Effect of motor tasks with left monocular eyeglasses on visual search and line-bisection performance in people with left unilateral spatial neglect.

Training with an eyepatch or eyeglasses is one of the effective approaches for unilateral spatial neglect (USN), and it usually uses a device that covers the right side. However, few approaches are available for the left side. In this study, we examine the effect of motor tasks with left/right monocular eyeglasses on visual search and line-bisection performance in people with left USN. Seven participants with left USN admitted to convalescent hospitals were included. We conducted the Bells test, line-crossing test, and line-bisection test of the behavioral inattention test before/after the motor task. Our analyses focused on the improvement or decline in these assessment scores and the achievement/errors/non-smoothness scores of the motor task. When using the left monocular eyeglasses, the percentages of participants categorized as "improvement," "unchanged," and "decline" were 71.4%, 28.6%, and 0%, respectively (when using the right one they were 14.3%, 85.7%, and 0%). In the motor task, when using the left monocular eyeglasses, total achievement scores in five of seven participants were greater than those when using the right one, and they performed efficiently with fewer movement errors. These results suggest that training with left monocular eyeglasses might improve visual search performance in people with left USN.

Comparisons of Edoxaban Versus Warfarin on Levels of Plasma Prothrombin Fragment in Patients With Nonvalvular Atrial Fibrillation.

The effect of edoxaban on plasma prothrombin fragment 1+2 (PTF1+2), a sensitive maker of in vivo thrombin generation, has not been fully investigated in nonvalvular atrial fibrillation (NVAF). We compared plasma PTF1+2 levels between 25 NVAF patients receiving warfarin and 100 NVAF patients receiving edoxaban and additionally analyzed the association between plasma PTF1+2 levels and the dose of edoxaban. Plasma PTF1+2 levels were significantly higher in patients receiving edoxaban than in those receiving warfarin (141.5 ± 50.0 pmol/l vs 93.1 ± 55.7 pmol/l, p < 0.001). The prevalence of plasma PF1+2 levels above the upper limit (229 pmol/l) of the normal range did not differ between the 2 groups (4% vs 4%), whereas the prevalence of plasma PTF1+2 levels below the lower limit (69 pmol/l) of the normal range was significantly lower in patients receiving edoxaban than in those receiving warfarin (1% vs 48%, p < 0.001). Multiple linear regression analysis identified age and warfarin treatment as independent variables associated with the plasma PTF1+2 level. In a subgroup analysis, plasma PTF1+2 levels were significantly higher in 58 receiving edoxaban of 30 mg/day than in 42 receiving edoxaban of 60 mg/day (157.6 ± 50.8 pmol/l vs 121.6 ± 39.8 pmol/l, p = 0.01); however, after adjusting for confounding factors, the dose of edoxaban was not independently associated with the plasma PTF1+2 level. In conclusion, edoxaban sufficiently inhibits thrombin generation unrelated to its dose in NVAF, although its inhibitory effect is weaker compared with warfarin.

Reliability and validity of the Japanese version of a self-report (DEMQOL) and carer proxy (DEMQOL-PROXY) measure of health-related quality of life in people with dementia.

AIM: The DEMQOL is a self-report measure of subjective quality of life of people with dementia, and the DEMQOL-PROXY is a carer proxy version. The study aimed to develop Japanese versions of the DEMQOL and DEMQOL-PROXY, and test their reliability and validity. METHODS: Translation, reverse translation and equivalency evaluation by the original author were used to develop Japanese versions of the DEMQOL (DEMQOL-J) and DEMQOL-PROXY (DEMQOL-PROXY-J). Interviews were carried out with 90 pairs of people with dementia and their carers to assess their quality of life using the DEMQOL-J, DEMQOL-PROXY-J and other quality of life scales. Internal consistency was evaluated using Cronbach's alpha. Test-retest reliabilities were evaluated using intraclass correlation coefficients. Criterion validity was determined using Pearson's correlation coefficient. RESULTS: Data from 87 pairs who completed the interviews were analyzed. Cronbach's alphas for the DEMQOL-J and DEMQOL-PROXY-J were 0.930 and 0.927, respectively. For 27 pairs who were re-interviewed, the intraclass correlation coefficients for the DEMQOL-J and DEMQOL-PROXY-J were 0.942 (P < 0.001) and 0.942 (P < 0.001), respectively. Both the DEMQOL-J and DEMQOL-PROXY-J correlated significantly with other quality of life scales (the Quality of Life - Alzheimer's Disease instrument, the EuroQol-5D-3L and the World Health Organization Well-Being Index-5-J; P < 0.001). There was also a significant correlation between the DEMQOL-J and the DEMQOL-PROXY-J (r = 0.645, P ≤ 0.001). CONCLUSIONS: The DEMQOL-J and DEMQOL-PROXY-J are reliable and valid measures of dementia-specific quality of life. Geriatr Gerontol Int 2019; 19: 487-491.

