Nocturnal Symptoms Research Articles

The CTS-2T: An Assessment of a Modified, Telephone-Based Version of the CTS-6 in the Evaluation of Carpal Tunnel Syndrome.

The CTS-2T: An Assessment of a Modified, Telephone-Based Version of the CTS-6 in the Evaluation of Carpal Tunnel Syndrome.

Natural sleep at home and psychosis in patients with Parkinson's disease: A post-hoc analysis of the ZEAL study.

Natural sleep at home and psychosis in patients with Parkinson's disease: A post-hoc analysis of the ZEAL study.

Distinct Convergent Brain Alterations in Sleep Disorders and Sleep Deprivation: A Meta-Analysis.

Sleep disorders have different etiologies yet share some nocturnal and daytime symptoms, suggesting common neurobiological substrates; healthy individuals undergoing experimental sleep deprivation also report analogous daytime symptoms. However, brain similarities and differences between long-term sleep disorders and short-term sleep deprivation are unclear. To investigate the shared and specific neural correlates across sleep disorders and sleep deprivation. PubMed, Web of Science, Embase, Scopus, and BrainMap were searched up to January 2024 to identify relevant structural and functional neuroimaging articles. Whole-brain neuroimaging articles reporting voxel-based group differences between patients with different sleep disorders and healthy control participants or between total or partial sleep-deprived and well-rested individuals were included. Significant coordinates of group comparisons, their contrast direction (eg, patients < controls), and imaging modality were extracted. For each article, 2 raters independently evaluated eligibility and extracted data. Subsequently, several meta-analyses were performed with the revised activation likelihood estimation algorithm using P < .05 cluster-level familywise error correction. Transdiagnostic regional brain alterations were identified across sleep disorders and among articles reporting sleep deprivation. Their associated behavioral functions and task-based or task-free connectivity patterns were explored using 2 independent datasets (BrainMap and the enhanced Nathan Kline Institute-Rockland Sample). A total of 231 articles (140 unique experiments, 3380 unique participants) were retrieved. The analysis across sleep disorders (n = 95 experiments) identified the subgenual anterior cingulate cortex (176 voxels, z score = 4.86), associated with reward, reasoning, and gustation, and the amygdala and hippocampus (130 voxels, z score = 4.00), associated with negative emotion processing, memory, and olfaction. Both clusters had positive functional connectivity with the default mode network. The right thalamus (153 voxels, z score = 5.21) emerged as a consistent regional alteration following sleep deprivation (n = 45 experiments). This cluster was associated with thermoregulation, action, and pain perception and showed positive functional connectivity with subcortical and (pre)motor regions. Subanalyses regarding the direction of alterations demonstrated that the subgenual anterior cingulate cortex exhibited decreased activation, connectivity, and/or volume, while the amygdala and hippocampus cluster and the thalamus cluster demonstrated increased activation, connectivity, and/or volume. Distinct convergent brain abnormalities were observed between long-term sleep disorders (probably reflecting shared symptoms) and short-term sleep deprivation.

Suicidal risk, insomnia symptoms, and interoceptive sensitivity: Network analysis in a university student population

Objective: This cross-sectional study examines the relationships between insomnia symptoms, suicidal risk, and interoceptive sensitivity in university students. Participants: A sample of 288 students from French universities was recruited. Methods: The Sleep Condition Indicator, the Suicide Behaviors Questionnaire-Revised, and the Multidimensional Assessment of Interoceptive Awareness were used to assess insomnia, suicidal risk, and interoception. Network analysis explored the connections between insomnia and suicidal risk, while mediation analysis examined the role of the interoceptive sensitivity dimensions. Results: 46.18% of participants had clinical insomnia, and 37.84% had elevated suicide risk. Nocturnal insomnia symptoms were more strongly associated with suicidal risk than daytime symptoms. Trusting body signals was found to partially mediate this association. Conclusions: These findings suggest that nocturnal insomnia may have a greater impact on suicide risk, with trust influencing this relationship. Addressing both insomnia and trust in interventions could help reduce suicide risk in university students.

