Obesity hypoventilation syndrome treated with non-invasive ventilation:Is a switch to CPAP therapy feasible?

Background and objective: Obesity hypoventilation syndrome (OHS) can be treated with either continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV) therapy; the device choice has important economic and operational implications. Methods: This multicentre interventional trial investigated the safety and short-term efficacy of switching stable OHS patients who were on successful NIV therapy for ≥3 months to CPAP therapy. Patients underwent an autotitrating CPAP night under polysomnography (PSG); if the ensuing parameters were acceptable, they were sent home on a fixed CPAP for a 4–6-week period. It was hypothesized that blood gas analysis, PSG parameters and lung function tests would remain unchanged. Results: A total of 42 OHS patients were recruited, of whom 37 patients were switched to CPAP therapy. All patients had a history of severe obstructive sleep apnoea syndrome; chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease (GOLD) I/II) was present in 52%. Regarding the primary outcome, 30 of 42 patients (71%, 95% CI: 55–84%) maintained daytime partial pressure of carbon dioxide (PaCO2) levels ≤45 mm Hg after the home CPAP period. There was no further impairment in quality of life, sleep parameters or lung function. Interestingly, 24 patients (65%) preferred CPAP as their long-term therapy, despite the high pressure levels used (mean: 13.8 ± 1.8 mbar). After the CPAP period, 7 of 37 patients were categorized as CPAP failure, albeit only due to mild hypercapnia (mean: 47.9 ± 2.7 mm Hg). Conclusion: It is feasible to switch most stable OHS patients from NIV to CPAP therapy, a step that could significantly reduce health-related costs. The auto-adjusted CPAP device, used in combination with the analysis of the PSG and capnometry, is a valid titration method in OHS patients

Spatial surface-pattern analyses and boundary detection techniques applied in forest ecology

[EN] We review methods for uni- and multivariate surface pattern analysis and boundary detection used in forest ecology. A continuous surface pattern is defined as the locations of points (trees) in the space and the associated variable or variables. We illustrate useful methods to describe spatial patterns and infer the generating processes. We show the statistical basis and applied examples of univariate methods for binary (join counts) and quantitative variables (Moran and Geary correlograms, semivariograms, fractal dimension). We explain the calculus and interpretation of multivariate methods to describe surface patterns (Mantel test and correlogram) and their relationships with ordination methods. Finally, we show examples of techniques for boundary detection. Most analysed patterns corresponded to Pinus uncinata forests from the upper altitudinal limit in the Pyrenees or from a relict population. We discuss the advantages and disadvantages of each methodology and their applications in forest ecology.[ES] En este trabajo se revisan los métodos de análisis univariable y multivariable de los patrones de superficies y de detección de fronteras más utilizados en ecología forestal. El patrón de superficies es un patrón espacial continuo definido por las posiciones de los puntos (árboles) en el espacio y una o varias variables asociadas a cada punto. Se ilustran métodos útiles para describir patrones espaciales e inferir los procesos que los generaron. Se muestra el fundamento estadístico y ejemplos aplicados de métodos de análisis univariables para variables binarias (conteo contiguo) y cuantitativas (correlogramas de Moran y Geary, semivariogramas, dimensión fractal). Se detalla el cálculo e interpretación de métodos multivariables para la descripción de patrones de superficies (correlograma y test de Mantel) y su relación con los métodos de ordenación. Finalmente, se muestran ejemplos de métodos para la detección de fronteras. La mayor parte de los patrones reales analizados provienen de bosques de Pinus uncinata del límite altitudinal superior en los Pirineos o bien de una población relíctica. Se discuten las ventajas y desventajas de cada metodología y sus aplicaciones en ecología forestal.Los datos de Vinuesa se obtuvieron en el proyecto AMB95-0160 (CICyT).Peer reviewe

Compliance with Positive Airway Pressure Treatment for Obstructive Sleep Apnea

ObjectivesPositive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients.MethodsWe performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7® of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors.ResultsAfter 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other.ConclusionThe affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use

