Cessation Of Breathing Research Articles

A deep learning model for QRS delineation in organized rhythms during in-hospital cardiac arrest.

Cardiac arrest (CA) is the sudden cessation of heart function, typically resulting in loss of consciousness and cessation of pulse and breathing. The electrocardiogram (ECG) stands as an essential tool extensively utilized by clinicians, during CA treatment. Within the ECG, the QRS complex reflects the depolarization of the ventricles, yielding valuable perspectives on cardiac health and potential irregularities. The delineation of QRS complexes is crucial for obtaining that information, but classical algorithms have not been tested with CA rhythms. This research aims to introduce a new deep learning-based model for accurately delineating QRS complexes in patients experiencing organized rhythms during in-hospital CA. Two databases have been employed, one comprising 332 episodes of in-hospital CA (151815 QRS complexes) and another consisting of 105 hemodynamically stable patients (112497 QRS complexes). The method comprises three stages: signal preprocessing for noise removal, windowing and sample classification with a U-Net model, and finally, the segmented windows are merged to complete the process. The proposed method exhibited mean (standard deviation) F1 score/Sensitivity/Specificity/intersection over union values of 97.03(8.28)/ 97.69(11.38)/96.47(9.92)/79.09(15.78), and a 8.56(11.62) error for QRSon, and 25.11(25.86) for QRSoff instant delineation. A precise delineator like this could support clinical practice by quantifying QRS features to enhance diagnostic accuracy and optimize treatment strategies.

Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy-A Narrative Review.

Sleep apnea-hypopnea syndrome (SAHS) is a respiratory disorder characterized by cessation of breathing during sleep, resulting in daytime somnolence and various comorbidities. SAHS encompasses obstructive sleep apnea (OSA), caused by upper airway obstruction, and central sleep apnea (CSA), resulting from lack of brainstem signaling for respiration. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for SAHS, reducing apnea and hypopnea episodes by providing continuous airflow. CPAP enhances sleep quality and improves overall health by reducing the risk of comorbidities such as hypertension, type 2 diabetes mellitus, cardiovascular disease and stroke. CPAP nonadherence leads to health deterioration and occurs due to mask discomfort, unsupportive partners, upper respiratory dryness, and claustrophobia. Technological advancements such as auto-titrating positive airway pressure (APAP) systems, smart fit mask interface systems, and telemonitoring devices offer patients greater comfort and enhance adherence. Future research should focus on new technological developments, such as artificial intelligence, which may detect treatment failure and alert providers to intervene accordingly.

Efficacy of combination therapy with mometasone and montelukast versus mometasone alone in treatment of adenoid hypertrophy in children: A systematic review and meta-analysis.

Intranasal mometasone and oral montelukast have been found to be effective for adenoid hypertrophy in children. We aimed to compare the efficacy of combination therapy of mometasone and montelukast versus mometasone alone for adenoid hypertrophy in children. Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing combination therapy of mometasone and montelukast with mometasone alone for adenoid hypertrophy in children. The outcomes of interest were rhinorrhea, snoring, mouth breathing, and adenoid/nasopharynx ratio. Data were pooled using a random effects model to generate mean differences (MD). 3 RCTs comprising a total of 207 patients were included; (combination therapy n=104 (50.2%). Rhinorrhea (MD -1.47; 95% CI -1.85 to -1.09; p<0.01; I2=0%), snoring (MD -1.33; 95% CI -1.65 to -1.00; p<0.01; I2=0%), and mouth breathing (MD -1.06; 95% CI -1.40 to -0.71; p<0.01; I2=0%) were significantly lower in patients treated with combination therapy. No difference was observed in the adenoid/nasopharynx ratio between the groups. However, analysis excluding the study with a high risk of bias showed a significant reduction in the adenoid/nasopharynx ratio (MD -10.73; 95% CI -13.56 to -7.90; p<0.01; I2=0%) in the combination therapy group. During the 3-month follow-up period after cessation of treatment, adenoid/nasopharynx ratio, rhinorrhea, snoring, and mouth breathing were significantly lower in the combination therapy group. In children with adenoid hypertrophy, combination therapy reduced rhinorrhea, snoring, mouth breathing, and adenoid/nasopharynx ratio at the end of the treatment period and 3months after treatment cessation.

