Pediatric Down Syndrome Upper Airway Stimulation: Patient Selection and Post-Implantation Optimization.

OBJECTIVE: The Food and Drug Administration recently approved upper airway stimulation (UAS) for children with Down Syndrome and persistent obstructive sleep apnea who meet certain inclusion and exclusion criteria. Although there is a robust experience with this therapy in the adult population, established protocols used in adults are not directly transferrable to a complex pediatric population. This review aims to combine the protocols from several institutions for patient selection and postimplantation optimization, including a protocol for Drug-Induced Sleep Endoscopy in children with Down Syndrome, preactivation threshold measurements, device titration, and follow-up sleep studies. STUDY DESIGN: Expert panel development of best Practice algorithm. SETTING: Multi-institutional investigator review. METHODS: An expert panel was assembled of pediatric otolaryngologists with extensive experience in hypoglossal nerve stimulation in children with Down Syndrome. Thirty statements were created during an initial drafting session. A modified Delphi method was used assess consensus among the panel. RESULTS: After 2 rounds of Delphi surveys, 29 statements met criteria for consensus. One statement did not meet consensus. The statements were grouped into several categories to facilitate presentation. CONCLUSIONS: A standardized approach to UAS for children with Down Syndrome must take into account the unique challenges inherent to treating a complex pediatric population with a high rate of sensory processing disorders. This expert panel has met consensus on several statements that will guide clinicians as this novel therapy is adopted.

Minimally Invasive Hypoglossal Nerve Stimulator Enabled by ECG Sensor and WPT to Manage Obstructive Sleep Apnea.

A hypoglossal nerve stimulator (HGNS) is an invasive device that is used to treat obstructive sleep apnea (OSA) through electrical stimulation. The conventional implantable HGNS device consists of a stimuli generator, a breathing sensor, and electrodes connected to the hypoglossal nerve via leads. However, this implant is bulky and causes significant trauma. In this paper, we propose a minimally invasive HGNS based on an electrocardiogram (ECG) sensor and wireless power transfer (WPT), consisting of a wearable breathing monitor and an implantable stimulator. The breathing external monitor utilizes an ECG sensor to identify abnormal breathing patterns associated with OSA with 88.68% accuracy, achieved through the utilization of a convolutional neural network (CNN) algorithm. With a skin thickness of 5 mm and a receiving coil diameter of 9 mm, the power conversion efficiency was measured as 31.8%. The implantable device, on the other hand, is composed of a front-end CMOS power management module (PMM), a binary-phase-shift-keying (BPSK)-based data demodulator, and a bipolar biphasic current stimuli generator. The PMM, with a silicon area of 0.06 mm2 (excluding PADs), demonstrated a power conversion efficiency of 77.5% when operating at a receiving frequency of 2 MHz. Furthermore, it offers three-voltage options (1.2 V, 1.8 V, and 3.1 V). Within the data receiver component, a low-power BPSK demodulator was ingeniously incorporated, consuming only 42 µW when supplied with a voltage of 0.7 V. The performance was achieved through the implementation of the self-biased phase-locked-loop (PLL) technique. The stimuli generator delivers biphasic constant currents, providing a 5 bit programmable range spanning from 0 to 2.4 mA. The functionality of the proposed ECG- and WPT-based HGNS was validated, representing a highly promising solution for the effective management of OSA, all while minimizing the trauma and space requirements.

Obstructive Sleep Apnea in Adults and Ear, Nose, and Throat (ENT) Health: A Narrative Review.

Obstructive sleep apnea (OSA), a form of sleep-disordered breathing, is a significant health concern that leads to substantial morbidity. The collapse or occlusion of the upper airway, which results in reduced or cessation of airflow, is the pathophysiology of sleep apnea. The condition has been attributed to numerous cardiovascular, metabolic, and neuropsychological issues and carries serious health concerns. The ensuing intermittent hypoxia and sleep disruption set off a chain of physiological reactions that aid in developing endothelial dysfunction, systemic inflammation, and oxidative stress. The following line of treatment depends on the appropriate diagnosis of sleep apnea and the underlying cause. The gold standard for diagnosis is polysomnography (PSG), which assesses different physiological parameters during sleep. However, because polysomnography is expensive, patients may use more friendly screening and diagnostic testing kits, like home sleep apnea testing. The clinical symptoms and head and neck history may reveal essential risk factors. The primary objectives of management treatments for sleep apnea are to lessen symptoms, enhance sleep quality, and reduce any health concerns that may be present. It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently. The primary treatment for moderate to severe sleep apnea is continuous positive airway pressure (CPAP) therapy, which includes administering pressurized air to keep the airway open while you sleep. Oral appliances, positional therapy, surgery, and complementary therapies are other treatment choices that can be adapted to each patient's needs and preferences. The goal of the review is to evaluate the morphological and functional aspects of the upper airway, including the nose and throat, that influence the onset and severity of OSA. With a focus on the interaction between otorhinolaryngologists, sleep medicine specialists, and other healthcare professionals, we aim to consider how OSA affects otorhinolaryngology-related medical issues, look at any potential reciprocal relationships, and provide a summary of the interdisciplinary management strategy for OSA. We tried to analyse the various surgical and non-surgical therapy options for OSA management available in the otorhinolaryngology field for improving OSA symptoms and results.

