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British Journal of Hospital Medicine... Feb 2024Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is... (Review)
Review
Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.
Topics: Child; Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Adenoidectomy; Tonsillectomy
PubMed: 38416524
DOI: 10.12968/hmed.2023.0275 -
Lung Feb 2024In recent years, there has been a substantial increase in the development of antitussive therapies and the first new therapy, gefapixant has been licenced in Europe.... (Review)
Review
In recent years, there has been a substantial increase in the development of antitussive therapies and the first new therapy, gefapixant has been licenced in Europe. This review describes current unlicenced treatments for chronic cough and details treatments currently in development for refractory chronic cough and cough in idiopathic pulmonary fibrosis, as well as compounds previously explored.
Topics: Humans; Chronic Cough; Chronic Disease; Cough; Antitussive Agents; Europe
PubMed: 38127133
DOI: 10.1007/s00408-023-00666-y -
European Respiratory Review : An... Jan 2024Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse... (Review)
Review
Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild-moderate OSA based on the apnoea-hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature.
Topics: Male; Humans; Female; Sleep, REM; Sleep Apnea, Obstructive; Patient Compliance; Continuous Positive Airway Pressure; Polysomnography
PubMed: 38355150
DOI: 10.1183/16000617.0166-2023 -
Ugeskrift For Laeger Feb 2024In his case report, a 74-year-old physically fit man was evaluated repeatedly for several years in the cardiology department due to dyspnoea on exertion (DOE). Several...
In his case report, a 74-year-old physically fit man was evaluated repeatedly for several years in the cardiology department due to dyspnoea on exertion (DOE). Several standard cardiac and pulmonary tests were performed but did not provide sufficient cause for the DOE. Lastly, the patient was evaluated with a cardiopulmonary exercise test (CPET) with simultaneous in- and expiratory gas sampling. The test revealed a low aerobic capacity due to chronotropic incompetence (CI), thus explaining the DOE. Subsequently, the patient was treated with a rate-responsive pacemaker. CPET-is an ideal test for diagnosing CI.
Topics: Male; Humans; Aged; Exercise Test; Heart; Dyspnea; Pacemaker, Artificial
PubMed: 38445323
DOI: 10.61409/V09230566 -
Molecular Genetics and Metabolism Nov 2023At any age, respiratory manifestations are a major cause of increased morbidity and mortality of inherited metabolic diseases (IMDs). Type and severity are extremely... (Review)
Review
At any age, respiratory manifestations are a major cause of increased morbidity and mortality of inherited metabolic diseases (IMDs). Type and severity are extremely variable, this depending on the type of the underlying disorder. Symptoms and signs originating from upper or lower airways and/or thoracic wall and/or respiratory muscles involvement can occur either at presentation or in the late clinical course. Acute respiratory symptoms can trigger metabolic decompensation which, in turn, makes airway symptoms worse, creating a vicious circle. We have identified 181 IMDs associated with various types of respiratory symptoms which were classified into seven groups according to the type of clinical manifestations affecting the respiratory system: (i) respiratory failure, (ii) restrictive lung disease, (iii) interstitial lung disease, (iv) lower airway disease, (v) upper airway obstruction, (vi) apnea, and (vii) other. We also provided a list of investigations to be performed based on the respiratory phenotypes and indicated the therapeutic strategies currently available for IMD-associated airway disease. This represents the thirteenth issue in a series of educational summaries providing a comprehensive and updated list of metabolic differential diagnoses according to system involvement.
Topics: Humans; Metabolic Diseases; Respiratory Tract Diseases; Diagnosis, Differential
PubMed: 37517329
DOI: 10.1016/j.ymgme.2023.107655 -
Pulmonology 2024
Topics: Humans; Chronic Cough; Cough
PubMed: 37210335
DOI: 10.1016/j.pulmoe.2023.04.004 -
Scientific Reports Dec 2023The existence of causal relationship between dietary factors and respiratory diseases is uncertain. We comprehensively investigated the association between dietary...
The existence of causal relationship between dietary factors and respiratory diseases is uncertain. We comprehensively investigated the association between dietary factors and respiratory diseases by using Mendelian randomization (MR). Genetic variants linked to dietary factors were selected as instrumental variables with genome-wide significance. These instrumental variables were obtained from large GWAS databases. These databases include Biobank, the FinnGen study, and other large consortia. We used multivariate MR analyses to control the effects of smoking and education. Median analysis was conducted to evaluate whether body mass index (BMI) played a role in dietary factors in respiratory diseases. Dried fruit intake was found to be associated with a decreased risk of chronic obstructive pulmonary disease (COPD) (OR: 0.211; 95% CI 0.117-0.378; P < 0.001) and asthma (OR: 0.539; 95% CI 0.357-0.815; P = 0.003). Conversely, pork intake was associated with an increased risk of international pharmaceutical federation (IPF) (OR: 1.051*10, 95% CI 4.354-2.56*10, P = 0.004). However, no significant associations were observed between the 20 dietary factors and obstructive sleep apnea (OSA). In addition, multivariate MR analyses showed that the above results were unchanged in smoking and nonsmoking populations, while the effect of dried fruit intake on asthma was significantly attenuated after corrective education. The results of the mediator variable analysis indicated that BMI could serve as a mediator of the above results. This study found that dried fruits slowed the progression of COPD and asthma, while pork promoted IPF. However, no effect of dietary factors on OSA was found. Meanwhile, we showed that the above results were unchanged in smoking and non-smoking populations. In contrast, education could influence the role of diet on asthma, and BMI could be used as a mediating variable to influence the above results.
