Mean Oxygen Saturation Research Articles

0639 Polysomnographic Biomarkers of Sleep Disruption and Sleep Disordered Breathing in Migraine: a Large Matched Case Control Clinical Registry-Based Study

Abstract Introduction Sleep disruption and sleep architectural changes in relation to migraine are not well characterized. Disruption in sleep may serve as a risk for migraine or result from migraine. We leveraged a large clinical cohort to examine the hypothesis that those with migraine have greater degrees of sleep architectural alterations and sleep disordered breathing (SDB). Methods This was a polysomnogram-based retrospective case (migraine) control (non-migraine) study of patients aged >18 matched 1:3 on age, sex, race, body mass index (BMI), and year of polysomnogram. Two domains were considered: 1)Sleep architecture (arousal index:AI, (primary predictor), total sleep time (TST), percentage of sleep stage time) and 2)SDB (apnea hypopnea index (AHI:primary predictor), mean oxygen saturation) were considered. Comparisons were performed by two-sample t-test or Wilcoxon rank sum test for continuous variables, and chi-square test or Fisher’s exact test for categorical variables. Results 4,783 migraine cases (47.5 ±13.3 years, 76.4% Caucasian, body mass index:BMI 33.7 ±8.6kg/m2) were matched to 14,287 controls. In migraine patients vs those without, TST was lower (359.0[307.0, 421.0] minutes vs 363.0[306.0, 432.5] minutes,p=0.01), percentage of N2 was higher (67.8%[59.6, 75.6] vs 67.0%[58.4, 74.8],p<0.001), percentage of REM was lower (16.7% [10.0, 22.0] vs 17.0% [11.1, 22.2],p=0.012), AHI was lower (7.4 [2.6, 17.0] vs 9.5 [3.7, 22.1],p<0.001), AI was lower (19.6 [12.8, 30.9] vs 22.6 [14.7, 34.9],p<0.001), and mean oxygen saturation was higher (93.7%±2.4 vs 93.3±2.6,p<0.001). Conclusion In this largest study of its kind, we identify novel associations of migraine in relation to curtailed sleep and sleep architectural alterations, i.e. increase in N2 and reduced REM sleep and lower AI compared to contemporaneously matched controls. Directionality of these relationships requires further elucidation given the cross-sectional nature of this study. Interestingly, we observed lower degree of sleep apnea and hypoxia burden in patients with migraine. As Calcitonin Gene-Related Peptide (CGRP), a neuropeptide increased during and between migraine attacks in migraine patients, and serotonin are implicated in arousals due to apnea-related increases in CO2, there is biologic plausibility for migraines patients to exhibit potential protection from SDB. Further investigation is needed to confirm these findings. Support (If Any)

0745 Sleep-Related Hypoxemia Association with Incident Atrial Fibrillation in a Clinic-Based Cohort

Abstract Introduction Sleep disordered breathing (SDB) has been implicated in atrial fibrillation (AF) in population-based studies, however, its role remains unclear and inconsistent. We hypothesize greater risk of 5-year incident AF with SDB and sleep-related hypoxia in a clinic-based cohort. Methods Cleveland Clinic patients (age>18) who underwent polysomnogram (PSG) or split studies 11/27/2004-12/30/2015 with >3 hours diagnostic time were examined. Predictors include AHI, % sleep time oxygen saturation<90% (T90), and minimum and mean oxygen saturation(minSaO2 and meanSaO2, respectively). Cox proportional hazard models were fit with time from sleep study to AF diagnosis as the dependent variable. Covariates included age, sex, race, body mass index(BMI), cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia), heart failure, coronary artery disease, myocardial infarction, history of coronary artery bypass grafting, chronic obstructive pulmonary disease, tobacco use, and use of anti-arrhythmic drugs. Data were censored at date of last follow up or at 5-years. Results The sample was comprised of 43,634 patients: age 51.7±14.5, 51.9% male, 74.5% White, and 7.1%(n=3,090) with AF. Of those without AF, 1,176(2.9%) developed 5-year incident AF. For each 10% increase in T90, incident AF increased by 7% (HR=1.07, 95%CI=1.05-1.10). Compared to reference, patients with 25.01-50%, 50.01-75%, and 75.01-100% time T90 had 22% (HR=1.22, 95%CI=1.01-1.46), 49% (HR=1.49, 95%CI=1.20-1.85), and 65% (HR=1.65, 95%CI=1.26-2.15) higher incident AF, respectively. For every 10-unit increase in minSaO2 and meanSaO2, incident AF decreased by 11%(HR=0.89, 95%CI=0.83-0.95) and 23% (HR=0.77, 95%CI=0.68-0.86), respectively. AHI did not demonstrate a statistically significant relationship with incident AF at a significance level of 0.05. Conclusion Sleep-related hypoxemia, defined by cumulative burden below 90% SaO2, demonstrated an association with incident AF in this large clinic-based cohort, even considering confounding factors. On the other hand, SDB severity as defined by AHI did not demonstrate this relationship. These findings are consistent with experimental models that identify intermittent hypoxia and oxidative stress leading to alterations of the cardiac substrate, thus implicating sleep-related hypoxemic mechanisms as a salient driver in the evolution of atrial arrhythmogenesis. Support (If Any) Cleveland Clinic Neurological Institute Center for Outcomes Research & Education Pilot Grant, Neuroscience Transformative Research Resource Development Award

