[German Translation and Linguistic Validation of the Multidimensional Dyspnea Profile (MDP)]. / Deutsche Übersetzung und sprachliche Validierung des multidimensionalen Dyspnoe-Profils (MDP).

BACKGROUND: Dyspnea is characterized as a subjective perception of breathing discomfort. This includes distinct sensory qualities with distinct intensities. The detection and quantization of these quality distinctions can be quite difficult. As yet, there is no instrument in German covering the multidimensionality of dyspnea. Banzett et al. developed the Multidimensional Dyspnea Profile (MDP) in 2015 to meet and to understand the multidimensional nature of dyspnea, disease span and at varying times or situations. METHODS: This paper presents the German translation of the MDP. The MAPI Research Trust has developed the German version in accordance with the recognized guidelines for intercultural adaption of patient reported outcomes. That included a linguistic validation in patients with this condition. RESULTS: The Multidimensional Dyspnea Profile measures the intensity of dyspneic breathing discomforts. It tests five sensory qualities that describe the patient's dyspnea in its respective intensity. Additionally, it includes five potential reactions. The MDP is designed to refer to a specific event in time. CONCLUSION: The authors made the instrument freely available for academic use in English language. In addition, the German version is finally available and can be used in both everyday clinical practice and laboratory research.

[Positionpaper on Telemonitoring in Sleep-Related Breathing Disorders]. / Positionspapier zum Telemonitoring bei schlafbezogenen Atmungsstörungen.

The use of telemonitoring in the care of patients with Sleep-related Breathing Disorders (SBD) can enhance medical support significantly. Telemonitoring aims at helping physicians to detect therapy problems early and thus improve patients' therapy adherence. Diagnostics and therapy decisions in the telemonitoring process nevertheless remain the responsibility of sleep specialists. The selection of data monitored, their evaluation and resulting consequences fall to the physician, who makes decisions and prescribes therapy in consultation with the patient. In light of professional legal and ethical requirements, it must be ensured that the extensive changes to the process flow in sleep medicine are designed in a way to guarantee high-quality patient care. In this position paper, the German Sleep Society, the German Respiratory Society, the Association of Pneumological Hospitals and the Federal Association of German Pneumologists comment on important aspects for implementation of telemonitoring for SRBD and describe the basic conditions required for its use.

[Nasal Highflow (NHF): A New Therapeutic Option for the Treatment of Respiratory Failure]. / Nasaler Highflow (NHF): Eine neue Therapiealternative zur Behandlung der respiratorischen Insuffizienz.

The therapy of choice in hypoxemic respiratory failure (type 1) is the application of supplemental oxygen at flow rates of 1 to 15 l/min via nasal prongs or mask. Non-invasive or invasive positive pressure ventilation will be initiated when the oxygen therapy effects are not sufficient or if hypercapnic respiratory failure (type 2) is the underlying problem. Recently, an alternative therapy option is available, from the pathophysiology it can be classified between oxygen therapy and positive pressure ventilation. The therapy called Nasal High Flow (NHF) is based on the nasal application of a heated and humidified air oxygen mixture with a flow range of up to 60 l/min. The precise pathophysiological principles of NHF are only partly understood, yet various aspects are well studied already: it is possible to deliver high oxygen concentrations, airway dryness can be avoided, dead space ventilation reduced and clearance of nasal dead space is achieved. Additionally, an end expiratory positive pressure is built up, which helps to prevent airway collapse, thus resulting in an improvement of respiratory efficiency and reduction of breathing work. Current studies demonstrate improvement in gas exchange and reduction of reintubation rate when applying the NHF treatment in acute respiratory failure. Thus the NHF therapy attracts attention in intensive care medicine. The application in other fields like chronic respiratory insufficiency is less well clarified. The objectives of this review are to present the pathophysiological effects and mechanisms of NHF, as far as understood, and to give an overview over the current state of relevant studies.

[Unilateral reduction of lung volume by application of intrabronchial valves on patients selected after endoscopic collateral ventilation assessment]. / Unilaterale Lungenvolumenreduktion mit intrabronchialen Ventilen nach Selektion mittels endoskopischer Kollateralventilationsmessung.

