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Saha S, Ghahjaverestan NM, Yadollahi A. Separating obstructive and central respiratory events during sleep using breathing sounds: Utilizing transfer learning on deep convolutional networks. Sleep Med 2025; 131:106485. [PMID: 40188799 DOI: 10.1016/j.sleep.2025.106485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 02/25/2025] [Accepted: 03/28/2025] [Indexed: 05/20/2025]
Abstract
Sleep apnea diagnosis relies on polysomnography (PSG), which is resource-intensive and requires manual analysis to differentiate obstructive sleep apnea (OSA) from central sleep apnea (CSA). Existing portable devices, while valuable in detecting sleep apnea, often do not distinguish between the two types of apnea. Such differentiation is critical because OSA and CSA have distinct underlying causes and treatment approaches. This study addresses this gap by leveraging tracheal breathing sounds as a non-invasive and cost-effective method to classify central and obstructive events. We employed a transfer learning strategy on six pre-trained deep convolutional neural networks (CNNs), including Alexnet, Resnet18, Resnet50, Densenet161, VGG16, and VGG19. These networks were fine-tuned using spectrograms of tracheal sound signals recorded during PSG. The dataset, comprising 50 participants with a combination of central and obstructive events, was used to train and validate the model. Results showed high accuracy in differentiating central from obstructive respiratory events, with the combined CNN architecture achieving an overall accuracy of 83.66 % and a sensitivity and specificity above 83 %. The findings suggest that tracheal breathing sounds can effectively distinguish between OSA and CSA, providing a less invasive and more accessible alternative to traditional PSG. This methodology could be implemented in portable devices to enhance the diagnosis of sleep apnea, enabling targeted treatment. By facilitating earlier and more accurate diagnoses, this method supports personalized treatment strategies, optimizing therapy selection (e.g., CPAP for OSA, ASV for CSA) and ultimately enhancing clinical outcomes.
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Affiliation(s)
- Shumit Saha
- Department of Biomedical Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN, USA; Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nasim Montazeri Ghahjaverestan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Electrical and Computer Engineering, Queens University, London, ON, Canada
| | - Azadeh Yadollahi
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Kalaydzhiev P, Velikova T, Davidkova Y, Voynova G, Borizanova A, Spasova N, Georgieva N, Ilieva R, Kinova E, Goudev A. Effects of SGLT2 Inhibitors on Sleep Apnea Parameters and Cheyne-Stokes Respiration in Patients with Acute Decompensated Heart Failure: A Prospective Cohort Study. Biomedicines 2025; 13:1474. [PMID: 40564192 DOI: 10.3390/biomedicines13061474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2025] [Revised: 06/09/2025] [Accepted: 06/13/2025] [Indexed: 06/28/2025] Open
Abstract
Background: Sleep-disordered breathing (SDB), particularly Cheyne-Stokes respiration (CSR), is highly prevalent among patients hospitalized with acute decompensated heart failure (ADHF) and is associated with worse clinical outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiorenal benefits in heart failure, but their effects on nocturnal respiratory parameters remain underexplored. Objectives: This study aims to evaluate the impact of SGLT2i therapy on key respiratory and cardiac indices including CSR burden, oxygenation, and right heart function in patients with ADHF and reduced left ventricular ejection fraction. Methods: In this single-center prospective cohort study, 60 patients with ADHF, LVEF < 40%, and a baseline apnea-hypopnea index (AHI) > 5 were assessed before and three months after the initiation of SGLT2i therapy. Sleep respiratory parameters were measured using home polygraphy (ApneaLinkTM), while cardiac and renal indices were evaluated by echocardiography, NT-proBNP, and the estimated glomerular filtration rate (eGFR). Structural and functional echocardiographic changes were analyzed both at baseline and following the 3-month treatment period. Patient-reported outcomes were assessed using the Epworth Sleepiness Scale (ESS) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Results: After 3 months of SGLT2i therapy, significant improvements were observed in daytime sleepiness (ESS: -2.68 points; p < 0.001), CSR index (-5.63 events/h; p < 0.001), AHI (-3.07 events/h; p < 0.001), ODI (-6.11 events/h; p < 0.001), and mean nocturnal SpO2 (+1.95%; p < 0.001). KCCQ scores increased by 9.16 points (p < 0.001), indicating improved quality of life. Cardiac assessments revealed reductions in NT-proBNP (-329.6 pg/mL; p < 0.001) and E/e' ratio (-1.08; p < 0.001), with no significant change in LVEF or chamber dimensions. Right ventricular function improved, as evidenced by the increased TAPSE/sPAP ratio (+0.018; p < 0.001). Renal function remained stable, with a non-significant upward trend in eGFR. Conclusions: This exploratory study suggests that SGLT2 inhibitors may be associated with the attenuation of Cheyne-Stokes respiration and an improvement in right heart function in patients with ADHF, warranting further investigation in controlled trials. These findings highlight the potential of SGLT2is to address overlapping cardio-respiratory dysfunction in this high-risk population.
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Affiliation(s)
- Petar Kalaydzhiev
- Department of Emergency Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1407 Sofia, Bulgaria
| | - Yanitsa Davidkova
- Department of Clinical Hematology, Specialized Hospital of Active Treatment of Hematological Diseases, 1000 Sofia, Bulgaria
| | - Gergana Voynova
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Angelina Borizanova
- Department of Emergency Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Natalia Spasova
- Department of Emergency Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Neli Georgieva
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Radostina Ilieva
- Department of Emergency Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Elena Kinova
- Department of Emergency Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
| | - Assen Goudev
- Department of Emergency Medicine, Medical University-Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital "Tsaritsa Yoanna-ISUL", 1000 Sofia, Bulgaria
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Taniguchi Y, Sakamoto M, Fujii H, Miwa K, Tsuboi Y, Yanaka K, Emoto N, Otake H. Nocturnal desaturation in patients with non-operable chronic thromboembolic pulmonary hypertension. BMC Pulm Med 2025; 25:254. [PMID: 40405120 PMCID: PMC12096539 DOI: 10.1186/s12890-025-03712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 05/07/2025] [Indexed: 05/24/2025] Open
Abstract
BACKGROUND Nocturnal desaturation is occasionally observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) despite the absence of parenchymal lung disease; however, the underlying mechanism remains unclear. This study aimed to clarify the clinical features of nocturnal desaturation in patients with CTEPH. METHODS Data of 163 patients with CTEPH who underwent balloon pulmonary angioplasty (BPA) between March 2011 and December 2022 were retrospectively analyzed. We evaluated their hemodynamics using right heart catheterization, arterial blood gas examination, respiratory function tests, nocturnal oximetry, and cardiopulmonary exercise testing, which were routinely performed at baseline and after BPA. RESULTS A higher ratio of dead space to tidal volume (VD/VT) (p < 0.001) and higher alveolar-arterial oxygen difference (A-aDO2) (p = 0.026) at baseline were associated with greater nocturnal desaturation in the multivariable linear analysis. After BPA, nearly normal hemodynamics was achieved (mean pulmonary arterial pressure: 37.5 ± 10.0 to 20.2 ± 4.9 mmHg, p < 0.01). Nocturnal desaturation also improved from - 13.3 ± 5.8% at baseline to -10.3 ± 5.4% after BPA (p < 0.01). Improvement in VD/VT correlated well with improvement in nocturnal desaturation after BPA (p < 0.001, R2 linear = 0.18). CONCLUSIONS Nocturnal desaturation often coexists with CTEPH. VD/VT, a marker of physiologic dead-space fraction, A-aDO2, a marker of ventilation-perfusion mismatch, and lung diffusing capacity were strongly associated. Nocturnal desaturation improved slightly after BPA, which was associated with a decrease in the physiological dead- space fraction. Our study emphasizes the importance of including nocturnal oximetry in routine evaluations and continuation of nocturnal oxygen therapy, if necessary, in patients with CTEPH.
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Affiliation(s)
- Yu Taniguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan.
| | - Miki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
| | - Keisuke Miwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
| | - Yasunori Tsuboi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
| | - Kenichi Yanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
| | - Noriaki Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
- Laboratory of Clinical Pharmaceutical Science, Kobe Pharmaceutical University, Kobe, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
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Müller C, Kerl J, Dellweg D. A comparative study on the hemodynamic effects of initiating positive airway pressure treatment in patients with obstructive and central sleep apnea. Sleep Breath 2025; 29:154. [PMID: 40208443 PMCID: PMC11985557 DOI: 10.1007/s11325-025-03317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/18/2024] [Accepted: 03/26/2025] [Indexed: 04/11/2025]
Abstract
PURPOSE Both obstructive (OSA) and central sleep apnea (CSA) are associated with considerable cardiovascular morbidity which argues for treatment initiation with a positive airway pressure (PAP) device even in the absence of significant day-time sleepiness. While the long-term consequences of PAP treatment in patients with sleep disordered breathing have been investigated in several studies, less is known about the immediate hemodynamic effects. Therefore, the present study intended to investigate the immediate effect of PAP treatment on non-invasively measured hemodynamic parameters in 10 patients with either OSAS or CSA. METHODS During diagnostic and therapeutic conditions, the routine polysomnographic assessment was extended with an impedance cardiography (ICG) system. Statistical analysis was performed to find differences between both groups and conditions. In addition, the relationship between the treatment associated effect on stroke volume (SV) with biometric, polysomnographic, and cardiovascular parameters was assessed. RESULTS Comparing both subgroups, we found statistically significant differences for biometric, polysomnographic, and cardiovascular parameters. Patients with CSA were older (p = 0.0005) and had higher values for diagnostic (p = 0.015) and therapeutic (p = 0.029) pulse pressure and the pre-ejection period under diagnostic conditions (p = 0.031). In contrast to patients with CSA who exhibited a slight increase of SV and derived parameters under therapeutic conditions, a pronounced decrease was observed in patients with OSAS which was statistically significant for the cardiac index (p = 0.038). CONCLUSION Our results indicate that patients with OSAS and CSA who are characterized by unique clinical features may show a distinguishable hemodynamic response to PAP treatment that can be measured non-invasively with ICG.
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Affiliation(s)
- Christoph Müller
- Department of Internal Medicine, Lahn-Dill-Kliniken, Philipps University of Marburg, Marburg, Germany.
