Breathing Sessions Research Articles

Heart Failure (HF): Recent innovations in clinical therapy and critical profiles of acute and chronic forms

Background and objectives: Heart failure is a pathological condition characterized by the inability of the heart to pump (cardiac output) an adequate amount of blood to meet the metabolic needs of the body or, at any rate, to be able to do so only at the expense of increased filling pressures in one or more cardiac chambers and the upstream venous circulation. The research group states here the primary objective of expanding the indications contained in the ESC 2021 with the results of the last year on the subject of treatment profiles, to facilitate a better understanding of the overall clinical picture and contribute to the next edition of the guidelines. Materials and methods: Systematic literature review in the English language from January 1, 2021, to September 30, 2022, on PubMed/MedLine, Web on Science, and Cochrane archive. Our search strategy retrieved 8,317 articles. We excluded books and papers, meta-analyses, reviews, and systematic reviews and selected only 46 studies most significant about the clinical trial and randomized controlled trial. Results: The recent ESC 2021 guidelines are accurate and timely, and have confirmed their usefulness from a functional perspective, including concerning certain aspects that were represented as a “grey area”. Early risk prediction plays a key role in the subsequent management of patients, and to optimize risk prediction and intensity of management, one should take into account that: a) biomarkers have improved the understanding of the pathophysiology of heart failure and may therefore help to adjust the intensity of management in AHF; b) among the wide variety of biomarkers currently available, NT-proBNP and cTn seem the most promising in this indication; c) among the risk scores described, those combining demographic and clinical parameters with biomarkers in a model with routinely available rapid variables seem the most promising tools; d) in addition to biomarkers, age, systolic blood pressure, respiratory rate, oxygen saturation, creatinine, electrolytes, and blood urea nitrogen are the most commonly used predictor variables in the risk scores described; e) among the models selected, the MEESSI-AHF risk score appears to be currently the most promising tool for predicting the risk of AHF; f) during the management of decompensated patients (and in later stages), the psychological aspect is completely ignored, thus promoting the worsening of psychological symptoms (the need is as evident during the acute episode as it is in the daily management of chronic heart failure). Conclusions: The scientific literature search enriched the structure of ESC 2021, suggesting its implementation, with other findings related to new drug therapies such as Sotagliflozin, Hydrochlorothiazide Apabetalone, Alprostadil, Empagliflozin, Sacubitril/Valsartan, Dapagliflozin, Sodium-glucose co-transporter-2 inhibitors, and biomarkers such as Urinary sodium (UNa+), IL-6 levels and rh-brain natriuretic peptide (rhBNP), as well as the use of mindful breathing session, osteopathic manipulative treatment, electrical muscle stimulation, low-level tragus stimulation, venoarterial extracorporeal membrane oxygenation, oral nutritional supplements, and the correlative hypothesis between heart failure and intestinal dysbiosis, also concerning the psychological profile. However, these clinical studies suffer from some limitations that will necessarily have to be taken into account, such as the limited size of the population sample selected or the conflict of interest determined by the fact that some research is funded by the same pharmaceutical company producing the drug used that do not necessarily represent a negative limitation on the results obtained from studies.

SNOOZE AND SLUMBER: THE SLEEP APNEA APNEA-HYPOPNEA INDEX (AHI) VS THE EPWORTH SLEEPINESS SCALE (ESS)

