Axicons for mode conversion in high peak power, higher-order mode, fiber amplifiers.

Higher-order mode fiber amplifiers have demonstrated effective areas as large as 6000 µm2, allowing for high pulse energy and peak power amplification. Long-period gratings are used to convert the fundamental mode to the higher-order mode at the entrance to the amplifier, and reconvert back to the fundamental at the exit, to achieve a diffraction limited beam. However, long period gratings are susceptible to nonlinearity at high peak power. In this work, we propose and demonstrate axicons for linear bulk-optic mode conversion at the output of higher order mode amplifiers. We achieve an M2 of less than 1.25 for 80% mode conversion efficiency. Experiments with pulsed amplifiers confirm that the mode conversion is free from nonlinearity. Furthermore, chirp pulse amplifier experiments confirm that HOM amplifiers plus axicon mode convertors provide energy scalability in femtosecond pulses, compared to smaller effective area, fundamental mode fiber amplifiers. We also propose and demonstrate a route towards fiber integration of the axicon mode convertor by fabricating axicons directly on the tip of the fiber amplifier end-cap.

Scaling the effective area of higher-order-mode erbium-doped fiber amplifiers.

We demonstrate scaling of the effective area of higher-order mode, Er-doped fiber amplifiers. Two Er-doped higher-order mode fibers, one with 3800 µm(2) A(eff) in the LP(0,11) mode, and one with 6000 µm(2) effective area in the LP(0,14) mode, are demonstrated. Output beam profiles show clean higher order modes, and S(2) imaging measurements show low extraneous higher order mode content. CW and pulsed amplifier experiments are reported. Nanosecond pulses are amplified to 0.5 mJ pulse energy with 0.5 MW peak power.

Multicore fiber distributed feedback lasers.

We demonstrate parallel fabrication of seven fiber distributed feedback (DFB) lasers in a hexagonally arrayed multicore core Er doped fiber with 40 µm core spacing. DFB grating cavities 8 cm long and operating near 1545 nm were fabricated with a single UV inscription exposure. We observed dual polarization, single longitudinal mode operation with a linewidth below 300 kHz for each laser.

Mode-locked picosecond pulse generation from an octave-spanning supercontinuum.

We generate mode-locked picosecond pulses near 1110 nm by spectrally slicing and reamplifying an octave-spanning supercontinuum source pumped at 1550 nm. The 1110 nm pulses are near transform-limited, with 1.7 ps duration over their 1.2 nm bandwidth, and exhibit high interpulse coherence. Both the supercontinuum source and the pulse synthesis system are implemented completely in fiber. The versatile source construction suggests that pulse synthesis from sliced supercontinuum may be a useful technique across the 1000 - 2000 nm wavelength range.

Perturbative approach to continuum generation in a fiber Bragg grating.

We derive a perturbative solution to the nonlinear Schrödinger equation to include the effect of a fiber Bragg grating whose bandgap is much smaller than the pulse bandwidth. The grating generates a slow dispersive wave which may be computed from an integral over the unperturbed solution if nonlinear interaction between the grating and unperturbed waves is negligible. Our approach allows rapid estimation of large grating continuum enhancement peaks from a single nonlinear simulation of the waveguide without grating. We apply our method to uniform and sampled gratings, finding good agreement with full nonlinear simulations, and qualitatively reproducing experimental results.

Assessment of accuracy and analysis time of a novel device to monitor sleep and breathing in the home.