- Philipps University of Marburg, Baldinger Straße, 35037, Marburg, Germany.
| | - Jens Kerl
- Sleep Clinic, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany
| | - Dominic Dellweg
- Department of Pulmonology, Pius-Hospital Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Pinna GD, Robbi E, La Rovere MT, Maestri R. Heart rate response to transient hypoxia in patients with heart failure and Cheyne-Stokes respiration. Exp Physiol 2025; 110:532-542. [PMID: 39962768 PMCID: PMC11963901 DOI: 10.1113/ep092304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 12/11/2024] [Indexed: 04/03/2025]
Abstract
Cheyne-Stokes respiration (CSR), a rhythmic rise and fall in ventilation often experienced by patients with heart failure during sleep, is typically accompanied by an oscillation in heart rate (HR) at the same frequency. The mechanisms responsible for this oscillation are still debated. In this study, we used the experimental model of the transient hypoxia test (i.e., a laboratory test that mimics the transient nature of the cyclic desaturations that occur during hyperpnoeic phases of CSR) to assess accurately the temporal relationship between the HR response to transient hypoxia and the tidal volume response in six heart failure patients. The same relationship was assessed during CSR using polysomnographic signals. We hypothesized that this relationship would provide important insights into the key mechanisms contributing to the HR response. During transient hypoxia, HR started to increase around the onset of tidal volume increase but continued to increase after the peak of the latter had been reached. The time delay between the two peaks (HR vs. tidal volume) was 7.9 ± 4.8 s. The same delay during hyperpnoeic phases of CSR was 1.0 ± 0.9 s. In addition, the increases in lung volume were much greater than those found in the laboratory tests. Based on the known dynamics of vagal and sympathetic control of HR, we speculate that the HR response to transient hypoxia might be attributable predominantly to the sympathetically mediated tachycardic effect of the increased central inspiratory drive, whereas the fast, vagally mediated pulmonary inflation reflex might be the predominant mechanism during CSR.
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Affiliation(s)
- Gian Domenico Pinna
- Department of Biomedical Engineering of Montescano InstituteIstituti Clinici Scientifici Maugeri IRCCSMontescanoItaly
| | - Elena Robbi
- Respiratory Physiopathology and Sleep Unit of Montescano InstituteIstituti Clinici Scientifici Maugeri IRCCSMontescanoItaly
| | - Maria Teresa La Rovere
- Department of Cardiology of Montescano InstituteIstituti Clinici Scientifici Maugeri IRCCSMontescanoItaly
| | - Roberto Maestri
- Department of Biomedical Engineering of Montescano InstituteIstituti Clinici Scientifici Maugeri IRCCSMontescanoItaly
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Akbari A, Raji H, Islampanah M, Barati S, Davoodian N, Aminizadeh S, Baniassad S, Amini M, Baniasad A. Sleep apnea in pulmonary hypertension patients: a systematic review and meta-analysis sleep disorders and pulmonary hypertension. Sleep Breath 2025; 29:120. [PMID: 40056328 DOI: 10.1007/s11325-025-03280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 02/07/2025] [Accepted: 02/12/2025] [Indexed: 03/10/2025]
Abstract
INTRODUCTION Patients with pulmonary hypertension (PH) often have comorbid sleep apnea (SA), but the prevalence, severity, and clinical characteristics of PH patients with SA have not been well studied. METHODS Using a combination of the keywords "pulmonary hypertension" and "sleep apnea," the PubMed, Embase, Web of Science, and Scopus databases were searched for articles reporting the prevalence, severity, and clinical characteristics of PH patients with SA that were available through June 25, 2024. RESULTS Of the 7969 studies, 39 were included in the final analysis. Prevalence of obstructive and central SA was 45.4% [39.2%, 51.6%]) and 9.3% [6%, 14.2%], respectively. The mean apnea hypopnea index (AHI) of patients with obstructive SA and PH was 18 [13.6, 22.4] with a standard error of 2.2. Subgroup analysis revealed that 51.4% [38.4%, 64.2%] had mild SA, 28% [22.5%, 33.6%] had moderate, and 20% [15.2%, 25%] had severe SA. PH patients with SA were characterized by male sex (odds ratio (OR) = 1.86 [1.45, 2.37], P < 0.001), older age (mean difference (MD) = -9.37 [-14.23, -4.43], P < 0.001), and higher body mass index (BMI) (MD = -2.16 [-3.32, -1.00], P < 0.001) compared to those without SA. However, mean pulmonary arterial pressure (mPAP) was not significantly different between SA and non-SA (MD = -2.4 [-5.1, 0.3], P = 0.078). Meta-regression showed no significant association between mPAP and AHI among patients with PH and SA (P = 0.13). CONCLUSION Our study found that SA is common in PH patients with certain clinical characteristics. We recommend conducting sleep studies in all PH patients, especially in older, overweight male patients.
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Affiliation(s)
- Abolfazl Akbari
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Raji
- Department of Internal Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Division of Sleep Medicine, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Muhammad Islampanah
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sama Barati
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Davoodian
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Soheil Aminizadeh
- Department of Physiology and Pharmacology, Afzalipour School of Medicine, and Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Shima Baniassad
- Department of Anesthesiology, Sina Hospital, Medical Sciences University of Tehran, Tehran, Iran
| | - Mahnaz Amini
- Division of Sleep Medicine, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Baniasad
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kasai T, Kohno T, Shimizu W, Ando S, Joho S, Osada N, Kato M, Kario K, Shiina K, Tamura A, Yoshihisa A, Fukumoto Y, Takata Y, Yamauchi M, Shiota S, Chiba S, Terada J, Tonogi M, Suzuki K, Adachi T, Iwasaki Y, Naruse Y, Suda S, Misaka T, Tomita Y, Naito R, Goda A, Tokunou T, Sata M, Minamino T, Ide T, Chin K, Hagiwara N, Momomura S. JCS 2023 Guideline on Diagnosis and Treatment of Sleep Disordered Breathing in Cardiovascular Disease. Circ J 2024; 88:1865-1935. [PMID: 39183026 DOI: 10.1253/circj.cj-23-0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Affiliation(s)
- Takatoshi Kasai
- Division of School of Health Science, Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Shinichi Ando
- Sleep Medicine Center, Fukuokaken Saiseikai Futsukaichi Hospital
| | - Shuji Joho
- Second Department of Internal Medicine, University of Toyama
| | - Naohiko Osada
- Department of Cardiology, St. Marianna University School of Medicine
| | - Masahiko Kato
- Division of School of Health Science, Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | | | | | - Akiomi Yoshihisa
- Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Science
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | | | - Motoo Yamauchi
- Department of Clinical Pathophysiology of Nursing and Department of Respiratory Medicine, Nara Medical University
| | - Satomi Shiota
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Jiro Terada
- Department of Respiratory Medicine, Japanese Red Cross Narita Hospital
| | - Morio Tonogi
- 1st Depertment of Oral & Maxillofacial Surgery, Nihon Univercity School of Dentistry
| | | | - Taro Adachi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Tomofumi Misaka
- Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Science
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Ryo Naito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine
| | - Tomotake Tokunou
- Division of Cardiology, Department of Medicine, Fukuoka Dental College
| | - Makoto Sata
- Department of Pulmonology and Infectious Diseases, National Cerebral and Cardiovascular Center
| | | | - Tomomi Ide
- Faculty of Medical Sciences, Kyushu University
| | - Kazuo Chin
- Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Nobuhisa Hagiwara
- YUMINO Medical Corporation
- Department of Cardiology, Tokyo Women's Medical University
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Pinna GD, Maestri R, Robbi E, Guazzotti G, Caporotondi A, La Rovere MT. Nocturnal hypoxemic burden in patients with heart failure: Emerging prognostic role of its nonspecific component. Am Heart J 2024; 276:1-11. [PMID: 38972337 DOI: 10.1016/j.ahj.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/19/2024] [Accepted: 06/29/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Nocturnal hypoxemic burden has been shown to be a robust, independent predictor of all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to occur in a severe form even in patients with low or negligible frequency of respiratory events (apneas/hypopneas). This suggests the existence of two components of hypoxemic burden: one unrelated to respiratory events and the other related. The aim of this study was to characterize these two components and to evaluate their prognostic value. METHODS Nocturnal hypoxemic burden was assessed in a cohort of 280 patients with HFrEF by measuring the percentage of sleep with an oxygen saturation (SpO2) <90% (T90), and the area of the SpO2 curve below 90% (Area90). Both indices were also recalculated within the sleep segments associated with respiratory events (event-related component: T90Eve, Area90Eve) and outside these segments (nonspecific component: T90Nspec, Area90Nspec). The outcome of the survival analysis (Cox regression) was all-cause mortality. RESULTS During a median follow-up of 60 months, 87 patients died. T90, Area90, and their components were significant in univariate analysis (P < .05 all). However, when these indices were adjusted for known risk factors, T90, T90Nspec, Area90, and Area90Nspec remained statistically significant (P = .018, hazard ratio (HR)=1.12, 95%CI=(1.02, 1.23); P = .007, HR=1.20, 95% CI = [1.05, 1.37]; P = .020, HR = 1.05, 95% CI = [1.01, 1.10]; P = .0006, HR = 1.15, 95% CI = [1.06, 1.25]), whereas T90Eve and Area90Eve did not (P = .27, P = .28). These results were internally validated using bootstrap resampling. CONCLUSIONS By demonstrating a significant independent association of nonspecific hypoxemic burden with all-cause mortality, this study suggests that this component of total nocturnal hypoxemic burden may play an important prognostic role in patients with HFrEF.
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Affiliation(s)
- Gian Domenico Pinna
- Department of Biomedical Engineering of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Laboratory for the Study of Ventilatory Instability, Montescano, PV, Italy.
| | - Roberto Maestri
- Department of Biomedical Engineering of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Laboratory for the Study of Ventilatory Instability, Montescano, PV, Italy
| | - Elena Robbi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Physiopathology and Sleep Unit of Montescano Institute, Montescano, PV, Italy
| | - Giampaolo Guazzotti
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiology of Montescano Institute, Montescano, PV, Italy
| | - Angelo Caporotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiology of Montescano Institute, Montescano, PV, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiology of Montescano Institute, Montescano, PV, Italy
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Zheng Y, Tai JE, Yee BJ. Management of central sleep apnoea: a review of non-hypercapnic causes. Breathe (Sheff) 2024; 20:230235. [PMID: 39534487 PMCID: PMC11555585 DOI: 10.1183/20734735.0235-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/18/2024] [Indexed: 11/16/2024] Open
Abstract
Central sleep apnoea (CSA) is characterised by recurrent episodes of airway cessation or reduction in the absence of respiratory effort. Although CSA is less common than obstructive sleep apnoea, it shares similar symptoms. CSA can be secondary to various medical conditions, high altitude and medication exposure. CSA can also emerge during obstructive sleep apnoea therapy. There are a range of treatment options and selecting the right therapy requires an understanding of the pathophysiology of CSA. This review explores the aetiology, pathophysiology and clinical management of non-hypercapnic CSA.
