Mean SaO2 Research Articles

0733 Elucidating Sleep-Related Health Disparities across The Socioeconomic Spectrum Leveraging a Large-Scale Sleep Registry

Abstract Introduction Sleep disparities have been implicated as a contributor to overall health disparities in socially disadvantaged groups. Despite epidemiological studies reporting sleep deprivation and poorer sleep quality among those with low socioeconomic status and group minorities, little is known about the extent to which sleep disorders such as sleep-disordered breathing (SDB), varies across the socioeconomic spectrum. Methods A retrospective cohort study was conducted utilizing data from the Cleveland Clinic Sleep Laboratory Registry. All adults who underwent diagnostic or split (baseline diagnostic) polysomnogram (PSG) or home sleep apnea test (HSAT) were included in the study. Area Deprivation Index (ADI), a biomarker of neighborhood socioeconomic disadvantage, was calculated by national rank, i.e. 25th, 50th and 75th percentiles; higher quartiles reflect greater deprivation. Generalized linear models adjusted for age, race, sex, body mass index(kg/m2) and primary payer were used to investigate association of ADI with SDB breathing measures (apnea hypopnea index, (AHI) and sleep-related hypoxemia (percentage of total sleep time <90%SaO2, [TST<90]). Results The analytic sample included 81,212 sleep studies; 60,013(74%) were PSG and 21,199(26%) HSAT with age: 52.0[41.0, 62.3], 49% females, 19% black race, with BMI=34.5±8.5 kg/m2, 44% with Medicaid and Medicare. Median ADI National Rank 59.0[39.0, 81.0] with higher 4th quartiles in PSG versus HSAT:29.1% vs 16.3%,p<0.001. In the PSG group, ADI was associated with hypoxia measures: TST<90(coefficient p<0.0001), model R2=0.171; mean SaO2(p<0.0001), R2=0.189; minimum SaO2(p<0.0001), R2=0.169; all measures were higher with higher ADI quartiles. In the HSAT group, ADI was associated with mean SaO2(p<0.0001), R2=0.188 and minimum SaO2(p<0.0001), R2=0.181 with all measures being higher with higher ADI quartiles. AHI was associated with ADI(p=0.0032), R2=0.239; but least squares mean AHI did not differ among ADI quartiles in PSG and HSAT groups. Interactions were observed between ADI and age, BMI and male sex (p<0.05), but not race. Conclusion Sleep-related hypoxia was greater among patients living in areas of higher deprivation when considering rankings of neighborhoods by socioeconomic disadvantage. Further understanding of the reason for this sleep disorder-related disparity is needed, i.e. further characterizing theoretical domains and social and geographic determinants of income, education, employment, and housing quality with the overarching goal to improve disparities in health. Support (If Any)

Effect of obstructive sleep apnoea on coronary collateral vessel development in patients with ST-segment elevation myocardial infarction.

The impact of obstructive sleep apnoea (OSA) in the setting of acute ST-segment elevation myocardial infarction (STEMI) is complex and divergent. This study aimed to investigate the association between OSA and coronary collateral vessel (CCV) development in patients with STEMI. The present study prospectively screened 282 STEMI patients with an overnight sleep study. OSA was defined as apnoea-hypopnoea index (AHI) ≥15 events/h. The coronary angiograms were used for the assessment of Rentrop grades representing CCVs. Among 119 patients enrolled, 60 patients had OSA (50.4%). The prevalence of CCV development (Rentrop grade ≥ 2) was significantly higher in OSA group than in the non-OSA group (43.3% vs. 5.1%, p < 0.001). There was a parallel increase in the Rentrop grades associated with OSA severity and worsening of hypoxaemia indicators (minimum arterial oxygen saturation [SaO2 ], mean SaO2 and time with SaO2 below 90%). After adjustment for clinical and angiographic characteristics, and pre-procedure medications that might interact with OSA, AHI as a continuous variable (OR 1.11, 95% CI 1.08-1.21, p < 0.001) and the presence of OSA (OR 11.41, 95% CI 2.70-48.15, p=0.001) were both associated with dramatically higher incidence of CCV development. Our study demonstrated that the presence of OSA might augment CCV development in STEMI patients. The potential protective effects and mechanisms of OSA in the acute setting of STEMI should be further investigated in larger studies.

Post-tuberculosis lung disease: a comparison of Brazilian, Italian, and Mexican cohorts.

