Sleep-related Breathing Disorders Research Articles

An audio-semantic multimodal model for automatic obstructive sleep Apnea-Hypopnea Syndrome classification via multi-feature analysis of snoring sounds

IntroductionObstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder that significantly impacts the daily lives of patients. Currently, the diagnosis of OSAHS relies on various physiological signal monitoring devices, requiring a comprehensive Polysomnography (PSG). However, this invasive diagnostic method faces challenges such as data fluctuation and high costs. To address these challenges, we propose a novel data-driven Audio-Semantic Multi-Modal model for OSAHS severity classification (i.e., ASMM-OSA) based on patient snoring sound characteristics.MethodsIn light of the correlation between the acoustic attributes of a patient's snoring patterns and their episodes of breathing disorders, we utilize the patient's sleep audio recordings as an initial screening modality. We analyze the audio features of snoring sounds during the night for subjects suspected of having OSAHS. Audio features were augmented via PubMedBERT to enrich their diversity and detail and subsequently classified for OSAHS severity using XGBoost based on the number of sleep apnea events.ResultsExperimental results using the OSAHS dataset from a collaborative university hospital demonstrate that our ASMM-OSA audio-semantic multimodal model achieves a diagnostic level in automatically identifying sleep apnea events and classifying the four-class severity (normal, mild, moderate, and severe) of OSAHS.DiscussionOur proposed model promises new perspectives for non-invasive OSAHS diagnosis, potentially reducing costs and enhancing patient quality of life.

Assessing sleep-related breathing disorders among newly diagnosed rheumatoid and psoriatic arthritis patients: a cross-sectional study.

This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to develop a screening algorithm for early detection. We evaluated newly diagnosed RA or PsA patients using the Epworth Sleepiness Scale (ESS) questionnaire, cardiorespiratory polygraphy (RPG), and clinical and laboratory assessments. Sleep apnea syndrome (SAS) was diagnosed based on pathological RPG findings excessive daytime sleepiness, defined as ESS score above 10. The study included 39 patients (22 RA, 17 PsA) and 23 controls. In RPG, SRBD was identified in 38.5% of arthritis patients compared to 39.1% of controls (p = 1.00), with male gender (p = .004) and age (p < .001) identified as risk factors. Excessive daytime sleepiness was noted in 36.4% of RA patients, 17.6% of PsA patients, and 21.7% of controls. Of the 24 patients diagnosed with SRBD, 41.6% met the criteria for SAS. SAS prevalence was 31.8% among RA patients, 0% in PsA patients, and 13% in controls. A significant association was observed between excessive daytime sleepiness and SRBD (p = .036). Our findings reveal a high prevalence of SRBD in newly diagnosed, untreated RA and PsA patients in ESS and RPG, with excessive daytime sleepiness being a reliable predictor of SRBD. Patients with RA exhibited a higher predisposition to SAS. We therefore suggest incorporating ESS and RPG as screening tools in RA or PsA for early detection and management of SRBD.

Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study

BackgroundBoth sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls.MethodsA comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison.ResultsThe mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls.ConclusionsEarly detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.

Prediction of Treatment Response and Effect on Clinical Manifestations for Normal Pressure Hydrocephalus of Sleep Related Breathing Disorders

Objectives: Sleep disorders and normal pressure hydrocephalus (NPH) are increasingly important issues observed in neurological disorders. However, the correlation between these diseases has not been sufficiently studied. Thus, we discuss the correlation between sleep disorders and the clinical features of NPH. Methods: Overall, 40 patients with idiopathic NPH were included in the study. To evaluate the sleep disorders and psychiatric problems, surveys were administered, including the 36-Item Short Form Survey, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire, STOP-Bang Questionnaire, Hospital Anxiety and Depression Scale (HADS), Morningness-Eveningness Questionnaire, and the REM Sleep Behavior Disorder Screening Questionnaire. To evaluate the severity of dementia and ataxia, all of the patients completed the Korean mini-mental state examination; Korea frontal assessment battery score, amd unified Parkinson’s disease rating scale-motor scores before and after cerebrospinal fluid (CSF) drainage. The Pearson’s chi-square test, independent Student’s t-test, Mann–Whitney U test, and linear regression analysis were used to analyze the relationship between sleep disorders and symptom improvement after CSF drainage. Results: Of the 40 patients, 21 patients had poor sleep quality (PSQI&gt;5), 8 patients had insomnia (ISI≥8), 11 patients had daytime sleepiness (ESS≥11), 9 (STOP-Bang≥3) to 13 (Berlin≥2 categories) patients had sleep apnea, 13 patients were anxious (HAS≥8), and 27 patients were depressed (HDS≥8). A linear regression analysis showed that sleep apnea was significantly correlated with cognitive function, and insomnia was correlated with cognitive, motor, and frontal lobe functions. Additionally, patients with severe sleep apnea demonstrated a greater recovery of cognitive function after CSF drainage. Conclusions: Obstructive sleep apnea (OSA) is closely related to the clinical symptoms and treatment effectiveness of NPH. The diagnosis and proper treatment of OSA is expected to improve the prognosis of patients with NPH.