Prevalence and prognostic influence of bacterial pyuria in elderly patients with pneumonia: A retrospective study.

AIM: The number of elderly patients with pneumonia is significantly increasing as the populations in many countries age. Although elderly patients with pneumonia are at risk of developing urinary tract infections, no studies have examined the prevalence or the prognostic impact of this complication. The aim of the present study was to investigate the prevalence of comorbid bacterial pyuria and the impact on the prognosis of elderly patients with pneumonia. METHODS: We retrospectively evaluated 132 patients aged >65 years who were hospitalized for pneumonia and who underwent a urinary sediment test on admission. The background characteristics, laboratory results and treatment regimens were documented, and the risk factors for the complication of bacterial pyuria and its association with 90-day mortality in pneumonia patients were elucidated. RESULTS: A total of 37 (28%) of 132 patients were complicated by bacterial pyuria. The patients with bacterial pyuria were more often women, showed a poorer performance status, were more frequently fed by percutaneous endoscopic gastrostomy, and more frequently used diapers and/or a bladder catheter. Regarding first-line drugs, 82.6% of the patients received beta-lactamase inhibitors and extended-spectrum penicillins. The use of a bladder catheter and a poor performance status were associated with bacterial pyuria. A multivariate analysis showed that a poor performance status was the only factor associated with 90-day mortality. CONCLUSIONS: Bacterial pyuria did not affect the prognosis of patients who were treated with penicillin-based regimens. Thus, broad-spectrum antibiotics are not necessarily required for elderly patients with pneumonia complicated by urinary tract infection. Geriatr Gerontol Int 2017; 17: 1076-1080.

Association between obstructive sleep apnea and premature supraventricular contractions.

OBJECTIVE: The exact association between obstructive sleep apnea (OSA) and premature supraventricular contractions (PSVCs) has not been established. METHODS: We prospectively performed polysomnography together with 24-hour Holter electrocardiography in 431 patients who were clinically suspected of having OSA and examined the association between OSA severity and PSVCs during wakefulness and sleep. The patients were classified into 4 groups according to the apnea-hypopnea index (AHI) quartiles (Q1=patients with AHI<13.8, Q2=those with 13.8≤AHI<28.8, Q3=those with 28.8≤AHI<48.1, Q4=those with AHI≥48.1). RESULTS: The number of PSVCs/hour during sleep differed significantly among the 4 groups, but the number of PSVCs/hour during wakefulness did not. The prevalence of PSVC≥5/hour during sleep was significantly higher in Q4 (21.0%) than the other 3 groups (Q1, 9.0%; Q2, 8.0%; Q3, 6.0%; all p<0.05 for Q4), but the prevalence of PSVC≥5/hour during wakefulness did not differ among the 4 groups. A multivariate logistic regression analysis showed that the highest AHI quartile was significantly associated with PSVC≥5/hour during sleep (odds ratio 3.04, 95% confidence interval 1.44-6.42, p=0.004). CONCLUSIONS: Severe OSA can cause PSVCs during sleep, but its effect appears not to be strong. Further studies are needed to clarify the clinical significance of this small but significant increase in PSVCs during sleep in severe OSA patients.

Takotsubo cardiomyopathy triggered by lateral wall ST-segment elevation myocardial infarction.