Obstructive sleep apnea is increasingly recognized as a common and debilitating disorder. As a result, a variety of diagnostic technologies have evolved to potentially decrease cost and improve access and ease of assessment. In this study we compared the Healthdyne NightWatch (NW) System (a home sleep diagnostic methodology) to standard polysomnography (PSG) in two sleep centers. Two separate studies were completed. NW was compared to a simultaneously obtained PSG in 30 patients (IN-LAB study). Seventy additional patients were studied in both the home with NW and in the laboratory with PSG (HOME-LAB study). The NW system records eye movement, leg movement, SaO2, nasal-oral airflow, chest and abdominal wall motion, body position and heart rate on a solid state recorder, which permits sleep staging based on body and eye movement and standard respiratory assessment. For the PSG, standard paper recording techniques were used. The IN-LAB study revealed a correlation between NW and PSG for total sleep time of r = 0.72, with NW tending to score some awake time as nonrapid eye movement sleep. The correlation for apnea-hypopnea index (AHI) was r = 0.94 between systems, with a sensitivity of 100% and specificity of 63.6% at an AHI threshold of 10. The HOME-LAB study demonstrated understandably poor correlations between NW and PSG for most measures of sleep, which is likely a product of night-to-night variability in sleep, home versus laboratory effects and the differences in sleep staging methodology. However, the correlation for AHI was r = 0.92, with a sensitivity of 90.7% and a specificity of 70.4% at an AHI threshold of 10. Using a new methodology to assess agreement between diagnostic systems, we observed 78.6% diagnostic agreement between NW and PSG in the HOME-LAB study, with NW underestimating AHI 4.3% of the time and overestimating it in 17.1% of cases. This may relate to night-to-night variability in AHI or greater NW computer sensitivity to subtle hypopneas. We conclude that NW provides an accurate determination of AHI in both the home and laboratory, using limited instrumentation. The analysis time for NW is also reduced compared to PSG, and patients generally prefer the NW evaluation.

Obstructive sleep apnea in patients with human immunodeficiency virus (HIV) disease.

Adenotonsillar hypertrophy has been identified as an early manifestation of human immunodeficiency virus (HIV) disease. Three patients with HIV disease were identified with obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy. In order to examine the relationship between HIV-induced adenotonsillar hypertrophy and OSA, 134 patients with asymptomatic HIV disease were screened with a self-administered sleep survey designed to detect OSA and excessive daytime somnolence. Patients meeting trigger score criteria were studied with overnight polysomnography and nine additional patients were identified with OSA. The only consistent risk factor for OSA in this young and primarily nonobese population was the presence of adenotonsillar hypertrophy, found in 11 of 12 patients with OSA. Three patients had tonsillar biopsy or tonsillectomy and all displayed benign follicular lymphoid hyperplasia. Scores on the Epworth Sleepiness Scale (ESS) were significantly higher for patients with OSA, indicating a greater degree of hypersomnolence (mean ESS scores: OSA+ = 11.4 +/- 3.6, OSA- = 7.8 +/- 4.6, p = 0.012). In our population, patients with HIV disease had a prevalence of OSA of 7%. HIV-induced adenotonsillar hypertrophy is a risk factor for the development of OSA. HIV patients with complaints of excessive daytime sleepiness and snoring who are found to have adenotonsillar hypertrophy on exam should undergo a sleep evaluation to rule out the presence of OSA.

Obstructive sleep apnea syndrome in patients with class II malocclusion.

This study was designed to analyze the effect of class II malocclusion as a factor in the development of obstructive sleep apnea syndrome. Although mandibular retrusion has been reported coincidentally with obstructive sleep apnea syndrome many times, no causal relationship has been established. No previous study has analyzed the occurrence of obstructive sleep apnea syndrome in patients with class II malocclusion without sleep complaints. In this study, we selected 12 patients with class II malocclusion who required surgical mandibular-lengthening or repositioning procedures. These patients were surveyed for sleep habits or sleep complaints and then studied with overnight polysomnography for sleeping or breathing abnormalities. None of these patients had obstructive sleep apnea syndrome. From this sample population, an incidence of obstructive sleep apnea syndrome of no more than 26.5% in the surgical population of patients with class II malocclusion can be extrapolated.

Effects of alterations in pulmonary function and sleep variables on survival in patients with amyotrophic lateral sclerosis.

Breathing abnormalities and nocturnal hypoventilation occur in patients with amyotrophic lateral sclerosis (ALS). A prospective study was undertaken to determine the relationship of pulmonary function test abnormalities with quality of sleep and survival in 21 patients with ALS. Results of spirometry including determination of maximal respiratory pressures and arterial blood gases were compared with several formal polysomnographic variables and then also with 18-month survival. The patients had mild to moderate pulmonary function deficits, but the quality of sleep was best related to age (mean age, 58.5 years). The results of pulmonary function tests and arterial blood gas measurements did not correlate well with the presence of nocturnal breathing events or survival time, but the maximal inspiratory pressure was 86% sensitive for predicting the presence of a nocturnal oxygen saturation nadir of 80% or less and 100% sensitive for predicting 18-month survival. Although obstructive breathing events occurred, the primary explanation for the decline in nocturnal oxygen saturation was hypoventilation. We conclude that routine pulmonary function tests may be useful for screening for reductions in nocturnal oxygen saturation and also may have prognostic value. Further studies may determine whether treatment of nocturnal hypoventilation will have an effect on survival in patients with ALS who have breathing impairment.

