Episodes Of Apnea Research Articles

First report of PURA syndrome in a Colombian patient with de novo missense variant c.692T>C (p.Phe231Ser)

We present the first documented case of PURA syndrome in Colombia. This rare neurological disease results from mutations in the PURA gene located on chromosome 5, leading to haploinsufficiency of the PUR-α protein. This protein is essential for early brain development and neuronal function. The patient, a seven-years-old boy, started showing dystonic hand movements at 14 days of age; at six, he had neurodevelopmental delay, generalized hypotonia, frequent episodes of apnea, and swallowing difficulties. Although other conditions were initially considered, such as Duchenne muscular dystrophy and neuronal ceroid lipofuscinosis, a whole exome sequencing revealed the pathogenic variant c.692T>C (p.Phe231Ser) in the exon 1 of the PURA gene, not previously reported in other patients. With this finding, we adopted a comprehensive management approach addressing the patient’s characteristics and alterations. Since the PURA syndrome is not on the list of orphan/rare diseases recognized by the Colombian Ministerio de Salud y Protección Social, we hope our report will contribute to its official recognition. The case shows the importance of considering rare diagnoses in patients with uncommon neurological symptoms, underlining the usefulness of genomic sequencing in diagnosis and the need for collaboration to optimize healthcare for patients with PURA syndrome and similar diseases.

The clinical value of integrated pulmonary index monitoring during an endobronchial ultrasound-guided transbronchial needle aspiration procedure under sedoanalgesia: A prospective study.

To evaluate the clinical relevance of Integrated Pulmonary Index (IPI) monitoring during transbronchial needle aspiration (EBUS-TBNA) under sedation and determine whether it reduces hypoxic events compared to standard monitoring. This prospective observational research was carried out at Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey, between July 2022 and July 2023. A total of 50 patients, aged 18-80 years with American Society of Anesthesiologists scores of I-III, undergoing EBUS-TBNA with deep sedation for diagnostic purposes were included. The IPI values were measured at 6 time points: baseline, induction, 3, 5, 10 minutes, and at the end of the procedure. Patients were categorized based on whether their IPI scores were above 7 (group 1) or below 7 (group 2). A total of 43 patients completed the study. Group 1 had higher end-tidal carbon dioxide and respiratory rate at multiple time points, including induction and at 3, 5, and 10 minutes post-induction (p<0.05). Group 2 experienced a higher rate of apnea at these times (p<0.05). Those with lower IPI scores (namely, IPI=3 and IPI=4) showed significantly higher apnea rates, while those with higher scores (namely, IPI=7 and IPI=8) were less likely to have apneic episodes. The IPI monitoring during EBUS-TBNA under sedation demonstrated improved detection of apnea episodes and enhanced respiratory safety compared to standard monitoring techniques. Additional research involving more varied populations is necessary to confirm these results.

A IMPORTÂNCIA DA CIRURGIA ORTOGNÁTICA NA SÍNDROME DA APNÉIA OBSTRUTIVA DO SONO

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder that significantly impacts individuals' quality of life, increasing the risk of various health conditions, including cardiovascular diseases and psychological issues. This study reviews the effectiveness of orthognathic surgery as a therapeutic intervention for OSAS, highlighting its ability to improve the functionality of the upper airways and reduce apnea episodes. Literature analysis reveals that patients with dentofacial deformities, such as retrognathia and maxillary hypoplasia, show significant improvements post-surgery. A multidisciplinary approach, involving collaboration between dentistry and sleep medicine, is essential to optimize treatment outcomes. The study concludes that orthognathic surgery should be considered a valuable option in the management of OSAS, with a need for further research to enhance clinical practices and promote restorative sleep.

