Chronic Obstructive Sleep Apnea Research Articles

Biomarkers of the L-Arginine/Dimethylarginine/Nitric Oxide Pathway in People with Chronic Airflow Obstruction and Obstructive Sleep Apnoea.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are common chronic diseases that are associated with chronic and intermittent hypoxemia, respectively. Patients affected by the overlap of COPD and OSA have a particularly unfavourable prognosis. The L-arginine/nitric oxide (NO) pathway plays an important role in regulating pulmonary vascular function. Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) interfere with NO production. We analysed the serum concentrations of ADMA, SDMA, L-arginine, L-citrulline, and L-ornithine in a large sample of the Icelandic general population together with chronic airflow obstruction (CAO), a key physiological marker of COPD that was assessed by post-bronchodilator spirometry (FEV1/FVC < LLN). OSA risk was determined by the multivariable apnoea prediction (MAP) index. 713 individuals were analysed, of whom 78 (10.9%) showed CAO and 215 (30%) had MAP > 0.5. SDMA was significantly higher in individuals with CAO (0.518 [0.461-0.616] vs. 0.494 [0.441-0.565] µmol/L; p = 0.005), but ADMA was not. However, ADMA was significantly associated with decreasing FEV1 percent predicted among those with CAO (p = 0.002). ADMA was 0.50 (0.44-0.56) µmol/L in MAP ≤ 0.5 versus 0.52 (0.46-0.58) µmol/L in MAP > 0.5 (p = 0.008). SDMA was 0.49 (0.44-0.56) µmol/L versus 0.51 (0.46-0.60) µmol/L, respectively (p = 0.004). The highest values for ADMA and SDMA were observed in individuals with overlap of CAO and MAP > 0.5, which was accompanied by lower L-citrulline levels. The plasma concentrations of ADMA and SDMA are elevated in COPD patients with concomitant intermittent hypoxaemia. This may account for impaired pulmonary NO production, enhanced pulmonary vasoconstriction, and disease progression.

Sleep-disordered breathing and lung function abnormalities in adults with congenital heart disease

PurposeAdvances in treatment enables most patients with congenital heart diseases (CHD) to survive into adulthood, implying the need to address comorbid conditions in this growing cohort of patients. The aim of this study was to evaluate the prevalence of sleep-disordered breathing (SDB) and lung function abnormalities in patients with adult congenital heart disease (ACHD).MethodsPatients with ACHD underwent level 3 sleep testing (Embletta MPR polygraphy) and pulmonary function testing. Results were stratified by the underlying haemodynamic ACHD lesion group.ResultsPatients with ACHD (n = 100) were middle-aged (42.3 ± 14.6 years), 54% male and slightly overweight (BMI 25.9 ± 5.5 kg/m2). Polygraphy revealed a prevalence of sleep apnoea of 39% with 15% of patients presenting with predominantly obstructive apnoeic episodes, while 23% of patients presenting primarily with central sleep apnoea. The distribution of mild, moderate, and severe sleep apnoea in the total study population was 26%, 7% and 6%, respectively. Comparison of apnoea–hypopnoea index, presence of sleep apnoea, and apnoea severity did not offer significant differences between the four ACHD lesion groups (p = 0.29, p = 0.41 and p = 0.18, respectively). Pulmonary function testing revealed obstructive lung disease in 19 of 100 patients. Concomitant chronic obstructive pulmonary disease and obstructive sleep apnoea were diagnosed in 3% of patients and were associated with profound nocturnal desaturation.ConclusionThe findings suggest a mild propensity amongst patients with ACHD to develop SDB that seems to be unaffected by the specific underlying congenital lesion.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA)—prevalence of the COPD-OSA overlap syndrome in Germany since 2017

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA)—prevalence of the COPD-OSA overlap syndrome in Germany since 2017

Bacterial colonisation of surface and core of palatine tonsils among Tanzanian children with recurrent chronic tonsillitis and obstructive sleep apnoea who underwent (adeno)tonsillectomy.

