood pressure monitoring device (Spacelabs 90207, USA). After identifying dipping status of the subjects, uric acid, triglycerides and HDL cholesterol were measured. AIP was calculated by using formula (log [TG/HDL]). Median (interquartile range) of serum uric acid in the dipper group was 5.08mg/dl (4.12-5.66) and the non-dipper group was 5.27mg/dl (4.63-6.33). The median (interquartile range) for AIP was 0.24 (0.05-0.38) in the dipper group and 0.48 (0.32-0.67) in the non-dipper group. The median (interquartile range) of uric acid and AIP in the non-dipper group was significantly higher than that of dipper group (p&lt;0.05). This study observed in even normotensive subjects, the non-dipper group has significantly higher serum uric acid and AIP than that of dipper group. These cardiovascular risk factors increased in non-dipper group compared to dipper group. The study come out with concluded that non-dipper group had higher cardiovascular risk than dipper group even in normotensive healthy subjects.

Signal acquisition and analysis of ambulatory electromyographic recordings for the assessment of sleep bruxism: A scoping review.

BackgroundAmbulatory electromyographic (EMG) devices are increasingly being used in sleep bruxism studies. EMG signal acquisition, analysis and scoring methods vary between studies. This may impact comparability of studies and the assessment of sleep bruxism in patients.Objectives(a) To provide an overview of EMG signal acquisition and analysis methods of recordings from limited‐channel ambulatory EMG devices for the assessment of sleep bruxism; and (b) to provide an overview of outcome measures used in sleep bruxism literature utilising such devices.MethodA scoping review of the literature was performed. Online databases PubMed and Semantics Scholar were searched for studies published in English until 7 October 2020. Data on five categories were extracted: recording hardware, recording logistics, signal acquisition, signal analysis and sleep bruxism outcomes.ResultsSeventy‐eight studies were included, published between 1977 and 2020. Recording hardware was generally well described. Reports of participant instructions in device handling and of dealing with failed recordings were often lacking. Basic elements of signal acquisition, for example amplifications factors, impedance and bandpass settings, and signal analysis, for example rectification, signal processing and additional filtering, were underreported. Extensive variability was found for thresholds used to characterise sleep bruxism events. Sleep bruxism outcomes varied, but typically represented frequency, duration and/or intensity of masticatory muscle activity (MMA).ConclusionAdequate and standardised reporting of recording procedures is highly recommended. In future studies utilising ambulatory EMG devices, the focus may need to shift from the concept of scoring sleep bruxism events to that of scoring the whole spectrum of MMA.

Evaluation of Transfusion-Related Hemodynamic Parameters in Patients with Beta-Thalassemia Major by Ambulatory Blood Pressure Monitoring Method

Introduction: There are very few studies on the effects of regular blood transfusions on the hemodynamic organization of patients with Beta-Thalassemia Major (BTM). Ambulatory Blood Pressure Monitoring is method that evaluates fluctuations in day-night periods and life cycle changes. In this study, we aimed to investigate the effects of blood transfusion on hemodynamic parameters by the Ambulatory Blood Pressure Monitoring method on the day of transfusion in patients with a diagnosis of Beta-Thalassemia Major. Material and Methods: This study was conducted in patients who were followed up with a diagnosis of BTM between June 2020 and July 2020. The study consisted of 30 patients. The blood pressure of the patients was measured by auscultation method on the morning of the day when they received routine red blood cell transfusion treatments, and the patients were fitted with an Ambulatory Blood Pressure Monitoring device. With Ambulatory Blood Pressure Monitoring, mean systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure, values were calculated for each patient. Statistical analysis was performed by the IBM SPSS Statistics 21 package program. The significance limit for the p-value was accepted as &lt;0.05. Results: There was a significant difference in mean systolic blood pressure and heart rate values between pre-transfusion, transfusion, and post-transfusion periods. In our study, the rate of white coat hypertension was 8.3%, and the rate of masked hypertension was 4.1%. It was observed that 67% of the patients were non-dippers, and the blood pressure burden of one patient was more than 25%. Conclusions: Measurement of hemodynamic parameters with Ambulatory Blood Pressure Monitoring is the gold standard in terms of detection and follow-up of non-dipper patients, indicating increased cardiovascular risk. In practice, Ambulatory Blood Pressure Monitoring should be used more in the follow-up of chronic patients.