Mechanism underlying joint loading and controlled release of ß-carotene and curcumin by octenylsuccinated Gastrodia elata starch aggregates.

This study aimed to fabricate a novel codelivery system to simultaneously load ß-carotene and curcumin in a controlled and synergistic manner. We hypothesized that the aggregates of octenylsuccinated Gastrodia elata starch (OSGES) could efficiently load and control the release of ß-carotene and curcumin in combination. Mechanisms underlying the self-assembly of OSGES, coloading, and corelease of ß-carotene and curcumin by relevant aggregates were studied. The OSGES could form aggregates with a size of 120.2 nm containing hydrophobic domains surrounded by hydrophilic domains. For coloading, the increased solubilities were attributed to favorable interactions between ß-carotene and curcumin as well as interactions with octenyl and starch moieties via hydrophobic and hydrogen-bond interactions, respectively. The ß-carotene and curcumin molecules occupied the interior and periphery of hydrophobic domains of OSGES aggregates, respectively, and they did not exist in isolation but interacted with each other. The ß-carotene and curcumin combination-loaded OSGES aggregates with a size of 310.5 nm presented a more compact structure than ß-carotene-only and curcumin-only loaded OSGES aggregates with sizes of 463.5 and 202.9 nm respectively, suggesting that a transition from a loose cluster to a compact cluster was accompanied by coloading. During in vitro digestion, the joint effect of ß-carotene and curcumin prolonged their release and increased their bioaccessibility due to competition between favorable hydrophobic and hydrogen-bond interactions and the unfavorable structure erosion and relaxation of the loaded aggregates. Therefore, OSGES aggregates were designed for the codelivery of ß-carotene and curcumin, indicating their potential to be applied in functional foods and dietary supplements.

Relieving psychological stress and improving sleep quality by bergamot essential oil use before bedtime and upon awakening: A randomized crossover trial.

OBJECTIVES: The COVID-19 pandemic increased psychological stress and decreased sleep quality, especially among young people. Aromatherapy alleviates psychological stress, and bergamot essential oil helps improve depression. This study aimed to verify whether bergamot essential oil use alleviates psychological stress due to the COVID-19 pandemic and improves sleep quality and morning wakefulness. DESIGN: A placebo-controlled, randomized, open-label, two-arm, two-period crossover trial. INTERVENTIONS: Each intervention period was 1 week, with a 1-week washout period between the two periods. Participants used a bergamot or placebo spray before bedtime and upon awakening in each period. MAIN OUTCOME MEASURES: The primary outcome measures were sleep quality and morning wakefulness, assessed using the Ogri-Shirakawa-Azumi sleep inventory MA version (OSA-MA). The secondary outcome measures were depression, anxiety, and stress, assessed using the Depression Anxiety Stress Scales-21 (DASS-21). RESULTS: A total of 48 university students participated in the study. A significant improvement was observed in "sleepiness on rising," "refreshing on rising," and "sleep length" in the bergamot group. Additionally, a significant improvement was observed in depression, anxiety, and stress. CONCLUSION: Using bergamot essential oil before bedtime helps relax the mind and body and provides sound sleep. It also improves mood and wakefulness when used upon awakening. Using aromatic essential oils is expected to relieve psychological stress and improve sleep quality and morning wakefulness.

Obstructive Sleep Apnea, Metabolic Dysfunction, and Periodontitis-Machine Learning and Statistical Analyses of the Dental, Oral, Medical Epidemiological (DOME) Big Data Study.