Acute and chronic tonsillitis are frequently treated with antibiotics. This study aimed to understand the presence of pathogenic micro-organisms on the surface and core of chronically infected tonsils among Tanzanian children. The study enrolled children undergoing adenotonsillectomy. Surface and core tonsillar swabs were taken. Quantitative polymerase chain reaction was performed for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Neisseria meningitidis and Pseudomonas aeruginosa. Surface and core combined, isolated N meningitidis (86.1 per cent) was found the most, followed by H influenzae (74.9 per cent), S pneumoniae (42.6 per cent) and S aureus (28.7 per cent). M catarrhalis and P aeruginosa were only found in a few patients, 5.6 per cent and 0.8 per cent respectively. Colonisation of the tonsillar surface and core has been found. Potentially pathogenic micro-organisms are likely to be missed based on a throat swab. Hence, the practice of surface tonsillar swabbing may be misleading or insufficient.

0859 Characterizing Comorbid Chronic Pain in Veterans with Obstructive Sleep Apnea

Abstract Introduction Evidence suggests that chronic noncancer pain (CP) and obstructive sleep apnea (OSA) are highly prevalent in the adult civilian population. As military veterans are disproportionally affected by both CP and OSA, greater understanding of the frequency and characteristics of CP that most commonly affect veterans with OSA is needed. Thus, this study characterized CP among veterans with OSA in terms of frequency, location, duration, severity, interference on daily activities, and etiology (neuropathic versus not). Methods A descriptive, observational, cross-sectional survey of veterans with newly diagnosed, untreated OSA and reporting pre-existing CP (N=107). Descriptive statistics characterized the sample and comorbid CP outcomes. Results In total, 69.5% (107/154) of participants with OSA who consented for the study had CP. Among participants with CP completing the survey (66.4% [71/107]), CP symptoms persisted for 15 years (IQR = 10-26.5). On average, Brief Pain Inventory – Short Form scores (0-10 scale) indicate moderate pain severity (5.2 ± 2.0) and interference on daily activities (5.7 ± 2.3). Greater pain interference was with sleep (6.3 ± 3.1) and enjoyment of life (6.0 ± 2.5). Pain affected multiple body regions and symptoms of predominantly neuropathic origin (defined as Self-completed Leeds Assessment of Neuropathic Symptoms and Signs scores ≥ 12) were reported by 49.3% of the sample. Conclusion CP is commonly comorbid with OSA. Primary care, pain management, and sleep medicine providers should prioritize CP screening, OSA screening, and management among patients with OSA. Future investigations of CP and OSA should focus on their association and how the effective treatment of one affects the severity of the other. Support (if any) SRSF Small Research Grant Award: 05-SRG-20. University of Pennsylvania School of Nursing, Office of Nursing Research.

PO-03-237 PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION AND PERIPROCEDURAL OUTCOMES TREND IN THE UNITED STATES: AN INSIGHT FROM NATIONWIDE READMISSION DATABASE 2016-2019

The watchman device is the first percutaneous left atrial appendage closure device (pLAAC) indicated in patients with non-valvular AF who cannot tolerate anticoagulation. Our study aims to assess the national trend of utilization of percutaneous left atrial appendage closure device (pLAAC) in atrial fibrillation (AF) patients and determine risk factors and predictors associated with periprocedural morbidity and mortality. Using the National Readmission Database (NRD) database between January 2016 to December 2019, patients with AF who underwent pLAAC evaluated for complications and mortality. Logistic/multivariate regression and Cox regression were used. A total of 54,903 procedures were identified from 2016-2019, mean age 75.91± 7.74, and 76.34 ± 7.42 for the years 2016 and 2019 respectively, 58.23% were male. The total volume of procedures across the board increased consistently each year being 4671 in 2016, 9389 in 2017, 12,698 in 2018, and 25,361 in 2019. Procedures were done in patients with higher number of chronic comorbidities including Prior myocardial infarction (MI), percutaneous coronary intervention, coronary artery disease, heart failure, hypertension, valvular disease, anemia, obesity, chronic lung disease, chronic kidney disease, diabetes, and obstructive sleep apnea (P<0.001). The rate of complications showed a trend toward reduction from 8.2% in 2016 to 7.1% in 2019 (Ptrend=0.006). Bleeding-related complications were significantly reduced for the year 2019 compared with 2016 (4.7% vs 5.5% respectively, Ptrend=0.024). This was primarily driven by fewer hemorrhagic strokes, major bleeds, and blood transfusion procedures. Hospitals with a higher volume of procedures had decreased mortality rates (aOR:0.89, CI0.85-0.93, P<0.0001). Mortality rates did not differ between different years (0.2%). This large NRD study shows there is an inverse relationship between hospital volume and odds of mortality for pLAAC procedures. The number of patients with chronic comorbidities undergoing pLAAC is increasing. Complication rates have been consistently decreasing. Despite this, there was no significant change in mortality.