Identical Limb Dynamics for Unilateral Impairments through Biomechanical Equivalence

Dynamic models, such as double pendulums, can generate similar dynamics as human limbs. They are versatile tools for simulating and analyzing the human walking cycle and performance under various conditions. They include multiple links, hinges, and masses that represent physical parameters of a limb or an assistive device. This study develops a mathematical model of dissimilar double pendulums that mimics human walking with unilateral gait impairment and establishes identical dynamics between asymmetric limbs. It introduces new coefficients that create biomechanical equivalence between two sides of an asymmetric gait. The numerical solution demonstrates that dissimilar double pendulums can have symmetric kinematic and kinetic outcomes. Parallel solutions with different physical parameters but similar biomechanical coefficients enable interchangeable designs that could be incorporated into gait rehabilitation treatments or alternative prosthetic and ambulatory assistive devices.

Reliability of the BodyGuard2 (FirstBeat) in the Detection of Heart Rate Variability.

There has been an increasing interest in using cardiac indicators of self-regulation in developmental science. Many researchers are interested in unobtrusive mobile devises that are able to collect reliable cardiac data outside of the laboratory setting. Although numerous new ambulatory devices have become available over the last decade, testing these devices on children in comparison to industry gold-standard devices is rarely conducted. The current study evaluated the reliability of one of these ambulatory systems, the BodyGuard2 (FirstBeat), relative to gold-standard laboratory electrocardiogram (Biopac MP150), during active and resting conditions in 4- to 6-year-old children. The BodyGuard2 performed and produced highly similar indices of heart rate variability across resting and active conditions.

Diagnostic Accuracy of Ambulatory Devices in Detecting Atrial Fibrillation: Systematic Review and Meta-analysis.

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Early diagnosis of AF is crucial for preventing AF-related morbidity, mortality, and economic burden, yet the detection of the disease remains challenging. The 12-lead electrocardiogram (ECG) is the gold standard for the diagnosis of AF. Because of technological advances, ambulatory devices may serve as convenient screening tools for AF.ObjectiveThe objective of this review was to investigate the diagnostic accuracy of 2 relatively new technologies used in ambulatory devices, non-12-lead ECG and photoplethysmography (PPG), in detecting AF. We performed a meta-analysis to evaluate the diagnostic accuracy of non-12-lead ECG and PPG compared to the reference standard, 12-lead ECG. We also conducted a subgroup analysis to assess the impact of study design and participant recruitment on diagnostic accuracy.MethodsThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE and EMBASE were systematically searched for articles published from January 1, 2015 to January 23, 2021. A bivariate model was used to pool estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating curve (SROC) as the main diagnostic measures. Study quality was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool.ResultsOur search resulted in 16 studies using either non-12-lead ECG or PPG for detecting AF, comprising 3217 participants and 7623 assessments. The pooled estimates of sensitivity, specificity, PLR, NLR, and diagnostic odds ratio for the detection of AF were 89.7% (95% CI 83.2%-93.9%), 95.7% (95% CI 92.0%-97.7%), 20.64 (95% CI 10.10-42.15), 0.11 (95% CI 0.06-0.19), and 224.75 (95% CI 70.10-720.56), respectively, for the automatic interpretation of non-12-lead ECG measurements and 94.7% (95% CI 93.3%-95.8%), 97.6% (95% CI 94.5%-99.0%), 35.51 (95% CI 18.19-69.31), 0.05 (95% CI 0.04-0.07), and 730.79 (95% CI 309.33-1726.49), respectively, for the automatic interpretation of PPG measurements.ConclusionsBoth non-12-lead ECG and PPG offered high diagnostic accuracies for AF. Detection employing automatic analysis techniques may serve as a useful preliminary screening tool before administering a gold standard test, which generally requires competent physician analyses. Subgroup analysis indicated variations of sensitivity and specificity between studies that recruited low-risk and high-risk populations, warranting future validity tests in the general population.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020179937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179937

Effects of using assistive devices on the components of the modified instrumented timed up and go test in healthy subjects

IntroductionEvaluation of the changes in gait spatiotemporal parameters and functional mobility with using assistive devices (ADs) would provide useful information and mutual assistance when prescribing such ambulatory devices. This study aimed to investigate the spatiotemporal gait and functional mobility parameters in healthy adults when walking using different ADs. MethodsA group of healthy subjects participated in the study. The instrumented modified Timed Up and Go test (iTUG) was used to investigate the impact of different types of ADs on spatiotemporal and functional mobility parameters. ResultsSubjects showed a significant difference in the gait task performance (P = .001) in stride velocity, stride length, and cadence when walking with and without ADs. A significant difference was also found in the performance of the turn-to-sit task (P = .001) in both velocity and duration when walking with and without ADs. The time to complete sit-to-stand was significantly slower when using a walker (98.3 ± 22.3°/sec, P = .004) and a cane (78.2 ± 21.9°/sec, P = .004) compared to walking without an AD (78.2 ± 21.8°/sec). No significant difference was found between walking with a cane group versus walking with a four-wheeled walker group (P = .94). ConclusionADs altered gait and functional mobility parameters differently in healthy subjects. Using a four-wheeled walker showed a tendency to increase stride velocity, cadence, stride length, and slow sit-to-stand velocity compared to using a cane. The findings highlight using more caution clinically when prescribing ADs and providing gait training.

