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Zhurnal Nevrologii I Psikhiatrii Imeni... 2024To study the relationship between brain-derived neurotrophic factor (BDNF) and the severity of nocturnal hypoxemia in patients in the acute and early recovery period of...
OBJECTIVE
To study the relationship between brain-derived neurotrophic factor (BDNF) and the severity of nocturnal hypoxemia in patients in the acute and early recovery period of ischemic stroke (IS).
MATERIAL AND METHODS
We enrolled 44 patients (27 men, 17 women), aged 18-85 years, in the acute phase of IS. At 3-month follow-up, 35 people were examined (21 men and 14 women). In the acute period, in addition to routine diagnostic procedures, respiratory monitoring was carried out, and the serum level of BDNF was measured by enzyme-linked immunosorbent assay. BDNF level was also evaluated at 3-month follow-up visit. Neurological status and its dynamics in the acute period of stroke were assessed as part of the clinical routine according to the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.
RESULTS
We found a direct correlation between the duration of hypoxemia with SpO less than 90% (=0.327, =0.035) and less than 85% (=0.461, =0.003) and BDNF level in the acute phase of IS. BDNF level in the acute period of IS was negatively correlated with the minimum saturation value (=-0.328, =0.034). There was a direct relationship between BDNF level in the early recovery period and the duration of hypoxemia with SpO less than 85% (=-0.389, =0.028). A regression model showed that BDNF level was associated with the minimum SpO level. No significant associations were found with indicators of sleep-disordered breathing severity, such as the apnea-hypopnea index and the oxygen desaturation index.
CONCLUSION
The severity of nocturnal hypoxemia is associated with the increase in BDNF levels both in the acute and recovery periods of IS, regardless of the presence of concomitant breathing disorders during sleep.
Topics: Humans; Male; Brain-Derived Neurotrophic Factor; Female; Middle Aged; Aged; Adult; Hypoxia; Aged, 80 and over; Adolescent; Ischemic Stroke; Young Adult
PubMed: 38934669
DOI: 10.17116/jnevro202412405272 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA). (Review)
Review
OBJECTIVE
Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA).
MATERIAL AND METHODS
The literature search was carried out using the databases PubMED, Google Scholar, E-library, Cyberleninka for the period 2013-2023 and included reviews and original articles.
RESULTS
The main groups of factors affecting adherence to CPAP therapy in patients with OSA have been established. These include sociodemographic and socioeconomic factors, the severity of OSA and the severity of clinical symptoms, and psychosocial factors. Strategies that can improve adherence were identified (educational technologies for patients, telemedicine technologies, behavioral therapy, modern technical interventions).
CONCLUSION
Factors that improve adherence to CPAP therapy are high levels of education and income, more severe OSA forms accompanied by daytime sleepiness, support from the patient's spouse and social support. Factors such as low levels of education and income, smoking, symptoms of depression and hypochondria, as well as side-effects worsen adherence to CPAP therapy, including refusal to continue treatment. It should be noted that all the identified factors are very closely associated with each other, so it is necessary to evaluate them comprehensively in each patient with OSA.
Topics: Humans; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Patient Compliance; Social Support; Socioeconomic Factors
PubMed: 38934667
DOI: 10.17116/jnevro202412405258 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep... (Review)
Review
Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.
Topics: Humans; Sleep Apnea, Obstructive; Tonsillectomy; Pharynx; Treatment Outcome; Otorhinolaryngologic Surgical Procedures; Bariatric Surgery
PubMed: 38934666
DOI: 10.17116/jnevro202412405253 -
The Laryngoscope Jun 2024To develop and validate machine learning (ML) and deep learning (DL) models using drug-induced sleep endoscopy (DISE) images to predict the therapeutic efficacy of...
OBJECTIVES
To develop and validate machine learning (ML) and deep learning (DL) models using drug-induced sleep endoscopy (DISE) images to predict the therapeutic efficacy of hypoglossal nerve stimulator (HGNS) implantation.
METHODS
Patients who underwent DISE and subsequent HGNS implantation at a tertiary care referral center were included. Six DL models and five ML algorithms were trained on images from the base of tongue (BOT) and velopharynx (VP) from patients classified as responders or non-responders as defined by Sher's criteria (50% reduction in apnea-hypopnea index (AHI) and AHI < 15 events/h). Precision, recall, F1 score, and overall accuracy were evaluated as measures of performance.
RESULTS
In total, 25,040 images from 127 patients were included, of which 16,515 (69.3%) were from responders and 8,262 (30.7%) from non-responders. Models trained on the VP dataset had greater overall accuracy when compared to BOT alone and combined VP and BOT image sets, suggesting that VP images contain discriminative features for identifying therapeutic efficacy. The VCG-16 DL model had the best overall performance on the VP image set with high training accuracy (0.833), F1 score (0.78), and recall (0.883). Among ML models, the logistic regression model had the greatest accuracy (0.685) and F1 score (0.813).
