Breathing Pauses Research Articles

Computer Aided Detection of Obstructive Sleep Apnea from EEG Signals

Sleep Apnea is an anomaly in sleeping characterized by short pause in breathing. Failure to treat sleep apnea leads to fatal complications in both psychological and physiological being of human. Electroencephalogram (EEG) performs an important task in probing for sleep apnea through identifying and recording the brain’s activities while sleeping. In this study, computer aided detection of sleep apnea from EEG signals is developed to optimize and increase the prompt recognition and diagnosis of sleep apnea in patients. The time domain, wavelets, and frequency domain of the EEG signals were computed, and features were extracted from these domains. These features are inputted into two machine learning algorithms: Support Vector Machine and K-Nearest Neighbors of different kernel functions and orders. Evaluation metrics such as specificity, accuracy, and sensitivity are computed and analyzed for the classifiers. The KNN classifier outperforms the SVM in classifying apnea from non-apnea events in patients. The KNN order 3 shows the highest performance sensitivity of 85.92%, specificity of 80% and accuracy of 82.69%.

Associated factors of obstructive sleep apnea syndrome in hypertensive patients at Brazzaville (Republic of the Congo)

To determine the frequency of obstructive sleep apnea syndrome (OSAS) in hypertensive patients and report the associated factors. This cross-sectional study was conducted from March to August 2019 (6 months), in hypertensive outpatient followed up at the University Hospital of Brazzaville. The diagnosis criteria of OSAS were those of Berlin questionnaire. A total of 315 patients were included, 210 women (64.9%). The mean age was 58.5 ± 12.4 years. The standard of living was high in 59 cases (18.7%). Medical history was: hospitalization ( n = 209, 66.3%), diabetes ( n = 95, 30.2%), heart failure ( n = 57, 18.1%). Lifestyle habits were: sedentarity ( n = 181, 57.5%), excessive alcohol intake ( n = 97, 30.8%). Normal blood pressure ( n = 86, 27.3%), severe obesity ( n = 23, 7.3%), obdominal obesity ( n = 230.73%). Anomalies in the Berlin questionnaire were represented by snoring ( n = 197, 62.5%), tiredness upon waking ( n = 127, 40.3%), tiredness during the day ( n = 97, 30.8%), breathing pauses ( n = 75, 23.8%) and falling asleep at the wheel ( n = 22, 7%). The frequency of OSAS was 75.8% ( n = 239). The factors associated with OSA were: excessive alcohol intake ( n = 86, 36% OR 3.3, 95% CI 1.6-6.6, P < 0.01), severe obesity ( n = 20, 8.3%, OR 7, 95% CI 1.6-35, P = 0.01), abdominal obesity ( n = 185, 77.4%, OR 2.3, 95% CI 1.3-4, P = 0.002). OSAS is a real problem among hypertensive patients at Brazzaville. This fact requires its systematic screening, and the implementation of polysomnography, a more efficient means of diagnosis for appropriate treatment.

Integrated Activity Cpap and Bipap Machine for Sleep Apnea

Sleep apnea is a disorder that patients experience during sleep because of pauses in breath. The breath pauses usually remain for seconds to minutes and they might happen some times during night and it causes loud choking or snorting sounds when breathing is resumed. As it disturbs normal sleep, patients affected might feel sleepiness or tired in case of day time. In order to cure sleep apnea disorder, the breathing assistants like CPAP and BiPAP machines are used. CPAP devices are the best for treatment of OSA and can monitor during sleep and BiPAP is suggested for patients who are suffering with both OSA and CSA. The lack of treatment for both OSA and CSA might lead to heart attack, stroke, diabetes, heart failure, and irregular heartbeat. The overview of our project is to get people know the awareness of sleep apnea disorder and make the low-cost integrated CPAP and BiPAP machine as single non-invasive method working model.

