Diagnosis of obstructive sleep apnea using a bio-radar contact-free system compared with an established HST device in older adults.

GOAL AND AIMS: To compare a bio-radar contact-free monitoring device in diagnosing obstructive sleep apnea (OSA) in older people with an established home sleep apnea testing system (HST). FOCUS METHOD/TECHNOLOGY: A bio-radar contact-free monitoring device (OrbSense+). REFERENCE METHOD/TECHNOLOGY: An established HST, Alice NightOne. SAMPLE: Fifty-three out of 63 recruited subjects were included in the final analysis. Seventy-two percent were male (age 72 ± 9 years; body mass index 31.05 ± 5.56 kg/m2). DESIGN: An observational, prospective study. CORE ANALYTICS: Intraclass correlation coefficient (ICC), Bland-Altman analysis, and receiver operating characteristic analysis. ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES: None. CORE OUTCOMES: Both 45 (84.91%) were diagnosed with OSA by Alice NightOne (average respiratory event index = 21.23 events/h) and by OrbSense+ (average respiratory event index = 25.98 events/h). Respiratory event index and oxygen desaturation index obtained by Alice NightOne and OrbSense+ were highly correlated, with ICC of 0.93 and 0.88, respectively. The Bland-Altman plot comparing the means showed good agreement between the 2 diagnostic techniques. With more than 5 respiratory events per hour as the standard for OSA diagnosis, OrbSense+ had a sensitivity of 100% and a specificity of 100% in diagnosis of OSA (P < .0001). With more than 15 respiratory events per hour as the standard for OSA diagnosis, OrbSense+ was found to have a sensitivity of 100% and a specificity of 86.96% in diagnosis of OSA (P < .0001). IMPORTANT ADDITIONAL OUTCOMES: None. CORE CONCLUSION: The bio-radar sleep monitoring device is a reasonably accurate home sleep apnea test for use in older patients.

SERPINA1 Methylation Levels are Associated with Lung Cancer Development in Male Patients with Chronic Obstructive Pulmonary Disease.

Purpose: The mechanism of lung cancer (LC) in male patients with chronic obstructive pulmonary disease (COPD) has not been well understood, and the early diagnosis is currently challenging. The study aimed to explore the association of DNA methylation levels with LC development in male COPD patients. Patients and Methods: A total of 147 male participants were divided into four groups, ie, COPD+LC group, COPD group, LC group, and control (CON) group. The methylation levels of human serine protease inhibitor A1 (SERPINA1) and the serum levels of inflammatory biomarkers were compared among groups. Multivariate logistic regression was performed to explore the correlation of inflammatory biomarkers and gene methylation with lung cancer combining COPD. Results: SERPINA1 methylation levels were significantly higher in the COPD+LC group than that in the COPD group and LC group, respectively (all p < 0.05). The serum levels of interleukin (IL)-1ß, IL-17, and transforming growth factor (TGF)-ß1 were significantly higher in the COPD+LC group than in the LC group (all p < 0.05). The SERPINA1 methylation levels were positively correlated with the IL-1ß levels (r = 0.5188, p = 0.0012). The AUC (area under curve) of SERPINA1 methylation for the diagnosis of LC in COPD was 0.677 (sensitivity of 52.2% and specificity of 78.2%). Conclusion: The methylation of SERPINA1 is linked to LC in patients with COPD. The SERPINA1 methylation levels were positively correlated with the IL-1ß levels. These findings may be of diagnostic value.

Changes of circulating biomarkers of inflammation and glycolipid metabolism by CPAP in OSA patients: a meta-analysis of time-dependent profiles.