BACKGROUND: Endoscopic collateral ventilation assessment (ECVA) can be used to select patients suffering from emphysema for application of valves to achieve a reduction of lung volume. The objective is to obtain a post-operatively minimal clinically important improvement of the selected patient's physical capacity. METHODS: Patients with severe chronic obstructive pulmonary disease (COPD) underwent examination for a possible reduction of lung volume. Those selected got ECVA. Patients whose collateral resistance (Rcoll) increased to Rcoll > 10 cm H2O/(mL/s) within a measurement duration of up to 300 s, were submitted to unilateral lobar application of intrabronchial valves (IBV). Differences in residual volume (RV) as well as distances in 6 minute walk tests (6MWT) between the time after application of valves (TX) and that before (T1) were calculated (TX minus T1). RESULTS: Of a tested 310 emphysema patients, 17 met criteria allowing ECVA; 10 of 17 proved eligible for valve application. After 312 ±â€Š170 days (TX - T1) the increase in walking distance was 44 ±â€Š89.7 m; 7 of 10 patients achieved clinically relevant improvements (> 25 m). Differences in RV proved to correlate with differences in walking distances, but not yet with differences in measurement duration in ECVA. CONCLUSIONS: Only a small portion of patients with progressive emphysema of the lung seem suitable for endoscopic reduction of lung volume by application of valves. Unilateral lobar application of IBV can result in durable, clinically relevant improvements of the patient's physical capacity. ECVA measurements should take a minimum of 300 s.

[Consensus paper on the diagnosis and treatment of sleep disordered breathing]. / Konsensuspapier zur Diagnostik und Therapie schlafbezogener Atmungsstörungen bei Erwachsenen.

Diagnosis and treatment of sleep disordered breathing (SDB) undergo substantial changes, both in terms of increasing scientific knowledge and also in terms of patient provision and socio-economic aspects. Increasing evidence shows the relevance of SDB on morbidity and mortality of affected patients. The precise differentiation of different phenotypes of SDBs has improved substantially in recent years. These proceedings influence the approach to the patients suspected of suffering from SDB. The scientific advances on the one hand are facing intentions to simplify diagnostical processes and treatment initiation and intentions to translate duties of physicians to non-medical personnel on the other hand. This consensus paper presents the principals of diagnosis, treatment initiation and provision, including the role of different participants of the healthcare system, and compares different treatment options. Major aspects include the differentiation of the diagnostical process in screening, affirmation of diagnosis and differential diagnosis. In addition, it focusses on the relevance of the pretest probability and describes a therapeutical algorithm.

Obstructive pressure peak: a new method for differentiation of obstructive and central apneas under auto-CPAP therapy.

PURPOSE: Auto-CPAP devices (APAP) are controlled, e.g.,by the respiratory flow and pressure to adjust the treatment pressure to the variable obstruction in sleep apnea syndromes.By obstruction of the upper airway during inspiration,a pressure difference between the lower airways and the mask can be measured. In case of an opening of the pharynx at the end of the obstruction, the pressure decreases immediately. This brief negative pressure, the so-called obstructive pressure peak (OPP) can be used to identify obstruction or open airways with the algorithm of an APAP device. Useless pressure increases, e.g., after central apneas without obstruction may be avoided. We therefore investigated the association of the OPP signal with respiratory events during APAP therapy. METHODS: In this pilot study, 13 patients with obstructive sleep apnea syndrome were evaluated. Attended automatic CPAP titration (SOMNO balance, Fa Weinmann Hamburg/Germany)was performed. The OPP signal was recorded synchronous lyin parallel with the polysomnographic data. If the OPP signal was within a time range of ± 5 s of the resumption of normal breathing, it was assigned to the event. RESULTS: A total of 480 sleep-related breathing disorders events were studied. The most common were the mixed apneas associated with more than 90% of all cases with an OPP signal, followed by obstructive sleep apneas (66.7%)and central apneas (38%). The difference in OPP frequency distribution between central apneas and obstructive apneas was significant with p<0.001. CONCLUSIONS: The analysis of the pressure characteristics of APAP treatment with the registration of OPP allows a further differentiation in obstructed and not obstructed upper airways.

