Nocturnal Monitoring Research Articles

Unobtrusive Nocturnal Heartbeat Monitoring by a Ballistocardiographic Sensor in Patients with Sleep Disordered Breathing

Sleep disordered breathing (SDB) is known for fluctuating heart rates and an increased risk of developing arrhythmias. The current reference for heartbeat analysis is an electrocardiogram (ECG). As an unobtrusive alternative, we tested a sensor foil for mechanical vibrations to perform a ballistocardiography (BCG) and applied a novel algorithm for beat-to-beat cycle length detection. The aim of this study was to assess the correlation between beat-to-beat cycle length detection by the BCG algorithm and simultaneously recorded ECG. In 21 patients suspected for SDB undergoing polysomnography, we compared ECG to simultaneously recorded BCG data analysed by our algorithm. We analysed 362.040 heartbeats during a total of 93 hours of recording. The baseline beat-to-beat cycle length correlation between BCG and ECG was rs = 0.77 (n = 362040) with a mean absolute difference of 15 ± 162 ms (mean cycle length: ECG 923 ± 220 ms; BCG 908 ± 203 ms). After filtering artefacts and improving signal quality by our algorithm, the correlation increased to rs = 0.95 (n = 235367) with a mean absolute difference in cycle length of 4 ± 72 ms (ECG 920 ± 196 ms; BCG 916 ± 194 ms). We conclude that our algorithm, coupled with a BCG sensor foil provides good correlation of beat-to-beat cycle length detection with simultaneously recorded ECG.

Sleep-disordered breathing and epicardial adipose tissue in patients with heart failure

Background and aimsSleep-disordered breathing (SDB) is common in patients with heart failure (HF), contributes to the progression of cardiac disease, and is associated with adverse prognosis. Previous evidence indicates that epicardial adipose tissue (EAT) is independently associated with sleep apnea in obese individuals. We explored the relationship between SDB and EAT in HF patients. Methods and resultsEAT thickness was assessed by echocardiography in 66 patients with systolic HF undergoing nocturnal cardiorespiratory monitoring. A significantly higher EAT thickness was found in patients with SDB than in those without SDB (10.7 ± 2.8 mm vs. 8.3 ± 1.8 mm; p = 0.001). Among SDB patients, higher EAT thickness was found in both those with prevalent obstructive sleep apnea (OSA) and those with prevalent central sleep apnea (CSA). Of interest, EAT thickness was significantly higher in CSA than in OSA patients (11.9 ± 2.9 vs. 10.1 ± 2.5 p = 0.022). Circulating plasma norepinephrine levels were higher in CSA than in OSA patients (2.19 ± 1.25 vs. 1.22 ± 0.92 ng/ml, p = 0.019). According to the apnea-hypopnea index (AHI), patients were then stratified in three groups of SDB severity: Group 1, mild SDB; Group 2, moderate SDB; Group 3, severe SDB. EAT thickness progressively and significantly increased from Group 1 to Group 3 (ANOVA p < 0.001). At univariate analysis, only left ventricular ejection fraction and AHI significantly correlated with EAT (p = 0.019 and p < 0.0001, respectively). At multivariate analysis, AHI was the only independent predictor of EAT (β = 0.552, p < 0.001). ConclusionsOur results suggest an association between the presence and severity of sleep apneas and cardiac visceral adiposity in HF patients.

Abstract P471: Increased Salt Intake Reduces Diet-induced Thermogenesis in Healthy Men