Chronic Obstructive Pulmonary Disease and Sleep Apnea Syndrome – a Multidisciplinary Problem of Clinical Medicine

Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are more common pathologies in clinical practice, which are accompanied very often by cardiovascular comorbidity. The objective: to analyze the clinical features of chronic obstructive pulmonary disease course in combination with the risk of sleep apnea syndrome. Materials and methods. 47 patients with COPD III degree of bronchial obstruction, group E participated in the study: 9 (19.1%) women and 38 (80.9%) men. The study participants were divided into two groups: I group (COPD) – 32 persons, II group (COPD + apnea syndrome) – 15 individuals. Clinical, spirographic laboratory, X-ray, ultrasound, and electrocardiographic examinations were performed to the patients, the STOP-Bang questionnaire was used to determine the risk of sleep apnea syndrome development, and the influence of bronchial obstruction on the daytime sleepiness (Epworth scale) and depression (Beck questionnaire) was studied. Results. The analysis of the results of the study presented that among the examined patients with COPD 32 (68.1%) subjects were identified with a high risk of sleep apnea syndrome. In this cohort of patients there were signs of daytime sleepiness according to the Epworth scale, and according to the Beck questionnaire they scored more than 10 points, that is, a mild level of depression of situational or neurotic origin was found. It was found that among patients with COPD in combination with the risk of night apnea (II group), coronary heart disease was diagnosed in 24 (75%) cases, arterial hypertension – in 22 (68.8%) cases, diabetes – in 15 (46.9%). At the same time, the prevalence of these nosologies in patients with COPD without the risk of night apnea was significantly (p&lt;0.05) lower. The Charlson comorbidity index in patients with COPD and risk of apnea was within 3–4 points, 10-year survival was within 77–53%. Conclusions. The high risk of apnea syndrome according to the results of the screening questionnaire, excessive daytime sleepiness, and depressive states in patients with COPD should prompt primary care physicians to refer such patients to a comprehensive polysomnography examination to confirm OSAS. After all, COPD, OSAS and cardiovascular comorbidity are characterized by a more unfavorable clinical course and prognosis than each of these diseases separately.

Effect of prophylactic amoxicillin on tonsillar bacterial pathogens after (adeno)tonsillectomy in children

ObjectivesUnnecessary and inappropriate antibiotic use is an increasing global health challenge. In limited resource settings, prophylactic antibiotics are still often used in (adeno)tonsillectomy (AT), despite evidence against their effectiveness. This study aimed to investigate the effect of prophylactic amoxicillin, given after AT in children. MethodsThis is a secondary analysis from a two-center, double-blinded, randomized controlled, non-inferiority trial to study the effect of prophylactic amoxicillin on post-AT morbidity. Children aged 2-14 years with recurrent chronic tonsillitis and/or obstructive sleep apnea were randomly assigned to receive either placebo or amoxicillin for 5 days after the operation. Pre- and postoperative samples were collected for polymerase chain reaction (PCR) analyses to detect the five most important pathogens known to be common causes of tonsillitis. PCR results were compared before and after surgery as well as between placebo and amoxicillin. ResultsPCR results were obtained, 109 in the amoxicillin group and 115 in the placebo group. In the amoxicillin group, 91% of patients had at least one positive PCR test before surgery and 87% after surgery. In the placebo group, the respective percentages were 92% and 90%. In both groups, a decrease in the total number of pathogens was found after surgery. ConclusionProphylactic amoxicillin given after AT in children did not show a clinically relevant effect with respect to the number of oropharyngeal microorganisms as compared to placebo.