The Role of Oxidative Stress and the Potential Therapeutic Benefits of Aronia melanocarpa Supplementation in Obstructive Sleep Apnea Syndrome: A Comprehensive Literature Review

Obstructive sleep apnea (OSA) is a sleep disorder characterized by repeated episodes of apnea and hypopnea, leading to inflammation and oxidative stress that contribute to numerous health complications, including cardiovascular diseases. Continuous positive airway pressure (CPAP) is a standard for treating OSA and is effective in reducing inflammation and oxidative stress. Aronia melanocarpa (a black chokeberry), a deciduous shrub belonging to the Rosaceae family and native to eastern North America that is rich in polyphenols, has garnered attention for its therapeutic potential due to its ability to neutralize reactive oxygen species (ROS) and modulate inflammatory pathways, such as NF-κB. This review supports the hypothesis that combining CPAP with black chokeberry supplementation might provide a more comprehensive approach to treating OSA, reducing the risk of health complications by further reducing oxidative stress. In conclusion, Aronia melanocarpa has potential benefits as an adjunct therapy in the treatment of OSA, enhancing overall health and well-being. This review compiles the latest scientific findings on the benefits of black chokeberry supplementation, its application in OSA treatment, and its potential use in the treatment of other conditions linked to oxidative stress.

PRODIGY score predicts respiratory depression in the post-anesthesia care unit: A post-hoc analysis.

Surgical patients who experience respiratory depressive episodes (RDEs) during their post-anesthesia care unit (PACU) admission are at a higher risk of developing subsequent respiratory complications in general care wards. A risk assessment tool for PACU RDEs has not been previously assessed. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) score is an assessment tool that uses baseline patient variables to categorize patients into low, intermediate, or high risk groups for RDEs in general care wards. This study assessed whether PRODIGY groups are associated with PACU RDEs. This analysis utilized data from a previous observational trial of PACU RDEs detected by capnography. PRODIGY scores were retrospectively calculated, and the number and duration of respiratory alerts were compared among PRODIGY groups. Twenty-six (29.9%) patients were classified as low risk, 29 (33.3%) as intermediate risk, and 32 (36.8%) as high risk. A total of 3,580 alerts were recorded in the PACU, 47% of which were apnea episodes lasting ≥ 10 seconds. The total number and duration of alerts were highest in high risk group patients (median 56 [IQR 12 - 87] alerts per patient vs 22 [9 - 37] in low risk and 26 [13 - 42] in intermediate risk patients, P = 0.035; 303 [123 - 885] seconds vs 177 [30 - 779] in low risk and 301 [168 - 703] in intermediate risk patients, P = 0.042). Poisson regression analysis indicated that the rate of RDEs in the high PRODIGY risk group was higher than in the intermediate (rate ratio estimate = 2.01 [95% CI 1.86 - 2.18], P < 0.001) and low (rate ratio estimate = 2.25 [95% confidence interval 2.07 - 2.45], P < 0.001) risk groups. This analysis suggests that the PRODIGY score may be useful in assessing the risk of PACU RDEs. Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT02707003.

Oral Feeding Readiness Assessment Tools for Preterm Infants

Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings.

Cardiac arrhythmias in a patient with severe whooping cough in the first year of life (clinical case)

Whooping cough continues to lead in the group of vaccine-controlled infectious diseases. It is proved that in infants (especially in the first three months of life) patients more often endure severe forms of whooping cough with the development of complications, including apnea and pulmonary hypertension. There are few studies analyzing heart rhythm disorders in children with whooping cough and their relationship to the severity of the disease. The article presents a clinical case of a patient with severe whooping cough of the first year of life. Despite the absence of leukocytosis characteristic of severe whooping cough, the child’s condition was considered as severe due to episodes of apnea accompanied by desaturation and asystole. Detection of heart rhythm disorders in children with whooping cough is important in determining the tactics of their treatment and the need for further observation by a cardiologist.

Comparison of oral caffeine and oral theophylline for apnea of prematurity: A randomized clinical trial