Obstructive sleep Apnea detection and alerting system using Piezoelectric sensor array embedded Quilt

Obstructive sleep apnea (OSA) is a prevalent and serious sleep disorder. OSA causes involuntary cessation of breathing for brief periods of time during sleep. Usually a person may not be aware of breath interruption during sleep which may lead to nocturnal death. We proposed a novel body movement sensing method for detecting apneic episodes. Body movement signals were acquired using piezoelectric sensor array embedded inside a quilt. Acquired signals were digitally processed and peak response of the sensor during loading and unloading phase was analyzed. Alerting system will be activated whenever the movement signal time duration exceeds the threshold (t > 10 s). Also vibration stimulation is applied to the user whenever the breathing pause exceeds preset threshold (t > 20 s) using a vibration motor disc placed inside the quilt. This method was evaluated with 10 subjects in a normal sleep environment. Experimental results revealed that the proposed method efficiently detects and alerts the user within 10 seconds of breathing cessation. The proposed method can also assist in early detection of OSA in asymptomatic individuals.

Development of Sleep Apnea Device by detection of blood pressure and heart rate measurement

A condition during the sleep of a person, in which a period of a hitch or pause in breathing occurs is termed as “Sleep Apnea”, which is a very common but potentially serious sleep disorder. In this paper, development of a bio-medical non-invasive device is presented for recognition and measurement of this disorder. The blood pressure and heartbeat patterns are obtained from various sensors by regularly monitoring the changes in them and when a dip in the relevant monitoring values is observed, the proposed device generates mild impulse of current which is sufficient to make the patient awake and save them from a possible fatality (mid sleep death). A basic user-friendly mobile application has also been developed for the purpose of monitoring by a remote user also.

Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study.

The effects of serotonergic agents on respiration neuromodulation may vary according to differences in the serotonin system, such as those linked to depression. This study investigated how sleep-related respiratory disturbances relate to depression and the use of medications commonly prescribed for depression. Retrospective polysomnography was collated for all 363 individuals who met selection criteria out of 2,528 consecutive individuals referred to a specialized sleep clinic (Ottawa, Canada) between 2006 and 2016. The apnea-hypopnea index (AHI), oxygen saturation nadir, and oxygen desaturation index during REM and NREM sleep were analyzed using mixed analyses of covariance comparing 3 main groups: (1) medicated individuals with depressive disorders (antidepressant group; subdivided into the selective serotonin reuptake inhibitor and norepinephrine-dopamine reuptake inhibitor subgroups), (2) non-medicated individuals with depressive disorders (non-medicated group), and (3) mentally healthy control patients (control group). Individuals with depressive disorders (on antidepressants or not) had significantly higher AHIs compared to control patients (both P ≤ .007). The antidepressant group had a lower NREM sleep oxygen saturation nadir and a higher NREM sleep oxygen desaturation index than the control and non-medicated groups (all P ≤ .009). Within individuals with depressive disorders, independent of depression severity, the selective serotonin reuptake inhibitor group had a lower oxygen saturation nadir and a higher oxygen desaturation index during NREM sleep than the norepinephrine-dopamine reuptake inhibitor (both P ≤ .045) and non-medicated groups (both P < .001) and a higher NREM sleep AHI than the non-medicated group (P = .014). These findings suggest that the use of selective serotonin reuptake inhibitors may be associated with impaired breathing and worse nocturnal oxygen saturation in individuals with depressive disorders and sleep complaints, but this needs to be confirmed by prospective studies.

Robotic Surgery in Obstructive Sleep Apnea-Hypopnoea Syndrome

Obstructive sleep apnoea-hypopnoea (OSAH) syndrome is a sleep disorder characterised by pauses in breathing (apnoea) or periods of reduced breathing (hypopnoea) during sleep. It results in cerebral hypoxia and a disturbed sleep pattern. The gold standard treatment for OSA is continuous positive airway pressure (CPAP). However, significant number of patients are not able to tolerate this device and approximately 50% of patients report inability to achieve long term usage to CPAP.Robotic surgery is an emerging technique for sleep surgery. TORS is an alternative treatment for OSA for patients who have failed CPAP treatment or conventional non-robotic sleep surgery. This technology is assisted by remote-controlled miniaturized surgical instruments and magnified visualization with a high-definition three-dimensional camera. Tongue base reduction (TBR) refers to the primary focus of this targeted surgery for obstructive sleep apnea (OSA).TORS approach for OSA may include 2 different surgical steps frequently combined in the same procedures according to the patient’s features: tongue base reduction and supraglottoplasty (SGP).In the light of the present results and of the literature, TORS tongue-base reduction appears to be effective. With the improved visualization and precise tissue removal provided by robotic surgery, TORS may become more widespread in the treatment of OSA in the coming years. There was an improvement in objective and subjective sleep measures. The comparison among pre-operative and post-operative parameters showed a significant decreasing in post-operative AHI, ESS and an increasing of the lowest SpO2 value.