[Telemonitoring of bike exercise training in patients with obstructive sleep apnoea]. / Telemonitoring von Fahrrad-Heimtraining bei Patienten mit obstruktiver Schlafapnoe.

BACKGROUND: Patients with obstructive sleep apnoea (OSA) suffer from daytime sleepiness, cognitive disorders and are at increased risk of cardiovascular diseases. In addition to continuous positive airway pressure (CPAP), major lifestyle changes to increase physical activity contribute to risk reduction. The daily training duration should be at least 20 minutes to achieve a relevant effect. In addition to exercise training in groups, home training is useful. However, sufficiently intensive training is often not performed because of unavailable feedback (monitoring). It is not clear yet how many patients accept a bicycle home training and to what extent they meet the specified training time. METHOD: Of the 152 consecutive OSA patients surveyed, 74 (48.7 %) agreed to a 4-week home exercise bike training. After exclusion of 51 patients, 17 for logistical reasons, and 34 because of severe comorbidities, 23 patients remained (age 51.0 +/- 9.3 years, BMI 33.7 +/- 4.2, ESS score 10.4 +/- 6.7, AHI 33.8 +/- 24.0). The daily duration of training at the ventilatory threshold (VT1) was recorded and transmitted by a wireless module (Cinterion) via Internet to a doctor or instructor. RESULTS: The patients exercised during 27.3 +/- 2.9 days. 19 of the 23 patients (83 %) accomplished the training period of > 20 minutes per day. In 4 patients (17 %) the training time was well below this target level with 5.9 +/- 2.3 min. The average training time of all patients was 24.4 +/- 9.0 min. CONCLUSION: About 50 % of the OSA patients are interested in a regular physical exercise bike training with telemonitoring, and are performing it quite constantly. The described method of telemonitoring provides a simple and, compared to group training cost-effective way to reduce cardiovascular risk in OSA.

[Technique and clinical importance of breathing wave generators]. / Technik und Aussagemöglichkeiten von Atmungsmodellen.

In recent years, several comparisons of ventilators for invasive and noninvasive mechanical ventilation or automatic continuous pressure therapy (APAP) were published. Simulations were used with different test sequences. Simulations are particularly helpful when identical breathing patterns should be reproduced several times. In the following we report on recent developments of flow- and lung simulators from other groups and present our own experiences in Hagen. To study automatic CPAP devices we applied a custom-made simulator which reproduces the obstruction of the upper airway and any breathing waveform. From the different behavior of automatic CPAP devices concerning pressure dynamics important conclusions can be drawn about the real clinical situation.

[Detection of daytime sleepiness using Epworth Sleepiness Scale and a 3-item questionnaire in obstructive sleep apnea]. / Erfassung der Tagesschläfrigkeit mittels Epworth-Schläfrigkeits-Skala und einem 3-Item-Fragebogen bei obstruktiver Schlafapnoe.

INTRODUCTION: The Epworth Sleepiness Scale (ESS) describes the likelihood of falling asleep in 8 specific situations. Pathological sleepiness (TS) of patients with obstructive sleep apnea (OSA) is most often diagnosed with an ESS score≥11 (TS-ESS). In an epidemiological study on the prevalence of sleep apnea syndrome (OSAS), only three questions with yes-no answers were used for the characterization of pathological daytime sleepiness (TS-Young): Due to the different construction of the ESS and the Young's questionnaire, we asked whether with the combination of the two questionnaires a larger number of patients with OSA and TS compared to the ESS can be identified. In addition, we examined the sleepiness questionnaires (FB) using objective vigilance in defined groups of OSA patients. METHODS: Using PSG 328 OSA patients with an AHI≥5 were identified. Vigilance was examined using the computer program CARDA. RESULTS: With both FB the same percentage of patients with AHI>5 with pathological sleepiness was found (48 %). By combining both FB (TS-comb), the number of patients increased from 158 (48.2 %) to 195 (59.5 %) significantly. The combination showed a significantly higher percentage with additional 37 (11.3 %) patients in comparison to the TS-ESS alone. Combining both FB, an increase of TS resulted in patients with below-average number of errors in the vigilance test (n=192) from 23.2 % to 31.4 % of these cases (p<0.001). CONCLUSIONS: As a single test both questionnaires can be used to detect daytime sleepiness with equal incidence. Combining both questionnaires a higher percentage of daytime sleepiness can be found in comparison to the ESS-questionnaire alone especially in patients without disturbance of vigilance.