Is osseous reattachment of the greater trochanter necessary compared to soft-tissue-only abductor repair in proximal femoral megaprosthesis reconstruction?

One of the challenges to surgical reconstruction following oncologic proximal femur resection is reliable re-establishment of the abductor mechanism. Surgical and functional outcomes following re-approximation of the abductor mechanism to a metallic endoprosthetic after tumor resection of the proximal femur have not been well established in the literature. A retrospective review was performed, inclusive of patients who received a proximal femur replacement with a metallic endoprosthesis following tumor resection. Patients were divided into two groups: (1) those that received an abductor repair involving a trochanteric osteotomy and osseous fixation of the greater trochanter/abductor mechanism to the endoprosthesis, and (2) those that did not have a trochanteric osteotomy and therefore had an abductor repair consisting of only soft tissue reattachment to the endoprosthesis. The two groups were assessed for demographic characteristics, diagnosis, surgical outcomes including rates of complication and failure, radiographic evidence of trochanteric failure, and functional outcomes. Descriptive statistics, comparative statistics, and logistic regression analyses were performed to discern differences between the two study groups. Fifty-three patients were included in the analysis, 29 had abductor reconstructions involving reattachment of the greater trochanter to the metallic endoprosthesis and 24 had soft tissue reconstruction of the abductor mechanism without bony fixation. There were no differences between the two groups for demographic data, cancer diagnosis, follow up, or survivorship. Radiographic evidence of trochanteric dissociation from the endoprosthesis was observed in 45% of osteotomy cases. Only 10% of patients in the trochanter osteotomy group and 38% of the soft tissue only group were able to resume a normal, non-Trendelenburg gait at final postoperative visit (p = .024). Need for an assistive ambulatory device was seen in 83% and 67% of the osteotomy and soft-tissue-only patients, respectively (p = .21). Re-establishing the abductor mechanism following proximal femur oncologic resection remains a challenge to orthopedic oncologists. Even when possible, salvage of the greater trochanter for reattachment to the endoprosthesis did not lead to improved function in this series, when compared to a similar cohort that received a soft-tissue-only abductor repair. Abductor mechanism reconstruction with a greater trochanteric osteotomy and subsequent fixation to the proximal femur endoprosthesis had a high rate of radiographic failure. Additionally, reattachment of the greater trochanter to the proximal femur endoprosthesis demonstrated no improvement in Trendelenburg gait or reliance on an assistive ambulatory device when compared to a soft-tissue-only abductor repair.

Effect of Sleep Bruxism Intensity on Blood Pressure in Normotensives.

The present research aimed to investigate the influence of sleep bruxism (SB) intensity on blood pressure parameters in normotensive subjects by using an ambulatory blood pressure device. The study group included 65 normotensive individuals suspected of having SB. All participants underwent one-night video-polysomnography, and ambulatory blood pressure monitoring was performed the next day; 86.15% of them were diagnosed with SB. Statistical analysis included correlation and regression analysis. The obtained results showed that systolic blood pressure variability during sleep significantly increased in individuals with BEI > 4 (bruxism episodes index; episodes/hour) compared to those with BEI ≤ 4 (8.81 ± 3.36 versus 10.57 ± 3.39, p = 0.05). Multivariable regression analysis showed that systolic blood pressure variability at nighttime was also associated with the following independent risk factors: higher apnea-to-bruxism index, male gender, BEI > 4 episodes/hour, body mass index (BMI) ≥ 25 kg/m2, higher arousal index, and shorter total sleep time. In summary, sleep bruxism intensity was associated with increased systolic blood pressure variability during sleep. Coincidental apnea, male gender, severe sleep bruxism (SB intensity with BEI > 4/hour), excess weight and obesity, higher arousal index, and shorter sleep time seem to be the main determinants that influence blood pressure in normotensive sleep bruxers.