SESSION TITLE: Updates on Sleep-Disordered Breathing and Central HypersomniasSESSION TYPE: Original InvestigationsPRESENTED ON: 10/16/2022 10:30 am - 11:30 amPURPOSE: Obstructive sleep apnea (OSA) has a prevalence of approximately one billion people worldwide and is characterized by hypopneas, apneas and repetitive upper airway collapse during sleep. Several risk factors have been associated with this diagnosis including obesity, older age, male gender as well as upper airway and anatomical abnormalities. While the STOPBANG score is available to determine the pretest probability of OSA, there is little data available comparing a patient’s subjective degree of sleepiness to his OSA classification.METHODS: To better determine if there is any identifiable relation between the symptoms reported by a patient to the likelihood of actually having sleep apnea and to what degree, a retrospective analysis was done looking at 1443 patients seen in the Pulmonary and Sleep Clinic at Beaumont Hospital between the years 2014-2019. The Apnea-Hypopnea Index (AHI) was then compared to the Epworth Sleepiness Scale (ESS) score and evaluated using a Pearson correlation.RESULTS: The data was statistically significant and revealed there is no relation between a patient’s objective AHI versus subjective ESS (Pearson correlation= 0.106, p-value= 0.000). This information was further classified into employed versus unemployed and there was again no correlation indicating a higher ESS equates to more severe OSA, irrespective of employment status (employed AHI average = 25.5, employed ESS average = 10.0, unemployed average AHI = 27, unemployed average ESS = 9.97).CONCLUSIONS: Daytime sleepiness, snoring, nocturnal gasping and unrefreshing sleep are all indicators of possible sleep apnea yet based on this study, symptom severity as measured by the ESS does not correlate to actual sleep apnea or help classify the degree (mild, moderate, or severe) of OSA. Furthermore, whether the patient is employed versus unemployed does not lend itself to any correlation when evaluating the aforementioned scores.CLINICAL IMPLICATIONS: Therefore, it is imperative that physicians never underestimate the possibility of a patient having obstructive sleep apnea if he or she has any of the cardinal symptoms, irrespective of symptomatology severity.DISCLOSURES: No relevant relationships by Patrick FrahmNo relevant relationships by Vishal PatelNo relevant relationships by Tanaz Salimnia SESSION TITLE: Updates on Sleep-Disordered Breathing and Central Hypersomnias SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Obstructive sleep apnea (OSA) has a prevalence of approximately one billion people worldwide and is characterized by hypopneas, apneas and repetitive upper airway collapse during sleep. Several risk factors have been associated with this diagnosis including obesity, older age, male gender as well as upper airway and anatomical abnormalities. While the STOPBANG score is available to determine the pretest probability of OSA, there is little data available comparing a patient’s subjective degree of sleepiness to his OSA classification. METHODS: To better determine if there is any identifiable relation between the symptoms reported by a patient to the likelihood of actually having sleep apnea and to what degree, a retrospective analysis was done looking at 1443 patients seen in the Pulmonary and Sleep Clinic at Beaumont Hospital between the years 2014-2019. The Apnea-Hypopnea Index (AHI) was then compared to the Epworth Sleepiness Scale (ESS) score and evaluated using a Pearson correlation. RESULTS: The data was statistically significant and revealed there is no relation between a patient’s objective AHI versus subjective ESS (Pearson correlation= 0.106, p-value= 0.000). This information was further classified into employed versus unemployed and there was again no correlation indicating a higher ESS equates to more severe OSA, irrespective of employment status (employed AHI average = 25.5, employed ESS average = 10.0, unemployed average AHI = 27, unemployed average ESS = 9.97). CONCLUSIONS: Daytime sleepiness, snoring, nocturnal gasping and unrefreshing sleep are all indicators of possible sleep apnea yet based on this study, symptom severity as measured by the ESS does not correlate to actual sleep apnea or help classify the degree (mild, moderate, or severe) of OSA. Furthermore, whether the patient is employed versus unemployed does not lend itself to any correlation when evaluating the aforementioned scores. CLINICAL IMPLICATIONS: Therefore, it is imperative that physicians never underestimate the possibility of a patient having obstructive sleep apnea if he or she has any of the cardinal symptoms, irrespective of symptomatology severity. DISCLOSURES: No relevant relationships by Patrick Frahm No relevant relationships by Vishal Patel No relevant relationships by Tanaz Salimnia

A STUDY ON SLEEP QUALITY AND SLEEP-DISORDERED BREATHING IN KOREAN PATIENTS WITH LUNG CANCER

SESSION TITLE: Sleep Disordered Breathing and Narcolepsy Abstract PostersSESSION TYPE: Original Investigation PostersPRESENTED ON: 10/18/2022 01:30 pm - 02:30 pmPURPOSE: To date, there have been few studies on sleep quality and sleep disordered breathing (SDB) in lung cancer patients. Hypoxia is well known to play a key role in regulating cancer formation and progression. Chronic intermittent hypoxia, a main feature of SDB, has the potential to influence cancer progression. The aim of this study is to investigate the sleep quality and the role of SDB in patients with lung cancer.METHODS: A total of 110 patients who were histologically confirmed with lung cancer were enrolled. All patients were offered home sleep apnea testing (HSAT) and administered a sleep-specific questionnaire. SDB was defined as an apnea-hypopnea index (AHI) of > 5/h. The sleep related symptoms were assessed using the Epworth Sleepiness Scale (ESS), Korean version of the Pittsburgh Sleep Quality Index (PSQI-K), and Korean version of the Insomnia Severity Index (ISI-K).RESULTS: The median ESS, PSQI-K and ISI-K were 5.0 (2.0-8.0), 6.0 (3.0-9.0) and 7.0 (2.0-12.0). About 50% of patients were poor sleepers and 10% had clinical insomnia. The median AHI was 10.3 (7.5-13.2) and the overall prevalence of SDB in the study population was 55.9 %. The prevalence of moderate to severe SDB was 25 %. There were no significant differences in AHI, mean oxygen saturation, and time with oxygen saturation under 90% among the cancer cell type, mutation type, cancer stage, and survival.CONCLUSIONS: Our results show that SDB was prevalent in Korean lung cancer patients. SDB related symptoms were also frequently found. An additional large-scale study is needed to find the association of sleep parameters with the characteristics of lung cancer.CLINICAL IMPLICATIONS: This is a study that investigated the quality of sleep and sleep disordered breathing in actual lung cancer patients, which has not been published much yet. The sleep index of the subject was obtained using the home sleep apnea test device, and various information related to lung cancer (stage, cell type, mutation result, and survival) was included.DISCLOSURES: No relevant relationships by Seiwon Kim SESSION TITLE: Sleep Disordered Breathing and Narcolepsy Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: To date, there have been few studies on sleep quality and sleep disordered breathing (SDB) in lung cancer patients. Hypoxia is well known to play a key role in regulating cancer formation and progression. Chronic intermittent hypoxia, a main feature of SDB, has the potential to influence cancer progression. The aim of this study is to investigate the sleep quality and the role of SDB in patients with lung cancer. METHODS: A total of 110 patients who were histologically confirmed with lung cancer were enrolled. All patients were offered home sleep apnea testing (HSAT) and administered a sleep-specific questionnaire. SDB was defined as an apnea-hypopnea index (AHI) of > 5/h. The sleep related symptoms were assessed using the Epworth Sleepiness Scale (ESS), Korean version of the Pittsburgh Sleep Quality Index (PSQI-K), and Korean version of the Insomnia Severity Index (ISI-K). RESULTS: The median ESS, PSQI-K and ISI-K were 5.0 (2.0-8.0), 6.0 (3.0-9.0) and 7.0 (2.0-12.0). About 50% of patients were poor sleepers and 10% had clinical insomnia. The median AHI was 10.3 (7.5-13.2) and the overall prevalence of SDB in the study population was 55.9 %. The prevalence of moderate to severe SDB was 25 %. There were no significant differences in AHI, mean oxygen saturation, and time with oxygen saturation under 90% among the cancer cell type, mutation type, cancer stage, and survival. CONCLUSIONS: Our results show that SDB was prevalent in Korean lung cancer patients. SDB related symptoms were also frequently found. An additional large-scale study is needed to find the association of sleep parameters with the characteristics of lung cancer. CLINICAL IMPLICATIONS: This is a study that investigated the quality of sleep and sleep disordered breathing in actual lung cancer patients, which has not been published much yet. The sleep index of the subject was obtained using the home sleep apnea test device, and various information related to lung cancer (stage, cell type, mutation result, and survival) was included. DISCLOSURES: No relevant relationships by Seiwon Kim