We herein report the case of a 72-year-old female with a lateral wall acute myocardial infarction (MI) complicated by takotsubo cardiomyopathy (TC). The patient presented with "severe" chest pain lasting for one hour. She did not experience any obvious emotional or physical stress preceding the chest pain. An admission electrocardiogram showed ST-segment elevation in leads I, aVL, and V6 and ST-segment depression in leads II, III, aVF, and V1. Emergent coronary angiography showed total occlusion of the obtuse marginal branch. Subsequently, primary percutaneous old balloon angioplasty followed by everolimus-eluting stenting was performed. Left ventriculography performed immediately after final coronary angiography revealed hypokinesis in the lateral wall and mid-ventricular ballooning. The electrocardiographic findings and left ventricular wall motion later normalized. Cardiac magnetic resonance imaging showed late gadolinium enhancement in the lateral wall. In conclusion, to the best of our knowledge, this is the second case report of TC triggered by an acute MI, which provides further evidence that an acute MI can potentially trigger TC. .

Care staff training in residential homes for managing behavioural and psychological symptoms of dementia based on differential reinforcement procedures of applied behaviour analysis: a process research.

Previous studies of care staff training programmes for managing behavioural and psychological symptoms of dementia (BPSD) based on the antecedent-behaviour-consequence analysis of applied behaviour analysis have not included definite intervention strategies. This case study examined the effects of such a programme when combined with differential reinforcement procedures. We examined two female care home residents with dementia of Alzheimer's type. One resident (C) exhibited difficulty in sitting in her seat and made frequent visits to the restroom. The other resident (D) avoided contact with others and insisted on staying in her room. These residents were cared for by 10 care staff trainees. Using an original workbook, we trained the staff regarding the antecedent-behaviour-consequence analysis with differential reinforcement procedures. On the basis of their training, the staff implemented individual care plans for these residents. This study comprised a baseline phase and an intervention phase (IN) to assess the effectiveness of this approach as a process research. One month after IN ended, data for the follow-up phase were collected. In both residents, the overall frequency of the target behaviour of BPSD decreased, whereas the overall rate of engaging in leisure activities as an alternative behaviour increased more during IN than during the baseline phase. In addition, the overall rate of staff actions to support residents' activities increased more during IN than during the baseline phase. However, the frequency of the target behaviour of BPSD gradually increased during IN and the follow-up phase in both residents. Simultaneously, the rate of engaging in leisure activities and the staff's treatment integrity gradually decreased for C. The training programme was effective in decreasing BPSD and increasing prosocial behaviours in these two cases. However, continuous support for the staff is essential for maintaining effects.

Severe obstructive sleep apnoea is independently associated with pulmonary artery dilatation.

BACKGROUND AND OBJECTIVE: We hypothesised that obstructive sleep apnoea (OSA) may cause pulmonary artery dilatation through excessively negative intrathoracic pressure generated during inspiratory efforts against the upper airway collapse during obstructive apnoeas. To test this hypothesis, we examined the association between OSA severity and pulmonary artery dilatation. METHODS: A total of 173 patients who were clinically suspected of having OSA underwent chest radiography and polysomnography. We measured the right descending pulmonary artery diametre (RDPAD) on the chest radiogram and defined an abnormal increase in the RDPAD as RDPAD > 16 mm in males and RDPAD > 15 mm in females. RESULTS: An abnormal increase in the RDPAD was more prevalent in patients with severe OSA (46.3%) compared to those with no or mild OSA (14.5%) and those with moderate OSA (21.6%). A univariate logistic regression analysis showed that severe OSA was associated with an abnormal increase in the RDPAD (odds ratio 3.94, 95% confidence interval 1.98-7.87). After controlling for age, gender, body mass index, smoking history and partial pressure of arterial oxygen, severe OSA still remained significantly associated with an abnormal increase in the RDPAD (odds ratio 4.06, 95% confidence interval 1.82-9.07). CONCLUSIONS: Severe OSA is independently associated with an abnormal increase in the RDPAD, suggesting that severe OSA may cause pulmonary artery dilatation.

Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a single-blind, controlled clinical trial.