Topics: Humans; Mendelian Randomization Analysis; Smoking; Respiratory Tract Diseases; Asthma; Pulmonary Disease, Chronic Obstructive; Sleep Apnea, Obstructive; Genome-Wide Association Study
PubMed: 38114639
DOI: 10.1038/s41598-023-50055-x -
Cleveland Clinic Journal of Medicine Aug 2023The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be... (Review)
Review
The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be secondary to benign conditions such as reflux or viral laryngitis, it may suggest benign or malignant vocal-fold pathology. It is important for caregivers to know how to evaluate, treat, and when to refer patients for direct visualization via laryngoscopy. In this article, we review basic laryngeal anatomy and function, symptoms of vocal-fold pathology, and current guidelines from the American Academy of Otolaryngology-Head and Neck Surgery on the diagnosis and treatment of dysphonia, including patient referral.
Topics: Humans; United States; Hoarseness; Dysphonia; Laryngitis; Gastroesophageal Reflux; Laryngoscopy
PubMed: 37527869
DOI: 10.3949/ccjm.90a.23010 -
Nature Communications Oct 2023Alternative splicing generates functional diversity in isoforms, impacting immune response to infection. Here, we evaluate the causal role of alternative splicing in...
Alternative splicing generates functional diversity in isoforms, impacting immune response to infection. Here, we evaluate the causal role of alternative splicing in COVID-19 severity and susceptibility by applying two-sample Mendelian randomization to cis-splicing quantitative trait loci and the results from COVID-19 Host Genetics Initiative. We identify that alternative splicing in lung, rather than total expression of OAS1, ATP11A, DPP9 and NPNT, is associated with COVID-19 severity. MUC1 and PMF1 splicing is associated with COVID-19 susceptibility. Colocalization analyses support a shared genetic mechanism between COVID-19 severity with idiopathic pulmonary fibrosis at the ATP11A and DPP9 loci, and with chronic obstructive lung diseases at the NPNT locus. Last, we show that ATP11A, DPP9, NPNT, and MUC1 are highly expressed in lung alveolar epithelial cells, both in COVID-19 uninfected and infected samples. These findings clarify the importance of alternative splicing in lung for COVID-19 and respiratory diseases, providing isoform-based targets for drug discovery.
Topics: Humans; Alternative Splicing; Genetic Predisposition to Disease; COVID-19; Lung; Pulmonary Disease, Chronic Obstructive; Protein Isoforms; Respiration Disorders; Genome-Wide Association Study
PubMed: 37794074
DOI: 10.1038/s41467-023-41912-4 -
Sensors (Basel, Switzerland) Nov 2023Obstructive Sleep Apnea (OSA) is a respiratory disorder characterized by frequent breathing pauses during sleep. The apnea-hypopnea index is a measure used to assess the... (Review)
Review
Obstructive Sleep Apnea (OSA) is a respiratory disorder characterized by frequent breathing pauses during sleep. The apnea-hypopnea index is a measure used to assess the severity of sleep apnea and the hourly rate of respiratory events. Despite numerous commercial devices available for apnea diagnosis and early detection, accessibility remains challenging for the general population, leading to lengthy wait times in sleep clinics. Consequently, research on monitoring and predicting OSA has surged. This comprehensive paper reviews devices, emphasizing distinctions among representative apnea devices and technologies for home detection of OSA. The collected articles are analyzed to present a clear discussion. Each article is evaluated according to diagnostic elements, the implemented automation level, and the derived level of evidence and quality rating. The findings indicate that the critical variables for monitoring sleep behavior include oxygen saturation (oximetry), body position, respiratory effort, and respiratory flow. Also, the prevalent trend is the development of level IV devices, measuring one or two signals and supported by prediction software. Noteworthy methods showcasing optimal results involve neural networks, deep learning, and regression modeling, achieving an accuracy of approximately 99%.
Topics: Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep; Sleep Apnea Syndromes; Oximetry
PubMed: 38067885
DOI: 10.3390/s23239512