RESUMO
Both sleep alterations and epileptiform activity are associated with the accumulation of amyloid-ß and tau pathology and are currently investigated for potential therapeutic interventions in Alzheimer's disease (AD). However, a bidirectional intertwining relation between sleep and neuronal hyperexcitability might modulate the effects of AD pathology on the corresponding associations. To investigate this, we performed multiple day simultaneous foramen ovale (FO) plus scalp EEG and polysomnography (PSG) recordings and acquired 18F-MK6240 tau PET-MR in three patients in the prodromal stage of AD and in two patients with mild and moderate dementia due to AD, respectively. As an eligibility criterion for the present study, subjects either had a history of a recent seizure (n = 2) or subclinical epileptiform activity (SEA) on a previous scalp EEG taken in a research context (n = 3). The 18F-MK6240 standard uptake value ratio (SUVR) and asymmetry index (AI) were calculated in a priori defined volumes of interest (VOIs). Linear mixed effects models were used to study associations between interictal epileptiform discharges (IEDs), PSG parameters and 18F-MK6240 SUVR. Epileptiform activity was bilateral but asymmetrically present on FO electrodes in all patients and ≥ 95% of IEDs were not visible on scalp EEG. In one patient two focal seizures were detected on FO electrodes, both without visual scalp EEG correlate. We observed lateralized periodic discharges, brief potentially ictal rhythmic discharges and lateralized rhythmic delta activity on FO electrodes in four patients. Unlike scalp EEG, intracranial electrodes showed a lateralization of epileptiform activity. Although the amount of IEDs on intracranial electrodes was not associated to the 18F-MK6240 SUVR binding in different VOIs, there was a congruent asymmetry of the 18F-MK6240 binding towards the most epileptic hemisphere for the mesial (P = 0.007) and lateral temporal cortex (P = 0.006). IEDs on intracranial electrodes were most abundant during slow wave sleep (SWS) (92/h) and N2 (81/h), followed by N1 (33/h) and least frequent during wakefulness (17/h) and REM sleep (9/h). The extent of IEDs during sleep was not reflected in the relative time in each sleep stage spent (REM% (P = 0.415), N1% (P = 0.668), N2% (P = 0.442), SWS% (P = 0.988)), and not associated with the arousal index (P = 0.317), apnea-hypopnea index (P = 0.846) or oxygen desaturation index (P = 0.746). Together, our observations suggest a multi-directional interaction between sleep, epileptiform activity and tau pathology in AD.
RESUMO
Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk factor for cardiovascular disease in patients with obstructive sleep apnea. The aim of the study was to determine whether the presence of periodic limb movements during sleep affects serum lipid levels in obstructive sleep apnea. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non- high-density lipoprotein cholesterol and triglyceride levels were investigated in 4138 patients with obstructive sleep apnea in the European Sleep Apnea Database (ESADA) cohort, divided into those with periodic limb movements during sleep indexâ ≥ 15 per hr (n = 628) and controls (n = 3510). ANCOVA adjusted for age, sex, body mass index, apnea-hypopnea index, alcohol intake, smoking status, diabetes, insomnia and study site was used to assess differences in lipids between periodic limb movements during sleep and controls. Patients with periodic limb movements during sleep (24% female, 54.4 ± 12.1 years, body mass index 31.9 ± 5.8 kgâ m-2 , apnea-hypopnea index 36.7 ± 25.4 per hr) had higher triglyceride (1.81 ± 1.04 versus 1.69 ± 0.90 mmolâ L-1 , p = 0.002) and lower high-density lipoprotein cholesterol (1.19 ± 0.34 versus 1.24 ± 0.37 mmolâ L-1 , p = 0.002) levels, whilst there was no difference in either total cholesterol (4.98 ± 1.10 versus 4.94 ± 1.07 mmolâ L-1 ), low-density lipoprotein cholesterol (3.04 ± 0.96 versus 2.98 ± 0.98 mmolâ L-1 ) or non- high-density lipoprotein cholesterol (3.78 ± 1.10 versus 3.70 ± 1.05 mmolâ L-1 ) concentrations (all p > 0.05). The results remained unchanged after most sensitivity analyses. Patients with obstructive sleep apnea with periodic limb movements during sleep had more prevalent cardiovascular disease (11% versus 6%, p < 0.01). Periodic limb movements during sleep in obstructive sleep apnea is associated with dyslipidaemia independently of important confounders. Our results highlight periodic limb movements during sleep as an additional risk factor for cardiovascular disease in obstructive sleep apnea.