This study aimed to analyze the associations of obstructive sleep apnea (OSA) with dental parameters while controlling for socio-demographics, health-related habits, and each of the diseases comprising metabolic syndrome (MetS), its consequences, and related conditions. We analyzed data from the dental, oral, and medical epidemiological (DOME) cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel for one year. Analysis included statistical and machine learning models. The study included 132,529 subjects; of these, 318 (0.2%) were diagnosed with OSA. The following parameters maintained a statistically significant positive association with OSA in the multivariate binary logistic regression analysis (descending order from highest to lowest OR): obesity (OR = 3.104 (2.178-4.422)), male sex (OR = 2.41 (1.25-4.63)), periodontal disease (OR = 2.01 (1.38-2.91)), smoking (OR = 1.45 (1.05-1.99)), and age (OR = 1.143 (1.119-1.168)). Features importance generated by the XGBoost machine learning algorithm were age, obesity, and male sex (located on places 1-3), which are well-known risk factors of OSA, as well as periodontal disease (fourth place) and delivered dental fillings (fifth place). The Area Under Curve (AUC) of the model was 0.868 and the accuracy was 0.92. Altogether, the findings supported the main hypothesis of the study, which was that OSA is linked to dental morbidity, in particular to periodontitis. The findings highlight the need for dental evaluation as part of the workup of OSA patients and emphasizes the need for dental and general medical authorities to collaborate by exchanging knowledge about dental and systemic morbidities and their associations. The study also highlights the necessity for a comprehensive holistic risk management strategy that takes systemic and dental diseases into account.

Application of Pickering emulsions stabilized by corn, potato and pea starch nanoparticles: Effect of environmental conditions and approach for curcumin release.

To apply octenyl succinic anhydride (OSA)-modified corn, potato and pea starch nanoparticles (OCSNPs, OPtSNPs and OPSNPs, respectively) as Pickering emulsion stabilizers, effect of environmental conditions such as 30 days of storage period, pH of 1-11, ionic strength of 0.1-0.9 mol/L and heat of 30-90 °C on the stability of the emulsions was evaluated. Compared with emulsions stabilized by starch nanoparticles (SNPs), the emulsions stabilized by OSA-modified SNPs (OSNPs) kept stable against different environmental stresses (pH, ionic strength and heat) as well as for a storage period of 30 days, especially for OPtSNPs. Additionally, oiling-off was not observed in OSNPs emulsions over the storage time. OSNPs emulsions also showed improved protection on curcumin during storage and controlled release during in vitro digestion. These findings enlarged the application of OCSNPs, OPtSNPs and OPSNPs stabilized-Pickering emulsion in food systems and deliver system.

Adherence to CPAP Treatment: Can Mindfulness Play a Role?

Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients' adherence, as almost 50% of patients discontinue treatment after a year. Several interventions have been used in order to increase CPAP adherence. Mindfulness-based therapies have been applied in other sleep disorders such as insomnia but little evidence exists for their application on OSA patients. This review aims to focus on the current data on whether mindfulness interventions may be used in order to increase CPAP adherence and improve the sleep quality of OSA patients. Even though controlled trials of mindfulness and CPAP compliance remain to be performed, this review supports the hypothesis that mindfulness may be used as an adjunct method in order to increase CPAP adherence in OSA patients.

Relationship of obstructive sleep apnea with periodontal condition and its local and systemic risk factors.

OBJECTIVE: Obstructive sleep apnea (OSA) and periodontitis share risk factors, such as age, obesity, stress, and cardiovascular events, which have a bidirectional cause-effect relationship through systemic inflammation. Our objective was to determine the relationship between OSA and the periodontal condition and its associated local and systemic risk factors. MATERIAL AND METHODS: This was an observational case-control study involving 60 patients. Local oral risk factors and the systemic condition of each patient were evaluated. All patients underwent polysomnography for the diagnosis of OSA. Chi-squared, one-way ANOVA, and Bonferroni's tests were performed. RESULTS: A higher percentage of patients with periodontitis had severe OSA (66.66%); however, no statistically significant association was found between the two pathologies (p = 0.290). In terms of systemic risk factors, an association was found between arterial hypertension and severe OSA (p = 0.038), and in terms of local factors, an association was found between the use of removable prostheses and severe OSA (p = 0.0273). CONCLUSION: In the general population, patients with periodontitis showed a higher prevalence of severe OSA. Obesity and hypothyroidism were the most prevalent systemic findings in patients with OSA and periodontitis. Arterial hypertension and osteoarthritis were found to be associated with severe OSA. The local risk factors associated with periodontitis and severe OSA were removable partial dentures and misfit resins. CLINICAL RELEVANCE: To study the factors that can facilitate the progression of OSA and periodontitis, physicians and dentists should be advised to provide comprehensive care for patients with both pathologies.