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Affiliation(s)
- Yizhong Zheng
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, Australia
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales Faculty of Medicine, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jian Eu Tai
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, Australia
| | - Brendon J. Yee
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, Central Clinical School, The University of Sydney, Sydney, Australia
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10
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Lyons OD. Sleep disorders in chronic kidney disease. Nat Rev Nephrol 2024; 20:690-700. [PMID: 38789686 DOI: 10.1038/s41581-024-00848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
Sleep disorders are highly prevalent in chronic kidney disease (CKD) but are often under-recognized. Restless legs syndrome, which is common in CKD owing to issues with dopamine metabolism and is exacerbated by iron deficiency and uraemia, can lead to poor sleep quality and increased daytime fatigue. Insomnia is also prevalent in CKD, particularly in patients requiring dialysis, with increased sleep latency and sleep fragmentation being reported. The cause of insomnia in CKD is multifactorial - poor sleep habits and frequent napping during dialysis, uraemia, medications and mood disorders have all been suggested as potential contributing factors. Sleep apnoea and CKD are also now recognized as having a bi-directional relationship. Sleep apnoea is a risk factor for accelerated progression of CKD, and fluid overload, which is associated with kidney failure, can lead to both obstructive and central sleep apnoea. The presence of obstructive sleep apnoea in CKD can exacerbate the already heightened cardiovascular morbidity and mortality in these patients, as well as leading to daytime fatigue and reduced quality of life. Increased awareness, timely diagnosis and appropriate therapeutic interventions are essential to reduce the negative impact of sleep disorders in patients with kidney disease.
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Affiliation(s)
- Owen D Lyons
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Women's College Hospital, Toronto, Canada.
- Women's College Research Institute, Toronto, Ontario, Canada.
- Sleep Research Laboratory, Toronto Rehabilitation Institute, KITE-UHN, Toronto, Ontario, Canada.
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11
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Gao M, Yang Z, Choi J, Wang C, Dai G, Yang J. Triboelectric Nanogenerators for Preventive Health Monitoring. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:336. [PMID: 38392709 PMCID: PMC10892167 DOI: 10.3390/nano14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
With the improvement in life quality, the increased focus on health has expedited the rapid development of portable preventative-health-monitoring devices. As one of the most attractive sensing technologies, triboelectric nanogenerators (TENGs) are playing a more and more important role in wearable electronics, machinery condition monitoring, and Internet of Things (IoT) sensors. TENGs possess many advantages, such as ease of fabrication, cost-effectiveness, flexibility, material-selection variety, and the ability to collect low-frequency motion, offering a novel way to achieve health monitoring for human beings in various aspects. In this short review, we initially present the working modes of TENGs based on their applications in health monitoring. Subsequently, the applications of TENG-based preventive health monitoring are demonstrated for different abnormal conditions of human beings, including fall-down detection, respiration monitoring, fatigue monitoring, and arterial pulse monitoring for cardiovascular disease. Finally, the discussion summarizes the current limitations and future perspectives. This short review encapsulates the latest and most influential works on preventive health monitoring utilizing the triboelectric effect for human beings and provides hints and evidence for future research trends.
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Affiliation(s)
- Mang Gao
- School of Physics, Central South University, Changsha 410083, China; (M.G.); (G.D.)
| | - Zhiyuan Yang
- Department of Mechanical Engineering, The University of Tokyo, Tokyo 113-8656, Japan;
| | - Junho Choi
- Department of Mechanical Engineering, Tokyo City University, Tokyo 158-8557, Japan;
| | - Chan Wang
- Department of Electrical and Computer Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117576, Singapore
- Center for Intelligent Sensors and MEMS, National University of Singapore, Block E6 #05-11, 5 Engineering Drive 1, Singapore 117608, Singapore
| | - Guozhang Dai
- School of Physics, Central South University, Changsha 410083, China; (M.G.); (G.D.)
| | - Junliang Yang
- School of Physics, Central South University, Changsha 410083, China; (M.G.); (G.D.)
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12
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Abu K, Khraiche ML, Amatoury J. Obstructive sleep apnea diagnosis and beyond using portable monitors. Sleep Med 2024; 113:260-274. [PMID: 38070375 DOI: 10.1016/j.sleep.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic sleep and breathing disorder with significant health complications, including cardiovascular disease and neurocognitive impairments. To ensure timely treatment, there is a need for a portable, accurate and rapid method of diagnosing OSA. This review examines the use of various physiological signals used in the detection of respiratory events and evaluates their effectiveness in portable monitors (PM) relative to gold standard polysomnography. The primary objective is to explore the relationship between these physiological parameters and OSA, their application in calculating the apnea hypopnea index (AHI), the standard metric for OSA diagnosis, and the derivation of non-AHI metrics that offer additional diagnostic value. It is found that increasing the number of parameters in PMs does not necessarily improve OSA detection. Several factors can cause performance variations among different PMs, even if they extract similar signals. The review also highlights the potential of PMs to be used beyond OSA diagnosis. These devices possess parameters that can be utilized to obtain endotypic and other non-AHI metrics, enabling improved characterization of the disorder and personalized treatment strategies. Advancements in PM technology, coupled with thorough evaluation and validation of these devices, have the potential to revolutionize OSA diagnosis, personalized treatment, and ultimately improve health outcomes for patients with OSA. By identifying the key factors influencing performance and exploring the application of PMs beyond OSA diagnosis, this review aims to contribute to the ongoing development and utilization of portable, efficient, and effective diagnostic tools for OSA.
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Affiliation(s)
- Kareem Abu
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon; Neural Engineering and Nanobiosensors Group, American University of Beirut, Beirut, Lebanon; Sleep and Upper Airway Research Group (SUARG), American University of Beirut, Beirut, Lebanon
| | - Massoud L Khraiche
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon; Neural Engineering and Nanobiosensors Group, American University of Beirut, Beirut, Lebanon
| | - Jason Amatoury
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon; Sleep and Upper Airway Research Group (SUARG), American University of Beirut, Beirut, Lebanon.
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13
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Lin Y, Xu S, Peng Y, Li S, Huang X, Chen L. Preoperative slow-wave sleep is associated with postoperative delirium after heart valve surgery: A prospective pilot study. J Sleep Res 2023; 32:e13920. [PMID: 37147892 DOI: 10.1111/jsr.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/28/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023]
Abstract
Postoperative delirium (POD) is a very common neurological complication after valve surgery. Some studies have shown that preoperative sleep disorder is associated with POD, but the correlation between preoperative slow wave sleep (SWS) and POD remains unclear. Therefore, this study aims to identify the correlation between preoperative slow wave sleep and postoperative delirium in patients with heart valve disease. This was a prospective, observational study of elective valve surgery patients admitted to the Heart Medical Center between November 2021 and July 2022. Polysomnography (PSG) was used to monitor sleep architecture from 9:30 p.m. for 1 night before surgery to 6:30 a.m. on the day of surgery. Patients were assessed for postoperative delirium from postoperative day 1 to extubation or day 5 by using the Richmond Agitation/Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). A total of 60 elective valve surgery patients were enrolled in this study. Prolonged N1 (11.44%) and N2 (58.62%) sleep, decreased N3 sleep (8.75%) and REM sleep (18.24%) within normal limits were the overall sleep architecture. Compared with patients without POD, patients with POD had less slow wave sleep 1 night before surgery (5.77% vs 10.88%, p < 0.001). After adjusting for confounding factors, slow wave sleep (OR: 0.647, 95% CI 0.493-0.851, p = 0.002) was found to be a protective factor for postoperative delirium. The preoperative SWS is a predictive factor of the POD in patients undergoing valve surgery. But further studies with larger sample sizes are still needed to elucidate the relationship between preoperative slow wave sleep and postoperative delirium.
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Affiliation(s)
- Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shurong Xu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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14
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Kato M. Diet- and Sleep-Based Approach for Cardiovascular Risk/Diseases. Nutrients 2023; 15:3668. [PMID: 37686700 PMCID: PMC10489927 DOI: 10.3390/nu15173668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023] Open
Abstract
Central sleep apnea represented by Cheyne-Stokes Respiration (CSR) is frequently observed in heart failure (HF) patients, and its severity has been reported to be associated with morbidity and mortality in patients with HF [...].
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Affiliation(s)
- Masahiko Kato
- Division of School of Health Science, Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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15
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Bucklin AA, Ganglberger W, Quadri SA, Tesh RA, Adra N, Da Silva Cardoso M, Leone MJ, Krishnamurthy PV, Hemmige A, Rajan S, Panneerselvam E, Paixao L, Higgins J, Ayub MA, Shao YP, Ye EM, Coughlin B, Sun H, Cash SS, Thompson BT, Akeju O, Kuller D, Thomas RJ, Westover MB. High prevalence of sleep-disordered breathing in the intensive care unit - a cross-sectional study. Sleep Breath 2023; 27:1013-1026. [PMID: 35971023 PMCID: PMC9931933 DOI: 10.1007/s11325-022-02698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Sleep-disordered breathing may be induced by, exacerbate, or complicate recovery from critical illness. Disordered breathing during sleep, which itself is often fragmented, can go unrecognized in the intensive care unit (ICU). The objective of this study was to investigate the prevalence, severity, and risk factors of sleep-disordered breathing in ICU patients using a single respiratory belt and oxygen saturation signals. METHODS Patients in three ICUs at Massachusetts General Hospital wore a thoracic respiratory effort belt as part of a clinical trial for up to 7 days and nights. Using a previously developed machine learning algorithm, we processed respiratory and oximetry signals to measure the 3% apnea-hypopnea index (AHI) and estimate AH-specific hypoxic burden and periodic breathing. We trained models to predict AHI categories for 12-h segments from risk factors, including admission variables and bio-signals data, available at the start of these segments. RESULTS Of 129 patients, 68% had an AHI ≥ 5; 40% an AHI > 15, and 19% had an AHI > 30 while critically ill. Median [interquartile range] hypoxic burden was 2.8 [0.5, 9.8] at night and 4.2 [1.0, 13.7] %min/h during the day. Of patients with AHI ≥ 5, 26% had periodic breathing. Performance of predicting AHI-categories from risk factors was poor. CONCLUSIONS Sleep-disordered breathing and sleep apnea events while in the ICU are common and are associated with substantial burden of hypoxia and periodic breathing. Detection is feasible using limited bio-signals, such as respiratory effort and SpO2 signals, while risk factors were insufficient to predict AHI severity.