Smart T-Shirt Based on Wireless Communication Spiral Fiber Sensor Array for Real-Time Breath Monitoring: Validation of the Technology

In this paper, we present the design and the validation of a new smart textile developed for real time monitoring of human breath. The smart textile is a wearable stretching T-shirt featuring an array of six contactless and non-invasive sensors placed on human’s thoraco-abdominal walls. The wireless sensors communicate quasi-simultaneously the data to a detection base station through Bluetooth protocol. The sensor is composed of a spiral shaped multi-material fiber antenna with a central frequency at 2.4 GHz connected to a compact Bluetooth transmitter. The sensors are integrated on the stretchable T-shirt without compromising the user’s comfort. The sensing mechanism of the system is based on the shift of the central frequency of the spiral fiber antenna induced by the deformation of the thorax and the abdomen during the breath. As a consequence, the breathing pattern is obtained through the received signal strength indicator recorded by a portable detection base station. With the sensor array integrated into a T-shirt, we demonstrate the feasibility assessment for monitoring breathing of seven volunteers in seating and standing positions. Using an array of sensors strategically placed on the T-shirt provides a more reliable approach to detect interpretable breathing patterns by sensing the movement of the abdomen and the thorax at the same time. Using a commercial spirometer as a standard reference, we assessed the validity of breathing parameters (ie; expiration and inspiration times, breathing period, and breathing rate) measured with the T-shirt. Based on Bland-Altman statistical analysis, a good agreement between textile-based sensors and the standard reference was obtained. We were able to show that the smart T-shirt could detect breathing patterns and pauses in breathing, which could be very useful to monitor sleep apnea and clinical monitoring of patients.

Prediction of upper airway dryness and optimal continuous positive airway pressure conditions

Continuous positive airway pressure is the most effective long-term treatment for obstructive sleep apnoea, which is a sleeping disorder characterized by pauses in breathing during sleep. It introduces pressurized atmospheric air into the respiratory system in order to maintain open airways without blockage. Some continuous positive airway pressure devices incorporate a convective heat transfer humidifier to overcome dryness. However, many side effects, including the unacceptable excess of water droplets in the air supply line, have been reported and improvements are essential for better patient’s comfort and acceptance of the therapy. The excess of water droplets is attributed to the qualitative rather than the quantitative approach of determining the rise in temperature and humidity of the inspired air. Therefore, a human upper airway mathematical model is developed to predict the heat and water transfer variation between normal breathing and continuous positive airway pressure conditions and determine the optimal input temperature and relative humidity in the continuous positive airway pressure humidifier.

Long-Term Impact of Adenotonsillectomy on Quality of Life in Thai Children with Sleep-Disordered Breathing

Background: Sleep disordered breathing (SDB) is a spectrum of disorders that is characterized by abnormal respiratory patterns during sleep, with symptoms that include snoring, mouth breathing, and pauses in breathing. No previous study has investigated the long-term impact of adenotonsillectomy on the quality of life in Thai children with SDB. Objective: To investigate the long-term impact of adenotonsillectomy on the quality of life in Thai pediatric patients with SDB as measured by Obstructive Sleep Apnea-18 (OSA-18) questionnaire. Materials and Methods: The present study was retrospectively conducted in Thai pediatric SDB that underwent adenotonsillectomy at Siriraj Hospital between January 1997 and December 2010. Caregivers of the present study children completed the OSA-18 questionnaire pre-operatively and at least 6-months post-operatively. Demographic and pre-operative polysomnography (PSG) data were also collected and analyzed. Pre-operative and post-operative OSA-18 total score and OSA-18 scores for all five domains were compared using paired t-test. Results: Forty-nine children with SDB that underwent adenotonsillectomy were included. There were 30 boys (61.2%) and 19 girls (38.8%), with a mean age of 6.1±2.6 years (range 3.0 to 12.1). Pre-operative PSG was performed in 32 children (65.3%), with a mean apnea-hypopnea index of 12.6±12.4. Mean pre-operative and post-operative total OSA-18 score was 69.8±16.1 and 36.0±12.9, respectively. Mean duration from surgery to completion of the OSA-18 questionnaire after adenotonsillectomy was 12.5±4.6 months (range 6 to 28). Total OSA-18 score and the scores for all five OSA-18 domains were significantly improved after adenotonsillectomy (p&lt;0.001 and &lt;0.001, respectively). Conclusion: Long-term quality of life in Thai children with SDB was improved significantly after adenotonsillectomy, as evidenced by the significant improvement in OSA-18 total score and all OSA-18 domains. Based on these findings, the authors encourage adenotonsillectomy as the first-line treatment for SDB in Thai pediatric population. Keywords: Long-term impact, Adenotonsillectomy, Quality of life, Thai children, Sleep-disordered breathing, SDB