Comparative characterization of sugar beet fibers to sugar beet pectin and octenyl succinic anhydride modified maltodextrin in aqueous solutions using viscometry, conductometry, tensiometry and component analysis.

BACKGROUND: Knowledge about specific functional characteristics, such as viscosimetric, conductometric, tensiometric and structural properties of polysaccharide aqueous solutions is highly important in the successful and adequate application in food emulsion formulation. For the first time detailed characterization of sugar beet fibers aqueous solutions in comparison to high molecular weight (sugar beet pectin) and low molecular weight [octenyl succinic anhydride (OSA) maltodextrin] hydrocolloids/stabilizers was performed through viscometry, conductometry, tensiometry and component analysis. RESULTS: Sugar beet fibers and its water-soluble fraction were investigated. All sugar beet fiber samples showed substantial surface-active properties but different effect on the viscosity values of aqueous solutions. Sugar beet pectin had higher impact on aqueous solutions viscosity values compared to sugar beet fiber samples. Structural bonding between investigated polysaccharides were evaluated through conductometric measurements. Intermolecular linking and probable embedding of OSA maltodextrin molecules into the sugar beet fiber complex structure was detected in conductometric studies. The increased concentration of sugar beet fibers in the presence of sugar beet pectin led to the accelerated increase in specific conductivity values indicating effects of 'macromolecular crowding', intermolecular and intramolecular conformation changes and charge formation. CONCLUSIONS: Detailed characterization of sugar beet fibers provided scientific insight towards fundamental characteristics of sugar beet fiber aqueous solutions. The presented characteristics are particularly applicable in the field of food emulsion stabilization due to the presented surface-active properties of sugar beet fibers as well as specific characteristics of investigated multi-polysaccharide systems. © 2022 Society of Chemical Industry.

Properties of OSA-modified starch and emulsion prepared with different materials: Glutinous rice starch, japonica rice starch, and indica rice starch.

Octenyl succinic acid (OSA)-modified starch was prepared using three kinds of rice starch with different amylose content: glutinous rice starch (GRS, 3.67 g/100 g), japonica rice starch (JRS, 17.61 g/100 g), and indica rice starch (IRS, 27.94 g/100 g). The degree of polymerization of OSA and the starch types was 0.0093, 0.0143, and 0.0159, respectively. In addition, holes and cracks were observed in the starch particles owing to esterification. The OSA modification introduced OS group and affected hydrogen bond, but exerted no effect on the crystal form (A-type). The contact angle and emulsifying index revealed that OSA-JRS exhibited the most promising emulsification effect compared to the other samples. Next, soybean oil was added into the OSA-JRS solution to prepare an oil-water emulsion. The results revealed that compared to natural JRS, OSA-JRS exhibited decreased D4,3 and a more uniform distribution. Additionally, its absolute potential value increased to 21.34 mV. Further, the dynamic interfacial tension and contact angle of the OSA-modified samples decreased, whereas the storage and loss moduli of the emulsion increased. The shear resistance, centrifugal force resistance, and storage stability of the OSA-modified emulsion significantly improved. The results demonstrated the potential of the OSA-modified JRS for preparing stable emulsions.

Interference With Implanted Upper Airway Stimulation Device by Phones With Magnet Technology.

Newer iPhone models with MagSafe magnetic technology can cause electromagnetic interference with the Inspire upper airway stimulator device (a surgical implant for the treatment of obstructive sleep apnea). Laryngoscope, 132:2513-2515, 2022.

Efficiency of oro-facial myofunctional therapy in treating obstructive sleep apnoea: A meta-analysis of observational studies.