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Affiliation(s)
- Abigail A Bucklin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Wolfgang Ganglberger
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Syed A Quadri
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Noor Adra
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Madalena Da Silva Cardoso
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Parimala Velpula Krishnamurthy
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Aashritha Hemmige
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Subapriya Rajan
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Ezhil Panneerselvam
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Jasmine Higgins
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Muhammad Abubakar Ayub
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Elissa M Ye
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | - Brian Coughlin
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
| | | | - Oluwaseun Akeju
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, MGH, Boston, MA, USA
| | | | - Robert J Thomas
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MA, 02114, USA.
- Clinical Data Animation Center (CDAC), MGH, Boston, MA, USA.
- Henry and Allison McCance Center for Brain Health, MGH, Boston, MA, USA.
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16
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Piccirillo F, Crispino SP, Buzzelli L, Segreti A, Incalzi RA, Grigioni F. A State-of-the-Art Review on Sleep Apnea Syndrome and Heart Failure. Am J Cardiol 2023; 195:57-69. [PMID: 37011555 DOI: 10.1016/j.amjcard.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/05/2023]
Abstract
Heart failure (HF) affects many patients worldwide every year. It represents a leading cause of hospitalization and still, today, mortality remains high, albeit the progress in treatment strategies. Several factors contribute to the development and progression of HF. Among these, sleep apnea syndrome represents a common but still underestimated factor because its prevalence is substantially higher in patients with HF than in the general population and is related to a worse prognosis. This review summarizes the current knowledge about sleep apnea syndrome coexisting with HF in terms of morbidity and mortality to provide actual and future perspectives about the diagnosis, evaluation, and treatment of this association.
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Affiliation(s)
- Francesco Piccirillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy.
| | - Simone Pasquale Crispino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Lorenzo Buzzelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Andrea Segreti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Raffaele Antonelli Incalzi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Geriatrics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
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17
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Cheong CS, Dedhia RC, Seay EG, Jara SM, Mora JI, Thaler ER, Schwartz AR. Enhanced drug-induced sleep endoscopy: Distinguishing central from obstructive apnea. Laryngoscope 2023; 133:706-708. [PMID: 36515430 PMCID: PMC9974765 DOI: 10.1002/lary.30517] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
This case report describes a patient originally diagnosed with obstructive sleep apnea (OSA) who was later found to have central sleep apnea (CSA) during drug-induced sleep endoscopy, which was subsequently confirmed on an in-laboratory sleep study. The revised diagnosis resulted in a change in recommended therapy from hypoglossal nerve stimulation to phrenic nerve stimulation. This case report is a reminder that the sleep surgeon must be cognizant of the possibility of CSA being misclassified as OSA especially as home sleep studies become increasingly routine, and discusses ways to more easily distinguish between CSA and OSA. Laryngoscope, 133:706-708, 2023.
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Affiliation(s)
- Crystal S. Cheong
- Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, PA, USA
| | - Raj C. Dedhia
- Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, PA, USA
| | - Everett G. Seay
- Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Sebastian M. Jara
- Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, PA, USA
| | - Jorge I. Mora
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, PA, USA
| | - Erica R. Thaler
- Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Alan R. Schwartz
- Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
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18
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Abulimiti A, Naito R, Kasai T, Ishiwata S, Nishitani-Yokoyama M, Sato A, Suda S, Matsumoto H, Shitara J, Yatsu S, Murata A, Shimizu M, Kato T, Hiki M, Daida H, Minamino T. Prognostic Value of Cheyne-Stokes Respiration and Nutritional Status in Acute Decompensated Heart Failure. Nutrients 2023; 15:964. [PMID: 36839321 PMCID: PMC9966345 DOI: 10.3390/nu15040964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Malnutrition frequently coexists with heart failure (HF), leading to series of negative consequences. Cheyne-Stokes respiration (CSR) is predominantly detected in patients with HF. However, the effect of CSR and malnutrition on the long-term prognosis of patients with acute decompensated HF (ADHF) remains unclear. We enrolled 162 patients with ADHF (median age, 62 years; 78.4% men). The presence of CSR was assessed using polysomnography and the controlling nutritional status score was assessed to evaluate the nutritional status. Patients were divided into four groups based on CSR and malnutrition. The primary outcome was all-cause mortality. In total, 44% of patients had CSR and 67% of patients had malnutrition. The all-cause mortality rate was 26 (16%) during the 35.9 months median follow-up period. CSR with malnutrition was associated with lower survival rates (log-rank p < 0.001). Age, hemoglobin, albumin, lymphocyte count, total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine, estimated glomerular filtration rate, B-type natriuretic peptide, administration of loop diuretics, apnea-hypopnea index and central apnea-hypopnea index were significantly different among all groups (p < 0.05). CSR with malnutrition was independently associated with all-cause mortality. In conclusion, CSR with malnutrition is associated with a high risk of all-cause mortality in patients with ADHF.
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Affiliation(s)
- Abidan Abulimiti
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Ryo Naito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Akihiro Sato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Jun Shitara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Azusa Murata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo 113-8421, Japan
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Ludwig K, Malatantis-Ewert S, Huppertz T, Bahr-Hamm K, Seifen C, Pordzik J, Matthias C, Simon P, Gouveris H. Central Apneic Event Prevalence in REM and NREM Sleep in OSA Patients: A Retrospective, Exploratory Study. BIOLOGY 2023; 12:298. [PMID: 36829574 PMCID: PMC9953334 DOI: 10.3390/biology12020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Patients with sleep-disordered breathing show a combination of different respiratory events (central, obstructive, mixed), with one type being predominant. We observed a reduced prevalence of central apneic events (CAEs) during REM sleep compared to NREM sleep in patients with predominant obstructive sleep apnea (OSA). The aim of this retrospective, exploratory study was to describe this finding and to suggest pathophysiological explanations. The polysomnography (PSG) data of 141 OSA patients were assessed for the prevalence of CAEs during REM and NREM sleep. On the basis of the apnea-hypopnea index (AHI), patients were divided into three OSA severity groups (mild: AHI < 15/h; moderate: AHI = 15-30/h; severe: AHI > 30/h). We compared the frequency of CAEs adjusted for the relative length of REM and NREM sleep time, and a significantly increased frequency of CAEs in NREM was found only in severely affected OSA patients. Given that the emergence of CAEs is strongly associated with the chemosensitivity of the brainstem nuclei regulating breathing mechanics in humans, a sleep-stage-dependent chemosensitivity is proposed. REM-sleep-associated neuronal circuits in humans may act protectively against the emergence of CAEs, possibly by reducing chemosensitivity. On the contrary, a significant increase in the chemosensitivity of the brainstem nuclei during NREM sleep is suggested.
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Affiliation(s)
- Katharina Ludwig
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Sebastian Malatantis-Ewert
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Tilman Huppertz
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Katharina Bahr-Hamm
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Christopher Seifen
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Johannes Pordzik
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Christoph Matthias
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Perikles Simon
- Department of Sport Medicine, Rehabilitation and Disease Prevention, Faculty of Social Science, Media and Sport, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Haralampos Gouveris
- Sleep Medicine Center, Department of Otorhinolaryngology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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20
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Pinna GD, Dacosto E, Maestri R, Crotti P, Montemartini S, Caporotondi A, Guazzotti G, Bruschi C. Postural changes in lung volumes in patients with heart failure and Cheyne-Stokes respiration: Relationship with sleep apnea severity. Sleep Med 2023; 101:154-161. [PMID: 36395720 DOI: 10.1016/j.sleep.2022.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIM It has been proposed that the increased severity of sleep apnea frequently observed in heart failure (HF) patients with Cheyne-Stokes respiration (CSR) when sleeping in the supine compared to the lateral position, may be caused by the concomitant reduction in functional residual capacity (FRC). We assessed positional changes in FRC in patients with CSR and investigated the relationship between these changes in the laboratory and corresponding changes in CSR severity during sleep. METHODS After a diagnostic polysomnography, 18 HF patients with dominant CSR and an apnea-hypopnea index (AHI)≥15 events/h underwent a standard pulmonary function test in the sitting position. Measurements were repeated in the supine, left lateral and right lateral. The latter two measurements were averaged to obtain a single lateral measurement. RESULTS The FRC in the seated position was 3.0 ± 0.5 L (85 ± 13% of predicted), decreased to 2.3 ± 0.3 L (-21 ± 8%, p < 0.0001) in the supine position, and increased to 2.8 ± 0.4 L (+21 ± 12%, p < 0.0001) from the supine to the lateral position (-5±8% vs seated, p = 0.013). During sleep, the AHI and the apnea index (AI) decreased from 47 ± 15 events/h to 26 ± 12 events/h (-46 ± 20%, p < 0.0001) and from 29 ± 21 events/h to 12 ± 10 events/h (-61 ± 40%, p < 0.001) from the supine to the lateral position. Changes in the AI were significantly correlated with corresponding changes in FRC (ρ = -0.55, p = 0.032). CONCLUSION In patients with HF and CSR, lying in the supine position causes a significant reduction in FRC in the context of a chronically reduced FRC. The negative correlation between postural changes in FRC and AI supports the hypothesis that the reduction in lung gas stores in the supine position may promote/exacerbate respiratory control instability.
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Affiliation(s)
- Gian Domenico Pinna
- Laboratory for the Study of Ventilatory Instability, Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy.
| | - Elena Dacosto
- Respiratory Physiopathology and Sleep Unit, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
| | - Roberto Maestri
- Laboratory for the Study of Ventilatory Instability, Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
| | - Paola Crotti
- Respiratory Physiopathology and Sleep Unit, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
| | - Silvia Montemartini
- Respiratory Physiopathology and Sleep Unit, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
| | - Angelo Caporotondi
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
| | - Giampaolo Guazzotti
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
| | - Claudio Bruschi
- Department of Pneumology, Istituti Clinici Scientifici Maugeri, Montescano Institute - IRCCS, Montescano, Italy
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21
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Beres E, Babes K, Beres ZL, Botea M, Davidescu L. Effect of home non-invasive ventilation on left ventricular function and quality of life in patients with heart failure and central sleep apnea syndrome. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Central Sleep Apnea Syndrome (CSAS) and Cheyne-Stokes breathing are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). Positive respiratory pressure therapy (PAP) associated with drug therapy for heart failure can improve quality of life, although tolerance to PAP therapy can be difficult to achieve.