Risk factors of sleep-disordered breathing and poor asthma control in children with asthma

BackgroundSleep-disordered breathing (SDB) may lead to poor asthma control in children.ObjectiveTo identify risk factors of SDB in children with asthma and assess its impact on asthma control.MethodsIn this cross-sectional study, we collected data of outpatients with asthma at the Children’s Hospital of Chongqing Medical University from June 2020 to August 2021. The Pediatric Sleep Questionnaire—Sleep-Related Breathing Disorder and the age-appropriate asthma control tests Childhood Asthma Control Test and Test for Respiratory and Asthma Control in Kids were completed.ResultsWe enrolled 397 children with a male-to-female ratio of 1.7:1 and a mean age of 5.70 ± 2.53 years. The prevalence of SDB was 21.6%. Allergic rhinitis (odds ratio OR = 3.316), chronic tonsillitis (OR = 2.246), gastroesophageal reflux (OR = 7.518), adenoid hypertrophy (OR = 3.479), recurrent respiratory infections (OR = 2.195), and a family history of snoring (OR = 2.048) were risk factors for the development of combined SDB in children with asthma (p < 0.05). Asthma was poorly controlled in 19.6% of the children. SDB (OR = 2.391) and irregular medication use (OR = 2.571) were risk factors for poor asthma control (p < 0.05).ConclusionsAllergic rhinitis, chronic tonsillitis, gastroesophageal reflux, adenoid hypertrophy, recurrent respiratory infections, and a family history of snoring were independent risk factors for the development of SDB in children with asthma. SDB and irregular medication use were independent risk factors for poor asthma control.

Sleep-related breathing disorders in infants with spina bifida repaired prenatally and postnatally.

Advances in prenatal repair of myelomeningocele (MMC) have improved outcomes involving different organ systems. There is limited data on respiratory outcomes following prenatal surgical repair. We hypothesize there is no difference in respiratory outcomes between spina bifida (SB) patients who have undergone prenatal versus postnatal repair. We performed a retrospective study of 46 infants <1 year with SB seen at Children's Hospital Los Angeles from 2004-2022. Demographic data, timing of closure, neonatal course, Chiari II malformation (CIIM), ventriculoperitoneal shunt (VPS), polysomnography (PSG) results, and need for supplemental oxygen were collected. Unpaired t-test and Chi-square Test were used to analyze results. 31/46 had prenatal repair of MMC; average age at repair was 27 weeks post-conception (PCA). Average age at postnatal repair was 37 PCA. There was no difference in age at PSG. There was no difference in CIIM presence (p=0.61). 60% of patients with postnatal repair and 23% in the prenatal group underwent VPS placement (p=0.01). Patients with SB who've undergone closure of neural tube defect have persistent central apneas, obstructive apneas, and significant hypoxemia. There were no differences in the frequency or severity of sleep-disordered breathing in those with prenatal repair versus postnatal repair.

Noncontact respiration monitoring techniques in young children: A scoping review.