Investigation of the flexibility of bronchoscopes.

OBJECTIVE: For transbronchial biopsy of peripheral pulmonary lesions manouevering the biopsy instrument into acutely angulated subsegmental ostia is frequently problematic. The aim of the present study was to compare the stiffness of various biopsy instruments with regard to their use in the clinical setting. - METHODS: The maximal anterograde and retrograde bending angles, were measured for various bronchoscopes and biopsy instruments. Measurement was made with the distal tip of the biopsy instrument either flush with the distal end of the bronchoscope, or extending 1.5 cm beyond it. The following scopes and biopsy instruments were investigated: 1. the 6.2 mm outside diameter (OD) bronchoscope, with the 2.4 mm OD forceps, 0.7 mm needle, 2.3 mm catheter, and the 1.9 mm cryoprobe. 2. the 5.1 mm OD bronchoscope, with the 1.8 mm forceps, 0.7 mm needle, and the 1.8 mm catheter. 3. the 3.7 mm bronchoscope, with the 1.0 mm forceps and the 0.8 mm forceps. - RESULTS: Maximum angulation was greater by 35.4° with the needle extended, vis-a-vis the needle "flush". Both needle and catheter were associated with a greater angulation of up to 20.5° in comparison with the forceps. With an instrument in the working channel the largest anterograde angles were measured for the 5.1 mm bronchoscope, and the largest retrograde angles for the 6.2 mm bronchoscope. - CONCLUSION: When selecting the optimal instrument for transbronchial biopsy specimen collection, account must be taken of the fact that the degree of angulation will depend on the type and diameter of the instrument employed.

[Clinical views on biosignal processing of ventilation in sleep medicine]. / Klinische Aspekte der Biosignalverarbeitung von Atmungsparametern in der Schlafmedizin.

Biological signals recorded by polysomnography such as electroencephalograms (EEG), electrooculograms (EOG) und electromyograms (EMG), airflow, thoracic and abdominal motions, O(2) saturation and heart frequency pass through a processing chain with amplification and filtering of the measured variables. In the signal processing the original signal is manipulated to extract information in order to correlate various parameters and to visualise the signal in different representations. The task of the clinician is now to take advantage of the information available and to come to clinical conclusions. Therefore the characteristics, especially the methodology of the signal processing in the devices, should be disclosed by the manufacturers and thus be verifiable. In this review for the example of O(2) saturation, the consequence of different processing criteria with regard to the apnea/hypopnea index is presented. Biosignals such as the respiratory flow are also increasingly being used to control therapy equipment for automatic CPAP devices (APAP). However, the implemented algorithms are often not known, and cannot directly be derived from the polysomnographic records under APAP therapy. In model experiments with a flow generator, defined flow patterns can be simulated. Using bench tests with simulated apneas and waking periods, diagnosed from the flow characteristics, the methods of signal processing can be verified by measuring the pressure profiles and made more transparent for the clinician.

[Use of cryoextraction in different types of airway obstruction]. / Kryoextraktion bei unterschiedlichen Formen einer Atemwegsobstruktion: Vier exemplarische Fälle.

