174 Reverse atrial electrical remodeling induced by CPAP in patients with severe sleep apnea
H PangD. P. RedfearnC.S. SimpsonK. MichaelEdísio PereiraPeter W. MuntM F FitzpatrickAdrián Baranchuk
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Apnea–hypopnea index
Nocturnal muscle activity in legs (MAL) was studied in 19 patients with sleep apnea syndrome before and during nCPAP. We distinguished periodic (P-MAL) and nonperiodic (N-MAL) as well as apnea-associated and independent MALs. N-MALs were strongly associated with apneas and disappeared during nasal continuous positive airway pressure (nCPAP). P-MALs showed a rather long intermovement interval (IMI) of about 54 s when associated with respiratory disturbances and a shorter one of about 38 s when occurring independently. In 5 patients with predominantly independent P-MALs and a short IMI before and during nCPAP an incidental coexistence of sleep apnea with periodic leg movements in sleep syndrome (PLMS) was postulated. Five patients with an equal number of apnea-associated and independent MALs before nCPAP had a long IMI which shortened under nCPAP, while the majority of MALs become independent. This could indicate a facilitating or an unmasking effect of nCPAP on PLMS. Four patients with predominantly apnea-associated MALs with a long IMI before nCPAP showed an unchanged MAL pattern under nCPAP, despite the disappearance of apneas. Since some arousals persisted in these patients, insufficient nCPAP pressure with an upper airway resistance syndrome was suspected. We conclude that when P-MALs persist under nCPAP therapy a long IMI may indicate an upper airway resistance syndrome, whereas a short IMI may indicate a coexisting or even induced PLMS.
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Apnea–hypopnea index
Positive airway pressure
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The gold standard for assessing sleep apnea, polysomnography, is resource intensive and inconvenient. Thus, several simpler alternatives have been proposed. However, validations of these alternatives have focused primarily on estimating the apnea‐hypopnea index (apnea events per hour of sleep), which means information, clearly important from a physiological point of view such as apnea type, apnea duration, and temporal distribution of events, is lost. The purpose of the present study was to investigate if this information could also be provided with the combination of radar technology and pulse oximetry by classifying sleep apnea events on a second‐by‐second basis. Fourteen patients referred to home sleep apnea testing by their medical doctor were enrolled in the study (6 controls and 8 patients with sleep apnea; 4 mild, 2 moderate, and 2 severe) and monitored by Somnofy (radar‐based sleep monitor) in parallel with respiratory polygraphy. A neural network was trained on data from Somnofy and pulse oximetry against the polygraphy scorings using leave‐one‐subject‐out cross‐validation. Cohen’s kappa for second‐by‐second classifications of no event/event was 0.81, or almost perfect agreement. For classifying no event/hypopnea/apnea and no event/hypopnea/obstructive apnea/central apnea/mixed apnea, Cohen’s kappa was 0.43 (moderate agreement) and 0.36 (fair agreement), respectively. The Bland‐Altman 95% limits of agreement for the respiratory event index (apnea events per hour of recording) were ‐8.25 and 7.47, and all participants were correctly classified in terms of sleep apnea severity. Furthermore, the results showed that the combination of radar and pulse oximetry could be more accurate than the two technologies separately. Overall, the results indicate that radar technology and pulse oximetry could reliably provide information on a second‐by‐second basis for no event/event which could be valuable for management of sleep apnea. To be clinically useful, a larger study is necessary to validate the algorithm on a general population.
Pulse Oximetry
Hypopnea
Apnea–hypopnea index
Central sleep apnea
Gold standard (test)
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Indroduction: Treatment-emergent central sleep apnea(complex sleep apnea) has been observed in approximately 3,5%-20% of patients treated with CPAP for obstructive sleep apnea Aims and objectives: To identify facrors that influence the evolution of treatment-emergent central sleep apnea Patients and methods: 40 patients diagnosed with treatment-emergent central sleep apnea in a general hospital were followed up using data from the CPAP memory cards and repeated clinical examinations.95% were men, with mean age:61±9.7 years, Body Mass Index:29.1±4.2 and polysomnography Apnea Hypopnea Index(AHI):60.9±27.2 Results: 2 to 6 months after the initiatin of treatment with CPAP 45.9% of patients had a residual AHI<5, whereas only 8% had residual AHI>15. There was a further resolution of treatment-emergent central sleep apnea after the initial 6 months of follow-up. Changes in the initial CPAP pressure settings were not found to be related to residual AHI improvement. Conclusions: Improvement in residual AHI of treatment-emergent central sleep apnea patients beyond the initial 6 months warrants further investigation.Changes in the initial CPAP pressure settings are not correlated to improved residual AHI
Central sleep apnea
Apnea–hypopnea index
Sleep
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Apnea of prematurity
Airway obstruction
Positive pressure
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Sleep
Positive airway pressure
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In patients with obstructive sleep apnea (OSA) and epilepsy, the frequency of generalized spike and wave complexes (GSWCs) usually decreases after the initiation of nasal continuous positive airway pressure (nCPAP) therapy. However, we herein report a patient who had a transient increase in GSWCs following nCPAP treatment. A woman with epilepsy underwent polysomnography, who showed severe OSA and 30 GSWCs during the sleep study. Polysomnography at the introduction nCPAP showed that the GSWCs increased to 94 times during the monitoring period, despite improvement of her OSA. Polysomnography was again performed four months later, and the GSWCs had decreased to 23 times. Physicians should therefore be cautious regarding a possible increase in epileptiform discharges and seizures immediately after the introduction of nCPAP.
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Objective Of continuous positive airway pressure(CPAP) for the treatment of neonatal apnea effects of repeated. Methods Observed before and after CPAP treatment changes in the number of apnea episodes and the changes in blood gas before and after treatment to determine efficacy. Results As a result of the original incidence varied in different effects,with a total effective rate of 80%. After treatment,pH and PaO2 significantly increased,the partial pressure of carbon dioxide had no significant change(P ＞0.05). Conclusion CPAP treatment of neonatal apnea repeatedly significant,it is worth at all levels to promote the use of the hospital.
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Apnea; Newborn; Continuous positive airway pressure; Blood gas analysis
Positive airway pressure
Positive pressure
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In this work, a method to analyse the effects of an apnea on the pulse photopletismography signal (PPG) is proposed. Therefore, an apnea detector based on respiratory signals has been developed and a decreases in amplitude of PPG (DAP) detector developed in a previous study was used. The apnea detector was tested using real signals. S and +PV of the detector were 95.3% and 94.4%, respectively. For each of the apneic events, we analyzed the presence of DAP in a window previous to the apnea event and another during/following the apnea. An increase of about 15% in DAP events in the window during/following the apnea with respect to the previous to apnea window is produced. These results shows an association between apneic events and DAP events, which indicates that DAP events provide useful information in sleep research and PPG signals might be useful in the diagnosis of OSAS
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