Economic viability of irrigated cultivation of table cassava cultivars under phosphate fertilization / Viabilidade econômica do cultivo irrigado de cultivares de mandioca de mesa sob fertilização fosfatada

Phosphate fertilization of cassava cultivars leads to increased production costs that may be economically viable depending on the quantity used and the corresponding productivity. In this sense, the objective of the work was to analyse the economic viability of the irrigated cultivation of table cassava cultivars in response to the application of phosphorus doses in the Brazilian semiarid region. Two agricultural crops were conductedat the Experimental Farm Rafael Fernandes, Mossoró, RN, from June 2018 to April 2019 and from June 2019 to April 2020. The experimental design was in randomized blocks arranged in subdivided plots, with four replications. The doses of phosphorus (0, 60, 120, 180, and 240 kg ha-1of P2O5) were applied to the plots and the table cassava cultivars (Água Morna, BRS Gema de Ovo, Recife and Venâncio) arranged in the subplots. The total costs for one hectare of cultivation were estimated and the gross income, netincome, rate of return, and profitability index were calculated. The use of phosphatefertilizer was economically viable for the cassava cultivars studied in the two crops. The cultivars Água Morna, BRS Gema de Ovo, and Recife are the best cultivation options for the semiarid region of Rio Grande do Norteas they give high yields with the highest profitability. The Recife cultivar was the region's most profitable cultivation, with a profit ranging from R$ 40,331.07 ha-1to R$ 57,603.46 ha-1in both seasons,with an average recommendation of 120 kg ha-1of P2O5.(AU)

A adubação fosfatada de cultivares de mandioca leva ao aumento dos custos de produção que podem ser economicamente viáveis dependendo da quantidade utilizada e da respectiva produtividade. Nesse sentido, o objetivo dotrabalho foi analisar a viabilidade econômica do cultivo irrigado de cultivares de mandioca de mesa em resposta à aplicação de doses de fósforono semiárido brasileiro. Foram conduzidos duas safras agrícolas na Fazenda Experimental Rafael Fernandes, Mossoró, RN, nos meses de junho de 2018 a abril de 2019 e junho de 2019 a abril de 2020. O delineamento experimental foi em blocos casualizados dispostos em parcelas subdivididas, com quatro repetições. As doses de fósforo (0, 60, 120,180 e 240 kg ha-1de P2O5) foram aplicadas nas parcelas e as cultivares de mandioca de mesa (Água Morna, BRS Gema de Ovo, Recife e Venâncio) dispostas nas subparcelas. Estimaram-se os custos totais de um hectare de cultivo e calcularam-se a receita bruta,a receita líquida, a taxade retorno e o índice de lucratividade. O uso da adubação fosfatada mostrou-se economicamente viável para as cultivares de mandioca estudadas nas duas safras. As cultivares Água Morna, BRS Gema de Ovo e Recife são as melhores opções de cultivo para o semiárido do Rio Grande do Norte, pois apresentam altas produtividades com maior rentabilidade. A cultivar Recife foi o cultivo mais rentável da região, com rendimento variando de R$ 40.331,07 ha-1a R$ 57.603,46 ha-1nas duas safras,com recomendação média de120 kg ha-1de P2O5.(AU)

Screening for obstructive sleep apnea: comparing the American Academy of Sleep Medicine proposed criteria with the STOP-Bang, NoSAS, and GOAL instruments.