With the development of mechanically stable cryoprobes, direct endoscopic removal of tissue from the bronchial system with cryotherapy is now possible. Tissue is frozen to the tip of the probe and removed by pulling on the probe together with the fiberscope. This procedure, also referred to as cryoextraction, additionally provides good quality biopsy specimens for histopathological examination. We report here on four patients with different forms of bronchial obstruction, in whom cryoextraction was performed for rapid recanalization. In addition to the immediate effect, the procedure has few complications and is cost-effective. Indications were mucoid impaction, foreign body aspiration, removal of suprastomal granulation tissue prior to decannulation after prolonged mechanical ventilation, and obstruction of the trachea and the main bronchi by a carcinosarcoma. In the latter case, the diagnosis was additionally based on a specimen obtained by cryobiopsy.

[Heated humidification during CPAP with and without tube insulation]. / Warmluftbefeuchtung unter CPAP mit und ohne Schlauchisolation.

BACKGROUND: Patients with obstructive sleep apnoea syndrome (OSAS) under continuous positive pressure (CPAP) often complain about drying-up of the throat and nasal mucosa. In many cases the problem can be eliminated with a heated humidifier (WLB). Especially in a cold environment condensation forming on cooling of the air in the tube and the mask can be observed. To avoid this, some patients use an insulating tube covering. We investigated the effect of temperature (T) and relative humidity (rH) of the environment, the ventilation pressure, mask leaks, insulation of tubing on the T and rH% of the delivered air at the end of the tube or in the mask in OSAS patients. METHOD: All measurements were performed with a conventional WLB (S8, Resmed Fa) and a temperature and humidity sensor (Fa Testo, Lenzkirch). PATIENTS: 8 patients with OSAS were examined during the day at a room temperature of 16.4 degrees C. RESULTS: The temperature at the outlet of the WLB increased with a higher ambient temperature. Through isolation with a hose cover the temperature drop in the tube was reduced by 2.3 degrees C. By tube insulation a mean increase in temperature between 1.6 and 1.0 C during normal breathing in dependence on the leakage flow in the mask was found. CONCLUSIONS: Due to additional insulation with a tube cover the mask temperature can be increased, albeit slightly, and the formation of condensation is reduced.

Transbronchial catheter aspiration compared to forceps biopsy in the diagnosis of peripheral lung cancer.

OBJECTIVE: The usual procedure for obtaining material for histological analysis for the diagnosis of peripheral carcinoma of the lung is transbronchial forceps biopsy (TBB). Not widely spread is acquiring samples for cytological examination by transbronchial catheter aspiration (TBCA). Data were retrospectively collected to determine the diagnostic sensitivity of TBCA in comparison with TBB concerning malignancy. METHODS: We analysed the results of 51 consecutively examined patients (age 68.7 +/- 8.8 yrs.) applying both methods. 48 of 51 peripheral lesions proved to be malignant, 34 of which measured > 3 cm in diameter and 14 < or = 3 cm. Fluoroscopy provided guidance in biopsies for both techniques. RESULTS: The mean diameter of the lesion was 3.7 +/- 1.5 cm. We were able to establish a correct diagnosis by TBCA in 36 of 48 patients with lung cancer, and in 21 of 48 patients by TBB (75% vs. 44%, p < 0.01, chi-square-test). By combination of both methods 39 of 48 patients were correctly diagnosed. For carcinoma > 3 cm the success rate for TBCA was 76% (26/34) and for TBB 56% (19/34). For carcinoma < or = 3 cm the success rate for TBCA was 71% (10/14) and for TBB 14% (2/14). CONCLUSIONS: Even in lesions < or = 3 cm application of TBCA results in an only marginally lower success rate compared to lesions > 3 cm. Due to the overall high success rate we suggest to apply the easy-to-handle and inexpensive method of TBCA in diagnostic procedure of peripheral lung carcinoma.

[Exercise testing by spiroergometry in a patient with sarcoidosis stage II. An unusual combination of functional impairments]. / Spiroergometrie bei einem Patienten mit Sarkoidose II. Eine aussergewöhnliche Kombination von Funktionsstörungen.