Effects of rapid maxillary expansion in pediatric patients affected by obstructive sleep apnea syndrome: a literature review.

Obstructive sleep apnea syndrome (OSAS) is a breathing disorder during sleep, characterized by upper airway obstruction with many subsequent daytime and nocturnal symptoms. Children with OSAS may show abnormalities of the maxillary structure. This review aims to evaluate the effectiveness of rapid maxillary expansion (RME) as a treatment for OSAS in children to reduce apnea/hypopnea index and oxygen saturation. An electronic search for all articles published in English from January 2004 to February 2022. The study focused on children between 5 and 12 years old and meeting the following inclusion criteria: clinical signs of malocclusion, no syndromic children, adenotonsillar hypertrophy, underwent an otolaryngology evaluation and no previous treatment for OSAS. The device was fixed to the second deciduous molars. After 12 months, the RME was removed. The investigation recorded a statistically significant reduction in AHI (apnea/hypopnea index) (on average 60-65%) and an increase in oxygen saturation ranging from 95% to 97%. This review shows that RME, through the enlargement of dental arches and nasal-maxillary structures, may be a helpful approach in children with malocclusion and OSAS.

A187 VANCOMYCIN CAN INDUCE AND MAINTAIN REMISSION OF REFRACTORY INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS – A CASE SERIES

Abstract Background The microbiome is suspected to play a role in the pathogenesis of inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). Meta-analyses have shown a positive response for antimicrobials in IBD, although the results are difficult to apply clinically given the wide variability in antimicrobial modality and treatment regimen as well as perceived reduced effectiveness compared to advanced therapies. Fewer antimicrobial studies have been performed in the PSC population. There is some evidence that vancomycin may represent a treatment option with concurrent IBD and PSC. Aims To determine the clinical and endoscopic effect of vancomycin for patients with refractory PSC-IBD. Methods Retrospective chart review. Results We identified 6 patients (4 male) with IBD and PSC who were started on vancomycin (Figure 1). Four had ulcerative colitis (UC) and 2 had Crohn’s disease. Three had pre-existing cirrhosis; 1 of these patients had undergone liver transplantation for PSC. All had failed multiple therapies for IBD with up to 4 advanced therapies failed. One patient had previously required surgery for UC. Patients were started on induction vancomycin at 125 mg 4 times daily or BID (twice daily) for 8 weeks followed by maintenance therapy at 125 mg BID or daily. The initial response to vancomycin therapy was demonstrated for all 6 patients at early follow-up ranging from 1 to 3 months. All had improvement of clinical symptoms with reduction in stool frequency and improvement in consistency. Some had bloody stools, nocturnal symptoms, and abdominal pain, which also improved. One patient is awaiting post-vancomycin endoscopy. The remaining 5 started with moderate-to-severe inflammation and improved to mild or no inflammation on follow-up endoscopy 2 months to 2 years after starting vancomycin. Two patients had documented repeat endoscopy at a longer period of follow-up (4 and 6 years) and maintained remission. The follow-up duration ranged from 2 months to 6 years. No adverse effects to vancomycin were reported. None of the 6 patients required steroids, addition of alternative therapy, admission, or surgery. All patients were on concurrent therapy (vedolizumab, ustekinumab, or 5-ASA) either started prior to or at the same time as vancomycin. Three of these patients discontinued their ustekinumab at 6, 8, and 14 months respectively given treatment effectiveness and maintained remission on vancomycin alone. Conclusions In a subset of patients with PSC-IBD, vancomycin can induce clinical and mucosal remission for refractory IBD. We present two dosing regimens which produced rapid clinical improvement and those with longer follow-up sustained durable results. Prospective studies with larger sample sizes are needed. Funding Agencies None

P0410 Clinical outcomes of endoscopically confirmed immune checkpoint inhibitor-induced colitis: A multicentre retrospective study