Materials and method: Patients for this prospective, mono-center, cohort study were selected from patients with chronic heart failure who present at the Sleep Laboratory of the Medical Clinic of Pneumology, Oradea who underwent polysomnography. 38 HFrEF and CSAS patients were included between January 2019 to December 2021 in the study, with an apnea-hypopnea index (AHI) >=15/hour of sleep. Echocardiographic hemodynamic parameters (left ventricular ejection fraction-LVEF, mitral regurgitation score), PAP compliance, and quality of life using the severe respiratory failure questionnaire (SRI) at the initiation of PAP and after 3 months were included.
Results: After 3 months of PAP therapy LVEF increased significantly (from 31.4% ±12.2to 38.0%±10.9, p=0.0181), AHI decreased (from 40.1±18.7 to 6.8±6.1 events/h, p<0.0001) and all the categories of SRI showed improvement with significant general score increase (from 57.0±15.1 to 66.6±16.9, p<0.0001).
Conclusion: The association of PAP therapy with drug therapy in patients with HFrEF and CSAS improves hemodynamic parameters and quality of life.
Keywords: Chronic heart failure, positive airway pressure therapy, central sleep apnea syndrome
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Affiliation(s)
| | | | | | - Mihai Botea
- University of Oradea, Emergency Medicine Department;
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22
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Cho MY, Kim IS, Kim MJ, Hyun DE, Koo SM, Sohn H, Kim NY, Kim S, Ko S, Oh JM. NaCl Ionization-Based Moisture Sensor Prepared by Aerosol Deposition for Monitoring Respiratory Patterns. SENSORS (BASEL, SWITZERLAND) 2022; 22:5178. [PMID: 35890859 PMCID: PMC9317478 DOI: 10.3390/s22145178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
A highly polarizable moisture sensor with multimodal sensing capabilities has great advantages for healthcare applications such as human respiration monitoring. We introduce an ionically polarizable moisture sensor based on NaCl/BaTiO3 composite films fabricated using a facile aerosol deposition (AD) process. The proposed sensing model operates based on an enormous NaCl ionization effect in addition to natural moisture polarization, whereas all previous sensors are based only on the latter. We obtained an optimal sensing performance in a 0.5 µm-thick layer containing NaCl-37.5 wt% by manipulating the sensing layer thickness and weight fraction of NaCl. The NaCl/BaTiO3 sensing layer exhibits outstanding sensitivity over a wide humidity range and a fast response/recovery time of 2/2 s; these results were obtained by performing the one-step AD process at room temperature without using any auxiliary methods. Further, we present a human respiration monitoring system using a sensing device that provides favorable and stable electrical signals under diverse respiratory scenarios.
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Affiliation(s)
- Myung-Yeon Cho
- Department of Electronic Materials Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea; (M.-Y.C.); (M.-J.K.); (D.-E.H.); (S.-M.K.)
| | - Ik-Soo Kim
- Department of Materials Science and Engineering, Pohang University of Science and Technology, 77 Cheongam-ro, Pohang 37673, Korea;
| | - Min-Ji Kim
- Department of Electronic Materials Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea; (M.-Y.C.); (M.-J.K.); (D.-E.H.); (S.-M.K.)
| | - Da-Eun Hyun
- Department of Electronic Materials Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea; (M.-Y.C.); (M.-J.K.); (D.-E.H.); (S.-M.K.)
| | - Sang-Mo Koo
- Department of Electronic Materials Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea; (M.-Y.C.); (M.-J.K.); (D.-E.H.); (S.-M.K.)
| | - Hiesang Sohn
- Department of Chemical Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea;
| | - Nam-Young Kim
- RFIC Center, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea;
| | - Sunghoon Kim
- Department of Applied Chemistry, Dong-Eui University, Busan 47227, Korea;
| | - Seunghoon Ko
- Department of Electronic Materials Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea; (M.-Y.C.); (M.-J.K.); (D.-E.H.); (S.-M.K.)
| | - Jong-Min Oh
- Department of Electronic Materials Engineering, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea; (M.-Y.C.); (M.-J.K.); (D.-E.H.); (S.-M.K.)
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23
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Wang N, Tong J, Wang J, Wang Q, Chen S, Sheng B. Polyimide-Sputtered and Polymerized Films with Ultrahigh Moisture Sensitivity for Respiratory Monitoring and Contactless Sensing. ACS APPLIED MATERIALS & INTERFACES 2022; 14:11842-11853. [PMID: 35143181 DOI: 10.1021/acsami.1c24833] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Respiratory monitoring and contactless sensing using the moisture produced by respiration and perspiration have garnered considerable attention in recent years. In this study, we fabricated polyimide-sputtered and polymerized (PSP) humidity sensors with ultrahigh capacitive sensitivity, fast response, and a wide working range of relative humidity (RH). The sensors produced >40 000 times increment in the sensing signal over the 10-95% RH range at 10 Hz and exhibited good performance at low RH levels (<40%) as well. These sensors displayed excellent sensing properties with small hysteresis, long-time stability, and fast response and recovery times (2.4 and 1.2 s, respectively). In the mechanism study of PSP humidity sensors, we found that the high sensitivity can be attributed to massive hydrophilic functional groups formed on the polymer chains by moist aging with oxidation and the fast response speed is due to the mesoporous structure of PSP films. We also fabricated a 5 × 5 array of PSP humidity sensors to identify the shapes of wet objects and of leaves during transpiration. Thus, we reported a novel and effective method for fabricating high-performance humidity polymer films, channeling new pathways for the development of advanced humidity and gas sensors.
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Affiliation(s)
- Nan Wang
- School of Optical Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Key Laboratory of Modern Optical Systems, Engineering Research Center of Optical Instruments and Systems, Shanghai 200093, China
| | - Jianhao Tong
- School of Optical Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Key Laboratory of Modern Optical Systems, Engineering Research Center of Optical Instruments and Systems, Shanghai 200093, China
| | - Junjie Wang
- School of Optical Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Key Laboratory of Modern Optical Systems, Engineering Research Center of Optical Instruments and Systems, Shanghai 200093, China
| | - Qi Wang
- School of Optical Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Key Laboratory of Modern Optical Systems, Engineering Research Center of Optical Instruments and Systems, Shanghai 200093, China
| | - Shangbi Chen
- School of Optical Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Key Laboratory of Modern Optical Systems, Engineering Research Center of Optical Instruments and Systems, Shanghai 200093, China
- Shanghai Aerospace Control Technology Institute, Shanghai 200233, China
- Shanghai Xin Yue Lian Hui Electronic Technology Co. LTD, Shanghai 200233, China
| | - Bin Sheng
- School of Optical Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Shanghai Key Laboratory of Modern Optical Systems, Engineering Research Center of Optical Instruments and Systems, Shanghai 200093, China
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24
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Pinna GD, Maestri R. Computer-Assisted Assessment of the Interaction Between Arousals, Breath-by-Breath Ventilation, and Chemical Drive During Cheyne-Stokes Respiration in Heart Failure Patients. Front Physiol 2022; 13:815352. [PMID: 35222084 PMCID: PMC8867072 DOI: 10.3389/fphys.2022.815352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Transient increases in ventilation induced by arousal from sleep during Cheyne-Stokes respiration in heart failure patients are thought to contribute to sustaining and exacerbating the ventilatory oscillation. The only possibility to investigate the validity of this notion is to use observational data. This entails some significant challenges: (i) accurate identification of both arousal onset and offset; (ii) detection of short arousals (<3 s); (iii) breath-by-breath analysis of the interaction between arousals and ventilation; (iv) careful control for important confounding factors. In this paper we report how we have tackled these challenges by developing innovative computer-assisted methodologies. The identification of arousal onset and offset is performed by a hybrid approach that integrates visual scoring with computer-based automated analysis. We use a statistical detector to automatically discriminate between dominant theta–delta and dominant alpha activity at each instant of time. Moreover, a statistical detector is used to validate visual scoring of K complexes, delta waves or artifacts associated with an EEG frequency shift, as well as frequency shifts to beta activity. A high-resolution (250 ms) state-transition diagram providing continuous information on the sleep-wake state of the subject is finally obtained. Based on this information, arousals are automatically identified as any state change from sleep to wakefulness lasting ≥2 s. The assessment of the interaction between arousals and ventilation is performed using a breath-by-breath, case-control approach. The arousal-associated change in ventilation is measured as the normalized difference between minute ventilation in the case breath (i.e., with arousal) and that in the control breath (i.e., without arousal), controlling for sleep stage and chemical drive. The latter is estimated by using information from pulse oximetry at the finger. In the last part of the paper, we discuss main potential sources of error inherent in the described methodologies.
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25
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Pinna GD, Robbi E, Bruschi C, La Rovere MT, Maestri R. Interaction Between Arousals and Ventilation During Cheyne-Stokes Respiration in Heart Failure Patients: Insights From Breath-by-Breath Analysis. Front Med (Lausanne) 2022; 8:742458. [PMID: 34977056 PMCID: PMC8717813 DOI: 10.3389/fmed.2021.742458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Study Objectives: Arousals from sleep during the hyperpneic phases of Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) in patients with heart failure are thought to cause ventilatory overshoot and a consequent longer apnea, thereby sustaining and exacerbating ventilatory instability. However, data supporting this model are lacking. We investigated the relationship between arousals, hyperpnea and post-hyperpnea apnea length during CSR-CSA. Methods: Breath-by-breath changes in ventilation associated with the occurrence of arousal were evaluated in 18 heart failure patients with CSR-CSA, apnea-hypopnea index ≥15/h and central apnea index ≥5/h. The change in apnea length associated with the presence of arousal during the previous hyperpnea was also evaluated. Potential confounding variables (chemical drive, sleep stage) were controlled for. Results: Arousals were associated with a large increase in ventilation at the beginning of the hyperpnea (+76 ± 35%, p < 0.0001), that rapidly declined during its crescendo phase. Around peak hyperpnea, the change in ventilation was -8 ± 26% (p = 0.14). The presence of arousal during the hyperpnea was associated with a median increase in the length of the subsequent apnea of +4.6% (Q1, Q2: -0.7%, 20.5%; range: -8.5%, 36.2%) (p = 0.021). The incidence of arousals occurring at the beginning of hyperpnea and mean ventilation in the region around its peak were independent predictors of the change in apnea length (p = 0.004 and p = 0.015, respectively; R2 = 0.78). Conclusions: Arousals from sleep during CSR-CSA in heart failure patients are associated with a rapidly decreasing ventilatory overshoot at the beginning of the hyperpnea, followed by a tendency toward a slight ventilatory undershoot around its peak. On average, arousals are also associated with a modest increase in post-hyperpnea apnea length; however, large increases in apnea length (>20%) occur in about a quarter of the patients.