Sarcoidosis is a multisystem disease of unknown origin characterised by epitheloid cell granulomas in the lung and many other organs. The measurement of the alveolo-arterial O(2)-gradient (AaDO(2)) during exercise is the most sensitive method to detect the involvement of the lung with impairment of gas exchange. The method is suitable for follow-up observations to make the indication for a steroid therapy in the case of deterioration. In this case presentation using the 9-panel display proposed by Wasserman we diagnosed besides a slight impairment of the gas exchange a cardiocirculatory dysfunction with a reduction of the oxygen pulse and a reduced minute ventilation with a decrease of the alveolar ventilation. The hypoventilation could be explained by a weakness of the respiratory muscles or a reduction of the central respiratory drive. The functional disturbances could be diagnosed by spiroergometry without expensive or invasive methods. The findings should be examined more specifically with regard to therapeutic consequences.

[Telemonitoring of arm ergometric training in COPD patients. A pilot study]. / Telemonitoring von Armergometer-Training bei COPD-Patienten. Eine Pilotstudie.

INTRODUCTION: Regular moderate physical activity in COPD reduces morbidity and improves life expectancy. Many programmes often fail after rehabilitation because regular training at home, possibly caused by a lack of motivation, is not maintained, the performance parameters then decline to the prerehabilitation levels. For cost reasons, a simple procedure is required to measure the training times in the home environment with a daily transmission of telemetric data so that, in the case of decline, advice and assistance can be provided. QUESTIONS: How long is the actual daily training time monitored by telemetry of COPD patients if a target of 20 minutes per day is prescribed by the doctor? Is there a correlation between physical activity at home and the training period? METHOD: We used a device for training the upper extremities with a GSM data transmission module for the transfer of the training times. The physical activity before an exacerbation of COPD and the willingness to modify the training behaviour were determined by questionnaires. 13 patients with COPD (age 69 +/- 9 years, FEV1 48.6 +/- 23.9 %) were investigated prospectively for 6 days under stationary conditions. RESULTS: The mean training period (target 20 min/day) was 16.1 +/- 11.7 min/day. The frequency of physical activity per week correlated with the daily ergometry training period in the clinic (r = 0.59). CONCLUSION: Training supervised by telemonitoring represents a useful way to objectively obtain training times. Ergometric training in combination with online transmission (telemetric monitoring) and regular phone calls could be an inexpensive method to increase physical activity.

[Characteristics of auto-CPAP devices during the simulation of sleep-related breathing flow patterns]. / Regulationsverhalten von Auto-CPAP-Geräten während der Simulation von schlafbezogenen Atemflussmustern.

INTRODUCTION: The function of automatic CPAP devices is difficult to investigate using clinical examinations due to the high variability of breathing disorders. With a flow generator, however, identical breathing patterns can be reproduced so that comparative studies on the behaviour of pressure of APAP devices are possible. Because the algorithms of APAP devices based on the experience of users can be modified without much effort, also previously investigated devices should regularly be reviewed with regard to programme changes. QUESTIONS: Had changes occurred in the algorithms of 3 selected devices--compared to the previously published benchmark studies? Do the current versions of these investigated devices differentiate between open and closed apnoeas? METHOD: With a self-developed respiratory pump, sleep-related breathing patterns and, with the help of a computerised valve, resistances of the upper respiratory tract were simulated. Three different auto-CPAP devices were subjected to a bench test with and without feedback (open/closed loop). RESULTS: Open loop: the 3 devices showed marked differences in the rate of pressure rise but did not differ from the earlier published results. From an initial pressure of 4 mbar the pressure increased to 10 mbar after a different number of apnoeas (1-6 repetitive apnoeas). Only one device differentiated between closed and open apnoeas. Closed loop: due to the pressure increase, the flow generator simulated reduced obstruction of the upper airways (apnoeas changed to hypopnoeas, hypopnoeas changed to flattening) but different patterns of pressure regulation could still be observed. CONCLUSION: By applying bench-testing, the algorithms of auto-CPAP devices can regularly be reviewed to detect changes in the software. The differentiation between open and closed apnoeas should be improved in several APAP devices.