Acute Normobaric Hypoxia Lowers Executive Functions among Young Men despite Increase of BDNF Concentration.

Background: Decreased SpO2 during hypoxia can cause cognitive function impairment, and the effects of acute hypoxia on high-order brain functions such as executive processing remain unclear. This study’s goal was to examine the impact of an acute normobaric hypoxia breathing session on executive function and biological markers. Methods: Thirty-two healthy subjects participated in a blind study performing two sessions of single 30 min breathing bouts under two conditions (normoxia (NOR) and normobaric hypoxia (NH), FIO2 = 0.135). The Stroop test was applied to assess cognitive function. Results: No significant difference was observed in the Stroop interference in the “reading” part of the test in either condition; however, there was a significant increase in the “naming” part under NH conditions (p = 0.003), which corresponded to a significant decrease in SpO2 (p < 0.001). There was a significant increase (p < 0.013) in the brain-derived neurotrophic factor (BDNF) level after NH conditions compared to the baseline, which was not seen in NOR. In addition, a significant drop (p < 0.001) in cortisol levels in the NOR group and a slight elevation in the NH group was noticed. Conclusions: According to these findings, acute hypoxia delayed cognitive processing for motor execution and reduced the neural activity in motor executive and inhibitory processing. We also noted that this negative effect was associated with decreased SpO2 irrespective of a rise in BDNF.

Take a deep breath: Benefits of neuroplasticity practices for software developers and computer workers in a family of experiments

ContextComputer workers in general, and software developers specifically, are under a high amount of stress due to continuous deadlines and, often, over-commitment.ObjectiveThis study investigates the effects of a neuroplasticity practice, a specific breathing practice, on the attention awareness, well-being, perceived productivity, and self-efficacy of computer workers.MethodThe intervention was a 12-week program with a weekly live session that included a talk on a well-being topic and a facilitated group breathing session. During the intervention period, we solicited one daily journal note and one weekly well-being rating. We created a questionnaire mainly from existing, validated scales as entry and exit survey for data points for comparison before and after the intervention. We replicated the intervention in a similarly structured 8-week program. The data was analyzed using Bayesian multi-level models for the quantitative part and thematic analysis for the qualitative part.ResultsThe intervention showed improvements in participants’ experienced inner states despite an ongoing pandemic and intense outer circumstances for most. Over the course of the study, we found an improvement in the participants’ ratings of how often they found themselves in good spirits as well as in a calm and relaxed state. We also aggregate a large number of deep inner reflections and growth processes that may not have surfaced for the participants without deliberate engagement in such a program.ConclusionThe data indicates usefulness and effectiveness of an intervention for computer workers in terms of increasing well-being and resilience. Everyone needs a way to deliberately relax, unplug, and recover. A breathing practice is a simple way to do so, and the results call for establishing a larger body of work to make this common practice.

Single Slow-Paced Breathing Session at Six Cycles per Minute: Investigation of Dose-Response Relationship on Cardiac Vagal Activity.