Unraveling the relationship between sleep behaviors and physical activity in the United States: insights from 2015 to 2020 NHANES data

BackgroundPhysical activity is an important component of metabolic health. However, little is known about the impact of specific types/intensities of physical activity on sleep health, especially among ethnically diverse populations. We examined the association of various sleep behaviors with moderate to vigorous work/recreational activity.MethodsSelf-reported data from the National Health and Nutrition Examination Survey 2015–2020 were cross-sectionally analyzed for a sample of 11,039 participants in the United States (U.S.). Weighted univariate logistic regressions determined unadjusted associations, while weighted multivariable regression models adjusting for age, sex, ethnicity, BMI categories, and socio-economic status assessed the multivariable associations with moderate and vigorous work/recreational activity. Stratified analyses were performed to determine across-group differences by ethnicity and BMI categories.ResultsOf 11,039 adults (mean age 41 years), 50.7% were female, 59.8% were Non-Hispanic White, 17.8% Hispanic/Latino, 12% Non-Hispanic Black, 6.3% Non-Hispanic Asian, and 4.1% other/multiple ethnicities. Moderate work activity increased the odds of short sleep duration [aOR = 1.42; 95% CI: 1.22, 1.65], snoring [aOR = 1.45; 95% CI: 1.21, 1.73], breath cessation [aOR = 1.37; 95% CI: 1.18, 1.59], and daytime sleepiness [aOR = 1.63; 95% CI: 1.39, 1.91]. Vigorous recreational activity reduced the odds of short sleep duration [aOR = 0.81; 95% CI: 0.71, 0.94] and trouble sleeping [aOR = 0.83; 95% CI: 0.73, 0.96]. Stratified analyses indicated significant ethnicity-based differences in the odds of sleep behaviors across physical activity groups and increased odds of poor sleep behaviors among participants who were underweight, overweight or had obesity.ConclusionWork-related activity was significantly associated with suboptimal sleep behaviors while recreational activity was associated with favorable sleep behaviors. These associations were more pronounced among certain ethnic groups. Further longitudinal investigation is needed to examine the mechanism driving the relationship between sleep behaviors and physical activity.

Determining the Relationship Between Sleep Problems, Shock Pain, and Shock Anxiety in Patients With ICD.

This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors. The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a "General Information Form", the "Florida Shock Anxiety Scale (FSAS)", the "Epworth Sleepiness Scale (ESS)", the "Pittsburgh Sleep Quality Index (PSQI)", and the "Visual Pain Scale (VPS)". The mean age of the patients was 66.13 years. The VPS was 6.40±3.36; the mean FSAS score was 29.98±8.46; the mean PSQI score was 8.02±3.81; the mean ESS score was 7.59±4.10. PSQI had a statistically significant correlation with the total FSAS score (p<0.001) and a statistically insignificant correlation with ESS (p>0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares. It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of "normal but increased daytime sleepiness".

Diaphragm relaxation causes seizure-related apnoeas in chronic and acute seizure models in rats

Ictal central apnoea is a feature of focal temporal seizures. It is implicated as a risk factor for sudden unexpected death in epilepsy (SUDEP). Here we study seizure-related apnoeas in two different models of experimental seizures, one chronic and one acute, in adult genetically-unmodified rats, to determine mechanisms of seizure-related apnoeas. Under general anaesthesia rats receive sensors for nasal temperature, hippocampal and/or neocortical potentials, and ECG or EMG for subsequent tethered video-telemetry. Tetanus neurotoxin (TeNT), injected into hippocampus during surgery, induces a chronic epileptic focus. Other implanted rats receive intraperitoneal pentylenetetrazol (PTZ) to evoke acute seizures. In chronically epileptic rats, convulsive seizures cause apnoeas (9.9 ± 5.3 s; 331 of 730 convulsive seizures in 15 rats), associated with bradyarrhythmias. Absence of EEG and ECG biomarkers exclude obstructive apnoeas. All eight TeNT-rats with diaphragm EMG have apnoeas with no evidence of obstruction, and have apnoea EMGs significantly closer to expiratory relaxation than inspiratory contraction during pre-apnoeic respiration, which we term “atonic diaphragm”. Consistent with atonic diaphragm is that the pre-apnoeic nasal airflow is expiration, as it is in human ictal central apnoea. Two cases of rat sudden death occur. One, with telemetry to the end, reveals a lethal apnoea, the other only has video during the final days, which reveals cessation of breathing shortly after the last clonic epileptic movement. Telemetry following acute systemic PTZ reveals repeated seizures and seizure-related apnoeas, culminating in lethal apnoeas; ictal apnoeas are central – in 8 of 35 cases diaphragms initially contract tonically for 8.5 ± 15.0 s before relaxing, in the 27 remaining cases diaphragms are atonic throughout apnoeas. All terminal apnoeas are atonic. Differences in types of apnoea due to systemic PTZ in rats (mainly atonic) and mice (tonic) are likely species-specific. Certain genetic mouse models have apnoeas caused by tonic contraction, potentially due to expression of epileptogenic mutations throughout the brain, including in respiratory centres, in contrast with acquired focal epilepsies. We conclude that ictal apnoeas in the rat TeNT model result from atonic diaphragms. Relaxed diaphragms could be particularly helpful for therapeutic stimulation of the diaphragm to help restore respiration.