[Effects of a breath-triggered modulation of positive airway pressure ventilation on the AHI from patients with obstructive sleep apnoea]. / Effekte einer Atemzyklus-gesteuerten Druckmodulation (Flexline) auf den AHI bei Uberdrucktherapie von Patienten mit einem OSAS.

BACKGROUND: Positive airway pressure (CPAP) is the treatment of choice for patients with obstructive sleep apnoea syndrome (OSAS). Especially in relation to side effects, it is not clear whether it is better to administer a constant positive pressure during the respiratory cycle or to vary it while breathing. The Flexline maybe improves patients' adherence by increasing the pressure in the early inspiration and lowering it in early expiration. METHODS: The pressure characteristics of the Flexline were examined in healthy persons. Patients with OSAS were titrated with CPAP or with the Flexline in random order under PSG control in the sleep laboratory. The apnoea/hypopnoea index (AHI) per pressure level was determined. PATIENTS: 20 patients with the new diagnosis of OSAS, first time treated with CPAP (age 56.6 +/- 11.5 years, BMI 28.4 +/- 3.2 kg/m (2), AHI 44.1 +/- 18.7, SO2 min 77.7 +/- 8.4 % and ESS 8.6 +/- 5.1). RESULTS: Constant CPAP and the mean pressure in the modus Flexline are similar. The differences in pressure between inspiration and expiration in the Flexline are dependent on the breathing frequency and the primarily chosen pressure level. Reduction of upper airway obstructions is similar with both types of therapy (AHI: CPAP: 9.1 +/- 7.4, Flexline: 9.1 +/- 7.4) without influencing sleep quality (arousal index: CPAP: 21.7 +/- 8.4, Flexline: 20.1 +/- 9.8). CONCLUSIONS: The Flexline is equally efficient as CPAP in the treatment of OSAS.

Impact of a controlled heated breathing tube humidifier on sleep quality during CPAP therapy in a cool sleeping environment.

There are conflicting data on the effect of adding a heated humidifier to nasal continuous positive airway pressure (CPAP) therapy for patients with obstructive sleep apnoea syndrome (OSAS). The effects of heated humidification on sleep quality and treatment side-effects for patients who prefer a cold bedroom environment have not been studied. A randomised, controlled crossover trial involving 19 patients with a first-ever diagnosis of OSAS measured the effect of conventional heated humidification added to CPAP compared with a controlled heated breathing tube humidifier (ThermoSmart(R); Fisher and Paykel Healthcare, Auckland, New Zealand) on sleep quality. During the night in the sleep laboratory at a mean room temperature of 14 degrees C, less condensation formed with the controlled heated breathing tube humidifier (1.9 mL versus 35.3 mL) in the delivery system. In addition, the total sleep time, time spent in sleep stages 3 and 4, and rapid eye movement sleep phases were significantly longer and the overall side-effect score was lower than with conventional heated humidification. Patients on nasal continuous positive airway pressure desiring a cool bedroom temperature could benefit from controlled heated breathing tube humidification technology (with inputs from ambient temperature, set pressure and flow).

[Microsleep, sleepiness and driving performance in patients with sleep apnoea syndrome]. / Sekundenschlaf, Schläfrigkeit und Verkehrstüchtigkeit beim Schlafapnoe-Syndrom.

Especially during monitoring activities or car driving needing high vigilance, episodes of microsleep are extremely dangerous. Microsleep can be described by observing behaviour patterns or electrophysiological parameters. An early recognition of these episodes is desirable. In the automobile industry intensive development is ongoing to register sleepiness and subsequent microsleep during driving to avoid accidents. The monitoring of eyelid frequency and diameter of the pupil (eye tracking) are most promising. Compared with a reference population, the accident risk of patients with sleep-related breathing disorders is more than two-fold higher. But up to now there are no definitive criteria--neither subjective nor objective tests such as, for instance, driving simulators--to predict driving impairment. By means of screening examinations, patients with obstructive sleep apnoea syndrome (OSAS) should be detected because therapy with CPAP normalises the accident rate. A further measure to reduce the risk of accidents is the so-called alertness management where techniques are communicated to detect and avoid sleeping episodes.