Reduction In Airflow Research Articles

Are scoring respiratory effort-related arousals worth the effort? --A study comparing outcomes between 4 % vs 3 % hypopnea scoring rules

Study objectivesThe respiratory effort-related arousal (RERA) has been combined with apneas and hypopneas into the respiratory disturbance index (RDI). RERAs are characterized by ≥ 10 s of increasing upper airway effort terminating in arousal without meeting hypopnea criteria. The recent change to hypopnea definitions now includes a ≥30 % reduction in airflow for 10 s with EITHER a 3 % oxygen desaturation OR an arousal. Consequently, many events previously categorized as RERAs will now be included in the 3 % hypopneas, likely reducing the number of events scored as RERAs. We hypothesized that the 3 % apnea-hypopnea index (3%AHI) would approximate the 4%RDI, with the number of 3 % RERAs being negligible. Research questionHow does the transition from the 4 % to the 3 % hypopnea rules impact the significance of RERAs in clinical practice, and how we should relate the AHI and RDI using the different hypopnea rules? MethodsWe prospectively collected 76 consecutive polysomnography results in 4 adult age groups. We re-scored the respiratory events utilizing both the 3 % and the 4 % hypopnea rules and compared the outcomes. ResultsAmong 76 diagnostic studies (mean age 47.5 years, males 47.4 %), the 3 % RERA index [0.8 (0.0, 3.1)] [median (Q1, Q3)] was significantly lower than the 4 % RERA index [3.5 (1.0, 7.3)]. The 3%AHI was 3.07 ± 9.23 (mean ± SD) higher than the 4%RDI (p = 0.005). The 3%AHI was 8.63 ± 8.86 higher than the 4%AHI in all age groups (p < 0.001). This was mainly due to an increased hypopnea index (+8.51 ± 9.03, p < 0.001). In patients with obstructive sleep apnea (OSA), the 3%RERA contributes 4.3 % to the 3%RDI, while the 4%RERA contributes 27.7 % to the 4%RDI. InterpretationsBoth 3%RDI and 3%AHI are higher than the 4%RDI, primarily due to identification of more hypopnea events, resulting in more patients being classified as having OSA. This change in criteria complicates the comparison of hypopnea and RERA contributions between sleep studies scored using the different hypopnea rules.

Impact of cylinder deactivation on fuel efficiency in off-road heavy-duty diesel engines during high engine speed operation

Off-road heavy-duty diesel engines are equipped with complex aftertreatment systems to meet the stringent EPA Tier 4 emission standards. Traditionally, the thermal management of the aftertreatment system, aimed at efficiently reducing tailpipe emissions, involves controlling engine exhaust flow and temperature. However, this approach often leads to inefficient engine operation, especially in the low to mid-load regions, resulting in higher fuel consumption. Prior studies have highlighted the potential of cylinder deactivation (CDA) in reducing fuel consumption and increasing the exhaust temperature for thermal management in on-road applications. As the significance of controlling greenhouse gas (GHG) emissions from off-road machinery comes into focus, this study aims to experimentally demonstrate the fuel efficiency benefits and efficient aftertreatment thermal management achieved through CDA during high-speed operation on a Tier 4 level off-road heavy-duty diesel engine. In a typical off-road duty cycle, such as Non-Road Transient Cycle (NRTC), about 82.5% of cycle’s energy is produced in the engine speed range of 1750–2200 rpm, prompting investigation into the impact of CDA during high-speed operations. CDA results in airflow reductions and increased exhaust gas temperatures due to lower air–fuel ratio (AFR). The reduced airflow operation minimizes pumping work, allowing for higher open cycle efficiency, and thereby translating into lower fuel consumption. The study reveals a new finding: fuel benefits from CDA extend over a larger load range (up to 8.3 bar BMEP) during high-speed operation in off-road heavy-duty engines compared to findings in on-road heavy-duty engines. This phenomenon can be attributed to sufficient oxygen inducted during CDA operation, resulting from similar turbocharger speeds compared to all-cylinder firing operation, especially at high-loads, thereby maintaining particulate matter (PM) concentration within prescribed constraints. Steady-state test results demonstrate a reduction in fuel consumption from 33.7% at 0.4 bar to 1.4% at 8.3 bar BMEP, at 2100 rpm engine speed.