Abstract Background Immune checkpoint inhibitors (CPIs) have transformed cancer outcomes, but frequently trigger CPI-induced colitis (CPI-c) leading to significant morbidity and prolonged immunosuppression. This study characterises CPI-c patients (pts) using robust definitions. Additionally, the impact of macroscopic inflammation (endoscopic and histological evidence) compared to microscopic inflammation (histological only) on clinical outcomes remains unclear. Methods Retrospective outcome data were obtained from consecutive CPI-c pts from 2 U.K centres. Pts with diarrhoea and histological ± endoscopic colonic inflammation were included. Factors associated with macroscopic inflammation were analysed using Chi squared tests and multivariable logistic regression. Results Of 161 pts (55% male, median age 64), cancers included melanoma (50%), renal (18%), lung (16%) and others (16%). CPI therapies included anti-PD-1/L1 monotherapy (41%), dual anti-CTLA-4/PD-1 (47%) and chemoimmunotherapy (6%). Toxicity onset was earlier with dual anti-PD-(L)1/CTLA-4 therapy vs. anti PD-(L)1 monotherapy (47 vs.150 days, p &amp;lt; 0.001). The average bowel frequency was 8x/day (range 2-20); 115 (71%) had nocturnal symptoms; 28 (17%) had bloody stool and 63% required hospitalisation. 89 pts (54%) were corticosteroid (cs) refractory, requiring biologics (infliximab (IFX), 73; vedolizumab, 13). 41/73 (56%) responded to IFX, and 5/13 (38%) to vedolizumab. Three underwent colectomy for refractory colitis. Macroscopic inflammation occurred in 78%, while 22% had microscopic inflammation. Time to endoscopy did not differ between groups. Among macroscopic cases, 91 (70%) had mild (Mayo 1), while 30% had moderate or severe inflammation (Mayo 2-3). CTCAE grade did not correlate with endoscopic severity. In the regression analysis, male sex (OR 3.25 p&amp;lt;0.01) and dual anti-CTLA-4/PD-1 (OR 2.63 p&amp;lt;0.01) predicted macroscopic inflammation. Age, cancer, CTCAE grade, duration of diarrhoea, concurrent CMV colitis, number of cs tapers, duration of cs therapy, hospitalisation and recurrence of colitis were not predictive. Macroscopic inflammation correlated with higher faecal calprotectin (FC) levels (889 vs 414, p=0.02) and biologic escalation (52.7% vs 30.6%, p&amp;lt;0.05). 30% received CPI re-challenge, with colitis relapse in 13/45 (29%). No relapses exceeded initial CTCAE or endoscopic severity. Conclusion This study represents one of the largest real-world cohorts of robustly defined CPI-c pts. Pts with macroscopic inflammation have a more aggressive clinical course, marked by higher FC levels and greater need for biologic escalation, emphasising the need for heightened monitoring in this group. Reassuringly, CPI re-challenge did not lead to more severe colitis relapses than the initial episode.

Characteristics of type 2 inflammation in nocturnal asthma and evaluation of the effectiveness of inhaled corticosteroids combination therapy

