Meierbradley9803

After adjusting for baseline AHI, body mass index and supine dependency, the position of the soft palate [odds ratio (OR) 4.0 (1.3-11.8); P=0.013] and crowding of the oropharynx [OR 7.7 (1.4-41.4); P=0.017] were related to treatment deterioration. Addition of both features significantly (P=0.031) improved the accuracy of baseline models based on clinical measurements alone. Moreover, with the MAD in situ, a posteriorly located soft palate [OR 9.8 (1.7-56.3); P=0.010] and a posteriorly located tongue base [OR 7.4 (1.5-35.9); P=0.013] were associated with treatment deterioration. CONCLUSIONS Awake nasopharyngoscopy might be a valuable office-based examination to exclude the risk of treatment deterioration and improve patient selection for MAD treatment. © 2020 American Academy of Sleep Medicine.STUDY OBJECTIVES Thermistors, nasal cannulas and respiratory inductance plethysmography (RIP) are the reference sensors (AASM recommendations) for the detection and characterization of apneas and hypopneas. However, these sensors are not well tolerated by patients and have a poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds and RIP signals. METHODS Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in a random order using the AASM standard signals and the combination tracheal sound (TS) and RIP signals, TS-RIP, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-Flow signals for detection of apneas and hypopneas respectively, and the suprasternal pressure (SSP) and RIP belts signals for the characterization of apneas. RESULTS Sensitivity (Se) and specificity (Sp) of the TS-RIP combination were 96.21% and 91.34% for apnea detection, and 89.94% and 93.25% for detecting hypopneas, respectively, with a Kappa coefficient of 0.87. For the characterization of apneas, Se and Sp were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a Kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea (OSA) into severity classes (no OSA, mild, moderate and severe OSA) with a Cohen's Kappa coefficient of 0.96. CONCLUSIONS Compared to the AASM reference sensors, the TS-RIP combination allows reliable non-invasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for OSA diagnosis, in adults, either as an alternative or in combination with the recommended AASM sensors. © 2020 American Academy of Sleep Medicine.STUDY OBJECTIVES To undertake a meta-analysis of literatures comparing the prevalence of cardio- and cerebrovascular comorbidities between overlap syndrome (OS) patients and chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea (OSA) patients. METHODS Studies about the cardio- and cerebrovascular disease of OS were searched among several electronic databases from the time of database construction to June, 2019. Two independent reviewers performed the process of study screening, quality assessment and data extraction. Meta-analysis of odds ratios was carried out by RevMan5.3 under either fixed- or random- effects models. Sensitivity analysis was conducted to examine the robustness of pooled outcome. RESULTS A total of 17 articles were included. Compared with COPD/OSA, OS significantly increased the risk of developing hypertension (OS vs. COPD OR=1.94, 95% CI [1.49, 2.52]; OS vs. OSA OR=2.05, 95% CI [1.57, 2.68]) and pulmonary hypertension (OS vs. COPD OR=2.96, 95% CI [1.30, 6.77]; OS vs. OSA OR=5.93, 95% CI [1.84, 18.42]). There was no significant difference in the prevalence of coronary heart disease (OR=1.19，95%CI[0.67,2.11]) and cerebrovascular disease (OR=2.43, 95%CI[0.81, 7.31]) between COPD and OS patients. However, the sensitivity analysis showed that the pooled outcome of the comparison of pulmonary arterial pressure between OS and COPD patients was not stable. Muvalaplin clinical trial CONCLUSIONS OS significantly increased cardiovascular risk including the prevalence of hypertension and pulmonary hypertension. However, since the pooled outcome about pulmonary arterial pressure was not stable, further studies were still required. © 2020 American Academy of Sleep Medicine.STUDY OBJECTIVES Sleep-disordered breathing (SDB) and nocturnal hypoxia are prevalent among patients with precapillary pulmonary hypertension (PAH). The rationale for these associations remains unclear and these relationships have not been well studied in other forms of pulmonary hypertension (PH). We hypothesized that severity of SDB and nocturnal hypoxia are associated with worsening pulmonary hemodynamics, regardless of hemodynamic profile. METHODS 493 Patients were divided into 4 groups 1) no PH, 2) postcapillary pulmonary hypertension (PVH), 3) PAH, and 4) mixed PAH/PVH. The relationship between RHC measurements and apnea-hypopnea index (AHI) or the percentage of sleep time spent with oxygen saturation less then 90% (T90) was calculated using multiple linear regression. ANOVA was used for between-group comparisons. Statistical models were adjusted for known confounders. RESULTS AHI did not differ between hemodynamic subgroups (p=0.27) and was not associated with right atrial pressure (RAP) (0.11 ± 0.19, p=0.55), Cardiac index (CI) (0.25 ± 1.64, p=0.88)), mean pulmonary artery pressure (mPAP) (-0.004 ± 0.09, p=0.97) or pulmonary artery occlusion pressure (PAOP) (0.16 ± 0.14, p=0.26). While patients with PH had a higher T90 than those without (mean 24.2% vs. 11.7%, p less then 0.001), there was no difference in T90 between individual PH subgroups (p=0.70). T90 was associated with mPAP (0.55 ± 0.10, p less then 0.0001), PVR (1.61 ± 0.49, p=0.001) and RAP (0.50 ± 0.20, p=0.01), but not CI (-0.76 ± 1.73, p=0.66) or PAOP (0.23 ± 0.15, p=0.13). CONCLUSIONS Increased PH severity was associated with longer duration of nocturnal hypoxia regardless of hemodynamic subgroup. © 2020 American Academy of Sleep Medicine.