Validation of an overnight wireless high-resolution oximeter for the diagnosis of obstructive sleep apnea at home.

Obstructive sleep apnea (OSA) is extremely common and has several consequences. However, most cases remain undiagnosed. One limitation is the lack of simple and validated methods for OSA diagnosis at home. The aim of this study was to validate a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis (Biologix) that was compared with a home sleep test (HST, Apnea Link Air) performed on the same night. We recruited 670 patients out of a task force of 1013 patients with suspected OSA who were referred to our center for diagnosis. The final sample consisted of 478 patients (mean age: 56.7 ± 13.1 years, mean body mass index: 31.9 ± 6.3 kg/m2). To estimate the night-to-night OSA severity variability, 62 patients underwent HST for two consecutive nights. The HST-apnea-hypopnea index (AHI) and the Biologix-oxygen desaturation index (ODI) was 25.0 ± 25.0 events/h and 24.9 ± 26.5 events/h, respectively. The area under the curve-sensibility/specificity to detect at least mild (HST-AHI > 5), moderate-to-severe (HST-AHI > 15), and severe OSA (HST-AHI > 30) were (0.983)-94.7/92.8, (0.986)-94.8/93.9, and (0.990)-95.8/94.3, respectively. The limits of agreement originating from the Bland-Altman plot and the correlation between HST-AHI and Biologix-ODI were lower than the night-to-night HST-AHI variability (25.5 and 34.5 events/h, respectively, p = 0.001). We conclude that Biologix is a simple and reliable technique for OSA diagnosis at home.

Validation of an Overnight Wireless High-Resolution Oximeter plus Cloud-Based Algorithm for the Diagnosis of Obstructive Sleep Apnea.

OBJECTIVES: Obstructive sleep apnea (OSA) is a common but largely underdiagnosed condition. This study aimed to test the hypothesis that the oxygen desaturation index (ODI) obtained using a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis, Overnight Digital Monitoring (ODM), is a reliable method for the diagnosis of OSA. METHODS: Consecutive patients referred to the sleep laboratory with suspected OSA underwent in-laboratory polysomnography (PSG) and simultaneous ODM. The PSG apnea-hypopnea index (AHI) was analyzed using the criteria recommended and accepted by the American Academy of Sleep Medicine (AASM) for the definition of hypopnea: arousal or ≥3% O2 desaturation (PSG-AHI3%) and ≥4% O2 desaturation (PSG-AHI4%), respectively. The results of PSG and ODM were compared by drawing parallels between the PSG-AHI3% and PSG-AHI4% with ODM-ODI3% and ODM-ODI4%, respectively. Bland-Altman plots, intraclass correlation, receiver operating characteristics (ROC) and area under the curve (AUC) analyses were conducted for statistical evaluation. ClinicalTrial.gov: NCT03526133. RESULTS: This study included 304 participants (men: 55%; age: 55±14 years; body mass index: 30.9±5.7 kg/m2; PSG-AHI3%: 35.3±30.1/h, ODM-ODI3%: 30.3±25.9/h). The variability in the AASM scoring bias (PSG-AHI3% vs PSG-AHI4%) was significantly higher than that for PSG-AHI3% vs ODM-ODI3% (3%) and PSG-AHI4% vs ODM-ODI4% (4%) (9.7, 5.0, and 2.9/h, respectively; p<0.001). The limits of agreement (2±SD, derived from the Bland-Altman plot) of AASM scoring variability were also within the same range for (PSG vs ODM) 3% and 4% variability: 18.9, 21.6, and 16.5/h, respectively. The intraclass correlation/AUC for AASM scoring variability and PSG vs ODM 3% or 4% variability were also within the same range (0.944/0.977 and 0.953/0.955 or 0.971/0.964, respectively). CONCLUSION: Our results showed that ODM is a simple and accurate method for the diagnosis of OSA.

