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). © 2013 IEEE

Bionic for Training: Smart Framework Design for Multisensor Mechatronic Platform Validation

: Home monitoring supports the continuous improvement of the therapy by sharing data with healthcare professionals. It is required when life-threatening events can still occur after hospital discharge such as neonatal apnea. However, multiple sources of external noise could affect data quality and/or increase the misdetection rate. In this study, we developed a mechatronic platform for sensor characterizations and a framework to manage data in the context of neonatal apnea. The platform can simulate the movement of the abdomen in different plausible newborn positions by merging data acquired simultaneously from three-axis accelerometers and infrared sensors. We simulated nine apnea conditions combining three different linear displacements and body postures in the presence of self-generated external noise, showing how it is possible to reduce errors near to zero in phenomena detection. Finally, the development of a smart 8Ws-based software and a customizable mobile application were proposed to facilitate data management and interpretation, classifying the alerts to guarantee the correct information sharing without specialized skills

Bionic for training: Smart framework design for multisensor mechatronic platform validation

Home monitoring supports the continuous improvement of the therapy by sharing data with healthcare professionals. It is required when life-threatening events can still occur after hospital discharge such as neonatal apnea. However, multiple sources of external noise could affect data quality and/or increase the misdetection rate. In this study, we developed a mechatronic platform for sensor characterizations and a framework to manage data in the context of neonatal apnea. The platform can simulate the movement of the abdomen in different plausible newborn positions by merging data acquired simultaneously from three-axis accelerometers and infrared sensors. We simulated nine apnea conditions combining three different linear displacements and body postures in the presence of self-generated external noise, showing how it is possible to reduce errors near to zero in phenomena detection. Finally, the development of a smart 8Ws-based software and a customizable mobile application were proposed to facilitate data management and interpretation, classifying the alerts to guarantee the correct information sharing without specialized skills

Is the infant car seat challenge useful?:A pilot study in a simulated moving vehicle

Background and objective The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants. Methods A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°). Results Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg). Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations &lt;85% significantly increased during motion, regardless of gestational age. Conclusions This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.</p

Dreaming and parasomnias - a case with severe parasomnia overlap disorder and its treatment

Peer reviewe

Awake Fiberoptic Intubation Protocols in the Operating Room for Anticipated Difficult Airway: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Awake fiberoptic intubation is one of the recommended strategies for surgical patients with anticipated difficult airway, especially when concurrent difficult ventilation is expected. We performed the first systematic review of randomized controlled trials assessing different protocols for awake fiberoptic intubation in anticipated difficult airway, including studies investigating elective awake fiberoptic intubation for scheduled surgery; randomized controlled trials comparing different methods for performing awake fiberoptic intubation; and adult patients with anticipated difficult airway. We excluded studies in the nonoperating theater settings, randomized controlled trials comparing awake fiberoptic intubation with other techniques, and studies based on simulation. Primary outcomes were success rate and death; secondary outcomes were major adverse events. Thirty-seven randomized controlled trials evaluating 2045 patients and 4 areas were identified: premedication, local anesthesia, sedation, and ancillary techniques to facilitate awake fiberoptic intubation. Quality of evidence was moderate-low and based on small-sampled randomized controlled trials. Overall, 12 of 2045 intubation failures (0.59%) and 7 of 2045 severe adverse events (0.34%) occurred, with no permanent consequences or death. All evaluated methods to achieve local anesthesia performed similarly well. No differences were observed in success rate with different sedatives. Dexmedetomidine resulted in fewer desaturation episodes compared to propofol and opioids with or without midazolam (relative risk, 0.51 [95% CI, 0.28-0.95]; P = .03); occurrence of desaturation was similar with remifentanil versus propofol, while incidence of apnoea was lower with sevoflurane versus propofol (relative risk, 0.43 [95% CI, 0.22-0.81]; P = .01). A high degree of efficacy and safety was observed with minimal differences among different protocols; dexmedetomidine might offer a better safety profile compared to other sedatives