The practice of slow-paced breathing (SPB) has been linked to a range of positive outcomes, such as decreasing symptoms of depression, anxiety, and stress, as well as increasing well-being. Among the suggested mechanisms of action, SPB has been shown to increase cardiac vagal activity (CVA). The present study aimed to investigate whether there is a dose-response relationship modulating the effects of SPB on CVA. A total of 59 participants were involved in this study. In a within-subject design, participants attended the lab five times, and realized SPB at six cycles per minute with different durations (5, 10, 15, and 20 min), as well as a control condition without SPB. CVA was indexed via the root mean square of successive differences (RMSSD). During SPB, findings showed an increase in RMSSD in all conditions compared to the control condition. However, no differences were found in RMSSD among the different session durations, during SPB or during the resting measurement completed immediately after SPB. Noteworthily, session duration showed an influence on the spontaneous respiratory frequency in the resting measurement occurring immediately after SPB. Specifically, respiratory frequency appears to decrease with session duration, thus potentially contributing to additional relaxing effects.

The effect of a single session of 30-min mindful breathing in reducing fatigue among patients with haematological cancer \u2013 a randomised controlled trial

BackgroundPatients with haematological cancer had considerable symptom burden, in which fatigue was the most prevalent. Almost 70% of haematological cancer patients reported fatigue.MethodsWe conducted a parallel-group, non-blinded, randomised control trial at the haemato-oncology unit of University Malaya Medical Centre, from 1st October 2019 to 31st May 2020. Patients included were ≥ 18 years, had histopathological diagnosis of haematological cancer, and fatigue score of ≥4 based on the fatigue subscale of Edmonton Symptom Assessment System (ESAS). Patients allocated to the intervention group received standard care plus a guided 30-min mindful breathing session, while those in control group received standard care. The study outcomes include fatigue severity according to the fatigue subscale of ESAS, visual analogue scale of 0 – 10, and Functional Assessment of Chronic Illness Therapy Fatigue Scale Version 4, at minute 0 and minute 30.ResultsOf 197 patients screened, 80 were eligible and they were equally randomised into 30-min mindful breathing versus standard care. Lymphoma (58.9%) was the commonest haematological malignancy, followed by multiple myeloma (13.8%), acute leukaemia (11.3%), myeloproliferative neoplasm (6.3%), chronic leukaemia (5.0%) and myelodysplastic syndrome (5.0%). There was no difference in the demographic and clinical characteristics between the 2 groups.At minute 0, both arms of patients had similar ESAS-fatigue score (median, 5) and FACIT-fatigue score (mean ± SD, 24.7 ± 10.6 for intervention group versus 24.7 ± 9.7 for control group). At minute 30, intervention group had lower ESAS-fatigue score (median, 3 versus 5) and FACIT-fatigue score (mean ± SD, 17.1 ± 10.5 versus 24.8 ± 11.3) compared to control group. Both the ESAS-fatigue score reduction (median, − 2 versus 0, p = 0.002) and FACIT-fatigue score reduction (mean ± SD, − 6.7 versus + 0.8; p < 0.001) for the intervention group were statistically significant. The calculated effect size Cohen’s d was 1.4 for between-group comparison of differences in total FACIT-fatigue score.ConclusionsOur results provide evidence that a single session of 30-min mindful breathing was effective in reducing fatigue in haematological cancer patients. On top of all the currently available methods, 30-min mindful breathing can prove a valuable addition.Trial registrationNCT 05029024, date of registration 15th August 2021. (Retrospectively registered).

The Effectiveness of Social-Emotional Learning Strategies and Mindful Breathing with Biofeedback on the Reduction of Adolescent Test Anxiety

Educational programs that incorporate social emotional-learning (SEL) strategies, study skills, and mindful breathing using biofeedback can help adolescents decrease worry and social stress, increase test preparedness self-efficacy, and improve academic performance due to lowered levels of test anxiety. The current study examined the efficacy of a SEL intervention (implemented into a high school psychology course) focused on study skills and mindful breathing and its impact on student attitude and behavioural changes (e.g., test anxiety, self-efficacy), academic performance, and physical changes. A quasi-experimental explanatory mixed methods study conducted at a rural Alberta high school examined pre- and post-intervention results between two groups of Grades 9–12 students (N = 105) with one group receiving the intervention (mindful breathing sessions, emotional regulation techniques, study and test-taking skills, and coping strategies) while the other received regular programming. Quantitative data included a Test Anxiety Survey (TAS), Student Opinion Survey–Short Form (SOS-SF), and reading comprehension (RC) tests to measure attitude and behavioural changes, followed by qualitative data obtained from student semi-structured interviews and focus groups for further interpretation. Quantitative results from repeated-measures (RM) ANOVAs indicated significant increases in self-efficacy for preparation and test-taking, increased academic achievement, decreased worry about future social stress, and increased positive affect. Effect sizes for significant impacts ranged from .45 to .65. Qualitative data indicated that students acquired new SEL strategies to help them handle stressful test situations more effectively. The current study addresses topics of interest to educators (e.g., test anxiety, social emotional learning) with a discussion of applications for extension and development of the program in junior and senior high classrooms.&#x0D; Keywords: test anxiety, adolescents, social-emotional learning, mindfulness, biofeedback