Role of the Ambulatory Assessed Apnea-Hypopnea Index for Predicting Recurring Atrial Fibrillation After Ablation Therapy

Catheter ablation is an effective treatment for atrial fibrillation (AF). Obstructive sleep apnea (OSA) is a known risk factor for recurrent AF. The apnea-hypopnea index (AHI) is a measurement tool to screen patients for OSA. We sought to evaluate if the ambulatory assessed AHI is associated with AF recurrence following AF catheter ablation. 187 patients with paroxysmal (n = 155) or early persistent (n = 32) AF presenting for catheter ablation were included in the study. AHI was determined prior to ablation using an ambulatory screening device. All patients underwent pulmonary vein isolation (PVI). In patients with early persistent AF (17%) additional ablation of complex fractionated atrial electrograms (CFAE) was performed. Clinical follow-up was available after 3 and 12 months including 7-day Holter-ECG. All 187 patients (60.3 ± 11.4 years, 64.2% male) completed the 3 months follow-up and 170 patients the 12 months follow-up. A pathological AHI ≥15 was found in 45/187 (24.1%) patients. Additional CFAE did not differ between patients with an AHI ≥15 and AHI <15 (p = 0.663). After 3 months, 12/41 (29.3%) patients with AHI ≥15 showed recurrent AF compared to 24/146 (16.4%) patients with AHI <15 (p = 0.066). After 12 months, AHI ≥15 was associated with a significant higher rate of AF recurrence of 47.4% (18/38) versus 26.5% (35/132) in patients with AHI <15 (p = 0.014). In the logistic regression analysis AHI ≥15 was an independent predictor of recurrent AF at 12 months (p = 0.011). In conclusion, ambulatory assessed AHI ≥15 is associated with increased risk for AF recurrence following catheter ablation. OSA screening should be performed in AF patients as it might influence catheter ablation success.

Sleep apnoea and incident malignancy in type 2 diabetes.

BackgroundSleep apnoea and type 2 diabetes (T2D) have been linked to malignancy. The aim of the present study was to evaluate the association between sleep apnoea and incidence of malignancy in patients with T2D.MethodsThe DIACORE (DIAbetes COhoRtE) study is a prospective, population-based cohort study in T2D patients. In the sleep disordered breathing substudy, the apnoea–hypopnoea index (AHI), oxygen desaturation index (ODI) and percentage of night-time spent with a peripheral oxygen saturation of <90% (tsat90%) were assessed using a two-channel ambulatory monitoring device. Malignancy diagnoses were gathered using self-reported medical history data validated by medical records. Hazard ratios (HRs) for incident malignancy were derived by Cox regression adjusting for sex, age, body mass index, smoking status, alcohol intake, socioeconomic status and HbA1c.ResultsOf 1239 patients with T2D (mean age 67 years, 41% female, mean body mass index 30.9 kg·m−2), 79 (6.4%) were first-time diagnosed with a malignancy within a median follow-up period of 2.7 years (interquartile range 2.2–4.5 years). AHI, ODI and tsat90% were not associated with incident malignancy. In subgroup analysis, females showed increased cancer risk per AHI unit (adjusted HR 1.03 per AHI unit, 95% CI 1.00–1.06; p=0.028) and severe sleep apnoea (defined as AHI ≥30 events·h−1; adjusted HR 4.19, 95% CI 1.39–12.77; p=0.012). This was not seen in males, and a significant interaction was observed (interaction terms p=0.048 and p=0.033, respectively).ConclusionSleep apnoea was not associated with incident malignancy in T2D patients. However, stratified analysis revealed a significant association between sleep apnoea and incident malignancy in females, but not in males.

The 2020 "WHO Technical Specifications for Automated Non-Invasive Blood Pressure Measuring Devices With Cuff".

High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.

External Cardiac Loop Recorders: Functionalities, Diagnostic Efficacy, Challenges and Opportunities.

According to the World Health Organization's (WHO) report of 2016, cardiovascular diseases (CVDs) accounted for mortality of an estimated 17.9 million people globally. Of these deaths, 85% were due to myocardial infarction and stroke. Further, the pre-dominant atrial fibrillation (AF) arrhythmia has been the most suspected underlying cause of transient ischemic attack or stroke. Thus, the etiologies of early symptoms like syncope and palpitations in patients needs to be evaluated by employing proper diagnostic tests to make early treatment decisions. The most widely referred 24 to 48 hour Holter electrocardiographic (ECG) monitoring tests have not been proved to be much effective in recognizing infrequent intermittent arrhythmic episodes. These drawbacks have led to the development of long-term ambulatory ECG (AECG) monitoring devices. This review reports the state-of-the-art existing AECG monitoring devices and their role of long-term ECG recording in patients suspected with cardiac syncope and palpitations to understand the underlying arrhythmic cause, as well as in the diagnosis and management of AF. Primarily, the utility and diagnostic yield of external cardiac recorders or event loop recorders (ELRs) in capturing the symptom-rhythm correlation which constitutes a clinically useful recordings of heart's electrical activity during infrequent arrhythmic conditions was critically reviewed. Furthermore, a brief case study on challenges involved in clinical data acquisition at a cardiac care unit using ambulatory external monitoring device has been presented. Finally, improvements in design engineering and algorithmic developments to enhance the diagnostic yield and usability of ELRs in clinical settings have been proposed.