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Affiliation(s)
- Gian Domenico Pinna
- Laboratory for the Study of Ventilatory Instability, Department of Biomedical Engineering, Montescano Institute - IRCCS, Istituti Clinici Scientifici Maugeri, Montescano, Italy
| | - Elena Robbi
- Sleep and Respiratory Function Unit, Montescano Institute - IRCCS, Istituti Clinici Scientifici Maugeri, Montescano, Italy.,Laboratory for the Study of the Autonomic Nervous System, Department of Cardiology, Montescano Institute - IRCCS, Istituti Clinici Scientifici Maugeri, Montescano, Italy
| | - Claudio Bruschi
- Department of Pneumology, Montescano Institute - IRCCS, Istituti Clinici Scientifici Maugeri, Montescano, Italy
| | - Maria Teresa La Rovere
- Laboratory for the Study of the Autonomic Nervous System, Department of Cardiology, Montescano Institute - IRCCS, Istituti Clinici Scientifici Maugeri, Montescano, Italy
| | - Roberto Maestri
- Laboratory for the Study of Ventilatory Instability, Department of Biomedical Engineering, Montescano Institute - IRCCS, Istituti Clinici Scientifici Maugeri, Montescano, Italy
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26
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Respir Investig 2022; 60:3-32. [PMID: 34986992 DOI: 10.1016/j.resinv.2021.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared in order to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Because sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rho Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, Tokyo, Japan; Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Japan.
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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27
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Sleep Biol Rhythms 2022; 20:5-37. [PMID: 38469064 PMCID: PMC10900032 DOI: 10.1007/s41105-021-00353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/17/2022]
Abstract
The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610 Japan
- Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Rai NA, De A, Lamm C. Cheyne-Stokes Respiration in a 17-Year-Old Boy Awaiting Heart Transplantation. Tex Heart Inst J 2021; 48:472188. [PMID: 34665868 DOI: 10.14503/thij-20-7345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children. We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.
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Affiliation(s)
- Nooralam A Rai
- Department of Pediatrics, New York-Presbyterian Columbia University Medical Center, New York, New York
| | - Aliva De
- Department of Pediatrics, New York-Presbyterian Columbia University Medical Center, New York, New York
| | - Carin Lamm
- Department of Pediatrics, New York-Presbyterian Columbia University Medical Center, New York, New York
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Parekh A, Tolbert TM, Mooney AM, Ramos-Cejudo J, Osorio RS, Treml M, Herkenrath SD, Randerath WJ, Ayappa I, Rapoport DM. Endotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep Disordered Breathing. Am J Respir Crit Care Med 2021; 204:1452-1462. [PMID: 34449303 PMCID: PMC8865720 DOI: 10.1164/rccm.202011-4055oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment. Objectives Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies. Methods From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (Pobs). A development and initial test set of 29 subjects (development = 6, test = 23) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop Pobs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of Pobs. Measurements and Main Results A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, Pobs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R2 = 0.87, P < 0.001, area under the receiver operating characteristic curve = 0.74; set 2: cubic adj. R2 = 0.83, P < 0.001, area under the receiver operating characteristic curve = 0.7). On a subject level, median Pobs was associated with the median normalized upper airway resistance (set 1: linear adj. R2 = 0.59, P < 0.001; set 2: linear adj. R2 = 0.45, P < 0.001). Median Pobs exhibited low night-to-night variability [intraclass correlation(2, 1) = 0.93]. Conclusions Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.
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Affiliation(s)
- Ankit Parekh
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States;
| | - Thomas M Tolbert
- Mount Sinai School of Medicine, 5925, New York, New York, United States
| | - Anne M Mooney
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States
| | | | | | - Marcel Treml
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Simon-Dominik Herkenrath
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Winfried J Randerath
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute of Pneumology at the University of Witten / Herdecke, Pneumology, Solingen, Germany
| | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States
| | - David M Rapoport
- Icahn School of Medicine at Mount Sinai, 5925, New York, New York, United States
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30
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Bandi PS, Panigrahy PK, Hajeebu S, Ngembus NJ, Heindl SE. Pathophysiological Mechanisms to Review Association of Atrial Fibrillation in Heart Failure With Obstructive Sleep Apnea. Cureus 2021; 13:e16086. [PMID: 34345562 PMCID: PMC8325395 DOI: 10.7759/cureus.16086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/30/2021] [Indexed: 01/07/2023] Open
Abstract
Sleep-disordered breathing (SDB) comprising obstructive sleep apnea (OSA) is found in more than half of patients with heart failure (HF) and may have negative impacts on cardiovascular function. Increased atherosclerotic cardiovascular disease and the development of coronary events and congestive heart failure are associated with OSA. It is associated with a substandard quality of life, increased hospitalizations, and a poor prognosis. Despite its association with severe cardiovascular morbidity and mortality, the condition is frequently underdiagnosed. The substantial clinical evidence has established OSA as an independent risk factor for bradyarrhythmias and tachyarrhythmias in the last decade. The mechanisms which lead to such arrhythmias are uncertain. In short, OSA patients have a significantly elevated risk of HF and atrial fibrillation (AF). The direct correlation between HF, SDB, and cardiac arrhythmias has been poorly understood. The purpose of this study is to get a better understanding of the relation between AF, OSA, and HF by focusing on the pathophysiological mechanisms underlying these conditions. Therefore, we searched for articles to support our association in PubMed and Google Scholar databases.
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Affiliation(s)
- Pushyami Satya Bandi
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Sreehita Hajeebu
- Medicine, California Institute of Behavioural Neurosciences & Psychology, Fairfield, USA
| | - Ngonack J Ngembus
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Stacey E Heindl
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Avalon University School of Medicine, Willemstad, CUW
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31
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Requirements for Supporting Diagnostic Equipment of Respiration Process in Humans. SENSORS 2021; 21:s21103479. [PMID: 34067611 PMCID: PMC8156866 DOI: 10.3390/s21103479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022]
Abstract
There is abundant worldwide research conducted on the subject of the methods of human respiration process examination. However, many of these studies describe methods and present the results while often lacking insight into the hardware and software aspects of the devices used during the research. This paper’s goal is to present new equipment for assessing the parameters of human respiration, which can be easily adopted for daily diagnosis. This work deals with the issue of developing the correct method of obtaining measurement data. The requirements of the acquisition parameters are clearly pointed out and examples of the medical applications of the described device are shown. Statistical analysis of acquired signals proving its usability is also presented. In the examples of selected diseases of the Upper Respiratory Tract (URT), the advantages of the developed apparatus for supporting the diagnosis of URT patency have been proven.
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32
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Cho MY, Kim IS, Kim SH, Park C, Kim NY, Kim SW, Kim S, Oh JM. Unique Noncontact Monitoring of Human Respiration and Sweat Evaporation Using a CsPb 2Br 5-Based Sensor. ACS APPLIED MATERIALS & INTERFACES 2021; 13:5602-5613. [PMID: 33496182 DOI: 10.1021/acsami.0c21097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Respiration monitoring and human sweat sensing have promising application prospects in personal healthcare data collection, disease diagnostics, and the effective prevention of human-to-human transmission of fatal viruses. Here, we have introduced a unique respiration monitoring and touchless sensing system based on a CsPb2Br5/BaTiO3 humidity-sensing layer operated by water-induced interfacial polarization and prepared using a facile aerosol deposition process. Based on the relationship between sensing ability and layer thickness, the sensing device with a 1.0 μm thick layer was found to exhibit optimal sensing performance, a result of its ideal microstructure. This sensor also exhibits the highest electrical signal variation at 0.5 kHz due to a substantial polarizability difference between high and low humidity. As a result, the CsPb2Br5/BaTiO3 sensing device shows the best signal variation of all types of breath-monitoring devices reported to date when used to monitor sudden changes in respiratory rates in diverse situations. Furthermore, the sensor can effectively detect sweat evaporation when placed 1 cm from the skin, including subtle changes in capacitance caused by finger area and motion, skin moisture, and contact time. This ultrasensitive sensor, with its fast response, provides a potential new sensing platform for the long-term daily monitoring of respiration and sweat evaporation.
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Affiliation(s)
- Myung-Yeon Cho
- Department of Electronic Materials Engineering, Kwangwoon University, Seoul 01897, Republic of Korea
| | - Ik-Soo Kim
- Department of Electronic Materials Engineering, Kwangwoon University, Seoul 01897, Republic of Korea
| | - Seok-Hun Kim
- Department of Applied Chemistry, Dong-eui University, Busan 47227, Republic of Korea
| | - Chulhwan Park
- Department of Chemical Engineering, Kwangwoon University, Seoul 01897, Republic of Korea
| | - Nam-Young Kim
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Seoul 01897, Republic of Korea
| | - Sang-Wook Kim
- Nanomaterials Laboratory, Department of Molecular Science and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Sunghoon Kim
- Department of Applied Chemistry, Dong-eui University, Busan 47227, Republic of Korea
| | - Jong-Min Oh
- Department of Electronic Materials Engineering, Kwangwoon University, Seoul 01897, Republic of Korea
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33
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Si L, Zhang J, Wang Y, Cao J, Chen BY, Guo HJ. Obstructive sleep apnea and respiratory center regulation abnormality. Sleep Breath 2020; 25:563-570. [PMID: 32870421 DOI: 10.1007/s11325-020-02175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a complex disease in which phenotypic analysis and understanding pathological mechanisms facilitate personalized treatment and outcomes. However, the pathophysiology responsible for this robust observation is incompletely understood. The objective of the present work was to review how respiratory center regulation varies during sleep and wakeness in patients with OSA. DATA SOURCES We searched for relevant articles up to December 31, 2019 in PubMed database. METHODS This review examines the current literature on the characteristics of respiratory center regulation during wakefulness and sleep in OSA, detection method, and phenotypic treatment for respiratory center regulation. RESULTS Mechanisms for ventilatory control system instability leading to OSA include different sleep stages in chemoresponsiveness to hypoxia and hypercapnia and different chemosensitivity at different time. One can potentially stabilize the breathing center in sleep-related breathing disorders by identifying one or more of these pathophysiological mechanisms. CONCLUSIONS Advancing mechanism research in OSA will guide symptom research and provide alternate and novel opportunities for effective treatment for patients with OSA.