Effect of device-guided paced breathing of biofeedback on blood pressure, stress and anxiety levels in hypertensives

The present study aimed to evaluate the influence of cardiac coherence through Biofeedback Therapy (BT) with paced breathing on blood pressure, stress and anxiety levels in individuals with essential arterial hypertension. The participants underwent 8 sessions of paced breathing guided by biofeedback visual therapy for 20 minutes, in which they were evaluated through clinical assessment, Hamilton Anxiety Rating Scale, Perceived Stress Scale and cardiovascular variables. Comparisons of means were performed using the paired and unpaired Student's t-test. Statistically significant correlations were considered when p ≤ 0.05 with a 95% confidence interval. The effect size (Cohen's d) and common language effect size were calculated to assess the effect of such therapy. Sixteen patients with mean age of 57.3 ± 14 years old participated in this study. Comparisons between mean initial and final systolic blood pressure levels (SBP) in women (p = 0.007; Cohen's d = 0.50), pre- and post-training heart rate (p = 0.02; Cohen's d = 0.60) and anxiety levels (p = 0.01; Cohen's d = 1.04) were significant. Comparisons between pre- and post-training SBP (p = 0.006; Cohen's d = 0.81) and pre- and post-training anxiety levels (p = 0.04; Cohen's d = 0.32) were significant among males. In conclusion, paced breathing training with biofeedback therapy can be promising to reduce anxiety levels in individuals with essential arterial hypertension.

Apport des techniques de relaxation respiratoire au cours des injections intravitréennes : étude pilote

To study the effects of breathing techniques for anxiety, perceived pain, and patient satisfaction while receiving intravitreal injections. This prospective, randomized clinical study included patients admitted for intravitreal anti-VEGF injections. They were randomized into two groups: a relaxation group who listened to a prerecorded relaxation breathing session before and during the injection, and a control group who received the injection without a relaxation session. Statistical analysis was then performed to assess the factors influencing satisfaction, anxiety, and perceived pain. We included one-hundred four patients in total: 52 in the relaxation group versus 52 in the control group. The relaxation group had a greater decrease in anxiety than the control group (P=0.03) but similar levels of pain (P=0.86). In total, 80.76% of patients in the relaxation group expressed the wish to have a relaxation session during their next injection. Multivariate analysis showed that the patient's usual level of stress as well as the relaxation session affected the level of anxiety experienced before the injection. Relaxation techniques before and during intravitreal injections decrease anxiety in patients without decreasing pain during IVT. Prerecorded relaxation breathing sessions are non-invasive, inexpensive, easy to set up, and reduce anxiety during intravitreal injections on an outpatient basis.

Semiautomatic quantification of abdominal wall muscles deformations based on dynamic MRI image registration.

Quantitative analysis of abdominal organs motion and deformation is crucial to better understand biomechanical alterations undermining respiratory, digestive or perineal pathophysiology. In particular, biomechanical characterization of the antero-lateral abdominal wall is central in the diagnosis of abdominal muscle deficiency. Here, we present a dedicated semiautomatic dynamic MRI postprocessing method enabling the quantification of spatial and temporal deformations of the antero-lateral abdominal wall muscles. Ten healthy participants were imaged during a controlled breathing session at the L3-L4 disc level using real-time dynamic MRI at 3 T. A coarse feature-tracking step allowed the selection of the inhalation cycle of maximum abdominal excursion. Over this image series, the described method combines (1) a supervised 2D+t segmentation procedure of the abdominal wall muscles, (2) the quantification of muscle deformations based on masks registration, and (3) the mapping of deformations within muscle subzones leveraging a dedicated automatic parcellation. The supervised 2D+t segmentation (1) provided an accurate segmentation of the abdominal wall muscles throughout maximum inhalation with a 0.95 ± 0.03 Dice similarity coefficient (DSC) value and a 2.3 ± 0.7 mm Hausdorff distance value while requiring only manual segmentation of 20% of the data. The robustness of the deformation quantification (2) was indicated by high indices of correspondence between the registered source mask and the target mask (0.98 ± 0.01 DSC value and 2.1 ± 1.5 mm Hausdorff distance value). Parcellation (3) enabled the distinction of muscle substructures that are anatomically relevant but could not be distinguished based on image contrast. The present genuine postprocessing method provides a quantitative analytical frame that could be used in further studies for a better understanding of abdominal wall deformations in physiological and pathological situations.