ABSTRACTObjective:To evaluate lung function in a cohort of patients with a history of pulmonary tuberculosis in Brazil, as well as to evaluate the decline in lung function over time and compare it with that observed in similar cohorts in Mexico and Italy. Methods:The three cohorts were compared in terms of age, smoking status, pulmonary function test results, six-minute walk test results, and arterial blood gas results. In the Brazilian cohort, pulmonary function test results, six-minute walk test results, and arterial blood gas results right after the end of tuberculosis treatment were compared with those obtained at the end of the follow-up period. Results:The three cohorts were very different regarding pulmonary function test results. The most common ventilatory patterns in the Brazilian, Italian, and Mexican cohorts were an obstructive pattern, a mixed pattern, and a normal pattern (in 58 patients [50.9%], in 18 patients [41.9%], and in 26 patients [44.1%], respectively). Only 2 multidrug-resistant tuberculosis cases were included in the Brazilian cohort, whereas, in the Mexican cohort, 27 cases were included (45.8%). Mean PaO2 and mean SaO2 were lower in the Mexican cohort than in the Brazilian cohort (p < 0.0001 and p < 0.002 for PaO2 and SaO2, respectively). In the Brazilian cohort, almost all functional parameters deteriorated over time. Conclusions:This study reinforces the importance of early and effective treatment of drug-susceptible tuberculosis patients, because multidrug-resistant tuberculosis increases lung damage. When patients complete their tuberculosis treatment, they should be evaluated as early as possible, and, if post-tuberculosis lung disease is diagnosed, they should be managed and offered pulmonary rehabilitation because there is evidence that it is effective in these patients.

How to treat patients with acute respiratory failure? Conventional oxygen therapy versus high‐flow nasal cannula in the emergency department

Objective:To investigate whether high‐flow nasal cannula oxygen therapy could reduce the rate of endotracheal intubation and improve arterial blood gas values, vital signs, and clinical outcomes of patients with hypoxemic acute respiratory failure as compared with conventional oxygen therapy alone.Methods:This retrospective, observational study was performed in the 15‐month study period and included adult patients with tachypnea and hypoxemia, whose vital signs and arterial blood gas were monitored. The high‐flow nasal cannula oxygen group consisted of patients admitted to the emergency department with acute respiratory failure when high‐flow nasal cannula oxygen treatment was available in the hospital, while the conventional oxygen therapy group consisted of patients who have presented to the emergency department with acute respiratory failure in the absence of high‐flow nasal cannula oxygen device in the hospital. The primary outcome of the study was improvement in vital signs and arterial blood gas values within first and fourth hours of the treatment. The second outcome was the need for intubation in the emergency department, length of hospital stay, and hospital mortality.Results:The decrease in the pulse and respiratory rate of high‐flow nasal cannula oxygen–treated group was significantly greater than the conventional oxygen therapy group on the first and fourth hours of treatment (p &lt; 0.001). PaO2 values were significantly higher in the high‐flow nasal cannula oxygen group at the first and fourth hours of treatment (p ⩽ 0.001). Likewise, mean SaO2 levels of patients receiving high‐flow nasal cannula oxygen treatment was significantly higher than those of patients in the conventional oxygen therapy group (p = 0.006 at 1 h and p &lt; 0.001 at 4 h). In the hypercapnic patients, the decrease in PaCO2 and increase in pH and PaO2 values were significantly greater in high‐flow nasal cannula oxygen group (p &lt; 0.001). The difference between the groups regarding the need for invasive mechanical ventilation was not statistically significant (p = 0.179).Conclusion:High‐flow nasal cannula oxygen treatment has been associated with favorable effects in vital signs and arterial blood gas values in patients with acute respiratory failure. High‐flow nasal cannula oxygen might be considered as the first‐line therapy for patients with hypoxemic and/or hypercapnic acute respiratory failure.

A diffusion MRI study of brain white matter microstructure in adolescents and adults with a Fontan circulation: Investigating associations with resting and peak exercise oxygen saturations and cognition

IntroductionAdolescents and adults with a Fontan circulation are at risk of cognitive dysfunction; Attention and processing speed are notable areas of concern. Underlying mechanisms and brain alterations associated with worse long-term cognitive outcomes are not well determined. This study investigated brain white matter microstructure in adolescents and adults with a Fontan circulation and associations with resting and peak exercise oxygen saturations (SaO2), predicted maximal oxygen uptake during exercise (% pred VO2), and attention and processing speed. MethodsNinety-two participants with a Fontan circulation (aged 13–49 years, ≥5 years post-Fontan completion) had diffusion MRI. Averaged tract-wise diffusion tensor imaging (DTI) metrics were generated for 34 white matter tracts of interest. Resting and peak exercise SaO2 and % pred VO2 were measured during cardiopulmonary exercise testing (CPET; N = 81). Attention and processing speed were assessed using Cogstate (N = 67 and 70, respectively). Linear regression analyses adjusted for age, sex, and intracranial volume were performed to investigate associations between i) tract-specific DTI metrics and CPET variables, and ii) tract-specific DTI metrics and attention and processing speed z-scores. ResultsForty-nine participants were male (53%), mean age was 23.1 years (standard deviation (SD) = 7.8 years). Mean resting and peak exercise SaO2 were 93.1% (SD = 3.6) and 90.1% (SD = 4.7), respectively. Mean attention and processing speed z-scores were −0.63 (SD = 1.07) and −0.72 (SD = 1.44), respectively. Resting SaO2 were positively associated with mean fractional anisotropy (FA) of the left corticospinal tract (CST) and right superior longitudinal fasciculus I (SLF-I) and negatively associated with mean diffusivity (MD) and radial diffusivity (RD) of the right SLF-I (p ≤ 0.01). Peak exercise SaO2 were positively associated with mean FA of the left CST and were negatively associated with mean RD of the left CST, MD of the left frontopontine tract, MD, RD and axial diffusivity (AD) of the right SLF-I, RD of the left SLF-II, MD, RD and AD of the right SLF-II, and MD and RD of the right SLF–III (p ≤ 0.01). Percent predicted VO2 was positively associated with FA of the left uncinate fasciculus (p < 0.01). Negative associations were identified between mean FA of the right arcuate fasciculus, right SLF-II and right SLF-III and processing speed (p ≤ 0.01). No significant associations were identified between DTI-based metrics and attention. ConclusionChronic hypoxemia may have long-term detrimental impact on white matter microstructure in people living with a Fontan circulation. Paradoxical associations between processing speed and tract-specific DTI metrics could be suggestive of compensatory white matter remodeling. Longitudinal investigations focused on the mechanisms and trajectory of altered white matter microstructure and associated cognitive dysfunction in people with a Fontan circulation are required to better understand causal associations.