Background: Continuous positive airway pressure (CPAP) is the first-line therapy for moderate-to-severe obstructive sleep apnea (OSA). Specifying timing of CPAP benefits on OSA-related biomarkers will help to assess the effectiveness of CPAP and to optimize the treatment strategies. Purpose: To explore the time-dependent changes of circulating biomarkers to CPAP treatment in patients with OSA, including inflammatory biomarkers [C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α)] and glycolipid metabolic biomarkers [fasting blood glucose (FBG), fasting insulin (FINS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG)]. Methods: Searches of PubMed and Embase database were completed. Two independent reviewers extracted data from 68 included studies. A meta-analysis was conducted using a random-effect (or fixed-effect) model and standardized mean difference (SMD) model. The timing profiles of circulating biomarkers changes of inflammation and glycolipid metabolism were analyzed based on different CPAP duration, that is, short-term (<3 months), mid-term (3-6 months), and long-term (⩾6 months). Results: Those first improved by short-term treatment include CRP [SMD: 0.73, 95% confidence interval (CI): 0.15-1.31; p = 0.014], TNF-α [SMD: 0.48 (95% CI: 0.10-0.86; p = 0.014)], FBG [SMD: 0.32 (95% CI: 0.07-0.57; p = 0.011)], and LDL [SMD: 0.40 (95% CI: 0.18-0.62; p = 0.000)]. Those first improved by the mid-term or long-term treatment include HDL [SMD: -0.20 (95% CI: -0.36 to -0.03; p = 0.018)] and TC [SMD: 0.20 (95% CI: 0.05-0.34; p = 0.007)]. There were insignificant changes for TG and FINS after short or long CPAP. Conclusion: Our results imply that changes of circulating biomarkers for patients with OSA under CPAP treatment have a time-dependent profile.

Moderate to severe OSA screening based on support vector machine of the Chinese population faciocervical measurements dataset: a cross-sectional study.

OBJECTIVES: Obstructive sleep apnoea (OSA) has received much attention as a risk factor for perioperative complications and 68.5% of OSA patients remain undiagnosed before surgery. Faciocervical characteristics may screen OSA for Asians due to smaller upper airways compared with Caucasians. Thus, our study aimed to explore a machine-learning model to screen moderate to severe OSA based on faciocervical and anthropometric measurements. DESIGN: A cross-sectional study. SETTING: Data were collected from the Shanghai Jiao Tong University School of Medicine affiliated Ruijin Hospital between February 2019 and August 2020. PARTICIPANTS: A total of 481 Chinese participants were included in the study. PRIMARY AND SECONDARY OUTCOME: (1) Identification of moderate to severe OSA with apnoea-hypopnoea index 15 events/hour and (2) Verification of the machine-learning model. RESULTS: Sex-Age-Body mass index (BMI)-maximum Interincisal distance-ratio of Height to thyrosternum distance-neck Circumference-waist Circumference (SABIHC2) model was set up. The SABIHC2 model could screen moderate to severe OSA with an area under the curve (AUC)=0.832, the sensitivity of 0.916 and specificity of 0.749, and performed better than the STOP-BANG (snoring, tiredness, observed apnea, high blood pressure, BMI, age, neck circumference, and male gender) questionnaire, which showed AUC=0.631, the sensitivity of 0.487 and specificity of 0.772. Especially for asymptomatic patients (Epworth Sleepiness Scale <10), the SABIHC2 model demonstrated better predictive ability compared with the STOP-BANG questionnaire, with AUC (0.824 vs 0.530), sensitivity (0.892 vs 0.348) and specificity (0.755 vs 0.809). CONCLUSION: The SABIHC2 machine-learning model provides a simple and accurate assessment of moderate to severe OSA in the Chinese population, especially for those without significant daytime sleepiness.

A narrative review of exploring potential salivary biomarkers in respiratory diseases: still on its way.

Saliva is abundant with proteins, metabolites, DNA, and a diverse range of bacterial species. During the past two decades, saliva has emerged as a novel diagnostic and evaluation medium for several diseases. Collection of saliva samples is simple, minimally invasive, and convenient even in infants, children, and patients with anxious. Furthermore, with the development of hypersensitive techniques [e.g., microsensor arrays, enzyme-labeled immunosensors, nanoparticle-labeled immunosensors, capacitive or impedimetric immunosensors, magneto immunosensors, field effect transistor immunosensors, and surface enhanced Raman spectroscopy (SERS)], the sensitivity and accuracy of saliva diagnostic procedures have been improved. Nowadays, saliva has been used as a potential medium for several disease diagnosis and assessment, such as periodontitis, caries, cancers, diabetes mellitus, and cardiovascular diseases. Saliva has been used widely for studying microbiomics, genomics, transcriptomics, proteomics, and metabolomics of respiratory diseases, however, the use of salivary biomarkers for the diagnosis, prognosis, and monitoring of respiratory disease is still in its infancy. Herein, we review the progress of research on salivary biomarkers related to several respiratory diseases, including bronchial asthma, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), pneumonia, tuberculosis (TB), Langerhans cell histiocytosis (LCH) and cystic fibrosis (CF). Furthermore, several limitations of saliva test such as the lack of standard protocol for saliva collection and reasonable reference values for saliva test are also mentioned in this review.

