Antibiotic Sensitivity and Nasal Microbiome in Patients with Acute Bacterial Rhinosinusitis.

OBJECTIVES: Acute rhinosinusitis (ARS) is a common upper respiratory tract infection that is mostly of viral origin. However, little is known about the nasal microbiome profile at presentation and the changes caused by antibiotics in acute bacterial rhinosinusitis (ABRS). METHODS: This was a prospective single-center study. Overall, 43 ARS patients were screened and were assessed with the symptom questionnaires, nasal endoscopy, and Water's view. Five healthy subjects were recruited as controls. Middle meatal mucus samples were obtained using a cotton swab (for bacterial culture and antimicrobial susceptibility testing) and the suction technique (for 16S rRNA sequencing). After 1 week of antibiotic use (amoxicillin with clavulanic acid), we enrolled 13 patients with ABRS with positive isolates and middle meatal samples for 16S rRNA sequencing were obtained again. RESULTS: Overall, we demonstrated a significantly lower abundance of the Lactobacillaceae family in ABRS patients than in healthy controls. Resistant ABRS had different characteristics of middle meatal microbiomes when compared to sensitive ABRS as follows: (1) lower proportion of lactic acid bacteria, (2) increased pathogens such as Rhodococcus sp., Massila sp., Acinetobacter sp., and H. influenza, and (3) increased beta diversity. However, no remarkable changes were observed in the middle meatal microbiome after antibiotic use. CONCLUSION: We showed the roles of Lactobacillaceae in ABRS, and Acinetobacter and Massilia in case of amoxicillin resistance. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1081-1088, 2024.

Longitudinal changes in quality of life before and after thyroidectomy in patients with differentiated thyroid cancer.

OBJECTIVE: The objective of this prospective study was to assess longitudinal variations in health-related quality of life (HR-QOL) in patients diagnosed with differentiated thyroid cancer (DTC) before and after thyroidectomy. PATIENTS AND DESIGN: A cohort of 185 DTC patients who underwent thyroidectomy between January 2013 and December 2017 and completed all necessary questionnaires was evaluated. Health-related QOL was gauged using the University of Washington Quality of Life questionnaire (UW-QOL) and the City of Hope Quality of Life-Thyroid Version questionnaire (QOL-TV) both prior to surgery and at 3 months, 6 months, 1 year, 2 years, 3 years, and 5 years postoperatively. RESULTS: Out of 185 patients, 150 (81.1%) were females with an average age of 48.7 ± 12.9 years. For both UW-QOL and QOL-TV, the total composite QOL scores notably declined from preoperative levels to 3 months postoperatively, then gradually improved over 5 years, ultimately exceeding preoperative scores. Factors such as total thyroidectomy, radioactive iodine (RAI) ablation, and postoperative hypoparathyroidism were associated with lower physical composite QOL scores. Patients who underwent remote-access thyroidectomy expressed significantly higher satisfaction with appearance compared to those who had conventional thyroidectomy. Mood and anxiety were major clinical concerns both pre- and post-surgery, showing considerable improvement postoperatively. CONCLUSIONS: For DTC patients, HR-QOL experienced a significant drop 3 months post-surgery, subsequently showing gradual improvement, surpassing preoperative QOL by 5 years. Factors contributing to improved physical QOL included the utilization of remote-access thyroidectomy, less extensive thyroidectomy, and the absence of RAI ablation and hypoparathyroidism.

Clinical Trial to Reconfirm the Efficacy and Safety of Cefetamet Pivoxil Treatment in Sinusitis Patients: A Double-Blind, Randomized, Parallel Designed, Multicenter, Active Comparator Study (CASIS Study).