Influence of a Single Slow-Paced Breathing Session on Cardiac Vagal Activity in Athletes

IntroductionSlow-paced breathing (SPB) is a well-known relaxation technique in athletes, which has also the potential to help optimize addiction treatments based on its effects on the autonomic nervous system. Specifically, these effects directly impact cardiac vagal activity (CVA), the activity of the vagus nerve regulating cardiac functioning. The effects of long-term SPB interventions on CVA have already received some attention; however, the effects of a single SPB session on CVA still require further investigation. Consequently, the aim of this study was to investigate the effects of SPB on CVA during, immediately after, and 60 min after a single SPB session.MethodologyTwenty-four athletes were involved in a within-subject design, with two conditions: slow-paced breathing (at 6 cycles per minute) and a control condition watching an emotionally neutral TV documentary while breathing at a spontaneous breathing rate. CVA was derived from heart rate variability measurement and indexed via the root mean square of successive differences, RMSSD.ResultsResults showed that RMSSD measured during SPB was significantly higher than when measured before SPB, right after SPB, and 60 min after SPB. No changes were observed in the control condition.DiscussionFindings regarding concomitant effects of SPB on CVA are in line with previous literature. The return to baseline observed immediately after SPB and 60 min after SPB suggests that the effects on CVA are only transitory.Practical ImplicationsGiven higher CVA has been linked to decreased cravings in addictions, future research should investigate to which extent SPB may be an effective technique to help coping with craving attacks on an acute basis.

A feasibility trial of an instructed breathing course in prison to improve emotion regulation in people with substance use difficulties

ABSTRACT Substance abuse can be associated with difficulties in emotion regulation. It has been proposed that advantageous emotion regulation is positively associated with heart rate variability , and that slow-paced breathing can increase values of heart rate variability. We explored the feasibility of delivering a six-week, slow-paced breathing intervention in a prison setting, and investigated the effects of the intervention on indices of emotion regulation. The final sample consisted of seven male prisoners with histories of illicit substance and alcohol abuse who were identified as presenting with difficulties in emotion regulation. During the instructed breathing sessions, a device provided a visual aid to encourage a cycle of breathing that corresponds to six breaths per minute (i.e., 0.1 Hz). Changes in scores for psychometric measures were analysed with the Reliable and Clinically Significant Change Statistic. Most participants reported improvements in scores for depression, anxiety, and stress. A qualitative account of interviews with participants and factors influencing successful delivery of sessions was also included for the purposes of triangulation and to inform on feasibility. It is concluded that further evaluation of the intervention is feasible, and that the intervention offers promise for improving emotion regulation in offenders with histories of substance use difficulties.

Assessing Dynamic Cerebral Autoregulation in Patients with Sickle Cell Disease Using Near-Infrared Spectroscopy and Paced Breathing

Introduction. Sickle cell disease (SCD) is caused by hemoglobin S polymerization leading to vaso-occlusion, small vessel disease, and reduced tissue oxygen saturation. Noninvasive assessments and screening of small vessel disease and decreased oxygen saturation in select organs, like the brain, are poorly developed. Cerebral autoregulation, a mechanism that ensures cerebral blood flow (CBF) remains constant with changes in mean arterial pressure, is impaired with and is a marker of small vessel disease. Frequency-domain near-infrared spectroscopy (FD-NIRS) can be used as a noninvasive technique to measure cerebral autoregulation by recording cerebral microvascular changes in hemoglobin concentration that are related to cerebral blood flow. Transfer function analysis is a method to noninvasively quantify the relationship between measured physiologic signals, and can be used to estimate cerebral autoregulation. In this study, we hypothesized patients with SCD have impaired cerebral autoregulation and reduced tissue oxygen saturation, which we evaluated via FD-NIRS with transfer function analysis, as compared to healthy controls. Methods. All patients provided informed consent under an IRB protocol approved by the University of Pittsburgh and Carnegie Mellon University. Patients with SCD (n = 11) and healthy, race-matched controls (n =14) were enrolled. All participants sat upright in a chair with probes of a commercial multi-distance FD-NIRS apparatus applied to their forehead in a dark room (Fig. 1A). We used paced breathing to dynamically induce controlled changes in the microvascular tone at 0.1, 0.125, and 0.1667 Hz, spanning normal to more challenging breathing rates, with a visual metronome guiding each paced breathing session (Fig.1.B). To validate each breathing pace, we recorded the participants' respiratory rate via a belt placed around their chest, and their mean arterial pressure through a finger and arm cuff attached to a beat-to-beat finger plethysmographer (Fig.1.A). We used the modified Beer-Lambert law to calculate changes in oxy-hemoglobin (O), deoxy-hemoglobin (D), and total hemoglobin (T) concentrations. Data was bandpass-filtered around the paced breathing frequencies, and the Hilbert transform was applied to calculate the amplitude ratios, |D|/|O|, and phase latency, Arg(D)−Arg(O). The tissue oxygen saturation of hemoglobin, StO2 (mean ±SD), was computed based on an average baseline of two minutes. Results. Arg(D)−Arg(O) and |D|/|O| are shown for controls and patients at all paced breathing frequencies (Fig.1C-D) from the largest source-detector distance. A non-zero phase lag between D and O within both groups indicates influences of cerebral blood volume (CBV) and CBF changes. The phase differences of D and O are therefore related to cerebral autoregulation. We found a greater phase difference (mean range: -320° to -340°) in patients with SCD compared to controls (mean range: -200° to -240°), indicating the presence of vascular obstruction and impaired cerebral autoregulation. Higher amplitude ratios |D|/|O| may indicate slower blood transmit times. We found that patients with SCD had increased amplitude ratios for hemodynamic oscillations at lower paced breathing frequencies compared to healthy controls (Fig. 1D). Finally, we found a significantly reduced cerebral tissue oxygen saturation in patients with SCD (63.1 % ± 7.8 %) in comparison with controls (65.9 % ± 4.9 %, p&amp;lt;0.05, Fig.1E). Discussion. We provide preliminary evidence that FD-NIRS can be used to assess cerebral autoregulation in SCD. Our results confirm and extend those of a prior study by Reinhard et al, 2003, by using the phase latency, Arg(D)−Arg(O), and the amplitude ratios, |D|/|O|, to assess autoregulation. In addition, we detected a noticeable reduction in oxygen saturation in patients with SCD as compared to healthy controls. Further studies may extend our findings to additional frequencies in a larger sample size to more comprehensively assess the impact of mean arterial pressure on autoregulation. Noninvasive measurement of cerebral autoregulation and brain oxygenation in SCD by FD-NIRS may represent a novel biomarker of cerebral vasculopathy in SCD and may help monitor changes in cerebral oxygenation, particularly during treatment with drugs that modulate the hemoglobin oxygen affinity, such as the recently FDA-approved voxelotor. Figure 1 Disclosures No relevant conflicts of interest to declare.