Validation of an overnight wireless high-resolution oximeter plus cloud-based algorithm for the diagnosis of obstructive sleep apnea

OBJECTIVES: Obstructive sleep apnea (OSA) is a common but largely underdiagnosed condition. This study aimed to test the hypothesis that the oxygen desaturation index (ODI) obtained using a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis, Overnight Digital Monitoring (ODM), is a reliable method for the diagnosis of OSA. METHODS: Consecutive patients referred to the sleep laboratory with suspected OSA underwent in-laboratory polysomnography (PSG) and simultaneous ODM. The PSG apnea-hypopnea index (AHI) was analyzed using the criteria recommended and accepted by the American Academy of Sleep Medicine (AASM) for the definition of hypopnea: arousal or ≥3% O2 desaturation (PSG-AHI3%) and ≥4% O2 desaturation (PSG-AHI4%), respectively. The results of PSG and ODM were compared by drawing parallels between the PSG-AHI3% and PSG-AHI4% with ODM-ODI3% and ODM-ODI4%, respectively. Bland-Altman plots, intraclass correlation, receiver operating characteristics (ROC) and area under the curve (AUC) analyses were conducted for statistical evaluation. ClinicalTrial.gov: NCT03526133. RESULTS: This study included 304 participants (men: 55%; age: 55±14 years; body mass index: 30.9±5.7 kg/m2; PSG-AHI3%: 35.3±30.1/h, ODM-ODI3%: 30.3±25.9/h). The variability in the AASM scoring bias (PSG-AHI3% vs PSG-AHI4%) was significantly higher than that for PSG-AHI3% vs ODM-ODI3% (3%) and PSG-AHI4% vs ODM-ODI4% (4%) (9.7, 5.0, and 2.9/h, respectively; p<0.001). The limits of agreement (2±SD, derived from the Bland-Altman plot) of AASM scoring variability were also within the same range for (PSG vs ODM) 3% and 4% variability: 18.9, 21.6, and 16.5/h, respectively. The intraclass correlation/AUC for AASM scoring variability and PSG vs ODM 3% or 4% variability were also within the same range (0.944/0.977 and 0.953/0.955 or 0.971/0.964, respectively). CONCLUSION: Our results showed that ODM is a simple and accurate method for the diagnosis of OSA.

Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA.

BACKGROUND: An oronasal mask is frequently used to treat OSA. In contrast to nasal CPAP, the effectiveness of oronasal CPAP varies by unknown mechanisms. We hypothesized that oral breathing and pressure transmission through the mouth compromises oronasal CPAP efficacy. METHODS: Thirteen patients with OSA, well adapted to oronasal CPAP, were monitored by full polysomnography, pharyngeal pressure catheter, and nasoendoscope. Patients slept with low doses of midazolam, using an oronasal mask with sealed nasal and oral compartments. CPAP was titrated during administration by the oronasal and nasal routes, and was then reduced to induce stable flow limitation and abruptly switched to the alternate route. In addition, tape sealing the mouth was used to block pressure transmission to the oral cavity. RESULTS: Best titrated CPAP was significantly higher by the oronasal route rather than the nasal route (P = .005), and patients with > 25% oral breathing (n = 5) failed to achieve stable breathing during oronasal CPAP. During stable flow limitation, inspiratory peak flow was lower, driving pressure was higher, upper airway inspiratory resistance was higher, and retropalatal and retroglossal area were smaller by the oronasal rather than nasal route (P < .05 for all comparisons). Differences were observed even among patients with no oral flow and were abolished when tape sealing the mouth was used (n = 6). CONCLUSIONS: Oral breathing and transmission of positive pressure through the mouth compromise oronasal CPAP.

Hipertrofia de mama: estudo comparativo dos achados histológicos e de imagem / Breast hyperthophy: a comparative study of histopathological and imaging findings