Pediatric sleep-related breathing disorders, or sleep-disordered breathing (SDB), cover a range of conditions, including obstructive sleep apnea,central sleep apnea,sleep-related hypoventilation disorders, and sleep-related hypoxemia disorder. Pediatric SDB is often underdiagnosed, potentially due to difficulties associated with performing the gold standard polysomnographyin children. This scoping review aims to: (1) provide an overview of the studies reporting on safe, noncontact monitoring of respiration in young children,(2) describe the accuracy of these techniques, and (3) highlight their respective advantages and limitations. PubMed and EMBASE were searched for studies researching techniques in children <12 years old. Both quantitative data and the quality of the studies were analyzed. The evaluation of study quality was conducted using the QUADAS-2 tool. A total of 19 studies were included. Techniques could be grouped into bed-based methods, microwave radar, video, infrared (IR) cameras, and garment-embedded sensors. Most studies either measured respiratory rate (RR) or detected apneas; n = 2 aimed to do both. At present, bed-based approaches are at the forefront of research in noncontact RRmonitoring in children, boasting the most sophisticated algorithms in this field. Yet, despite extensive studies, there remains no consensus on a definitive method that outperforms the rest. The accuracies reported by these studies tend to cluster within a similar range, indicating that no single technique has emerged as markedly superior. Notably, all identified methods demonstrate capability in detecting body movements and RR, with reported safety for use in children across the board. Further research into contactless alternatives should focus on cost-effectiveness, ease-of-use, and widespread availability.

Chronic intermittent hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production.

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that results in multiple bouts of intermittent hypoxia. OSA has many neurological and systemic comorbidities, including dysphagia, or disordered swallow, and discoordination with breathing. However, the mechanism in which chronic intermittent hypoxia (CIH) causes dysphagia is unknown. Recently, we showed the postinspiratory complex (PiCo) acts as an interface between the swallow pattern generator (SPG) and the inspiratory rhythm generator, the preBötzinger complex, to regulate proper swallow-breathing coordination (Huff et al., 2023). PiCo is characterized by interneurons co-expressing transporters for glutamate (Vglut2) and acetylcholine (ChAT). Here we show that optogenetic stimulation of ChATcre:Ai32, Vglut2cre:Ai32, and ChATcre:Vglut2FlpO:ChR2 mice exposed to CIH does not alter swallow-breathing coordination, but unexpectedly disrupts swallow behavior via triggering variable swallow motor patterns. This suggests that glutamatergic-cholinergic neurons in PiCo are not only critical for the regulation of swallow-breathing coordination, but also play an important role in the modulation of swallow motor patterning. Our study also suggests that swallow disruption, as seen in OSA, involves central nervous mechanisms interfering with swallow motor patterning and laryngeal activation. These findings are crucial for understanding the mechanisms underlying dysphagia, both in OSA and other breathing and neurological disorders.

Chronic intermittent hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that results in multiple bouts of intermittent hypoxia. OSA has many neurological and systemic comorbidities, including dysphagia, or disordered swallow, and discoordination with breathing. However, the mechanism in which chronic intermittent hypoxia (CIH) causes dysphagia is unknown. Recently, we showed the postinspiratory complex (PiCo) acts as an interface between the swallow pattern generator (SPG) and the inspiratory rhythm generator, the preBötzinger complex, to regulate proper swallow-breathing coordination (Huff et al., 2023). PiCo is characterized by interneurons co-expressing transporters for glutamate (Vglut2) and acetylcholine (ChAT). Here we show that optogenetic stimulation of ChATcre:Ai32, Vglut2cre:Ai32, and ChATcre:Vglut2FlpO:ChR2 mice exposed to CIH does not alter swallow-breathing coordination, but unexpectedly disrupts swallow behavior via triggering variable swallow motor patterns. This suggests that glutamatergic–cholinergic neurons in PiCo are not only critical for the regulation of swallow-breathing coordination, but also play an important role in the modulation of swallow motor patterning. Our study also suggests that swallow disruption, as seen in OSA, involves central nervous mechanisms interfering with swallow motor patterning and laryngeal activation. These findings are crucial for understanding the mechanisms underlying dysphagia, both in OSA and other breathing and neurological disorders.

Existence and pattern of sleep-related breathing disorders in patients diagnosed with bronchial asthma.

Asthma and obstructive sleep apnea (OSA) are commonly prevalent diseases, and both can co-exist to result in an alternate overlap syndrome, where a bidirectional relationship can adversely affect each other. This study aimed to determine the existence and pattern of sleep-related breathing disorders in subjects with bronchial asthma. It was prospectively conducted at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi, in diagnosed cases of bronchial asthma. A subjective assessment of sleepiness was done using the Epworth sleepiness scale (ESS). All subjects underwent overnight polysomnography (PSG) in the Sleep Laboratory of the Institute. A total of 70 subjects were screened, and among them, finally, 30 were enrolled. The mean age of the subjects was 37.53±11.21 years, the mean body mass index (BMI) was 26.4±5.58 kg/m2, the mean ESS score was 3.1, and 80% of the subjects were male. After PSG, OSA (apnea hypopnea index >5/hour) was found in 63% (19/30) of the patients, of whom 43% had mild OSA, 10% had moderate OSA, and 10% had severe OSA. 10% (3/30) had nocturnal oxygen desaturation, while none had sleep hypoventilation. Patients with OSA compared to those without OSA had a higher BMI, more co-morbid allergic rhinitis, severe bronchial asthma, and a worse percentage of predicted forced expiratory volume in the first second. The study showed high detection rates of OSA in bronchial asthma patients. Hence, asthma patients should be evaluated for OSA.

