Demonstration of opposing thermal sensitivities in hollow-core fibers with open and sealed ends.

The output phase and propagation time of an optical signal propagating through a hollow-core optical fiber (HCF) drift with changes in environmental temperature significantly less than in conventional optical fibers. In all earlier experimental studies, however, the simplifying assumption was made that the thermo-optic effect of air was negligible. In this Letter, we present, to the best of our knowledge, the first experimental demonstration that the air inside a HCF core can make an appreciable contribution to the fiber's thermal sensitivity with the performance depending on whether the fiber is open to the atmosphere or sealed at both ends (e.g., spliced to solid fiber pigtails). We measure both the sensitivity of the accumulated phase as well as the signal propagation time for both open and sealed HCF and show that these are opposite in sign. Most importantly, we show that the thermal sensitivity contribution from the air inside an open HCF has the sign opposite to the effect of fiber elongation (which is otherwise the dominant effect responsible for the overall thermal sensitivity of HCF). We then go on to show that these two effects can be used to balance each other out in order to achieve zero thermal sensitivity for both accumulated phase and propagation time. We demonstrate this property experimentally over a large spectral range.

Low-loss Kagome hollow-core fibers operating from the near- to the mid-IR.

We report the fabrication and characterization of Kagome hollow-core antiresonant fibers, which combine low attenuation (as measured at ∼30 cm bend diameter) with a wide operating bandwidth and high modal purity. Record low attenuation values are reported: 12.3 dB/km, 13.9 dB/km, and 9.6 dB/km in three different fibers optimized for operation at 1 µm, 1.55 µm, and 2.5 µm, respectively. These fibers are excellent candidates for ultra-high power delivery at key laser wavelengths including 1.064 µm and 2.94 µm, as well as for applications in gas-based sensing and nonlinear optics.

Optoelectronic oscillator incorporating hollow-core photonic bandgap fiber.

We demonstrate, to the best of our knowledge, the first optoelectronic oscillator that uses hollow-core photonic bandgap fiber (HC-PBGF) as a delay element of a sufficient length to allow for low-noise operation. We show experimentally that HC-PBGF can improve the temperature stability of the oscillator by a factor of more than 15, as compared to standard optical fiber. We also measured the oscillator's phase noise, allowing evaluation of the suitability of HC-PBGF for this application. Additionally, this Letter also provides, to the best of our knowledge, the first characterization of the temperature stability of a long length (>800 m in our Letter) of low-thermal sensitivity (2 ps/km/K) HC-PBGF wound on a spool.

Optical side scattering radiometry for high resolution, wide dynamic range longitudinal assessment of optical fibers.

Current optical reflectometric techniques used to characterize optical fibers have to trade-off longitudinal range with spatial resolution and therefore struggle to provide simultaneously wide dynamic range (>20dB) and high resolution (<10cm). In this work, we develop and present a technique we refer to as Optical Side Scattering Radiometry (OSSR) capable of resolving discrete and distributed scattering properties of fibers along their length with up to 60dB dynamic range and 5cm spatial resolution. Our setup is first validated on a standard single mode telecoms fiber. Then we apply it to a record-length 11km hollow core photonic band-gap fiber (HC-PBGF) the characterization requirements of which lie far beyond the capability of standard optical reflectometric instruments. We next demonstrate use of the technique to investigate and explain the unusually high loss observed in another HC-PBGF and finally demonstrate its flexibility by measuring a HC-PBGF operating at a wavelength of 2µm. In all of these examples, good agreement between the OSSR measurements and other well-established (but more limited) characterization methods, i.e. cutback loss and OTDR, was obtained.

Millijoule laser pulse delivery for spark ignition through kagome hollow-core fiber.

We report on power handling oriented design of kagome lattice hollow-core fiber and demonstrate through it for the first time nanosecond laser pulses induced spark ignition in a friendly manner. Two different core designs and transmission bands are investigated and evaluated. The energy threshold damage was measured to be in excess of the 10 mJ level and the output power density is approaching the TW/cm2 after focusing; demonstrating the outstanding ability of such fiber for high power delivery.

Design and fabrication of hollow-core photonic crystal fibers for high-power ultrashort pulse transportation and pulse compression.