Objective: To investigate the characteristics of type 2 inflammation in patients with nocturnal asthma, and analyze the improvement of asthma symptoms after the use of inhaled corticosteroids (ICS) combined with different long-acting bronchodilators. Methods: Data of 231 asthma patients who first visited the Respiratory and Critical Care Medical Clinic of Nanfang Hospital of Southern Medical University from January 2020 to June 2023 and had positive bronchodilator tests (BDT), were retrospectively analyzed. These patients were divided into nocturnal asthma group and non-nocturnal asthma group based on the presence or absence of nocturnal symptoms. According to fractional exhaled nitric oxide (FeNO) levels, patients were divided into type 2 inflammatory group [FeNO≥20 ppb (×10-12)] and non-type 2 inflammatory group (FeNO<20 ppb). Patients were further divided into ICS+long-actingβ2 agonist (LABA) group and ICS+LABA+long-acting anticholinergic agent (LAMA) group based on medication regimens. Patients were followed-up at the 3rd, 6th, and 12th months after enrollment to evaluate the patient's asthma control test (ACT) questionnaire, actual medication status and number of acute attacks. The clinical characteristics, treatment and prognosis of different groups were compared. Results: A total of 231 asthma patients were included, including 152 males and 79 females, with a age[M (Q1, Q3)] of 52 (42, 60) years. There were 144 cases (62.3%) in the nocturnal asthma group and 87 cases (37.7%) in the non-nocturnal asthma group. Among the 144 patients with nocturnal asthma, 133 patients completed FeNO testing, of which 95 were classified into the type 2 inflammation group and 38 to the non-type 2 inflammation group. The eosinophil (EOS) count and FeNO level in the nocturnal asthma group were both higher than those in the non-nocturnal asthma group [(0.45±0.40) ×109/L vs (0.25±0.20)×109/L, 38 (18, 82) vs 29 (15, 48) ppb, both P<0.05]. Baseline ACT score was lower in nocturnal asthma group than in non-nocturnal asthma group [16 (14, 18) vs 21 (19, 23) scores, P<0.001]. There was no significant difference in the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) in the two groups (both P>0.05). During the follow-up at the 3rd, 6th, and 12th months, the improvement values of ACT scores (ΔACT) in the nocturnal asthma group were higher than the non-nocturnal asthma group [5 (3, 7) vs 2 (1, 3), 7 (4, 9) vs 3 (1, 4) and 7 (6, 9) vs 3 (1, 5) scores, all P<0.05]. The EOS count [0.40 (0.29, 0.80)×109/L vs 0.20 (0.12, 0.29)×109/L] and percentage [5.10% (3.55%, 9.10%) vs 2.20% (1.65%, 3.85%)] of the type 2 inflammation group were both higher than the non-type 2 inflammation group (both P<0.05). In the nocturnal asthma group, there was no significant difference in ΔACT between ICS+LABA and ICS+LABA+LAMA groups (both P>0.05). Conclusions: Patients with nocturnal asthma have more pronounced type 2 inflammation and the symptoms are often not well controlled or even worse. After one year of combined therapy with ICS, significant improvements in asthma symptoms can be observed. But there is no significant difference in symptom improvement among different medication regimens in the nocturnal asthma group.

The effects of experimental sleep disruption on daytime performance among children with asthma living in urban environments.

The effects of experimental sleep disruption on daytime performance among children with asthma living in urban environments.

The Relationship Between Self-Reported Nocturnal Cough Symptoms and Acoustic Cough Monitoring

The Relationship Between Self-Reported Nocturnal Cough Symptoms and Acoustic Cough Monitoring

Evaluation of arterial stiffness and quality of life in the treatment of moderate to severe obstructive sleep apnea with Continuous Positive Airway Pressure or Mandibular Advancement Appliance: a cross-sectional study

BackgroundObstructive sleep apnea (OSA) is highly associated with a significant reduction in the Quality of Life (QoL) and is associated with deleterious effects on the cardiovascular system. Arterial stiffness is characterized by morphofunctional changes in the arteries and its assessment can be obtained non-invasively mainly through the measurement of pulse wave velocity (PWV). Arterial stiffness has been proposed as a predictor of cardiovascular diseases.ObjectiveTo compare arterial stiffness as well as QoL in patients diagnosed with moderate to severe OSA treated with Continuous Positive Airway Pressure (CPAP) or Mandibular Advancement Appliance (MAA) therapies.MethodsThis is a cross-sectional study involving 105 participants diagnosed with moderate to severe OSA categorized into three independent groups: A Non-treated Control Group and CPAP and MAA treated Groups. QoL was assessed by the Quebec Sleep Questionnaire (QSQ) and arterial stiffness was assessed noninvasively by Mobil-O-Graph.ResultsThe groups were homogeneous, except for the polysomnographic parameters Apnea and Hypopnea Index (AHI) (p = 0.036) and Minimum O2 saturation (p = 0.011) (evaluated to diagnose the OSA condition before treatment) and Body Mass Index (BMI) (p < 0.001). The MAA group presented higher scores in all QoL domains (p < 0.05), except Social Interactions in relation to the Control group. For the CPAP group, only Nocturnal Symptoms presented significantly higher scores compared to the control group (p = 0.39). For Arterial Stiffness, no statistical differences were observed among comparisons.ConclusionsOur results show better QoL scores in patients with OSA treated by CPAP and mainly by MAA. Differently, arterial stiffness parameters did not differ between the groups treated with CPAP and MAA and the control group.