OBJECTIVE: The literature on oro-facial myofunctional therapy (OMT) in children and adults with obstructive sleep apnoea (OSA) was systematically reviewed to investigate the effects of OMT on patients with OSA by age and disease severity to verify the effect of OMT on OSA. DATA SOURCES: All the comparative literature was retrieved from the PubMed, Embase and Cochrane libraries. METHOD: We searched the articles published up to 12 February 2022 and followed the preferred reporting project for systematic review and meta-analysis of reports. The quality of the studies was evaluated using the Newcastle-Ottawa scale. RESULTS: Of the primary indicators for evaluating OSA, 13 studies reported on the apnoea index (AHI), showing a decrease in the mean standard deviation of AHI from before OMT to after OMT (p < .00001). The lowest oxygen saturation was reported in nine studies, and the mean standard deviation of the lowest oxygen saturation increased from before to after OMT (p = .0009). Ten studies reported the Epworth Sleepiness Scale (ESS), indicating that the mean standard deviation of the ESS decreased from before to after OMT (p < .00001). The subgroup analysis showed that the AHI scores indicating mild and moderate OSA were significantly reduced, and the AHI scores indicating severe OSA also decreased, but this was not statistically significant. The lowest oxygen saturation increased obviously in patients with both mild and moderate and severe OSA. Of the secondary indicators of OSA, there was a statistically significant improvement in snoring intensity (p = .0002). CONCLUSION: Oral and facial muscular function therapy can be used as a simple and non-invasive new technique to improve the AHI, minimum oxygen saturation, ESS, and snoring intensity in patients with mild and moderate OSA and the lowest oxygen saturation in patients with severe OSA.

Low-frequency ultrasound-assisted esterification of Bixa orellana L. seed starch with octenyl succinic anhydride.

This study aimed to evaluate the impact of the ultrasound intensity (0, 5, 10, and 20 W/cm2) on the esterification of annatto (Bixa orellana L.) seed starch with octenyl succinic anhydride (OSA) employing a short processing time (5 min) to produce a novel emulsifier. OSA-esterified annatto seed starches were examined according to their degree of substitution (DS), amylose content, granule size distribution, microstructure, and X-ray diffractogram. Also, the performance of the OSA-modified annatto seed starch to stabilize colloidal systems was compared to commercial samples of OSA-modified starches. For this, annatto seed oil-in-water emulsions were produced and characterized according to their droplet size distribution, microstructure, and kinetic stability. Increasing ultrasound intensity from 5 W/cm2 to 20 W/cm2, DS values reached up to 0.139 ± 0.031. Likewise, these treatments yielded approximately 1.24-1.36 times more amylose content than the sample without ultrasound application. Most of the starch granules presented smooth surfaces without visible fissures. The higher ultrasound intensity hindered the aggregation of starch granules, thus forming well-defined elliptical particles. On the other hand, the increase of the ultrasound intensity did not change Brouckere mean diameter of the starch granules. No significant qualitative differences were seen in the X-ray diffractograms in terms of diffraction angle and peak intensity, indicating that the main functional characteristics of starches were not altered with ultrasound treatment. Furthermore, modified annatto starch was able to stabilize annatto seed oil-in-water emulsions. When compared to two commercial modified starches, OSA-esterified annatto starch produced a colloidal system with a larger Sauter mean diameter (14 ± 2 µm). However, the emulsion stabilized with modified annatto starch was more kinetically stable during the storage time in comparison to those stabilized with commercial starches.

Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry.

Obstructive sleep apnea (OSA) is a common, identifiable, and treatable disorder with serious health, safety, and financial implications-including sleepiness- related crashes and incidents-in workers who perform safety-sensitive functions in the transportation industry. Up to one-third of crashes of large trucks are attributable to sleepiness, and large truck crashes result in more than 4,000 deaths annually. For each occupant of a truck who is killed, 6 to 7 occupants of other vehicles are killed. Treatment of OSA is cost-effective, lowers crash rates, and improves health and well-being. A large body of scientific evidence and expert consensus supports the identification and treatment of OSA in transportation operators. An Advanced Notice of Proposed Rulemaking regarding the diagnosis and treatment of OSA in commercial truck and rail operators was issued by the Federal Motor Carrier Safety Administration and Federal Railroad Administration, but it was later withdrawn. This reversal of the agencies' position has caused confusion among some, who have questioned whether efforts to identify and treat the disorder are warranted. In response, we urge key stakeholders, including employers, operators, legislators, payers, clinicians, and patients, to engage in a collaborative, patient-centered approach to address the disorder. At a minimum, stakeholders should follow the guidelines issued by a medical review board commissioned by the Federal Motor Carrier Safety Administration in 2016 alone, or in combination with the 2006 criteria, "Sleep Apnea and Commercial Motor Vehicle Operators," a Statement from the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation developed by a joint task force. As research in this area continues to evolve, waiting is no longer an option, and the current standard of care demands action to mitigate the burden of serious health and safety risks due to this common, treatable disorder. CITATION: Das AM, Chang JL, Berneking M, Hartenbaum NP, Rosekind M, Gurubhagavatula I. Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry. J Clin Sleep Med. 2022;18(10):2471-2479.

