Effect of particulate matter on continuous positive airway pressure adherence in obstructive sleep apnea patients.

Background: Sleep quality could be affected by air pollution, especially for particulate matter with a diameter of less than 10 microns (PM10) and particulate matter with a diameter of less than 2.5 microns (PM2.5). However, no direct study demonstrates the relationship and impact of air pollution especially PM10 and PM2.5 on continuous positive airway pressure (CPAP) adherence. Thus, we aimed to study the correlation between PM10, PM2.5, and low CPAP adherence in subjects with obstructive sleep apnea (OSA). Methods: We conducted a time-series study from August 2016 to May 2022 in Chiang Mai, Thailand. The data from 2,686 visits of CPAP compliance records from 839 OSA patients' electronic medical records at the Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University, Chiang Mai, Thailand were reviewed. The level of adherence was determined utilizing the provided data. Low CPAP adherence was defined as using CPAP for less than 240 minutes per night or less than 70% of nights (i.e., <5 nights/week) in the previous month. The correlation between the monthly average of PM10 and PM2.5 and the rate of low CPAP adherence was analyzed using generalized linear mixed model (GLMM) after adjustment for confounding factors. Results: There was no effect of an increase in PM10 and PM2.5 on low CPAP adherence [adjusted risk ratio (RR) =0.97; 95% confidence interval (CI): 0.87, 1.09; P value =0.624 and adjusted RR =0.93; 95% CI: 0.81, 1.08; P value =0.350 for PM10 and PM2.5, respectively]. Conclusions: There was no effect of particulate matter on CPAP adherence in OSA patients.

Factors influencing continuous positive airway pressure adherence in elderly with obstructive sleep apnea.

Background: Continuous positive airway pressure (CPAP) is the most effective treatment for symptomatic obstructive sleep apnea (OSA). The identification of actual predictors of CPAP adherence in real-world practice is essential since it enhances more individualized management for the patient. CPAP acceptance and adherence in elderly patients with OSA have the same challenges but the conclusion remains unclear. Therefore, our aim was to explore the factors influencing the adherence of CPAP in elderly OSA patients. Methods: The retrospective observational study was conducted from OSA patients' computerized medical records at Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University Hospital, Chiang Mai, Thailand between 2018 and 2020. Multivariable risk regression analyses were performed to evaluate the independent factors associated with CPAP non-acceptance and CPAP non-adherence. Results: Of the 1,070 patients who underwent overnight polysomnography (PSG), 336 (31.4%) were elderly. Of 759 patients who accepted CPAP treatment, 221 (29.1%) were elderly, including 27 (12.2%) non-adherences, 139 (62.9%) adherences and 55 (24.8%) loss follow-up. Elderly patients with adverse attitudes toward CPAP use affected adherence to treatment [adjusted risk ratio (RR) =4.59, 95% CI: 1.79, 11.78, P=0.002]. Female was also associated with low CPAP adherence with adjusted RR =3.10 (95% CI: 1.07, 9.01), P=0.037. Conclusions: In our largest cohort to date, elderly OSA patients treated with CPAP over long-term follow-ups demonstrated that adherence rates were associated with personal life issues and adverse attitudes towards treatment as well as health problems. Female was also associated with low CPAP adherence. Therefore, in the elderly with OSA, the indication and treatment of CPAP should be customized individually, and if prescribed, regular monitoring to address noncompliance and tolerance should be considered.

Implications of the Presence of Hyperdense Middle Cerebral Artery Sign in Determining the Subtypes of Stroke Etiology.

BACKGROUND: Identifying stroke subtypes is crucial in choosing appropriate treatment, predicting outcomes, and managing recurrent stroke prevention. OBJECTIVES: To study the association of hyperdense middle cerebral artery sign (HMCAS) on noncontrast computed tomography (NCCT) brain and subtypes of stroke etiology. METHODS: This is a retrospective hypothesis testing study. Patients aged 18 or over who had middle cerebral artery occlusion symptoms with HMCAS with verification on brain NCCT and received intravenous thrombolysis between January 2016 and June 2019 were enrolled. The demographic data, clinical outcomes, stroke subtypes, and characteristics of HMCAS were collected from medical records. RESULTS: Ninety-nine out of 299 enrolled patients presented with HMCAS. The most common stroke subtype was cardioembolism (59%). Of the baseline characteristics, hypertension was more common in cases of large-artery atherosclerosis (LAA) (86.4%), and atrial fibrillation (AF) was the highest in cardioembolism (44.8%). HMCAS disappearance in cardioembolism was lowest compared to LAA and others (63% vs. 91% vs. 94.7%, respectively). The univariable analysis found that HMCAS disappearance is significantly associated with all stroke subtypes (Odds ratio, 95% confidence interval 10.58, 1.31-85.43; P = 0.027 for other and 5.88, 1.24-27.85; P = 0.026 for LAA). Multinomial logistic regression found that body weight and hypertension were associated with the LAA subtype. AF and intracranial hemorrhage (ICH) were associated with cardioembolism. CONCLUSION: The most likely diagnosis from the presence of HMCAS is cardioembolism, but the definite stroke etiologic subtype can not be identified. Combining the patient risk factors, including body weight, hypertension, and AF, with HMCAS and its characteristics will predict stroke subtypes more accurately.

Prevalence and Clinical Characteristics of Probable REM Behavior Disorder in Thai Parkinson's Disease Patients.

BACKGROUND: Previous studies have shown that Parkinson's disease (PD) patients who have REM behavior disorder (PD with RBD) might be a PD subtype since they have different symptom clusters and disease trajectories from PD without RBD. OBJECTIVE: To study the prevalence of PD with pRBD and to compare the clinical characteristics with PD without pRBD. The feasibility of clinical interview of items adopted from the Mayo Sleep Questionnaire was also to be determined. METHODS: A total of 140 Parkinson's patients visiting neurological clinics during January to December 2016 were enrolled in this study. "Probable RBD (pRBD)" was defined as present when the patient answered "yes" to a question adapted from the first Mayo Sleep Questionnaire (MSQ). The demographic data, motor symptoms, and nonmotor symptoms were obtained. RESULTS: The prevalence of pRBD among this study's PD patients was 48.5% (68 out of the total of 140). The median onset of RBD before PD diagnosis was 5 years (range: 0-11 years). By comparison of PD with pRBD and PD without pRBD, this study showed significant difference in the levodopa equivalent dose (742 mg/day versus 566 mg/day; p < 0.01), prevalence of symptomatic orthostatic hypotension (35.3% versus 8.3%; p < 0.01). The multivariable analysis found that pRBD is independently associated with orthostatic hypotension (OR = 5.02, p < 0.01). Conclusion. The findings regarding prevalence and main clinical features of PD with pRBD in this study were similar to those of a previous study of PD with polysomnogram- (PSG-) proven RBD. This study hypothesized that interviewing by adopted MSQ may be a cost-effective tool for screening RBD. Further studies with direct comparison are needed.