Assuntos
Doenças Cardiovasculares , Dislipidemias , Apneia Obstrutiva do Sono , Humanos , Feminino , Masculino , Doenças Cardiovasculares/complicações , Sono/fisiologia , Triglicerídeos , Colesterol , Dislipidemias/complicações , Lipoproteínas HDL , Lipoproteínas LDLRESUMO
Wearable electroencephalography devices emerge as a cost-effective and ergonomic alternative to gold-standard polysomnography, paving the way for better health monitoring and sleep disorder screening. Machine learning allows to automate sleep stage classification, but trust and reliability issues have hampered its adoption in clinical applications. Estimating uncertainty is a crucial factor in enhancing reliability by identifying regions of heightened and diminished confidence. In this study, we used an uncertainty-centred machine learning pipeline, U-PASS, to automate sleep staging in a challenging real-world dataset of single-channel electroencephalography and accelerometry collected with a wearable device from an elderly population. We were able to effectively limit the uncertainty of our machine learning model and to reliably inform clinical experts of which predictions were uncertain to improve the machine learning model's reliability. This increased the five-stage sleep-scoring accuracy of a state-of-the-art machine learning model from 63.9% to 71.2% on our dataset. Remarkably, the machine learning approach outperformed the human expert in interpreting these wearable data. Manual review by sleep specialists, without specific training for sleep staging on wearable electroencephalography, proved ineffective. The clinical utility of this automated remote monitoring system was also demonstrated, establishing a strong correlation between the predicted sleep parameters and the reference polysomnography parameters, and reproducing known correlations with the apnea-hypopnea index. In essence, this work presents a promising avenue to revolutionize remote patient care through the power of machine learning by the use of an automated data-processing pipeline enhanced with uncertainty estimation.
RESUMO
OBJECTIVES: To investigate the efficacy of closed-loop acoustic stimulation (CLAS) during slow-wave sleep (SWS) to enhance slow-wave activity (SWA) and SWS in patients with Alzheimer's disease (AD) across multiple nights and to explore associations between stimulation, participant characteristics, and individuals' SWS response. DESIGN: A 2-week, open-label at-home intervention study utilizing the DREEM2 headband to record sleep data and administer CLAS during SWS. SETTING AND PARTICIPANTS: Fifteen older patients with AD (6 women, mean age: 76.27 [SD = 6.06], mean MOCA-score: 16.07 [SD = 6.94]), living at home with their partner, completed the trial. INTERVENTION: Patients first wore the device for two baseline nights, followed by 14 nights during which the device was programmed to randomly either deliver acoustic stimulations of 50 ms pink noise (± 40 dB) targeted to the slow-wave up-phase during SWS or only mark the wave (sham). RESULTS: On a group level, stimulation significantly enhanced SWA and SWS with consistent SWS enhancement throughout the intervention. However, substantial variability existed in individual responses to stimulation. Individuals received more stimulations on nights with increased SWS compared to baseline than on nights with no change or a decrease. In individuals, having lower baseline SWS correlated with receiving fewer stimulations on average during the intervention. CONCLUSION: CLAS during SWS is a promising nonpharmacological method to enhance SWA and SWS in AD. However, patients with lower baseline SWS received fewer stimulations during the intervention, possibly resulting in less SWS enhancement. Individual variability in response to stimulation underscores the need to address personalized stimulation parameters in future research and therapy development.
RESUMO
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
Assuntos
Síndromes da Apneia do Sono , Apneia do Sono Tipo Central , Apneia Obstrutiva do Sono , Criança , Adulto , Humanos , Síndromes da Apneia do Sono/diagnóstico , Sono , EletroencefalografiaRESUMO
The American Academy of Sleep Medicine (AASM) uses similar apnea-hypopnea index (AHI) cut-off values to diagnose and define severity of sleep apnea independent of the technique used: in-hospital polysomnography (PSG) or type 3 portable monitoring (PM). Taking into account that PM theoretically might underestimate the AHI, we explored whether a lower cut-off would be more appropriate. We performed mathematical re-calculations on the diagnostic PSG-AHI (scored using AASM 1999 rules) of 865 consecutive patients with an AHI of ≥20 events/h who started continuous positive airway pressure (CPAP). For a PSG-AHI of ≥15 events/h re-scored using AASM 2012 rules (PSG-AHIAASM2012 ), a PM-respiratory event index (REI)AASM2012 cut-off point of ≥15 events/h resulted in a post-test probability of 100% of having the disease, but with negative tests in 57.1%. A PM-REIAASM2012 cut-off of 8 events/h, still resulted in a positive post-test probability of 100% but with negative tests in only 34.3%. Combination of the cut-off values with clinical estimation of being 'at high risk' based on Epworth Sleepiness Scale (ESS) and Berlin Questionnaire scores only resulted in a small reduction in the percentage of negative tests (respectively 52.7% and 32.7%). After 6 months, CPAP adherence was not lower using the PM-REIAASM 2012 cut-off ≥8 events/h in comparison to ≥15 events/h (median 5.7 vs. 5.8 h/night, p = 0.368) and the reduction in ESS was similar too (median -4 and -5 points, p = 0.083). Consequently, using a lower PM-REIAASM2012 cut-off could result in cost savings because of less negative studies and lesser need for a confirmatory PSG or a performance of a CPAP trial.