Improving heat transfer and compressed air consumption in low pressure die casting of aluminum wheels

Automotive wheels made from aluminum alloys are generally manufactured using the Low-Pressure Die Casting (LPDC) method. The molten aluminum is pressurized and filled into the cavities between the molds, and it is cooled using cooling channels in the LPDC. While the cooling fluid can be either air or water in industrial applications, only air cooling is utilized within the scope of this study. The primary expenditures of the process are attributed to the cycle time and the consumption of compressed air. In industrial settings, the primary coolant supply, emanating from either one or two inlet sources, is systematically channeled through a series of nozzles. These nozzles are strategically designed to impinge air onto specific areas of the mold pockets, ensuring efficient cooling.This research focuses on enhancing the cooling channels and mold pocket regions in LPDC through a combination of experiments and Computational Fluid Dynamics (CFD) integrated with Conjugate Heat Transfer (CHT) analyses. The study involves designing cooling channels to achieve a uniform mass flow distribution at the nozzle outlets, and optimizing the mold pocket regions. This optimization resulted in a 46% reduction in compressed air flow while maintaining comparable levels of heat transfer in the optimized mold pocket design. Moreover, flow rate non-uniformity at nozzle outlets was reduced from 11.5% to 2.0% to achieve uniform cooling and temperature distribution across the wheel spokes. An experimental setup with a cooling pipe network allowed simultaneous flow rate measurements from 20 outlets using flow rate sensors.The improved cooling channel and mold pocket design were adapted to the LPDC, and 20 aluminum alloy wheels were successfully cast with a 46% lower mass flow rate. All these wheels were tested in accordance with the relevant test specifications and the results obtained were assessed as compliant according to certain limits.

Therapeutic efficacy of adrenergic agents on systemic and spinal hemodynamics in an acute cervical spinal cord injury rodent model

BACKGROUNDCervical spinal cord injury usually results in cardiorespiratory dysfunctions due to interruptions of the bulbospinal pathways innervating the cervical phrenic motoneurons and thoracic sympathetic preganglionic neurons. PURPOSEThe present study aimed to evaluate the therapeutic effects of adrenergic agents on systemic and spinal hemodynamics during acute cervical spinal cord injury. STUDY DESIGNIn vivo animal study. METHODSThe cardiorespiratory function and spinal cord blood flow and oxygenation level were monitored in response to cervical spinal cord contusion and intravenous infusion of three types of adrenergic agents (phenylephrine, dobutamine, and norepinephrine). RESULTSCervical spinal cord contusion resulted in immediate reduction of respiratory airflow, arterial blood pressure, and spinal cord blood flow. The arterial blood pressure and spinal cord blood flow remained lower than the preinjury value in contused animals infused with saline at 60 min postinjury. Infusion of phenylephrine (500, 1000, and 2000 μg/kg) and norepinephrine (125, 250, and 500 μg/kg) significantly increased the arterial blood pressure, while only norepinephrine augmented the spinal cord blood flow. Conversely, dobutamine (1000 and 2000 μg/kg) reduced both arterial blood pressure and spinal cord blood flow. Notably, administration of adrenergic agents tended to increase spinal cord hemorrhage in contused animals. CONCLUSIONSInfusion of norepinephrine can effectively maintain the blood pressure and improve spinal cord blood flow during acute spinal cord injury. CLINICAL SIGNIFICANCENorepinephrine may be a superior medicine for hemodynamic management; however, the potential hemorrhage should be considered when utilizing the vasopressor to regulate systemic and spinal hemodynamics at the acute injured stage.

Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea.

Rationale: Moderate-severe obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI], >15 events/h) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate-severe OSA (i.e., AHI <15 events/h) also report sleepiness. Objectives: To test the hypothesis that sleepiness in the AHI <15 events/h group is a consequence of substantial flow limitation in the absence of overt reductions in airflow (i.e., apnea/hypopnea). Methods: A total of 1,886 participants from the MESA sleep cohort were analyzed for frequency of flow limitation from polysomnogram-recorded nasal airflow signal. Excessive daytime sleepiness (EDS) was defined by an Epworth Sleepiness Scale score ⩾11. Covariate-adjusted logistic regression assessed the association between EDS (binary dependent variable) and frequency of flow limitation (continuous) in individuals with an AHI <15 events/h. Results: A total of 772 individuals with an AHI <15 events/h were included in the primary analysis. Flow limitation was associated with EDS (odds ratio, 2.04; 95% confidence interval, 1.17-3.54; per 2-standard deviation increase in flow limitation frequency) after adjusting for age, sex, body mass index, race/ethnicity, and sleep duration. This effect size did not appreciably change after also adjusting for AHI. Conclusions: In individuals with an AHI <15 events/h, increasing flow limitation frequency by 2 standard deviations is associated with a twofold increase in the risk of EDS. Future studies should investigate addressing flow limitation in low-AHI individuals as a potential mechanism for ameliorating sleepiness.