A long-term follow-up study of noninvasive positive pressure ventilation on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome

Objective: To investigate the effect of noninvasive positive pressure ventilation(NIPPV) on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome(OVS) through long-term follow-up. Methods: A total of 187 OVS patients were divided into the NIPPV group(n=92) and the non-NIPPV group(n=95). Of these, 85 males and 7 females were in the NIPPV group with an average age of (66.5±8.5) years(range 47-80 years); 89 males and 6 females were in the non-NIPPV group with an average age of (67.4±7.8) years(range 44-79 years). Follow-up was performed from enrolment with an average duration of 39(20, 51) months. The all-cause mortality was compared between the two groups. Result: There were no significant differences in their baseline clinical characteristics(all P>0.05), indicating that the data from the two groups were comparable. The Kaplan-Meier curve showed no difference in all-cause mortality between the two groups(log rank P=0.229). However, deaths from cardio-cerebrovascular diseases were higher in the non-NIPPV than in the NIPPV group(15.8% vs. 6.5%,P=0.045). Age, BMI, neck circumference, PaCO2, FEV1, FEV1%, moderate to severe OSA(AHI>15 events/h), mMRC, CAT, number of acute exacerbations of COPD and number of hospitalizations were associated with all-cause death in OVS patients; among which, age(HR 1.067, 95%CI 1.017-1.119, P=0.008), FEV1(HR 0.378, 95%CI 0.176-0.811, P=0.013), and number of COPD exacerbations(HR 1.298, 95%CI 1.102-1.530, P=0.002) were independent risk factors for all-cause mortality in OVS patients. Conclusions: The combination of NIPPV and conventional treatment may reduce cardio-cerebrovascular disease-related mortality in OVS patients. The deceased OVS patients had severe airflow limitation and mild to moderate OSA. Old age, low FEV1 and COPD exacerbations were independent risk factors for all-cause mortality in OVS patients.

Treatment of patients with chronic tonsillitis and obstructive sleep apnoea

Obstructive sleep apnoea syndrome (OSAS) is a disease associated with high morbidity and mortality that can significantly affect the patient's quality of life. The consequences of OSAS are a decrease in blood oxygenation and frequent nocturnal episodes of awakening, which can lead to the increase of sleep fragmentation and, as a result, daytime sleepiness, increased activity of the sympathetic nervous system, and increased blood pressure with further complications. In the case of hypertrophy of the tonsils, the condition can gain complications which require a complex approach towards the tactics of treating the patients. In this case, surgery highlights the best treatment option for mild to moderate OSAS over CPAP, which calls into question the benefits of this method and encourages reconsideration of surgical intervention as the first-line treatment.

Role of Tongue Fat in The Pathogenesis of Obstructive Sleep Apnea: Review Article

Humans are fortunate to have sleep. A happy, fulfilling life depends on getting a restful night of sleep. Obstructive sleep apnea is a widespread sleep disorder is characterized by snoring loudly, difficulty breathing, and partial or complete lack of sleep. Systemic side effects from chronic obstructive sleep apnea may affect the cardiovascular system and other important body organs. Although the exact cause is unknown, a number of factors may contribute to this condition. Increased intramuscular fat may impair the tongue's capacity to act as a pharyngeal dilator muscle by changing its shape and decreasing its contractile force. More fat was found in apneic person at the base of the tongue, where the tongue's extrinsic muscles attach to the bone. Each extrinsic muscle's ability to position the tongue correctly away from the airway may be impacted by the increased fat.

Association between parental autoimmune disease and childhood atopic dermatitis varied by sex: a nationwide case-control study.

Atopic dermatitis (AD) is a common inflammatory skin disorder induced by dysfunction of immune suppression sharing similar pathogenesis to autoimmune diseases. To explore the association between autoimmune diseases and AD in children, we linked the birth data from National Birth Registry with National Health Insurance Research Database. There were 1,174,941 children obtained from 2006 to 2012 birth cohort. A total of 312,329 children diagnosed with AD before 5years old were compared to 862,612 children without AD in the control group. Conditional logistic regression was utilized to calculate adjusted odds ratio (OR) and Bonferroni-corrected confidence interval (CI) for overall significance level of 0.05. In 2006-2012 birth cohort, the prevalence rate of AD was 26.6% (95% CI 26.5, 26.7) before 5years of age. Having parental autoimmune disease (including rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, ankylosing spondylitis, and psoriasis) was associated with a significant higher risk of children AD development. The other associated factors were maternal obstetric complications (including gestational diabetes mellitus and cervical incompetence), parental systemic diseases (including anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, hyperthyroidism, and obstructive sleep apnea), and parental allergic disease (including asthma and AD). The subgroup analysis showed similar results between children's sexes. Moreover, maternal autoimmune disease had higher impact on the risk of developing AD in the child compared with paternal autoimmune disease. In conclusion, parental autoimmune diseases were found to be related to their children's AD before 5years old.