Assuntos
Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Polissonografia/métodos , Pressão Positiva Contínua nas Vias AéreasRESUMO
Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.
RESUMO
PURPOSE: Obstructive sleep apnea (OSA) is a prevalent and multifaceted disease. To date, the presence and severity of objectively identified comorbidities and their association with specific OSA phenotypes, CPAP adherence, and survival remain to be elucidated. The aim of this study is to cluster patients with OSA based on 10 clinically important objectively identified comorbidities, and to characterize the comorbidity clusters in terms of clinical and polysomnographic characteristics, CPAP adherence, and survival. STUDY DESIGN AND METHODS: Seven hundred ten consecutive patients starting CPAP for moderate-to-severe OSA were included. Comorbidities were based on generally accepted cutoffs identified in the peer-reviewed literature. Self-organizing maps were used to order patients based on presence and severity of their comorbidities and to generate clusters. RESULTS: The majority of patients were men (80%). They were generally middle-aged (52 years) and obese (BMI: 31.5 kg/m2). Mean apnea-hypopnea index (AHI) was 41 ± 20 per h of sleep. More than 94% of the patients had one or more comorbidities with arterial hypertension, dyslipidemia, and obesity being the most prevalent. Nine comorbidity clusters were identified. The clinical relevance of these comorbidity clusters was highlighted by the difference in symptoms, PSG parameters, and cardiovascular risk. Also, differences in CPAP adherence, improvements in ESS, and long-term survival were present between the clusters. CONCLUSION: Comorbidity prevalence in patients with OSA is high, and different comorbidity clusters, demonstrating differences in cardiovascular risk, CPAP adherence, and survival, can be identified. These results further substantiate the need for a comprehensive assessment of patients with OSA beyond the AHI.
Assuntos
Apneia Obstrutiva do Sono/complicações , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/mortalidade , Apneia Obstrutiva do Sono/terapia , Taxa de SobrevidaRESUMO
Data concerning sleep-disordered breathing (SDB) after lung transplantation (LTX) are scarce. This study aims to analyze prevalence, associated factors, and impact on survival of moderate to severe SDB in a large cohort of consecutive LTX patients (n = 219). Patients underwent a diagnostic polysomnography 1 year after LTX. Moderate to severe SDB was present in 57.5% of patients, with the highest prevalence in chronic obstructive pulmonary disease/emphysema (71.1%) and pulmonary fibrosis (65.1%). SDB patients were older, mostly male, and had higher body mass index and neck circumference. Nocturnal diastolic and 24-hour blood pressures were higher in SDB patients. In 45 patients, polysomnography was also performed pre-LTX. Compared to pre-LTX, mean apnea/hypopnea index (AHI) increased significantly after LTX. A significant correlation was seen between lung function parameters and AHI, suggesting a role of decreased caudal traction on the pharynx. Presence of SDB had no impact on mortality or prevalence of chronic lung allograft dysfunction. However, survival was better in continuous positive airway pressure (CPAP) compliant SDB patients compared to SDB patients without CPAP treatment. These findings may be pertinent for systematic screening of SDB after LTX.