Objective: High salt intake is a potential risk factor for obesity independent of energy intake, though underlying mechanisms remain unclear. Excessive body fat accumulation is caused by a positive energy balance over an extended period of time. Food intake causes a postprandial increase in energy expenditure. This postprandial effect represents approximately 10% of the total energy ingested over 24h. A decrease in diet-induced thermogenesis (DIT) contributes to a positive energy balance and weight gain over time. The present study investigated the effect of a 14-day high salt intake on DIT in healthy men. Methods: We enrolled eight healthy men (34 ± 7 years, BMI 24 ± 2 kg/m 2 ) in an exploratory, longitudinal study (Clincaltrials.gov identifier: NCT02509962). Probands received 6 g salt daily using sodium chloride tablets (Slow Sodium tablets, HK Pharma Ltd.) over 14 days on top of their habitual diet. Measurements were taken at baseline (V1), on day 3 (V2) and day 14 (V3) during and on day 9 (V4) after the salt challenge, respectively. At these time points, nocturnal ambulatory blood pressure monitoring, bioelectrical impedance analysis (BIA), food intake from 3-day food records, and resting and postprandial energy expenditure were obtained. Energy expenditure was measured by indirect calorimetry in a respiratory chamber after a 12h overnight fast and a standardized 440 kcal, high-protein meal. Results: Nocturnal systolic blood pressure increased after salt challenge (V1: 105.8 ± 8.5, V3: 111.2 ± 9.1 mmHg, P = 0.02). There was a trend towards higher energy intakes (V1: 2296 ± 752 kcal, V3: 2866 ± 831 kcal, P = 0.1). However, DIT was significantly decreased at all time points during and after salt challenge compared to baseline (V1: 17.3 ± 2.7%; V2: 11.3 ± 2.3%, P = 0.01; V3: 10.7 ± 3.6 %, P = 0.03; V4: 14.4 ± 2.5%, P = 0.04; all vs. V1). After 14 days of high salt, subjects expended 30 kcal less for metabolic processes after meal challenge. Assuming a total energy intake of 2300 kcal/d, this accounts for a 150 kcal positive energy balance. Conclusion: A moderate short-term increase of salt intake decreased the thermic effect of a high-protein meal. This could contribute to the observed weight gain in populations consuming a Western diet high in salt.

Evidence of perceptive impairment in OSA patients investigated by means of a visual search task

Obstructive Sleep Apnoea (OSA) is a common sleep disorder characterized by episodes of complete or partial obstruction of respiratory airways during sleep that leads to hypoxaemia and sleep fragmentation. One relevant daytime consequence of OSA is a negative impact on neurocognitive domain, ranging from psychomotor performance to executive function. In spite of a huge amount of evidence regarding cognitive impairment, little is known about perceptual processing in these patients. The aim of this research is to investigate the effects of OSA on visual mechanisms by employing a visual search paradigm. 19 OSA patients and 19 age-matched healthy controls (HC) participated in a case-control study. After a nocturnal cardiorespiratory monitoring, patients performed a visual search task in which they had to detect the presence/absence of a target (letter T) embedded in the 50% of trials into a set of distractors (letters Os, Xs, or Ls). Target's salience and distractors' numerosity were manipulated as independent variables, whereas accuracy and reaction times (RT) were recorded as dependent variables. HC, after the exclusion of any sleep disorder or sleepiness, performed the same experiments. Results generally confirmed the typical effects of visual search. OSA patients reported significantly slower RT in comparison with HC, indicating an overall perceptual deficit consisting in a harder extraction of relevant information from noise. Neither patients' age nor the objective clinical indices were associated with RT. This study indicates the presence of an impairment in OSA patients involving basic mechanisms of visual processing and likely ascribable to the disorder per se.

A Study of Sleep Disorders in Patients with Chronic Kidney Disease (CKD)

Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD). Although the increased prevalence of sleep apnea in patients with CKD is well established, few studies have examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines. 45 patients were recruited from outpatient nephrology clinics, nephrology department, and hemodialysis units. All patients completed an overnight inpatient polysomnograhy test to determine the prevalence of sleep apnea (AHI ≥ 5 events /h) and nocturnal hypoxia (oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time). Patients were stratified according to their estimated glomerular filtration rate (eGFR) at the time of the study visit into three groups as follows: CKD stage 2 (eGFR 60 to 89 mL/min/1.73 m2) (control group), CKD stages 3 and 4 (eGFR 15 to 59 mL/min/1.73 m2), and CKD stage 5 (eGFR less than 15 mL/min/1.73 m2). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Out of the 45 patients included in our study with the full spectrum of kidney function, ranging from those with eGFR 60 to 89 ml/min./1.73m2 to patients with eGFR less than 15 ml/min./1.73m2, 15 (33.3%) had sleep apnea (Mean AHI; 8.71±5.86). Our study found that prevalence of sleep apnea increased as kidney function declined (Group (I), 20%; Group (II), 36.4%; Group (III), 37.5%). Furthermore, severity of sleep apnea increased as kidney function declined (Group (I), mean AHI: 5.75±0.35; Group (II), mean AHI: 6±1.38; Group (III), mean AHI: 10.6±7.04). We also found that prevalence of nocturnal hypoxia which is characteristically associated with sleep apnea was greater among groups (II) and (III) (27.3% and 16.7%, respectively) than in group (I) (10%). Severity of nocturnal hypoxia increased as kidney function declined (Group (I), 13%; Group (II), 13.6±1.22%; Group (III), 16.75±3.30%). Overall, 8 out of the 45 studied CKD patients (17.8%) had nocturnal hypoxia (Mean SaO2 below 90% for ≥12% of the nocturnal monitoring time; 15.1±2.87%). Our study revealed that as kidney function declined, Apnea/Hypopnea (AHI) indices increased, oxygen desaturation indices increased, minimal peripheral capillary oxygen saturation values decreased, peripheral capillary oxygen saturation time less than 90% increased, and snore indices increased. Also, respiratory distress index (RDI) was higher among groups (II) and (III) than in group (I). However, only differences between groups as regards respiratory distress events, respiratory distress indices, snore events, and snore indices were statistically significant. These results show that as kidney function declines, several respiratory parameters deteriorate during sleep. In addition, wake events and indices, and sleep stage 1 (%) increased as kidney function deteriorated. Sleep efficiency (%) was highest among group (I) patients and lower among groups (II) and (III), Light sleep (%) was lowest among group (I) patients and higher among groups (II) and (III), and deep sleep (%) was highest among group (I) patients and lower among groups (II) and (III). It is clear from the above results that as kidney function declines, sleep efficiency deteriorates, wake indices increase, light sleep (%) increases, and deep sleep (%) decreases. We concluded that prevalence and severity of sleep apnea in patients with CKD increase as kidney function declines. Almost 18% of patients with CKD experience nocturnal hypoxia, which may contribute to loss of kidney function.

Maternal-infant outcome of patients with OSAHS and gestational hypertension treated by CPAP

Objective:To explore the clinical characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) diagnosed during pregnancy.To explore the effect on maternal and infant after treated with CPAP.Method:Data of 117 patients with OSAHS diagnosed by nocturnal blood oxygen saturation (SaO₂) monitoring and PSG during pregnancy were analyzed retrospectively. All the 117 patients were voluntary and divided into intervention group [received continuous positive airway pressure (CPAP) treatment with good compliance under informed consent and conventional drug] 70 cases and control group(received conventional drug) 47 cases. Record the relevant data during the treatment about maternal and infant.Result:There was no statistical significance on the difference of cesarean delivery and postpartum hemorrhage in the pregnant women with mild OSAHS (P> 0.05), there was no statistical significance on the difference of cesarean delivery and postpartum hemorrhage in the pregnant women with moderate OSAHS (P> 0.05) and there were statistical significance on the difference of cesarean delivery and postpartum hemorrhage in the pregnant women with severe OSAHS (P< 0.05 or P< 0.01). There was no statistical significance on the difference of asphyxia neonatorum, fetal growth restriction and fetal distress in the pregnant women with mild OSAHS (P> 0.05), there were statistical significance on the difference of fetal growth restriction and fetal distress in the pregnant women with moderate OSAHS (P< 0.05), and there were statistical significance on the difference of asphyxia neonatorum, fetal growth restriction and fetal distress in the pregnant women with severe OSAHS (P< 0.05 or P< 0.01).Conclusion:Pregnant women who have OSAHS risk factors should be paid attention to during the perinatal care and nocturnal SaO₂ monitoring or PSG should be performed in the suspected OSAHS patients. Strongly advise that those serious OSAHS patients should be treated by CPAP early before delivery. CPAP was a safe and effective treatment to OSAHS patients in pregnancy.