Nocturnal oxygen therapy in obstructive sleep apnoea: a systematic review and meta-analysis.

Obstructive sleep apnoea is characterised by recurrent reduction of airflow during sleep leading to intermittent hypoxia. Continuous positive airway pressure is the first-line treatment but is limited by poor adherence. Nocturnal oxygen therapy may be an alternative treatment for obstructive sleep apnoea but its effects remain unclear. This meta-analysis evaluates the effects of nocturnal oxygen therapy on both obstructive sleep apnoea severity and blood pressure.A literature search was performed based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Peer-reviewed, randomised studies that compared the effect of nocturnal oxygen therapy to sham in obstructive sleep apnoea patients were included. The main outcomes were the apnoea-hypopnoea index and systolic and diastolic blood pressure.The search strategy yielded 1295 citations. Nine studies with 502 participants were included. When nocturnal oxygen therapy was compared to sham/air, it significantly reduced the apnoea-hypopnoea index (mean difference (MD) -15.17 events·h-1, 95% CI -19.95- -10.38 events·h-1, p<0.00001). Nocturnal oxygen therapy had no significant effect on blood pressure at follow-up without adjustment for baseline values, but did, where available, significantly attenuate the change in blood pressure from baseline to follow-up for both systolic blood pressure (MD -2.79 mmHg, 95% CI -5.45- -0.14 mmHg, p=0.040) and diastolic blood pressure (MD -2.20 mmHg, 95% CI -3.83- -0.57 mmHg, p=0.008).Nocturnal oxygen therapy reduced the apnoea-hypopnoea index severity and the change in (but not absolute) systolic and diastolic blood pressure, compared to sham. This suggests that nocturnal oxygen therapy may be a treatment option for obstructive sleep apnoea. Further studies with longer-term follow-up and standardised measurements are needed.

Obstructive sleep apnoea-hypopnoea syndrome.

Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a common disorder characterised by repetitive episodes of the complete or partial collapse of the pharyngeal airway during sleep. This results in cessation (apnoea) or reduction (hypopnoea) of airflow, leading to oxygen desaturation and sleep fragmentation. An individual's disposition to develop OSAHS depends on the collapsibility of a segment of the upper airway. The degree of collapsibility can be quantified by the balance between occluding or extraluminal pressures of the surrounding tissues. Patients can experience snoring, unrefreshing sleep, witnessed apnoeas, waking with a choking sensation and excessive daytime sleepiness. OSAHS has a broad range of consequences, including cardiovascular, metabolic, and neurocognitive sequelae. Treatment options include lifestyle measures, in particular weight loss, and strategies to maintain upper airway patency overnight, including continuous positive airway pressure, mandibular advancement devices and positional modifiers.

Rethinking O2, CO2 and breathing during wakefulness and sleep.

We have examined the importance of three long-standing questions concerning chemoreceptor influences on cardiorespiratory function which are currently experiencing a resurgence of study among physiologists and clinical investigators. Firstly, while carotid chemoreceptors (CB) are required for hypoxic stimulation of breathing, use of an isolated, extracorporeally perfused CB preparation in unanaesthetized animals with maintained tonic input from the CB, reveals that extra-CB hypoxaemia also provides dose-dependent ventilatory stimulation sufficient to account for 40-50% of the total ventilatory response to steady-state hypoxaemia. Extra-CB hyperoxia also provides a dose- and time-dependent hyperventilation. Extra-CB sites of O2-driven ventilatory stimulation identified to date include the medulla, kidney and spinal cord. Secondly, using the isolated or denervated CB preparation in awake animals and humans has demonstrated a hyperadditive effect of CB sensory input on central CO2 sensitivity, so that tonic CB activity accounts for as much as 35-40% of the normal, air-breathing eupnoeic drive to breathe. Thirdly, we argue for a key role for CO2 chemoreception and the neural drive to breathe in the pathogenesis of upper airway obstruction during sleep (OSA), based on the following evidence: (1) removal of the wakefulness drive to breathe enhances the effects of transient CO2 changes on breathing instability; (2) oscillations in respiratory motor output precipitate pharyngeal obstruction in sleeping subjects with compliant, collapsible airways; and (3) in the majority of patients in a large OSA cohort, a reduced neural drive to breathe accompanied reductions in both airflow and pharyngeal airway muscle dilator activity, precipitating airway obstruction.