Short Communication on Obstructive Sleep Apnea

Obstructive sleep apnea is a severe sleep disorder. It causes breathing to stop and start repeatedly while you sleep.With sleep apnea, the muscles in your upper airway relax while you’re sleeping. This causes your airways to become blocked off, keeping you from getting enough air. This may cause your breathing to pause for 10 seconds or longer until your reflexes initiate br eathing to restart.You’re considered to have severe sleep apnea if your breathing stops and restarts more than 30 times an hour The apnea hypopnea index (AHI) measures obstructive sleep apnea to determine a range from mild to severe, based on the number of breathing pauses per hour you have while sleeping

The Impact of Parkinson's Disease on Breath Pauses and Their Relationship to Speech Impairment: A Longitudinal Study.

Purpose The purposes of this longitudinal study were to (a) examine the impact of Parkinson's disease (PD) progression on breath pause patterns and speech and linguistic errors and (b) determine the extent to which breath pauses and speech and linguistic errors contribute to speech impairment. Method Eight individuals with PD and eight age- and sex-matched control participants produced a reading passage on two occasions (Time 1 and Time 2) 3 years and 7 months apart on average. Two speech-language pathologists rated the severity of speech impairment for all participants at each time. Dependent variables included the location of each breath pause relative to syntax and punctuation as well as the number of disfluencies and mazes. Results At Time 1, there were no significant differences between the groups regarding breath pause patterns. At Time 2, individuals with PD produced significantly fewer breath pauses at major syntactic boundaries and periods as well as significantly more breath pauses at locations with no punctuation than control participants. Individuals with PD produced a significantly greater number of disfluencies than control participants at both time points. There were no significant differences between the groups in the number of mazes produced at either time point. Together, the number of mazes and the percentage of breath pauses at locations with no punctuation explained 50% of the variance associated with the ratings of severity of speech impairment. Conclusion These results highlight the importance of targeting both respiratory physiological and cognitive-linguistic systems in order to improve speech production in individuals with PD.

Self-reported Snoring Patterns Predict Stroke Events in High-Risk Patients With OSA: Post Hoc Analyses of the SAVE Study

The relation of snoring to risks of stroke and other major cardiovascular (CV) events is uncertain. We aimed to determine associations of snoring patterns and major CV events in relation to OSA among participants of the international Sleep Apnea cardiovascular Endpoints (SAVE) trial. Post hoc analyses of the SAVE trial, which involved 2,687 patients with coexisting moderate-to-severe OSA and established coronary or cerebral CV disease, who were randomly allocated to CPAP treatment plus usual care or usual care alone, and followed-up for a median 3.5 years. Associations of self-reported snoring patterns (frequency and loudness) and breathing pauses collected on the Berlin questionnaire at baseline and multiple times during follow-up, and adjudicated composites of CV outcomes (primary, CV death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for unstable angina, heart failure, or transient ischemic attack; and separately of cardiac and cerebral events), were evaluated in time-dependent Cox proportional hazards models adjusted for various confounders including the apnea-hypopnea index. Increase (per category) of snoring frequency (adjusted hazard ratio [HR], 1.10; 95%CI, 1.02-1.20; P= .015), loudness (HR, 1.16; 95%CI, 1.06-1.27; P= .001), and breathing pauses (HR, 1.16; 95%CI, 1.08-1.25; P< .001) at any time point during follow-up were each associated with the primary composite CV outcome. These associations were driven by significant associations for cerebral rather than cardiac events, and positive interactions between the three snoring patterns for cerebral events. There was no significant interaction between CPAP treatment and snoring variables for cerebral events. Snoring in patients with OSA with established CV disease is associated with greater risks of cerebral but not cardiac events, independent of CPAP treatment and frequency of apnea and hypopnea events. ClinicalTrials.gov; No.: NCT00738179; URL: www.clinicaltrials.gov.