0734 Examining the diagnostic validity of the WatchPAT in a preliminary sample of cognitive normal Black/African-American older adults

Abstract Introduction The WatchPAT®️ is an innovative Home Sleep Apnea Device (HSAT) that utilizes the peripheral arterial signal (PAT®️) for OSA diagnosis. We examined the diagnostic validity of the WatchPAT and assessed the correlation between its sleep indices and those measured by PSG in a cognitive normal predominantly older Black/African-American sample. Methods Preliminary data analysis on a limited sample of 26 participants without a prior diagnosis of OSA who underwent HSAT and 2-nights of nocturnal polysomnography (NPSG). An apnea-hypopnea index (AHI) ≥ 15 events/h characterized moderate to severe OSA. Pearson correlation statistics (Fisher's z Transformation) for PAT/NPSG indices including respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (Spo2), REM Latency (min), awake period during sleep (WASO), and sleep onset latency (SOL) were determined. Results Of the 26 participants, 17 (65.4%) were Black/African-American, 9 (34.6%) were non-Hispanic White, and 19 (73.1% [13/19 (68.4%) Black/African-American]) were female. Mean (SD) age, BMI and education was 66.3 (4.5) vs. 69.9 (3.7) years, 29.6 (6.4) vs. 26.6 (5.5) kg/m2 and 15.6 (3.1) vs. 17.6 (1.3) years for Black/African-American vs. non-Hispanic White, respectively. 35.3% vs. 33.3% and 17.7% vs. 22.2% of participants met criteria for moderate to severe OSA based on HSAT and NPSG, for Black/African-American vs. non-Hispanic White, respectively. The HSAT had a sensitivity and negative predictive value of 100% for both races, specificity of 78.6% vs. 85.7%, and positive predictive value (PPV) of 50% vs. 66.7%, for Black/African-American vs. non-Hispanic White, respectively. Analyses stratified by sex suggested that the WatchPAT had better diagnostic validity in Black/African-American women than men, with specificity of 83.3% vs. 75.0%. Among Blacks/African-Americans, the correlation for PAT/NPSG AHI, ODI and RDI were modest ranging from r = 0.65 to 0.70 P = .004, and mild for Spo2 and Nadir oxygen desaturation (r = 0.53 [95%CI, 0.04-0.79]; P = .03 for both). WASO, REM Latency and SOL showed no significant correlations. Conclusion Our preliminary data show HSAT having lower specificity, PPV, insights on sleep architecture for OSA diagnosis, and respiratory indices’ correlations with those from PSG, in Blacks/African-Americans compared to general population samples. The measure performed better among women. Support (If Any) AASM 231-BS-20, AARGD-21-8488397, NIH/NIA/NHLBI (K23AG068534, L30-AG064670, CIRAD P30AG059303 Pilot, NYU ADRC P30AG066512 Developmental Grant, R25HL105444 SRG, R01AG12101, R01AG022374, R01AG13616, RF1AG057570, R01HL118624, R01AG056031)

Correlation between retinal oxygen saturation and the haemodynamic parameters of the ophthalmic artery in healthy subjects.

