A promising concept of combination therapy for positional obstructive sleep apnea

PURPOSE: The objective of this randomized controlled trial was to assess the additional effect of a chest-worn sleep position trainer (SPT) in patients with residual supine-dependent obstructive sleep apnea (sdOSA) under mandibular advancement device (MAD) therapy. METHODS: Baseline and follow-up polysomnography with MAD were performed. Twenty patients with sdOSA under MAD therapy underwent two consecutive randomized polysomnographies: one with SPT and one with combination of SPT + MAD. Data are presented as median (quartile 1, quartile 3). RESULTS: The SPT reduced the time spent in supine sleeping position compared to baseline and MAD therapy. Both MAD and SPT were individually effective in reducing the overall apnea/hypopnea index (AHI) significantly when compared to baseline from 20.8 (15.1; 33.6)/h at baseline to 11.0 (6.7; 13.8)/h and to 11.1 (3.5; 17.7)/h with MAD or SPT, respectively. The combination of SPT + MAD further reduced the overall AHI to 5.7 (3.6; 7.4), which was significantly lower than with MAD alone (p < 0.001) and SPT alone (p < 0.008), respectively. CONCLUSIONS: The results of this study indicate that combination of SPT + MAD leads to a higher therapeutic efficacy in patients with sdOSA under MAD therapy when compared to one of the treatment modalities alone

Middle-Holocene alluvial forests and associated fluvial environments: a multi-proxy reconstruction from the lower Scheldt, N Belgium

Analyses of pollen, plant macrofossils (seeds, fruits, wood and mosses), molluscs, diatoms and vertebrate (mainly fish) remains allowed a detailed reconstruction of a middle-Holocene alluvial forest and its associated hydrological conditions. The use of multiple proxies resulted in a taxonomically more detailed and environmentally more comprehensive understanding of terrestrial as well as aquatic habitats. The results demonstrate possible biases in palaeoecological reconstructions of alluvial and estuarine environments drawn from single proxies. Many locally occurring woody taxa were underrepresented or remained undetected by pollen analyses. Seeds and fruits also proved to be inadequate to detect several locally important taxa, such as Ulmus and Hedera helix. Apparently brackish conditions inferred from diatoms, pollen and other microfossils conflicted strikingly with the evidence from molluscs, fish bones and botanical macroremains which suggest a freshwater environment. Brackish sediment (and the microfossil indicators) is likely to have been deposited during spring tides or storm surges, when estuarine waters penetrated more inland than usual. Despite the reworking and deposition of estuarine and saltmarsh sediment well above the tidal node at such events, local salinity levels largely remained unaffected