STUDY OBJECTIVES: We evaluated the performance of the 2017 American Academy of Sleep Medicine criteria (AASM2017) in screening obstructive sleep apnea (OSA) and compared them with 3 other validated instruments: NoSAS score, STOP-Bang, and GOAL questionnaires. METHODS: From July 2019 to December 2021, 4,499 adults undergoing overnight polysomnography were included. The AASM2017 instrument considers an increased high risk for moderate-to-severe OSA in the presence of excessive daytime sleepiness and at least 2 of the following 3 criteria: loud snoring; observed apnea, gasping, or choking; and hypertension. OSA severity was based on polysomnography-derived apnea-hypopnea index cutoffs: 5.0 events/h, 15.0 events/h, and 30.0 events/h. Predictive performance was evaluated by the area under the curve and contingency tables. RESULTS: When screening for any OSA severity, AASM2017 displayed a sensitivity of 31.0-40.6% and a specificity of 80.8-89.6%. For all apnea-hypopnea index thresholds, AASM2017, unlike the GOAL, STOP-Bang, and NoSAS, exhibited superior specificity but markedly lower sensitivity. GOAL, STOP-Bang, and NoSAS, but not AASM2017 criteria, emerged as an adequate screening tool for any OSA severity (all areas under the curve > 0.7) and performed significantly better than AASM2017 in predicting any OSA severity (all P < .001). For all severity OSA levels, GOAL, STOP-Bang, and NoSAS displayed similar performance when compared to each other (all P > .05). CONCLUSIONS: GOAL, STOP-Bang, and NoSAS instruments, but not AASM2017 criteria, emerge as useful OSA screening tools in a large referral single-center clinical cohort. CITATION: Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Screening for obstructive sleep apnea: comparing the American Academy of Sleep Medicine proposed criteria with the STOP-Bang, NoSAS, and GOAL instruments. J Clin Sleep Med. 2023;19(7):1239-1246.

Clinical and polysomnographic predictors of suboptimal auto-adjusting CPAP titration in adult OSA patients: a single-center study.

PURPOSE: To examine potential clinical, demographic, anthropometric, and polysomnographic predictors of successful auto-adjusting continuous positive airway pressure (CPAP) titration for treatment of obstructive sleep apnea (OSA). METHODS: This cross-sectional study was conducted in adults diagnosed with moderate-to-severe OSA (baseline apnea-hypopnea index [AHI] ≥ 15.0/h), who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed®) in a sleep laboratory setting while wearing a nasal or pillow mask. Participants were then grouped into two groups: optimal CPAP titration (residual AHI < 5.0/h) or suboptimal CPAP titration (residual AHI ≥ 5.0/h). Multivariate logistic regression analysis was used to assess possible independent predictive factors for suboptimal CPAP titration. RESULTS: A total of 1222 adults consisting of 874 subjects with optimal CPAP titration (71.5%) and 348 subjects with suboptimal CPAP titration (28.5%) were evaluated. Multivariate analysis resulted in a model with an adequate calibration (Hosmer-Lemeshow chi-square-test: 7.088; p = 0.527), with male sex, higher values of baseline AHI, therapeutic pressure (95th percentile), and mask leak (95th percentile) emerging as significant and independent predictors for suboptimal CPAP titration: adjusted odds ratio (OR): 1.456 (95% confidence interval [CI] 1.076-1.971; p = 0.015), OR: 1.009 (95% CI 1.002-1.016; p = 0.013), OR: 1.281 (95% CI 1.206-1.361; p < 0.001), and 1.035 (1.026-1.043; p < 0.001), respectively. CONCLUSIONS: In a large cohort of adults undergoing auto-adjusting CPAP titration due to moderate-to-severe OSA, male sex, increased values of baseline AHI, pressure requirements, and mask leak were significant predictors for less than optimal CPAP titration.

Agronomic performance of cassava fertilized with phosphorus doses

We have evaluated the agronomic performance of table cassava cultivars fertilized with phosphorus doses in the Brazilian Semiarid Region. Two agricultural crops were grown at the Rafael Fernandes Experimental Farm, Mossoró, RN, from June/2018 to April/2019 and from June/2019 to April/2020. The experimental design was in randomized blocks, arranged in subdivided plots, with four replications. In the plots, doses of phosphorus were applied (0, 60, 120, 180 and 240 kg P2O5 ha-1), and in the subplots, the table cassava cultivars (Água Morna, BRS Gema de Ovo, Recife and Venâncio). The following were evaluated: dry matter of leaf, stem, and commercial root; harvest index; commercial root number; commercial productivity and aerial part productivity. The cultivars used had high root and aerial part productivities indicating that their irrigated cultivation is appropriate under the conditions of the Semiarid region of Rio Grande do Norte. The cultivars Água Morna, BRS Gema de Ovo and Recife are more efficient in the use of phosphorus, obtaining high productivity even in the absence of phosphate fertilization. The cultivar Venâncio is more responsive to phosphate fertilization, as it needs an input of this nutrient to increase its productivity.