Assuntos
Transplante de Pulmão , Síndromes da Apneia do Sono , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Transplante de Pulmão/efeitos adversos , Masculino , Polissonografia , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologiaRESUMO
Clinical activities regarding sleep disordered breathing (SDB) have been sharply interrupted during the initial phase of the coronavirus disease 2019 (COVID-19) epidemic throughout Europe. In the past months, activities have gradually restarted, according to epidemiological phase of COVID-19 and national recommendations. The recent increase in cases throughout Europe demands a reconsideration of management strategies of SDB accordingly. Diagnosis of SDB and initiation of treatment pose some specific problems to be addressed to preserve the safety of patients and health personnel. This perspective document by a group of European sleep experts aims to summarise some different approaches followed in Europe and United States, which reflect national recommendations according to the epidemiological phase of the COVID-19 infection. Respiratory sleep medicine is likely to change in the near future, and use of telemedicine will grow to avoid unnecessary risks and continue to provide optimal care to patients. In addition, the document covers paediatric sleep studies and indications for titration of noninvasive ventilation, as well as precautions to be followed by patients who are already on positive airway pressure treatment. A single consensus document developed by the European Respiratory Society and national societies would be desirable to harmonise SDB management throughout Europe.
Assuntos
COVID-19 , Laboratórios/organização & administração , Pneumologia/organização & administração , Síndromes da Apneia do Sono/diagnóstico , COVID-19/epidemiologia , Europa (Continente)/epidemiologia , HumanosRESUMO
BACKGROUND AND PURPOSE: Antiganglioside antibodies have been implicated in several autoimmune-mediated neuropathies, and binding of these antibodies can result in inflammatory changes of the nerves. Diaphragmatic paralysis is a rare condition, mostly arising from diseases affecting the phrenic nerve, neuromuscular junction, or skeletal muscle. OBJECTIVES: In this case series, we identified five patients with diaphragmatic paralysis due to unilateral or bilateral neuropathy of the phrenic nerve associated with the presence of antiganglioside antibodies (immunoglobulin G anti-GT1a antibodies and immunoglobulin M anti-GM1 antibodies). DISCUSSION: The combination of an isolated phrenic nerve palsy with anti-GM1 antibodies has only once been described. On the other hand, the association of anti-GT1a antibodies with phrenic nerve palsy has never been reported before. CONCLUSIONS: We report an association between phrenic nerve palsy and the presence of antiganglioside antibodies, but it remains unclear if there is a causal relationship. Further studies are needed to explore this matter.
Assuntos
Doenças do Sistema Nervoso Periférico , Nervo Frênico , Humanos , Imunoglobulina G , Imunoglobulina MRESUMO
Obstructive sleep apnea (OSA) patients would strongly benefit from comfortable home diagnosis, during which detection of wakefulness is essential. Therefore, capacitively-coupled electrocardiogram (ccECG) and bioimpedance (ccBioZ) sensors were used to record the sleep of suspected OSA patients, in parallel with polysomnography (PSG). The three objectives were quality assessment of the unobtrusive signals during sleep, prediction of sleep-wake using ccECG and ccBioZ, and detection of high-risk OSA patients. First, signal quality indicators (SQIs) determined the data coverage of ccECG and ccBioZ. Then, a multimodal convolutional neural network (CNN) for sleep-wake prediction was tested on these preprocessed ccECG and ccBioZ data. Finally, two indices derived from this prediction detected patients at risk. The data included 187 PSG recordings of suspected OSA patients, 36 (dataset "Test") of which were recorded simultaneously with PSG, ccECG, and ccBioZ. As a result, two improvements were made compared to prior studies. First, the ccBioZ signal coverage increased significantly due to adaptation of the acquisition system. Secondly, the utility of the sleep-wake classifier increased as it became a unimodal network only requiring respiratory input. This was achieved by using data augmentation during training. Sleep-wake prediction on "Test" using PSG respiration resulted in a Cohen's kappa (κ) of 0.39 and using ccBioZ in κ = 0.23. The OSA risk model identified severe OSA patients with a κ of 0.61 for PSG respiration and κ of 0.39 using ccBioZ (accuracy of 80.6% and 69.4%, respectively). This study is one of the first to perform sleep-wake staging on capacitively-coupled respiratory signals in suspected OSA patients and to detect high risk OSA patients based on ccBioZ. The technology and the proposed framework could be applied in multi-night follow-up of OSA patients.
Assuntos
Síndromes da Apneia do Sono , Eletrocardiografia , Humanos , Polissonografia , Respiração , Sono , Síndromes da Apneia do Sono/diagnósticoRESUMO
The electrocardiogram (ECG) is an important diagnostic tool for identifying cardiac problems. Nowadays, new ways to record ECG signals outside of the hospital are being investigated. A promising technique is capacitively coupled ECG (ccECG), which allows ECG signals to be recorded through insulating materials. However, as the ECG is no longer recorded in a controlled environment, this inevitably implies the presence of more artefacts. Artefact detection algorithms are used to detect and remove these. Typically, the training of a new algorithm requires a lot of ground truth data, which is costly to obtain. As many labelled contact ECG datasets exist, we could avoid the use of labelling new ccECG signals by making use of previous knowledge. Transfer learning can be used for this purpose. Here, we applied transfer learning to optimise the performance of an artefact detection model, trained on contact ECG, towards ccECG. We used ECG recordings from three different datasets, recorded with three recording devices. We showed that the accuracy of a contact-ECG classifier improved between 5 and 8% by means of transfer learning when tested on a ccECG dataset. Furthermore, we showed that only 20 segments of the ccECG dataset are sufficient to significantly increase the accuracy.
