Nocturnal positive pressure ventilation improves relationship satisfaction of patients with OSA and their partners.

OBJECTIVE: Continuous positive airway pressure (CPAP) ventilation is considered the therapeutic standard for obstructed sleep apnea (OSA). Therapy success may also be affected by the patient's bed partner. A questionnaire was developed and tested that measures the attitude of the bed partner towards CPAP therapy and relationship effects. METHODS: A new questionnaire to capture bed partners' attitude towards CPAP mask therapy was used with an anonymous sample of 508 bed partners. Possible constructs underlying the attitude of the bed partner towards mask appearance have been investigated by means of a Principal Components Analysis. RESULTS: The survey revealed bed partners' positive attitude towards their partner's CPAP therapy (over 90% of bed partners were happy with the therapy, over 75% would recommend the therapy). Importantly, the bed partners' satisfaction with the relationship increased significantly during CPAP therapy (before therapy: 49% were satisfied, after therapy initiation: 70%; p<.001). There was a strong correlation between support for CPAP therapy and improved sleep quality of bed partners (r = 0.352, p>.001). Furthermore, the validation of the questionnaire through principal components analysis revealed three major factors: Attitude (of the bed partner towards CPAP therapy), Looks (of the mask perceived by the bed partner), Intimacy (effect of CPAP therapy on relationship and intimacy). CONCLUSION: Both, the OSA patient and the bed partner benefit from CPAP therapy. This is the first bed partner questionnaire - interviewing the bed partner alone and anonymously - that showed that CPAP therapy also positively influences the relationship. We recommend that the bed partner be involved in the CPAP treatment from the start of therapy.

Comparative study of the SleepImage ring device and polysomnography for diagnosing obstructive sleep apnea.

Purpose We aim to evaluate the diagnostic performance of the SleepImage Ring device in identifying obstructive sleep apnea (OSA) across different severity in comparison to standard polysomnography (PSG). Methods Thirty-nine patients (mean age, 56.8 ± 15.0 years; 29 [74.3%] males) were measured with the SleepImage Ring and PSG study simultaneously in order to evaluate the diagnostic performance of the SleepImage device for diagnosing OSA. Variables such as sensitivity, specificity, positive and negative likelihood ratio, positive and negative predictive value, and accuracy were calculated with PSG-AHI thresholds of 5, 15, and 30 events/h. Receiver operating characteristic curves were also built according to the above PSG-AHI thresholds. In addition, we analyzed the correlation and agreement between the apnea-hypopnea index (AHI) obtained from the two measurement devices. Results There was a strong correlation (r = 0.89, P < 0.001 and high agreement in AHI between the SleepImage Ring and standard PSG. Also, the SleepImage Ring showed reliable diagnostic capability, with areas under the receiver operating characteristic curve of 1.00 (95% CI, 0.91, 1.00), 0.90 (95% CI, 0.77, 0.97), and 0.98 (95% CI, 0.88, 1.000) for corresponding PSG-AHI of 5, 15 and 30 events/h, respectively. Conclusion The SleepImage Ring could be a clinically reliable and cheaper alternative to the gold standard PSG when aiming to diagnose OSA in adults. Supplementary Information: The online version contains supplementary material available at 10.1007/s13534-023-00304-9.

Neural correlates of visual and tactile path integration and their task related modulation.

Self-motion induces sensory signals that allow to determine travel distance (path integration). For veridical path integration, one must distinguish self-generated from externally induced sensory signals. Predictive coding has been suggested to attenuate self-induced sensory responses, while task relevance can reverse the attenuating effect of prediction. But how is self-motion processing affected by prediction and task demands, and do effects generalize across senses? In this fMRI study, we investigated visual and tactile self-motion processing and its modulation by task demands. Visual stimuli simulated forward self-motion across a ground plane. Tactile self-motion stimuli were delivered by airflow across the subjects' forehead. In one task, subjects replicated a previously observed distance (Reproduction/Active; high behavioral demand) of passive self-displacement (Reproduction/Passive). In a second task, subjects travelled a self-chosen distance (Self/Active; low behavioral demand) which was recorded and played back to them (Self/Passive). For both tasks and sensory modalities, Active as compared to Passive trials showed enhancement in early visual areas and suppression in higher order areas of the inferior parietal lobule (IPL). Contrasting high and low demanding active trials yielded supramodal enhancement in the anterior insula. Suppression in the IPL suggests this area to be a comparator of sensory self-motion signals and predictions thereof.

Impact of Gender on Insomnia.