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing.

Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

Influence of nocturnal insomnia symptoms on obstructive sleep apnea diagnosis in a clinical referral cohort.

STUDY OBJECTIVES: To assess whether nocturnal symptoms of insomnia influence the prevalence of obstructive sleep apnea (OSA) in a clinical referral cohort. METHODS: Insomnia was defined by the presence of 1 or more of the following complaints: difficulty initiating sleep, difficulty maintaining sleep, and/or early morning awakenings. OSA severity was based on an apnea-hypopnea index: ≥ 5.0 events/h (any OSA), ≥ 15.0 events/h (moderate/severe OSA), and ≥ 30 events/h (severe OSA). Multivariate logistic regression analysis was used to evaluate predictive factors for OSA diagnosis and severity. RESULTS: Overall, 12,021 outpatients referred for polysomnography were grouped into 2 cohorts: without insomnia (58.2%) and with insomnia (41.8%). Individuals without insomnia had a higher prevalence of OSA than those with insomnia (P < .001, for all OSA severity levels). The presence of insomnia was negatively associated with diagnosis of any OSA (adjusted odds ratio: 0.852; 95% confidence interval: 0.769-0.944), moderate/severe OSA (adjusted odds ratio: 0.819; 95% confidence interval: 0.751-0.892), and severe OSA (adjusted odds ratio: 0.816; 95% confidence interval: 0.746-0.892). Moreover, the number of nocturnal symptoms of insomnia was associated with a lower likelihood of OSA, even when adjusted for other confounders such as sex, age, body mass index, neck circumference, excessive daytime sleepiness, hypertension, and type 2 diabetes mellitus. CONCLUSIONS: In this present study that included a large sample of consecutive outpatients, there was an inverse relationship between the number of nocturnal symptoms of insomnia and OSA diagnosis. CITATION: Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Influence of nocturnal insomnia symptoms on obstructive sleep apnea diagnosis in a clinical referral cohort. J Clin Sleep Med. 2022;18(5):1271-1278.

Predictive Factors for Obstructive Sleep Apnea Diagnosis in Bariatric Surgery Candidates with or Without Chronic Insomnia Complaints.

OBJECTIVE: This study aims to evaluate the frequency of insomnia complaints in bariatric patients and to assess obstructive sleep apnea (OSA) predictors according to the presence or absence of chronic insomnia. METHODS: Insomnia was defined as the presence of at least one specific symptom: difficulty falling asleep, difficulty maintaining sleep, and/or waking up earlier than expected. Diagnosis of OSA was objectively obtained from in-laboratory polysomnography. Multivariate logistic regression analysis was used to assess OSA predictors. RESULTS: This cross-sectional study contains 1,737 bariatric surgery candidates: 59.6% without insomnia and 40.4% with insomnia. OSA prevalence was similar among participants with or without insomnia either for any OSA (p = 0.168) or for moderate-to-severe OSA (p = 0.185). Patients without insomnia showed a higher prevalence of severe OSA than those with insomnia (p = 0.005). In both cohorts, five parameters were independent OSA predictors: sex, age, body mass index (BMI), neck circumference (NC), and excessive daytime sleepiness (EDS). Male sex was the most important predictor, whether in individuals without insomnia (adjusted odds ratio [OR] ranging from 4.874 to 8.369) or in those with insomnia (adjusted OR ranging from 5.672 to 12.441). CONCLUSIONS: A considerable proportion of bariatric patients report insomnia complaints. The probability of suffering from OSA was similar among bariatric candidates with or without insomnia, except for severe OSA diagnosis. Sex, age, BMI, NC, and EDS were independent predictors for OSA diagnosis irrespective of insomnia symptoms, and male sex was the main predictor for OSA in bariatric individuals with or without insomnia.

