Predictors of continuous positive airway pressure adherence

Continuous positive airway pressure (CPAP) is the leading treatment for obstructive sleep apnoea (OSA), a prevalent disorder of breathing in sleep strongly associated with obesity. OSA has serious adverse health, social and community effects arising from disturbed breathing, loud snoring, poor quality sleep and cardiovascular sequelae. When used appropriately, CPAP treatment is highly effective in normalising breathing and sleep, improving symptoms and lowering adverse event risk. However, patients do not necessarily accept, tolerate or comply with treatment, with many factors influencing CPAP uptake and longer term use. Although knowledge to address challenges affecting CPAP adherence and CPAP mask and machine technologies continue to improve incrementally, optimising CPAP treatment adherence is an ongoing challenge in sleep medicine

Reflex tachycardia with airway opening in obstructive sleep apnea

Arousal from sleep is traditionally defined as a visually discernible shift to higher frequency activity in the sleep EEG lasting > 3 sec, with > 15-sec shifts considered full awakening. Arousals can occur spontaneously without an obvious trigger or be elicited by virtually any sensory stimulus applied with sufficient intensity to reach the “arousal threshold,” which varies between individuals and according to the “depth” or stage of sleep. Rather than simply a return to wakefulness, arousal appears to reflect a transiently activated state with altered responses to sensory inputs compared to wakefulness. Rapid cortical re-activation along with augmented cardiorespiratory and metabolic activity accompanying arousal has clear survival advantages, since all may be required to support “fight or flight” responses to exogenous or endogenous threats arising during sleep.Australian National Health and Medical Research Counci

High-quality and anti-inflammatory diets and a healthy lifestyle are associated with lower sleep apnea risk

Study Objectives: Most studies on diet and sleep apnea focus on calorie restriction. Here we investigate potential associations between dietary quality (Healthy Eating Index [HEI], Dietary Inflammatory Index [DII]) and overall healthy lifestyle with sleep apnea risk. Methods: National Health and Nutrition Examination Survey data (waves 2005-2008 and 2015-2018; n = 14,210) were used to determine HEI, DII, and their quintiles, with the fifth quintile indicating highest adherence to each dietary construct. A healthy lifestyle score was determined using diet, smoking, alcohol intake, and physical activity level. The STOP-BANG questionnaire was used to define sleep apnea risk. Generalized linear regression models with binomial family and logit link were used to investigate potential associations. The models were adjusted for socioeconomic status, lifestyle factors, and chronic conditions. Results: The prevalence of high sleep apnea risk was 25.1%. Higher DII was positively associated with sleep apnea (odds ratioQuintile 5 vs Quintile 1 = 1.55; 95% confidence interval, 1.24-1.94; P for trend < .001), whereas higher HEI was associated with reduced sleep apnea risk (odds ratioQuintile 5 vs Quintile 1 = 0.72; 95% confidence interval, 0.59-0.88; P for trend = .007). Higher healthy lifestyle score was also associated with decreased odds of sleep apnea (P for trend < .001). There was a significant interaction between healthy lifestyle and sex with sleep apnea risk (P for interaction = .049) whereby females with higher healthy lifestyle scores had a lower risk of sleep apnea compared to males. Conclusions: Higher-quality and anti-inflammatory diets and a healthier overall lifestyle are associated with lower sleep apnea risk. These findings underline the importance of strategies to improve overall diet quality and promote healthy behavior, not just calorie restriction, to reduce sleep apnea risk

Megaphylogeny resolves global patterns of mushroom evolution

Mushroom-forming fungi (Agaricomycetes) have the greatest morphological diversity and complexity of any group of fungi. They have radiated into most niches and fulfil diverse roles in the ecosystem, including wood decomposers, pathogens or mycorrhizal mutualists. Despite the importance of mushroom-forming fungi, large-scale patterns of their evolutionary history are poorly known, in part due to the lack of a comprehensive and dated molecular phylogeny. Here, using multigene and genome-based data, we assemble a 5,284-species phylogenetic tree and infer ages and broad patterns of speciation/extinction and morphological innovation in mushroom-forming fungi. Agaricomycetes started a rapid class-wide radiation in the Jurassic, coinciding with the spread of (sub)tropical coniferous forests and a warming climate. A possible mass extinction, several clade-specific adaptive radiations and morphological diversification of fruiting bodies followed during the Cretaceous and the Paleogene, convergently giving rise to the classic toadstool morphology, with a cap, stalk and gills (pileate-stipitate morphology). This morphology is associated with increased rates of lineage diversification, suggesting it represents a key innovation in the evolution of mushroom-forming fungi. The increase in mushroom diversity started during the Mesozoic-Cenozoic radiation event, an era of humid climate when terrestrial communities dominated by gymnosperms and reptiles were also expanding.Fil: Varga, Torda. Hungarian Academy Of Sciences; HungríaFil: Krizsán, Krisztina. Hungarian Academy Of Sciences; HungríaFil: Földi, Csenge. Hungarian Academy Of Sciences; HungríaFil: Dima, Bálint. Eötvös Loránd University; HungríaFil: Sánchez-García, Marisol. Clark University; Estados UnidosFil: Lechner, Bernardo Ernesto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Micología y Botánica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Micología y Botánica; ArgentinaFil: Sánchez-Ramírez, Santiago. University of Toronto; CanadáFil: Szöllosi, Gergely J.. Eötvös Loránd University; HungríaFil: Szarkándi, János G.. University Of Szeged; HungríaFil: Papp, Viktor. Szent István University; HungríaFil: Albert, László. Hungarian Mycological Society; HungríaFil: Andreopoulos, William. United States Department Of Energy. Joint Genome Institute; Estados UnidosFil: Angelini, Claudio. Jardin Botanico Nacional Ma. Moscoso; República DominicanaFil: Antonín, Vladimír. Moravian Museum; República ChecaFil: Barry, Kerrie W.. United States Department Of Energy. Joint Genome Institute; Estados UnidosFil: Bougher, Neale L.. Western Australian Herbarium; AustraliaFil: Buchanan, Peter. Manaaki Whenua-landcare Research; Nueva ZelandaFil: Buyck, Bart. Muséum National d'Histoire Naturelle; FranciaFil: Bense, Viktória. Hungarian Academy Of Sciences; HungríaFil: Catcheside, Pam. State Herbarium Of South Australia; AustraliaFil: Chovatia, Mansi. United States Department Of Energy. Joint Genome Institute; Estados UnidosFil: Cooper, Jerry. Manaaki Whenua-landcare Research; Nueva ZelandaFil: Dämon, Wolfgang. Oberfeldstrasse 9; AustriaFil: Desjardin, Dennis. San Francisco State University; Estados UnidosFil: Finy, Péter. Zsombolyai U. 56.; HungríaFil: Geml, József. Naturalis Biodiversity Center; Países BajosFil: Haridas, Sajeet. United States Department Of Energy. Joint Genome Institute; Estados UnidosFil: Hughes, Karen. University of Tennessee; Estados UnidosFil: Justo, Alfredo. Clark University; Estados UnidosFil: Karasinski, Dariusz. Polish Academy of Sciences; Poloni