Prevalence, characteristics, and respiratory arousal threshold of positional obstructive sleep apnea in China: a large scale study from Shanghai Sleep Health Study cohort

PurposeTo evaluate the prevalence, characteristics, and respiratory arousal threshold (ArTH) of Chinese patients with positional obstructive sleep apnea (POSA) according to the Cartwright Classification (CC) and Amsterdam Positional Obstructive Sleep Apnea Classification (APOC).MethodsA large-scale cross-sectional study was conducted in our sleep center from 2007 to 2018 to analyze the clinical and polysomnography (PSG) data of Chinese POSA patients. Low ArTH was defined based on PSG indices.ResultsOf 5,748 OSA patients, 36.80% met the CC criteria, and 42.88% the APOC criteria, for POSA. The prevalence of POSA was significantly higher in women than men (40.21% and 46.52% vs. 36.13% and 42.18% for CC and APOC, respectively). Chinese POSA patients had a lower apnea hypopnea index (AHI) and lower oxygen desaturation index, shorter duration of oxygen saturation (SaO2) < 90%, and a higher mean SaO2 and higher lowest SaO2 value compared to subjects with non-positional OSA (NPOSA). More than 40% of the POSA patients had a low ArTH; the proportion was extremely high in the supine-isolated-POSA (si-POSA) group and APOC I group. In multivariate logistic regression analyses, higher mean SaO2 and lower AHI during sleep were positive predictors of POSA.ConclusionsAccording to the CC and APOC criteria, more than 1/3 of our Chinese subjects with OSA had POSA. Chinese POSA patients had less severe OSA and nocturnal hypoxia. Compared to NPOSA patients, significantly more patients with POSA had a low ArTH. A low ArTH may be an important endotype in the pathogenesis of POSA, especially in patients with si-POSA and APOC I. Further studies are necessary to develop personalized management strategies for POSA patients.Trial registration: Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn; No. ChiCTR1900025714 (retrospectively registered).

Risk factors associated with mortality in COVID-19 patients in Nishtar Hospital Multan.

Objective: To identify risk factors associated with mortality in COVID-19. Study Design: Retrospective Cross Sectional Study. Setting: Nishtar Hospital Multan. Period: April 2020 to September 2020. Material &amp; Methods: Charts of all PCR confirmed COVID-19 cases expired during the study period. Results: Out of 96 cases, 62(64.6%) were male and 34(35.4%) were female. Sixty five (67.7%) were from urban areas. Niney two (95.8%) patients had a co-morbid condition. Fifty two (54.2%) had diabetes, 42(43.8%) had hypertension, 29(30.20%) had heart disease, 21(21.9%) had chronic kidney disease, 14(14.5%) had chronic lung disease and 5(5.2%) had chronic liver disease. Mean respiratory rate was 25.01±7.80, mean SaO2 was73.99±17.53 and 57(59.37%) had bilateral infiltrates on chest X-ray. Mean CRP was 59.95±46.28, mean S/LDH was 765.92 ±266.61, mean S/Ferritin was 1446.00±1261.69 and mean D-dimer was 1.26±0.45μg/ml. Thirty five (36.45%) had sepsis, 26(27.08%) had cytokine storm, 17(17.7%) had respiratory failure and 13(13.5%) had hypotension. Conclusion: Male gender, old age, diabetes, hypertension, ischemic heart disease and chronic kidney disease were associated with increased mortality in COVID 19. Tachypnea, hypoxia, bilateral infiltrates on chest X-ray and raised inflammatory markers also had poor prognosis. Sepsis, cytokine release syndrome, shock, and respiratory failure were common complications. These high risk patients with COVID 19 should be timely admitted and managed aggressively to improve outcome.