Gender-related sleep duration perception in a Brazilian sleep clinic cohort.

PURPOSE: This study aims to evaluate if gender influences the sleep duration perception in adults referred for polysomnography (PSG). METHODS: A cross-sectional study was undertaken from December 2019 to January 2021. Total sleep time was objectively assessed from the overnight PSG and subjectively estimated. The sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of obstructive sleep apnea (OSA) was based on an apnea-hypopnea index ≥ 5.0/h. Insomnia was defined by the presence of one or more specific complaints: difficulty falling asleep, difficulty maintaining sleep, and/or waking up earlier than desired. The association between continuous variables and SPI was assessed by linear regression analysis. RESULTS: This study enrolled 2,004 outpatients (56% men) who were grouped into four subsamples: controls (n = 139), insomnia (n = 154), OSA (n = 912), and insomnia comorbid with OSA [COMISA] (n = 799). In women, the median SPI differed among groups and ranged from 89 to 102% (p = 0.001); while in men, it ranged from 90% to 99% (p = 0.007). However, no gender-related SPI value differences emerged within each of the subgroups: controls (p = 0.907), insomnia (p = 0.830), OSA (p = 0.070), and COMISA (p = 0.547). The presence of insomnia (ß, - 0.101, p < 0.001) or OSA (ß, - 0.082, p = 0.001), but not gender (ß, - 0.017, p = 0.612), were independent predictors of the SPI. CONCLUSION: In a clinical referral cohort, no evidence of sex dimorphism emerged for SPI irrespective of the underlying sleep diagnosis.

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing / Consenso em Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia

ABSTRACT Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

RESUMO O sono é essencial para o adequado funcionamento de todos os indivíduos. Os distúrbios respiratórios do sono ocorrem em todas as faixas etárias, constituindo motivo frequente de consulta médica. O objetivo deste consenso foi atualizar os conhecimentos sobre os principais distúrbios respiratórios do sono tanto na população adulta quanto na pediátrica, com ênfase na apneia obstrutiva do sono. A apneia obstrutiva do sono é uma doença extremamente prevalente, porém frequentemente subdiagnosticada. Associa-se frequentemente a uma série de comorbidades, notadamente cardiovasculares, metabólicas e neurocognitivas, que impactam significativamente na qualidade de vida e na mortalidade. Por conta disso, o Departamento de Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 14 especialistas com reconhecida e comprovada experiência em distúrbios respiratórios do sono para a elaboração deste documento.

Predominance of SARS-CoV-2 P.1 (Gamma) lineage inducing the recent COVID-19 wave in southern Brazil and the finding of an additional S: D614A mutation.

Recently, the highest wave of SARS-CoV-2 epidemic occurred since the beginning of the pandemic in Brazil was registered in Rio Grande do Sul (RS) State, Southern Brazil, considering the number of cases, deaths and hospitalization per day caused by COVID-19. In this study we described which lineages were circulating in the first quarter of 2021 in Southern Brazil to better understand the viral factors involved in the health crisis caused by SARS-CoV-2 in the region, searching also for possible additional SARS-CoV-2 sequence mutations. A total of 70 positive SARS-CoV-2 samples collected between January 28th, 2021 until April 23rd, 2021, were selected to sequencing. Whole genome sequencing of 70 SARS-CoV-2 samples showed a predominance of Gamma lineage (67%, 47/70), followed by P.2 lineage (27%, 19/70) and B.1.1.28 (6%, 4/70). Two Gamma lineage consensus sequences presented a new S:D614A mutation. Newly mutations could be emerging due the quick SARS-CoV-2 spreading. Thus, the greater understanding about immune protection and variants vigilance is essential to the better management of the health SARS-CoV-2 crisis.