Stimulation-Evoked Resonant Neural Activity in the Subthalamic Nucleus Is Modulated by Sleep.

Deep brain stimulation is a treatment for advanced Parkinson's disease and currently tuned to target motor symptoms during daytime. Parkinson's disease is associated with multiple nocturnal symptoms such as akinesia, insomnia, and sleep fragmentation, which may require adjustments of stimulation during sleep for best treatment outcome. There is a need for a robust biomarker to guide stimulation titration across sleep stages. This study aimed to investigate whether evoked resonant neural activity (ERNA) is modulated by sleep. We recorded local field potentials from the subthalamic nucleus of four Parkinson's patients with externalized electrodes while applying single stimulation pulses to investigate the effect of sleep on ERNA. We found that ERNA features change with wakefulness and sleep stages and are correlated with canonical frequency bands and heart rate. Given that ERNA modulates with sleep, it could be used as a robust marker for automatic stimulation titration during sleep. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Adaptive servo-ventilation for the treatment of intrathecal baclofen-induced central sleep apnea: A case report.

Baclofen is a common muscle relaxant agent used in a number of neurological disorders acting at central level and potentially causing adverse respiratory events, still largely unknown at therapeutic doses. We present the case of a young woman with spastic tetraparesis secondary to perinatal asphyxia treated with a standard dose of intrathecal baclofen who developed nocturnal symptoms, somnolence and memory loss during the day. Nocturnal cardio-respiratory sleep monitoring showed a high number of central sleep apneas (CSA). The patient was adapted and treated with a positive air pressure device, Adaptative Servo-Ventilator, specific designed to treat CSA particularly in patients with heart failure. The treatment was well tolerated and within few days CSA was reversed. The patient reported a feeling of restful sleep and disappearance of morning tiredness. The efficacy of the treatment was verified with nocturnal cardio-respiratory monitoring after 2 months and complete resolution of all symptoms was also confirmed.

Characteristics of Geriatric Rehabilitation Inpatients with Nocturia: RESORT

Introduction: Nocturnal lower urinary tract symptoms are common in geriatric rehabilitation inpatients but have not been well described. The aim of this study was to compare patient characteristics stratified by self-reported nocturia severity in geriatric rehabilitation inpatients. Methods: The REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal, prospective inception cohort of geriatric rehabilitation inpatients who underwent a Comprehensive Geriatric Assessment (CGA) at admission and discharge. Nocturia was captured by item 7 of the American Urology Association Symptom Score (AUASS) and dichotomised as ≤1 void and >1 void at night as per the International Continence Society definition. Differences in demographic, functional, and medical characteristics of the inpatients with and without nocturia >1 were compared. Results: Overall, 641 inpatients completed the nocturia item (mean age 82.6 [SD 7.7] years, 59.9% female). Nocturia occurred >once per night in 57.4%; mean number of episodes was 1.96 (SD 1.38), ranging from 0 to 5. There was no change in nocturia severity between admission and discharge. Daily urinary incontinence, urinary urgency, and comorbid illness were independently associated with multiple nocturia episodes. A history of falls within the last year, difficulty climbing stairs pre-admission, higher faecal incontinence score, impaired quality of life domains, higher levels of anxiety and depression were significantly more common in inpatients with multiple episodes of nocturia compared to no or only one episode of nocturia. Conclusion: Lower urinary tract symptoms, poor functional status and frailty markers were associated with repeated episodes of nocturia. Targeted intervention may reduce the severity of nocturia, with potential to improve sleep quality, impact therapeutic gains and influence discharge destination.

