5,693 research outputs found
Screening of Obstructive Sleep Apnea with Empirical Mode Decomposition of Pulse Oximetry
Detection of desaturations on the pulse oximetry signal is of great
importance for the diagnosis of sleep apneas. Using the counting of
desaturations, an index can be built to help in the diagnosis of severe cases
of obstructive sleep apnea-hypopnea syndrome. It is important to have automatic
detection methods that allows the screening for this syndrome, reducing the
need of the expensive polysomnography based studies. In this paper a novel
recognition method based on the empirical mode decomposition of the pulse
oximetry signal is proposed. The desaturations produce a very specific wave
pattern that is extracted in the modes of the decomposition. Using this
information, a detector based on properly selected thresholds and a set of
simple rules is built. The oxygen desaturation index constructed from these
detections produces a detector for obstructive sleep apnea-hypopnea syndrome
with high sensitivity () and specificity () and yields better
results than standard desaturation detection approaches.Comment: Accepted in Medical Engineering and Physic
Resting state functional thalamic connectivity abnormalities in patients with post-stroke sleep apnoea: a pilot case-control study
OBJECTIVE: Sleep apnoea is common
after stroke, and has adverse effects on the
clinical outcome of affected cases. Its pathophysiological
mechanisms are only partially known. Increases
in brain connectivity after stroke might influence
networks involved in arousal modulation
and breathing control. The aim of this study was to
investigate the resting state functional MRI thalamic
hyper connectivity of stroke patients affected
by sleep apnoea (SA) with respect to cases not
affected, and to healthy controls (HC).
PATIENTS AND METHODS: A series of stabilized
strokes were submitted to 3T resting state
functional MRI imaging and full polysomnography.
The ventral-posterior-lateral thalamic nucleus was
used as seed.
RESULTS: At the between groups comparison
analysis, in SA cases versus HC, the regions significantly
hyper-connected with the seed were
those encoding noxious threats (frontal eye
field, somatosensory association, secondary visual
cortices). Comparisons between SA cases
versus those without SA, revealed in the former
group significantly increased connectivity with
regions modulating the response to stimuli independently
to their potentiality of threat (prefrontal,
primary and somatosensory association, superolateral
and medial-inferior temporal, associative
and secondary occipital ones). Further
significantly functionally hyper connections were
documented with regions involved also in the modulation
of breathing during sleep (pons, midbrain,
cerebellum, posterior cingulate cortices), and in
the modulation of breathing response to chemical
variations (anterior, posterior and para-hippocampal
cingulate cortices).
CONCLUSIONS: Our preliminary data support
the presence of functional hyper connectivity in
thalamic circuits modulating sensorial stimuli, in
patients with post-stroke sleep apnoea, possibly
influencing both their arousal ability and breathing
modulation during sleep
Characterization of the microvascular cerebral blood flow response to obstructive apneic events during night sleep
Peer ReviewedPostprint (author's final draft
Sleep clinical record. what differences in school and preschool children?
The sleep clinical record (SCR) may be a valid method for detecting children with obstructive sleep apnoea (OSA). This study aimed to evaluate whether there were differences in SCR depending on age and to identify the possible risk factors for OSA development. We enrolled children with sleep disordered breathing between 2013 and 2015, and divided them according to age into preschool- and school-age groups. All patients underwent SCR and polysomnography. OSA was detected in 81.1% and 83.6% of preschool- and school-age groups, respectively. Obesity, malocclusions, nasal septal deviation and inferior turbinate hypertrophy were significantly more prevalent in school-age children (p6.5 had a sensitivity of 74% in predicting OSA in preschool children with positive predictive value of 86% (p=0.0001). Our study confirms the validity of the SCR as a screening tool for patient candidates for a PSG study for suspected OSA, in both school and preschool children
Unconstrained video monitoring of breathing behavior and application to diagnosis of sleep apnea
This paper presents a new real-time automated infrared video monitoring technique for detection of breathing anomalies, and its application in the diagnosis of obstructive sleep apnea. We introduce a novel motion model to detect subtle, cyclical breathing signals from video, a new 3-D unsupervised self-adaptive breathing template to learn individuals' normal breathing patterns online, and a robust action classification method to recognize abnormal breathing activities and limb movements. This technique avoids imposing positional constraints on the patient, allowing patients to sleep on their back or side, with or without facing the camera, fully or partially occluded by the bed clothes. Moreover, shallow and abdominal breathing patterns do not adversely affect the performance of the method, and it is insensitive to environmental settings such as infrared lighting levels and camera view angles. The experimental results show that the technique achieves high accuracy (94% for the clinical data) in recognizing apnea episodes and body movements and is robust to various occlusion levels, body poses, body movements (i.e., minor head movement, limb movement, body rotation, and slight torso movement), and breathing behavior (e.g., shallow versus heavy breathing, mouth breathing, chest breathing, and abdominal breathing). Ă© 2013 IEEE
Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy.
