Treatment of obstructive sleep apnea with a simple CPAP device.

PURPOSE: CPAP is the "gold standard" treatment for obstructive sleep apnea (OSA). Current CPAP models have developed additional functions including automatic CPAP and pressure relief. However, CPAP adherence has not improved over the last three decades. Many patients in low-income countries cannot afford these CPAP devices. A novel simple CPAP device with a fixed pressure without pressure controller was developed. METHODS: Manual CPAP pressure titration was performed in 127 patients with OSA. Six patients with a titration pressure higher than 11 cmH2O and 14 patients who could not tolerate CPAP were excluded, leaving 107 participating in the following 2 studies. In study one, 54 of 107 patients were treated by both conventional fixed CPAP and simple CPAP in random order. In the second study, another 53 patients were treated by both autoCPAP in automatic function and simple CPAP in random order. Simple CPAP was fixed at 10 cmH2O, 8 cmH2O, and 6 cmH2O for patients whose titration pressure was between 9-10, 7-8, and ≤ 6 cmH2O, respectively. Conventional fixed CPAP device was set exactly the same as manual titration pressure. RESULTS: All patients whose manual titration pressure ≤ 10 cmH2O were effectively treated by simple CPAP (AHI 40.7 ± 2.3 events/h before vs 2.5 ± 0.3 events/h after, p < 0.001). Patients expressed similar preferences for simple CPAP, autoCPAP, and conventional fixed CPAP (p > 0.05). CONCLUSIONS: We conclude that a novel simple CPAP is an alternative treatment for most patients with OSA, which may widen access to CPAP therapy in the developing countries because of its low cost.

[Neural respiratory drive and nocturnal hypoventilation in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To explore the effects of neural respiratory drive on ventilation in patients with chronic obstructive pulmonary disease (COPD) during sleep. METHODS: Diaphragm electromyogram (EMG) from a multipair esophageal electrodes and airflow derived from pneumotachography were recorded during overnight polysomnography in 13 patients with stable COPD recruited from outpatient clinic of First Affiliated Hospital of Guangzhou Medical College from May 2010 to May 2011. Changes in diaphragm EMG and ventilation during wakefulness and different sleep stages were observed. RESULTS: Diaphragm EMG decreased by 26% in non-rapid eye movement sleep (NREM) stage and 39% in rapid eye movement (REM) as compared with wakefulness. Coinciding with change in diaphragm EMG, ventilation (VE) (ml×min(-1)×kg(-1)) significantly decreased from wakefulness (156 ± 53) ml×min(-1)×kg(-1) to steady NREM stage (112 ± 35) ml×min(-1)×kg(-1) (P < 0.05) and further decreased from NREM stage to REM stage (95 ± 27) ml×min(-1)×kg(-1) (P < 0.05). Oxygen saturation also decreased significantly from 97.1% ± 1.8% in wakefulness to REM stage (94.0% ± 3.9%) (P < 0.01). CONCLUSION: Reduced neural respiratory drive contributes to nocturnal hypoventilation in COPD patients.

[Comparison of manual versus automatic titration in pressure determination for long-term therapy of continuous positive airway pressure in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To compare the continuous positive airway pressure (CPAP) of automatic titration with that of manual titration. METHODS: A total of 58 patients with obstructive sleep apnea and hypopnea syndrome (OSAHS) diagnosed by overnight polysomnography at sleep center of First Affiliated Hospital, Guangzhou Medical University were studied between December 2010 and December 2012. Manual titration was performed under full polysmnography and auto-titration at home for 3-7 nights. RESULTS: There were 52 males and 6 females with an age range of (48 ± 11) years. CPAP pressure titrated by automatic device (10.0 ± 2.2) cm H2O (1 cm H2O = 0.098 kPa) was significantly higher than that titrated manually (7.5 ± 1.5) cm H2O (P = 0.000). Apnea-hyponea index decreased significantly from (54.0 ± 21.0) events/h pre-treatment to (3.8 ± 2.5) events/h post-treatment under manual titration (P < 0.01). CONCLUSIONS: CPAP pressure titrated by automatic device is usually higher than that titrated manually. Manual titration should be performed if a patient can not tolerate the CPAP pressure titrated by an automatic device.

[Prevalence of central sleep apnea in different age groups of children with sleep apnea-hypopnea].

OBJECTIVE: To explore the prevalence of central sleep apnea in different age groups of children with sleep apnea-hypopnea (SAH). METHODS: A total of 431 children with SAH diagnosed by overnight polysomnography at our Sleep Center were retrospectively studied. They were divided into 3 groups based on their ages: toddler group (1 - < 3 years old), preschool group (3 - < 6 years old) and school group (6 - < 13 years old). The relationship between age and different types of apnea-hyponea index (AHI) was analyzed. And the prevalence of central sleep apnea and sleep structure were compared between the groups. RESULTS: A negative correlation existed between age and central sleep apnea index (r = -0.322, P < 0.01). However, there was no correlation between age and obstructive apnea index (P > 0.05). AHI was similar in different age groups, but the medians of central sleep apnea index for toddler, preschool and school groups were 2.35, 1.50 and 0.90 events/h respectively (all P < 0.01). Sleep structure was similar between the groups (P > 0.05). CONCLUSIONS: Central sleep apnea is common in children with sleep disordered breathing. The younger their ages, a higher prevalence of central sleep apnea.