Reduction of group delay ripple of multi-channel chirped fiber gratings using adiabatic UV correction.

We demonstrate reduction of group delay ripple (GDR) from 24 ps to 9 ps peak to peak in a four channel 43 Gb/s dispersion compensating chirped fiber grating by adiabatic UV post processing. The eye opening penalty due to the grating GDR was improved from ~2dB to <1dB for all of the channels over a range of carrier frequencies of 15GHz. Our results demonstrate that at 43 Gb/s, the adiabatic UV correction technique is sufficient to substantially improve multi-channel fiber grating performance. We also discuss three limitations of the correction technique which cause GDR to vary from channel to channel: Noise in the sampling function, cladding mode loss, and varying channel reflectivity. While these limitations are visible in our results they do not reduce the effectiveness of the adiabatic correction for our gratings.

Experimental and scalar beam propagation analysis of an air-silica microstructure fiber.

We study the higher order guided modes in an air-silica microstructure fiber comprising a ring of six large air-holes surrounding a Germanium doped core. We characterize the modes experimentally using an intra-core Bragg grating. The experimentally observed modes are then accurately modeled by beam propagation simulations using an index profile similar to the observed fiber cross section. Theory and experiment confirm the presence of "inner cladding" modes with approximate cylindrical symmetry near the core, similar to conventional cladding modes, but which strongly exhibit the symmetry of the microstructure at large radius. Such modes are useful in fabricating robust tunable grating filters and we show that the Bragg grating is a useful diagnostic to measure their effective indices and intensity profiles.

High power, single mode, all-fiber source of femtosecond pulses at 1550 nm and its use in supercontinuum generation.

We present a source of high power femtosecond pulses at 1550 nm with compressed pulses at the end of a single mode fiber (SMF) pigtail. The system generates 34 femtosecond pulses at a repetition rate of 46 MHz, with average powers greater than 400 mW. The pulses are generated in a passively modelocked, erbium-doped fiber laser, and amplified in a short, erbium-doped fiber amplifier. The output of the fiber amplifier consists of highly chirped picosecond pulses. These picosecond pulses are then compressed in standard single mode fiber. While the compressed pulses in the SMF pigtail do show a low pedestal that could be avoided with the use of bulk-optic compression, the desire to compress the pulses in SMF is motivated by the ability to splice the single mode fiber to a nonlinear fiber, for continuum generation applications. We demonstrate that with highly nonlinear dispersion shifted fiber (HNLF) fusion spliced directly to the amplifier output, we generate a supercontinuum spectrum that spans more than an octave, with an average power 400 mW. Such a high power, all-fiber supercontinuum source has many important applications including frequency metrology and bio-medical imaging.

Microstructured optical fiber devices.

We present several applications of microstructured optical fibers and study their modal characteristics by using Bragg gratings inscribed into photosensitive core regions designed into the air-silica microstructure. The unique characteristics revealed in these studies enable a number of functionalities including tunability and enhanced nonlinearity that provide a platform for fiber device applications. We discuss experimental and numerical tools that allow characterization of the modes of the fibers.

Fiber-laser-based frequency comb with a tunable repetition rate.

A phase-locked, self-referenced frequency comb generated by a mode-locked fiber soliton laser with a tunable repetition rate is presented. The spacing of the frequency comb is set by the laser's repetition rate, which can be scanned from 49.3 MHz to 50.1 MHz while one tooth of the comb is held phase-locked to a stable RF source. This variable repetitionrate frequency comb should be useful for wavelength and length metrology, synchronization of different fiber laser-based frequency combs, and the generation of precise swept wavelength sources.

Effect of nasal continuous positive airway pressure on cardiac output and oxygen delivery in patients with congestive heart failure.