The aim of the study was to obtain the values of oxygen saturation in retinal vessels and ophthalmic blood flow parameters in a healthy Caucasian population and assess whether the oximetry parameters are affected by the flow rate or the vascular resistance. The spectrophotometric retinal oximetry and colour Doppler imaging (CDI) of retinal vessels were successfully performed with 52 healthy subjects (average age 29.7 ± 5.6 years). The retinal oximeter simultaneously measures the wavelength difference of haemoglobin oxygen saturation in retinal arterioles and venules. The arteriolar and venular saturation in both eyes was measured. The peak systolic (PSV) end diastolic (EDV) velocities, resistive (RI) and pulsatility (PI) indices were obtained for both eyes using CDI in the ophthalmic artery. A paired t-test and two sample t-tests were used for statistical analyses. The correlation was assessed using the Pearson coefficient correlation. The mean oxygen saturation level was 96.9 ± 3.0% for the retinal arterioles and 65.0 ± 5.1% for the retinal venules. The A-V difference was 31.8 ± 4.6%. The mean of the measured haemodynamic parameters was PSV 46.6 ± 9.4 cm/s, EDV 12.0 ± 3.5 cm/s, PI 1.68 ± 0.38 and RI 0.74 ± 0.05. No significant difference in oxygen saturation and haemodynamic parameters was found between the left and the right eyes or the dominant and non-dominant eye. The oximetry and ultrasound values were sex independent. The Pearson correlation coefficient demonstrated a significant yet weak negative correlation between A-V difference and RI (r = -0.321, p = 0.020). A negative correlation between A-V difference and resistance index was observed, suggesting that reduced oxygen consumption may reflect the increased vascular tone of the ophthalmic vessels, which is likely determined by autoregulatory mechanisms.

Safety and Tolerability of Remdesivir in Patients with End-stage Renal Disease on Maintenance Hemodialysis.

IntroductionThe use of remdesivir is not recommended in patients with end-stage renal disease (ESRD) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection unless potential advantage offset disadvantage due to limited safety data. Our objective was to assess the safety of remdesivir in patients with end-stage renal failure and evaluate the outcome of this vulnerable group.MethodologyWe carried out a retrospective observational study in dialysis-dependent ESRD patients with SARS-CoV-2 infection who received a standard 5-day course of remdesivir (powder form) from June 2020 to December 2020. Oxygen requirement, hemogram, inflammatory markers, and liver function tests before and after remdesivir treatment were compared.ResultWe found thirty-nine such patients with mean age of patients 58.79 ± 12.13 years. Diabetes mellitus, hypertension, and cardiac diseases were present in 58.97, 87.17, and 23.07% of patients, respectively. Mean oxygen saturation on admission was 85.41% (±7.73). There were no events of hepatotoxicity, altered behavior, or infusion reaction. There was statistically significant improvement in total leukocyte count, absolute lymphocyte counts, and C-reactive protein (p value <0.001, 0.01, and 0.02, respectively) post remdesivir treatment. A total of 60% of patients had improved oxygenation while 13% of patients had no change in oxygen requirement after completion of remdesivir course. Mortality in our study was 28.21%. We did not find any significant benefit of early remdesivir administration (3–6 days of illness) on mortality or days of hospitalization.ConclusionThe use of remdesivir in end-stage kidney disease is safe. Improvement in oxygenation was significant when baseline oxygen requirement was less. It requires prospective controlled trials with larger population to assess its impact on mortality.How to cite this articleShah MK, Parikh M, Prajapati D, Kute VB, Bhende P, Prajapati A, et al. Safety and Tolerability of Remdesivir in Patients with End-stage Renal Disease on Maintenance Hemodialysis. Indian J Crit Care Med 2022;26(5):619–625.

The effect of Positions on selected Physiological parameters among Term Neonates in a selected Hospital, Kerala

Simple intervention like appropriate positioning of neonate is vital since it affects many physiological parameters and reduces neonatal morbidity. This study was conducted to assess the effect of positions on selected physiological parameters among term neonates in a selected hospital, Kerala. The objectives were (1) To assess the effect of supine position on selected physiological parameters among term neonates. (2) To assess the effect of lateral position on selected physiological parameters among term neonates. (3) To assess the effect of prone position on selected physiological parameters among term neonates. (4) To compare the effects of supine, lateral and prone positions on physiological parameters among term neonates. (5) To associate the effect of positions on physiological parameters among term neonates with selected variables. One group pre-test post- test design was used to collect data from a total of forty subjects, by purposive sampling method. Baseline proforma and observation chart were used to collect the data. The heart rate, respiratory rate and oxygen saturation were recorded at 5th, 15th and 30th minutes in supine, lateral and prone positions. The data was analyzed by descriptive and inferential statistics. Comparison of effect of positions revealed that the mean heart rate and mean oxygen saturation showed the highest values in supine position. Highest mean respiratory rate was same in supine and prone position. With neonatal age in days and gestational age in weeks oxygen saturation showed a positive correlation. The Fisher test revealed that there was statistical difference at 5% significant level only in heart rate and respiratory rate in supine and prone position.