Therapeutic Agents Rounding Up the Immunopathology of COVID-19.

COVID-19 pandemic has caused more than 3 million deaths globally during the past year. The direct attack from SARS-CoV-2 and hyperactivated immune response contribute to the progress and deterioration of COVID-19. After the virus invades, the activation and release of cytokines/chemokines cause "cytokine storm", leading to acute respiratory distress syndrome (ARDS) and multiple organs dysfunction syndrome (MODS). Eliminating virus and blocking cytokines are important checkpoints of COVID-19 therapy, and several agents targeting immunopathology, including interferons, thymosin, glucocorticoids and immunoglobulin, have shown therapeutic effects in severe patients with COVID-19. Herein, we reviewed the practice evidences and concluded that several agents rounding up the immunopathology of COVID-19 may be the alternative approaches under the scenario of the lacking of effective antiviral drugs.

Burden of Sleep Disturbance During COVID-19 Pandemic: A Systematic Review.

Coronavirus disease 2019 (COVID-19) pandemic may exert adverse impacts on sleep among populations, which may raise awareness of the burden of sleep disturbance, and the demand of intervention strategies for different populations. We aimed to summarize the current evidence for the impacts of COVID-19 on sleep in patients with COVID-19, healthcare workers (HWs), and the general population. We searched PubMed and Embase for studies on the prevalence of sleep disturbance. Totally, 86 studies were included in the review, including 16 studies for COVID-19 patients, 34 studies for HWs, and 36 studies for the general population. The prevalence of sleep disturbance was 33.3%-84.7%, and 29.5-40% in hospitalized COVID-19 patients and discharged COVID-19 survivors, respectively. Physiologic and psychological traumatic effects of the infection may interact with environmental factors to increase the risk of sleep disturbance in COVID-19 patients. The prevalence of sleep disturbance was 18.4-84.7% in HWs, and the contributors mainly included high workloads and shift work, occupation-related factors, and psychological factors. The prevalence of sleep disturbance was 17.65-81% in the general population. Physiologic and social-psychological factors contributed to sleep disturbance of the general population during COVID-19 pandemic. In summary, the sleep disturbance was highly prevalent during COVID-19 pandemic. Specific health strategies should be implemented to tackle sleep disturbance.

The Role of Aldosterone in OSA and OSA-Related Hypertension.

Obstructive sleep apnea (OSA) is regarded as an independent risk factor for hypertension. The possible mechanism includes oxidative stress, endothelial injury, sympathetic excitement, renin-angiotensin-aldosterone system activation, etc. Clinical studies have found that there is a high coexistence of OSA and primary aldosteronism in patients with hypertension and that elevated aldosterone levels are independently associated with OSA severity in resistant hypertension. The underlying mechanism is that aldosterone excess can exacerbate OSA through increasing overnight fluid shift and affecting the mass and function of upper airway muscles during the sleep period. Thus, a bidirectional influence between OSA and aldosterone exists and contributes to hypertension in OSA patients, especially resistant hypertension.

Autophagy Promotes Peripheral Nerve Regeneration and Motor Recovery Following Sciatic Nerve Crush Injury in Rats.

Autophagy maintains cellular homeostasis by stimulating the lysosomal degradation of cytoplasmic structures, including damaged organelles and dysfunctional proteins. The role of autophagy in the renewal and regeneration of injured peripheral nerves remains poorly understood. The current study investigated the role of autophagy in peripheral nerve regeneration and motor function recovery following sciatic nerve crush injury in rats by stimulating or suppressing autophagy and detecting the presence of autophagosomes and LC3-II expression by electron microscopy and Western blotting, respectively. Neurobehavioral function was tested by CatWalk gait analysis 1, 2, 3, and 6 weeks after injury, and the expression of neurofilament (NF)-200 and myelin basic protein (MBP) at the injury site was examined by immunocytochemistry. Apoptosis at the lesion site was determined by the terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Treatment of injured rats with the autophagy inducer rapamycin increased the number of autophagosomes and LC3-II expression while reducing the number of apoptotic cells at the lesion; this was associated with an upregulation of MBP and NF-200 expression and increased motor function recovery as compared to sham-operated rats and those that were subjected to crush injury but untreated. The opposite effects were observed in rats treated with the autophagy inhibitor 3-methyladenine. These data indicate that the modulation of autophagy in peripheral nerve injury could be an effective pharmacological approach to promote nerve regeneration and reestablish motor function.