We studied the acute hemodynamic effects of increasing nasal continuous positive airway pressure (CPAP) in 13 patients with acute decompensation of congestive heart failure. Heart rate, respiratory rate, pulmonary capillary wedge pressure, right atrial pressure, systemic blood pressure, and thermodilution cardiac outputs were measured at baseline, during, and after application of nasal CPAP at increasing pressures of 5, 10, and 15 cm H2O. Cardiac index, stroke volume, and oxygen delivery were calculated. Based on a significant change in cardiac output greater than or equal to 400 ml, seven patients were classified as responders, whereas six patients were considered to be nonresponders. In responders, significant increases were noted in cardiac index (2.5 +/- 0.7 to 2.9 +/- 0.9 L/min/m2), stroke volume (49 +/- 15 to 57 +/- 16 ml), and oxygen delivery (10.3 +/- 5.1 to 12.3 +/- 6.0 ml/min/kg) without a change in pulmonary capillary wedge pressure. In contrast, the nonresponders showed no significant change in any of the hemodynamic parameters. Improvement in cardiac output could not be predicted by any of the baseline hemodynamic or clinical variables, nor was it related to random variations since all variables returned to baseline after cessation of CPAP. Increase in stroke volume without a change in pulmonary capillary wedge pressure (preload) suggests either improved inotropic function of the left ventricle or reduced left ventricular afterload with CPAP. Thus, CPAP may offer a new noninvasive adjunct to improving left ventricular function and augmenting cardiac performance in a subset of patients with congestive heart failure.

Estimation of dynamic chemoresponsiveness in wakefulness and non-rapid-eye-movement sleep.

We developed a method for quantifying dynamic chemoresponsiveness on the basis of the ventilatory response to pseudorandom binary CO2 stimulation. The dynamic chemoreflex gain (GD) and effective time delay (TDeff) relating breath-to-breath fluctuations in alveolar PCO2 to ventilation were evaluated at frequencies between 0 and 0.05 Hz. Application of the method to simulated "data" showed that estimation errors in GD and TDeff were most likely to be minimized in the range of 0.01-0.03 Hz, corresponding to periodicities of 30-100 s. Estimation of TDeff was generally more susceptible to error than that of GD because of the limited time resolution of the breath-by-breath measurements. In eight awake normal adults, we compared estimates of GD derived from the pseudorandom binary CO2 stimulation test with peripheral and central hypercapnic sensitivities deduced from single-breath and Read rebreathing measurements in the same subject. GD at 0.02 Hz was highly correlated with peripheral hypercapnic sensitivity but poorly correlated with central hypercapnic sensitivity, underscoring the importance of the peripheral chemoreflexes in mediating ventilatory responses to phasic stimuli. Application of the procedure to a different group of 10 healthy volunteers during wakefulness and stage 2 sleep showed decreases in GD in 8 subjects but increases in 2 subjects. However, for the group as a whole, GD and TDeff did not change significantly between wakefulness and sleep. The proposed method may provide information more pertinent to periodic breathing than traditional CO2 response tests do, since the chemoreflex responses to phasic variations in blood gases are likely to be important in determining ventilatory control during sleep.

Ventilatory dynamics during transient arousal from NREM sleep: implications for respiratory control stability.

The polysomnographic and ventilatory patterns of nine normal adults were measured during non-rapid-eye-movement (NREM) stage 2 sleep before and after repeated administrations of a tone (40-72 dB) lasting 5 s. The ventilatory response to arousal (VRA) was determined in data sections showing electrocortical arousal following the start of the tone. Mean inspiratory flow and tidal volume increased significantly above control levels in the first seven breaths after the start of arousal, with peak increases (64.2% > control) occurring on the second breath. Breath-to-breath occlusion pressure 100 ms after the start of inspiration showed significant increases only on the second and third postarousal breaths, whereas upper airway resistance declined immediately and remained below control for > or = 7 consecutive breaths. These results suggest that the first breath and latter portion of the VRA are determined more by upper airway dynamics than by changes in the neural drive to breathe. Computer model simulations comparing different VRA time courses show that sustained periodic apnea is more likely to occur when the fall in the postarousal increase in ventilation is more abrupt.

Regression of nifedipine-induced gingival hyperplasia following switch to a same class calcium channel blocker, isradipine.