Polysomnographic Markers of Obstructive Sleep Apnea Severity and Cancer-related Mortality: A Large Retrospective Multicenter Clinical Cohort Study.

Rationale: The evidence for an association between cancer survival and obstructive sleep apnea (OSA) remains underexplored. Objectives: To evaluate an association between markers of OSA severity (respiratory disturbances, hypoxemia, and sleep fragmentation) and cancer-related mortality in individuals with previously diagnosed cancer. Methods: We conducted a multicenter retrospective cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four Canadian academic hospitals and were previously diagnosed with cancer through the Ontario Cancer Registry. Multivariable cause-specific Cox regressions were used to address the research objective. Results: We included 2,222 subjects. Over a median follow-up time of 5.6 years (interquartile range [IQR], 2.7-9.1 years), 261/2,222 (11.7%) individuals with prevalent cancer died from cancer-related causes, which accounted for 44.2% (261/590) of all-cause death. Controlling for age, sex, alcohol use disorder, prior heart failure, chronic obstructive pulmonary disease, hypertension, diabetes, treatment for OSA, clinic site, year of the sleep study, and time since the cancer diagnosis, measures of hypoxemia and sleep fragmentation, but not apnea-hypopnea index, were significantly associated with the cancer-specific mortality: percentage of time spent with arterial oxygen saturation (SaO2) < 90% (hazard ratio [HR] per 5% increase, 1.05; 95% confidence interval, 1.01-1.09); mean SaO2 (HR per 3% increase, 0.79; 0.68-0.92); and percentage of stage 1 sleep (HR per 16% increase, 1.27; 1.07-1.51). Conclusions: In a large clinical cohort of adults with suspected OSA and previously diagnosed cancer, measures of nocturnal hypoxemia and sleep fragmentation as markers of OSA severity were significantly associated with cancer-related mortality, suggesting the need for more targeted risk awareness.

The safety and short-term efficacy of modified lateral pharyngoplasty combined with multilevel surgery for OSA

Objective:To explore the safety and short-term efficiency of modified lateral pharyngoplasty combined with surgeries in other sites including nose and tongue. Methods:Thirty-five patients with OSA confirmed with polysomnography received modified lateral pharyngoplasty under general anesthesia. Some of the patients may also receive glossopharyngeal or nasal surgeries according to their physical examination, Müller test with electronic nasolaryngology and polysmnography. The postoperativepain, capacities of swallowing and speaking, and related postoperative complications after surgeries were recorded. And the changes of epworth sleep scale （ESS） snoring sore, apnea and hypopnea index （AHI） and lowest oxygen saturation （LSaO2） were compared before and after surgeries. Results:Among the 35 patients, 1 patient experienced experienced dyspnea after extubation and 2 patients experienced postoperative bleeding. The mean VAS after 1, 4 and 7 days of the surgery were 5.41±2.42, 2.93±1.80, 2.91±1.26, respectively. The mean pain visual analogue scale（VAS） was 5.41±2.42, 2.93±1.80 and 2.91±1.26 on the 1st, 4th and 7th day after operation. The mean time of starting to eat liquid and semi-liquid were （3.23±2.11） dand （5.55±2.67） d after surgery, respectively. Twenty-eight patients underwent 3-6 months follow-up, there was no significant difference in body mass index （BMI） before and after surgery, while mean ESS and snore index were significantly improved, ESS decreased from 11.33±4.91 to 6.19±4.45, and snore index decreased from 6.93±2.23 to 1.25±1.96. Among them, 23 of patients those patients received polysomnography after surgeries, AHI, LSaO2 and time with oxygen saturation below 90% （CT90） were significantly improvement. The mean AHI decreased from 45.05±27.90/h to 18.61±20.85/h，and mean SaO2 increased from 71.17% to 80.87%. Conclusion:Modified lateral pharyngoplasty combined with selective nasal and lingual plane surgery in the treatment of OSA is safe and can significantly improve ESS, snoring, AHI， LSaO2and other indicators.Modified lateral pharyngoplasty selectively with surgeries of nose or tongue is a kind of safe and effective surgery to treat OSA that ESS, snoring, AHI and SaO2can have satisfactory improvement.

The effect of simulative heartbeat nest used in preterm new-borns on vital signs, pain, and comfort in Turkey: A randomized controlled study

BackgroundCreating a womb-like environment for the preterm infant is vital to reduce the stress caused by stimuli and facilitate optimal neurological-behavioral development. PurposeThis randomized-controlled study aimed to determine the effect of simulative heartbeat nest use on vital signs, pain level, and comfort in preterms. MethodsThe study population consisted of 52 (experiment: 25, control: 27) preterms hospitalized in a university hospital's neonatal intensive care unit between May–November 2018. Before the application, preterms in both groups were evaluated with PIPP and Comfort scales. The experiment group was monitored in the nest with a heart beating device for 15 min. The control group was observed in the nest without the device for 15 min. Their heartbeats and oxygen saturation were recorded. After the application, preterms in both groups were re-evaluated with PIPP and Comfort scale. ResultsThere was no statistically significant difference between the groups in terms of gestation week, age, birth weight and height, HB, SaO2, PIPP, and Comfort Scale total scores before and after the application (p > .05). However, the mean SaO2 increased significantly during the application (p < .003) in the experiment group; and that the PIPP total score decreased statistically significantly (p: 0.001) after the application. The comfort scale total score averages of the preterms in both groups decreased statistically significantly after the application (experiment:p < .01; control:p < .05). Implications for practice and researchPreterms in both groups had similar indicators. The nests that create heartbeat provide positive outcomes, such as the standard nests'.