OBJECTIVES: Cognitive stimulation therapy (CST) has shown to have significant benefits in improving the cognitive function and quality of life (QOL) in people with mild-to-moderate dementia in a UK randomized controlled trial (RCT). We developed and examined the Japanese version of group CST (CST-J) in a single-blind, controlled clinical trial. METHOD: CST-J consisting of 14 sessions was administered to a treatment group (n = 26) twice a week for 7 weeks. The treatment group was compared with a control group (n = 30). Based on single-blindness, cognition was evaluated by a researcher, and QOL and mood were rated by the participants themselves. Additionally, QOL and mood of participants were rated by care workers who were not blind but who observed them most directly in their daily life (important for social validity). RESULTS: A linear mixed model was used for analyses of cognition and QOL. There were significant improvements in cognition [COGNISTAT (Neurobehavioral Cognitive Status Examination) and MMSE (Mini-Mental State Examination)] for the treatment group compared with the control group (p < 0.01). Regarding QOL, the EQ-5D was significant (p = 0.019) and the QoL-AD (Quality of Life - Alzheimer's Disease) showed a positive trend (p = 0.06) when rated by care workers, although not when rated by the participants themselves. Using a nonparametrical analysis, there were significant improvements in the face scale for mood when rated by both the participants (p < 0.01) and the care workers (p = 0.017). CONCLUSION: The CST-J shows promising improvements in cognition, mood, and aspects of QOL for people with dementia in Japanese care settings. A large RCT is now needed.

Abnormal P-wave terminal force in lead V1 is associated with cardiac death or hospitalization for heart failure in prior myocardial infarction.

The aim of this study was to clarify the prognostic significance of P-wave terminal force in lead V1 (PTFV1) in patients with prior myocardial infarction (MI). We retrospectively examined 185 patients with prior MI. The primary end point was cardiac death or hospitalization for heart failure. Abnormal PTFV1 was defined as PTFV1 ≥ 40 mm × ms. During a follow-up period of 6.4 ± 2.9 years, 39 patients developed the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in 79 patients with abnormal PTFV1 than in 106 patients with normal PTFV1 (P < 0.001). When we classified 79 patients with abnormal PTFV1 into 31 with a purely negative P wave in lead V1 and 48 with a biphasic negative P wave in lead V1, the primary event-free rate did not differ between the two groups of patients. A multivariate Cox regression analysis selected age (hazard ratio (HR) 1.09, 95 % confidence interval (CI) 1.04-1.14, P < 0.001), multivessel coronary disease (HR 2.33, 95 % CI 1.02-5.28, P = 0.04), and abnormal PTFV1 (HR 2.72, 95 % CI 1.24-5.99, P = 0.01) as independent predictors of the primary end point. In conclusion, abnormal PTFV1 is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI. The analysis of P waves in lead V1 should provide useful prognostic information in patients with prior MI.

Obstructive sleep apnea increases hemoglobin A1c levels regardless of glucose tolerance status.

OBJECTIVE: We sought to clarify the association between the severity of obstructive sleep apnea (OSA) and hemoglobin A1c (HbA1c) levels. METHODS: HbA1c levels were measured in 330 subjects who were suspected of having OSA and who underwent polysomnography. A 75-g oral glucose tolerance test was performed in 308 subjects who had not been diagnosed to have diabetes mellitus. Patients with use of hypoglycemic agents were excluded. The 330 subjects were divided into three subgroups: 164 with normal glucose tolerance, 111 with impaired glucose tolerance, and 55 with diabetes mellitus (DM). RESULTS: Univariate regression analyses showed that natural logarithm(Ln)age, Lnbody mass index, hypertension, DM, Lnapnea-hypopnea index, Lnarousal index, and Lnlowest arterial oxyhemoglobin saturation (L-SpO(2)) were associated with LnHbA1c. A multiple regression analysis showed that Lnage (ß=0.16, P=0.003), DM (ß=0.39, P<0.001), and Ln L-SpO(2) (ß=-0.29, P<0.001) were associated with LnHbA1c. Subgroup analyses showed that Ln L-SpO(2) was independently associated with LnHbA1c in each subgroup. CONCLUSIONS: L-SpO(2) was independently associated with HbA1c regardless of the glucose tolerance status. This suggests that OSA-induced hypoxia could increase an individual's average blood glucose level.

Upright T waves in lead aVR are associated with cardiac death or hospitalization for heart failure in patients with a prior myocardial infarction.