Objetivo: avaliar a sensibilidade e a especificidade dos exames de mamografia e de ultrassonografia na detecção de alterações mamárias, em mulheres com hipertrofia mamária em seus diversos graus, fazendo correlação com os achados nos exames histopatológicos. Métodos: foi feito um estudo prospectivo, realizado com 60 pacientes, portadoras de hipertrofia mamária, com idade entre 16 e 72 anos, no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal do Maranhão. De acordo com a faixa etária, foi indicado o exame de imagem, classificando o resultado pelo sistema Breast Imaging Reporting and Date System (BI-RADS®). O resultado desse exame foi correlacionado com o grau de hipertrofia (peso) e com o exame histopatológico das 120 peças cirúrgicas obtidas na cirurgia plástica de redução mamária. Resultados: o exame histopatológico detectou 47,5% de lesões benignas não neoplástica, sendo 7,5% com risco relativo levemente aumentado. O exame de ultrassonografia apresentou especificidade de 80,6% e sensibilidade de 40,5%. A mamografia apresentou especificidade de 54,5% e sensibilidade de 49,0%. A ultrassonografia mamária não apresentou comprometimento da especificidade, mas apresentou baixa sensibilidade. A mamografia apresentou baixa especificidade e sensibilidade. Mesmo em faixas etárias mais avançadas, onde se esperava uma redução da densidade mamária que favorecia a sensibilidade mamográfica, o resultado foi compatível com o encontrado em mamas densas. Conclusão: estes dados sugerem que a hipertrofia mamária deve ser considerada na interpretação de laudos de mamografia e de ultrassonografia em rastreamento de doenças mamárias.

Comparison of the outcomes of the sling technique using a commercial and hand-made polypropylene sling.

PURPOSE: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®). MATERIALS AND METHODS: Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery. RESULTS: The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100%), as well as, in 94.7% of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100% in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1% of patients of group 1 and 10.5% of group 2. No complications were observed in either group. CONCLUSION: The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.

Comparison of the outcomes of the sling technique using a commercial and hand-made polypropylene sling

PURPOSE: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®). MATERIALS AND METHODS: Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery. RESULTS: The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100 percent), as well as, in 94.7 percent of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100 percent in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1 percent of patients of group 1 and 10.5 percent of group 2. No complications were observed in either group. CONCLUSION: The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.

Avaliação ultrassonográfica da espessura endometrial em usuárias de terapia hormonal de baixa dose na pós-menopausa / Ultrasonographic evaluation of endometrial thickness in postmenopausal women using low-dose hormonal therapy

Introdução: a terapia hormonal (TH) pode alterar a espessura do endométrio, e a ultrassonografia transvaginal é indicada para avaliar o efeito proliferativo do estrogênio e o efeito protetor do progestagênio sobre o endométrio. Objetivo: avaliar, por meio do exame ultrassonográfico, o efeito da terapia hormonal de baixa dose sobre o endométrio de mulheres na pós-menopausa submetidas a um ano de terapia. Material e métodos: foram estudadas 40 mulheres pós-menopausadas entre 35 e 65 anos e com indicação para TH, divididas igualmente em: grupo I – pacientes tratadas durante 12 meses com 1 mg de 17 β-estradiol diariamente e 90 μg de norgestimato cíclico; grupo II – pacientes não submetidas à TH. O endométrio foi avaliado antes do tratamento e depois de 12 meses. Resultados: o grupo de usuárias de TH apresentou aumento estatisticamente significativo da espessura do eco endometrial (p=0,004) em relação ao grupo de não-usuárias, sendo observado no primeiro uma tendência a discreto espessamento endometrial (65,0%) e, no segundo, endométrio predominantemente inalterado (60,0%) ou com tendência à atrofia (30,0%). Conclusão: a TH de baixa dose aumentou a espessura endometrial dentro da normalidade de 5 mm nas usuárias dos hormônios após 12 meses de tratamento.

Introduction: hormonal therapy (HT) can modify the endometrial thickness, and the transvaginal ultrasonography is indicated to assess the proliferative effect of estrogen and the protective effect of progestin on endometrial thickening. Objective: to evaluate the effect of low-dose HT on the endometrium of postmenopausal women after one year of therapy through the variation of endometrial thickness measured by transvaginal ultrasonography. Material and methods: forty post-menopausal women between 35 and 65 years old and with indication for HT were divided into two groups: in Group I, patients were treated for 12 months with continuous oral 17 β-estradiol combined with norgestimate. In Group II, patients were not submitted to HT. The endometrial evaluation was performed before treatment and after 12 months. Results: HT users presented a statistically significant increase in endometrial thickness (p=0.004), when compared to the non-users, being observed in the first case a discreet endometrial thickening tendency (65.0%), and in the second group, the endometrium remained unchanged (60.0%) or tended to atrophy (30.0%). Conclusion: The low-dose HT caused the increase of endometrial thickness within the 5 mm normality in hormone users after 12 months of treatment.