Understanding the clinical management of co-occurring sleep-related bruxism and obstructive sleep apnea in adults: A narrative and critical review.

Sleep-related bruxism (SRB) is a motor oral behavior characterized by tooth grinding and jaw clenching activity, reported by 8%-12% of the adult general population and 3% of older individuals. The frequency of one of its biomarkers, rhythmic masticatory muscle activity (RMMA), remains elevated across ages. Obstructive sleep apnea (OSA) is associated with the brief and repetitive pause of breathing (apnea) and with transient reduction in oxygen (hypoxia). OSA is observed at all ages and in about 50% of older individuals with a male preponderance. SRB clinical assessment is based on self-reporting of tooth grinding sound, awareness of clenching, jaw pain or headache, and clinical observation of tooth damage. OSA clinical assessment is based on sleepiness and fatigue, snoring, sleep quality, and awareness of breathing cessation, plus clinical examination of anatomical factors (e.g., obesity, retrognathia, large tonsil, macroglossia), age, gender, and body mass. Although the literature does not support association or causality between these two conditions, the co-occurrence is reported in about 30%-50% of adults. To confirm a diagnosis of co-occurring SRB and OSA, home sleep testing (HST) may be indicated. A sleep test is performed using electromyography (EMG) of jaw muscle (masseter or temporalis) and cardio-respiratory variables (e.g., air flow, respiratory effort, oxygen level, heart rate). The management of co-occurring SRB and OSA for individuals with prosthodontic needs is challenging to prevent compromising the oro-pharyngeal space and breathing efficiency. OSA treatment in the presence of SRB includes continuous positive airway pressure (CPAP) use alone or with an occlusal splint or mandibular advancement device (MAD). In addition, the following may be considered: supine sleep correction device, myofuncional therapy, medications, and surgeries. All have limitations and risks. Individual variability suggests that phenotyping is mandatory to select the most efficient and personalized treatment.

Right ventricular outflow tract arrhythmias in patients with obstructive sleep apnea- electrophysiological insights