Significance of Plasma Irisin, Adiponectin, and Retinol Binding Protein-4 Levels as Biomarkers for Obstructive Sleep Apnea Syndrome Severity.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder that is caused by the reduction or cessation of airflow in the upper airway. Irisin, retinol-binding protein-4 (RBP-4), and adiponectin are the three significant factors in the metabolic process of the human body. The objective of this study was to investigate whether plasma irisin, RBP-4, and adiponectin levels are associated with the severity of OSAS. According to inclusion and exclusion criteria, 125 patients with OSAS and 46 healthy, gender-matched controls were included in this study. The patients were classified according to the apnea hypopnea index (AHI) as 14 mild cases (5 < AHI < 15), 23 moderate OSAS cases (15 < AHI < 30), and 88 severe OSAS cases (AHI > 30). The plasma irisin, RBP-4, and adiponectin levels were measured and compared between groups. RBP-4 levels were higher in severe OSAS compared to other groups, and irisin levels were significantly lower in severe OSAS compared to other groups. There was a negative correlation between irisin and RBP-4 (r = -0.421; p < 0.001), and irisin and AHI (r = -0.834; p < 0.001), and a positive correlation between irisin and adiponectin (r = 0.240; p = 0.002). There was a negative correlation between RBP-4 and adiponectin (r = -0.507; p < 0.001) and a positive correlation between RBP-4 and AHI (r = 0.473; p < 0.001). As a predictor of OSAS, adiponectin showed the highest specificity (84.8%) and RBP-4 the highest sensitivity (92.0%). Circulating adiponectin, irisin, and RBP-4 may be new biomarkers in OSAS patients in addition to risk factors such as diabetes, obesity, and hypertension. When polysomnography is not available, these parameters and clinical data can be used to diagnose the disease. As a result, patients with an AHI score greater than thirty should be closely monitored for metabolic abnormalities.

OBSTRUCTIVE SLEEP APNEA AND ITS PROSTHODONTIC MANAGEMENT: A DENTAL OUTLOOK

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. Prevalence of obstructive sleep apnea is favored in men more than woman. Risk factors include nasal obstruction, obesity, gender, craniofacial anatomy, and smoking. Polysomnography is proved to be the golden-standard method for diagnosing obstructive sleep apnea. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures. Oral appliance, namely, mandibular advancement device (MAD) is the recommended treatment appliance for the patient with mild to moderate OSA. For the dental profession in general and in prosthodontists speciality, the subject of sleep medicine continues to offer great challenges and opportunities in diagnosis, treatment planning, and treatment based on qualitative evidence. This article discusses the various aspects and prosthodontic perspectives of obstructive sleep apnea in detail.

Contactless camera-based AHI score estimation in SAS patients

Abstract Sleep apnea syndrome (SAS) is a common sleeprelated breathing disorder characterized by recurring cessations of airflow during sleep. The gold standard for diagnosing SAS is polysomnography (PSG) which requires the patient to spend one or several nights in a sleep clinic. A PSG involves a significant amount of contact-based sensors, which leads to discomfort and deviations in sleep behavior. In this work, a contactless, multispectral camera-based approach for the autonomous detection of events of nocturnal airflow reduction is presented. The detected events are further employed in estimators of sleep diagnostic metrics, such as the apnea-hypopnea index (AHI) and the SAS stage. The AHI estimation resulted in a Pearson correlation coefficient of r = 0.9993. The SAS stage estimator correctly predicted the SAS stage for all three recruited patients.

Improving the Efficiency of Fan Coil Units in Hotel Buildings through Deep-Learning-Based Fault Detection.