Background Caffeine and theophylline are methylxanthine compounds that have been widely used in the treatment of apnea of prematurity (AOP). Previous studies comparing the two agents have shown inconsistent results and have mostly used intravenous preparations. Objective To assess the effectiveness of oral administration of caffeine compared to oral theophylline as therapy for apnea of prematurity. Methods Fifty consecutively recruited premature neonates (gestational age 28-34 weeks, birth weight &lt;2,500 g) with AOP who were able to tolerate at least 10 mL/kg of enteral feeding were randomized to receive either oral caffeine or oral theophylline for seven days. The main outcome was the daily frequency of apnea after treatment. Secondary outcomes were duration of oxygen or CPAP administration, duration of oxygen fraction (FiO2) taper to reach 21%, time to achievement of full feeding tolerance, length of hospital stay, and side effects. Results We randomized 25 subjects into each group. The distribution of baseline characteristics (gender, gestational age, mode of delivery, birth weight and length, age at onset of AOP, and initial frequency of AOP) was similar between both groups. The mean daily number of apnea episodes after treatment was significantly higher in the caffeine group compared to the theophylline group [3.16 (SD 1.31) vs. 2.28 (SD 1.40); P=0.031]. The caffeine group, compared to the theophylline group, also had a longer mean duration of oxygen or CPAP use [12.56 (SD 7.67) days vs. 8.40 (SD 6.41) days; P=0.030] and duration of FiO2 taper [5.76 (SD 2.68) vs. 4.08 (SD 2.54); P=0.035]. There were no significant differences in mean time to full feeding and mean length of hospital stay. There was no significant difference in the occurrence of side effects between the two groups. Conclusion In premature neonates with AOP, oral theophylline is slightly more effective than oral caffeine in reducing the frequency of apnea and is associated with a shorter duration of oxygen or CPAP use and duration to reach 21% FiO2.

Utilization of a Clark electrode device as a respirometer for small insects: A convincing test on ants allowing to detect discontinuous gas exchange

Respirometry provides a direct measure of an organism’s O2 consumption rate (VO2), which is a significant component of its metabolic rate (energy expenditure). Amongst ants, variations in lifespan between different social castes (such as workers and queens) can be substantial, varying depending on the species. As metabolic rate is higher in short-living species, we aimed to determine how VO2 and longevity may have coevolved within ant casts. Measuring VO2 in such tiny animal models can be challenging, and as a first methodological step, we validate the use of a Clark electrode, initially designed for measuring mitochondrial respiration control pathways, for assessing VO2 in ants within a sealed chamber. This was done by comparing it with stop-flow VO2 and CO2 production, using a traditional indirect calorimetry device. The global aim is to provide a reliable protocol to conduct accurate comparisons of metabolic rates within and among ant species. As expected, using the Clark electrode entails high time resolution and revealed that queens and workers exhibited discontinuous gas exchange, with episodes of apnea lasting up to 20 min.

A Survey Study of the 3D Facial Landmark Detection Techniques Used as a Screening Tool for Diagnosis of the Obstructive Sleep Apnea Syndrome.

Obstructive Sleep Apnea (OSA) is a common disorder affecting both adults and children. It is characterized by repeated episodes of apnea (stopped breathing) and hypopnea (reduced breathing), which result in intermittent hypoxia. We recognize pediatric and adult OSA, and this paper focuses on pediatric OSA. While adults often suffer from daytime sleepiness, children are more likely to develop behavioral abnormalities. Early diagnosis and treatment are important to prevent negative effects on children's development. Without the treatment, children may be at increased risk of developing high blood pressure or other heart problems. The gold standard for OSA diagnosis is the polysomnography (sleep study) PSG performed at a sleep center. Not only is it an expensive procedure, but it can also be very stressful, especially for children. Patients have to stay at the sleep center during the night. Therefore, screening tools are very important. Multiple studies have shown that OSA screening tools can be based on facial anatomical landmarks. Anatomical landmarks are landmarks located at specific anatomical locations. For the purpose of the screening tool, a specific list of anatomical locations needs to be identified. We are presenting a survey study of the automatic identification of these landmarks on 3D scans of the patient's head. We are considering and comparing both knowledge-based and AI-based identification techniques, with a focus on the development of the automatic OSA screening tool.