Magnesium sulfate administration in difficult laryngoscopy: An effective and safe method

PurposeDifficult laryngeal exposure during laryngeal microsurgery and laser surgery is a major concern for otolaryngologists. This study evaluated the efficacy and safety of magnesium sulfate administration in difficult laryngeal exposure patients. Study designQuasi-experimental design. Materials and methodsForty adult patients scheduled for laryngeal microsurgery with difficult laryngeal exposure according to Cormack-Lehane (CL) classification were included. Magnesium sulfate 50% (20–30 mg/kg) was administered as a bolus injection. Laryngeal exposure and hemodynamic stability were evaluated before and after the intervention. ResultsCL grading was shown a statistically significant improvement after magnesium sulfate administration. There are no clinically significant changes in the mean arterial pressure, heart rate, and oxygen saturation levels in the patients who received magnesium sulfate for better laryngeal exposure. ConclusionMagnesium sulfate is an effective and safe drug for better viewing in difficult laryngeal exposure patients.

Effectiveness of Surgical Mandibular Advancement in Improving Airway Dimensions in Nongrowing Skeletal Class II Patients With Obstructive Sleep Apnea—A CBCT Study

Background: Skeletal nongrowing class II patients with retrognathic mandible are often at risk of developing obstructive sleep apnea (OSA). This skeletal discrepancy, when severe enough, is often addressed by surgical mandibular advancement which not only achieves aesthetics, structural balance, and functional efficiency but also improves the airway function. Objective: The aim of the study was to evaluate the effectiveness of surgical mandibular advancement on airway dimensions, in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA. Materials and Methods: The sample consisted of 8 patients with skeletal class II due to retrognathic mandible associated with OSA. Screening was done with functional outcomes of sleep questionnaire (FOSQ) score and confirmed with polysomnography. Pretreatment and posttreatment airway dimensions/volume were assessed and calculated on cone beam computed tomography (CBCT). Three months post surgery, oxygen saturation was recorded. Results: A statistically significant improvement in mean oxygen saturation level was observed from 87.62 ± 7.70 to 97.75 ± 0.46 and mean increase in airway volume was from 48.60 ± 7.17 to 69.48 ± 26.22. The smallest cross section increased from 137 ± 74.37 to 253.75 ± 76.67. Anteroposterior dimensions increased significantly from 6.17 ± 1.78 to 9.33 ± 2.07 and transversed from 24.56 ± 6.41 to 30.14 ± 3.35. FOSQ score improved from 9.37 ± 2.61 to 15.25 ± 0.88. Conclusion: Surgical mandibular advancement is an effective treatment option in improving airway dimensions in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA.

Efficiency of maxillomandibular advancement for the treatment of obstructive apnea syndrome: a comprehensive overview of systematic reviews.

To evaluate the efficiency of maxillomandibular advancement using aggregated individual patient data from multiple studies. This overview was structured according to the PICO strategy. It adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and was recorded on the international prospective register of systematic reviews (PROSPERO-CRD42020206135). Searches were conducted in the PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, and Cochrane databases for studies published until January 1, 2021. Data from the included studies were collected by one author, while another reviewed the compilation. Twelve systematic reviews were included. The outcome measures studied were the apnea-hypopnea index, respiratory disturbance index, mean oxygen saturation, lowest oxygen saturation, sleepiness data, posterior air space, sella-nasion point A angle, sella-nasion point B angle, surgical success, and surgical cure in patients who underwent surgery. The AMSTAR scale presented moderate evaluations, with grades varying between 6 and 10 points. The Glenny scale revealed that the study selection did not include all languages. Only three reviews identified quality assessments conducted by at least two reviewers and only five related possible searches for unpublished data. Bimaxillary advancement surgery improved respiratory indicators, sleepiness data, and increased upper airway size. However, it is necessary to standardize the surgical criteria to establish measurable efficiency of the procedure. This overview makes a critical analysis of the results of the selected systematic reviews with the aim of presenting the most clinically relevant data on the maxillomandibular advancement for treating obstructive apnea syndrome, with a focus on improving respiratory, anatomical, and quality of life indices. There are no overviews that approach this theme from a well-structured perspective.

