Mechanisms by which the cystic fibrosis transmembrane conductance regulator may influence SARS-CoV-2 infection and COVID-19 disease severity.

Patients with cystic fibrosis (CF) exhibit pronounced respiratory damage and were initially considered among those at highest risk for serious harm from SARS-CoV-2 infection. Numerous clinical studies have subsequently reported that individuals with CF in North America and Europe-while susceptible to severe COVID-19-are often spared from the highest levels of virus-associated mortality. To understand features that might influence COVID-19 among patients with cystic fibrosis, we studied relationships between SARS-CoV-2 and the gene responsible for CF (i.e., the cystic fibrosis transmembrane conductance regulator, CFTR). In contrast to previous reports, we found no association between CFTR carrier status (mutation heterozygosity) and more severe COVID-19 clinical outcomes. We did observe an unexpected trend toward higher mortality among control individuals compared with silent carriers of the common F508del CFTR variant-a finding that will require further study. We next performed experiments to test the influence of homozygous CFTR deficiency on viral propagation and showed that SARS-CoV-2 production in primary airway cells was not altered by the absence of functional CFTR using two independent protocols. On the contrary, experiments performed in vitro strongly indicated that virus proliferation depended on features of the mucosal fluid layer known to be disrupted by absent CFTR in patients with CF, including both low pH and increased viscosity. These results point to the acidic, viscous, and mucus-obstructed airways in patients with cystic fibrosis as unfavorable for the establishment of coronaviral infection. Our findings provide new and important information concerning relationships between the CF clinical phenotype and severity of COVID-19.

Patient-predicted sleep position vs. HST data: a tendency to underestimate supine sleep.

PURPOSE: The purpose of this study is to measure people's accuracy when they estimate what proportion of their nightly sleep at home is supine vs. non-supine. METHODS: A series of patients referred for obstructive sleep apnea (OSA) evaluation were asked if they "knew with confidence" how they slept with regard to their body position. "Yes" responders were then asked to estimate what percentage of their sleep was supine vs. non-supine. This value was compared with the actual proportion of supine vs. non-supine sleep that they exhibited in a home sleep test (HST) that followed. RESULTS: We obtained data from 49 subjects who expressed that they "knew with confidence" how they sleep in terms of body position. Subjects in aggregate underestimated their proportion of supine sleep by 21.6% (p < .001). Thirty-nine subjects (80%) slept supine more in the HST whereas 8 (16%) slept supine less compared to their pre-test estimates. Using a common classification of OSA severity, 9 subjects (18%) demonstrated a more severe degree of OSA than would have occurred had they slept as they had predicted. CONCLUSIONS: Subjects in this study frequently underestimated their proportion of supine sleep compared to values measured in an HST. Because of the increased supine sleep they exhibited, the severity of their OSA was often greater in the test than it would have been had the subjects slept as they predicted. Sleep physicians should take into account the tendency of people to underestimate supine sleep. If patients with positional sleep apnea assert that they "always sleep laterally" when at home, they may be underestimating their true night-by-night OSA disease burden.

Insomnia: Getting to the cause, facilitating relief.

Chronic insomnia is often the result of multiple underlying physiologic, psychological, and social factors. A sleep log, sleep hygiene, CBT, and medication can help.

Recognizing and managing insomnia in primary care and specialty settings.

Insomnia is a common feature of both medical and psychiatric disorders. Whether as a symptom of an illness or as a comorbid disorder, insomnia worsens patient outcomes related to quality of life, functioning, workplace productivity, and health care expenditures. This CME webcast covers how to screen for insomnia in patients with both medical and mental illnesses and how to develop a comprehensive treatment plan. The authors also review evidence-based therapies for insomnia, including psychological/behavioral interventions and medications.

Development and growth of a large multispecialty certification examination: sleep medicine certification--results of the first three examinations.

This paper summarizes the results of the first three examinations (2007, 2009, and 2011) of the Sleep Medicine Certification Examination, administered by its six sponsoring American Board of Medical Specialty Boards. There were 2,913 candidates who took the 2011 examination through one of three pathways-self-attested practice experience, previous certification by the American Board of Sleep Medicine, or formal Sleep Medicine fellowship training. The 2011 exam was the last administration in which candidates who had not previously been admitted could take it without completion of formal Sleep Medicine fellowship training. As expected, the number of candidates admitted to the 2011 examination through the practice experience pathway increased, and the overall scores of these candidates were on average lower than the other candidates. Consequently, the pass rate for all first takers of the 2011 examination (65%) was lower than that observed from the 2009 examination (78%) and the 2007 examination (73%). For each administration, candidates admitted through the fellowship training pathway scored the highest; over 90% of them passed the 2011 and 2009 examinations.

Frequency of provision of CPAP in the inpatient setting: an observational study : "CPAP provision in the inpatient setting".

BACKGROUND: Little is known about the rates of provision of CPAP in inpatient settings. A single prior "data mining" study using diagnostic and procedural codes concluded that 6% of people with sleep apnea receive CPAP when in the hospital. The purpose of this study is to reexamine the frequency with which people who have an established diagnosis of sleep apnea receive therapy for it when they are admitted to the hospital for other reasons. METHODS: A retrospective cohort study of 195 people with an existing diagnosis of obstructive sleep apnea admitted to a tertiary medical center from March 2009-July 2009. A logistic regression analysis was used to determine relative risk for provision of CPAP therapy controlling for the following variables: admission diagnosis, unit of admission (medical/surgical/psychiatric/pediatrics), length of stay, comorbidities, and patient characteristics (age/ race/ gender). RESULTS: Twenty-six percent of people with an established diagnosis of OSA received CPAP therapy during their hospitalization. In an additional 10%, therapy was offered but not implemented. Of the variables considered, only admission diagnosis of obesity (n = 3) was associated with an increased likelihood of receiving CPAP. CONCLUSIONS: This rate of provision of CPAP to hospitalized patients, while low at 26%, is much higher than a previous study on this topic that estimated frequency of use of CPAP strictly linking diagnostic codes for OSA and procedural codes for CPAP.

How is your sleep: a neglected topic for health care screening.

PURPOSE: Inadequate sleep, whether it is caused by voluntary sleep curtailment or specific sleep disorders, is highly prevalent, has wide-ranging negative consequences for human health and well-being, and is greatly under-diagnosed. The objective of this study was to determine the frequency of inquiry by family medicine clinics about unhealthy sleep patterns and symptoms in their health history database questionnaires. METHODS: This study surveyed health history database forms used by family medicine clinics in the 7-county Minneapolis/St. Paul metropolitan area for questions related to sleep disorders. Fourteen distinct database batteries that are used in 121 primary care clinics and employ 935 family medicine doctors (roughly 75% of physicians practicing in this region) were analyzed. RESULTS: Direct questions about sleep health are often not included in health history questionnaires. Eight of 14 (57%) database batteries reviewed in this study featured no sleep-related questions. Other lifestyle issues were screened with much greater frequency. For example, questions about healthy eating patterns and regular physical activity were present in 13 and 12 of the 14 batteries (93% and 86%), respectively. CONCLUSIONS: Despite the significant burden that sleep disorders place on human health, this study found that family medicine clinics do not screen for them as frequently as they do for other lifestyle/behavioral issues when they establish a health history database for new patients.