Renal denervation alleviates chronic obstructive sleep apnea-induced atrial fibrillation via inhibition of atrial fibrosis and sympathetic hyperactivity.

Previous studies have reported that renal denervation (RDN) prevents the occurrence of atrial fibrillation (AF) related to obstructive sleep apnea (OSA). However, the effect of RDN on chronic OSA (COSA)-induced AF is still unclear. Healthy beagle dogs were randomized into the OSA group (sham RDN + OSA), OSA-RDN group (RDN + OSA), and CON group (sham RDN + sham OSA). The COSA model was built via repeated apnea and ventilation rounds for 4h each day lasting 12weeks, and RDN was employed after 8weeks of modeling. All dogs were implanted Reveal LINQ™ to detect spontaneous AF and AF burden. Circulating levels of norepinephrine, angiotensin II, and interleukin-6 were determined at baseline and end of the study. In addition, measurements of the left stellate ganglion, AF inducibility, and effective refractory period were conducted. The bilateral renal artery and cortex, left stellate ganglion, and left atrial tissues were collected for molecular analysis. Of 18 beagles, 6 were randomized to each ofthe groups described above.RDN remarkably attenuated ERP prolongation and AF episodes and duration. RDN markedly suppressed the LSG hyperactivity and atrial sympathetic innervation, decreased the serum concentrations of Ang II and IL-6, further inhibited fibroblast-to-myofibroblast transformation via the TGF-β1/Smad2/3/α-SMA pathway, and reduced the expression of MMP-9, thus decreasing OSA-induced AF. RDN may reduce AF by inhibiting sympathetic hyperactivity and AF in a COSA model.

Effect of compliance to continuous positive airway pressure on exacerbations, lung function and symptoms in patients with chronic obstructive pulmonary disease and obstructive sleep apnea (overlap syndrome).

Patients with overlap syndrome (OS), that is obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), are at increased risk of acute exacerbations related to COPD (AECOPD). We assessed the effect of CPAP compliance on AECOPD, symptoms and pulmonary function in OS patients. Consecutive OS patients underwent assessment at baseline and at 12 months under treatment with CPAP of: AECOPD and hospitalizations, COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) questionnaires, pulmonary function testing and 6-min walking test (6MWT). In total, 59 patients(54 males) with OS were followed for 12 months and divided post hoc according to CPAP compliance into: group A with good (≥4 h CPAP use/night, n = 29) and group B with poor (<4 h CPAP use/night, n = 30) CPAP compliance. At 12 months, group A showed improvements in FEV1 (p = 0.024), total lung capacity (p = 0.024), RV/TLC (p = 0.003), 6MWT (p < 0.001) and CAT (p < 0.001). COPD exacerbations decreased in patients with good CPAP compliance from baseline to 12 months (17 before vs. 5 after, p = 0.001), but not in those with poor compliance (15 before vs. 15 after, p = 1). At multivariate regression analysis, COPD exacerbations were associated with poor CPAP compliance (β = 0.362, 95% CI: 0.075-0.649, p = 0.015). When compared to poorly compliant patients, OS patients with good CPAP compliance had a lower number of AECOPD and showed improved lung function and COPD related symptoms.