Obstruction level associated with outcome in hypoglossal nerve stimulation.

PURPOSE: Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome. METHODS: Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated. RESULTS: The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012). CONCLUSIONS: Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.

Selenium-Functionalized Corn Starch as a Biodegradable GPx Mimic with High Catalytic Performance.

Selenium-functionalized starch (Se-starch80) is one of the main functional foods used for selenium supplementation. In traditional agriculture, Se-starch has some deficiencies such as long growth cycle and unstable selenium content that prevent its antioxidant performance. In this study, Se-starch was prepared by the nucleophilic addition between NaSeH and carbon-carbon double bond of octenyl succinic anhydride waxy corn starch ester (OSA starch). Some techniques such as 1HNMR, XPS, SEM-EDS, XRD and FT-IR were used to characterize the relevant samples and the results showed that the modification did not destroy the starch framework significantly and the catalytic center (negative divalent selenium) was anchored on the starch framework. The intensive distribution of catalytic center on the starch surface and the hydrophobic microenvironments derived from the OSA chains furnished the Se-starch80 with a high GPx-like catalytic activity (initial reaction rate = 3.64 µM/min). This value was about 1.5 × 105 times higher than that of a typical small-molecule GPx mimic (PhSeSePh). In addition, the Se-starch80, without any cytotoxicity, showed a saturated kinetic catalytic behavior that is similar to a typical enzyme. This work exemplifies a biodegradable selenium-functionalized polymer platform for the high-performing GPx mimic.

Octenyl succinic anhydride modification alters blending effects of waxy potato and waxy rice starches.

This study compared blending effects of native and octenyl succinic anhydride (OSA) modified blends (waxy rice and waxy potato starch). OSA groups were observed to be present primarily in the outer layer of waxy potato starch granule, but throughout the whole waxy rice granule. A high linear correlation with blending ratio was observed for trough viscosity and final viscosity of native blends, but for peak viscosity (PV) and breakdown viscosity (BD) of esterified blends. PV and BD of esterified blends showed weaker non-additive effects than those of native blends. Consistency coefficient in downward curve, flow behavior index in downward curve, and loss tangent mainly showed non-additive effects in native blends, but additive effects in esterified blends. OSA modification affects interaction between molecules on the outer surfaces of two starch granules by altering molecular structures on the outer surfaces, resulting in different blending effects between native and esterified waxy starch blends.

Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions, and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum.

Hypoglossal nerve stimulation (HGNS) has evolved as a novel and effective therapy for patients with moderate-to-severe obstructive sleep apnea. Despite positive published outcomes of HGNS, there exist uncertainties regarding proper patient selection, surgical technique, and the reporting of outcomes and individual factors that impact therapy effectiveness. According to current guidelines, this therapy is indicated for select patients, and recommendations are based on the Stimulation Therapy for Apnea Reduction or STAR trial. Ongoing research and physician experiences continuously improve methods to optimize the therapy. An understanding of the way in which airway anatomy, obstructive sleep apnea phenotypes, individual health status, psychological conditions, and comorbid sleep disorders influence the effectiveness of HGNS is essential to improve outcomes and expand therapy indications. This article presents discussions on current evidence, future directions, and research gaps for HGNS therapy from the 10th International Surgical Sleep Society expert research panel. CITATION: Suurna MV, Jacobowitz O, Chang J, et al. Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum. J Clin Sleep Med. 2021;17(12):2477-2487.

Hypoglossal Nerve Stimulator: A Novel Treatment Approach for OSA - Overview of Treatment, Including Diagnostic and Patient Criteria and Procedural Terminology Codes.

Unilateral stimulation of the hypoglossal nerve may result in clinically valuable patency of the upper airway in well-selected patients for treatment of OSA. The Food and Drug Administration has established stringent criteria for the placement of this medical device. The treatment is a consideration among patients who have been nonadherent or intolerant of positive airway pressure therapy, with moderate to severe OSA, and a BMI of ≤ 32 kg/m2. Some of the insurance providers have lowered BMI guidelines to allow implantation in patients with a BMI of < 35 kg/m2. Further, a clinical assessment with sleep endoscopy is available to define proper anatomic features and to determine, based on the results, if the patients are appropriate surgical candidates. Current Procedural Terminology codes that are specific to the placement as well as removal or replacement of the device, or both, are discussed, as well as sleep medicine-related evaluation and management.