Abstract Background Obstructive sleep apnea (OSA) was associated with atrial fibrillation and heart failure. Furthermore, the arrhythmic sudden death during sleep in patients with OSA raises serious concerns. Non-ischemic ventricular arrhythmias arise frequently from the right ventricular outflow tract (RVOT). The involvement of obstructive sleep apnea in the genesis of arrhythmia (premature ventricular contraction or tachycardia) originating specifically in the RVOT is not yet coherently established. Purpose This study aims to demonstrate the possible relationship between untreated obstructive sleep apnea and the occurrence of RVOT arrhythmia and to follow the electrophysiological features and outcomes after radiofrequency catheter ablation (RFA) in patients carrying this double burden. Methods One-hundred-twelve (112) consecutive asymptomatic and symptomatic patients admitted with RVOT arrhythmia ((PVCs and VTs) underwent a sleep study (polysomnography). Apnea was set out as the cessation of breathing and hypopnea was defined as shallow, slow, and restricted breathing occurring in episodes of ten seconds or more. The patients had normal left and right ventricle ejection fractions and no structural cardiovascular disease or other known extracardiac arrhythmia predisposing conditions. No significantly elevated systolic pressure in the pulmonary artery was assessed at echocardiography. Every patient was investigated by electrophysiologic study (EPS) and RFA of the clinical ventricular arrhythmia was immediately performed. Practicing and former professional athletes were excluded. Results Seventy-eight (69 %) of the included patients had an apnea-hypopnea index &amp;gt; 10/h. The included patients had the following characteristics: mean age 52 ± 8 years, 62% males, 81% had a BMI &amp;gt;30kg/m². The cardiac electrophysiologic study did not induce sustained VTs. The distribution of the PVCs and non-sustained VTs evidenced a predilection for the superior, septal and anterior (68%) and also superior and anterolateral aspects of the RVOT (23%). Radiofrequency catheter ablation (RFA) guided by activation mapping, precocity (the site of earliest activation &amp;gt; 30 ms before the setting of the QRS complex) and pace-mapping were performed in all patients. Immediate success was obtained in 98 patients (88%). After a mean follow-up of 24± 6 months, 28 patients (28%) from the success arm had a recurrence of the PVCs or the non-sustained VTs, 22 patients (22%) with and 6 patients (6%) without sleep apnea. Conclusions RVOT arrhythmia genesis and relapse after successful RFA seem highly associated with sleep apnea. Furthermore, patients with sleep apnea are more prone to have recurrent arrhythmias after radiofrequency catheter ablation in the absence of appropriate control of OSA.

Correlation of lipid profile APO A1 and APO B100 in chronic periodontitis patients leading to coronary artery disease.

Increased attention has been focused on the association of periodontal disease with cardio-metabolic syndrome. Although the associations are multi-factorial, very few studies have explored the role of lipoprotein Apo A1 and Apo B100 with chronic periodontitis. Additionally, obstructive sleep apnea (OSA), a chronic multi-factorial respiratory disease, consists of a temporary decrease or cessation of breath for ≥ 10 seconds and leads to a reduction in blood oxygen saturation of more than 3% to 4% and/or neurological arousal. OSA involves the upper respiratory tract, and it has been proven that snoring and OSA have systemic consequences in humans. It has been recently suggested that OSA may be related to periodontitis, another chronic multi-factorial disease. A total of 600 participants aged between 30 and 80 years were analyzed. In this case control study, a total of 300 in the case group with chronic periodontitis and coronary artery disease (CAD) and 300 in the control group healthy population with chronic periodontitis were recruited. The following data were collected: 1) general information on socio-demographic, health-related factors, 2) periodontal status [clinical attachment loss (CAL), pocket probing depth (PPD)], and 3) a blood sample for estimation of lipoproteins and biochemical analysis. The results of the current investigation point to a potential relationship between lipid metabolism and systemic inflammation brought on by periodontitis. It was observed that there is a link between periodontal disease and CAD. A significant correlation was found between the lipid profile APO A1 and APO B100 and the blood vessels involved in the case groups. Hence, cardiovascular diseases can be efficiently circumvent with a biomarker based approach to treatment, which also benefits patient's quality of life.

Validation of the Arabic version of the sleep apnea scale of the sleep disorders questionnaire SDQ-SA

BackgroundObstructive sleep apnea (OSA) is a widespread syndrome characterized by breathing cessation or reduction. It has a wide range of significant symptoms, such as snoring and fatigue. This study aimed to assess the validity of the Arabic version of the Sleep Disorders Questionnaire-Sleep Apnea Scale (SDQ-SA) as a screening tool in Arabic-speaking countries.MethodsThis study was conducted at a sleep disorders clinic at Damascus University’s hospitals from June 2023 to September 2023. Patients aged 18 to 75 who spoke Arabic were included, while those under 18 or over 75, with incomplete questionnaires, previous OSA diagnoses, or certain chronic diseases and sedative drug use were excluded. The questionnaire was translated into the Arabic language by two bilingual researchers. It was then given to around 15 patients to ensure clarity of the questions. The questionnaire was readministered to 30 participants to ensure reliability. After analyzing the results of the Arabic version of the SDQ-SA, we administered Polysomnography (PSG) type III tests to validate our results. Data analysis was conducted using Microsoft Excel and IBM SPSS version 22.ResultsThe study included 103 participants, with an average age of 56.55 years. The SDQ-SA identified 85 (82.5%) participants as being at high risk for having OSA. Among those classified as high risk, 39 (45.9%) had severe OSA, 34 (40%) had moderate OSA, 8 (9.4%) had mild OSA, and 4 (4.7%) had no OSA based on the apnea–hypopnea index (AHI) calculated by the PSG. On the other hand, 18 (17.5%) participants were classified as low risk for OSA, 3 (16.7%) had severe OSA, 3 (16.7%) had moderate OSA, 7 (38.9%) had mild OSA, and 5 (27.8%) had no OSA based on the AHI calculated by the PSG. For AHI ≥ 5, the sensitivity and specificity for men were 0.87 and 0.6, respectively, and for women, they were 0.84 and 0.5, respectively.ConclusionOur study showed that the Arabic version of the SDQ-SA questionnaire had good sensitivity and negative predictive value NPV, especially for patients with moderate to severe OSA. We recommend that physicians use this questionnaire and other similar questionnaires more frequently to identify and treat this underrecognized disease properly.