OBJECTIVE: To evaluate the clinical efficacy and safety of cefetamet pivoxil for the treatment of acute bacterial rhinosinusitis in Korean patients compared to treatment with cefdinir. METHODS: A prospective, multicenter, randomized double-blind, comparative study was conducted by the Departments of Otorhinolaryngology-Head and Neck Surgery at 17 hospitals or universities in the Republic of Korea from March 2017 to April 2019. A total of 309 patients were screened and 249 patients participated in the study. RESULTS: Treatment with cefetamet pivoxil for 2 weeks showed 82.4% clinical cure and improvement rates in patients with acute bacterial rhinosinusitis compared to 84.68% in those taking cefdinir for 2 weeks, showing that cefetamet pivoxil administered twice a day for 2 weeks was as effective as cefdinir 3 times a day for 2 weeks for the treatment of acute bacterial rhinosinusitis. The overall adverse reaction rates of both drugs were 10.56% in the cefetamet pivoxil group and 15.49% in the cefdinir group, without serious adverse events or drug reactions. CONCLUSIONS: Cefetamet pivoxil twice a day was as efficacious and safe as cefdinir 3 times a day for the treatment of acute bacterial rhinosinusitis, which suggested that cefetamet pivoxil may be a suitable alternative to cefdinir.

Eosinophil-derived interferon-γ drives transmembrane protein 119-induced new bone formation in chronic rhinosinusitis with nasal polyps.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory sinonasal disease characterized by eosinophilic infiltration and new bone formation. These changes indicate the severity and prognosis of CRSwNP and may be closely linked to each other. METHODS: We performed RNA sequencing to screen specific osteogenic molecules and validated transmembrane protein 119 (TMEM119) expression by quantitative polymerase chain reaction (qPCR) and immunohistochemistry analyses. TMEM119 knockdown was performed to observe the downregulation of bone mineralization. We validated the bone-forming activity of interferon-γ (IFN-γ) and its signaling pathways in cultured primary sinus bone cells. Cellular sources of IFN-γ were identified using immunohistochemistry and immunofluorescence analyses. Interleukin-4-eosinophil-IFN-γ axis and the effect of dupilumab were investigated in Eol-1 cells. RESULTS: We observed elevated IFN-γ levels and eosinophils in the nasal fluid and predominantly eosinophil-derived IFN-γ in the sinus mucosa of patients with CRSwNP. TMEM119 expression and bone-forming activities were increased in the osteitic and primary sinus bone cells of CRSwNP. IFN-γ treatment enhanced bone mineralization and TMEM119 expression via signal transducer and activator of transcription 1 (STAT1) signaling. Moreover, TMEM119 knockdown inhibited sinus bone cell mineralization and dupilumab attenuated IFN-γ secretion by IL4-stimulated Eol-1 cells. CONCLUSION: Eosinophil-derived IFN-γ promotes the bone-forming activities of sinus bone cells via the STAT1-TMEM119 signaling pathway. Interleukin-4-eosinophil-IFN-γ axis may be crucial for TMEM119-mediated new bone formation in CRSwNP.

Early screening tool for developmental delay in infancy: Quantified assessment of movement asymmetry using IR-UWB radar.

In the untact COVID-19 era, the feasibility of a noncontact, impulse-radio ultrawideband (IR-UWB) radar sensor has important medical implications. Premature birth is a major risk factor for brain injury and developmental delay; therefore, early intervention is crucial for potentially achieving better developmental outcomes. Early detection and screening tests in infancy are limited to the quantification of differences between normal and spastic movements. This study investigated the quantified asymmetry in the general movements of an infant with hydrocephalus and proposes IR-UWB radar as a novel, early screening tool for developmental delay. To support this state-of-the-art technology, data from actigraphy and video camcorder recordings were adopted simultaneously to compare relevant time series as the infant grew. The data from the three different methods were highly concordant; specifically, the ρz values comparing radar and actigraphy, which served as the reference for measuring movements, showed excellent agreement, with values of 0.66 on the left and 0.56 on the right. The total amount of movement measured by radar over time increased overall; movements were almost dominant on the left at first (75.2% of total movements), but following shunt surgery, the frequency of movement on both sides was similar (54.8% of total movements). As the hydrocephalus improved, the lateralization of movement on radar began to coincide with the clinical features. These results support the important complementary role of this radar system in predicting motor disorders very early in life.

Noncontact assessment for fatigue based on heart rate variability using IR-UWB radar.

