Adaptive servo-ventilation in patients with chronic heart failure and sleep disordered breathing: predictors of usage.

PURPOSE: Adaptive servo-ventilation (ASV) is a therapy designed for patients with central sleep apnea (CSA) and Cheyne Stokes respiration. The aim of this study was to find predictors of ASV usage in patients with CSA in a routine sleep clinic cohort. METHODS: In this retrospective study, consecutive patients in whom ASV therapy was initiated at the University Hospital Regensburg between 2011 and 2015, were analyzed. Analysis included polysomnographies of diagnostic and ASV initiation nights, a phone questionnaire on ASV usage, readout of the ASV device 1 month after initiation ("early ASV usage," 1 month after ASV initiation), and the readout of the last month before a reappointment date set in 2015 ("late ASV usage," median 17 months after ASV initiation). RESULTS: In 69 consecutive patients, the mean early and late ASV usage per night was 4.8 ± 2.5 h and 4.1 ± 3.0 h, respectively. Seventeen months after initiation, 57% of patients used the device ≥ 4 h per night, and of those 91% reported a subjective benefit from ASV therapy. Early ASV usage was significantly associated with late ASV usage (univariable regression: Beta 0.8, 95%CI [0.6; 1.0] p < 0.001). In multivariable regression analysis, short duration of slow wave sleep (N3) during diagnostic polysomnography (Beta - 6.2, 95%CI [- 11.0; - 1.5]; p = 0.011) and subjective benefit from ASV (Beta 174.0, 95%CI [68.6; 279.5]; p = 0.002) were significantly associated with longer late ASV usage. CONCLUSION: Early ASV usage predicts late ASV usage. In addition, low slow wave sleep before ASV initiation and subjective benefit from ASV may contribute to higher late ASV usage.

The potential of volunteered geographic information to investigate peri-urbanization in the conservation zone of Mexico City.

Due to the availability of Web 2.0 technologies, volunteered geographic information (VGI) is on the rise. This new type of data is available on many topics and on different scales. Thus, it has become interesting for research. This article deals with the collective potential of VGI and remote sensing to detect peri-urbanization in the conservation zone of Mexico City. On the one hand, remote sensing identifies horizontal urban expansion, and on the other hand, VGI of ecological complaints provides data about informal settlements. This enables the combination of top-down approaches (remote sensing) and bottom-up approaches (ecological complaints). Within the analysis, we identify areas of high urbanization as well as complaint densities and bring them together in a multi-scale analysis using Geographic Information Systems (GIS). Furthermore, we investigate the influence of settlement patterns and main roads on the peri-urbanization process in Mexico City using OpenStreetMap. Peri-urbanization is detected especially in the transition zone between the urban and rural (conservation) area and near main roads as well as settlements.

Adaptive servo-ventilation and sleep quality in treatment emergent central sleep apnea and central sleep apnea in patients with heart disease and preserved ejection fraction.

BACKGROUND: Reduced sleep quality is associated with impaired quality of life and increased mortality in patients with heart failure. The aim of this study was to observe changes in sleep fragmentation and sleep quality in patients with heart disease and preserved left ventricular ejection fraction (pEF) treated with adaptive servo-ventilation (ASV) therapy for treatment of emergent central sleep apnea (TECSA) or central sleep apnea (CSA). METHODS: 114 patients with structural heart disease and pEF introduced to ASV therapy between 2010 and 2015 were retrospectively analyzed. Patients were stratified into two groups; TECSA (n = 60) or CSA (n = 54). Changes of sleep fragmentation and sleep quality from baseline to ASV initiation were compared. RESULTS: ASV therapy leads to a significant reduction of apnea-hypopnea index (AHI) and arousal index in patients with TECSA and CSA (∆AHI: - 43 ± 21 vs. - 47 ± 22/h; ∆arousal index - 11 ± 15, vs. - 11 ± 21/h). ASV treatment leads to a significant increase in sleep efficiency in TECSA compared to CSA (∆SE: 10 ± 19 vs. 1 ± 18%, p = 0.019). Both groups had significantly longer stage N3 (N3) and rapid eye movement sleep (REM) on ASV (∆N3: 8 ± 11 vs. 9 ± 13%; ∆REM 7 ± 9 vs. 3 ± 8%; p < 0.05 for all comparisons baseline vs. ASV). CONCLUSIONS: In patients with heart disease and pEF, whose TECSA and CSA were treated with ASV, a significant reduction of AHI and arousal index as well as an increase of N3 and REM sleep was observed. Increase of sleep efficiency was significantly greater in TECSA compared to CSA. Hence, improvements of sleep quality were modestly greater in patients with TECSA compared to those with CSA.

Human and remote sensing data to investigate the frontiers of urbanization in the south of Mexico City.

The data presented here were originally collected for the article "Frontiers of Urbanization: Identifying and Explaining Urbanization Hot Spots in the South of Mexico City Using Human and Remote Sensing" (Rodriguez et al. 2017) [4]. They were divided into three databases (remote sensing, human sensing, and census information), using a multi-method approach with the goal of analyzing the impact of urbanization on protected areas in southern Mexico City. The remote sensing database was prepared as a result of a semi-automatic classification, dividing the land cover data into urban and non-urban classes. The second data set details an alternative view of the phenomena of urbanization by concentrating on illegal settlements in the conservation zone. It was based on voluntary complaints about environmental and land use offences filed at the Procuraduria Ambiental y del Ordenamiento Territorial del Distrito Federal (PAOT), which is a governmental entity responsible for reviewing and processing grievances on five basic topics: illegal land use, deterioration of green areas, waste, noise/vibrations, and animals. Anyone can file a PAOT complaint by phone, electronically, or in person. The complaint ends with a resolution, act of conciliation, or recommendation for action by other actors, such as the police or health office. The third data about unemployment was extracted from Mexico׳s National Census 2010 database available via public access.