Airway and Airway Obstruction Site Segmentation Study Using U-Net with Drug-Induced Sleep Endoscopy Images.

Obstructive sleep apnea is characterized by a decrease or cessation of breathing due to repetitive closure of the upper airway during sleep, leading to a decrease in blood oxygen saturation. In this study, employing a U-Net model, we utilized drug-induced sleep endoscopy images to segment the major causes of airway obstruction, including the epiglottis, oropharynx lateral walls, and tongue base. The evaluation metrics included sensitivity, specificity, accuracy, and Dice score, with airway sensitivity at 0.93 (± 0.06), specificity at 0.96 (± 0.01), accuracy at 0.95 (± 0.01), and Dice score at 0.84 (± 0.03), indicating overall high performance. The results indicate the potential for artificial intelligence (AI)-driven automatic interpretation of sleep disorder diagnosis, with implications for standardizing medical procedures and improving healthcare services. The study suggests that advancements in AI technology hold promise for enhancing diagnostic accuracy and treatment efficacy in sleep and respiratory disorders, fostering competitiveness in the medical AI market.

Wearable Smart Silicone Belt for Human Motion Monitoring and Power Generation.

Human physical activity monitoring plays a crucial role in promoting personalized health management. In this work, inspired by an ancient Chinese belt, a belt-type wearable sensor (BWS) based on a triboelectric nanogenerator (TENG) is presented to monitor daily movements and collect the body motion mechanical energy. The developed BWS consists of a soft silicone sheet and systematically connected sensing units made from triboelectric polymer materials including polytetrafluoroethylene (PTFE) and polyamide (PA). A parameter study of the sensing units is firstly conducted to optimize the structure of BWS. The experimental studies indicate that the parameter-optimized BWS unit achieves a maximum output voltage of 47 V and a maximum current of 0.17 μA. A BWS with five sensing units is manufactured to record body movements, and it is able to distinguish different physical activities including stillness, walking, running, jumping, normal breathing, cessation of breathing, and deep breathing. In addition, the developed BWS successfully powers electronic devices including a smartphone, digital watch, and LED lights. We hope this work provides a new strategy for the development of wearable self-powered intelligent devices.

Apnoea suppresses brain activity in infants

Abstract Apnoea—the cessation of breathing—is commonly observed in premature infants. These events can reduce cerebral oxygenation and are associated with poorer neurodevelopmental outcomes. However, relatively little is known about how apnoea and shorter pauses in breathing impact brain function in infants, which will provide greater mechanistic understanding of how apnoea affects brain development. We analysed simultaneous recordings of respiration, electroencephalography (EEG), heart rate, and peripheral oxygen saturation in 124 recordings from 118 infants (post-menstrual age: 38.6 ± 2.7 weeks [mean ± standard deviation]) during apnoeas (pauses in breathing greater than 15 seconds) and shorter breathing pauses between 5 and 15 seconds. EEG amplitude significantly decreased during both apnoeas and short breathing pauses compared with normal breathing periods. Change in EEG amplitude was significantly associated with change in heart rate during apnoea and short breathing pauses and, during apnoeas only, with oxygen saturation change. No associations were found between EEG amplitude changes and apnoea/pause duration, post-menstrual age, or sleep state. As apnoeas often occur in premature infants, frequent disruption to brain activity may impact neural development and result in long-term neurodevelopmental consequences.