Physical fatigue can be assessed using heart rate variability (HRV). We measured HRV at rest and in a fatigued state using impulse-radio ultra wideband (IR-UWB) radar in a noncontact fashion and compared the measurements with those obtained using electrocardiography (ECG) to assess the reliability and validity of the radar measurements. HRV was measured in 15 subjects using radar and ECG simultaneously before (rest for 10 min before exercise) and after a 20-min exercise session (fatigue level 1 for 0-9 min; fatigue level 2 for 10-19 min; recovery for ≥ 20 min after exercise). HRV was analysed in the frequency domain, including the low-frequency component (LF), high-frequency component (HF) and LF/HF ratio. The LF/HF ratio measured using radar highly agreed with that measured using ECG during rest (ICC = 0.807), fatigue-1 (ICC = 0.712), fatigue-2 (ICC = 0.741) and recovery (ICC = 0.764) in analyses using intraclass correlation coefficients (ICCs). The change pattern in the LH/HF ratios during the experiment was similar between radar and ECG. The subject's body fat percentage was linearly associated with the time to recovery from physical fatigue (R2 = 0.96, p < 0.001). Our results demonstrated that fatigue and rest states can be distinguished accurately based on HRV measurements using IR-UWB radar in a noncontact fashion.

The Long-Term Effects of Budesonide Nasal Irrigation in Chronic Rhinosinusitis with Asthma.

Chronic rhinosinusitis with nasal polyps (CRSwNP) in asthmatic patients has a high recurrence rate even after surgery. For this reason, oral steroids are frequently used, but their long-term use may cause side effects. The purpose of this study is to investigate the long-term effects of budesonide nasal irrigation (BNI) in CRSwNP and asthma. An analysis of 33 patients with CRSwNP and well-controlled asthma, who performed BNI for more than 12 months, was performed. We compared oral steroid and antibiotic dosages as well as nasal endoscopy scores before, and every six months after, BNI. The six-month dosages of oral steroids and antibiotics prescribed were significantly decreased at all time points after BNI compared to before BNI. When the dosages were compared at the time point immediately preceding six months, oral steroid intake decreased significantly until 12 months, and antibiotic intake decreased until 6 months. Furthermore, the endoscopic score decreased significantly until 12 months. The nasal symptom questionnaire score also significantly improved after BNI. Therefore, BNI is considered an effective treatment method that can improve subjective symptoms and objective intranasal findings while reducing oral steroid and antibiotic doses after long-term use in patients with CRSwNP accompanied by asthma.

Preclinical trial of noncontact anthropometric measurement using IR-UWB radar.

Anthropometric profiles are important indices for assessing medical conditions, including malnutrition, obesity, and growth disorders. Noncontact methods for estimating those parameters could have considerable value in many practical situations, such as the assessment of young, uncooperative infants or children and the prevention of infectious disease transmission. The purpose of this study was to investigate the feasibility of obtaining noncontact anthropometric measurements using the impulse-radio ultrawideband (IR-UWB) radar sensor technique. A total of 45 healthy adults were enrolled, and a convolutional neural network (CNN) algorithm was implemented to analyze data extracted from IR-UWB radar. The differences (root-mean-square error, RMSE) between values from the radar and bioelectrical impedance analysis (BIA) as a reference in the measurement of height, weight, and body mass index (BMI) were 2.78, 5.31, and 2.25, respectively; predicted data from the radar highly agreed with those from the BIA. The intraclass correlation coefficients (ICCs) were 0.93, 0.94, and 0.83. In conclusion, IR-UWB radar can provide accurate estimates of anthropometric parameters in a noncontact manner; this study is the first to support the radar sensor as an applicable method in clinical situations.

Preclinical evaluation of noncontact vital signs monitoring using real-time IR-UWB radar and factors affecting its accuracy.