Reinfection cases by closely related SARS-CoV-2 lineages in Southern Brazil.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the pandemic that started in late 2019 and still affects people's lives all over the world. Lack of protective immunity after primary infection has been involved with reported reinfection cases by SARS-CoV-2. In this study, we described two cases of reinfection caused by non-VOC (Variants of Concern) strains in southern Brazil, being one patient a healthcare worker. The four samples previously positive for SARS-CoV-2 by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) were sequenced by a high-performance platform and the genomic analysis confirmed that lineages responsible for infections were B.1.91 and B.1.1.33 (patient 1), and B.1.1.33 and B.1.1.28 (patient 2). The interval between the two positive RT-qPCR for patients 1 and 2 was 45 and 61 days, respectively. This data shows that patients may be reinfected even by very closely related SARS-CoV-2 lineages.

Phosphate Fertilization as a Modulator of Enzymatic Browning in Minimally Processed Cassava.

This study proposes to relate the increase in phosphorus (P) supply in the soil, via phosphate fertilization, to oxidative damage and protection, phenylpropanoid metabolism, and enzymatic browning in minimally processed cassava. The roots were grown with 0, 60, and 120 kg ha-1 P2O5. The roots were harvested, and the yield and P content in the root, stem, and leaves were quantified. The roots were minimally processed and stored for 12 days at 5 °C. The higher supply of P in the soil increased the P content of roots and stems but not the agro-industrial yields. Roots grown at 120 kg ha-1 P2O5 showed higher detection of hydrogen peroxide, which was accompanied by increased phenolic compounds, soluble quinones, and antioxidant capacity and increased activities of the enzymes superoxide dismutase, catalase, ascorbate peroxidase, polyphenol oxidase, and peroxidase. The present study thus demonstrates the role of phosphorus application, induction of the synthesis of phenolic compounds, and quality of fresh-cut cassava.

Nocturnal oximetry in bariatric surgery patients referred to overnight in-lab polysomnography.

OBJECTIVE: This study aimed to evaluate nocturnal oximetry approaches in identifying obstructive sleep apnea (OSA) among bariatric surgical candidates. METHODS: This was a cross-sectional study involving adult bariatric patients who were undergoing in-lab polysomnography and who were previously screened with the GOAL questionnaire. OSA severity was established as any OSA, moderate/severe OSA, and severe OSA. Oximetry data were evaluated as oxygen saturation (average and nadir), oxygen desaturation index (ODI) at 3%, and proportion of time spent with oxygen saturation <90%. Associations between oximetry data and the apnea-hypopnea index (AHI) were assessed by Spearman correlation index (r), linear regression, logistic regression, and discrimination. RESULTS: All oximetry values were significantly correlated with the AHI among 1,178 individuals, with the ODI emerging as the better parameter (r = 0.911, p < 0.001). Using linear regression, the ODI was the only predictor of the AHI (ß = 0.952, p < 0.001). In the multivariate analysis, the ODI was the only independent parameter predicting OSA at all severity levels. In addition, the ODI exhibited excellent discrimination to predict OSA and displayed improved performance among individuals screened as being at high risk versus those at low risk with the GOAL instrument. CONCLUSIONS: The ODI emerges as a valid surrogate predictor of the AHI, particularly among those screened as being at high risk for OSA.

Early detection of SARS-CoV-2 P.1 variant in Southern Brazil and reinfection of the same patient by P.2.