Outcome of tonsillotomy in children with obstructive sleep-disordered breathing

Objective/BackgroundMost children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters. MethodsChildren aged 2–10 years with oSDB were selected for ATO based uponclinical findings according to current standards of care in Denmark. Each childunderwent standardized assessment before and 3 months after surgery, including aPSG, tonsil size assessment, and the Pediatric Sleep Questionnaire –Sleep RelatedBreathing Disorder (PSQ) to quantify symptom burden. Obstructive sleep apnea (OSA)was defined as an obstructive apnea-hypopnea index (oAHI) ≥2/h. Successfultreatment was defined as post-surgery oAHI ≤5/h, and complete cure as oAHI ≤2/h. ResultsFifty-two children were included. Mean age was 5.0 years (SD ± 1.76). Thirteen children were identified with baseline oAHI <2/h. Significant improvement inOSA severity was observed in children with moderate-to-severe OSA, in whom oAHI decreased from 15.7/h to 2.6/h (p < 0.001). Treatment success was obtained in 85% and cure was obtained in 42% of children. PSQ-score significantly improved from 0.52 (CI 0.47–0.56) to 0.26 (CI 0.21–0.32) (p < 0.001). Baseline OSA severity was notcorrelated to baseline symptom burden nor to symptom relief after ATO. There were noserious adverse events. ConclusionsAdeno-tonsillotomy significantly reduced symptom burden in otherwise healthy children with oSDB symptoms. Significant improvement in oAHI was observedonly in children with moderate-to-severe OSA. We recommend combining clinicalevaluation with PSQ and oAHI.

Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population

BackgroundPediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. MethodsThe translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4–18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. ResultsThe factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. ConclusionsCultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.

3D analysis of upper airway morphology related to obstructive sleep apnea severity

BackgroundObstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep. However, little evidence is available on the differences between the sub-regions of the upper airway morphology and OSA severity. Since orthodontists frequently perform cone beam computed tomography (CBCT) in the neck area, we aimed to investigate the relationship and the differences between upper airway morphology and OSA severity using CBCT. Materials and methodsThe medical records, CBCT imaging of 21 OSA patients diagnosed by polysomnography, and the apnea-hypopnea index (AHI) results were included to classify OSA severity as mild, moderate, or severe. The minimum cross-sectional areas (MCA) and volumes of the upper pharyngeal airway boundaries in four sub-regions: nasopharynx, retropalatal, retroglossal, and hypopharynx were measured. Dolphin Imaging software was used for upper airway segmentation. The correlation coefficient (r), one-way ANOVA, and the least significant difference post hoc multiple comparison test were applied to fulfill the objectives. ResultsA statistically significant relationship was found between the MCA of the nasopharynx and the AHI (r = −0.473, P < 0.05). Furthermore, a difference was found between mild and moderate and moderate and severe OSA severity in the MCA results of the retroglossal region (P < 0.05). However, no relationship was found between the upper airway volume and OSA severity. ConclusionsMCA was moderately negatively correlated to AHI only in the nasopharynx subregion. Moderate OSA presented significantly less MCA than mild and severe OSA only in the oropharynx and retroglossal subregions.