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Affiliation(s)
- Liang Si
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jing Zhang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yan Wang
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jie Cao
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Bao-Yuan Chen
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Heng-Juan Guo
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, 300052, China
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Pinna GD, La Rovere MT, Robbi E, Tavazzi L, Maestri R. CARDIAC chronotropic effects of sleep-disordered breathing in patients with heart failure. J Sleep Res 2020; 30:e13160. [PMID: 32791565 DOI: 10.1111/jsr.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
It is still not known whether the oscillation in heart rate (HR) induced by sleep-disordered breathing (SDB) in patients with heart failure entails significant chronotropic effects. We hypothesised that since cyclical changes in ventilation and arterial blood gases during SDB affect HR through multiple and complexly interacting mechanisms characterised by large inter-subject variability, chronotropic effects may change from patient to patient. A total of 42 patients with moderate-to-severe chronic heart failure with systolic dysfunction underwent an in-hospital sleep study. Chronotropic effects of SDB were quantified by comparing the distribution of instantaneous HR during SDB with that during periods without SDB (noSDB) within the same night in each patient. Based on distribution changes from noSDB to SDB, 12, nine, 11, and 10 patients showed a significant tachycardic, bradycardic, tachycardic and bradycardic, and neither significant tachycardic nor significant bradycardic effect, respectively. Tachycardic and bradycardic effects were primarily due to an increase in the rate rather than in the magnitude of cyclical HR elevations and reductions, and were more prevalent and severe in patients with dominant obstructive and central events, respectively. The apnea-hypopnea index did not differ between groups. Conversely, the time spent with an oxygen saturation of <90% was greater in the tachycardic and tachycardic-bradycardic groups compared to the bradycardic group. These findings indicate that HR distribution changes induced by SDB can vary from patient to patient revealing four distinct and well-characterised chronotropic effects. These effects are related to the degree of hypoxic burden brought about by SDB and are affected by the type of sleep apnea (central/obstructive).
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Affiliation(s)
- Gian Domenico Pinna
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Montescano, Italy
| | - Maria Teresa La Rovere
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Montescano, Italy
| | - Elena Robbi
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Montescano, Italy.,Sleep Laboratory, Department of Pneumology, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Montescano, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Montescano, Italy
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35
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Zhou C, Zhang X, Tang N, Fang Y, Zhang H, Duan X. Rapid response flexible humidity sensor for respiration monitoring using nano-confined strategy. NANOTECHNOLOGY 2020; 31:125302. [PMID: 31778983 DOI: 10.1088/1361-6528/ab5cda] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Development of wearable devices for continuous respiration monitoring is of great importance for evaluating human health. Here, we propose a new strategy to achieve rapid respiration response by confining conductive polymers into 1D nanowires which facilitates the water molecules absorption/desorption and maximizes the sensor response to moisture. The nanowires arrays were fabricated through a low-cost nanoscale printing approach on flexible substrate. The nanoscale humidity sensor shows a high sensitivity (5.46%) and ultrafast response (0.63 s) when changing humidity between 0% and 13% and can tolerate 1000 repetitions of bending to a curvature radius of 10 mm without influencing its performance. Benefited by its fast response and low power assumption, the humidity sensor was demonstrated to monitor human respiration in real time. Different respiration patterns including normal, fast and deep respiration can be distinguished accurately.
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36
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Jeong IC, Bychkov D, Searson PC. Wearable Devices for Precision Medicine and Health State Monitoring. IEEE Trans Biomed Eng 2020; 66:1242-1258. [PMID: 31021744 DOI: 10.1109/tbme.2018.2871638] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Wearable technologies will play an important role in advancing precision medicine by enabling measurement of clinically-relevant parameters describing an individual's health state. The lifestyle and fitness markets have provided the driving force for the development of a broad range of wearable technologies that can be adapted for use in healthcare. Here we review existing technologies currently used for measurement of the four primary vital signs: temperature, heart rate, respiration rate, and blood pressure, along with physical activity, sweat, and emotion. We review the relevant physiology that defines the measurement needs and evaluate the different methods of signal transduction and measurement modalities for the use of wearables in healthcare.
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37
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Loop Gain in Heart Failure with Reduced Ejection Fraction and Periodic Breathing Is Associated with Sleep Stage and Arousals. Ann Am Thorac Soc 2019; 16:1591-1595. [DOI: 10.1513/annalsats.201903-224rl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Ferreira JP, Duarte K, Woehrle H, Cowie MR, Angermann C, d'Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Teschler H, Wegscheider K, Bresso E, Dominique-Devignes M, Rossignol P, Koenig W, Zannad F. Bioprofiles and mechanistic pathways associated with Cheyne-Stokes respiration: insights from the SERVE-HF trial. Clin Res Cardiol 2019; 109:881-891. [PMID: 31784904 DOI: 10.1007/s00392-019-01578-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The SERVE-HF trial included patients with heart failure and reduced ejection fraction (HFrEF) with sleep-disordered breathing, randomly assigned to treatment with Adaptive-Servo Ventilation (ASV) or control. The primary outcome was the first event of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening heart failure. A subgroup analysis of the SERVE-HF trial suggested that patients with Cheyne-Stokes respiration (CSR) < 20% (low CSR) experienced a beneficial effect from ASV, whereas in patients with CSR ≥ 20% ASV might have been harmful. Identifying the proteomic signatures and the underlying mechanistic pathways expressed in patients with CSR could help generating hypothesis for future research. METHODS Using a large set of circulating protein-biomarkers (n = 276, available in 749 patients; 57% of the SERVE-HF population) we sought to investigate the proteins associated with CSR and to study the underlying mechanisms that these circulating proteins might represent. RESULTS The mean age was 69 ± 10 years and > 90% were male. Patients with CSR < 20% (n = 139) had less apnoea-hypopnea index (AHI) events per hour and less oxygen desaturation. Patients with CSR < 20% might have experienced a beneficial effect of ASV treatment (primary outcome HR [95% CI] = 0.55 [0.34-0.88]; p = 0.012), whereas those with CSR ≥ 20% might have experienced a detrimental effect of ASV treatment (primary outcome HR [95% CI] = 1.39 [1.09-1.76]; p = 0.008); p for interaction = 0.001. Of the 276 studied biomarkers, 8 were associated with CSR (after adjustment and with a FDR1%-corrected p value). For example, higher PAR-1 and ITGB2 levels were associated with higher odds of having CSR < 20%, whereas higher LOX-1 levels were associated with higher odds of CSR ≥ 20%. Signalling, metabolic, haemostatic and immunologic pathways underlie the expression of these biomarkers. CONCLUSION We identified proteomic signatures that may represent underlying mechanistic pathways associated with patterns of CSR in HFrEF. These hypothesis-generating findings require further investigation towards better understanding of CSR in HFrEF. SUMMARY OF THE FINDINGS PAR-1 proteinase-activated receptor 1, ADM adrenomedullin, HSP-27 heat shock protein-27, ITGB2 integrin beta 2, GLO1 glyoxalase 1, ENRAGE/S100A12 S100 calcium-binding protein A12, LOX-1 lectin-like LDL receptor 1, ADAM-TS13 disintegrin and metalloproteinase with a thrombospondin type 1 motif, member13 also known as von Willebrand factor-cleaving protease.
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Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigation Clinique Inserm, CHU, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), 4, rue du Morvan, 54500, Vandoeuvre-les-Nancy, France
| | - Kévin Duarte
- Centre d'Investigation Clinique Inserm, CHU, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), 4, rue du Morvan, 54500, Vandoeuvre-les-Nancy, France
| | - Holger Woehrle
- ResMed Science Center, ResMed Germany Inc, Martinsried, Germany
| | | | - Christiane Angermann
- Department of Medicine and Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Marie-Pia d'Ortho
- University Paris Diderot, Sorbonne Paris Cité, Hôpital Bichat, Explorations Fonctionnelles, DHU FIRE, AP-HP, Paris, France
| | | | - Patrick Levy
- University of Grenoble Alpes, Inserm, HP2 lab, Grenoble, France
| | | | | | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Emmanuel Bresso
- Université de Lorraine, CNRS, Inria, LORIA, Nancy, 54500, France
| | | | - Patrick Rossignol
- Centre d'Investigation Clinique Inserm, CHU, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), 4, rue du Morvan, 54500, Vandoeuvre-les-Nancy, France
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Faiez Zannad
- Centre d'Investigation Clinique Inserm, CHU, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), 4, rue du Morvan, 54500, Vandoeuvre-les-Nancy, France.
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Characteristics of respiratory measures in young adults scanned at rest, including systematic changes and "missed" deep breaths. Neuroimage 2019; 204:116234. [PMID: 31589990 DOI: 10.1016/j.neuroimage.2019.116234] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/04/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022] Open
Abstract
Breathing rate and depth influence the concentration of carbon dioxide in the blood, altering cerebral blood flow and thus functional magnetic resonance imaging (fMRI) signals. Such respiratory fluctuations can have substantial influence in studies of fMRI signal covariance in subjects at rest, the so-called "resting state functional connectivity" technique. If respiration is monitored during fMRI scanning, it is typically done using a belt about the subject's abdomen to record abdominal circumference. Several measures have been derived from these belt records, including the windowed envelope of the waveform (ENV), the windowed variance in the waveform (respiration variation, RV), and a measure of the amplitude of each breath divided by the cycle time of the breath (respiration volume per time, RVT). Any attempt to gauge respiratory contributions to fMRI signals requires a respiratory measure, but little is known about how these measures compare to each other, or how they perform beyond the small studies in which they were initially proposed. Here, we examine the properties of these measures in hundreds of healthy young adults scanned for an hour each at rest, a subset of the Human Connectome Project chosen for having high-quality physiological records. We find: 1) ENV, RV, and RVT are all correlated, and ENV and RV are more highly correlated to each other than to RVT; 2) respiratory events like deep breaths exhibit characteristic heart rate elevations, fMRI signal changes, head motions, and image quality abnormalities time-locked to large deflections in the belt traces; 3) all measures can "miss" deep breaths; 4) RVT "misses" deep breaths more than ENV or RV; 5) all respiratory measures change systematically over the course of a 14.4-min scan. We discuss the implications of these findings for the literature and ways to move forward in modeling respiratory influences on fMRI scans.