Comparative Effects of an Angiotensin II Receptor Blocker (ARB)/Diuretic vs. ARB/Calcium-Channel Blocker Combination on Uncontrolled Nocturnal Hypertension Evaluated by Information and Communication Technology-Based Nocturnal Home Blood Pressure Monitoring ― The NOCTURNE Study ―

Nocturnal blood pressure (BP) is an independent risk factor of cardiovascular events. The NOCTURNE study, a multicenter, randomized controlled trial (RCT) using our recently developed information and communication technology (ICT) nocturnal home BP monitoring (HBPM) device, was performed to compare the nocturnal HBP-lowering effects of differential ARB-based combination therapies in 411 Japanese patients with nocturnal hypertension (HT).Methods and Results:Patients with nocturnal BP ≥120/70 mmHg at baseline even under ARB therapy (100 mg irbesartan daily) were enrolled. The ARB/CCB combination therapy (irbesartan 100 mg+amlodipine 5 mg) achieved a significantly greater reduction in nocturnal home systolic BP (primary endpoint) than the ARB/diuretic combination (daily irbesartan 100 mg+trichlormethiazide 1 mg) (-14.4 vs. -10.5 mmHg, P<0.0001), independently of urinary sodium excretion and/or nocturnal BP dipping status. However, the change in nocturnal home systolic BP was comparable among the post-hoc subgroups with higher salt sensitivity (diabetes, chronic kidney disease, and elderly patients). This is the first RCT demonstrating the feasibility of clinical assessment of nocturnal BP by ICT-nocturnal HBPM. The ARB/CCB combination was shown to be superior to ARB/diuretic in patients with uncontrolled nocturnal HT independently of sodium intake, despite the similar impact of the 2 combinations in patients with higher salt sensitivity.

Prognostic Value of Initial Assessment of Residual Hypoventilation Using Nocturnal Capnography in Mechanically Ventilated Neuromuscular Patients: A 5-Year Follow-up Study.

Restrictive respiratory failure is a major cause of morbidity and mortality in neuromuscular diseases (NMD). Home mechanical ventilation (HMV) is used to treat hypoventilation, and its efficiency is mostly assessed by daytime blood gases or nocturnal oxygen saturation monitoring (SpO2). Non-invasive transcutaneous measure of CO2 (TcCO2) allows to directly assess nocturnal hypercapnia and to detect residual hypoventilation with a higher sensitivity than SpO2. We aimed to compare the prognostic value of nocturnal SpO2 and TcCO2 in ventilated adult NMD patients. All consecutive capno-oximetries performed between 2010 and 2011 in ventilated adult NMD patients were analyzed retrospectively. Concomitant blood gas analysis and lung function data were collected. Patients on oxygen therapy were excluded. Nocturnal hypoxemia and hypercapnia (using four different definitions) at baseline were compared in their ability to predict mortality and respiratory events requiring ICU admission during follow-up. Data from 55 patients were analyzed (median age 28 [interquartile range: 25-36.5] years; 71% Duchenne muscular dystrophy; vital capacity 12 [7-27]% of predicted; 51% tracheostomy). Capno-oxymetry showed hypoxemia in 14.5% and hypercapnia in 12.7-41.8%, according to the used definition. Over a follow-up lasting up to 5 years (median 4.0 [3.6-4.5] years), we observed 12 deaths and 20 respiratory events requiring ICU admission. Hypercapnia was significantly associated with the study outcomes, with TcCO2 > 49 mmHg during ≥10% of the time being the best definition, while hypoxemia was not. Our data show for the first time that residual hypoventilation, assessed by capnometry, is significantly associated with negative outcomes in adult ventilated NMD patients, while oximetry is not. Accordingly, we suggest capnometry to be included in the systematic assessment of HMV efficiency in NMD patients. NCT02551406.