Increased serum levels of cyclophilin a and matrix metalloproteinase-9 are associated with cognitive impairment in patients with obstructive sleep apnea

ObjectivesTo investigate the relationship between serum cyclophilin A (CyPA) and matrix metalloproteinase-9 (MMP-9) levels and mild cognitive impairment (MCI) in patients with obstructive sleep apnea (OSA). MethodsStudy subjects underwent whole-night in-laboratory polysomnography (PSG), and all participants were scored using a neuropsychological scale and peripheral blood samples were collected the next morning. The presence and severity of OSA were assessed with the apnea hypopnea index (AHI), and OSA was defined as AHI ≥5 events/hour. MCI was defined as the MoCA ≤25, and met the revised Mayo Clinic criteria. Serum CyPA and MMP-9 levels were measured with enzyme-linked immunosorbent assays (ELISAs). A univariate analysis and a logistic model were used to assess risk factors for MCI in patients with OSA. A correlation analysis was performed to estimate whether a linear relationship existed between serum CyPA and MMP-9 levels and the severity of cerebral small vessel disease (CSVD) and white matter hyperintensities (WMHs). A linear regression analysis was used to clarify the relationship between serum CyPA and MMP-9 levels and the degree of cognitive impairment in patients with OSA. ResultsThe 186 patients who met the criteria for inclusion and exclusion comprised 71 patients with OSA presenting with MCI (OSA + MCI), 73 patients with OSA without MCI (OSA-MCI), and 42 controls. Patients with OSA + MCI presented higher serum CyPA and MMP-9 levels than patients in the OSA-MCI (11.56 ± 4.52 ng/ml vs 9.95 ± 3.63 ng/ml, p = 0.020; 597.71 ± 204.41 ng/ml vs 523.05 ± 205.47 ng/ml, p = 0.030) and control groups (11.56 ± 4.52 ng/ml vs 8.80 ± 3.71 ng/m, p = 0.001; 597.71 ± 204.41 ng/ml vs 490.39 ± 155.07 ng/ml, p = 0.002). The logistic regression analysis revealed that both CyPA (OR: 1.111, 95% CIs: 1.012–1.219, p = 0.027) and MMP-9 levels (OR: 1.003, 95% CIs: 1.000–1.004, p = 0.011) contributed significantly to MCI in patients with OSA. In the OSA + MCI group, positive correlations were observed between serum CyPA and MMP-9 levels with Scheltens scores (r = 0.437, p = 0.000; r = 0.613, p = 0.000, respectively) and total CSVD burden scores (r = 0.318, p = 0.003; r = 0.487, p = 0.000, respectively). Serum CyPA and MMP-9 levels were linearly negatively correlated with mean oxygen saturation during sleep (mean SaO2) (r = −0.595, p = 0.000; r = −0.570, p = 0.000). There was linear correlation between mean SaO2 and MoCA scores by Pearson's correlation coefficient (r = 0.403, p = 0.000). The linear regression analysis revealed negative correlations between serum CyPA and MMP-9 levels and the Montreal Cognitive Assessment (MoCA) scores (r = −0.528, p = 0.000; r = −0.459, p = 0.000, respectively), and serum CyPA levels were negatively correlated with score of cognitive subdomainss, including visuo-executive function, attention and delayed recall. However, serum MMP-9 levels were negatively correlated with score of cognitive subdomains, including visuo-executive function and delayed recall. ConclusionsIncreased serum levels of CyPA and MMP-9 are associated with MCI in OSA patients and directly related to the severity of CSVD and WMHs. The results suggest that damage to the blood–brain barrier (BBB) may be involved in the early stages of cognitive impairment in patients with OSA.