Optimizing the performance of heating, ventilation, and air-conditioning (HVAC) systems is critical in today's energy-conscious world. Fan coil units (FCUs) play a critical role in providing comfort in various environments as an important component of HVAC systems. However, FCUs often experience failures that affect their efficiency and increase their energy consumption. In this context, deep learning (DL)-based fault detection offers a promising solution. By detecting faults early and preventing system failures, the efficiency of FCUs can be improved. This paper explores DL models as fault detectors for FCUs to enable smarter and more energy-efficient hotel buildings. We tested three contemporary DL modeling approaches: convolutional neural network (CNN), long short-term memory network (LSTM), and a combination of CNN and gated recurrent unit (GRU). The random forest model (RF) was additionally developed as a baseline benchmark. The fault detectors were tested on a real-world dataset obtained from the sensory measurement system installed in a hotel and additionally supplemented with simulated data via a physical model developed in TRNSYS. Three representative FCU faults, namely, a stuck valve, a reduction in airflow, and an FCU outage, were simulated with a much larger dataset than is typically utilized in similar studies. The results showed that the hybrid model, integrating CNN and GRU, performed best for all three observed faults. DL-based fault detectors outperformed the baseline RF model, confirming these solutions as viable components for energy-efficient hotels.

Evaluation of passive flux samplers with different orifice sizes to measure ammonia volatilization losses

AbstractA common passive sampler used to measure NH3 volatilization losses in field studies has a nozzle with a 1‐mm, round orifice that reduces air flow to increase NH3 adsorption. This reduction in air flow, measured by the orifice's K value (0–1), implies a reduction in the amount of NH3 entering the sampler per unit of time, which may require a longer exposure to accumulate measurable quantities of NH3. Increasing the diameter of the orifice would increase the NH3 entering the sampler and possibly allow shorter exposure times, but it may also lead to increased NH3 bypass. The objectives of this research were to (1) determine the effect of wind speed on NH3 bypass in samplers with 1‐ or 2‐mm orifices, (2) determine the reduction in air speed in samplers with 1‐ or 2‐mm orifices by determining their K values, and (3) compare field NH3 volatilization losses measured with 1‐ and 2‐mm orifices. A laboratory study with wind speeds ranging from 0.6 to 10 m·s−1 showed that both orifice sizes had NH3 bypass at low and high wind speeds. Results from wind tunnel studies determined that flow was reduced to 63% (K = 0.63) in 1‐mm orifices and to 74% (K = 0.74) in 2‐mm orifices. Field studies indicated that 1‐mm orifices may measure greater NH3 volatilization losses than 2‐mm orifices at average low wind speeds when maximum wind speeds &lt;10 m·s−1, but may measure equal or lower losses than 2‐mm orifices when several days occur with maximum wind speeds &gt;10 m·s−1.

The association of denture wearing with reduced lung function and increased airflow limitation in 58-72 year old men.

To investigate the association between denture wearing and airflow limitation in men in Northern Ireland enrolled in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study. A case-control design was used to study partially dentate men. Cases were men aged 58-72 years who were confirmed as denture wearers. Controls were never denture wearers who were matched by age (± 1 month) and smoking habit to the cases. The men had a periodontal assessment and completed a questionnaire detailing their medical history, dental history and behaviours, social circumstances, demographic background and tobacco use. Physical examination and spirometry measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were also undertaken. Spirometry data for edentulous men who wore complete dentures were compared with that recorded for the partially dentate men studied. There were 353 cases who were partially dentate and were confirmed denture wearers. They were matched for age and smoking habit to never denture wearer controls. The cases had an FEV1 that was on average 140 ml lower than the controls, p = 0.0013 and a 4% reduction in percent predicted FEV1, p = 0.0022. Application of the GOLD criteria indicated that 61 (17.3%) of the cases had moderate to severe airflow limitation compared with 33 (9.3%) of controls, p = 0.0051. Fully adjusted multivariable analysis showed that partially dentate men who were denture wearers were significantly more likely (p = 0.01) to have moderate to severe airflow reduction with an adjusted odds ratio (OR) of 2.37 (95% confidence intervals 1.23-4.55). In the 153 edentulous men studied moderate to severe airflow limitation was recorded in 44 (28.4%), which was significantly higher than in the partially dentate denture wearers (p = 0.017), and the men who had never worn a denture (p<0.0001). Denture wearing was associated with an increased risk of moderate to severe airflow limitation in the cohort of middle-aged Western European men studied.