The aim of the present study was to clarify the prognostic significance of upright T waves (amplitude > 0 mV) in lead aVR in patients with a prior myocardial infarction (MI). We retrospectively examined 167 patients with a prior MI. The primary end point was cardiac death or hospitalization for heart failure. During a follow-up period of 6.5 ± 2.8 years, 34 patients developed the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in patients with upright T waves in lead aVR than in those with nonupright T waves in lead aVR (P = 0.001). Univariate Cox proportional hazards regression analyses showed that age, gender, chronic kidney disease, anterior wall MI, upright T waves in lead aVR, left ventricular ejection fraction, loop diuretic use, and spironolactone use were significantly associated with the primary end point. A multivariate Cox proportional hazards regression analysis selected age [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.05-1.16, P < 0.001], upright T waves in lead aVR (HR 3.10, 95% CI 1.23-7.82, P = 0.017), and loop diuretic use (HR 4.61, 95% CI 1.55-13.67, P = 0.006) as independent predictors of the primary end point. In conclusion, the presence of upright T waves in lead aVR is an independent predictor of cardiac death or hospitalization for heart failure in patients with a prior MI. The analysis of T-wave amplitude in lead aVR provides useful prognostic information in patients with a prior MI.

Association between the severity of obstructive sleep apnea and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol.

The positive association between the ratio of serum low-density lipoprotein cholesterol (LDL-C) to serum high-density lipoprotein cholesterol (HDL-C) and cardiovascular events has recently been receiving much attention. However, the association between the severity of obstructive sleep apnea (OSA) and this ratio has not yet been investigated. Accordingly, we sought to clarify this association and the effect of continuous positive airway pressure (CPAP) therapy on the ratio. We performed polysomnography and LDL-C/HDL-C measurements in 215 patients who were suspected of having OSA. Furthermore, LDL-C/HDL-C was again evaluated 6 months after polysomnography in 30 OSA patients for whom CPAP therapy was initiated and continued, and in 11 age- and sex-matched OSA patients for whom the therapy could not be initiated. The LDL-C/HDL-C correlated positively with apnea-hypopnea index (ρ = 0.28, P < .001) and negatively with the lowest arterial oxyhemoglobin saturation (ρ = -0.30, P < .001). Multivariate regression analysis revealed that ln apnea-hypopnea index (or ln lowest arterial oxyhemoglobin saturation) was independently associated with LDL-C/HDL-C. The LDL-C/HDL-C decreased after 6 months in the CPAP group (2.29 ± 0.67 to 2.11 ± 0.74, P = .02), whereas it did not change in the non-CPAP group (2.65 ± 0.82 to 2.62 ± 0.66, P = .81). The severity of OSA was independently associated with LDL-C/HDL-C, and LDL-C/HDL-C was significantly reduced at 6 months after CPAP therapy. These findings suggest that LDL-C/HDL-C increases in proportion to the severity of OSA, which may contribute partly to an increased risk for cardiovascular events in OSA patients.

The number of leads with fragmented QRS is independently associated with cardiac death or hospitalization for heart failure in patients with prior myocardial infarction.

BACKGROUND: No information is currently available on the prognostic significance of the number of leads with fragmented QRS (fQRS). The objective of the study was to clarify the prognostic significance of the number of leads with fQRS in prior myocardial infarction (MI). METHODS AND RESULTS: We retrospectively examined 170 patients with prior MI. The primary end point was cardiac death or hospitalization for heart failure. During a mean follow-up period of 6.4 ± 2.9 years, 37 patients developed the primary end point. Univariate Cox proportional hazards regression analyses showed that age, male gender, chronic kidney disease, anterior wall MI, number of leads with fQRS, left ventricular ejection fraction, loop diuretic use, and spironolactone use were significantly associated with the primary end point. A multivariate Cox proportional hazards regression analysis selected age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.04-1.14, p<0.001) and the number of leads with fQRS (HR 1.33, 95% CI 1.11-1.60, p=0.002) as predictors of the primary end point. A receiver operating characteristic curve analysis showed that the presence of ≥3 leads with fQRS was most useful for distinguishing between patients with and without the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in patients with ≥3 leads with fQRS than in those with <3 leads with fQRS. CONCLUSIONS: The number of leads with fQRS, especially the presence of ≥3 leads with fQRS, is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI.

[Prostatectomy-pros and cons on open surgery/laparoscopic surgery/robot-assisted surgery].

We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy. We compared the characteristics and results of these techniques. Robot-assisted laparoscopic radical prostatectomy could be superior to the others in many ways. However, it would be very difficult to adopt it in Japan because it would pose economical difficulties. The administrative assistance in the insurance systems requireds much more than we have.