There is a distinct preponderance of female insomniacs when compared to male insomniacs. The aim of this study was to examine possible gender differences in the causes for insomnia, and the phenotypes of insomnia, and to investigate whether gender-specific insomnia diagnosis and treatment could be relevant in clinical practice. Data were collected from 121 insomniac patients by a medical specialist in the framework of normal clinical practice in Germany. The data consist of the patient's medical history and various sleep-related patient questionnaires. Data from both genders were tested for independence using chi-square tests and Mann-Whitney U tests. We found a correlation between the gender of the patient and insomnia phenotypes in several aspects: concomitant lipometabolic disorders, diabetes mellitus, and high BMIs are more common in male insomniacs (p < 0.05). Frequency of insomnia occurrence in certain age groups, insomnia severity, distribution of SOI (sleep onset insomnia), SMI (sleep maintenance insomnia) and combined SOI + SMI, sleep duration, the time needed to seek medical consultation, trying out sleep-inducing drugs/techniques and the trigger, etiology and familial predisposition of the insomniac disorder were independent of the patient's gender. We would like to re-evaluate the results with a larger number of patients in a further study.

Visuo-tactile heading perception.

Self-motion through an environment induces various sensory signals, i.e., visual, vestibular, auditory, or tactile. Numerous studies have investigated the role of visual and vestibular stimulation for the perception of self-motion direction (heading). Here, we investigated the rarely considered interaction of visual and tactile stimuli in heading perception. Participants were presented optic flow simulating forward self-motion across a horizontal ground plane (visual), airflow toward the participants' forehead (tactile), or both. In separate blocks of trials, participants indicated perceived heading from unimodal visual or tactile or bimodal sensory signals. In bimodal trials, presented headings were either spatially congruent or incongruent with a maximum offset between visual and tactile heading of 30°. To investigate the reference frame in which visuo-tactile heading is encoded, we varied head and eye orientation during presentation of the stimuli. Visual and tactile stimuli were designed to achieve comparable precision of heading reports between modalities. Nevertheless, in bimodal trials heading perception was dominated by the visual stimulus. A change of head orientation had no significant effect on perceived heading, whereas, surprisingly, a change in eye orientation affected tactile heading perception. Overall, we conclude that tactile flow is more important to heading perception than previously thought.NEW & NOTEWORTHY We investigated heading perception from visual-only (optic flow), tactile-only (tactile flow), or bimodal self-motion stimuli in different conditions varying in head and eye position. Overall, heading perception was body or world centered and non-Bayes optimal and revealed a centripetal bias. Although being visually dominated, tactile flow revealed a significant influence during bimodal heading perception.

The Interplay Between Poor Sleep and Work-Related Health.

Objectives: Sleep disorders can arise from work. Employees who experience work overload are more likely to develop sleep problems. Poor sleep leads to decreased performance, sick leave, and accidents. Therefore, sleep disorders may be linked to workplace hazards as well as decreased occupational health, however, the relationship remains unknown. Methods: This relationship was examined using secondary data analysis of aggregated survey data from 97 companies based in Germany between 2003 and 2020 as part of Workplace Health Management project. Two extreme groups with respect to sleep problems were analyzed (N = 4,865 + 9,795). The survey "Diagnosis of corporate health" contained 137 individual questions which recorded all relevant working conditions, aspects of health, and one question relating to insomnia traits. A one-way analysis of variance was used to examine whether and to what extent the potentials, hazards, and health aspects differed between employees depending on their perceived sleep problems. In addition, multiple linear regressions were used to determine whether and to what extent work characteristics affect various health aspects for both good and poor sleepers. Results: In total, 49.7% of staff reported moderate difficulty falling and/or remaining asleep. These poor sleepers perceived all health potentials worse than good sleepers, especially on scales such as fair assessment, work climate, and learning at work. Furthermore, poor sleepers perceived health hazards (physical environmental stress, job insecurity, and time pressure) more whilst positive health indicators (joy of work and confidence) were perceived less. Conclusion: Overall, the determination of sleep difficulties could be used as a substantial health indicator. Also, these sleep problems are reported more frequently in certain occupations compared to others, which could mean that the perception of sleep health varies between professions. Therefore, it is important to implement specific recommendations for each industry in order to improve working conditions for poor sleepers which in turn, improves their health.

Influence of Tactile Flow on Visual Heading Perception.

The integration of information from different sensory modalities is crucial for successful navigation through an environment. Among others, self-motion induces distinct optic flow patterns on the retina, vestibular signals and tactile flow, which contribute to determine traveled distance (path integration) or movement direction (heading). While the processing of combined visual-vestibular information is subject to a growing body of literature, the processing of visuo-tactile signals in the context of self-motion has received comparatively little attention. Here, we investigated whether visual heading perception is influenced by behaviorally irrelevant tactile flow. In the visual modality, we simulated an observer's self-motion across a horizontal ground plane (optic flow). Tactile self-motion stimuli were delivered by air flow from head-mounted nozzles (tactile flow). In blocks of trials, we presented only visual or tactile stimuli and subjects had to report their perceived heading. In another block of trials, tactile and visual stimuli were presented simultaneously, with the tactile flow within ±40° of the visual heading (bimodal condition). Here, importantly, participants had to report their perceived visual heading. Perceived self-motion direction in all conditions revealed a centripetal bias, i.e., heading directions were perceived as compressed toward straight ahead. In the bimodal condition, we found a small but systematic influence of task-irrelevant tactile flow on visually perceived headings as function of their directional offset. We conclude that tactile flow is more tightly linked to self-motion perception than previously thought.