AIM:
To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA).
METHODS:
A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant.
RESULTS:
Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]).
CONCLUSIONS:
These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease
The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience
The prevalence of resistant hypertension (RHT) still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH). We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM) was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA). Only 232 (5.8%) hypertensive patients fulfilled criteria for RHT. 91 (39%) had a SH; 56 (61%) hypertensive patients had a primary aldosteronism, 22 (24%) had OSA, 7 (7.7%) had a hypercortisolism, and 5 (5.5%) had a renovascular hypertension (RVH). Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment
Oximetry use in obstructive sleep apnea
ProducciĂłn CientĂficaIntroduction. Overnight oximetry has been proposed as an accessible, simple, and reliable technique for obstructive sleep apnea syndrome (OSAS) diagnosis. From visual inspection to advanced signal processing, several studies have demonstrated the usefulness of oximetry as a screening tool. However, there is still controversy regarding the general application of oximetry as a single screening methodology for OSAS.
Areas covered. Currently, high-resolution portable devices combined with pattern recognition-based applications are able to achieve high performance in the detection this disease. In this review, recent studies involving automated analysis of oximetry by means of advanced signal processing and machine learning algorithms are analyzed. Advantages and limitations are highlighted and novel research lines aimed at improving the screening ability of oximetry are proposed.
Expert commentary. Oximetry is a cost-effective tool for OSAS screening in patients showing high pretest probability for the disease. Nevertheless, exhaustive analyses are still needed to further assess unattended oximetry monitoring as a single diagnostic test for sleep apnea, particularly in the pediatric population and in especial groups with significant comorbidities. In the following years, communication technologies and big data analysis will overcome current limitations of simplified sleep testing approaches, changing the detection and management of OSAS.This research has been partially supported by the projects DPI2017-84280-R and RTC-2015-3446-1 from Ministerio de EconomĂa, Industria y Competitividad and European Regional Development Fund (FEDER), the project 66/2016 of the Sociedad Española de NeumologĂa y CirugĂa TorĂĄcica (SEPAR), and the project VA037U16 from the ConsejerĂa de EducaciĂłn de la Junta de Castilla y LeĂłn and FEDER. D. Ălvarez was in receipt of a Juan de la Cierva grant IJCI-2014-22664 from the Ministerio de EconomĂa y Competitividad
Nocturnal Oximetry-based Evaluation of Habitually Snoring Children
Rationale: The vast majority of children around the world
undergoing adenotonsillectomy for obstructive sleep
apneaâhypopnea syndrome (OSA) are not objectively diagnosed by
nocturnal polysomnography because of access availability and cost
issues. Automated analysis of nocturnal oximetry (nSpO2), which is
readily and globally available, could potentially provide a reliable and
convenient diagnostic approach for pediatric OSA.
Methods: DeidentifiednSpO2 recordings froma total of 4,191 children
originating from13 pediatric sleep laboratories around the worldwere
prospectively evaluated after developing and validating an automated
neural network algorithm using an initial set of single-channel nSpO2
recordings from 589 patients referred for suspected OSA.
Measurements and Main Results: The automatically
estimated apneaâhypopnea index (AHI) showed high
agreement with AHI from conventional polysomnography
(intraclass correlation coefficient, 0.785) when tested in 3,602
additional subjects. Further assessment on the widely used AHI
cutoff points of 1, 5, and 10 events/h revealed an incremental
diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and
0.913 area under the receiver operating characteristic curve,
respectively).
Conclusions: Neural networkâbased automated analyses of
nSpO2 recordings provide accurate identification of OSA
severity among habitually snoring children with a high pretest
probability of OSA. Thus, nocturnal oximetry may enable a
simple and effective diagnostic alternative to nocturnal
polysomnography, leading to more timely interventions and
potentially improved outcomes.Supported in part by project VA037 U16 from the ConsejerŽıa de EducacioÂŽ n de la Junta de Castilla y LeoÂŽ n and the European Regional Development Fund (FEDER), project RTC-2015-3446-1 from the Ministerio de EconomŽıa y Competitividad and FEDER, and project 153/2015 of the Sociedad EspanË ola de NeumologŽıa y CirugŽıa ToraÂŽ cica (SEPAR). L.K.-G. is supported by NIH grant 1R01HL130984. M.F.P. was supported by a Fellowship Educational grant award from the Kingdom of Saudi Arabia. D.ÂŽA. was in receipt of a Juan de la Cierva grant from the Ministerio de EconomŽıa y Competitividad. The funders played no role in the study design, data collection, data analysis, interpretation, and writing of the manuscript
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