Patients with obstructive sleep apnea present with chronic upregulation of serum HIF-1α protein

Obstructive sleep apnea (OSA) is a chronic condition that is characterized by recurrent pauses in breathing during sleep causing intermittent hypoxia. The main factor responsible for oxygen metabolism homeostasis is hypoxia-inducible factor 1 (HIF-1), comprised of 2 subunits: α (oxygen sensitive) and β. The aim of the study was to investigate the HIF-1α serum protein level and mRNA HIF-1α expression in patients with OSA and a healthy control group and determine their evening-morning variation and association with polysomnography parameters. Eighty-four individuals were enrolled in the study. All patients underwent polysomnography examination and based on the results were divided into 2 groups: OSA group (n = 60) and control group (n = 24). Peripheral blood was collected in the evening before and in the morning after the polysomnography. HIF-1α expression was evaluated on protein in blood serum and mRNA level in peripheral blood leukocytes. HIF-1α serum protein concentration was higher in patients with OSA compared with control patients in both the evening (1,490.1 vs. 727.0 pg/mL; P < .001) and the morning (1,368.9 vs. 702.1 pg/mL; P < .001) samples. There was no difference between evening and morning HIF-1α serum protein level in either group. No differences were observed in HIF-1α mRNA expression between the OSA and control group. Additionally, evening and morning HIF-1α serum protein level correlated with number of desaturations during sleep (r = .384, P < .001 and r = .433, P < .001, respectively). Observed differences in HIF-1α serum protein level between the OSA and the control groups without difference between evening and morning measurements suggest chronic increase in this protein concentration by intermittent nocturnal hypoxia in OSA.

Sleep in New Zealand children aged 7-9: associations with ethnicity, socioeconomic status, and achievement in reading and mathematics.

The aims were (1) to investigate differences by ethnicity and socioeconomic status (SES) in objective measures of sleep in children aged 7-9 years and (2) determine whether measures of sleep predict child achievement in reading or mathematics after controlling for ethnicity and SES. Four groups of parent-child dyads were recruited: Māori, low-SES schools (n = 18); Māori, high-SES schools (n = 17); New Zealand European, low-SES schools (n = 18); New Zealand European, high-SES schools (n = 17). Child sleep was measured by actigraphy. Parents and teachers reported child daytime sleepiness and behavior, and children completed a self-report of anxiety symptoms. Teachers also reported on child achievement in reading and mathematics. Children from low-SES schools went to bed later on school nights (F[1,68] = 12.150, P = .001) and woke later (F[1,68] = 15.978, P < .001) than children from high-SES schools but had similar sleep duration. There were no differences related to ethnicity. Children from low-SES schools were almost 3 times more likely to be below national standards for mathematics. Children not meeting academic standards in mathematics had a later sleep start time, lower sleep period efficiency, and a decreased total sleep time. However, when SES and sleep period efficiency were modeled together neither were found to significantly influence achievement in mathematics. In this study, SES influenced sleep timing but not the quality and quantity of sleep in 7- to 9-year-old children, and a significant independent effect of sleep efficiency on learning could not be demonstrated.

0240 College Football Players Compared to Other Collegiate Athletes: Symptoms of Insufficient Sleep Duration, Insomnia, and Sleep Apnea

Abstract Introduction College athletes experience frequent sleep disturbances. Data from professional football players suggests high rates of sleep apnea symptoms. Little data is available on college football players, especially compared to other athletes. Methods Data were obtained from N=189 NCAA Division-I student athletes, including N=45 football players). Outcomes of interest came from the Sleep Disorders Symptom Check List (SDSCL) which rated symptoms on a frequency scale of 0: never and 4: &amp;gt;5 times/week. Symptoms evaluated were daytime tiredness, any snoring, loud snoring, breathing pauses during sleep, and waking up choking/gasping sleep apnea), as well as difficulty falling asleep, difficulty with nighttime awakenings, and early morning awakenings (insomnia). Other outcomes include self-reported sleep duration, Insomnia Severity Index, frequency of caffeine use, and frequency of use of medications to help with sleep. Linear and ordinal logistic regression analyses were adjusted for age, sex, year in school, socioeconomic status, and mood. Post-hoc analyses examined men only. Results Regarding sleep apnea symptoms, football players reported more snoring (oOR=3.14, p=0.01), loud snoring (oOR=4.38, p=0.008), breathing pauses (oOR=5.42, p=0.0499), and choking/gasping (oOR=8.51), but not daytime tiredness. Regarding insufficient sleep, football players reported no difference in sleep duration but decreased caffeine use (oOR=0.27, p=0.002). Regarding insomnia, football players showed no difference in ISI scores or insomnia symptoms, but increased likelihood of sleeping pill use (oOR=3.01, p=0.03). When analyses were restricted to men only, all of these relationships were maintained. Conclusion College football athletes may exhibit different sleep symptoms than other college athletes, as they exhibit more sleep apnea-related symptoms, without the increase in daytime symptoms, such as tiredness. Support The REST study was funded by an NCAA Innovations grant. Dr. Grandner is supported by R01MD011600