Measures of overnight oxygen saturation to characterize sleep apnea severity and predict postoperative respiratory depression

BackgroundSleep apnea syndrome, characterized by recurrent cessation (apnea) or reduction (hypopnea) of breathing during sleep, is a major risk factor for postoperative respiratory depression. Challenges in sleep apnea assessment have led to the proposal of alternative metrics derived from oxyhemoglobin saturation (SpO2), such as oxygen desaturation index (ODI) and percentage of cumulative sleep time spent with SpO2 below 90% (CT90), as predictors of postoperative respiratory depression. However, their performance has been limited with area under the curve of 0.60 for ODI and 0.59 for CT90. Our objective was to propose novel features from preoperative overnight SpO2 which are correlated with sleep apnea severity and predictive of postoperative respiratory depression.MethodsPreoperative SpO2 signals from 235 surgical patients were retrospectively analyzed to derive seven features to characterize the sleep apnea severity. The features included entropy and standard deviation of SpO2 signal; below average burden characterizing the area under the average SpO2; average, standard deviation, and entropy of desaturation burdens; and overall nocturnal desaturation burden. The association between the extracted features and sleep apnea severity was assessed using Pearson correlation analysis. Logistic regression was employed to evaluate the predictive performance of the features in identifying postoperative respiratory depression.ResultsOur findings indicated a similar performance of the proposed features to the conventional apnea–hypopnea index (AHI) for assessing sleep apnea severity, with average area under the curve ranging from 0.77 to 0.81. Notably, entropy and standard deviation of overnight SpO2 signal and below average burden showed comparable predictive capability to AHI but with minimal computational requirements and individuals’ burden, making them promising for screening purposes. Our sex-based analysis revealed that compared to entropy and standard deviation, below average burden exhibited higher sensitivity in detecting respiratory depression in women than men.ConclusionThis study underscores the potential of preoperative SpO2 features as alternative metrics to AHI in predicting postoperative respiratory.

The Relationship between Smoking and Obstructive Sleep Apnea (OSA) in Students at the Faculty of Law, Indonesian Christian University Class (2018-2021)

Obstructive Sleep Apnea (OSA) is a condition of obstruction/narrowing of the upper airway during sleep, which results in cessation of breathing for some time. OSA can be experienced in all age groups, and as many as 56% reported having symptoms of excessive daytime sleepiness (EDS). Smoking can cause abnormal changes in the upper respiratory tract, both histologically and physiologically. Several mechanisms have been hypothesized to explain how smoking increases the risk of developing OSA. This study aimed to determine the relationship between smoking and OSA in law faculty students at the Indonesian Christian University Class of 2018-2021. The method used in this research is analytic observational with a cross-sectional study design. The sampling technique used simple random sampling of 94 respondents. The primary data was obtained using the ESS questionnaire and smoking history, and then the data were analyzed using the Chi-Square statistical test. Statistical test results obtained p value = 0.214. There is no relationship between smoking and OSA in law faculty students at the Indonesian Christian University class 2018-2021, which is the conclusion of this study.