We report on the recent design and fabrication of kagome-type hollow-core photonic crystal fibers for the purpose of high-power ultrashort pulse transportation. The fabricated seven-cell three-ring hypocycloid-shaped large core fiber exhibits an up-to-date lowest attenuation (among all kagome fibers) of 40 dB/km over a broadband transmission centered at 1500 nm. We show that the large core size, low attenuation, broadband transmission, single-mode guidance, and low dispersion make it an ideal host for high-power laser beam transportation. By filling the fiber with helium gas, a 74 µJ, 850 fs, and 40 kHz repetition rate ultrashort pulse at 1550 nm has been faithfully delivered at the fiber output with little propagation pulse distortion. Compression of a 105 µJ laser pulse from 850 fs down to 300 fs has been achieved by operating the fiber in ambient air.

Shift in sleep apnoea type in heart failure patients in the CANPAP trial.

In patients with heart failure (HF), the predominant type of sleep apnoea can change over time in association with alterations in circulation time. The aim of this study was to determine whether, in some patients with HF, a spontaneous shift from mainly central (>50% central events) to mainly obstructive (>50% obstructive events) sleep apnoea (CSA and OSA, respectively) over time coincides with improvement in left ventricular ejection fraction (LVEF). Therefore, sleep studies and LVEFs of HF patients with CSA from the control arm of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP) trial were examined to determine whether some converted to mainly OSA and, if so, whether this was associated with an increase in LVEF. Of 98 patients with follow-up sleep studies and LVEFs, 18 converted spontaneously to predominantly OSA. Compared with those in the nonconversion group, those in the conversion group had a significantly greater increase in the LVEF (2.8% versus -0.07%) and a significantly greater fall in the lung-to-ear circulation time (-7.6 s versus 0.6 s). In patients with HF, spontaneous conversion from predominantly CSA to OSA is associated with an improvement in left ventricular systolic function. Future studies will be necessary to further examine this relationship.

Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration.

BACKGROUND: Continuous positive airway pressure (CPAP) improves cardiac function in patients with congestive heart failure (CHF) who also have Cheyne-Stokes respiration and central sleep apnea (CSR-CSA). However, the effects of CPAP in CHF patients without CSR-CSA have not been tested, and the long-term effects of this treatment on clinical cardiovascular outcomes are unknown. METHODS AND RESULTS: We conducted a randomized, controlled trial in which 66 patients with CHF (29 with and 37 without CSR-CSA) were randomized to either a group that received CPAP nightly or to a control group. Change in left ventricular ejection fraction (LVEF) from baseline to 3 months and the combined mortality-cardiac transplantation rate over the median 2.2-year follow-up period were compared between the CPAP-treated and control groups. For the entire group of patients, CPAP had no significant effect on LVEF, but it was associated with a 60% relative risk reduction (95% confidence interval, 2% to 64%) in mortality-cardiac transplantation rate in patients who complied with CPAP therapy. Stratified analysis of patients with and without CSR-CSA revealed that those with CSR-CSA experienced both a significant improvement in LVEF at 3 months and a relative risk reduction of 81% (95% confidence interval, 26% to 95%) in the mortality-cardiac transplantation rate of those who used CPAP. CPAP had no significant effect on either of these outcomes in patients without CSR-CSA. CONCLUSIONS: CPAP improves cardiac function in CHF patients with CSR-CSA but not in those without it. Although not definitive, our findings also suggest that CPAP can reduce the combined mortality-cardiac transplantation rate in those CHF patients with CSR-CSA who comply with therapy.

Effect of continuous positive airway pressure on mitral regurgitant fraction and atrial natriuretic peptide in patients with heart failure.

OBJECTIVES: We sought to determine the effects of continuous positive airway pressure (CPAP) on mitral regurgitant fraction (MRF) and plasma atrial natriuretic peptide (ANP) concentration in patients with congestive heart failure (CHF). BACKGROUND: In patients with CHF, elevated plasma ANP concentration is associated with elevated cardiac filling pressures. Secondary mitral regurgitation may contribute to elevation in plasma ANP concentration in patients with CHF. Because CPAP reduces transmural cardiac pressures and left ventricular (LV) volume, we hypothesized that long-term CPAP application would decrease the MRF and plasma ANP concentration in patients with CHF and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). METHODS: Seventeen patients with CHF and CSR-CSA underwent baseline assessments of plasma ANP concentration and left ventricular ejection fraction (LVEF) and MRF by radionuclide angiography. They were then randomized to receive nocturnal CPAP plus optimal medical therapy (n = 9) or optimal medical therapy alone (n = 8) for 3 months and were then reassessed. RESULTS: In the CPAP-treated group, LVEF increased from (mean +/-SEM) 20.2 +/- 4.2% to 28.2 +/- 5.3% (p < 0.02); MRF decreased from 32.8 +/- 7.7% to 19.4 +/- 5.5% (p < 0.02); and plasma ANP concentration decreased from 140.9 +/- 20.8 to 103.9 +/- 17.0 pg/ml (p < 0.05). The control group experienced no significant changes in LVEF, MRF or plasma ANP concentration. Among all patients, the change in plasma ANP concentration from baseline to 3 months correlated significantly with the change in MRF (r = 0.789, p < 0.0002). CONCLUSIONS: In patients with CHF, CPAP-induced reductions in MRF and plasma ANP concentration in association with improvements in LVEF indicate improved cardiac mechanics. Our findings also suggest that reductions in plasma ANP concentration were at least partly due to reductions in MRF.