0581 Characteristics of US Women Veterans with Sleep Apnea: Results of a National Survey of VA Healthcare Users

Abstract Introduction Sleep apnea (SA) is the most commonly diagnosed sleep disorder among patients in the US Veterans Administration (VA). The dramatic rise in women receiving VA care makes it essential to understand the presentation and treatment of SA in women Veterans. We performed a nationwide survey about sleep among US women Veterans and compared characteristics of respondents with and without a self-reported history of SA diagnosis and treatment. Methods A survey was mailed to a random sample of 4000 women VA healthcare users. The survey included demographics, Insomnia Severity Index (ISI), Patient Health Questionnaire-4 (PHQ-4 depression/anxiety), Primary Care-Post-Traumatic Stress Disorder (PC-PTSD), RLS symptom presence, SA symptoms (snore loudly, observed breathing pauses), diagnosis of SA, and use of PAP therapy (APAP, BPAP, CPAP). We compared women with and without SA, and (among those with SA) women who did and did not use PAP, using Chi-square and t-tests. Results 1,498 completed surveys were returned (mean age 51.6 years, range 18-105 years, 62% non-Hispanic White). 200 respondents (13.4%) reported diagnosed SA. Women with SA were older (p&amp;lt;.001), likely to be employed (p=.013), more likely to snore loudly (p&amp;lt;.001) and to have breathing pauses while asleep (p&amp;lt;.001). They also had higher ISI (p&amp;lt;.001), were more like to report RLS (p&amp;lt;.001) nightmares (p=.027), and had higher PHQ-4 (p&amp;lt;.001) and PC-PTSD (p&amp;lt;.001) scores. Among women with SA, 130 (65%) used PAP. Loud snorers (p&amp;lt;.001) and those with observed breathing pauses were more likely to use PAP (p&amp;lt;.001). Conclusion One in 7 women who receive VA care report diagnosed SA. Women with SA had more mental health symptoms and comorbid sleep problems. Most reported using PAP therapy, although the amount of use is unknown. Those with SA symptoms were more likely to use PAP. Future work is needed to understand barriers to diagnosis and treatment of SA among women Veterans. Support Funding: VA Quality Enhancement Research Initiative RRP12-189 (Martin); NIH/NHLBI K24 HL143055 (Martin).

Exercise: a therapeutic modality to treat blood pressure in resistant hypertension

Background: Thirteen percent of deaths worldwide are attributed to blood pressure above the normal range, or hypertension. Activation of the sympathetic nervous system plays a predominant role in blood pressure elevation. A phenotype of hypertension, referred to as resistant hypertension, occurs when the goal blood pressure is not achieved when using three or more medications, including a diuretic. A sleep disorder, obstructive sleep apnea, is also associated with increased sympathetic activity and as well, is strongly associated with resistant hypertension. However whilst the use of a continuous positive airway pressure device during sleep is effective in eliminating the breath pauses in people with obstructive sleep apnea, it does not address the hypertension. Alternative therapeutic modalities are thus warranted. One such therapy, exercise, has been shown to have a positive influence on blood pressure in hypertensive and normotensive individuals and may potentially be used as a therapeutic modality to reduce blood pressure in individuals with resistant hypertension.Objectives: The purpose of this review was to explore the evidence in support of exercise as a valuable therapeutic modality to reduce blood pressure in adults with resistant hypertension.Major findings: All types of exercise have been shown to reduce blood pressure in hypertensives and normotensives. Aerobic exercise has the greatest effect on reducing blood pressure in individuals with resistant hypertension and thus also reduces morbidity and mortality risk.Conclusions: Exercise has been shown to reduce blood pressure in hypertension and resistant hypertension and is an effective, safe modality.