Unraveling the Role of Enkephalin Signaling in Respiratory Control

Opioid-induced respiratory depression (OIRD) is the primary cause of death during opioid overdose characterized by a dramatic decrease in respiratory frequency and regularity. Opioid drugs cause neural depression in the ventral respiratory column (VRC) of the medulla via activation of mu-opioid receptors (MORs) that partially contribute to breathing cessation. Nonetheless, little is known about the role of endogenous opioid signaling in respiratory modulation. This study investigates the role of endogenous MORs ligands, enkephalins encoded by the Penk gene, in breathing control. To test whether enkephalin-expressing neurons of the preBӧtzinger Complex (preBӧtC) — the inspiratory rhythm-generating region of the VRC — are necessary for breathing rhythmogenesis, we permanently silenced the region’s Penk+ population via AAV1 injections encoding tetanus toxin light chain. Using whole-body plethysmography, we recorded the animals' respiratory performance within 14 days post-injection. During the second week of testing, we observed unexpected mortality in some experimental but not control animals; post-hoc analysis of breathing traces revealed the development of severe tachypnea in succumbed mice. These data suggest that Penk+ preBӧtC cells are integral for normal respiration. Still, these observations did not assess the specific contribution of enkephalin, as opposed to other types of signaling, to breathing stability. To directly dissect the effects of enkephalin on respiratory rhythm, we utilized optogenetics and pharmacological approaches in brainstem slice preparation from neonatal mice. Brief optogenetic activation of Penk+ neurons in the preBӧtC evoked population bursts while prolonged stimulation increased the rhythm frequency. However, the application of MOR antagonist Naloxone did not affect the network’s responses to light stimulations indicating the lack of MOR/enkephalin involvement in mediating these excitatory effects. High fidelity and temporal coordination of evoked bursts implicated glutamatergic transmission as the primary mechanism of excitation. Likewise, we were able to optogenetically drive respiratory rhythm in urethane-anesthetized spontaneously breathing adult mice by stimulating the preBӧtC. Further, there was a small but significant difference in breathing responses in the presence of Naloxone compared to control conditions. We hypothesized that longitudinal projections to the VRC that might be disrupted during slice preparation contributed enkephalin to the respiratory circuits in the whole-body preparation. We utilized recombinase-dependent reporter mice crosses and retrograde AAV tracers to identify brain-wide Penk inputs to the preBӧtC. Using conventional and light sheet fluorescence microscopy, we located regions in the pons, midbrain, and forebrain that send direct enkephalinergic projections to the VRC. Functional characterizations of these projections will potentially uncover state-dependent mechanisms of respiratory modulation via endogenous opioids. Untimely, this study will help elucidate the role of enkephalin signaling in breathing control and may establish therapeutic targets for preventing OIRD. R01HL166317, R00HL145004. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Anterior palatoplasty as a treatment for mild and moderate obstructive sleep apnea: our experience

Abstract BACKGROUND. Obstructive sleep apnea (OSA) is characterized by frequent episodes of breathing cessation during sleep, resulting in low oxygen and high carbon dioxide levels, leading to daytime sleepnes, cognitive issues, and increased cardiovascular risk. The objective of this study was to assess the effectiveness of the anterior palatoplasty (AP) procedure in the treatment of patients with mild and moderate obstructive sleep apnea. MATERIAL AND METHODS. Sixteen patients diagnosed with mild and moderate OSA underwent AP in our clinic between 2021-2023. All patients were &gt; 18 years old, body mass index &lt; 30, with an apnea-hypopnea index (AHI) from 10 to 40 and disfunction of the velopharyngeal or of the retropalatal space. Patients underwent a one-night polysomnography examination prior to the surgical procedure, as well as six months after the procedure. Additionally, patients were asked to complete the Epworth Sleepiness Scale (ESS) both prior to and six months following the surgery. The procedure was done under general anaesthesia and involved AP surgery with or without reducing of the uvula. RESULTS. The average of total AHI values decreased from 28.89 per hour prior to surgery to 11.14 per hour six months after surgery. The oxygen desaturation index decreased after surgery with 2.57%. ESS scores of patients also decreased from 10.40 to 7.80 and all patients felt less tired. CONCLUSION. We believe that AP is an effective technique in the treatment of mild and moderate OSA caused by a disfunction of the velopharyngeal or retropalatal space. Additionally, we consider that AP is linked with a lower incidence of post-surgical complications compared to other surgical options.

Assessment of the Epworth Sleepiness Scale, Pediatric Sleep Questionnaire, and Mallampati Score in Children With Obstructive Sleep Apnea: An Observational Study