Congenital myasthenic syndrome secondary to pathogenic variants in the SLC5A7 gene: report of two cases

BackgroundCongenital Myasthenic Syndromes (CMS) are rare genetic diseases, which share as a common denominator muscle fatigability due to failure of neuromuscular transmission. A distinctive clinical feature of presynaptic CMS variants caused by defects of the synthesis of acetylcholine is the association with life-threatening episodes of apnea. One of these variants is caused by mutations in the SLC5A7 gene, which encodes the sodium-dependent HC-3 high-affinity choline transporter 1 (CHT1). To our knowledge there are no published cases of this CMS type in Latin America.Case presentationWe present two cases of CHT1-CMS. Both patients were males presenting with repeated episodes of apnea, hypotonia, weakness, ptosis, mild ophthalmoparesis, and bulbar deficit. The first case also presented one isolated seizure, while the second case showed global developmental delay. Both cases, exhibited incomplete improvement with treatment with pyridostigmine.ConclusionsThis report emphasizes the broad incidence of CMS with episodic apnea caused by mutations in the SLC5A7 gene and the frequent association of this condition with serious manifestations of central nervous system involvement.

Role of palmitoylation on the neuronal glycine transporter GlyT2.

The neuronal glycine transporter GlyT2 removes glycine from the synaptic cleft through active Na+, Cl-, and glycine cotransport contributing to the termination of the glycinergic signal as well as supplying substrate to the presynaptic terminal for the maintenance of the neurotransmitter content in synaptic vesicles. Patients with mutations in the human GlyT2 gene (SLC6A5), develop hyperekplexia or startle disease (OMIM 149400), characterized by hypertonia and exaggerated startle responses to trivial stimuli that may have lethal consequences in the neonates as a result of apnea episodes. Post-translational modifications in cysteine residues of GlyT2 are an aspect of structural interest we analyzed. Our study is compatible with a reversible and short-lived S-acylation in spinal cord membranes, detectable by biochemical and proteomics methods (acyl-Rac binding and IP-ABE) confirmed with positive and negative controls (palmitoylated and non-palmitoylated proteins). According to a short-lived modification, direct labeling using click chemistry was faint but mostly consistent. We have analyzed the physiological properties of a GlyT2 mutant lacking the cysteines with high prediction of palmitoylation and the mutant is less prone to be included in lipid rafts, an effect also observed upon treatment with the palmitoylation inhibitor 2-bromopalmitate. This work demonstrates there are determinants of lipid raft inclusion associated with the GlyT2 mutated cysteines, which are presumably modified by palmitoylation.

Features of dissomnia and cognitive impairments in chronic cerebral ischemia due to diabetes mellitus type 2

Introduction. Currently, diabetes mellitus occupies a leading position in terms of prevalence, disability, mortality and it is a medical and social problem. Microvascular and macrovascular diabetic complications negatively affect the quality and duration of sleep with detrimental effects on metabolism and weight regulation. The cognitive sphere is more impaired in type 2 diabetes mellitus in the form of a decrease in the speed of reaction to external stimuli and the ability to concentrate for a long time, so thinking becomes slower, and clinically significant cognitive impairments leads to work and social maladaptation and a decrease in adequate glycemic control. Aim of the study: to study the nature of diagnosed cognitive impairments and variants of dissomnias in chronic cerebral ischemia and to evaluate the features of identified dissomnias in the development of early dementia in type 2 diabetes mellitus. Object and methods. During the period from 2017 to 2023, 207 patients with chronic cerebral ischemia and neurological deficits of varying severity were examined. All patients underwent a comprehensive clinical and neurological examination using specialized scales to study the cognitive sphere and sleep level, laboratory and instrumental methods of examination. The study applied non-inclusion, inclusion and exclusion criteria and selected 147 patients with chronic cerebral ischemia and type 2 diabetes mellitus. The data has been processed statistically. Results. Cognitive impairments (95,1 ± 2,4%) and dyssomnia (88,9 ± 3,5%) develop in patients with type 2 diabetes mellitus with chronic cerebral ischemia, and their combination is significant (p &lt; 0,05) prevailed (82,7 ± 4,2%) with dysmetabolic signs. At the same time, moderate (43,2 ± 5,5%) and severe (34,6 ± 5,3%) cognitive disorders with moderate dyssomnia (63,0 ± 5,4%) and increased sleepiness (64,2 ± 5,3%) with episodes of obstructive sleep apnea (16,0 ± 4,1%) and narcolepsy (6,2 ± 2,7%) compared with patients without type 2 diabetes mellitus (p &lt; 0,05). Conclusions. The presence of type 2 diabetes mellitus increased the risk of developing dyssomnia and cognitive disorders, and the identification of dyssomnia led to an increased chance of a deterioration in the intellectual-mnestic level to the degree of moderate and severe impairments. Neuropsychological testing in combination with dyssomnia questionnaires and quantitative assessment of the severity of cognitive dysfunction is absolutely necessary.