Preserved Contextual Cueing in Realistic Scenes in Patients with Age-Related Macular Degeneration.

Foveal vision loss has been shown to reduce efficient visual search guidance due to contextual cueing by incidentally learned contexts. However, previous studies used artificial (T- among L-shape) search paradigms that prevent the memorization of a target in a semantically meaningful scene. Here, we investigated contextual cueing in real-life scenes that allow explicit memory of target locations in semantically rich scenes. In contrast to the contextual cueing deficits in artificial scenes, contextual cueing in patients with age-related macular degeneration (AMD) did not differ from age-matched normal-sighted controls. We discuss this in the context of visuospatial working-memory demands for which both eye movement control in the presence of central vision loss and memory-guided search may compete. Memory-guided search in semantically rich scenes may depend less on visuospatial working memory than search in abstract displays, potentially explaining intact contextual cueing in the former but not the latter. In a practical sense, our findings may indicate that patients with AMD are less deficient than expected after previous lab experiments. This shows the usefulness of realistic stimuli in experimental clinical research.

Tuberculosis transmission in nontraditional settings: a decision-tree approach.

BACKGROUND: Tuberculosis (TB) transmission in nontraditional settings and relationships (non-TSR) often eludes detection by conventional contact investigation and is increasingly common. The U.S.-based National Tuberculosis Genotyping and Surveillance Network collected epidemiologic data and genotyping results of Mycobacterium tuberculosis isolates from 1996 to 2000. METHODS: In 2003-2004, we determined the number and characteristics of TB patients in non-TSR that were involved in recent transmission, generated a decision tree to profile those patients, and performed a case-control study to identify predictors of being in non-TSR. RESULTS: Of 10,844 culture-positive reported TB cases that were genotyped, 4724 (43.6%) M. tuberculosis isolates were clustered with at least one other isolate. Among these, 520 (11%) had epidemiologic linkages discovered during conventional contact investigation or cluster investigation and confirmed by genotyping results. The decision tree identified race/ethnicity (non-Hispanic white or black) as having the greatest predictive ability to determine patients in non-TSR, followed by being aged 15 to 24 years and having positive or unknown HIV infection status. From the 520, 85 (16.4%) had non-TSR, and 435 (83.6%) had traditional settings and relationships (TSR). In multivariate analyses, patients in non-TSR were significantly more likely than those in TSR to be non-Hispanic white (adjusted odds ratio [aOR]=6.1; 95% confidence interval [CI]=1.7-21.1]) or to have an M. tuberculosis isolate resistant to rifampin (aOR=5.2; 95% CI=1.5-17.7). CONCLUSIONS: Decision-tree analyses can be used to enhance both the efficiency and effectiveness of TB prevention and control activities in identifying patients in non-TSR.

Added epidemiologic value to tuberculosis prevention and control of the investigation of clustered genotypes of Mycobacterium tuberculosis isolates.

The Centers for Disease Control and Prevention established the US National Tuberculosis Genotyping and Surveillance Network to study the utility of genotyping Mycobacterium tuberculosis isolates for prevention and control. From 1998 to 2000, four sites performed conventional contact investigations and epidemiologic investigations of cases with genotypically matched M. tuberculosis isolates, called cluster investigations. The authors compared cluster pairs (two cases with M. tuberculosis isolates having identical genotypes) whose epidemiologic linkages were discovered only during cluster investigation with those whose epidemiologic linkages were discovered during conventional contact investigation. Among the 2,141 reported culture-positive tuberculosis cases, 2,055 (96%) M. tuberculosis isolates were genotyped. By itself and at a minimum, cluster investigation added 43 (38%) of the 113 total epidemiologic linkages discovered. Of the epidemiologic linkages discovered during conventional contact investigation, 29% of tuberculosis case pairs were not supported by genotyping data. The linkages discovered only during cluster investigation were more likely discovered in nontraditional settings and relationships and among larger clusters (cluster size of >5: adjusted odds ratio = 57.6, 95% confidence interval: 31.8, 104.6). Information gained from genotyping M. tuberculosis isolates should initiate cluster investigations of tuberculosis cases not previously discovered as being epidemiologically linked during conventional contact investigation. Cluster investigations will play a crucial role in predicting recent tuberculosis transmission more accurately, as we move toward tuberculosis elimination in the United States.