SNORES N DM2: STUDY ON OSA HIGH RISK PREVALENCE, SYMPTOMS, AND SLEEPINESS AMONG PATIENTS WITH UNCONTROLLED TYPE 2 DIABETES MELLITUS SEEN AT THE OUT-PATIENT DEPARTMENT IN A TERTIARY HOSPITAL

SESSION TITLE: Advances Across the Diagnostic Spectrum in Sleep-Disordered Breathing SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: We determined the prevalence of patients at risk for OSA with uncontrolled T2DM at the OPD of UP -PGH from December 1, 2018 -February 28, 2019.We described the demographic characteristics of patients with uncontrolled T2DM and compared with high and low OSA risk, its association and correlation with quality of sleep. METHODS: Methodology:This is a prospective cross-sectional study among Uncontrolled T2DM.The questionnaires were Berlin Questionnaire (screen OSA–HR)and Epworth Sleepiness Score( level of sleepiness).Clinicodemographic profile and significant laboratory data were obtained. Descriptive statistics utilized. Chi- square test was used to compare categorical variables between patients with high vs.low OSA risk and to determine if an association exists between OSA-HR and sleep quality. RESULTS: 240 participants were included in the study. 88 males and 151 females. Over-all prevalence of OSA HR among patients with uncontrolled type 2DM is 58.33%. Majority of the OSA–HR(105 /140) were 46 years old and above. There is a significant association of tonsillar grade,malampati score, BMI, HGBA1C, hypercholesterolonemia, and Epworth sleepiness on OSA High risk. There is also substantial association with age, BMI, mallampati score, tonsillar grade, hypertension, asthma, HbA1c and hypercholesterelonemia on the level of sleepiness of OSA-HR. In conclusion, there is a high prevalence of high OSA- Risk among patients with uncontrolled DM . Factors associated with high OSA –Risk among uncontrolled diabetes mellitus include Hba1c, dyslipidemia, BMI , Mallampati Score , tonsillar grade and Epworth Score CONCLUSIONS: In conclusion, this study found that the prevalence rate of High risk OSA among type 2 uncontrolled Diabetes mellitus is 58.33% which is comparable to foreign literatures. Many patients with uncontrolled diabetes have higher risk for OSA. Factors associated with this higher risk include degree of sugar control (HbA1c), dyslipidemia, BMI, Mallampati score, tonsillar grading and Epworth scale. COPD, Asthma and uncontrolled hypertension are not correlated with OSA high risk but needs further investigation due to scarcity of cases recruited. CLINICAL IMPLICATIONS: A close follow-up and /or further definitive study (PSG) to confirm the results. It is recommended to increase the attention of our local health sector and department of Health in the provision of more sleep laboratories to correlate these results with a more definitive test for OSA. A creation of OSA club is recommended to follow-up those patients with High risk for OSA to prevent further complications and to provide a good glycemic control among T2DM. BQ and ESS plus sleep study should be incorporated as a screening test for patient with uncontrolled DISCLOSURES: No relevant relationships by Maria Lowella De Leon, source=Web Response no disclosure on file for Manuel Jorge; No relevant relationships by Anna Katrina Tojino, source=Web Response

OSA SEVERITY IS ASSOCIATED WITH INCREASED STEATOSIS AND LIVER STIFFNESS IN PATIENTS WITH HEPATIC PATHOLOGY INDEPENDENT OF BMI