[Determination of the 50% effective concentration of dexmedetomidine as an adjuvant in combined spinal-epidural anesthesia with Narcotrend].

OBJECTIVE: To determine the 50% effective concentration (EC(50) ) of dexmedetomidine (DEX) as an adjuvant for achieving the minimal effect in combined spinal-epidural anesthesia (CSEA) with Narcotrend. METHODS: Thirty ASA class I-II patients undergoing CSEA were allocated to receive 0.5% bupivacaine injection (2 ml) in the subarachnoid space, followed by a target-controlled infusion of DEX for at least 60 min. The target concentration of DEX was adjusted according to the response of the previous patient using a double-blind, up-and-down sequential method. The initial DEX concentration of the first patient was 0.5 ng/ml. An Observers Assessment of Alertness/Sedation Scale (OAA/S) score of no more than 3 within 30 min defined an effective sedation. The Narcotrend index (NTI) related to the OAA/S score was recorded as well. The correlation between Narcotrend and OAA/S score was analyzed. RESULTS: The EC(50) of DEX as an adjuvant in CSEA was 0.35∓0.07 ng/ml. The NTI was positively correlated to the OAA/S score (r=0.967, P=0.000). The regression equation was OAA/S =-3.922+0.094NTI (F=401.710, P=0.000). CONCLUSION: We suggest a novel protocol using DEX as a adjunct in CSEA. The EC(50) % of DEX to result in ideal sedation (OAA/S≤3) was 0.35∓0.07 ng/ml. NTI may serve as an objective index for sedation assessment in CSEA.

[Effect of the degree of muscle relaxation on motor-evoked potential elicited by transcranial electrical stimulation in spine surgery].

OBJECTIVE: To study the effect of the degree of muscle relaxation on motor-evoked potential elicited by transcranial electrical stimulation in patients undergoing spine surgery. METHODS: Sixty ASA I or II patients undergoing spine surgery were randomly divided into 5 groups (n=12). After an initial intubation, continuous cisatracurium infusion was administered with continuous monitoring of T1. The infusion dose was adjusted according muscle relaxation monitoring, and different muscle relaxation degrees were maintained in the 5 groups. The band and latency of D1 in motor-evoked potential was observed with also subjective assessment of the muscle relaxation. RESULTS: Significant differences in the band and latency were noted in groups I and II compared with the reference values, but not in groups III, IV and V. Subjective assessment revealed significant differences between groups IV and V and groups I and III in terms of the number of cases with poor muscle relaxation. CONCLUSION: T1 value between 10% and 15% is sufficient for MEP monitoring and allows the maintenance of good muscle relaxation during spine surgery.

[Influence of epidural ropivacaine in combination with fentanyl for labor analgesia on the clinical outcome of labor].

OBJECTIVE: To investigate the effect of epidural ropivacaine in combination with fentanyl for labor analgesia on the clinical outcome of labor. METHODS: A retrospective study was conducted involving 281 healthy primiparas, including 106 undergoing spontaneous labor who received epidural 0.15% ropivacaine in combination with fentany (1microg/ml) and 175 without epidural analgesia. The active phase duration, durations of each labor stages, delivery modes, management of labor, postpartum hemorrhage, incidence of fetal distress and asphyxia neonatorum were recorded in the two groups. The visual analogue scale (VAS) was used to assess the pain of uterine contraction, and modified Bromage scoring system applied to evaluate the lower limb motor block. RESULTS: There were no significant differences in the duration of the first, third or the total labor stages between the two groups, but the second labor stage was prolonged in the labor analgesia group. The ratio of spontaneous labor, assisted vaginal delivery, and incidence of asphyxia neonatorum were higher, whereas the duration of the active stage was shortened in the analgesia group. CONCLUSION: Epidural ropivacaine in combination with fentanyl in labor can decrease the incidence of cesarean section, and the duration of the active stage can be shortened with application of ocytocin.