Recently, noncontact vital sign monitors have attracted attention because of issues related to the transmission of contagious diseases. We developed a real-time vital sign monitor using impulse-radio ultrawideband (IR-UWB) radar with embedded processors and software; we then evaluated its accuracy in measuring heart rate (HR) and respiratory rate (RR) and investigated the factors affecting the accuracy of the radar-based measurements. In 50 patients visiting a cardiology clinic, HR and RR were measured using IR-UWB radar simultaneously with electrocardiography and capnometry. All patients underwent HR and RR measurements in 2 postures-supine and sitting-for 2 min each. There was a high agreement between the RR measured using radar and capnometry (concordance correlation coefficient [CCC] 0.925 [0.919-0.926]; upper and lower limits of agreement [LOA], - 2.21 and 3.90 breaths/min). The HR measured using radar was also in close agreement with the value measured using electrocardiography (CCC 0.749 [0.738-0.760]; upper and lower LOA, - 12.78 and 15.04 beats/min). Linear mixed effect models showed that the sitting position and an HR < 70 bpm were associated with an increase in the absolute biases of the HR, whereas the sitting position and an RR < 18 breaths/min were associated with an increase in the absolute biases of the RR. The IR-UWB radar sensor with embedded processors and software can measure the RR and HR in real time with high precision. The sitting position and a low RR or HR were associated with the accuracy of RR and HR measurement, respectively, using IR-UWB radar.

Urine 5-Eicosatetraenoic Acids as Diagnostic Markers for Obstructive Sleep Apnea.

Early detection of obstructive sleep apnea (OSA) is needed to reduce cardiovascular sequelae and mortality. Full-night polysomnography has been used for diagnosing OSA, but it is too expensive and inconvenient for patients to handle. Metabolome-wide analyses were performed to find and validate surrogate markers for OSA. We further investigated the mechanism underlying hypoxic induction of the markers in human cells and mice. Arachidonic acid derivatives 5-HETE and 5-oxoETE were detected in urine samples. The levels (mean ± SD, ng per mg creatinine) of 5-HETE and 5-oxoETE were 56.4 ± 26.2 and 46.9 ± 18.4 in OSA patients, respectively, which were significantly higher than those in controls (22.5 ± 4.6 and 18.7 ± 3.6). Both levels correlated with the apnea-hypopnea index and the lowest oxygen saturation on polysomnography. After the treatment with the continuous positive airway pressure, the metabolite levels were significantly reduced compared with those before the treatment. In human mononuclear cells subjected to intermittent hypoxia, 5-HETE and 5-oxoETE productions were induced by hypoxia-inducible factor 1 and glutathione peroxidase. When mice were exposed to intermittent hypoxia, 5-HETE and 5-oxoETE were excreted more in urine. They were identified and verified as new OSA markers reflecting hypoxic stress. The OSA markers could be used for OSA diagnosis and therapeutic evaluation.

Quantified assessment of hyperactivity in ADHD youth using IR-UWB radar.

Research on the quantification of hyperactivity in youth with attention-deficit/hyperactivity disorder (ADHD) has been limited and inconsistent. The purpose of this study was to test the discriminative value of impulse-radio ultra-wideband (IR-UWB) radar for monitoring hyperactive individuals with ADHD and healthy controls (HCs). A total of 10 ADHD patients and 15 HCs underwent hyperactivity assessment using IR-UWB radar during a 22-min continuous performance test. We applied functional ANOVA to compare the mean functions of activity level between the 2 groups. We found that the mean function of activity over time was significantly different and that the activity level of the ADHD group slightly increased over time with high dispersion after approximately 7 min, which means that the difference in activity level between the two groups became evident at this period. Further studies with larger sample sizes and longer test times are warranted to investigate the effect of age, sex, and ADHD subtype on activity level function.

Non-contact Sleep/Wake Monitoring Using Impulse-Radio Ultrawideband Radar in Neonates.

Background: The gold standard for sleep monitoring, polysomnography (PSG), is too obtrusive and limited for practical use with tiny infants or in neonatal intensive care unit (NICU) settings. The ability of impulse-radio ultrawideband (IR-UWB) radar, a non-contact sensing technology, to assess vital signs and fine movement asymmetry in neonates was recently demonstrated. The purpose of this study was to investigate the possibility of quantitatively distinguishing and measuring sleep/wake states in neonates using IR-UWB radar and to compare its accuracy with behavioral observation-based sleep/wake analyses using video recordings. Methods: One preterm and three term neonates in the NICU were enrolled, and voluntary movements and vital signs were measured by radar at ages ranging from 2 to 27 days. Data from a video camcorder, amplitude-integrated electroencephalography (aEEG), and actigraphy were simultaneously recorded for reference. Radar signals were processed using a sleep/wake decision algorithm integrated with breathing signals and movement features. Results: The average recording time for the analysis was 13.0 (7.0-20.5) h across neonates. Compared with video analyses, the sleep/wake decision algorithm for neonates correctly classified 72.2% of sleep epochs and 80.6% of wake epochs and achieved a final Cohen's kappa coefficient of 0.49 (0.41-0.59) and an overall accuracy of 75.2%. Conclusions: IR-UWB radar can provide considerable accuracy regarding sleep/wake decisions in neonates, and although current performance is not yet sufficient, this study demonstrated the feasibility of its possible use in the NICU for the first time. This unobtrusive, non-contact radar technology is a promising method for monitoring sleep/wake states with vital signs in neonates.