Effects of Obstructive Sleep Apnea and Insomnia on Cognitive Function

Purpose of Review. Obstructive sleep apnea and chronic insomnia are the most common sleep disorders in adults. Both sleep disorders can adversely affect physical and mental well-being. Cognitive function has been extensively studied in relation to chronic insomnia and obstructive sleep apnea. This paper reviews the recent studies investigating the cognitive effects of insomnia and obstructive sleep apnea as well as the potential benefits of treatment. Recent Findings. Recent studies indicate that insomnia is associated with impairments in attention, memory, and executive function. Chronic insomnia may have a moderating role in mild cognitive impairment and Alzheimer’s dementia. Mood and anxiety disorders may moderate the effects of insomnia on cognitive function. Hyperarousal and short sleep time associated with insomnia are risk factors for cognitive impairment. Cognitive behavior therapy for insomnia may improve cognitive function but more studies are needed. Nonbenzodiazepine receptor agonists improve insomnia without causing cognitive impairment. Benzodiazepine use is associated with cognitive impairment. Obstructive sleep apnea is associated with impairments in attention, concentration, memory, and executive function with apnea severity as measured by the apnea hypopnea index and severity of nocturnal hypoxemia being the largest risk factors. Untreated obstructive sleep apnea may have a significant impact on the progression of mild cognitive impairment and Alzheimer’s dementia. The impact of obstructive sleep apnea treatment, particularly with continuous positive airway pressure, appears to mitigate and slow the rate of cognitive decline but more randomized controlled studies are needed. Summary. Standardized cognitive assessments and larger, long-term controlled prospective studies with diverse populations are needed to further elucidate the cognitive impairments associated with chronic insomnia and obstructive sleep apnea. More studies are needed on the benefits of various treatments for obstructive sleep apnea and insomnia.

Prognostic efficacy of non-invasive ventilation in patients with overlap syndrome: chronic obstructive pulmonary disease and obstructive sleep apnea.

Limited evidence exists regarding the effects of non-invasive ventilation (NIV) on the prognosis of patients with concomitant chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also known as overlap syndrome (OS). This study aimed to assess whether NIV alongside standard care could improve the prognosis of this cohort. We retrospectively collected data from 229 patients with severe OS treated in Beijing Anzhen Hospital between January 1, 2016 and January 1, 2020, with follow-up until December 1, 2023. All patients were recommended usual care and NIV and were subsequently divided into non-NIV (usual care only) and NIV groups (usual care plus NIV) per their willingness and adherence to NIV. Endpoints included all-cause and acute exacerbation of COPD (AECOPD)-associated death and re-hospitalization. Multivariate analyses were used to determine the relationship of NIV with prognosis. The follow-up lasted for a median of 760 days (interquartile range, 245-1,374 days). Patients in the NIV group showed lower rates of all-cause (37.5% vs. 65.1%, P<0.001) and AECOPD-associated (31.7% vs. 58.7%, P<0.001) death compared with patients in the non-NIV group. Compared with usual care only, NIV treatment was associated with significant reduction in all-cause death [relative risks (RR) =0.459, 95% confidence interval (CI): 0.315-0.668, P<0.001], AECOPD-associated mortality (RR =0.424, 95% CI: 0.283-0.635, P<0.001), and re-hospitalization for all causes (RR =0.455, 95% CI: 0.342-0.605, P<0.001) and for AECOPD (RR =0.421, 95% CI: 0.308-0.575, P<0.001) in Cox hazards models, with significance persisting after multivariable adjustment. NIV may improve outcomes and survival in patients with severe OS of comorbid COPD and OSA. Confirmatory studies are needed to prove benefits.

The Overlap Syndrome of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A Systematic Review.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases that strongly impact the quality and length of life. Their coexistence is determined by overlap syndrome (OS). This systematic review aims to define the significance of these comorbidities according to the current state of knowledge. For this systematic review, we searched PubMed, Scopus, and Cochrane for studies published between 2018 and 26 October 2022, to find original, observational, human studies published in English, where the diagnosis of COPD was according to the Global Initiative for Obstructive Lung Disease guidelines and the diagnosis of OSA was based on polysomnography. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool for cohort and case-control studies, as well as its modification for cross-sectional studies. Of the 1548 records identified, 38 were eligible and included in this systematic review. The included studies covered a total population of 27,064 participants. This paper summarizes the most important, up-to-date information regarding OS, including the prevalence, meaning of age/gender/body mass index, polysomnography findings, pulmonary function, comorbidities, predicting OSA among COPD patients, and treatment of this syndrome.

The Role of Gut Bacteriome in Asthma, Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea.

The human body contains a very complex and dynamic ecosystem of bacteria. The bacteriome interacts with the host bi-directionally, and changes in either factor impact the entire system. It has long been known that chronic airway diseases are associated with disturbances in the lung bacteriome. However, less is known about the role of gut bacteriome in the most common respiratory diseases. Here, we aim to summarise the evidence concerning the role of the intestinal bacteriome in the pathogenesis and disease course of bronchial asthma, chronic obstructive pulmonary disease, and obstructive sleep apnea. Furthermore, we discuss the consequences of an altered gut bacteriome on the most common comorbidities of these lung diseases. Lastly, we also reflect on the therapeutic potential of influencing the gut microbiome to improve disease outcomes.