Continuous positive airway pressure increases heart rate variability in congestive heart failure.

OBJECTIVES: Our objective was to determine whether continuous positive airway pressure augments the low heart rate variability of congestive heart failure, a marker of poor prognosis. BACKGROUND: Nasal continuous positive airway pressure improves ventricular function in selected patients with heart failure. METHODS: In 21 sessions in 16 men (mean [+/- SE] age 56 +/- 2 years) with New York Heart Association functional class II to IV heart failure, we assessed the effects of 45 min with (n = 14) and without (as a time control, n = 7) nasal continuous positive airway pressure (10 cm of water) on heart rate variability and end-expiratory lung volume. Coarse-graining spectral analysis was used to derive total spectral power (PT), its nonharmonic component (fractal power [PF]) and the low (0.0 to 0.15 Hz [PL]) and high (0.15 to 0.50 Hz [PH]) frequency components of harmonic power. Standard deviation of the RR interval, high frequency power and the PH/PT ratio were used to estimate parasympathetic activity in the time and frequency domains, and the PL/PH ratio was used to estimate cardiac sympathetic activity in the frequency domain. RESULTS: Use of continuous positive airway pressure increased end-expiratory lung volume by 445 +/- 82 ml (p < 0.01) and both time (p < 0.006) and frequency domain indexes of heart rate variability: Total spectral power (p < 0.01), nonharmonic power (p < 0.023) and low (p < 0.04) and high (p < 0.05) frequency components of harmonic power all increased. Time alone had no effect on these variables. By comparison, the PH/PT ratio increased during nasal continuous positive airway pressure (p < 0.004), whereas the PL/PH ratio was unchanged. Breathing rate remained constant in both groups. CONCLUSIONS: Short-term application of nasal continuous positive airway pressure increases heart rate variability and time and frequency domain indexes of parasympathetic activity without influencing cardiac sympathetic activity. This increase may occur reflexively, through stimulation of pulmonary mechanoreceptor afferents.

Pathogenesis of obstructive sleep apnoea in hypertensive patients: role of fluid retention and nocturnal rostral fluid shift.

Obstructive sleep apnoea (OSA) is highly prevalent in hypertensive patients, particularly those with drug resistance. Evidence from animal experiments, epidemiologic studies and clinical trials strongly suggest a causal link. Mechanistic studies argue for increased sympathetic neural activity and endothelial dysfunction. However, disturbances in fluid volume regulation and distribution may also be involved in the pathogenesis of these two conditions. Several studies have shown a high prevalence of OSA in fluid-retaining states including hypertension, a direct relationship between the severity of OSA and the volume of fluid displaced from the legs to the neck during sleep, and a decrease in upper airway cross-sectional area in response to graded lower body positive pressure. Treatments targeting fluid retention and redistribution, including diuretics, mineralocorticoid antagonists, exercise, and possibly renal denervation lower blood pressure and reduce the apnoea-hypopnoea index, a measure of OSA severity. From these observations, it has been postulated that during the daytime, excess fluid collects in the lower extremities due to gravity, and on lying down overnight is redistributed rostrally to the neck, where it may narrow the upper airway and increase its collapsibility, predisposing to OSA when pharyngeal dilator muscle activity decreases during sleep. This article discusses the associations between OSA and hypertension and reviews the evidence for fluid accumulation and its nocturnal rostral redistribution in the pathogenesis of OSA in hypertensive patients.

High prevalence of unrecognized sleep apnoea in drug-resistant hypertension.