Cluster Analysis of Inhalant Allergens in South Korea: A Computational Model of Allergic Sensitization.

OBJECTIVES: Sensitization to specific inhalant allergens is a major risk factor for the development of atopic diseases, which impose a major socioeconomic burden and significantly diminish quality of life. However, patterns of inhalant allergic sensitization have yet to be precisely described. Therefore, to enhance the understanding of aeroallergens, we performed a cluster analysis of inhalant allergic sensitization using a computational model. METHODS: Skin prick data were collected from 7,504 individuals. A positive skin prick response was defined as an allergen-to-histamine wheal ratio ≥1. To identify the clustering of inhalant allergic sensitization, we performed computational analysis using the four-parameter unified-Richards model. RESULTS: Hierarchical cluster analysis grouped inhalant allergens into three clusters based on the Davies-Bouldin index (0.528): cluster 1 (Dermatophagoides pteronyssinus and Dermatophagoides farinae), cluster 2 (mugwort, cockroach, oak, birch, cat, and dog), and cluster 3 (Alternaria tenus, ragweed, Candida albicans, Kentucky grass, and meadow grass). Computational modeling revealed that each allergen cluster had a different trajectory over the lifespan. Cluster 1 showed a high level (>50%) of sensitization at an early age (before 19 years), followed by a sharp decrease in sensitization. Cluster 2 showed a moderate level (10%-20%) of sensitization before 29 years of age, followed by a steady decrease in sensitization. However, cluster 3 revealed a low level (<10%) of sensitization at all ages. CONCLUSION: Computational modeling suggests that allergic sensitization consists of three clusters with distinct patterns at different ages. The results of this study will be helpful to allergists in managing patients with atopic diseases.

Double-Blind Placebo-Controlled Trial of Bepotastine Salicylate in Patients With Allergic Rhinitis.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy and safety of a slow-release form of bepotastine salicylate (HL151, Belion CR) in patients with perennial allergic rhinitis (PAR). STUDY DESIGN: Double-blind, placebo-controlled multicenter comparative study. METHODS: Two hundred seventy-two PAR patients (aged 19-65 years) were studied to determine the efficacy and safety of HL151 (20 mg once daily administration) relative to those of a placebo in terms of improvements in total and nasal symptom scores. The subjects were randomized to the placebo (n = 138) or HL151 group (n = 134, 20 mg orally once daily for 4 weeks), and reflective and instantaneous total nasal symptom scores (TNSS) were measured daily in comparison with baseline. Among 272 subjects, 229 subjects (119 in the placebo group, 110 in the HL151 group) who completed the study were included for efficacy analysis. RESULTS: Instantaneous and reflective TNSS and nasal symptoms such as rhinorrhea, nasal itching, and sneezing at 2 and 4 weeks showed that HL151 was superior to the placebo (all P < .05). There were no significant differences in terms of adverse events and adverse drug reactions between the two groups. Regarding serious adverse events, there was only one case of acute hepatitis B, which was reported not to be associated with HL151. CONCLUSIONS: This multicenter trial showed that once-daily use of HL151 is efficacious and safe in adult patients with PAR and could improve compliance due to its convenience. LEVEL OF EVIDENCE: 1b Laryngoscope, 131:E702-E709, 2021.

Feasibility of non-contact cardiorespiratory monitoring using impulse-radio ultra-wideband radar in the neonatal intensive care unit.