Assuntos
Artefatos , Eletrocardiografia , Processamento de Sinais Assistido por Computador , Algoritmos , Cardiopatias/diagnóstico , Humanos , Máquina de Vetores de SuporteRESUMO
Transfer entropy (TE) has been used to identify and quantify interactions between physiological systems. Different methods exist to estimate TE, but there is no consensus about which one performs best in specific applications. In this study, five methods (linear, k-nearest neighbors, fixed-binning with ranking, kernel density estimation and adaptive partitioning) were compared. The comparison was made on three simulation models (linear, nonlinear and linear + nonlinear dynamics). From the simulations, it was found that the best method to quantify the different interactions was adaptive partitioning. This method was then applied on data from a polysomnography study, specifically on the ECG and the respiratory signals (nasal airflow and respiratory effort around the thorax). The hypothesis that the linear and nonlinear components of cardio-respiratory interactions during light and deep sleep change with the sleep stage, was tested. Significant differences, after performing surrogate analysis, indicate an increased TE during deep sleep. However, these differences were found to be dependent on the type of respiratory signal and sampling frequency. These results highlight the importance of selecting the appropriate signals, estimation method and surrogate analysis for the study of linear and nonlinear cardio-respiratory interactions.
RESUMO
There exists a technological momentum towards the development of unobtrusive, simple, and reliable systems for long-term sleep monitoring. An off-the-shelf commercial pressure sensor meeting these requirements is the Emfit QS. First, the potential for sleep apnea screening was investigated by revealing clusters of contaminated and clean segments. A relationship between the irregularity of the data and the sleep apnea severity class was observed, which was valuable for screening (sensitivity 0.72, specificity 0.70), although the linear relation was limited ( R 2 of 0.16). Secondly, the study explored the suitability of this commercial sensor to be merged with gold standard polysomnography data for future sleep monitoring. As polysomnography (PSG) and Emfit signals originate from different types of sensor modalities, they cannot be regarded as strictly coupled. Therefore, an automated synchronization procedure based on artefact patterns was developed. Additionally, the optimal position of the Emfit for capturing respiratory and cardiac information similar to the PSG was identified, resulting in a position as close as possible to the thorax. The proposed approach demonstrated the potential for unobtrusive screening of sleep apnea patients at home. Furthermore, the synchronization framework enabled supervised analysis of the commercial Emfit sensor for future sleep monitoring, which can be extended to other multi-modal systems that record movements during sleep.
Assuntos
Balistocardiografia/instrumentação , Programas de Rastreamento , Monitorização Fisiológica/instrumentação , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Sono/fisiologia , Algoritmos , Artefatos , Eletrocardiografia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Polissonografia , Respiração , Processamento de Sinais Assistido por ComputadorRESUMO
BACKGROUND: A flexible 19-gauge (Flex 19G) needle has been developed for endobronchial ultrasonography. OBJECTIVES: We aimed to evaluate quantitative and qualitative specimen characteristics of Flex 19G in a randomized controlled setting for patients with suspected lung cancer. METHODS: We undertook a single-center, randomized, controlled trial. A computer-generated randomization assigned all enrolled patients 1: 1 to undergo endobronchial ultrasonography using a Flex 19G or a 22-gauge (22G) needle for lymph node tissue sampling. Pathologists were blinded to the group assignment. The primary end point was histological tissue core procurement. The secondary end points were diagnostic yield, specimen bloodiness and overall quality, tissue surface area and performance for next-generation sequencing (NGS), and procedure-related complications. RESULTS: Between June 2016 and February 2017, we randomly allocated a total of 78 patients: 39 patients to Flex 19G and 39 patients to 22G. No superiority in tissue core procurement was observed for Flex 19G compared to 22G (67 vs. 72%, p = 0.81). No significant difference was observed in diagnostic yield and overall specimen quality, but transbronchial needle aspiration specimens by Flex 19G were bloodier and had a larger tissue surface area. NGS was successful for clinically relevant genes in 96% and for all 26 genes tested in 81% of the samples. There was no difference in clinically relevant complications. CONCLUSIONS: No superiority is observed for Flex 19G in histological tissue core procurement rate. The Flex 19G needle could be considered when a larger tissue surface is of special interest.
Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Neoplasias Pulmonares/diagnóstico , Agulhas/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a "marker" of disease severity or a "mediator" of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.
Assuntos
Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/fisiopatologia , Apneia do Sono Tipo Central/terapia , Sono , Comitês Consultivos , Analgésicos Opioides/uso terapêutico , Europa (Continente) , Humanos , Hipoventilação/etiologia , Polissonografia , Respiração com Pressão Positiva , Guias de Prática Clínica como Assunto , Literatura de Revisão como AssuntoRESUMO
Recent animal studies and intraoperative studies in humans suggested that phrenic nerve stimulation could attenuate ventilator-induced diaphragm dysfunction. The purpose of the present study is to examine the safety and feasibility of diaphragm pacing during the weaning process after bilateral lung transplantation. Four patients, suffering from chronic pulmonary disease, were included, and diaphragm pacing was evaluated after lung transplantation. Implantation of electrodes at the end of the lung transplant procedure was possible in three of the four patients. In all implanted patients, stimulation of the diaphragm could trigger the ventilator. Implanted electrodes were completely removed by percutaneous retraction after up to 7 days of pacing. Adverse events related to pacing included occurrence of pain. Diaphragm pacing with temporary electrodes, inserted during surgery, is feasible and is able to trigger the ventilator in patients after bilateral lung transplantation. The use of intradiaphragmatic electrodes creates the additional opportunity to monitor the evolution of diaphragm electromyography during the postoperative weaning process.
Assuntos
Terapia por Estimulação Elétrica , Eletrodos Implantados , Transplante de Pulmão/métodos , Insuficiência Respiratória/terapia , Desmame do Respirador/métodos , Diafragma , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
BACKGROUND AND OBJECTIVE: Non-invasive ventilation (NIV) improves survival, quality of life and sleep in patients with amyotrophic lateral sclerosis (ALS). Nevertheless, NIV titration is conducted in different ways. We aim to provide more insight into NIV titration by comparing the effects of a spontaneous (S) and spontaneous-timed (ST) modes on gas exchange, sleep architecture and patient-ventilator asynchronies (PVAs). METHODS: After an initial night of NIV titration, patients were randomized to S or ST mode in a cross-over design. NIV was titrated using polysomnography, oximetry (oxygen saturation, SpO2 %) and transcutaneous carbon dioxide (PtcCO2 ) measurement. PVAs were analysed breath-by-breath. RESULTS: Thirteen patients were analysed after inclusion. ST mode showed better results in gas exchange (minimal SpO2 %: 83 (80-89)% vs 87 (84-89)%; oxygen desaturation index: 15 (5-28)/h sleep vs 7 (3-9)/h sleep; PtcCO2 >55 mm Hg: 20 (0-59)% vs 0 (0-27)% total sleep time for S and ST mode, respectively, all P < 0.05) and respiratory events (obstructive: 8.9 (1.2-18.3)/h sleep vs 1.8 (0.3-4.9)/h sleep and central: 2.6 (0.4-14.1)/h sleep vs 0.2 (0.0-1.1)/h sleep for S and ST mode, respectively, both P < 0.01). No differences in sleep architecture were found. Ineffective efforts and respiratory events were more frequently present in S mode. Nevertheless, four patients were discharged on S mode as these patients showed clinically better results for sleep architecture and PVA during the night on S mode. CONCLUSION: ST mode shows better results in gas exchange, respiratory events and PVA. Nevertheless, accurate NIV titration remains necessary as some patients show equal or better results when using the S mode.
Assuntos
Esclerose Lateral Amiotrófica/fisiopatologia , Esclerose Lateral Amiotrófica/terapia , Ventilação não Invasiva/métodos , Sono/fisiologia , Adulto , Idoso , Esclerose Lateral Amiotrófica/complicações , Monitorização Transcutânea dos Gases Sanguíneos , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Polissonografia , Qualidade de VidaRESUMO
A lung transplant recipient was diagnosed with penicilliosis due to Talaromyces marneffei, a fungus endemic in South-East Asia, which was acquired by donor transmission. This first case of Talaromyces marneffei-transmission by transplantation underscores that current globalisation of travelling necessitates increased vigilance for transmission of unusual pathogens in organ recipients.