Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy.

STUDY OBJECTIVES: Women with sleep-disordered breathing (SDB) in pregnancy are at a greater risk of developing serious adverse perinatal outcomes. However, the pathogenesis of SDB in pregnancy is poorly understood. As nasal congestion is common in pregnancy, nasal obstruction may contribute to SDB in this population. This study aims to assess the impact of nasal dilator strips (NDS) on measures of SDB and their potential for use as a placebo condition. METHODS: Pregnant women ≥ 18 years old, body mass index ≥ 27 kg/m2, and habitual snoring were enrolled. Participants completed 2 consecutive level III home sleep apnea tests and used NDS during the second test. Objective measures including respiratory event index and pulse transit time drop index, a measure of increased arterial stiffness, were compared across tests. Subjective assessments of participants' perceived impact of NDS use was also obtained. RESULTS: 54 women, 59% White, 60% in the third trimester were enrolled. Median time between the 2 studies was 1 day (interquartile range [IQR] 4). There was no significant change between the night without NDS use and the night with NDS use in respiratory event index (5.30 [IQR 6.20] vs 4.80 [IQR 6.78], P = .8) or pulse transit time drop index (6.8 [IQR 13.3] vs 6.6 [IQR 15.8], P = .360). Subjective measures of sleep did not differ between the 2 nights. CONCLUSIONS: Despite the high prevalence of pregnancy-associated rhinitis, NDS do not have a significant impact on measures of SDB. Results from this study support the use of NDS as an appropriate placebo in prenatal clinical trials. CITATION: Maxwell M, Sanapo L, Monteiro K, et al. Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy. J Clin Sleep Med. 2022;18(2):477-483.

Delayed Diagnosis of Paget-Schroetter Syndrome in a Patient with COVID-19.

Paget-Schroetter Syndrome (PSS), a subtype of thoracic outlet syndrome, is a rare condition defined as thrombosis of the axillosubclavian vein secondary to anatomical abnormalities or repetitive injury to vessel endothelium from exertion. In the setting of the COVID-19 pandemic, venous thrombosis in COVID-positive patients may be attributed to the well-described hypercoagulability associated with the viral syndrome, increasing the rate of misdiagnosis of PSS and delaying definitive treatment. We report a case of PSS in a 19-year-old male who presented to multiple health care providers with an upper extremity thrombus and was found to be SARS-CoV-2 positive on hospitalization. In his case, his COVID status likely contributed to a delay in diagnosis of Paget- Schroetter syndrome, with the patient missing the window for the standard treatment protocol.