Resting forearm blood-tissue lactate and gas exchange kinetics during supine leg exercise / by Peter Catcheside.

Bibliography: leaves 230-255.xv, 255 leaves : ill. (some col.) ; 30 cm.The work described in this thesis was stimulated by the observation that during leg exercise, resting forearm lactate kinetics appear to resemble closely the blood-tissue exchange kinetics of inert gases that have been reported in many organs during inert gas inhalation. Two mathematical models of forearm lactate uptake were developed, and three series of experiments were conducted to investigate the contribution and impact of passive (inert-like) lactate movements to veno-arterial concentration differences in the resting forearm during leg exercise. The results are discussed.Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 200

Multi-input model uncertainty analysis for long-range wind farm noise predictions

One of the major sources of uncertainty in predictions of wind farm noise (WFN) reflect parametric and model structure uncertainty. The model structure uncertainty is a systematic uncertainty, which relates to uncertainty about the appropriate mathematical structure of the models. Here we quantified the model structure uncertainty in predicting WFN arising from multi-input models, including nine ground impedance and four wind speed profile models. We used a numerical ray tracing sound propagation model for predicting the noise level at different receivers. We found that variations between different ground impedance models and wind speed profile models were significant sources of uncertainty, and that these sources contributed to predicted noise level differences in excess of 10 dBA at distances greater than 3.5 km. We also found that differences between atmospheric vertical wind speed profile models were the main source of uncertainty in predicting WFN at long-range distances. When predicting WFN, it is important to acknowledge variability associated with different models as this contributes to the uncertainty of the predicted values

Marked Reduction in Obstructive Sleep Apnea Severity in Slow Wave Sleep

Introduction: Obstructive sleep apnea (OSA) is widely accepted to improve during slow wave sleep (SWS) compared to lighter stages of NREM sleep. However, supporting data to establish the magnitude and prevalence of this effect is lacking. Consequently, we examined this phenomenon, controlling for posture, in a large group of patients investigated for OSA at an academic clinical sleep service. Methods: A detailed retrospective analysis was conducted on data obtained from each 30-sec epoch of sleep in 253 consecutive full-night diagnostic polysomnography studies performed over a 3-month period. Respiratory and arousal event rates were calculated within each stage of sleep, in the supine and lateral postures, and across the whole night, with OSA patients classified on the basis of an overall apnea-hypopnea index (AHI) ≥ 15 events/h. Central sleep apnea (CSA) patients were defined by a central apnea index ≥ 5/h. Sleep latency and time, and respiratory and arousal event rates in OSA, CSA, and non-OSA patients were compared between sleep stages and postures using linear mixed model analysis. The numbers of patients achieving reduced event rates in SWS and in the lateral posture were also examined. Results: There were 171 patients with OSA, 14 with CSA, and 68 non-OSA patients. OSA patients took significantly longer to achieve slow wave and REM sleep (p < 0.001) than non-OSA patients and had less stage 4 sleep (p = 0.037). There were striking improvements in AHI and arousal index (AI) from stage 1 to 4 NREM sleep (p < 0.001), with intermediate levels in REM sleep. AHI and AI were also markedly reduced in lateral versus supine sleep in all sleep stages (p < 0.001), with an effect size comparable to that of the slow wave sleep effect. The majority of OSA patients achieved low respiratory event rates in SWS. Eighty-two percent of patients achieved an AHI < 15 and 57% < 5 events/hour during stage 4 sleep.Rajeev Ratnavadivel, Nuy Chau, Daniel Stadler, Aeneas Yeo, R. Doug McEvoy, Peter G. Catchesid