Strategies to Assess the Effect of Continuous Positive Airway Pressure on Long-Term Clinically Important Outcomes among Patients with Symptomatic Obstructive Sleep Apnea: An Official American Thoracic Society Workshop Report.

Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA). Although CPAP improves symptoms (e.g., daytime sleepiness), there is a lack of high-quality evidence that CPAP prevents many long-term outcomes, including cognitive impairment, myocardial infarction, and stroke. Observational studies suggest that patients with symptoms may be particularly likely to experience these preventive benefits with CPAP, but ethical and practical concerns limited the participation of such patients in prior long-term randomized trials. As a result, there is uncertainty about the full benefits of CPAP, and resolving this uncertainty is a key priority for the field. This workshop assembled clinicians, researchers, ethicists, and patients to identify strategies to understand the causal effects of CPAP on long-term clinically important outcomes among patients with symptomatic OSA. Quasi-experimental designs can provide valuable information and are less time and resource intensive than trials. Under specific conditions and assumptions, quasi-experimental studies may be able to provide causal estimates of CPAP's effectiveness from generalizable observational cohorts. However, randomized trials represent the most reliable approach to understanding the causal effects of CPAP among patients with symptoms. Randomized trials of CPAP can ethically include patients with symptomatic OSA, as long as there is outcome-specific equipoise, adequate informed consent, and a plan to maximize safety while minimizing harm (e.g., monitoring for pathologic sleepiness). Furthermore, multiple strategies exist to ensure the generalizability and practicality of future randomized trials of CPAP. These strategies include reducing the burden of trial procedures, improving patient-centeredness, and engaging historically excluded and underserved populations.

The effect of time until surgical intervention on survival in dogs with secondary septic peritonitis.

This retrospective study examined the effect of time to intervention on outcome in cases of dogs with secondary septic peritonitis, and also searched for other potential prognostic factors. The medical records of 55 dogs were reviewed. No association was found between outcome and the time from hospital admission to surgical source control. However, several other factors were found to influence survival, including: age, needing vasopressors, lactate, pre-operative packed cell volume, serum alkaline phosphatase, serum total bilirubin, and post-operative serum albumin. These values were then used to create accurate pre- and post-operative survival prediction models.

Effet du délai jusqu'à l'intervention chirurgicale sur la survie des chiens atteints de péritonite septique secondaire. Cette étude rétrospective a examiné l'effet du délai jusqu'à l'intervention sur le résultat dans les cas de chiens atteints de péritonite septique secondaire et a aussi cherché d'autres facteurs de pronostic potentiel. Les dossiers médicaux de 55 chiens ont été examinés. Aucune association n'a été trouvée entre le résultat et le délai entre l'admission à l'hôpital et le contrôle chirurgical de la source. Cependant, on a constaté que plusieurs autres facteurs influençaient la survie : l'âge, le besoin de vasopresseurs, le lactate, la valeur d'hématocrite avant l'opération, la phosphatase alcaline sérique, la bilirubine totale sérique et l'albumine sérique post-opératoire. Ces valeurs ont ensuite été utilisées pour créer des modèles de prédiction de la survie exacts avant et après l'opération.(Traduit par Isabelle Vallières).

Sleep-disordered breathing and behaviors of inner-city children with asthma.

OBJECTIVE: To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma. METHODS: We examined data for 194 children (aged 4-10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of >0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores. RESULTS: The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness). CONCLUSIONS: We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.