OBJECTIVES: To determine the prevalence of obstructive sleep apnoea (OSA) in adult patients with drug-resistant hypertension, a common problem in a tertiary care facility. DESIGN: Cross-sectional study. SETTING: University hypertension clinic. PATIENTS AND METHODS: Adults with drug-resistant hypertension, defined as a clinic blood pressure of > or = 140/90 mmHg, while taking a sensible combination of three or more antihypertensive drugs, titrated to maximally recommended doses. Each of the 41 participants completed an overnight polysomnographic study and all but two had a 24 h ambulatory blood pressure measurement. RESULTS: Prevalence of OSA, defined as an apnoea-hypopnoea index of > or = 10 obstructive events per hour of sleep, was 83% in the 24 men and 17 women studied. Patients were generally late middle-aged (57.2 +/- 1.6 years, mean +/- SE), predominantly white (85%), obese (body mass index, 34.0 +/- 0.9 kg/m2) and taking a mean of 3.6 +/- 0.1 different antihypertensive medications daily. OSA was more prevalent in men than in women (96 versus 65%, P = 0.014) and more severe (mean apnoea-hypopnoea index of 32.2 +/- 4.5 versus 14.0 +/- 3.1 events/h, P = 0.004). There was no gender difference in body mass index or age. Women with OSA were significantly older and had a higher systolic blood pressure, lower diastolic blood pressure, wider pulse pressure and slower heart rate than women without OSA. CONCLUSIONS: The extraordinarily high prevalence of OSA in these patients supports its potential role in the pathogenesis of drug-resistant hypertension, and justifies the undertaking of a randomized controlled trial to corroborate this hypothesis.

Hemodynamic and sympathoinhibitory effects of nasal CPAP in congestive heart failure.

Despite advances in medical therapy of congestive heart failure (CHF), morbidity and mortality for this disorder remain high. One factor that could contribute to the poor prognosis of CHF is Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). This breathing disorder is a frequent complication of CHF, where it is associated with increased mortality. One reason for this higher mortality may be that apnea-related hypoxia and arousals from sleep can increase sympathetic nervous system activity (SNA), as manifested by increases in overnight urinary and daytime plasma norepinephrine concentrations ([UNE] and [PNE], respectively). Recently published randomized trials have demonstrated that nasal continuous positive airway pressure (CPAP), if applied nightly at high enough levels over periods of at least 1-3 months, can alleviate CSR-CSA in patients with CHF in association with hemodynamic improvement, as evidenced by increased left ventricular ejection fraction (LVEF) and inhibition of SNA, as manifest by reductions in [UNE] and [PNE]. These findings indicate a role for CPAP as a non-pharmacologic adjunctive therapy for CHF complicated by CSR-CSA. Longer-term trials of CPAP are needed to determine whether this intervention can provide long-lasting clinical benefit to patients with CHF and CSR-CSA.

The role of continuous positive airway pressure in the treatment of congestive heart failure.

Congestive heart failure (CHF) is a serious medical condition frequently associated with sleep-related breathing disorders, which remain underdiagnosed and undertreated. Recent studies have provided important insight into the pathophysiology of sleep apnea syndrome in patients with CHF, with potential therapeutic implications. In addition to abolition of sleep apnea, continuous positive airway pressure (CPAP) treatment can improve cardiac function and relieve symptoms of CHF. Postulated mechanisms include beneficial hemodynamic effects on ventricular remodeling, unloading of fatigued respiratory muscles, and neurohormonal modulation. Although medium-term studies using CPAP to treat sleep-related breathing disorders associated with CHF have been encouraging, more definitive data from ongoing large clinical trials are necessary to clarify its therapeutic role.

Daytime hypercapnia in the development of nocturnal hypoxemia in COPD.

Arterial oxyhemoglobin saturation (SaO2) falls to a variable extent during sleep in patients with COPD. These nocturnal falls in SaO2 may contribute to the development of pulmonary hypertension, nocturnal cardiac arrhythmias, and death during sleep. In order to determine which physiologic factors measured during wakefulness might contribute to the development of nocturnal hypoxemia, we performed multiple stepwise linear regression analyses in 48 patients with stable COPD with mean and lowest nocturnal SaO2 as dependent variables. It was concluded that the two chief variables, measured while awake, which are associated with alterations in nocturnal oxygenation in patients with COPD are baseline awake SaO2 and PaCO2. Hypercapnia appears to be a risk factor for the development of nocturnal hypoxemia in patients who are normoxic while awake.

Negative pressure ventilation. Effects on ventilation during sleep in normal subjects.

Negative pressure ventilation (NPV) is used for ventilatory support of patients with respiratory failure due to neuromuscular disorders and thoracic deformities, and to provide ventilatory muscle rest for patients with severe chronic airflow limitation. To determine whether NPV would result in episodes of upper airway obstruction during sleep, we studied five normal subjects on two consecutive nights with the first night serving as a control and NPV being administered on the second night. Ventilators were adjusted so as to reduce the peak phasic diaphragm electromyogram signal by at least 50 percent. All subjects demonstrated an increase in the total number of apneas + hypopneas per hour on NPV control nights. Although differences were not significant, there was a tendency to develop decreased sleep efficiency, sleep fragmentation and altered sleep architecture with NPV. We conclude that nocturnal NPV can induce sleep apneas and impair sleep quality in normal subjects.