The Effect of Earmuff and Earplug Use on Preterm Infants Towards Oxygen Saturation and Pulse

Background: A bright circumstance, cold temperature with loud noise where there are many activities around could influence baby’s sleep.Objective: This study aimed to identify the effect of using earmuffs and earplugs on the physiological response of preterm infants.Methods: This crossover study involved 15 medically stable preterm infants treated in a closed incubator. It used the consecutive sampling technique where the babies’ physiological response using Anderson Behavioral State Scale was observed for 30 seconds every 15 minutes for two hours of using earmuff and earplug.Results: The result of repeated ANOVA analysis showed that there is no significant difference of pulse repetition frequency before, during, and after using the earmuff and earplug to preterm infants. Meanwhile, statistically, there was a difference in the mean of oxygen saturation during and after using the earmuff with p = 0.019.Conclusion: The use of ear protection (earmuff and earplug) could assist and support premature infants in maintaining physiological condition. This study therefore suggests the use of earplugs earlier on preterm infants.Keywords: earmuffs, earplugs, premature, physiological responses

Correlation between chest CT severity scoring system with oxygen saturation and laboratory inflammatory markers in adult patients with COVID-19 infection

BackgroundCOVID-19 pneumonia is responsible for the latest pandemics. Chest computed tomography (CT) scan is known to be an essential tool for diagnosis of COVID-19. In this research, the relationship between on-admission chest CT severity score, capillary blood oxygen saturation level, and laboratory inflammatory markers results in patients with SARS-COV-2 pneumonia was investigated.MethodsThis prospective analytical study was conducted in COVID-19 isolation unit, Zagazig University Hospitals, from 1st to end of April 2021. Adult patients with COVID-19 infection were included. Chest CT scan was performed for all patients, and CT severity score was computed. The initial capillary oxygen saturation was also assessed at the time of admission. The information was gathered and analyzed.ResultsA total number of 305 COVID-19 patients were involved in the study with the following data: age, gender, presence of co morbidities, capillary blood oxygen saturation, laboratory tests including absolute lymphocytic count, CRP, D-dimer and ferritin levels, as well as chest CT severity score. Based on chest CT severity score, we found that 110 cases (36.1%) were mild, 163 cases (53.4%) were moderate, and 32 cases (10.5%) were severe, with significant male predominance among moderate and severe cases. The initial measurements of blood oxygen saturation values revealed that mean blood oxygen saturation was 95.6% among mild to moderate cases and 85.4% among severe cases. Furthermore, there was a high statistically significant negative correlation between chest CT severity score and absolute lymphocytic count of studied cases, while there was a statistically significant positive correlation with D-dimer, CRP and ferritin levels.ConclusionsCT scans can help clinicians in developing a management strategy and serve as a predictor of illness severity and possible outcomes. In individuals with COVID-19 infection, the severity of a chest CT scan is positively correlated to inflammatory markers and oxygen demand.

The effect of white noise and classical music on pain and physiologic parameters in preterm infants during retinopathy of prematurity examinations: a randomized controlled trial

ABSTRACT This study was designed as a prospective, randomized controlled trial. A total of 90 preterm infants who underwent retinopathy of prematurity (ROP) examinations were categorized into three groups, a control group, a white noise group (WN), and a classical music group (CM), each comprising 30 preterm infants. The study data were obtained using an information form and the Premature Infant Pain Profile. During (WN: 9.70±3.02; CM: 11.2±2.28) and after the examination (WN: 3.60±2.11; CM: 3.77±1.83), the preterm infants in the WN and CM groups had lower mean pain scores and heart rates (181.17±15.76 and 3150.10±17.03 vs. 173.30±20.66 and 146.67±18.17, respectively; p<0.001) and higher mean oxygen saturation values (93.60±3.87 and 97.83±1.93 vs. 95.73±2.52 and 98.27±1.82, respectively; p<0.05) than those in the control group; the differences were statistically significant. The WN and CM listened to by the preterm infants during ROP examinations had positive effects on pain and heart rate and oxygen saturation values.

Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis.

In the face of limited fiscal and technical resources, improvised methods have been used to provide effective and sustainable ventilatory support in low-resource settings to reduce neonatal mortality associated with respiratory complications. This study assessed the use of improvised bubble continuous positive airway pressure (ibCPAP) ventilation among neonates with respiratory complications and determined its effect on neonatal outcomes in low- and middle-income countries (LMICs). Hospital-based studies conducted between 2010 and 2020 in LMICs were reviewed. Rayyan® software forsystematic review was used for screening and article selection. We used Stata® Statacorp Texas USA software to estimate pooled prevalence, proportion estimates, weighted mean differences and 95% Confidence Interval (CI), using the random effects model. A total of 193 articles were generated and 125 were reviewed. Thirteen articles with 806 neonates on ibCPAP ventilation were included. The pooled prevalence of ibCPAP use was 7.0% (95% CI: 3.0%-13.0%). There was a significant difference in mean oxygen saturation before and after ibCPAP use (-1.34% [95% CI:-1.65% to-1.02%, p<0.01). The duration of oxygen requirement among neonates on ibCPAP was 6.5hours less than controls (0.27days [95%CI:-0.49 to-0.05, p<0.01). IbCPAP had no effect on the respiratory rate, duration of admission, mortality and survival. IbCPAP use in LMIC hospitals is low and its use improved oxygen saturation and duration on oxygen among the neonates, but had no impact on length of stay, respiratory rate, mortality or survival.