CONCLUSION
Deep neural networks have potential to predict HGNS therapeutic efficacy using images from DISE, facilitating better patient selection for implantation. Development of multi-institutional data and image sets will allow for development of generalizable predictive models.
LEVEL OF EVIDENCE
N/A Laryngoscope, 2024.
PubMed: 38934474
DOI: 10.1002/lary.31609 -
Clinical Dysmorphology Jun 2024Prader-Willi syndrome (PWS) is a rare and complex genetic disorder caused by the loss of expression of the paternal copy of the imprinted genes on chromosome 15q11-q13....
OBJECTIVES
Prader-Willi syndrome (PWS) is a rare and complex genetic disorder caused by the loss of expression of the paternal copy of the imprinted genes on chromosome 15q11-q13. A variety of findings have been reported on the phenotypic differences between the genetic subtypes of PWS. This article compares the clinical findings of 57 PWS patients by genetic subtype and explores possible associations in this context.
METHODS
Methylation‑specific multiplex ligation-dependent probe amplification and single nucleotide polymorphism microarrays were used to diagnose deletion and uniparental disomy (UPD). For phenotype-genotype correlation, clinical data were collected and genetic subgroups were compared statistically, and P < 0.05 was considered to indicate statistical significance.
RESULTS
These 57 patients consisted of 15 type I deletions, 20 type II deletions, six atypic deletions, 11 heterodisomy UPD, four isodisomy UPD, and one translocation-type PWS. All patients had hypotonia, poor neonatal sucking, and feeding difficulties during infancy. Other PWS-related clinical findings, such as speech articulation problems (85.9%), sleep apnea (77.2%), normal birth length (71.9%), small hands/feet (71.9%), childhood polyphagia (57.9%), clinodactyly (56.1%), thick viscous saliva (54.4%), and behavioral problems (50.9%) were observed at varying rates with no statistical difference between genetic subtypes in general.
CONCLUSION
This study highlights the phenotype-genotype associations on PWS from a cohort of Turkish pediatric patients as a single-center experience.
PubMed: 38934057
DOI: 10.1097/MCD.0000000000000506 -
Journal of Diabetes and Metabolic... Jun 2024Sleep disorders are common health problems in the elderly. One of the unusual and often overlooked risk factors for hypertension is insomnia. Therefore, this study...
INTRODUCTION
Sleep disorders are common health problems in the elderly. One of the unusual and often overlooked risk factors for hypertension is insomnia. Therefore, this study investigated the relationships between insomnia and sleep problems with hypertension in the elderly population living in Tehran, Iran.
MATERIALS AND METHODS
In this cross-sectional study conducted in 2017, 450 elderly individuals (aged ≥ 60 years) living in households were randomly selected from five areas in the city of Tehran, Iran, via a multi-stage sampling method (stratified and clustered). Their sleep status and hypertension were examined using a self-reported comprehensive questionnaire to assess the physical, mental, and spiritual health needs of the elderly. The utilized questionnaire was designed and previously psychometrically validated. Univariate and multivariate logistic regression models assessed the responses regarding sleep and hypertension along with other variables to explore their relationships.
RESULTS
450 elderly individuals were recruited, of which 52.7% were men, and 47.3% were women. The mean age of the participants was 70.1 ± 7.3 years, and About 74.2% of participants were in the 60 to 74 years old, age group. Hypertension had a statistically significant relationship with insomnia. For one unit of increase in better sleep status score, hypertension decreased by 4% (OR = 0.96, = 0.017).
CONCLUSION
It seems that in preventive and therapeutic interventions related to insomnia, the risk of hypertension in the elderly should be considered, and their blood pressure should be monitored and constantly controlled. We suggest a more clinically accurate approach to insomnia, sleep disorders, and hypertension and further evaluation of variables such as sleep duration and obstructive sleep apnea in future studies.
PubMed: 38932900
DOI: 10.1007/s40200-024-01390-x -
Expert Review of Respiratory Medicine Jun 2024Sleep has important effects on breathing and gas exchange that may have negative consequences in patients with chronic obstructive pulmonary disease (COPD). COPD and... (Review)
Review
INTRODUCTION
Sleep has important effects on breathing and gas exchange that may have negative consequences in patients with chronic obstructive pulmonary disease (COPD). COPD and obstructive sleep apnea (OSA) are highly prevalent and may coexist, which is referred to as the overlap syndrome.
AREAS COVERED
The probability of OSA-COPD overlap represents the balance of protective and promoting factors such as hyperinflation and fluid retention; thus, different clinical COPD phenotypes influence the likelihood of comorbid OSA. The clinical presentation of OSA-COPD overlap is nonspecific, and the diagnosis requires clinical awareness to identify patients needing overnight studies. Both COPD and OSA are associated with a range of overlapping physiological and biological disturbances including hypoxia and inflammation that contribute to cardiovascular comorbidities. The management of OSA-COPD overlap patients differs from those with COPD alone and the survival of overlap patients treated with positive airway pressure (PAP) is superior to those untreated.