SESSION TITLE: Advances Across the Diagnostic Spectrum in Sleep-Disordered Breathing SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The diagnosis of obstructive sleep apnea (OSA) and severity of OSA by apnea-hypopnea index (AHI), has been associated with an increased risk of developing liver disease in population-based studies, and the severity of nocturnal hypoxia has been associated with worsening steatosis biomarkers. Further, nocturnal hypoxia has been associated with increased biopsy-proven fibrosis in patients undergoing bariatric surgery. FibroScan/Transient Elastography (EchoSens,Paris,France) is a non-invasive technique that uses ultrasound to measure liver stiffness and assess fibrosis with high reproducibility. The controlled attenuation parameter (CAP) has demonstrated good accuracy in quantifying the levels of liver steatosis and fibrosis, which are associated with the progression of hepatic disease, although with some variability by age, body mass index (BMI), and geography by meta-analysis. The goal of this retrospective study was to assess the relationship between OSA severity, body mass index, and liver stiffness measurements (LSM) by transient elastography with CAP (controlled attenuation parameter) in liver cirrhosis and steatosis. METHODS: Patients who had both a polysomnogram (PSG) and liver elastography between March 2015 - March 2020 were identified by Epic EMR SlicerDicer tool. Patients were included if they had a diagnostic or split-night PSG, and elastography occurred within 12 months prior and 3 months after PSG. AHI was calculated by American Academy of Sleep Medicine recommended criteria. Elastography readings with an interquartile range (IQR) greater than 30% of the mean were excluded as unreliable per literature cutoffs. Sleep and liver diagnoses were identified from the associated attending reports. Multiple linear models with AHI, BMI and etiology of liver disease were created. Analysis was performed using Microsoft Excel. RESULTS: Twenty-three subjects were identified. AHI (p=0.002) and BMI (p<0.001) are independently associated with increased liver attenuation. AHI (p=0.008) is associated with increased liver stiffness in non-obese patients with hepatitis C (n=14). For non-alcoholic steatohepatitis patients, BMI is associated with increased stiffness (p=0.03), but not increased attenuation. CONCLUSIONS: OSA severity is associated with worsening liver steatosis on elastography in patients with cirrhosis and steatohepatitis. In non-obese patients with hepatitis C, OSA severity is associated with worsening fibrosis on elastography. CLINICAL IMPLICATIONS: Patients with cirrhosis and hepatic steatosis should be screened for OSA, regardless of BMI or etiology of liver disease. Treatment of OSA may slow progression of liver disease. Liver attenuation should be interpreted with caution in patients with obesity and nonalcoholic steatohepatitis, as it may not accurately reflect severity of liver disease. DISCLOSURES: No relevant relationships by Bredon Crawford, source=Web Response No relevant relationships by Vidya Krishnan, source=Web Response No relevant relationships by Nicoleta Olteanu, source=Web Response

Symptom reduction in palliative care from single session mindful breathing: a randomised controlled trial

ContextThere has been increasing evidence of the role of mindfulness-based interventions in improving various health conditions. However, the evidence for the use of mindfulness in the palliative care setting is...

Surviving COVID-19 Pneumonia At Home: COVID Case #1906

Surviving COVID-19 Pneumonia At Home: COVID Case #1906

Treating PTSD with connected breathing: A clinical case study and theoretical implications

Extended connected breathing (Rebirthing-Breathwork) has been popular as a self-development tool for more than 4 decades, but has been subjected to minimal scientific research. Similarities between connected breathing and two therapeutic modalities used to treat posttraumatic stress disorder (PTSD)—Eye Movement Desensitization and Reprocessing and Somatic Experiencing—suggest connected breathing to be efficacious in treating PTSD. The underlying theoretical model in these three approaches suggests that trauma is a result of the blocking or repressing of spontaneous somatic and cognitive processing. This study investigated the efficacy of connected breathing to treat PTSD in a firefighter. Pre- and posttreatment measures consisted of instruments to measure PTSD symptom-severity, anxiety, depression and heart rate variability (HRV). After 8 connected breathing sessions the participant's PTSD and comorbid symptoms were in complete remission. Subjective reports and HRV data-analysis support the blocking/repression theory and suggest a role of the parasympathetic nervous system in the blocking of spontaneous trauma processing. In this case the original trauma appears have been a traumatic birth.

Respiratory cycle characterization and optimization of amplitude-based gating parameters for prone and supine lung cancer patients

The selection of posture between supine and prone induces changes in the characteristics of respiratory patterns in lung cancer patients. We characterize these differences, as well as introduce two new metrics to describe the quality of amplitude-based gating. The stability of the following metrics were measured for 134 supine-and-prone-paired individual breathing sessions from 22 patients: amplitude, period, inhale-to-exhale period ratio, and location of end-of-exhale and end-of-inhale peaks. A new normalization characteristic of typical amplitude was introduced for comparing patients based on external surrogates. This metric was used to characterize the baseline drift and to compare the overall gating efficiency between different amplitude-based gating parameters in a new proposed metric called the gating efficiency index. While the choice of supine or prone posture had negligible impact on the overall duty cycle or gating efficiency, some metrics showed greater difference, especially with prone showing reduced variability in period, inhale-to-exhale period ratio, amplitude, and relative amplitude of end-of-exhale. Therefore, the breathing pattern resulting from prone positioning was found to be more favorable due to less intrafraction variation. The gating efficiency index was used to quantitatively show that narrow amplitude gating windows near end-of-exhale have the best balance of decreased motion variability within gating while maintaining the longest duty cycle.