SLEEP-DISORDERED BREATHING IN INFANTS: ROLE OF PSG AND COMORBID CONDITIONS

TOPIC: Sleep Disorders TYPE: Original Investigations PURPOSE: To investigate the common indications for polysomnogram (PSG), associated comorbidities, and treatment options for management of sleep-disordered breathing (SDB) in infants. METHODS: This was a single center, retrospective study that included infants (age <12 months) who underwent PSG for evaluation of SDB at the University of Louisville and Norton Medical Group Pediatric Sleep Disorders Clinic from July 2012 to September 2020. SDB severity was categorized by apnea-hypopnea index (AHI): mild = 1–4.9 events/hour; moderate = 5–9.9 events/hour; severe ≥ 10 events/hour. RESULTS: A total of 101 infants who underwent PSG for evaluation of SDB were included in the study. The mean age was 6.9±3.5 months, 52.5% were male, and 73.3% were Caucasians. The most common indication for PSG was snoring 73.3% (74/101) followed by apneas 44.6% (45/101). Associated comorbid conditions included gastro-esophageal reflux (38.6%), craniofacial abnormalities (18.8%), prematurity (17.8%), and laryngomalacia (15.8%). Mean total sleep time was 400.6±82.8; the mean AHI was 9.9±17.4, obstructive apnea-hypopnea index (OAHI) was 6.8±12.8, SaO2 nadir was 85.5±8.6, mean SaO2 was 96.9±9.1, and mean EtCO2 was 40.5±7.4. The overall AHI was normal in 14.9%, mild in 36.6%, moderate in 10.9%, and severe in 14.9% of the included infants. OAHI was mild in 36.6%, moderate in 10.9%, and severe in 14.7% of the infants included in the study. Central apnea index was >1 events/hour in 53.5% of the infants. Oxygen supplement was used in 12.1%, gastro-esophageal reflux treatment was given in 13.1%, and 29.1% had surgical intervention. CONCLUSIONS: PSG is a valuable tool in the diagnosis of SDB in infants and may help guide timely and appropriate evaluation and interventions. Comorbidities of SDB in infants differ from associated comorbidities in older children. CLINICAL IMPLICATIONS: Infants with the reported comorbidities can benefit from screening for SDB. Management of SDB in these infants require a multidisciplinary approach given the range of the associated comorbid conditions. DISCLOSURES: Speaker/Speaker's Bureau relationship with United therapeutics Please note: $5001 - $20000 by Karim El-Kersh, source=Web Response, value=Honoraria Removed 04/21/2021 by Karim El-Kersh, source=Web Response Advisory Committee Member relationship with United therapeutics Please note: $1001 - $5000 by Karim El-Kersh, source=Web Response, value=Consulting fee Removed 04/21/2021 by Karim El-Kersh, source=Web Response Advisory Committee Member relationship with Actelion Please note: $5001 - $20000 by Karim El-Kersh, source=Web Response, value=Consulting fee Removed 04/21/2021 by Karim El-Kersh, source=Web Response Advisory Committee Member relationship with United Therapeutics Please note: Current Added 04/23/2021 by Karim El-Kersh, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Actelion Please note: 2019 and 2020 Added 04/23/2021 by Karim El-Kersh, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with United Therapeutics Please note: Current Added 04/29/2021 by Karim El-Kersh, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: Current Added 04/29/2021 by Karim El-Kersh, source=Web Response, value=Honoraria Advisory Committee Member relationship with Actelion Please note: 2019 and 2020 Added 04/29/2021 by Karim El-Kersh, source=Web Response, value=Honoraria Consultant relationship with Acceleron Pharma Please note: Current Added 04/29/2021 by Karim El-Kersh, source=Web Response, value=Consulting fee No relevant relationships by Quang Nguyen, source=Web Response No relevant relationships by Egambaram Senthilvel, source=Web Response

Angiographic features of pulmonary arteriovenous malformations: a new imaging classification system, BRAND, to guide embolisation

To introduce a new classification system for pulmonary arteriovenous malformations (PAVMs) based on the BRanches, ANgles and Diameter of the feeding artery (BRAND), which is intended provide a better understanding of the vascular structure of PAVMs and facilitate the selection of therapeutic strategies for embolisation. Twenty-one patients with PAVMs from 2005 to 2020 were reviewed retrospectively. According to angiographic morphology, classified the PAVMs using the BRAND classification. A total of 41 PAVMs were treated with transcatheter embolisation. Based on the BRAND classification, there were four branches (9.8%), four acute angles (9.8%), and 32 occlusion sites >4 mm in diameter (78%). A total of 30 PAVMs (73.2%) were treated with occluders and plugs while the rest were embolised with coils (26.8%). Immediate technical success was achieved in all patients. In feeding arteries with acute angles, balloon-assisted tracking and trans-septal puncture techniques were used to facilitate the advancement of delivery systems. All origins of branches were preserved. Mean SaO2 increased significantly from 79.5±7.5% before embolisation to 92±5.3% after embolisation (p<0.05). During a median follow-up of 5.4 years, two patients (9.5%) developed new PAVMs and required a second procedure. One patient (4.8%) underwent repeat embolisation due to the reperfusion of previously embolised PAVMs with coils. BRAND classification is well suited to address the challenging feeding arteries of PAVMs and allow precise placement of the delivery system, leading to minimal procedural risk and high success rates.