Multiple variants of the Severe Acute Respiratory Syndrome coronavirus 2 virus (SARS-CoV-2) have been constantly reported across the world. The B.1.1.28 lineage has been evolving in Brazil since February 2020 and originated the P.1 variant of concern (VOC), recently named as the Gamma variant by the newly WHO nomenclature proposal, and P.2 as a variant of interest (VOI). Here we describe an early case of P.1 primary infection in Southern Brazil in late November 2020, soon after the emergence of the variant in Manaus, Northern Brazil. The same male patient was reinfected by another B.1.1.28 variant, namely P.2, in March, 2021. The genomic analysis confirmed genetically significant differences between the two viruses recovered in both infections, the P.1 lineage in the first episode and P.2 in the reinfection. Due the very early detection of P.1, we have also investigated the circulation of P.1 in the same region by differential RT-qPCR, showing that this was an isolated case of P.1 at the time of detection, and this variant has disseminated and became prominent from late January to the end of March, 2021. SARS-CoV-2 recent reports of reinfection have raised critical questions on whether and how well a first infection protects against reinfection.

Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration?

STUDY OBJECTIVES: The first-choice therapy for adults with moderate/severe obstructive sleep apnea is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. METHODS: This cross-sectional study was conducted in adults diagnosed with moderate/severe obstructive sleep apnea [baseline apnea-hypopnea index (AHI) ≥ 15.0 events/h] who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep laboratory setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). RESULTS: A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values delineated during the titration; all P-values > .005. However, the median residual AHI was significantly higher in males vs females: 2.7 events/h vs 2.2 events/h (P = .008). Body mass index (ß: 0.292, P < .001), baseline AHI (ß: 0.167, P < .001), and age (ß: 0.065, P = .035) were independent predictors of the therapeutic CPAP level settings. CONCLUSIONS: Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95th percentile CPAP requirement during an auto-adjusting CPAP titration. CITATION: Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration? J Clin Sleep Med. 2021;17(9):1815-1820.

Using the No-Apnea score to screen for obstructive sleep apnea in adults referred to a sleep laboratory: comparative study of the performance of the instrument by gender.

OBJECTIVE: To evaluate the performance of the No-Apnea score, a simplified screening instrument for obstructive sleep apnea (OSA), by gender. METHODS: This was a cross-sectional study including adults undergoing full polysomnography. The No-Apnea model comprises two items (neck circumference and age) with a total score of 0 to 9. The severity of OSA was categorized, on the basis of the apnea-hypopnea index, as any (≥ 5 events/h), moderate-to-severe (≥ 15 events/h), or severe (≥ 30 events/h). The performance of the No-Apnea instrument was assessed by determining the area under the (ROC) curve (AUC) and by constructing contingency tables. RESULTS: We evaluated a total of 6,606 adults (53.8% men). For categorizing the level of OSA severity, the No-Apnea score had a sensitivity of 83.9-93.0% and a specificity of 57.3-35.2%. At all OSA severity levels, the No-Apnea score exhibited higher sensitivity and lower specificity in men than in women. The No-Apnea score proved to be an appropriate screening model for patients in general or when separated by gender or severity of OSA (AUC > 0.7 for all). The discriminatory power of the No-Apnea score to predict any, moderate-to-severe, and severe OSA was similar between genders (p = 0.109, p = 0.698, and p = 0.094, respectively). CONCLUSIONS: In a sample of adults referred to the sleep laboratory, there was no significant difference between men and women in terms of the discriminatory power of the No-Apnea instrument in for screening for OSA severity.

Perception of sleep duration in adult patients with suspected obstructive sleep apnea.

PURPOSE: Discrepancies between subjective and objective measures of total sleep time (TST) are frequent among insomnia patients, but this issue remains scarcely investigated in obstructive sleep apnea (OSA). We aimed to evaluate if sleep perception is affected by the severity of OSA. METHODS: We performed a 3-month cross-sectional study of Brazilian adults undergoing overnight polysomnography (PSG). TST was objectively assessed from PSG and by a self-reported questionnaire (subjective measurement). Sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5.0/h, being its severity classified according to AHI thresholds: 5.0-14.9/h (mild OSA), 15.0-29.9/h (moderate OSA), and ≥ 30.0/h (severe OSA). RESULTS: Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups (p = 0.014). Mean SPI values significantly decreased as the OSA severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036. Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028). However, insomnia was not considered as an independent variable for the presence of any OSA, moderate/severe OSA, and severe OSA (all p-values > 0.05). CONCLUSION: In a clinical referral cohort, SPI significantly decreases with increasing OSA severity, but is not modified by the presence of insomnia symptoms.