OS 03-01 HIGHER SALT INTAKE ATTENUATES NOCTURNAL DIPPING IN BLOOD PRESSURE AND HEART RATE

Objective: Objective: It is now established that “dippers” whose blood pressure (BP) falls at night have lower cardiovascular risks than nondippers without nocturnal BP fall. Our previous study on the middle-aged general population in Korea indicated increased 24-hour urinary (24U) sodium excretion was associated with increased nighttime BPs. Therefore, we further analyzed the association of salt intakes estimated by 24U analysis with dipping in nocturnal BP and heart rate. Design and Method: Design and method: In the rural area in South Korea 218 subjects aged 30 to 59 years were measured with casual and ambulatory BP monitoring (ABPM) (TM2430, A&D, Tokyo, Japan) and their 24U samples collected by aliquot cups were analyzed. Results: For both ABPM and 24U analyses, 148 subjects, aged 47.4 ± 8.3 years in average and female rates 57.4%, were accepted for data analysis by the 24U creatinine equation. Salt intake, previously proven to be associated with nighttime systolic and diastolic BP but not with casual and daytime BP, was further analyzed to be significantly inversely associated not only with nocturnal dipping in systolic and diastolic BP (P < 0.01, 0.001), but also in heart rate (P < 0.01). Correlations of the dipping of systolic (Fig) and diastolic BPs with heart rate were significant (P < 0.001, 0.01). Conclusions: Conclusion: Higher salt intake attenuates dipping not only in BP but also in heart rate. Nocturnal heart rate monitoring, more easily available than ABPM, may be useful for detecting nocturnal BP rise and salt sensitivity related to cardiovascular risks.

Innovative Visualizations Shed Light on Avian Nocturnal Migration.

Globally, billions of flying animals undergo seasonal migrations, many of which occur at night. The temporal and spatial scales at which migrations occur and our inability to directly observe these nocturnal movements makes monitoring and characterizing this critical period in migratory animals’ life cycles difficult. Remote sensing, therefore, has played an important role in our understanding of large-scale nocturnal bird migrations. Weather surveillance radar networks in Europe and North America have great potential for long-term low-cost monitoring of bird migration at scales that have previously been impossible to achieve. Such long-term monitoring, however, poses a number of challenges for the ornithological and ecological communities: how does one take advantage of this vast data resource, integrate information across multiple sensors and large spatial and temporal scales, and visually represent the data for interpretation and dissemination, considering the dynamic nature of migration? We assembled an interdisciplinary team of ecologists, meteorologists, computer scientists, and graphic designers to develop two different flow visualizations, which are interactive and open source, in order to create novel representations of broad-front nocturnal bird migration to address a primary impediment to long-term, large-scale nocturnal migration monitoring. We have applied these visualization techniques to mass bird migration events recorded by two different weather surveillance radar networks covering regions in Europe and North America. These applications show the flexibility and portability of such an approach. The visualizations provide an intuitive representation of the scale and dynamics of these complex systems, are easily accessible for a broad interest group, and are biologically insightful. Additionally, they facilitate fundamental ecological research, conservation, mitigation of human–wildlife conflicts, improvement of meteorological products, and public outreach, education, and engagement.

FV 8. Sleep-disordered breathing and effects of non-invasive ventilation on sleep outcomes in adult Pompe disease

In juvenile or adult onset Pompe disease, non-invasive ventilation (NIV) is indicated if sleep-disordered breathing (SDB), daytime hypercapnia, or significant diaphragmatic weakness is present. We investigated both short-term and long-term effects of NIV on measures of sleep and nocturnal ventilation in patients with late-onset Pompe disease. Polysomnography (PSG) and transcutaneous capnography were performed in 22 adult patients with late-onset Pompe disease. If indicated, NIV was initiated the subsequent night and long-term follow-up visits were scheduled for up to 28 months including PSG and nocturnal carbon dioxide monitoring. Retrospective data analysis comprised PSG-based sleep and ventilation outcome measures. Daytime performance, subjective sleep quality, and health-related quality of life (HRQoL) were self-assessed using standard questionnaires. 22 patients (12 females) initially underwent detailed sleep studies. Enzyme replacement therapy had been initiated in 18 individuals, and 3 patients were treatment-naïve. 9 patients reported excessive daytime sleepiness (Epworth Sleepiness Scale score > 10), 8 patients had obstructive sleep apnea with an apnea hypopnea index above 5/h total sleep time, 3 patients showed daytime hypercapnia, and 4 individuals showed nocturnal increase of transcutaneous tcCO2 above 50 mmHg. In patients with SDB, HRQoL and both subjective and objective sleep quality were significantly reduced, the latter reflected by frequent sleep stage changes and decreased slow wave sleep. NIV was initiated in 15 patients and significantly increased mean and minimal oxygen saturation, shortened desaturation time, and enhanced CO2 elimination. Sleep outcomes were not significantly influenced in the first night on NIV but on first follow-up after three months nocturnal wake time was significantly decreased. During long-term follow-up sleep studies revealed stable normoxia and normocapnia in all patients receiving nighttime ventilatory support. Objective measures of sleep quality did not show deterioration over time. Alterations to ventilator settings were necessary only in few patients. NIV significantly improves objective sleep quality and respiration in the first night of treatment in adult patients with late-onset Pompe disease and SDB. NIV warrants nocturnal normoventilation without deterioration of sleep quality in the long run with only minor changes to ventilator settings.