EXPERT OPINION
The recognition of OSA-COPD overlap has important clinical relevance because of its impact on outcomes and management. Management of the overlap should address both sleep quality and disordered gas exchange. PAP therapy has demonstrated reductions in COPD exacerbations, hospitalizations, healthcare costs and mortality in overlap patients.
PubMed: 38932721
DOI: 10.1080/17476348.2024.2373790 -
Journal of Yeungnam Medical Science Jun 2024The prevalence of childhood and adolescent obesity has increased and exacerbated during the coronavirus disease 2019 pandemic, both in Korea and globally. Childhood and...
The prevalence of childhood and adolescent obesity has increased and exacerbated during the coronavirus disease 2019 pandemic, both in Korea and globally. Childhood and adolescent obesity poses significant risks for premature morbidity and mortality. The development of serious comorbidities depends not only on the duration of obesity but also on the age of onset. Obesity in children and adolescents affects almost all organ systems, including the endocrine, cardiovascular, gastrointestinal, reproductive, nervous, and immune systems. Obesity in children and adolescents affects growth, cognitive function, and psychosocial interactions during development, in addition to aggravating known adult comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, nonalcoholic fatty liver disease, obstructive sleep apnea, and cancer. Childhood and adolescent obesity are highly associated with increased cardiometabolic risk factors and prevalence of metabolic syndrome. The risk of cardiovascular and metabolic diseases in later life can be considerably decreased by even a small weight loss before the onset of puberty. Childhood and adolescent obesity is a disease that requires treatment and is associated with many comorbidities and disease burdens. Therefore, early detection and therapeutic intervention are crucial.
PubMed: 38932702
DOI: 10.12701/jyms.2024.00360 -
Journal of Clinical Medicine Jun 2024Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current...
Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient's natural sleep. This study examines the reliability of an unobtrusive tracheal sound-based approach to monitor respiratory effort in the context of OSA, using manually marked respiratory inductance plethysmography (RIP) signals as a gold standard for validation. : In total, 150 patients were trained on the use of type III cardiorespiratory polygraphy, which they took to use at home, alongside a neck-worn AcuPebble system. The respiratory effort channels obtained from the tracheal sound recordings were compared to the effort measured by the RIP bands during automatic and manual marking experiments. A total of 133 central apnoeas, 218 obstructive apnoeas, 263 obstructive hypopneas, and 270 normal breathing randomly selected segments were shuffled and blindly marked by a Registered Polysomnographic Technologist (RPSGT) in both types of channels. The RIP signals had previously also been independently marked by another expert clinician in the context of diagnosing those patients, and without access to the effort channel of AcuPebble. The classification achieved with the acoustically obtained effort was assessed with statistical metrics and the average amplitude distributions per respiratory event type for each of the different channels were also studied to assess the overlap between event types. The performance of the acoustic effort channel was evaluated for the events where both scorers were in agreement in the marking of the gold standard reference channel, showing an average sensitivity of 90.5%, a specificity of 98.6%, and an accuracy of 96.8% against the reference standard with blind expert marking. In addition, a comparison using the Embla Remlogic 4.0 automatic software of the reference standard for classification, as opposed to the expert marking, showed that the acoustic channels outperformed the RIP channels (acoustic sensitivity: 71.9%; acoustic specificity: 97.2%; RIP sensitivity: 70.1%; RIP specificity: 76.1%). The amplitude trends across different event types also showed that the acoustic channels exhibited a better differentiation between the amplitude distributions of different event types, which can help when doing manual interpretation. : The results prove that the acoustically obtained effort channel extracted using AcuPebble is an accurate, reliable, and more patient-friendly alternative to RIP in the context of OSA.
PubMed: 38930155
DOI: 10.3390/jcm13123628 -
Journal of Clinical Medicine Jun 2024Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity...
Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity remains controversial. To study OSA's etiology, cephalometry, fiberoptic pharyngoscopy, polysomnography, and sleep endoscopy have been used; however, airway obstructions cannot be located. Recent research suggested ultrasonography for OSA screening and upper airway obstruction localization. Thus, this study aims to investigate the relationship between specific craniofacial cephalometric and ultrasonic airway parameters in adults at high risk of OSA. To assess craniofacial structure, lateral cephalograms were taken from thirty-three adults over 18 with a STOP-Bang questionnaire score of three or higher and a waist-to-height ratio (WHtR) of 0.5 or higher. Airway parameters were assessed through submental ultrasound. NSBA correlated with tongue base airspace width, while MP-H correlated with oropharynx, tongue base, and epiglottis airspace width. SNA, SNB, and NSBA correlated with tongue width at the oropharynx. At tongue base, ANB and MP-H correlated with tongue width. SNB and NSBA were associated with deep tissue thickness at the oropharynx, while MP-H correlated with superficial tissue thickness at velum and oropharynx. Cephalometric parameters (SNA, SNB, ANB, NSBA, and MP-H) were correlated with ultrasonic parameters in the velum, oropharynx, tongue base, and epiglottis.
PubMed: 38930069
DOI: 10.3390/jcm13123540