FREQUENCY OF CORONARY ARTERY DISEASE IN VALVULAR AORTIC STENOSIS :EXPERIENCE OF THE CARDIOLOGY CENTER OF MOHAMED V MILITARY HOSPITAL ABOUT 148 CASES

Introduction: The risk factors for aortic stenosis have been shown to be similar to those for atherosclerosis. Thus, coronary disease is often found simultaneously in patients with aortic stenosis. Our work aims to determine the frequency of coronary disease in a Moroccan population with aortic stenosis while recalling the causes and the prognostic and therapeutic impacts of this association. Materials and Methods: This is a retrospective study of 148 patients hospitalized at the cardiology center of the military hospital of Rabat over a period of 24 months, during which we analyzed clinical, electrocardiographic, echocardiographic and coronarographic data of the patients in order to evaluate the coronary involvement during aortic stenosis. Results: The mean age of the population was 65 [57, 74] years, the sex ratio was 1.21. Smoking reported in 38.5% of patients was the main modifiable cardiovascular risk factor, followed by hypertension in 35.8% of patients. Dyspnea on exertion was the most frequent reason for consultation at 81%, 64% of which were at least NYHA functional class III, followed by angina, which represented 33% of the series. The aortic stenosis was tight in the majority (mean SAo: 0.8 cm²) and the left ventricular ejection fraction was preserved overall. Coronary artery disease was associated with aortic stenosis in 24% of cases, with predominantly monotruncal involvement (53%) followed by tritruncal involvement (30%). 21.6% of these patients underwent coronary artery bypass grafting concomitantly with surgical replacement of the aortic valve. Conclusion: The incidence of coronary artery disease associated with aortic stenosis is variable according to age. It is higher in European series because of aging. In our relatively younger population, it is lower but not negligible.

Sleep disordered breathing in patients with Prader willi syndrome: Impact of underlying genetic mechanism

IntroductionSleep-disordered breathing (SDB) is common in children with PWS. In the current study, we aimed to evaluate the severity of SDB in patients with PWS using polysomnography (PSG), and assess the effect of the underlying genetic mechanism on PSG parameters. MethodsChildren with PWS, referred to our sleep laboratory between March 2016 and January 2020 were enrolled. PSG parameters, demographic data, body mass index (BMI), and symptoms related to SDB were recorded. The effect of non-invasive ventilation strategies and the outcome of therapy on PSG parameters were evaluated. ResultsIn our study, 64.5% of the patients had severe sleep apnea syndrome (total apnea hypopnea index (AHI) ≥10 events/hour). 22.6% had significantly high (>5 events/hour) central sleep apnea. Patients with a deletion had significantly lower initial and mean SaO2, longer sleep time SaO2 under 90%, oxygen desaturation % and total AHI when compared to those with uniparental disomy. PSG parameters were similar between patients who did or didn't receive growth hormone treatment. ConclusionThe majority of the PWS patients had severe sleep apnea syndrome characterized mainly by hypopneas which were accompanied by central apneas. There was a more severe impact on oxygen parameters and total AHI in patients with deletions.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

The effects of high-sensitivity C-reactive protein on the clinical outcomes in obstructive sleep apnea patients undergoing off-pump coronary artery bypass grafting

PurposeTo investigate the relationship between obstructive sleep apnea (OSA) severity and high-sensitivity C-reactive protein (Hs-CRP), and their respective impact on the clinical outcomes in patients undergoing off-pump cardiac artery bypass grafting (OPCABG).MethodsWe enrolled consecutive eligible patients listed for elective OPCABG who underwent cardiorespiratory polygraphy before surgery between January 2019 and December 2019 in this prospective observational single-center study. Baseline, intraoperative, and postoperative clinical data were compared between absent-mild and moderate-severe OSA groups. Regression analysis investigated the relationship between Hs-CRP level and severity of OSA, and further assessed the factors influencing postoperative atrial fibrillation, duration of hospitalization, and hospital cost.ResultsPatients with moderate-severe OSA accounted for 42.3% (52/123) of the cohort. Partial pressure of carbon dioxide (PCO2), Hs-CRP, apnea hypopnea index (AHI), mean apnea time, maximum apnea time, and oxygen desaturation index ODI ≥ 3% were significantly higher in the moderate-severe OSA group than in the absent-mild OSA group. Left ventricle ejection fraction (LVEF), lowest arterial oxygen saturation (SaO2), and mean SaO2 were significantly lower in the moderate-severe OSA group. Moderate-severe OSA was associated with elevated Hs-CRP level (OR = 2.356, 95% CI 1.101–5.041, P = 0.027). Hs-CRP was an independent risk factor for post-CABG atrial fibrillation (POAF) (OR = 1.212, P = 0.01). Hs-CRP level independently correlated with duration of hospitalization (B = 0.456, P = 0.001) and hospital cost (B = 1.111, P = 0.044).ConclusionHs-CRP level was closely related to OSA severity and have potential utility in predicting POAF, duration of hospitalization, and hospital costs in patients undergoing OPCABG.