Background and Objective Individuals diagnosed with obstructive sleep apnea (OSA) experience recurrent episodes of breathing cessation due to blockage of the upper airway during sleep. This study aimed to assess the Pediatric Sleep Questionnaire (PSQ) scores, Epworth Sleepiness Scale (ESS) scores, and Mallampati score in pediatric patients with OSA, compared with non-OSA.Methods An observational study was conducted on 100 pediatric female patients aged 9-13 years with retrognathic mandible. The participants were subjected to PSQ, ESS, and Mallampati score to assess the size and shape of the patient’s tongue and esophageal airway. Finally, polysomnographic examination was carried out for all the participants and they were divided into two groups: Group 1 (50 patients) who were diagnosed with OSA by polysomnography and Group 2 (50 patients) consisting of non-OSA patients. Chi-square and Mann–Whitney U test were applied to compare scores between the two groups.Results The mean PSQ, ESS, and Mallampati scores of participants were 0.78 ± 0.45, 9.86 ± 2.47, and 2.27 ± 0.98, respectively in Group 1 and 0.24 ± 0.03, 7.27 ± 2.39, and 1.32 ± 0.57, respectively in Group 2, and this difference was statistically significant (p &lt; 0.05). PSQ, ESS, and Mallampati scores had specificity of 100%, 95.5%, and 72.7%, respectively, whereas the sensitivity was 45.5%, 22.7%, and 63.6%, respectively. ESS scores ≥ 10, PSQ scores ≥ 0.3, and Mallampati scores ≥ 2 were indicative of OSA.Conclusions Patients with OSA having retrognathic mandible had higher PSQ, ESS, and Mallampati scores compared to healthy individuals without OSA. Mallampati score can be satisfactorily used for screening OSA patients.

Pre-morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study.

Whilst sleep disturbances are associated with stroke, their association with stroke severity is less certain. In the INTERSTROKE study, the association of pre-morbid sleep disturbance with stroke severity and functional outcome following stroke was evaluated. INTERSTROKE is an international case-control study of first acute stroke. This analysis included cases who completed a standardized questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration, quality, nocturnal awakening, napping duration, whether a nap was planned, snoring, snorting and breathing cessation) in the month prior to stroke (n = 2361). Two indices were derived representing sleep disturbance (range 0-9) and obstructive sleep apnoea (range 0-3) symptoms. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity defined by the modified Rankin Score. The mean age of participants was 62.9 years, and 42% were female. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2-3, odds ratio [OR] 1.44, 95% confidence interval [CI] 1.07-1.94; 4-5, OR 1.66, 95% CI 1.23-2.25; >5, OR 2.58, 95% CI 1.83-3.66). Having >5 sleep disturbance symptoms was associated with significantly increased odds of functional deterioration at 1 month (OR 1.54, 95% CI 1.01-2.34). A higher obstructive sleep apnoea score was also associated with significantly increased odds of initially severe stroke (2-3, OR 1.48; 95% CI 1.20-1.83) but not functional deterioration at 1 month (OR 1.19, 95% CI 0.93-1.52). Sleep disturbance symptoms were common and associated with an increased odds of severe stroke and functional deterioration. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcomes and should be the subject of future research.

Assessment of Impact of Dietary Patterns on Obstructive Sleep Apnea Patients.

Objective Obstructive sleep apnea syndrome (OSAS) is characterized by episodic cessations of breathing due to upper airway obstruction during sleep, which may cause disturbances in dietary patterns resulting from appetite-related hormonal changes. The aim of the present study was to investigate the relationship between OSAS and nutritional and dietary patterns. Materials and Methods A total of 20 female and 53 male OSAS patients aged > 30 years were enrolled. Demographic data, as well as data on smoking and alcohol habits, were noted, anthropometric measures were made, and a questionnaire regarding chronic diseases including OSAS and four questionnaires on recent food intake frequency and content of nutrition were filled out. The content of nutrition was noted under seven categories: meat, legumes, milk and dairy products, fruits and vegetables, bread and cereals, fat and carbohydrates, and beverages. Results The severity of OSAS (assessed by the apnea-hypopnea index. AHI) was positively correlated with the body mass index (BMI), the circumferences of the waist, chest, and buttocks, and, in males, with the circumference of the neck as well. There was no correlation between the AHI and nutritional habits in terms of the frequency of meals or snacks, the scores on the Snoring, Tiredness, Observed Apnea, and High Blood Pressure-Body Mass Index, Age, Neck Circumference, and Gender (STOP-BANG) Questionnaire and the corresponding macro- and micronutrients. Worsening apnea scores led to increased intake of macronutrients of carbohydrate and protein and micronutrients of niacin and pyridoxine ( p < 0.05), and decreased intake of fat ( p < 0.05). Conclusion The present study demonstrated an association between OSAS severity and recent food intake, manifested in increased intake of carbohydrates, niacin, and pyridoxine, and decreased fat intake.