Novel Triggered Nocturnal Blood Pressure Monitoring for Sleep Apnea Syndrome: Distribution and Reproducibility of Hypoxia-Triggered Nocturnal Blood Pressure Measurements.

Obstructive sleep apnea (OSA) causes blood pressure (BP) surges during sleep, which may lead to increased sleep-onset cardiovascular events. The authors recently developed a triggered nocturnal BP monitoring system that initiates BP measurements when oxygen desaturation falls below a variable threshold. The distribution and reproducibility of hypoxia-triggered nocturnal BP parameters compared with those of fixed-interval nocturnal BP parameters for two consecutive nights in 147 OSA patients (mean age 59.4 years, 86.4% men) were evaluated. The mean and distribution (standard deviation [SD]) of the hypoxia-peak systolic BP (SBP) were significantly greater than that of the mean nocturnal SBP (mean±SD: 148.8±20.5 vs 123.4±14.2 mm Hg, P<.001). The repeatability coefficient (expressed as %MV) of hypoxia-peak SBP between night 1 and night 2 was comparable to that of mean nocturnal SBP (43% vs 32%). In conclusion, hypoxia-peak nocturnal BP was much higher than mean nocturnal BP, and it was as reproducible as mean nocturnal BP.

A longitudinal, randomized, and prospective study of nocturnal monitoring in children and adolescents with epilepsy: Effects on quality of life and sleep.

Most studies on seizure detection systems focus more on the effectiveness of devices than on their practicability in and impact on everyday life. Our study investigated the impact of a technical monitoring system on subjective quality of sleep and the lives of affected families. Furthermore, we evaluated the impact of anxiety levels on seizure monitoring and vice versa. Forty-three patients with newly diagnosed epilepsy were included. Initially, the families decided whether they did (group 1, n=27) or did not (group 2, n=16) want to use a monitoring device. In group 1, patients were randomly assigned to using Epi-Care® (group 1A, n=14) or an audio baby monitor (group 1B, n=13). Quality of life was assessed at two points (t1, at the start of the study and t2, at 5-7months of follow-up) using the SF-12, Kindl-R, and "Familien-Belastungs-Fragebogen" (German version of the "Impact on Family Scale"). In addition, parental anxiety was measured using the State-Trait Anxiety-Inventory, and subjective quality of sleep was measured using the Pittsburgh Sleep Quality Index. Statistical analysis focused on the possible differences between groups 1 and 2 that may influence parents' decisions and the effects of the presence and types of technical monitoring over time. Anxiety levels were not significantly different between the groups with and without monitoring (group 1 vs. group 2). We also found no statistically significant, substantial baseline differences between the Epi-Care® and audio baby monitor groups, with at least medium effect sizes (group 1A vs. group 1B). Parents' health-related mental quality of life measured via the SF-12 increased significantly over time in all groups. By tendency, the fear of further seizures as well as the frequency of cosleeping arrangements in the monitoring group decreased during the study and approached the stable values of the control group. Individual parental anxiety levels are not crucial in the decision regarding the use of a monitoring device. A monitoring system may help some families in certain aspects of daily life. During the first months following a diagnosis of epilepsy, quality of life increases independently of the use of a monitoring system.

Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure

ObjectiveUnfavourable effects of sleep-disordered breathing (SDB) in heart failure (HF) are mainly mediated by impaired sympathetic activity. Few data are available on SDB and cardiac adrenergic impairment evaluated at myocardial...