Washout rate of cardiac iodine-123 metaiodobenzylguanidine is high in chronic heart failure patients with central sleep apnea.

BACKGROUND: The association between sleep-disordered breathing (SDB) assessed by polysomnography and cardiac sympathetic nerve activity (SNA) assessed by cardiac iodine-123 metaiodobenzylguanidine (123I-MIBG) imaging has not been investigated in patients with chronic heart failure (CHF). METHODS AND RESULTS: We performed cardiac 123I-MIBG scintigraphy and overnight polysomnography in 59 patients with stable CHF. The patients were classified into the 3 groups: 19 with no or mild SDB (NM-SDB, apnea-hypopnea index <15); 21 with central sleep apnea (CSA), and 19 with obstructive sleep apnea (OSA). The cardiac washout rate (WR) of 123I-MIBG was obtained from initial and delayed planar 123I-MIBG images. The WR was higher in patients with CSA (54.2 + or - 11.6%) than in those with OSA (37.9 + or - 8.6%, P < .05) or NM-SDB (40.8 + or - 8.8%, P < .05). The WR correlated positively with central apnea index (rho = 0.40, P = .002). A stepwise multiple regression analysis selected CSA and plasma brain natriuretic peptide levels as independent variables associated with the WR. CONCLUSIONS: The WR was higher in CHF patients with CSA than in those with OSA or NM-SDB, and CSA was independently associated with the WR, suggesting a link of CSA to increased cardiac SNA in CHF.

Association between coronary spastic angina pectoris and obstructive sleep apnea.

BACKGROUND: Previous studies have shown a higher prevalence of obstructive sleep apnea (OSA) in patients with coronary artery disease than in control subjects. However, the association between coronary spastic angina pectoris (CSA) and OSA has not been investigated. Accordingly, we examined this association. METHODS AND RESULTS: We performed overnight polysomnography in 42 consecutive patients with CSA confirmed by an acetylcholine or ergonovine provocation test and in 20 age- and gender-matched control subjects. OSA was classified into the following three groups: mild OSA (5≤apnea-hypopnea index [AHI]<15); moderate OSA (15≤AHI<30); severe OSA (AHI≥30). Patients with CSA had a greater AHI than control subjects (23.4±16.3 vs. 10.1±8.4, p=0.001), and the prevalence of moderate-to-severe OSA was significantly higher in patients with CSA than in control subjects (66.7% vs. 20%, p=0.001). A multivariate logistic regression analysis showed that moderate-to-severe OSA was independently associated with CSA (odds ratio 9.61, 95% confidence interval 2.11-43.78, p=0.003). CONCLUSIONS: The prevalence of moderate-to-severe OSA was significantly higher in patients with CSA than in control subjects, and moderate-to-severe OSA was an independent factor associated with CSA, suggesting that OSA may be one predisposing factor for coronary spasm.

Influence of the severity of obstructive sleep apnea on heart rate.

BACKGROUND: We sought to clarify the influence of the severity of obstructive sleep apnea (OSA) on heart rate (HR) in patients with OSA. METHODS: We examined 136 patients who underwent overnight polysomnography together with 24-h Holter electrocardiography and who were diagnosed as having OSA [apnea-hypopnea index (AHI) >/=5]. The patients were divided into the following 3 groups: 30 with 5/=30 (group C). Mean HRs during 24h, wakefulness, and sleep were calculated. RESULTS: Mean HRs during 24h, wakefulness, and sleep were significantly higher in group C than in groups A and B. Mean HRs during 24h, wakefulness, and sleep correlated positively with AHI (Spearman's rho=0.36, p<0.001; Spearman's rho=0.32, p<0.001; Spearman's rho=0.38, p<0.001; respectively). Multiple regression analyses revealed that lnAHI was independently associated with mean HRs during 24h, wakefulness, and sleep. In 21 OSA patients who started nasal continuous positive airway pressure (nCPAP) therapy, mean HRs during 24h, wakefulness, and sleep were significantly reduced at 6 months after the initiation of nCPAP. CONCLUSION: The severity of OSA was independently associated with mean HRs during 24h, wakefulness, and sleep, and 6-month treatment with nCPAP reduced the values. The prognostic significance of elevated mean HRs during 24h, wakefulness, and sleep is necessary to be clarified in patients with OSA.