BACKGROUND: Current cardiorespiratory monitoring equipment can cause injuries and infections in neonates with fragile skin. Impulse-radio ultra-wideband (IR-UWB) radar was recently demonstrated to be an effective contactless vital sign monitor in adults. The purpose of this study was to assess heart rates (HRs) and respiratory rates (RRs) in the neonatal intensive care unit (NICU) using IR-UWB radar and to evaluate its accuracy and reliability compared to conventional electrocardiography (ECG)/impedance pneumography (IPG). METHODS: The HR and RR were recorded in 34 neonates between 3 and 72 days of age during minimal movement (51 measurements in total) using IR-UWB radar (HRRd, RRRd) and ECG/IPG (HRECG, RRIPG) simultaneously. The radar signals were processed in real time using algorithms for neonates. Radar and ECG/IPG measurements were compared using concordance correlation coefficients (CCCs) and Bland-Altman plots. RESULTS: From the 34 neonates, 12,530 HR samples and 3,504 RR samples were measured. Both the HR and RR measured using the two methods were highly concordant when the neonates had minimal movements (CCC = 0.95 between the RRRd and RRIPG, CCC = 0.97 between the HRRd and HRECG). In the Bland-Altman plot, the mean biases were 0.17 breaths/min (95% limit of agreement [LOA] -7.0-7.3) between the RRRd and RRIPG and -0.23 bpm (95% LOA -5.3-4.8) between the HRRd and HRECG. Moreover, the agreement for the HR and RR measurements between the two modalities was consistently high regardless of neonate weight. CONCLUSIONS: A cardiorespiratory monitor using IR-UWB radar may provide accurate non-contact HR and RR estimates without wires and electrodes for neonates in the NICU.

Novel Nasal Epithelial Cell Markers of Parkinson's Disease Identified Using Cells Treated with α-Synuclein Preformed Fibrils.

Parkinson's disease (PD) is the most common neurodegenerative movement disorder, characterized by olfactory dysfunction in the early stages. α-Synuclein pathologies in the olfactory organs are shown to spread to the brain through the nose-brain axis. We first developed a nasal epithelial PD cellular model by treating RPMI-2650 cells with α-synuclein preformed fibrils (PFF). Upon uptake of PFF, RPMI-2650 cells showed mitochondrial proteome alteration and downregulation of parkin, which has previously been identified as a nasal biomarker of PD. Functional cluster analysis of differentially expressed genes in RPMI-2650 cells revealed various pathways affected by α-synuclein pathology, including the detection of chemical stimulus involved in sensory perception, olfactory receptor activity, and sensory perception of smell. Among genes that were most affected, we validated, by real-time quantitative PCR, the downregulation of MAP3K8, OR10A4, GRM2, OR51B6, and OR9A2, as well as upregulation of IFIT1B, EPN1, OR1D5, LCN, and OTOL1 in PFF-treated RPMI-2650 cells. Subsequent analyses of clinical samples showed a downregulation of OR10A4 and OR9A2 transcripts and an upregulation of IFIT1B in cells isolated from the nasal fluid of PD patients, as compared to those from the controls (cutoff value = 0.5689 for OR9A2, with 72.4% sensitivity and 75% specificity, and 1.4658 for IFIT1B, with 81.8% sensitivity and 77.8% specificity). Expression levels of these nasal PD markers were not altered in nasal fluid cells from SWEDD (scans without evidence of dopaminergic deficits) patients with PD-like motor symptoms. These nasal markers were significantly altered in patients of PD with hyposmia compared to the control hyposmic subjects. Our results validated the α-synuclein-treated nasal epithelial cell model to identify novel biomarkers for PD and suggest the utility of olfactory transcripts, along with olfactory dysfunction, in the diagnosis of PD.

Non-contact diagnosis of obstructive sleep apnea using impulse-radio ultra-wideband radar.