Inhibition of ERK1/2 regulates cognitive function by decreasing expression levels of PSD-95 in the hippocampus of CIH rats.

Obstructive sleep apnoea syndrome (OSAS) is a potentially severe sleep disorder characterized by intermittent hypoxia, and there is growing evidence that OSAS can lead to cognitive decline. Extracellular signal-regulated protein kinase 1/2 (ERK1/2) plays a key role in synaptic plasticity. We established CIH model in male SD rats and examined their expression of p-ERK1/2 and PSD-95, as well as in CIH group; the effect of SL327 on the expression of p-ERK1/2 and PSD-95 in hippocampus of CIH model rats was observed by pretreating the experimental rats with SL327 during peak time of p-ERK1/2 expression. Mean oxygen saturation in the tail artery was lower in the CIH group. CIH groups exhibited increased escape latencies in the navigation test and decreased numbers of platform crossings in the space exploration test. Reduced volume, irregular structure, deepened cytoplasmic eosinophilic staining in the cytoplasm and decreased nuclear size were found in hippocampal neurons in the 28-d CIH and 28-d CIH + SL327 group. The hippocampus of CIH rats' p-ERK expressions gradually increased with prolonged CIH exposure but decreased after SL327 treatment. Moreover, PSD-95 expressions gradually reduced in the 14-d CIH, 21-d CIH and 28-d CIH groups but increased in the SL327-treated group. The SL327 intervention decreased p-ERK1/2 expression, increased PSD-95 expression and improved cognitive function in CIH rats. The present findings provide some insights into the mechanisms underlying OSAS-associated cognitive impairment.

Abstract No. : ABS2330 : Comparison of three different sedative regimens for gastrointestinal endoscopic procedures

Background &Aims:Gastrointestinal (GI) endoscopic procedures are relatively invasive and unpleasant and need high level of patient co-operation. Aim of our study was to compare three different sedative regimens using propofol, dexmedetomidine and fentanyl-midazolam combination for safer sedation in GI endoscopic procedures.Methods:The patients who satisfied the inclusion criteria were randomly allocated into three groups of 30 each. Group P patients received propofol 1mg/kg i.v followed by 0.5mg/kg/hr infusion. Group- D received dexmedetomidine1µg/kg i.v. infusion over 10min followed by 0.5µg/kg/hr infusion. Group- FM received fentanyl 1µg/kg and midazolam 20 µg/kg i.v. followed by fentanyl 0.5µg/kg/hr infusion. The endoscopic procedure was started when the patient attained a level of conscious sedation [score of 2-4 on the Observer Assessment of Alertness/Sedation Scale(OAA/S scale)].The patient’s and endoscopist level of satisfaction was assessed using the 10 - point visual analogue scaleResults:Demographic data and the duration of the procedure between the three groups were similar and statistically insignificant. The heart rate, mean arterial pressure and oxygen saturation were lower in Group-D and were statistically significant. The onset of sedation was earlier with Group-P. The time to recovery, requirement of additional fentanyl, incidence of gagging, patient and surgeon’s satisfaction scores and maximum OAA/S score were similar in Groups D and P and better than Group-MF.Conclusion:I We conclude that dexmedetomidine provides an overall better experience for the patient, endoscopist and anaesthesiologist than propofol and midazolam-fentanyl combination.

Efficacy of titratable mandibular advancement device versus continuous positive airway pressure therapy in the treatment of obstructive sleep apnea: A clinical crossover trial