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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41
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Sorokina KV, Palman AD, Brovko MY, Poltavskaya MG. [Central sleep apnea in patients with chronic heart failure]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:99-104. [PMID: 31317922 DOI: 10.17116/jnevro201911904299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing seen in approximately half of patients with chronic heart failure and low left ventricular ejection fraction. The authors describe clinical features of CSR, mortality rate, treatment variants. Effects of continuous positive airway pressure (CPAP), bi-level ventilation, adaptive servoventilation (ASV) in patients with CSR and chronic heart failure are discussed. Diuretic acetazolamide is one more therapeutic option for CSR. It improves central sleep apnea and related daytime symptoms in patients with heart failure.
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Affiliation(s)
- K V Sorokina
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A D Palman
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M Yu Brovko
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M G Poltavskaya
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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42
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New-generation positional therapy in patients with positional central sleep apnea. Eur Arch Otorhinolaryngol 2019; 276:2611-2619. [DOI: 10.1007/s00405-019-05545-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/03/2019] [Indexed: 11/27/2022]
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Herkenrath SD, Randerath WJ. More than Heart Failure: Central Sleep Apnea and Sleep-Related Hypoventilation. Respiration 2019; 98:95-110. [PMID: 31291632 DOI: 10.1159/000500728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/02/2019] [Indexed: 12/29/2022] Open
Abstract
Central sleep apnea (CSA) comprises a variety of breathing patterns and clinical entities. They can be classified into 2 categories based on the partial pressure of carbon dioxide in the arterial blood. Nonhypercapnic CSA is usually characterized by a periodic breathing pattern, while hypercapnic CSA is based on hypoventilation. The latter CSA form is associated with central nervous, neuromuscular, and rib cage disorders as well as obesity and certain medication or substance intake. In contrast, nonhypercapnic CSA is typically accompanied by an overshoot of the ventilation and often associated with heart failure, cerebrovascular diseases, and stay in high altitude. CSA and hypoventilation syndromes are often considered separately, but pathophysiological aspects frequently overlap. An integrative approach helps to recognize underlying pathophysiological mechanisms and to choose adequate therapeutic strategies. Research in the last decades improved our insights; nevertheless, diagnostic tools are not always appropriately chosen to perform comprehensive sleep studies. This supports misinterpretation and misclassification of sleep disordered breathing. The purpose of this article is to highlight unresolved problems, raise awareness for different pathophysiological components and to discuss the evidence for targeted therapeutic strategies.
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Balloon pulmonary angioplasty attenuates sleep apnea in patients with chronic thromboembolic pulmonary hypertension. Heart Lung 2019; 48:321-324. [DOI: 10.1016/j.hrtlng.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/23/2022]
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Landry SA, Andara C, Terrill PI, Joosten SA, Leong P, Mann DL, Sands SA, Hamilton GS, Edwards BA. Ventilatory control sensitivity in patients with obstructive sleep apnea is sleep stage dependent. Sleep 2019; 41:4944421. [PMID: 29741725 DOI: 10.1093/sleep/zsy040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/14/2022] Open
Abstract
Study Objectives The severity of obstructive sleep apnea (OSA) is known to vary according to sleep stage; however, the pathophysiology responsible for this robust observation is incompletely understood. The objective of the present work was to examine how ventilatory control system sensitivity (i.e. loop gain) varies during sleep in patients with OSA. Methods Loop gain was estimated using signals collected from standard diagnostic polysomnographic recordings performed in 44 patients with OSA. Loop gain measurements associated with nonrapid eye movement (NREM) stage 2 (N2), stage 3 (N3), and REM sleep were calculated and compared. The sleep period was also split into three equal duration tertiles to investigate how loop gain changes over the course of sleep. Results Loop gain was significantly lower (i.e. ventilatory control more stable) in REM (Mean ± SEM: 0.51 ± 0.04) compared with N2 sleep (0.63 ± 0.04; p = 0.001). Differences in loop gain between REM and N3 (p = 0.095), and N2 and N3 (p = 0.247) sleep were not significant. Furthermore, N2 loop gain was significantly lower in the first third (0.57 ± 0.03) of the sleep period compared with later second (0.64 ± 0.03, p = 0.012) and third (0.64 ± 0.03, p = 0.015) tertiles. REM loop gain also tended to increase across the night; however, this trend was not statistically significant [F(2, 12) = 3.49, p = 0.09]. Conclusions These data suggest that loop gain varies between REM and NREM sleep and modestly increases over the course of sleep. Lower loop gain in REM is unlikely to contribute to the worsened OSA severity typically observed in REM sleep, but may explain the reduced propensity for central sleep apnea in this sleep stage.
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Affiliation(s)
- Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Christopher Andara
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Philip I Terrill
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia.,School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,Monash Partners - Epworth, Victoria, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia
| | - Dwayne L Mann
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,The Alfred and Monash University, Melbourne, VIC, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia.,School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,Monash Partners - Epworth, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, VIC, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
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Abstract
Complex sleep apnea syndrome (Comp-SAS) is the term used to describe a specific form of sleep disordered breathing characterized by the arise of central sleep apnea in patient with previous obstructive sleep apnea syndrome (OSAS) treated with continuous positive airway pressure devices (CPAP). The mechanisms of its occurrence are not well understood, but partly it seems to be a consequence of increased carbon dioxide elimination under positive airway pressure treatment and related improvement of pulmonary ventilation. The prevalence of Comp-SAS ranges from 5% to 20% of OSAS patient getting CPAP therapy with no significant predictors in comparison with simple obstructive sleep apnea, but more likely to happened in older males with more severe OSAS and accompanying cardiovascular pathology such as ischemic heart disease, atrial fibrillation and heart failure. In most cases of Comp-SAS, central apnea events are transient and disappear after continuous CPAP therapy use for 1 to 2 months. Novel treatment options like adaptive servo-ventilation or BiPAP-ST are available for such non-responders to CPAP but contra-indicated to patients with systolic heart failure. From the other hand, still not clear is it mandatory to treat all affected individuals with Comp-SAS if the disease is uncomplicated and patient is asymptomatic.
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Affiliation(s)
- A D Palman
- Sechenov First Moscow State Medical University, Moscow, Russia
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47
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Sarber KM, Ishman SL, Patil RD. Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2019; 145:389-390. [DOI: 10.1001/jamaoto.2018.4077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kathleen M. Sarber
- Division of Pulmonology Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stacey L. Ishman
- Division of Pulmonology Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Reena Dhanda Patil
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, Cincinnati VA, Cincinnati, Ohio
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48
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Dai J, Zhao H, Lin X, Liu S, Liu Y, Liu X, Fei T, Zhang T. Ultrafast Response Polyelectrolyte Humidity Sensor for Respiration Monitoring. ACS APPLIED MATERIALS & INTERFACES 2019; 11:6483-6490. [PMID: 30672684 DOI: 10.1021/acsami.8b18904] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Respiration monitoring is important for evaluating human health. Humidity sensing is a promising way to establish a relationship between human respiration and electrical signal. This work describes polymer humidity sensors with ultrafast response for respiration monitoring. The humidity-sensitive polyelectrolyte is in situ cross-linked on the substrate printed with interdigitated electrodes by a thiol-ene click reaction. The polyelectrolyte humidity sensor shows rapid water adsorption/desorption ability, excellent stability, and repeatability. The sensor with ultrafast response and recovery (0.29/0.47 s) when changing humidity between 33 and 95% shows good application prospects in breath monitoring and touchless sensing. Different respiration patterns can be distinguished, and the breath rate/depth of detection subjects can also be determined by the sensor. In addition, the obtained sensor can sense the skin evaporation in a noncontact way.
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Affiliation(s)
- Jianxun Dai
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
| | - Hongran Zhao
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
| | - Xiuzhu Lin
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
| | - Sen Liu
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
| | - Yunshi Liu
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
| | - Xiupeng Liu
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
| | - Teng Fei
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
- State Key Laboratory of Transducer Technology , Shanghai 200050 , P. R. China
| | - Tong Zhang
- State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering , Jilin University , Changchun 130012 , P. R. China
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Dohi T, Kasai T, Endo H, Wada H, Yanagisawa N, Nojiri S, Funamizu T, Shitara J, Doi S, Kato Y, Okai I, Iwata H, Isoda K, Okazaki S, Miyauchi K, Daida H. CPAP effects on atherosclerotic plaques in patients with sleep-disordered breathing and coronary artery disease: The ENTERPRISE trial. J Cardiol 2019; 73:89-93. [PMID: 30177302 DOI: 10.1016/j.jjcc.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a novel cardiovascular risk factor. To date, the effects of continuous positive airway pressure (CPAP) on coronary plaque atheroma in SDB patients with coronary artery disease (CAD) have remained unclear. The CPAP Effects on Atherosclerotic Plaques in Patients with Sleep-Disordered Breathing and Coronary Artery Disease (ENTERPRISE) trial was designed to evaluate the effects of CPAP treatment in addition to optimal medical treatment on coronary plaque regression in SDB patients. METHODS This study is planned as a prospective, randomized, open-label, single-center study. The presence of SDB is defined as a 3% oxygen desaturation index (ODI) of ≥15 events/h as measured by nocturnal pulse oximetry. A total of 100 eligible SDB patients undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention will be randomly assigned to either CPAP as add-on therapy or no CPAP for SDB (1:1 ratio for CPAP vs. no CPAP). The intervention will consist of 12 months of CPAP treatment. The primary endpoint will be percentage changes in plaque atheroma volume of the non-culprit lesion segment as measured by IVUS. A specialist sleep cardiology team will carefully monitor patients receiving CPAP treatment in order to quickly detect and resolve problems, and to motivate patients to continue treatment. CONCLUSION This study will provide novel information on the effects of SDB and its treatment with CPAP on coronary plaque stability with regard to secondary prevention of CAD.
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Affiliation(s)
- Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Takehiro Funamizu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Matsumoto H, Kasai T. Central Sleep Apnea in Heart Failure: Pathogenesis and Management. CURRENT SLEEP MEDICINE REPORTS 2018; 4:210-220. [DOI: 10.1007/s40675-018-0125-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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