While full-night polysomnography is the gold standard for the diagnosis of obstructive sleep apnea, its limitations include a high cost and first-night effects. This study developed an algorithm for the detection of respiratory events based on impulse-radio ultra-wideband radar and verified its feasibility for the diagnosis of obstructive sleep apnea. A total of 94 subjects were enrolled in this study (23 controls and 24, 14, and 33 with mild, moderate, and severe obstructive sleep apnea, respectively). Abnormal breathing detected by impulse-radio ultra-wideband radar was defined as a drop in the peak radar signal by ≥30% from that in the pre-event baseline. We compared the abnormal breathing index obtained from impulse-radio ultra-wideband radar and apnea-hypopnea index (AHI) measured from polysomnography. There was an excellent agreement between the Abnormal Breathing Index and AHI (intraclass correlation coefficient = 0.927). The overall agreements of the impulse-radio ultra-wideband radar were 0.93 for Model 1 (AHI ≥ 5), 0.91 for Model 2 (AHI ≥ 15), and 1 for Model 3 (AHI ≥ 30). Impulse-radio ultra-wideband radar accurately detected respiratory events (apneas and hypopneas) during sleep without subject contact. Therefore, impulse-radio ultra-wideband radar may be used as a screening tool for obstructive sleep apnea.

Validation of noncontact cardiorespiratory monitoring using impulse-radio ultra-wideband radar against nocturnal polysomnography.

PURPOSE: Polysomnography (PSG) is a standard diagnostic test for obstructive sleep apnea (OSA). However, PSG requires many skin-contacted sensors to monitor vital signs of patients, which may also hamper patients' sleep. Because impulse-radio ultra-wideband (IR-UWB) radar can detect the movements of heart and lungs without contact, it may be utilized for vital sign monitoring during sleep. Therefore, we aimed to verify the accuracy and reliability of the breathing rate (BR) and the heart rate (HR) measured by IR-UWB radar. METHOD: Data acquisition with PSG and IR-UWB radar was performed simultaneously in 6 healthy volunteers and in 15 patients with suspected OSA. Subjects were divided into 4 groups (normal, mild OSA, moderate OSA, and severe OSA) according to the apnea-hypopnea index (AHI). BRs and HRs obtained from the radar using a software algorithm were compared with the BRs (chest belt) and the HRs (electrocardiography) obtained from the PSG. RESULTS: In normal and in mild OSA, BRs (intraclass correlation coefficients R [ICCR] 0.959 [0.956-0.961] and 0.957 [0.955-0.960], respectively) and HRs ([ICCR] 0.927 [0.922-0.931] and 0.926 [0.922-0.931], respectively) measured in the radar showed excellent agreement with those measured in PSG. In moderate and severe OSA, BRs ([ICCR] 0.957 [0.956-0.959] and 0.873 [0.864-0.882], respectively) and HRs ([ICCR] 0.907 [0.904-0.910] and 0.799 [0.784-0.812], respectively) from the two methods also agreed well. CONCLUSIONS: The IR-UWB radar could accurately measure BRs and HRs in sleeping patients with OSA. Therefore, IR-UWB radar may be utilized as a cardiopulmonary monitor during sleep.

Gender-specific cephalometric features related to obesity in sleep apnea patients: trilogy of soft palate-mandible-hyoid bone.

BACKGROUND: The aim of this study is to investigate the relationship between gender-specific and obesity-related airway anatomy in patients with obstructive sleep apnea (OSA) by using cephalometric analyses. METHODS: We retrospectively evaluated 206 patients with suspected OSA undergoing polysomnography and anthropometric measurements such as body mass index, neck circumference, and waist-hip ratio. We checked lateral cephalometry to measure tissue landmarks including angle from A point to nasion to B point (ANB), soft palate length (SPL), soft palate thickness (SPT), retropalatal space (RPS), retrolingual space (RLS), and mandibular plane to hyoid (MPH). RESULTS: Male with OSA showed significantly increased SPL (P = .006) compared with controls. SPL and MPH had significant correlation with apnea-hypopnea index (AHI) and central obesity. Female with OSA showed significantly increased ANB (P = .013) and SPT (P = .004) compared with controls. The receiver operating characteristic curves revealed that SPT in male and ANB and SPT in female were significant in model 1 (AHI ≥ 5) and model 2 (AHI ≥ 15). MPH was also significant for male in model 2. CONCLUSION: Male and female with OSA had distinct anatomic features of the upper airway and different interactions among soft palate, mandible, and hyoid bone.