Steps to prevent SUDEP: the validity of risk factors in the SUDEP and seizure safety checklist: a case control study.

Our objectives were to compare people with epilepsy (PWE) who died of sudden unexpected death in epilepsy (SUDEP) with live controls using the risk factor items of the SUDEP and Seizure Safety Checklist. All 48 SUDEPs of 93 epilepsy deaths which occurred in Cornwall UK 2004-2012 were compared to 220 live controls using the SUDEP and Seizure Safety Checklist, an evidenced based tool used to communicate person centered risk of SUDEP to PWE. The odds ratio for having a specific factor in those who died was compared to controls and ranked according to Pvalue using a sequential Bonferroni correction for multiple comparisons. Of the 17 modifiable and non-modifiable risk factors analyzed 9 were statistically significant of which 7 are potentially modifiable. Well known modifiable factors such as nocturnal monitoring, compliance and sleeping position featured prominently in the risk association. This is the first case control study exploring the risk factors for SUDEP since 2009. The findings are compared to the current considered risk factors as identified in a major recent review. The study further validates certain SUDEP risk factors. It highlights that the majority of risk factors strongly associated with SUDEP are potentially modifiable. There is an emerging profile to rank the risk factors. It furthers the evidence to use structured risk assessment and communication tools such as the SUDEP and Seizure Safety Checklist in daily clinical practice. It highlights key areas for a person centered discussion to empower PWE to mitigate risk.

Hypoglycemia and the predisposition to cardiovascular disease: Is the pro-inflammatory-pro-coagulant diathesis a plausible explanation?

Hypoglycemia and the predisposition to cardiovascular disease: Is the pro-inflammatory-pro-coagulant diathesis a plausible explanation?

Notes on the Tropical Andean GenusDisceratus(Orthoptera, Tettigoniidae, Pseudophyllinae), the Probable Male ofD. nubiger,and Its Calling Song

A male Disceratus specimen found in cloud forest of Podocarpus National Park in southernmost Ecuador is apparently conspecific with Disceratus nubiger Scudder 1869, known only from the female holotype, collected one and a half centuries ago on slopes of the volcano Antisana. The song of this male could be recorded, confirming the identification of field recordings as well as additional acoustic records with an ultrasound detector at the same site. This incessant calling song, a series of steadily repeated short clicks with a sharp peak at 20 kHz, easily reveals the presence of this short-legged and brachypterous katydid — it lives in bamboo thickets within cloud forest, where individuals are very difficult to find. More fieldwork and nocturnal acoustic monitoring in the tropical Andes will be essential to shed light on the distribution and life history of this practically forgotten genus and its species, some of them probably still undiscovered. Disceratus is recognized as full genus rather than a subgenus of Gnathoclita.

Neural Stem Cells Transplantation as a Neuroprotective Strategy for Amyotrophic Lateral Sclerosis (ALS)