MON-502 Use of Continuous Subcutaneous Hydrocortisone Infusion Through Insulin Pump for Management of Primary Adrenal Insufficiency Complicated by Malabsorption and Frequent Hypoglycemia

Abstract A. Javed: None. A. Saif: None. M. Aguasvivas: None. P. Schroeder: None. P. Sack: None. Introduction: Continuous subcutaneous hydrocortisone infusion (CSHI) by insulin pump has been reported to lead to better physiologic replacement with lower requirements of daily hydrocortisone (HCT) and allows the patient to deliver boluses in acute illness. The use of insulin pump and continuous glucose monitor (CGM) are currently off label in patients with primary adrenal insufficiency poorly controlled on oral steroid therapy. Case: A 59-year-old female with Addison’s disease, primary hypothyroidism, primary ovarian failure, and severe gastrointestinal conditions including exocrine pancreatic insufficiency, gastroparesis, irritable bowel syndrome and acid reflux presented to our clinic after reading about off-label use of an insulin pump for continuous HCT delivery. She was frustrated with her steroid replacement regimen. She was taking sublingual HCT 1.75 mg at 12 and 2:30 am, and 2.5 mg at 7 am, 12 pm, 4 pm and 8:30 pm. In addition, she took sodium tablets 150 mg 4x daily and fludrocortisone 0.05 mg daily. She had tried higher doses of steroid and had major weight gain. Our first attempt to obtain the insulin pump for her was denied due to off label use. We tried a longer acting HCT regimen of 4 mg 3x daily with 5 mg of hydrocortisone acetate at 3 AM and fludrocortisone 0.05 mg daily. Historically she always had symptoms of low cortisol between 3-6 AM. She had hypoglycemic symptoms at night with weakness which she attributed to adrenal crisis. On several occasions her husband had given her a stress dose of HCT 100 mg intramuscularly with improvement in her symptoms. Her adrenal crisis symptoms and frequent HCT dosing were considered to be related to malabsorption and perhaps rapid metabolism of the HCT. She continued to have nocturnal symptoms and weight gain with the later HCT regimen. After repeated efforts, her insurance company approved the use of OmniPod5 with hydrocortisone (100 mg/ml). She required higher doses overnight: 0.75, 1.4, 1.6 and 1.3 mg/h at 12, 2, 4 and 6 am, respectively, and 0.5 mg/hr during the day (17.2 mg/day of basal HCT). She tried a CGM not integrated with the pump to track the overnight glucose. Based on the collected data, she bolused 0.5-1 mg of HCT if she had confirmed hypoglycemia less than 55mg/dL. The pancrelipase dose was increased, which resulted in less hypoglycemia. Lab test after 2 months on CSHI showed serial salivary cortisol throughout the day: 0.29, 1, 0.5 and 0.2 mcg/dL with lower levels at night and morning cortisol of 9.7 mcg/dL with suppressed ACTH 5.2 pg/mL. The physiologic replacement, which bypasses the gastrointestinal tract, prevents frequent crises. She is now able to sleep through the night with significant improvement in quality of life. Conclusion: CSHI in patients who are unable to tolerate conventional oral therapy is a viable option to replicate physiological circadian steroid pattern. In this case, concomitant use of CGM prevented nocturnal hypoglycemia. Monday, June 3, 2024

Evaluation and management of dyspnea as the dominant presenting feature in neuromuscular disorders.