Patients with nifedipine-induced gingival hyperplasia (GH) often require continued calcium channel blocker therapy. Switches to diltiazem and verapamil have been described; however, these drugs are of a different chemical class and present therapeutic limitations in some patients. The purpose of this study was to evaluate the effect on nifedipine-induced GH of a switch to a dihydropyridine derivative with a low incidence of GH. Fourteen patients with nifedipine-induced GH were given a medical exam and a periodontal exam. The following parameters were assessed: probing depth (PD), gingival margin (GM), gingival thickness (GT), plaque index (PI), and gingival index (GI). Intraoral photographs, study models, and a gingival biopsy for histological examination were taken. Following baseline measures, patients were randomized to continued treatment with nifedipine or an equivalent dose of isradipine in a single-blind fashion. Biweekly periodontal parameters were taken for 8 weeks. At the end of 8 weeks, some patients elected to receive 4 weeks of open label isradipine therapy, with biweekly examination continuing through the open label phase. The isradipine treatment arm showed a mean decrease in PD of 0.59 mm at week 8 (P < 0.05). No other measured parameter (GM, GT, PI, GI) was significantly changed, compared either to baseline or to the alternate treatment arm. Clinically, 60% of patients treated with isradipine exhibited a decrease in hyperplasia, while 66% of patients treated with nifedipine demonstrated an increase in hyperplasia, a significant difference (P < 0.05). When combined with open label data, patients switching therapy to isradipine exhibited an increase in GM (increase in recession) of 0.74 mm from baseline to week 12 (P < 0.05). No patients treated with isradipine exhibited an increase in gingival overgrowth. All patients exhibited adequate control of hypertension. We conclude that in hypertensive patients with nifedipine-induced GH, switching hypertensive therapy to isradipine may result in a regression of GH. When coupled with aggressive oral hygiene treatment, this drug may provide a reasonable option for patients requiring dihydropyridine treatment.

Sleep and breathing disturbance secondary to nasal obstruction.

The purpose of this study was to determine the effect of acute nasal obstruction on sleep and breathing in eight normal persons. The subjects were randomized into two groups. One night the subject was studied with the nose open and a second night with the nose obstructed. The electroencephalogram, electrocardiogram, inspiratory effort, nasal and oral airflow, and oxygen saturation were monitored. Sleep proved to be both subjectively and objectively disturbed. The subjects with the nose obstructed awoke more often, had a greater number of changes in sleep stage, had a prolongation of rapid-eye-movement (REM) latency, and spent a greater amount of time in stage I non-REM sleep (light sleep). Acute nasal obstruction caused a statistically significant increase in the number of partial and total obstructive respiratory events (obstructive hypopnea and obstructive apnea). Sleep apnea developed in one subject during this study merely on the basis of acute nasal obstruction.

Sleep disorders and upper airway obstruction in adults.

The OSA syndrome, described over 100 years ago, was rediscovered in 1966. It is a common disorder, especially among fat, middle-aged men. Stentorian snoring and diurnal somnolence are the cardinal manifestations and should always lead to an examination during sleep. That examination (polysomnography) can demonstrate the pathognomonic events--repetitive apneas occurring in sleep--which signal the failure of the sleeping brain to maintain the patency of the supraglottic airway. All evidence points to the problem being an abnormal pharyngeal airway, one which has a shape or size or compliance that allows inspiratory collapse as the normal loss of pharyngeal dilator muscle tone occurs with sleep. The apneas are asphyxic events terminated by arousals which fragment sleep continuity and lead to the daytime sleepiness. Because the snoring occurs during sleep, the arousals are unremembered, and the sleepiness can develop so gradually that the patient may forget what normal alertness is like. It is important to interview the patient's spouse or partner. Besides obesity and maleness, other risk factors for OSA are diseases that have an impact on the configuration or effective compliance of the pharyngeal passageway. Recent studies support the clinical intuition that sleep apnea is undesirable. Sleepiness leads to accidents. The hypoxemia occurring during apnea can lead to potentially fatal cardiac dysrhythmias. A number of reports suggest that snoring and sleep apnea are associated with an increased risk of stroke, myocardial ischemia, and infarction. Finally, there are now two papers showing a significantly decreased probability of 5-year survival in patients with symptomatic sleep apnea. The good news is that treatment with tracheostomy or NCPAP improves mortality rates to normal. Approximately 90 per cent of patients can tolerate a night's initial trial with CPAP. Long-term acceptance of CPAP has now been reviewed in a number of studies, and it appears to be about 65 to 70 per cent.