Hemodynamic effects of simulated obstructive apneas in humans with and without heart failure.

STUDY OBJECTIVES: To determine whether generation of negative intrathoracic pressure during apnea would cause more pronounced and sustained reductions in cardiac output in patients with congestive heart failure (CHF) than in healthy subjects. DESIGN: Physiologic intervention study. SETTING: Cardiorespiratory physiology laboratory. PARTICIPANTS: Nine patients with CHF and nine healthy control subjects matched for age and sex. INTERVENTIONS: Patients with CHF and healthy subjects generated - 30 cm H(2)O of intrathoracic pressure during 15-s Mueller maneuvers (MMs) to simulate the acute hemodynamic effects and aftereffects of obstructive apneas. RESULTS: In both groups, MMs caused an immediate rise in left ventricular transmural pressure during systole (LVPtmsys) [p < 0.05], but in CHF patients, this immediate increase was followed by a significant drop in LVPtmsys (p < 0.05), associated with significantly greater reductions in systolic BP and cardiac index than in healthy subjects (- 25 +/- 3 mm Hg vs - 11 +/- 2 mm Hg [p < 0.05] and - 0.53 +/- 0.11 L/min/m(2) vs - 0.15 +/- 0.11 L/min/m(2) [p < 0.05], respectively). Healthy subjects recovered promptly, but in CHF patients, these adverse hemodynamic effects were sustained following release of the MM. CONCLUSIONS: CHF patients experience more pronounced and sustained reductions in BP and cardiac output both during and following the MM than do healthy subjects. These findings suggest the potential for adverse hemodynamic effects and aftereffects of negative intrathoracic pressure generation during obstructive sleep apnea in patients with CHF.

Influence of body position on diaphragmatic and scalene activation during hypoxic rebreathing.

We measured electromyographic activity of the diaphragm (EMGdi) and scalene (EMGsc) during isocapnic progressive hypoxic ventilatory responses in five normal males in the supine and upright seated positions. The slope of the regression line relating EMGdi expressed as a percentage of maximum to percent fall in arterial oxyhemoglobin saturation was 93% steeper upright than supine (P < 0.005), whereas the slope of EMGdi activity to minute volume of ventilation was 73% higher upright than supine (P < 0.05). In addition, the slope of EMGsc activity relative to percent fall in arterial oxyhemoglobin saturation and minute ventilation was greater upright than supine (151%, P < 0.001 and 61%, P = 0.056, respectively). Greater EMGsc activity upright than supine was similar to findings during hypercapnic rebreathing. However, the greater EMGdi activity upright than supine stands in contrast to hypercapnic rebreathing where it was previously shown that EMGdi activity was not affected by a change in body position. We conclude that during hypoxic ventilatory responses both EMGdi and EMGsc activities are more pronounced upright than supine. Diaphragmatic activation during progressive hypoxia in response to a change in body position is different from that seen during progressive hypercapnia.

Glottic and cervical tracheal narrowing in patients with obstructive sleep apnea.

There are several studies showing that patients with idiopathic obstructive sleep apnea (OSA) have a narrow and collapsible pharynx that may predispose them to repeated upper airway occlusions during sleep. We hypothesized that this structural abnormality may also extend to the glottic and tracheal region. Consequently, we measured pharyngeal (Aph), glottic (Agl), cervical tracheal (Atr1), midtracheal (Atr2), and distal (Atr3) tracheal areas during tidal breathing in 66 patients with OSA (16 nonobese and 50 obese) and 8 nonapneic controls. We found that Aph, Agl, and Atr1, but not Atr2 or Atr3, were significantly smaller in the OSA group than in the control group. Obese patients with OSA had the smallest upper airway area, although the nonapneic controls had the largest areas. Multiple linear regression analysis revealed that the pharyngeal area, cervical tracheal area, and body mass index were all independent determinants of the apnea-hypopnea index, accounting for 31% of the variability in apnea-hypopnea index. Aph, Agl, and Atr showed significant correlation with the body mass index. We conclude that sleep-disordered breathing is associated with diffuse upper airway narrowing and that obesity contributes to this narrowing. Furthermore, we speculate that a common pathophysiological mechanism may be responsible for this reduction in upper airway area extending from the pharynx to the proximal trachea.