Dyspnea is a common symptom in neuromuscular disorders and, although multifactorial, it is usually due to respiratory muscle involvement, associated musculoskeletal changes such as scoliosis or, in certain neuromuscular conditions, cardiomyopathy. Clinical history can elicit symptoms such as orthopnea, trepopnea, sleep disruption, dysphagia, weak cough, and difficulty with secretion clearance. The examination is essential to assist with the diagnosis of an underlying neurologic disorder and determine whether dyspnea is from a cardiac or pulmonary origin. Specific attention should be given to possible muscle loss, use of accessory muscles of breathing, difficulty with neck flexion/extension, presence of thoraco-abdominal paradox, conversational dyspnea, cardiac examination, and should include a detailed neurological examination directed at the suspected differential diagnosis. Pulmonary function testing including sitting and supine spirometry, measures of inspiratory and expiratory muscle strength, cough peak flow, sniff nasal inspiratory pressure, pulse oximetry, transcutaneous CO2, and arterial blood gases will help determine the extent of the respiratory muscle involvement, assess for hypercapnic or hypoxemic respiratory failure, and qualify the patient for noninvasive ventilation when appropriate. Additional testing includes dynamic imaging with sniff fluoroscopy or diaphragm ultrasound, and diaphragm electromyography. Polysomnography is indicated for sleep related symptoms that are not otherwise explained. Noninvasive ventilation alleviates dyspnea and nocturnal symptoms, improves quality of life, and prolongs survival. Therapy targeted at neuromuscular disorders may help control the disease or favorably modify its course. For patients who have difficulty with secretion clearance, support of expiratory function with mechanical insufflation-exsufflation, oscillatory devices can reduce the aspiration risk.

Randomized crossover trial of a demand oxygen delivery system in nocturnal hypoxemia

The newly developed portable oxygen concentrator with an auto-demand oxygen delivery system (auto-DODS) automatically switches between 3 sensitivities according to the negative pressure gradient of inhalation and supplies oxygen only during inhalation. The aim of this study was to verify the effectiveness and safety of auto-demand devices compared with a continuous flow oxygen concentrator, during sleep, in a randomized crossover noninferiority trial. We alternatively used an auto-DODS or a continuous-flow oxygen concentrator, all night on separate days for HOT (Home Oxygen Therapy) patients with nocturnal hypoxemic symptoms. The primary endpoints were the mean value of oxygen saturation (SpO2) over the total sleep time. The secondary endpoints included the efficacy endpoints and the safety endpoints. Regarding the primary endpoint, the difference in SpO2 between the auto-DODS and continuous flow was 0.835%. Since the upper limit of this difference did not exceed 2.8, which was set as the noninferiority margin, it was shown that the auto-DODS did not reduce SpO2 by at least 2.8% on average compared to continuous flow. No equipment failure or exacerbation of disease was observed, confirming the safety of the auto-DODS during the night.

Risk factors, associations, and high-risk patient profiles for nocturnal pain in carpal tunnel syndrome: implications for patient care.

Carpal tunnel syndrome results from chronic compression of the median nerve, causing pain and paresthesia, especially at night. The impact of these symptoms on patients includes disrupted sleep patterns and a desire to alleviate discomfort through hand movements. Our study aims to investigate risk factors, associations, and high-risk patient profiles associated with these nocturnal manifestations in carpal tunnel syndrome. Utilizing a retrospective case-control design, our study comprises 681 patients with carpal tunnel syndrome, including 581 with nocturnal symptoms and 90 without. Data were obtained through personalized phone calls and health records, covering health profiles, medical comorbidities, perioperative variables, and selected outcomes. Analyzing 591 patients with night symptoms revealed significant differences compared to the non-night symptoms group. The night symptoms group exhibited a lower mean age (51.3 vs. 56.6 years, p = 0.001), higher prevalence of diabetes (30.1% vs. 45.6%, p = 0.003), and paresthesia (98.5% vs. 81.1%, p < 0.001). In addition, the night symptoms group reported a higher incidence of disabling pain (89.2% vs. 70.0%, p < 0.001), weak hand grip (80.5% vs. 62.2%, p < 0.001), and night splints use (37.7% vs. 24.4%, p < 0.001). Preoperatively, the night symptoms group exhibited slightly higher intraoperative anxiety (40.9% vs. 30.0%, p = 0.12) and a slightly longer recovery time (1.7 vs. 1.4 months, p = 0.22), with no significant difference in pain relief scores (8.1 vs. 7.7, p = 0.16). Patients with night symptoms show increased likelihood of comorbidities (diabetes, and renal, conditions), along with a propensity for disabling symptoms and paresthesia. Although they experience slightly longer recovery times, they demonstrate improved pain relief scores. Case-Control Study.