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review.

Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- ) downregulation. In human adipose tissue, PPAR- activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.

Prolonged unexplained event might change an “unreliable perpetrator” into a “reliable resuscitator”

During the 1980′s a sudden life-lessness attack in a very young infant was described as “near-SIDS”, and a caregiver who observed and tried to revive the infant was considered to be reliable and honourable. If, after the later acceptance of the traditional shaken baby theory, bilateral thin subdural hemorrhages (SDH) and retinal hemorrhages (RH) are detected after a lifelessness attack such a reliable caregiver has by default been transformed into an unreliable perpetrator of violent shaking. In 2016, the term “near-SIDS” was – via “apparent life-threatening event” (ALTE) − replaced by “brief resolved unexplained event” (BRUE). We suggest that such a life-threatening event is not always brief, and not always resolved. Based on a neglected hypoxia theory from 2004 we suggest as a hypothesis that a prolonged episode of apnea can result in brain hypoxia, brain edema, SDH, RH and increased intracranial pressure. The new hypothesis includes two new concepts: Prolonged Non-fatal Unexplained Event (PNUE) and Prolonged Fatal Unexplained Event (PFUE) which together with the hypoxia theory might explain why these two separate diagnoses have been conflated into one, viz. shaken baby syndrome (SBS). We suggest a study design that might corroborate or falsify the hypothesis, and if our hypothesis is corroborated, current “unreliable perpetrators” could be re-established as reliable resuscitators.

The Correlation between the Severity of Obstructive Sleep Apnea and Insulin Resistance in a Japanese Population.

Background: Repetitive episodes of apnea and hypopnea during sleep in patients with obstructive sleep apnea (OSA) are known to increase the risk of atherosclerosis. Underlying obesity and related disorders, such as insulin resistance, are indirectly related to the development of atherosclerosis. In addition, OSA is independently associated with insulin resistance; however, data regarding this relationship are scarce in Japanese populations. Methods: This study aimed to examine the relationship between the severity of OSA and insulin resistance in a Japanese population. We analyzed the data of consecutive patients who were referred for polysomnography under clinical suspicion of developing OSA and who did not have diabetes mellitus or any cardiovascular disease. Multiple regression analyses were performed to determine the relationship between the severity of OSA and insulin resistance. Results: The data from a total of 483 consecutive patients were analyzed. The median apnea-hypopnea index (AHI) was 40.9/h (interquartile range: 26.5, 59.1) and the median homeostasis model assessment for insulin resistance (HOMA-IR) was 2.00 (interquartile range: 1.25, 3.50). Multiple regression analyses revealed that the AHI, the lowest oxyhemoglobin saturation (SO2), and the percentage of time spent on SO2 < 90% were independently correlated with HOMA-IR (an adjusted R-squared value of 0.01278821, p = 0.014; an adjusted R-squared value of -0.01481952, p = 0.009; and an adjusted R-squared value of 0.018456581, p = 0.003, respectively). Conclusions: The severity of OSA is associated with insulin resistance assessed by HOMA-IR in a Japanese population.

Adaptive non-invasive ventilation treatment for sleep apnea.

The purpose of this study was to investigate the effectiveness of two non-invasive mechanical ventilation (NIV) modalities to treat sleep apnea: (1) Average Volume Assured Pressure Support (AVAPS) NIV, and (2) Pressure Support (PS) NIV with Continuously Calculated Average Required Ventilation (CCARV). Two detailed (previously developed and tested) simulation models were used to assess the effectiveness of the NIV modalities. One simulated subjects without chronic obstructive pulmonary disease (COPD), and the other simulated patients with COPD. Sleep apnea was simulated in each model (COPD and Non-COPD), and the ability of each NIV modality to normalize breathing was measured. In both NIV modalities, a low level continuous positive airway pressure was used and a backup respiratory rate was added to the algorithm in order to minimize the respiratory work rate. Both modalities could help normalize breathing in response to an episode of sleep apnea within about 5 min (during which time blood gases were within safe limits). AVAPS NIV and PS NIV with CCARV have potential value to be used for treatment of sleep apnea. Clinical evaluations are needed to fully assess the effectiveness of these NIV modalities.