Method of venous thromboembolism prophylaxis is not a predictor of pulmonary embolus following elective bariatric surgery: a retrospective cohort study of 135,409 patients.

Patients with obesity are at increased risk of pulmonary embolus (PE), a risk that increases perioperatively and is challenging to manage. An analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was performed to determine predictors of PE in patients undergoing elective bariatric surgery. North American accredited bariatric surgery institutions included in the MBSAQIP database from 2020-2021. We extracted data from the MBSAQIP database (2020-2021) on patients who underwent elective Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Data were extracted on patient co-morbidities, race, prior history of deep vein thrombosis (DVT), and type of DVT prophylaxis. A multivariate logistic regression model was developed to determine predictors of PE and impact of PE on 30-day serious complications and mortality. In the MBSAQIP database, a total of 135,409 patients underwent SG or RYGB from 2020 to 2021. PE was reported in 194 patients (.14%). Prior history of DVT (odds ratio [OR] = 3.28; 95% confidence interval [CI]: 1.85-5.83; P < .0001), Black race (OR = 3.03; 95% CI: 2.22-4.13; P<.0001), gastroesophageal reflux disease (OR = 1.51; 95% CI: 1.11-2.04; P = .008), higher body mass index (OR = 1.11; 95% CI: 1.01-1.20; P = .023), male sex (OR = 1.76; 95% CI: 1.26-2.45; P = .001), and older age (OR = 1.27; 95% CI: 1.10-1.46; P = .001) were associated with increased odds of PE. Chronic obstructive pulmonary disease, sleep apnea, and hypertension were not significant predictors of PE (P > .05). Neither combined mechanical and pharmacologic DVT prophylaxis nor pharmacologic prophylaxis alone was a significant predictor of PE (P > .05). Prior history of DVT is the strongest predictor of PE after bariatric surgery. African American race, male sex, and gastroesophageal reflux disease are additional risk factors. Method of venous thromboembolism prophylaxis was not identified as significant predictor of PE. Further, studies on the evaluation and optimization of venous thromboembolism prophylaxis are required.

Understanding user concerns and choice of app architectures in designing Audio-based mHealth Apps

Due to recent advancements in smartphone sensing and computing capabilities, artificially intelligent mobile health (mHealth) applications are getting popular to monitor a range of diseases, including coronavirus-caused COVID-19 disease, chronic obstructive pulmonary disease (COPD), asthma, bronchitis, emphysema, and sleep apnea, among many others utilizing the audio recordings obtained from the smartphone microphones. Compared to other mHealth apps, audio-based apps suffer from various user concerns, including the privacy of data and battery drain rate , among many other concerns, which can adversely affect the user compliance, and app utility and life cycle. To address user concerns, mHealth apps should provide users options to configure the app, i.e., choose an architecture from a set of options based on user concerns and preferences. However, there is a dearth of knowledge about audio-based health monitoring app design. In this work, we present a focused user-centric app design study to better understand various concerns and choices that users want to see in an audio-based mHealth app. From a detailed analysis of 60 subjects with varying backgrounds, we find that around 85% subjects are concerned about the privacy of data and 93% subjects prefer to pick an app architecture that will not send raw audio recordings to a server. Findings from this work can guide the design of future mHealth apps that utilizes privacy-sensitive audio data. • Determine the major user concerns about the audio-based health monitoring smartphone apps and user choice when provided with a set of app configurations, i.e., architectures, that a user can choose when using a health monitoring app that relies on continuous microphone sensing to obtain audio recordings. • People with diferent backgrounds have a similar level of concerns while reporting their concerns about audio-based health monitoring apps. • Most of the study paracipants (around 66%) choose either the complete on-phone architecture, i.e., architecture that performs all computations on the phone, or the non- speech data-driven architecture, i.e., architecture that removes all speech components from audio recordings in the phone before sending them to the server for additional computation. • Only 7% participants choose the raw data-driven architecture, i.e., architecture that sends raw audio recordings to the server for all computation. • These fndings could be used as guidelines for the future user-centric app design to address user concerns and provide app customization options with the goal to improve the utility and compliance of the mHealth apps that rely on audio data obtained from the continous microphone sensing.