NITES, a nocturnal bladder score to aid diagnosis during the transition to older age care.

As adults transition to older age, bothersome nocturnal lower urinary tract symptoms (LUTS) become common. There is need for a reliable assessment metric to detect and measure specific symptoms. To subject the nocturnal LUTS score for older individuals, Nocturia, Incontinence, Toileting and Enuresis Symptom Score (NITES), to psychometric analysis. Factor analysis of the metric was conducted with completed questionnaires from 151 older individuals who were either admitted to a tertiary hospital or attending an outpatient continence clinic. Test re-test reliability involved 18 older community dwelling individuals attending a Geriatrician clinic completing the metric at two timepoints separated by at least 1 week. Intra-class correlation coefficients were determined for reliability of each factor and item. The NITES metric was completed by 98 hospitalized older individuals and 53 attending a continence clinic (mean age 83.2 years [SD 7.0]). Factor analysis demonstrated that one item had a floor effect and two items had poor endorsement. After test re-test reliability analysis, a further three items were removed: one due to poor correlation between timepoints and two demonstrating inadequate internal consistency. The final NITES metric is comprised of three factors: Sleep 4-items, Incontinence 4-items, and Personal Bother 2-items. A 4-item short form for symptom screening was extracted from the longer measure. The final NITES metric is a 10-item questionnaire with an embedded 4-item short symptom screen. It has utility utilized to detect nocturnal bladder symptoms in both community dwelling and hospitalized older adults.

Nocturnal Urinary Symptoms as Screening Tools for Obstructive Sleep Apnea.

Nocturnal lower urinary tract symptoms are part of obstructive sleep apnea (OSA), and urogynecology clinics may serve as OSA screening sites. This study's aim was to determine the accuracy of nocturia and nocturnal enuresis (NE) as screening tools for OSA in new patients at a urogynecology clinic. Using a retrospective study design, we gathered information regarding diagnostic OSA testing, continuous positive airflow pressure use, and lower urinary tract symptoms improvement from women in a urogynecology clinic who were previously screened for OSA using validated questionnaires. Nocturia and NE were tested for sensitivity and specificity using positive OSA diagnosis by polysomnography as the gold standard. Nocturia with a cutoff of ≥2 episodes per night had the best test characteristics-86.4% sensitivity (95% confidence interval [CI], 65.1-97.1) and 58.5% specificity (95% CI, 44.1-71.9) for an overall accuracy of 78.4% (95% CI, 67.0-89.8). Nocturnal enuresis with a cutoff of ≥1 episode per week had the best NE characteristics with 31.8% sensitivity (95% CI, 13.9-54.9) and 79.3% specificity (95% CI, 65.9-89.2) for an overall accuracy of 56.1% (95% CI, 41.2-71). Lower urinary tract symptoms such as nocturia and NE are routinely assessed in urogynecology clinics, making them useful for OSA screening and referral. The present study found nocturia symptoms with ≥2 episodes per night to retain acceptable test characteristics in screening for OSA, whereas NE was found to have less acceptable test characteristics for OSA screening. Urogynecology clinics may utilize nocturia symptoms in clinical decision making for OSA referral.