Current aspects and future perspectives on polysomnography. Applicability in rehabilitation patients diagnosed with sleep related breathing disorders -A narrative review

Abstract: Background: Polysomnography is continually advancing technically, with its applica-bility expanding across various fields. This narrative review aims to highlight its recent develop-ments, current applications, and future perspectives from a clinical point of view. Methods: Relevant articles written in English published from 2015 to 2024 were searched in PubMed and Google Scholar. Results: Polysomnography remains the gold standard test in sleep disorders but in certain categories of patients it is not very accesible. Some of the home sleep tests (HSAT) perform closely to PSG testing. Identifying REM movement disorders early is important because it is a predictor factor for developing neurodegenerative diseases. Artificial intelligence (AI) cаn be used for diаgnosis by integrаting АI in weаrаble devices for remote monitoring, using it for fаster аnd а more аccurаte scoring, аs well аs using it to offer рersonаlized treаtment for eаch individuаl. Polysomnography can play a pivotal role in diagnosing sleep related breathing disorders in reha-bilitation patients to offer treatment, help in the improvement of sleep quality and consequently, offer better rehabilitation outcomes. Conclusions: Polysomnography opens up numerous possi-bilities for investigating sleep disorders, providing a comprehensive understanding of an indi-vidual's sleep health, and improving the management of sleep-related disorders

Genetic Influences on Snoring: A Narrative Review

Snoring is a sound that results from vibrations of soft tissues in the narrowed upper airway during sleep. Obstructive sleep apnea (OSA) is a disease entity that must be properly treated. Snoring, which is also considered a symptom of the spectrum of sleep-related breathing disorders, is often overlooked. Although many studies have been conducted on genetic risk factors related to OSA, studies focusing on snoring are limited. Here, we reviewed the literature regarding the influence of genetics on snoring. Initial studies on the influence of genetics on snoring were based on twin and familial studies. Twin studies demonstrated that the phenotypic correlation of snoring between monozygotic twins was greater than that in dizygotic twins, while family history of snoring increases the risk of snoring. Genome-wide association studies showed that traits such as minimum SpO&lt;sub&gt;2&lt;/sub&gt;, umbilical hernia or anthropometric measures such as leg fat mass were genetically correlated to snoring. Traits were mapped and genes such as &lt;i&gt;DLEU7&lt;/i&gt; and &lt;i&gt;MSRB3&lt;/i&gt; have been identified. Snoring is not a disease that should be overlooked. Those with genetic factors increasing the risk of snoring should put more effort into controlling the modifiable risk factor related to snoring.

Innovative Sleep Monitoring: A Non-Invasive Approach Using Force-Sensing Resistors for Analyzing Sleep Quality and Detecting Sleep-Related Breathing Disorders

Innovative Sleep Monitoring: A Non-Invasive Approach Using Force-Sensing Resistors for Analyzing Sleep Quality and Detecting Sleep-Related Breathing Disorders

Prevalence of obstructive sleep apnoea risk and its association with anthropometric indices of cardiometabolic risks and cognition in young and middle-aged adults

Objectives: Obstructive sleep apnoea (OSA), an often underdiagnosed and undertreated sleep-related breathing disorder, is associated with an increased risk of cardiovascular morbidity and mortality. Hence, this study aimed to assess the prevalence of OSA risk and its association with anthropometric indices (AI) of cardiometabolic risks, domain-specific cognitive functions and quality of sleep in apparently healthy young and middle-aged adults. Materials and Methods: One hundred and eighty-nine apparently healthy individuals (123 males and 66 females) aged 19–45 years were included in this cross-sectional study. The participant’s current risk of OSA was assessed using the STOP-Bang questionnaire, and AI indicative of cardiometabolic risk (body mass index, waist-hip ratio [W/H ratio], waist-height ratio [WHtR], conicity index and a body shape index) was assessed using standard techniques. Domain-specific cognitive tests were performed to assess the cognitive status of the individual. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. The correlation between the OSA risk score and the study parameters was assessed using the Pearson or Spearman correlation coefficient test. Results: The prevalence of high current risk of moderate to severe OSA was found to be 12.7%. Significant positive correlations were observed between OSA risk score and W/H, WHtR and sleep quality scores. While a significant positive correlation was observed between OSA risk score and executive functioning, significant negative correlations were observed with the other cognitive tests (short-term memory, verbal fluency, visuospatial memory and sustained attention and response speed). Conclusion: A high risk of moderate to severe OSA is associated with obesity, cognitive decline and poor sleep quality in apparently healthy young and middle-aged adults.