P-SP003. Idiopathic central sleep apnea with periodicity presenting as cheyne-stokes breathing

Introduction . Cheyne-Stokes breathing (CSB) is described by a cyclic variation in breathing with periods of central apneas or hypopneas alternating with periods of hyperpneas in a gradual waxing and waning manner. We describe this rare case of idiopathic central sleep apnea coming in a periodic fashion presenting as CSB pattern without specific causes. Results . A 72-year-old male (body mass index: 21.9 kg/m 2 ) with the complaints of excessive daytime sleepiness and fatigue for about 2 years. On detailed sleep history patient denied snoring, cataplexy, hypnogogic hallucination, sleep paralysis and sleep attack. No neurological deficit was seen in clinical evaluation. ENT evaluation was normal. Cardiac evaluation showed artrial fibrillation with no cardiac failure. An overnight Polysomnography (PSG) test showed total sleep time of 443 minutes, sleep latency of 19.0 min, and sleep efficiency of 70.0%. Sleep architecture for stage 1 sleep was 31.7%, stage 2 sleep was 52.4%, slow wave sleep was 12.9%, REM sleep was 3.1%. Total arousal index was 21.8/hr. Mean SaO2 was 96.4%, the lowest SaO2 was 82.8%, and SaO2 below 90% was 0.1%. Snoring was not observed and periodic limb movement index was 8.8/hr. PSG also showed cyclic fluctuation in breathing with periods of central apneas; alternating with periods of hyperpneas in a gradual waxing and waning fashion; but cardiac evaluation and magnetic resonance imaging of the brain could not find any cause of this sleep-disordered breathing. Conclusion . The pathogenesis and etiology of CSA is still vague. We think that further studies and follow up will be required to determine whether idiopathic central sleep apnea presenting as CSB pattern is the initial indication of certain diseases. So we concluded that this case was an idiopathic central sleep apnea with periodicity; presenting as CSB pattern.

Effect of Changing Selected body Positions on Oxygen Saturation among Patients with Acute Stroke

Background: Body position generally effect on respiratory and stroke disease. Stroke morbidity increased by inappropriate position during the early recovery phase. Aim: To evaluate the effect of changing selected body positions on oxygen saturation among patients with acute stroke. Research design: Quasi-experiment research design applied in this study. Sitting: the study carried out at the stroke intensive care unit of the Neurological Department of Aswan University Hospitals. Sample: 60 patients with acute stroke within 24- 48 hours following mild to moderate and severe stroke allocated a randomized sequence of four positions. One hour spent in each position. SaO2 was recorded each15 minutes by pulse oximetry with a finger probe. Tools of data collection: structured interview questionnaire sheet, Glasgow Coma Scale, the Scandinavian stroke scale, and oxygen saturation monitoring record. Results: mean score of SaO2 at 2nd 15 min, 3rd 15 min, 4th min, and mean SaO2 of one hour at the semi-sitting position was higher than different positions (Supine position, Right side position, and Left side position) with statistically significant differences with p-value .008, .05, .002, and .019 respectively, the semi-sitting position was the best position of all position. Conclusion: the study finding concluded that the semi-sitting position is the best position than other positions in improving oxygen saturation after one hour from positioning among stroke patients. Recommendation: use a semi-sitting position and implicate this positioning strategy in the future to improve arterial oxygen saturation in acute stroke patients.

Different clinical parameters inform epicardial fat thickness in pre- and post-menopausal women with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) is a sleep-related disorder with breathing difficulties. Previous studies revealed that epicardial fat thickness (EFT) correlates with OSA severity. Interestingly, female patients display a stronger EFT-OSA correlation than males. The purpose of this study is to investigate the relationship between EFT and different clinical characteristics in pre- and post-menopausal women diagnosed with OSA.MethodsPatients diagnosed with OSA were divided into pre/early peri-menopausal (Group 1) and post/late peri-menopausal (Group 2) according to the menopause status. EFT was obtained from parasternal long-axis echocardiographic images. We also collected general clinical characteristics of patients involved in this study, and performed spearman correlation analysis to explore the correlations between EFT and the general clinical characteristics. We further applied Multiple stepwise linear regression analysis to explore the predictors for EFT in both groups.ResultsA total number of 23 and 59 patients were enrolled in Group 1 and Group 2 respectively. EFT in Group 2 was significantly higher than that of Group 1. In both groups, EFT was positively correlated with apnea–hypopnea index (AHI), percentage of total sleep time when blood oxygen saturation was less than 90% (T90), oxygen desaturation index (ODI) and glucose; while EFT was negatively correlated with mean and lowest SaO2 (oxygen saturation) levels. However, EFT was positively correlated with total cholesterol (TC) only in Group 1 and body mass index (BMI) only in Group2, respectively. Multiple stepwise linear regression analysis showed that AHI was independently associated with EFT in Group 1. However, both AHI and BMI were independent predictors of EFT in Group 2.ConclusionEFT was notably correlated with menopausal status in women with OSA. AHI was the independent predictor of EFT in women with OSA. BMI was the independent predictor of EFT in post/late peri-menopausal women with OSA.