Tai Chi and Pulmonary Rehabilitation Compared for Treatment-Naive Patients With COPD: A Randomized Controlled Trial.

BACKGROUND: In COPD, functional status is improved by pulmonary rehabilitation (PR) but requires specific facilities. Tai Chi, which combines psychological treatment and physical exercise and requires no special equipment, is widely practiced in China and is becoming increasingly popular in the rest of the world. We hypothesized that Tai Chi is equivalent (ie, difference less than ±4 St. George's Respiratory Questionnaire [SGRQ] points) to PR. METHODS: A total of 120 patients (mean FEV1, 1.11 ± 0.42 L; 43.6% predicted) bronchodilator-naive patients were studied. Two weeks after starting indacaterol 150 µg once daily, they randomly received either standard PR thrice weekly or group Tai Chi five times weekly, for 12 weeks. The primary end point was change in SGRQ prior to and following the exercise intervention; measurements were also made 12 weeks after the end of the intervention. RESULTS: The between-group difference for SGRQ at the end of the exercise interventions was -0.48 (95% CI PR vs Tai Chi, -3.6 to 2.6; P = .76), excluding a difference exceeding the minimal clinically important difference. Twelve weeks later, the between-group difference for SGRQ was 4.5 (95% CI, 1.9 to 7.0; P < .001), favoring Tai Chi. Similar trends were observed for 6-min walk distance; no change in FEV1 was observed. CONCLUSIONS: Tai Chi is equivalent to PR for improving SGRQ in COPD. Twelve weeks after exercise cessation, a clinically significant difference in SGRQ emerged favoring Tai Chi. Tai Chi is an appropriate substitute for PR. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02665130; URL: www.clinicaltrials.gov.

Chelant extraction of heavy metals from contaminated soils using new selective EDTA derivatives.

Soil washing is one of the few permanent treatment alternatives for removing metal contaminants. Ethylenediaminetetraacetic acid (EDTA) and its salts can substantially increase heavy metal removal from contaminated soils and have been extensively studied for soil washing. However, EDTA has a poor utilization ratio due to its low selectivity resulting from the competition between soil major cations and trace metal ions for chelation. The present study evaluated the potential for soil washing using EDTA and three of its derivatives: CDTA (trans-1,2-cyclohexanediaminetetraacetic acid), BDTA (benzyldiaminetetraacetic acid), and PDTA (phenyldiaminetetraacetic acid), which contain a cylcohexane ring, a benzyl group, and a phenyl group, respectively. Titration results showed that PDTA had the highest stability constants for Cu(2+) and Ni(2+) and the highest overall selectivity for trace metals over major cations. Equilibrium batch experiments were conducted to evaluate the efficacy of the EDTA derivatives at extracting Cu(2+), Zn(2+), Ni(2+), Pb(2+), Ca(2+), and Fe(3+) from a contaminated soil. At pH 7.0, PDTA extracted 1.5 times more Cu(2+) than did EDTA, but only 75% as much Ca(2+). Although CDTA was a strong chelator of heavy metal ions, its overall selectivity was lower and comparable to that of EDTA. BDTA was the least effective extractant because its stability constants with heavy metals were low. PDTA is potentially a practical washing agent for soils contaminated with trace metals.

Simultaneous extraction of Cr(VI) and Cu(II) from humic acid with new synthesized EDTA derivatives.

Soil washing is one of the few permanent treatment alternatives for removing metal contaminants. Ethylenediaminetetraacetic acid and its salts (EDTA) is very effective at removing cationic metals and has been utilized globally. However it is ineffective for anionic metal contaminants or metals bound to soil organic matter. The simultaneous removal of cationic and anionic metal contaminants by soil washing is difficult due to differences in their properties. The present study evaluated the potential of a washing process using two synthesized EDTA-derivatives, C(6)HEDTA (2,2'-((2-((carboxymethyl)(2-(hexanoyloxy)ethyl)amino)ethyl)azanediyl)diacetic acid) and C(12)HEDTA (2,2'-((2-((carboxymethyl) (2-(dodecanoyloxy)ethyl)amino)ethyl)azanediyl)diacetic acid), which consist of a hydrophilic polycarboxylic moiety and a hydrophobic moiety with a monoalkyl ester group. A series of equilibrium batch experiments at room temperature were conducted to investigate the efficacy of C(6)HEDTA and C(12)HEDTA as extractants for both oxyanion Cr(VI) and cationic Cu(II). Results showed that either C(6)HEDTA or C(12)HEDTA can extract both Cr(VI) and Cu(II) from humic acid simultaneously. However, C(6)HEDTA was less effective for Cr(VI) probably because it has no surface activities to increase solubility of humic acid, like C(12)HEDTA. Extraction of Cr(VI) was mainly attributed to the decreased surface tension and enhanced solubility of organic matter. Extraction of Cu(II) was attributed to both the Cu(II) chelation and enhanced solubility of humic acid. It was demonstrated that the hydrophilic polycarboxylic moiety of C(12)HEDTA chelates cations while the monoalkyl ester group produces surface active properties that enhance the solubility of humic acid.