An Analytics of Sleep Apnea Classification using Caswideresnet Algorithm

Sleep apnea is a common yet serious sleep disorder that affects millions of individuals worldwide. Timely and accurate detection of sleep apnea can significantly improve patient outcomes and quality of life. In this study, we propose an advanced approach for sleep apnea classification and prediction using the CasWideResNet algorithm. Our methodology includes preprocessing steps such as Z-score normalization to standardize the data and improve algorithm performance. Additionally, we employ an improved Pan-Tompkins algorithm for feature selection, which helps in identifying relevant features from physiological signals such as electrocardiogram (ECG) and oxygen saturation (SpO2) data. The CasWideResNet algorithm, known for its deep learning capabilities, is utilized for the classification and prediction tasks. This algorithm leverages the power of deep convolutional neural networks (CNNs) to automatically learn discriminative features from the input data and make accurate predictions. By integrating Z-score normalization, improved feature selection, and the CasWideResNet algorithm, our proposed system aims to achieve high accuracy in detecting and predicting sleep apnea episodes. We evaluate the performance of our approach using a comprehensive dataset containing a diverse range of sleep apnea cases. Our results demonstrate the effectiveness of Z-score normalization in improving data quality and the role of the improved Pan-Tompkins algorithm in selecting informative features.

Effect of antihypertensive agents on sleep apnea and ambulatory blood pressure in patients with hypertension: A randomized controlled trial

BackgroundObstructive sleep apnea (OSA) and hypertension are common conditions that may be linked through sympathetic activation and water retention. We hypothesized that diuretics, which reduce the body water content, may be more effective than amlodipine, a blood pressure (BP)-lowering agent implicated with edema, in controlling OSA in patients with hypertension. We also aimed to compare the effects of these treatments on ambulatory blood pressure monitoring (ABPM). MethodsIn a randomized, double-blind clinical trial, we compared the effects of chlorthalidone/amiloride 25/5 mg with amlodipine 10 mg on OSA measured by portable sleep monitor and BP measured by ABPM. The study included participants older than 40 who had moderate OSA (10–40 apneas/hour of sleep) and BP within the systolic range of 140–159 mmHg or diastolic range of 90–99 mmHg. ResultsThe individuals in the experimental groups were comparable in age, gender, and other relevant characteristics. Neither the combination of diuretics nor amlodipine alone reduced the AHI after 8 weeks of treatment (AHI 26.3 with diuretics and 25.0 with amlodipine. P = 0.713). Both treatments significantly lowered office, 24-h, and nighttime ABP, but the two groups had no significant difference. ConclusionChlorthalidone associated with amiloride and amlodipine are ineffective in decreasing the frequency of sleep apnea episodes in patients with moderate OSA and hypertension. Both treatments have comparable effects in lowering both office and ambulatory blood pressure. The notion that treatments could offer benefits for both OSA and hypertension remains to be demonstrated. Trial registration clinicaltrials. gov identifierNCT01896661.

Application of multifractal analysis for recognition of sleep apnea using electroencephalogram

Sleep apnea is a common sleep disorder that causes an increased risk of mortality and affects quality of life. Identifying cases of sleep apnea is vital to promptly treating the condition. The goal of the work is to develop a software package for automatically detecting episodes of obstructive sleep apnea syndrome. The paper presents an approach based on the study of multifractal properties of the electroencephalogram (EEG) signal for detecting sleep apnea events. The results of tests conducted using the PhysioNet CAP Sleep database indicate excellent quality of detection of sleep apnea against the background of other diseases: using the Hurst index – sensitivity (90.00%) and specificity (91.50%), using the multifractal detrended fluctuation method analysis (by spectrum width) - sensitivity (90.00%) and specificity (90.50%).The use of a sleep apnea episode recognition system ensures timely detection of the disease at an early stage and thereby improves the effectiveness of the treatment of this disease.