BackgroundTo compare efficacy of continuous positive airway pressure (CPAP) and oral appliance (OA) in management of various grades of obstructive sleep apnea (OSA). MethodsThirty polysomnography diagnosed cases of OSA were divided into three groups based on baseline apnea hypopnea index (AHI) as follows: group 1: mild OSA (AHI = 5-14.9), group 2: moderate OSA (AHI = 15-29.9), and group 3: severe OSA (AHI >30) with 10 patients in each group. Half of the patients in each group were randomly allocated to CPAP or OA therapy, and crossover of therapy was performed after two months. AHI, Epworth's Sleepiness Scale (ESS), and mean oxygen saturation (SPO2) were measured at baseline, after each arm of treatment and after the crossover. A questionnaire survey including information regarding pretreatment sleep symptoms and improvement after therapy was performed at above time frames. At the end of therapy, the patients were surveyed regarding satisfaction and perceived effectiveness with both modalities. ResultsCPAP was more efficacious in reducing AHI and SPO2 as compared with OA across the three study groups. The improvement in most sleep-related symptoms was higher with CPAP. The satisfaction and perception on effectiveness of treatment were higher with OA than CPAP across three study groups (P-value<0.05 for all). ConclusionsOA is an effective alternative to CPAP across all grades of OSA in selected cases, which is more preferred owing to higher effectiveness and satisfaction among the patients.

Long-term outcomes of pharyngoplasty for Obstructive Sleep Apnea Syndrome.

Introduction: Pharyngoplasty techniques for the treatment of obstructive sleep apnea syndrome (OSAS) have evolved, which improved the understanding of the anatomy, patient selection, and adoption of functional approaches. Aim: To analyze long-term results of pharyngoplasty in OSAS patients. Material and methods: Between 2007 and 2021, a total of 234 adult patients with OSAS who had previously failed positive airway pressure (PAP) therapy underwent sleep surgery. Of this group, 75 patients met the criteria of a minimum 5-year follow-up. To date, 25 patients completed the follow-up study protocol, including the medical history, visual analog scale (VAS) for snoring loudness, body mass index (BMI), endoscopy of the upper airways, type III sleep study, and standardized questionnaires including Epworth Sleepiness Scale (ESS) and EQ-5D-5L Euro - Quality of Life Questionnaire. Results: The average period of follow-up was 96.80 ± 30.20 months. The mean age of participants was 54.6 ± 14.02 and the mean BMI 30.28 ± 2.74. Patients underwent uvulopalatopharyngoplasty (n = 21) and expansion sphincterpharyngoplasty (n = 4) between 2008-2015. A long-term improvement in sleep parameters was observed for the mean AHI (29.84 ± 20.06before and 19.45 ± 18.53 after surgery, p = 0.0294), and the median VAS (8.13 before and 3.78 after surgery), mean oxygen saturation during sleep 94,5% (IQR 93.0-95.25), and the median ESS score was 6.17 ± 4.57. The majority of patients reported subjective long-term improvement in sleep quality and a reduction of snoring. Conclusions: In OSAS patients who failed PAP therapy, pharyngoplasty may provide a long-term improvement in upper airway obstruction during sleep.

Prone position protocol in awake COVID-19 patients: A prospective study in the emergency department

BackgroundLimited effective interventions exist in the emergency department (ED) for COVID-19 patients with respiratory failure. One of the promising interventions is the prone position, which has been proven to improve oxygenation in ICU settings. Here, we aimed to describe and assess the utility of the prone position in awake non-intubated adult patients in EDs during the COVID-19 pandemic. MethodsWe conducted a prospective cohort study of hypoxic COVID-19 adult patients who presented to our emergency department. We collected the data from June to the end of August 2020, including vital signs and physiological and clinical parameters before and after completing the four-hour prone position protocol. The main outcomes assessed were improvement in oxygenation, respiratory rate, respiratory distress score, ICU admission, and intubation. Oxygenation was calculated based on the standard pulse oximeter saturation [SpO2]/fractional concentration of oxygen in inspired air (FiO2). ResultsThe study included 49 patients (81.63% men; mean age, 53.37 ± 11 years). The mean oxygen saturation during the triage was 84.49% ± 7.98 on room air. After completing of the four-hour prone protocol, the mean SpO2/FiO2 ratio increased from 1.62 ± 0.78–1.99 ± 0.75 (p < 0.0001). The respiratory rate decreased from 32.45 ± 5.24–26.29 ± 5.40 (p < 0.0001). Respiratory distress scores decreased after changing patients’ positions (p < 0.0001). Twenty-four patients (48.9%) were admitted to the ICU, 6 patients were intubated (12.2%), and 7 (14.3%) died in the hospital. ConclusionAfter applying the prone position in the ED, significant and immediate improvement was observed in oxygenation, respiratory rate, respiratory distress, and carbon dioxide levels. A linear relationship between the level of improvement in oxygenation and reduction in ICU admission was observed. However, further studies recommended to assess the advantage of the procedure in terms of ICU admission, intubation, or mortality.