Introduction Amiotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a prevalence rate of up to 7.4/100,000 and the overall risk of developing ALS over a lifetime is 1:400. Most patients die from respiratory failure following a course of progressive weakness. There is no effective therapy. Novel therapeutic strategies might be directed at replacing or repairing the damaged motor neurons; Cell therapy is emerging as a potential therapeutic option in ALS. The primary objective of our study was to verify the safety and tolerability of transplantation of human fetal neural stem cells (hNSCs) directly into the spinal cord of humans. The study was approved by the SuperiorNational Health Institute. Material and Methods 18 patients with definite ALS were recruited and treated. Patients were included if they had ALS of spinal onset with severe functional impairment of the lower limbs and mild functional impairment of the upper limbs without signs of respiratory failure. The patients were monitored by clinical evaluation which included the ALS-FRS scale, Norris score, bulbar score, and MRC strength scale. Respiratory assessment included clinical evaluation, pulmonary function tests, arterial blood gases analysis, and nocturnal cardio-respiratory monitoring. Neurophysiological assessments were made including EMG, and somatosensory evoked potentials. The neuroradiological assessment consisted of MRI of spinal cord and brain before and after Gadolinium DTA infusion. A clinical psychologist performed psychological evaluation including an interview and psychological tests. Human fetal brain tissue specimens, all derived from the forebrain, were routinely collected from fetuses at gestational ages greater than the 8th post-conceptional week. They were immediately dissected and used to generate hNSC lines under sterile conditions. Dissociation of brain tissue, primary culturing and cell propagation were performed according to the procedure described previously by Vescovi and colleagues. Six patients received hNSCs microinjections into the dorsal (T7-T9) cord tract (3 of them received unilateral hNSCs microinjection while the remaining ones received bilateral microinjections); the other twelve patients received hNSCs microinjections into the cervical (C5-C6) cord tract (3 of them received unilateral hNSCs microinjection while the remaining ones received bilateral microinjections). Results No patients manifested severe adverse events such as death, respiratory failure or permanent post-surgical neurological deficits. Minor adverse events were: intercostal pain (2 patients) which was reversible after a mean period of 3 days after surgery, arm and leg sensory dysesthesia (6 patients) which was reversible after a mean period of 6 weeks after surgery. No patient manifested bladder and bowel dysfunction, or arm and leg motor deficit. All patients showed a good acceptance of the procedure and no significant modifications of the psychological status or quality of life were observed. Conclusions Our results appear to demonstrate that the procedures of fetal stem cells transplantation into the spinal cord of humans are safe and well tolerated by ALS patients. The minimal side effects and the absence of detrimental effects on neurological function support further research in stem cell transplantation in carefully monitored patients with ALS.

Development of a Triggered Nocturnal Blood Pressure Monitoring which Detects Nighttime Blood Pressure Surges in Sleep Apnea Syndrome.

Obstructive sleep apnea (OSA) places an enormous pressure load on the cardiovascular system by inducing a temporary blood pressure (BP) surge during apnea episodes. This pressure load is regarded as a potential mechanism of development of cardiovascular diseases such as stroke. Therefore, accurate measurement of such BP surges would be valuable for the risk stratification of OSA patients. Recently we developed a new triggered nocturnal BP monitoring system (TNP) based on oxygen desaturation and have achieved success to detect BP surges with OSA. TNP would be a promising tool for assessment of cardiovascular risks in sleep apnea syndrome.

An assessment of spatio-temporal relationships between nocturnal bird migration traffic rates and diurnal bird stopover density.

BackgroundDaily magnitudes and fluxes of landbird migration are often measured via nocturnal traffic rates aloft or diurnal densities within terrestrial habitats during stopover. However, these measures are not consistently correlated and at times reveal opposing trends. For this reason we sought to determine how comparison methods (daily magnitude or daily flux), nocturnal monitoring tools (weather surveillance radar, WSR; thermal imaging, TI), and temporal scale (preceding or following diurnal sampling) influenced correlation strength from stopover densities estimated by daily transect counts. We quantified nocturnal traffic rates at two temporal scales; averaged across the entire night and within individual decile periods of the night, and at two spatial scales; within 1 km of airspace surrounding the site via WSR and directly overhead within the narrow beam of a TI.ResultsOverall, the magnitude of daily bird density during stopover was positively related to the magnitude of broad-scale radar traffic rates of migrants on preceding and following nights during both the spring and fall. These relationships were strongest on the following night, and particularly from measures early in the night. Only during the spring on the following nights did we find positive correlations between the daily flux of transect counts and migration traffic rates (both WSR and TI). This indicates that our site likely had a more consistent daily turnover of migrants compared to the fall. The lack of general correlations between seasonal trends or daily flux in fine-scale TI traffic rates and stopover densities across or within nights was unexpected and likely due to poor sampling of traffic rates due to the camera’s narrow beam.ConclusionsThe order (preceding or following day) and metric of comparisons (magnitude or flux), as well as the tool (WSR or TI) used for monitoring nocturnal migration traffic can have dramatic impacts when compared with ground-based estimates of migrant density. WSR provided measures of the magnitude and daily flux in nocturnal migration traffic rates that related to daily stopover counts of migrants during spring and fall. Relationships among migrating bird flux measures are more complex than simple measures of magnitude of migration. Care should be given to address these complexities when comparing data among methods.