A different sleep apnea classification system with neural network based on the acceleration signals

Background and objectiveThe apnea syndrome is characterized by an abnormal breath pause or reduction in the airflow during sleep. It is reported in the literature that it affects 2% of middle-aged women and 4% of middle-aged men, approximately. This study has vital importance, especially for the elderly, the disabled, and pediatric sleep apnea patients. MethodsIn this study, a new diagnostic method is developed to detect the apnea event by using a microelectromechanical system (MEMS) based acceleration sensor. It records the value of acceleration by measuring the movements of the diaphragm in three axes during the respiratory. The measurements are carried out simultaneously, a medical spirometer (Fukuda Sangyo), to test the validity of measurement results. An artificial neural network model was designed to determine the apnea event. For the number of neurons in the hidden layer, 1-3-5-10-18-20-25 values were tried, and the network with three hidden neurons giving the most suitable result was selected. In the designed ANN, three layers were formed that three neurons in the hidden layer, the two neurons at the input, and two neurons at the output layer. ResultsA study group was formed of 5 patients (having different characteristics (age, height, and body weight)). The patients in the study group have sleep apnea (SA) in different grades. Several 12.723 acceleration data (ACC) in the XYZ-axis from 5 different patients are recorded for apnea event training and detection. The measured accelerometer (ACC) data from one of the patients (called H1) are used to train an ANN. During the training phase, MSE is used to calculate the fitness value of the apnea event. Then Apnea event is detected successfully for the other patients by using ANN trained only with H1’s ACC data. ConclusionsThe sleep apnea event detection system is presented by using ANN from directly acceleration values. Measurements are performed by the MEMS-based accelerometer and Industrial Spirometer simultaneously. A total of 12723 acceleration data is measured from 5 different patients. The best result in 7000 iterations was reached (the number of iterations was tried up to 10.000 with 1000 steps). 605 data of only H1 measurements are used to train ANN, and then all data used to check the performance of the ANN as well as H2, H3, H4, and H5 measurement results. MSE performance benchmark shows us that trained ANN successfully detects apnea events. One of the contributions of this study to literature is that only ACC data are used in the ANN training step. After training for one patient, the ANN system can monitor the apnea event situation on-line for others.

The Prevalence of High Risk of Obstructive Sleep Apnea and its Association with Sociodemographic Factors among Adults in Taman Dato' Rashid Salleh, Indera Mahkota, Kuantan

Introduction: Obstructive sleep apnea (OSA) is an insidious sleep breathing disorder, with cardinal manifestations of snoring, witnessed breathing pause during sleep and excessive daytime sleepiness. The aim of the study was to estimate the prevalence of OSA and its associated factors among adult population in Taman Dato’ Rashid Salleh, Kuantan. Materials and method: A cross-sectional study was carried out among 157 participants who lived in Taman Dato’ Rashid Salleh from May 2018 to June 2018. Obstructive sleep apnea was quantified using the self-administered Malaynvalidated Berlin questionnaire which apart from the demographic data included three categories (10 questions) designed to elicit information regarding snoring (category 1), daytime somnolence (category 2) and the presence of obesity and/or hypertension (category 3). The respondents were considered as high risk of OSA if two or more categories were positive. Weight, height and neck circumference were measured by using Secca© weight scales, Secca© stadiometer and non-elastic plastic tape, respectively. Descriptive statistics was used to measure the prevalence, while chi-square test was used to explore the association of OSA and its background variables. Results: Out of 157 respondents, female and Malay were dominant with the 56.7% and 91.0 %, respectively. The mean age of the respondents was 36.7 (12.2) years old. The prevalence of high risk of OSA in was 18.5%. There was no association between gender, age, race, smoking and neck circumference with risk of OSA while Body Mass Index (BMI) and hypertension were significantly related to an increased risk for developing OSA (p-value &lt; 0.001 and p=0.001, respectively). Conclusions: Two in every 10 adults in Taman Dato’ Rashid Salleh, Kuantan were at high risk of OSA. It is recommended that appropriate health promotion should be targeted to this community to instill awareness and increase the level of understanding of the public on OSA.