Driving with obstructive sleep apnea policies, behaviors and screening measures

Le syndrome de l’apnée du sommeil (SAS) est un trouble grave qui se produit lorsque le débit respiratoire d'une personne est interrompu ou réduit de façon répétée pendant le sommeil, entraînant des baisses intermittentes de la saturation artérielle en oxygène. Le SAS a été caractérisé comme l'un des troubles médicaux les plus courants entraînant une somnolence diurne excessive. La somnolence et/ou la fatigue au volant sont des risques d'accidents de la route potentiellement mortels et peuvent remettre en question la capacité d’une personne à détenir un permis de conduire. Le SAS demeure un trouble du sommeil qui fait l'objet d'un large débat au sein des organismes responsables de la politique routière, en raison de nombreuses contradictions dans la littérature scientifique. Le but de cette thèse de doctorat est de revoir les positions des principaux pays leaders en matière des facultés de conduite des chez les conducteurs atteints du SAS et de proposer une approche d'évaluation au cas par cas qui tient compte des différences comportementales et des expériences individuelles chez ces patients. Nos travaux ont mis en lumière qu'il existe une variabilité au simulateur de conduite, sur les comportements au volant, ainsi que sur le nombre d’infractions commisses, entre les personnes atteintes du SAS. La fatigue joue également un rôle important dans les comportements de conduite qui semble refléter une expérience distincte de celle de la somnolence. De plus, notre étude ne révèle pas de profils de conduite différents entre les conducteurs atteint du SAS qui étaient adhérents ou non au traitement du trouble respiratoire du sommeil avec un appareil de pression positive continue; en effet les données n’ont pas mis en évidence de différence, soit une diminution de la fatigue, de la somnolence ou des infractions au code de la route après 6 mois de traitement. Enfin, notre étude suggère l’usage d’une nouvelle mesure, plus accessible que les examens routiers et aux tâches de simulateur de conduite, qui inventorierait les infractions au code de la route répertoriées par une agence gouvernementale officielle dans un contexte ciblé d’estimation des risques de conduite chez le sujet avec SAS. Cet outil simple, si un accès privilégié était disponible, pourrait être utile aux cliniciens pour aider à l’identification d’un conducteur à risque atteint du SAS et pourrait offrir aux cliniciens une alternative aux examens routiers et aux tâches de simulateur de conduite couteux et chronophages.Obstructive sleep apnea (OSA) is a serious disorder that occurs when a person's flow of breathing is repeatedly interrupted or reduced during sleep, leading to intermittent drops in blood oxygen saturation. OSA has been characterized as among the most common of medical disorders causing excessive daytime sleepiness. Sleepiness and/or fatigue at the wheel are unquestionably a risk for potentially fatal road accidents and a cause for questioning one’s ability to hold a driver’s license. OSA remains a sleep disorder that is widely debated among traffic policy-makers due to conflicting research findings available to them. The present study reviews the position of leading driving policy-making countries regarding driving competence among individuals with OSA; it proposes a case-by-case assessment approach that considers experiential and behavioural individual differences among individuals with OSA. This study demonstrates that there is considerable variability both in the driving simulator task, on actual driving behaviors and the number of driving violations among individuals with OSA; this makes it difficult to identify a risk profile in the sample. Fatigue, as an experience distinct from sleepiness, appears to play a significant role in driving behaviors. In addition, the present data do not reveal different driving profiles between drivers with OSA who were either adherent or non-adherent to continuous positive air pressure treatment of the sleep disorder, nor do the data show that treatment decreases fatigue, sleepiness, or the number of self-reported driving violations after 6 months of treatment. Finally, this study introduces a new and more accessible measure that mirrors all possible violations listed by the official government driving agency. This simple tool can be useful for clinicians to help identify a risky driver with OSA and may present an alternative to expensive and time-consuming road tests and driving simulator tasks