Comparison of the intensive care unit admission rate and mortalities of COVID-19 patients who received Hydroxychloroquine and Favipiravir in the ward

Background: Until now, a fully accepted treatment method for the management of COVID-19 has not been recommended. Some antiviral drugs such favipiravir and remdesivir, antimalarial drugs like hydroxychloroquine and anti-inflammatory drugs have been used for the treatment of the patients with COVID-19. The aim of this retrospective study is to compare the Intensive Care Unit (ICU) admission rate and mortalities of COVID-19 patients who received Hydroxychloroquine and Favipiravir in the COVID positive wards. Methods: First approval was obtained from the ethics committee, then the patients with COVID-19 who were under follow-up and treat in the COVID positive wards between March and December 2020 were retrospectively analyzed. We aimed to investigate the demographic characteristics, the reason for hospitalization, Charlson comorbidity index, hemodynamic and laboratory parameters, duration of the ward, the rate of discharged from the ward, the ward mortality rate, the ICU admission rate, and mortalities of these patients. The patients were divided into two groups as Hydroxychloroquine Group (H Group) and Favipiravir Group (F Group). The patients in the H Group received hydroxychloroquine 400 mg orally 2x/day on day 1, then 200 mg 2x/day on days 2-5. The patients in the F group received favipiravir 1600 mg 2x/day on day 1, then 600 mg 2x/day on days 2-5. Decreased oxygen saturation and PaO2/FiO2 rate, increased respiration rate with worsening clinical condition and elevated inflammatory parameters such CRP, ferritin, D-dimer, creatinine, lactate and troponin were accepted as criteria for admission to ICU. Demographic and clinical characteristics, and the ICU admission rate, the discharge from the ward and mortalities were compared between the two groups. Results: A total of 2734 patients were analyzed retrospectively and divided into H and F groups. The main reasons for hospitalization were fatigue, shortness of breath, fever, low oxygen saturation and positive PCR test with positive chest computerized tomography findings for COVID-19 in all patients. Age, gender, Body Mass Index (BMI), Charlson Comorbidity Index (CCI), mean blood pressure, heart rate, respiratory rate and oxygen saturation were not significant different between the H and F groups at admission. The treatments of the patients in the wards such the support of oxygen with reservoir mask, enoxaparin as an anticoagulant, acetylcysteine to loss mucus in the airways, steroid use, vitamin C and D, and patient’s nutrition were the same. The ICU admission criteria were similar between the two groups. The rate of discharged from the ward was significantly higher in the H group when compared with F group as 85,75% versus 73,74%. In addition, the ICU admission rate was significantly lower in the H group than F group as 9,79% versus 20,54%. The ward mortality and ICU mortality rates were not significant different between the two groups. However, total mortality rate, considering of the total ward and ICU, was significantly lower in The H group. Conclusion: This retrospective study showed that hydroxychloroquine lowers the ICU admission rate and raises the discharge rate when compared with favipiravir in the ward patients with COVID-19. However, it does not change the ward and the ICU mortality rates.

Mini-implant assisted rapid palatal expansion (MARPE) effects on adult obstructive sleep apnea (OSA) and quality of life: a multi-center prospective controlled trial

IntroductionTransverse maxillary deficiency is a high prevalent growth disorder within the adult population that may lead to serious health issues, such as detrimental malocclusions and higher risk of developing obstructive sleep apnea (OSA). Mini-implant assisted rapid palatal expansion (MARPE), as it expands the mid-face and augment the nasal and oral cavities dimensions, may reduce the airflow resistance and thus play an important role on OSA therapy in some patients. The main objective of the present trial is to assess MARPE effects on the sleep and quality of life of non-obese adult OSA patients with transverse maxillary deficiency.MethodsA total of 32 participants were divided into intervention and control groups. They underwent physical evaluation, Epworth Sleepiness Scale (EES) and Quebec Sleep Questionnaire (QSQ), cone-beam computed tomography (CBCT) and home sleep testing (HST) for OSA before MARPE (T1) and 6 months after the intervention (T2).ResultsQuestionnaires EES (daytime sleepiness) and QSQ (OSA-related quality of life) presented significant statistical differences between the groups. We also found clinical and statistical (p < 0.01) differences between the groups regarding the apnea/hypopnea index (AHI), as well as others HST parameters (mean oxygen saturation and snoring duration).ConclusionIn our sample, MARPE (without any auxiliary osteotomy) showed a good success rate (85%) and promoted important occlusal and respiratory benefits. We observed important daytime sleepiness and OSA-related quality of life improvement, as well as the AHI (65.3%), oxygen saturation and snoring duration.