Validation of the GOAL Questionnaire as an Obstructive Sleep Apnea Screening Instrument in Bariatric Surgery Candidates: a Brazilian Single-Center Study.

OBJECTIVE: To validate the GOAL questionnaire as obstructive sleep apnea (OSA) screening tool in bariatric surgery (BS) patients and compare it with other existing instruments. METHODS: Before performing full polysomnography (PSG), all participants were screened for OSA with the following instruments: GOAL, STOP, STOP-Bang, No-Apnea, NoSAS, and Epworth Sleepiness Scale (ESS). Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated by contingency tables. Correlation was evaluated by the Spearman correlation coefficient (r). OSA severity was classified based on the apnea/hypopnea index (AHI): ≥ 5.0/h (OSA≥ 5), ≥ 15.0/h (OSA≥ 15), and ≥ 30.0/h (OSA≥ 30). RESULTS: Overall, 814 BS individuals (70.8% of females) were enrolled. We found a high prevalence of OSA≥ 5 (82.6%), OSA≥ 15 (60.0%), and OSA≥ 30 (38.8%). GOAL questionnaire was positively correlated with the AHI (r = 0.570, p < 0.001). Using a score ≥ 2 to classify patients at high risk of OSA, GOAL questionnaire had sensitivities ranging from 73.7 to 89.2% and specificities ranging from 78.2 to 51.0% for predicting OSA≥ 5, OSA≥ 15, and OSA≥ 30. At all OSA severity levels, GOAL exhibited similar and non-inferior discrimination when compared with STOP-Bang, No-Apnea, and NoSAS (all p values > 0.05), and performed significantly better than STOP and ESS (all p values < 0.001). CONCLUSIONS: In a cohort of BS patients, GOAL, No-Apnea, STOP-Bang, and NoSAS, but not ESS and STOP, enable satisfactory discrimination as OSA screening instruments at all disease severity levels.

Nasal versus oronasal mask in patients under auto-adjusting continuous positive airway pressure titration: a real-life study.

PURPOSE: Mask type (nasal versus oronasal) can affect the optimal pressure required to correct the apnea/hypopnea index (AHI) in obstructive sleep apnea (OSA) subjects treated with CPAP. Our objective was to evaluate if mask type influenced CPAP titration outcomes in OSA patients. METHODS: A retrospective study of individuals with a baseline AHI ≥ 15.0/h, who received an auto-adjusting CPAP titrating device (S9 AutoSet ResMed®) in a sleep-lab setting. The mask type oronasal (OM) or nasal (NM) was always selected by the patients. Optimal pressure requirements, leak, and residual AHI were compared based on mask type. RESULTS: Overall, 436 patients were included: 283 with NM (64.9%) and 153 with OM (35.1%). At baseline, NM and OM cohorts had similar AHI (p = 0.160). Patients allocated to the OM cohort had a higher 95th percentile pressure, a higher 95th percentile leak, and a higher residual AHI than those with a NM: pressure requirement: 12.9 cm H2O (IQR: 10.6-15.0) versus 10.7 cm H2O (IQR: 9.2-12.3); leak: 21.6 L/min (IQR: 9.6-37.2) versus 9.6 L/min (IQR: 3.6-19.2); and residual AHI: 4.9/h (IQR: 2.4-10.2) versus 2.2/h (IQR: 1.0-4.4), respectively (p < 0.001 for all). CONCLUSIONS: CPAP mask type based on individual preferences exerts profound effects on optimal CPAP pressures and efficacy. Patients titrated with OM showed higher pressure requirements, had higher a leak, and higher residual AHI when compared to NM, which may adversely impact treatment adherence and other health outcomes.