0270 Obstructive Sleep Apnea detection using ECG morphology and Machine Learning

Abstract Introduction Obstructive Sleep Apnea (OSA) is characterized by reduction in airflow. Hypopnea is a smaller reduction in airflow compared to apnea but also accompanied by drop in oxygen saturation leading to sympathetic activation. Frequent OSA events are correlated with incidence of cardiovascular diseases. Measuring changes in airflow requires overnight polysomnography that is expensive. Electrocardiogram (ECG) is available through wearable devices at home and therefore, detecting OSA events using ECG can make OSA diagnostics more accessible. This paper studies the use of ECG morphology and an ensemble machine learning algorithm to detect OSA events. The algorithm designed is light weight to ensure that it can be implemented on an embedded processor. Methods The data from the Apnea, Bariatric surgery, and CPAP (ABC) study provided by the National Sleep Research Resource is used for the analysis. Twenty-six subjects diagnosed with severe OSA are considered with single night polysomnography before treatment. Since OSA events have a minimum 10s duration, 10s non-overlapping windows with OSA labels from a technician scoring is used. Features are extracted from the PQRST complex and majority voting across multiple algorithms is used to select the top 7 features (SDNN, RMSSD, P-P interval, P-duration, P-R interval, T-duration and T-P interval) with highest explanatory power. We train a random forest classifier using leave-one-out methodology where 25 subjects are used for training and the 26th subject is used for testing (all permutations are used). We use sensitivity, precision and F1 score for evaluation. Results The algorithm detects the precise occurrence (onset and offset) as well as the total number of events during the night. The precision, sensitivity and F1 scores are 70%, 96% and 80% respectively. The prediction leans towards higher occurrence of OSA events as the subjects suffer from severe OSA. We uncover 32% of false positives are events that are accompanied by significant SPO2 desaturation pointing to the inaccuracy of manual scoring. Assuming these false positives are correct predictions the precision increases to 79%. Conclusion The classification of OSA events using ECG features and machine learning demonstrates the feasibility of using wearables to measure OSA in a home setting. Support (if any)

Obstructive Sleep Apnea, Psychotic Symptoms Common in Alzheimer’s Disease Patients

Obstructive Sleep Apnea, Psychotic Symptoms Common in Alzheimer’s Disease Patients

Smell-related quality of life changes after total laryngectomy: a multi-centre study

PurposeA total laryngectomy creates an alternate airway for gas exchange that bypasses the upper aerodigestive tract. The subsequent reduction in nasal airflow, and therefore, reduction in deposition of particles to the olfactory neuroepithelium leads to hyposmia or anosmia. The aim of this study was to assess the quality of life impairment conferred by anosmia following laryngectomy and identify any specific patient-related risk factors that are associated with poorer outcomes.MethodsConsecutive patients with a total laryngectomy presenting for review at three tertiary head and neck services (in Australia, the United Kingdom and India) over a 12-month period were recruited. Patient demographic and clinical data were collected, and each subject completed the validated assessment of self-reported olfactory functioning and olfaction-related quality of life questionnaire (ASOF). Dichotomous comparisons were performed using the student's unpaired t-test for continuous variables (SRP), a chi-squared test for categorical variables, and a Kendall's tau-b for ordinal variables (SOC) to assess for a correlation with poorer questionnaire scores.ResultsA total of 66 laryngectomees (13.4% female; age 65.7 ± 8.6 years) were included in the study. The mean SRP score of the cohort was found to be 15.6 ± 7.4, while the mean ORQ score was noted to be 16.4 ± 8.1. No other specific risk factors associated with poorer quality of life were identified.ConclusionA significant quality of life detriment from hyposmia is conferred following laryngectomy. Further research to assess treatment options and the patient population that would best benefit from these interventions is required.

Association Between Anterior Rhinoscopic/Endoscopic Assessment of Internal Nasal Valve and Various Nasal Deformities in the Rural Population of Vidarbha Region of India: A Cross-Sectional Study.