Impact of Adaptive Servo-Ventilation in Heart Failure Patients

Objective: Sleep-related breathing disorders (SRBD) as obstructive apnea, central apnea, and Cheyne-Stokes respiration (CSR), can be seen in patients with chronic heart failure. SRBD can influence the prognosis of heart failure. We aim to reveal sleep-related breathing disorders in heart failure patients and display the effects of adaptive servo-ventilation (ASV) as a new therapeutic modality. Materials and Methods: In this prospective study, 32 patients with heart failure were included. One night polysomnography (PSG) was done. Results: According to the results of PSG, the SRBD ratio was 96.7%. Continuous positive airway pressure (CPAP) and ASV titrations were offered to all patients with an apnea-hypopnea index (AHI) &amp;gt; 5. Demographics, clinical properties, symptoms, PSG findings, Cheyne-Stokes respiration (CSR), and echocardiography results were recorded. Before and after ASV titration, pulmonary function tests and walking tests were performed, and concentrations of transferrin and pro-BNP were recorded. In the groups according to the AHI, severe obstructive sleep apnea syndrome (OSAS) in 18 of 30 patients, four moderate OSAS, five mild OSAS, and two central sleep apnea (CSA). PSG and, CPAP, ASV titrations were done in 7 male and one female patient that obstructive apnea, central apnea, AHI, arousal, and SpO2 min values had significant improvements (p=0,001, p=0,016, p=0,001, p=0,015 and p=0,008 respectively). We determined all CSRs were eliminated with ASV. After ASV titration pro-BNP, walking distance, and FVC values changed significantly (p=0,036, p=0,018, and p=0,018 respectively). Conclusion: As a result, we determined CSR and central apneas persisted with CPAP but were eliminated with a one-night ASV application. ASV also decreased pro-BNP and increased FVC and walking distance values significantly.

Non-Invasive Positive Pressure Ventilation Use-Practice Recommendations of the Slovak Society of Pulmonology and Phthisiology.

Non-invasive positive pressure ventilation (NIPPV) is increasingly used as a treatment method for patients with respiratory failure. The first recommendations for the use of NIPPV in Slovakia were developed by the Slovak Society of Pulmonology and Phthisiology in 2007 and were partially revised in 2015. New scientific evidence prompted the present update, which is based on widely accepted international guidelines and was adapted to address local needs. Important features of the present update include a classification of acute indications for NIPPV into three categories based on the level of supporting evidence, namely 1. definite indications for in-hospital use of NIPPV; 2. possible indications for in-hospital use of NIPPV; and 3. disorders and states in which in-hospital use of NIPPV is not recommended. The current update also reflects the importance of comorbid sleep-related breathing disorders and other chronic respiratory conditions, as well as the use and limitations of continuous positive airway pressure therapy. Since oxygen therapy is often administered along with NIPPV, guidance on the safe use of oxygen in NIPPV-treated patients has also been included. Also, the present update extends the range of its users, addressing the needs of specialists in pediatric respiratory medicine as a novelty.

Sleep-related breathing disorder in a Japanese occupational population and its association with hypertension-stratified analysis by obesity status.

Sleep-related breathing disorder (SRBD) causes hypertension, and obesity has been highly associated with SRBD, which has become a serious health problem in young and middle-aged Japanese males. However, the relation between SRBD and hypertension considering the effects of obesity remains unknown. In this cross-sectional study, we examined the relationship between SRBD and hypertension, with consideration for the effects of obesity, in Japanese occupational population. Using 3% oxygen desaturation index (3%ODI) obtained by simplified polysomnography (PSG), participants were classified into low (0 ≤ 3%ODI < 5), medium (5 ≤ 3%ODI < 15), and high (15 ≤ 3%ODI) 3%ODI groups. We excluded employees who had not undergone medical examination with simplified PSG in the same year from 2012 to 2018. Logistic regression analysis was performed to calculate odds ratios for having hypertension according to 3%ODI levels. In total, 2532 employees were included. Among them, 25% and 4% were categorized into the medium and high 3%ODI groups, respectively. The odds ratio for hypertension increased significantly with higher 3%ODI levels after adjustment for age, sex, alcohol drinking status and smoking status (p for trend < 0.0001). However, further adjustment for obesity status (body mass index ≥ 25 kg/m2) attenuated the associations. When we performed the stratified analysis by obesity status, the odds ratio for hypertension increased significantly with higher 3%ODI only for non-obese individuals, with significant interaction (p for interaction = 0.014). Higher 3%ODI was significantly associated with higher prevalence of hypertension especially in non-obese participants, suggesting the importance of vigilance for the presence of SRBD even in non-obese individuals. We investigated the association between SRBD and hypertension considering the effects of obesity, which would suggest the need to keep in mind the presence of SRBD even in non-obese individuals.