Background The nasal valves constitute the majority of the nasal cavity's resistance. Any reduction in this already narrow area can cause a significant reduction in the nasal airflow. In this present study, the aim was to do an endoscopic assessment of the internal nasal valve (INV) in patients with various nasal septal deviations, with or without external nasal deformity. We measured endoscopically the INV in various nasal deformities and derived its association with the INV on anterior rhinoscopy and endoscopic assessment. Method We included 75 patients in the study who were analyzed for angle and grade of the INV by anterior rhinoscopic examination and Hopkins rod zero-degree nasal endoscope (Karl Storz SE & Co., Tuttlingen, Germany). Nasal septal deviations were also studied with respect to the Mladina classification. Correlation between various nasal septal deviations with the INV was done. Since studies addressing the classification of INV are not available in the literature, for the purpose of simplification of observation of INV angle, (normal range 9-15 degrees), subjective stratification was made in the study, i.e.below 9, 9-15, and more than 15 degrees for the sake of knowing the underlying cause and its relationship. Result An anterior rhinoscopic examination was performed on 75 patients. INV Grade 1 was the most common, with 18 patients of (69.2%), 15 patients of DNS with caudal dislocation (55.6%), five patients of DNS with spur (38.5%), and four patients of DNS with external nasal deformity (50%). The next frequently observed Grade of INV on anterior rhinoscopy examination was Grade 2, in 11 patients of DNS with caudal dislocation (40.7%), four patients of DNS with spur (30.8%), and three patients of DNS with external deformity (37.5%), which was statistically significant in our study. In the majority of patients with all types of nasal septal deviations with or without external nasal deformity, INV (angle) of less than 9 degrees was noted, which was statistically significant. A linear relationship, ie., Grade 0 INV in Type I, Grade 1INV in types II, III, IV, and V, and Grade 2 in Type VII was observed. Our study is on par with the literature questioning the dogma of the normal angle of INV being 9-15 degrees. Conclusion We were able to establish a positive and complimentary role of anterior rhinoscopic and endoscopic assessment of INV. The proposed novel classification of the angle of INV by endoscopic assessment gives a better insight into the association of INV with various nasal septal deformities with or without external nasal septal deviation.

Design of a wearable device for respiratory rate monitoring and detection of anomalous values

Abstract Chronic obstructive pulmonary disease (COPD) is characterized by a persistent reduction in airflow. Symptoms gradually worsen and shortness of breath, dyspnea, increases over time to even appear at rest. Regarding measurement technology, spirometry is the reference standard for the diagnosis and evaluation of the severity of said condition. This test requires specialized equipment that does not allow it to be performed on an outpatient basis or for constant monitoring. For this reason, the doctor must systematically look for the presence of symptoms that may go unnoticed by the patient and that can be attributed to age, sedentary lifestyle, or the fact of smoking. Also, prolonged expiration in the trachea during a maximum forced effort can be useful in the early diagnosis of obstruction or when spirometry is not available, which is why it would be important to be able to constantly monitor breathing in order to increase the probability of identifying possible COPD at an early stage. The solution proposed in this article is focused on the design and implementation of a wearable device that allows the monitoring of the respiratory rate. This device will allow this biometric variable to be identified and will notify when it is outside the normal ranges to suggest an airflow test (spirometry) at a possible early stage of the disease. This instrumentation system will be integrated into the frame of a pair of glasses, specifically positioning the sensor on the nasal platelets.

Stop-bang questionnaire as a screening tool for obstructive sleep apnoea in the surgical population: a prospective observational study

Introduction and Aim: Obstructive sleep apnoea (OSA) is a type of sleep-related breathing disorder characterized by repetitive episodes of partial and complete pharyngeal collapse causing a reduction or total cessation of airflow during sleep. Undiagnosed, it increases the intraoperative and postoperative complications. This study aimed to screen patients undergoing surgical procedures for OSA using a validated self-report STOP-Bang questionnaire. Materials and Methods: This prospective observational study was conducted in a tertiary care hospital between June and November 2021 and included 174 patients posted for elective surgery. A modified STOP-Bang questionnaire was used to evaluate participants for OSA. Documentation also included the difficulty in mask holding, number of attempts at laryngoscopy and intubation, the type and size of the endotracheal tube, and attempts to place a supraglottic airway device. Results: The prevalence of self-reported OSA was 5.2% (n=9) among the 174 participants included in this study. Among the patients (n=98) who underwent general anaesthesia 32 had difficult airways, among which 20 (62.5%) had a predictor of difficult airway and two had OSA. One among the 2 OSA patients had other predictors of difficult airway. No statistical significance was observed between OSA and the difficult airway (p=0.723). However, a clinically significant association was seen for difficult mask holding for patients with OSA but having no other predictors of difficult airway. Conclusion: Using the STOP-Bang questionnaire to screen OSA in patients undergoing general anaesthesia or sedation can help the anaesthesiologist manage difficult airways more effectively.