Respiratory function and mechanics in pinnipeds and cetaceans

Author Posting. © Company of Biologists, 2017. This article is posted here by permission of Company of Biologists for personal use, not for redistribution. The definitive version was published in Journal of Experimental Biology 220 (2017): 1761-1773, doi:10.1242/jeb.126870.In this Review, we focus on the functional properties of the respiratory system of pinnipeds and cetaceans, and briefly summarize the underlying anatomy; in doing so, we provide an overview of what is currently known about their respiratory physiology and mechanics. While exposure to high pressure is a common challenge among breath-hold divers, there is a large variation in respiratory anatomy, function and capacity between species – how are these traits adapted to allow the animals to withstand the physiological challenges faced during dives? The ultra-deep diving feats of some marine mammals defy our current understanding of respiratory physiology and lung mechanics. These animals cope daily with lung compression, alveolar collapse, transient hyperoxia and extreme hypoxia. By improving our understanding of respiratory physiology under these conditions, we will be better able to define the physiological constraints imposed on these animals, and how these limitations may affect the survival of marine mammals in a changing environment. Many of the respiratory traits to survive exposure to an extreme environment may inspire novel treatments for a variety of respiratory problems in humans.Funding for this project was provided by the Office of Naval Research (ONR YIP Award no. N000141410563).2018-05-1

Treatment of Cheyne–Stokes respiration with adaptive servoventilation—analysis of patients with regard to therapy restriction

Purpose!#!The SERVE-HF study revealed no benefit of adaptive servoventilation (ASV) versus guideline-based medical treatment in patients with symptomatic heart failure, an ejection fraction (EF) ≤45% and a predominance of central events (apnoea-hypopnea Index [AHI] > 15/h). Because both all-cause and cardiovascular mortality were higher in the ASV group, an EF ≤ 45% in combination with AHI 15/h, central apnoea-hyponoea index [CAHI/AHI] > 50% and central apnoea index [CAI] > 10/h were subsequently listed as contraindications for ASV. The intention of our study was to analyse the clinical relevance of this limitation.!##!Methods!#!Data were analysed retrospectively for patients treated with ASV who received follow-up echocardiography to identify contraindications for ASV.!##!Results!#!Echocardiography was conducted in 23 patients. The echocardiogram was normal in 10 cases, a left ventricular hypertrophy with normal EF was found in 8 patients, there was an EF 45-50% in 2 cases and a valvular aortic stenosis (grade II) with normal EF was found in 1 case. EF <45% was present in just 2 cases, and only 1 of these patients also had more than 50% central events in the diagnostic night.!##!Conclusion!#!The population typically treated with ASV is entirely different from the study population in SERVE-HF, as nearly half of the patients treated with ASV showed a normal echocardiogram. Thus, the modified indication for ASV has little impact on the majority of treated patients. The current pathomechanistic hypothesis of central apnoea must be reviewed

Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA)

Purpose Different forms of training focusing on the muscles of the upper airways showed limited effects on obstructive sleep apnea (OSA) and/or snoring. We investigated the effect of generalized respiratory muscle training (RMT) in lean patients with mild to moderate OSA. Methods Nine male subjects (52.0 +/- 10.8 years, BMI 29.1 +/- 2.1 kg/m(2)) with obstructive sleep apnea (apneahypopnea index (AHI) 9-29) participated in an open, singlearm pilot study. After a 1-week build-up phase, patients underwent 4 weeks of normocapnic hyperpnea RMT five times a week for 30 min each. The initial and final measurements comprised polysomnography, pulmonary function tests, Epworth sleepiness scale (ESS), and SF-36 questionnaire (quality of life (QoL) self-assessment). The investigational site was a university-affiliated hospital for pulmonary diseases and sleep medicine, Solingen/Germany. Results Patients trained effectively, seen by a significant (p < 0.01) increase of breathing frequency (23.3 +/- 1.5/min vs. 30.6 +/- 2.9 / min) and minute volume (81.2 +/- 13.7 L vs. 109.1 +/- 21.9 L). AHI, snoring and ESS remained unchanged after training. QoL as measured by SF-36 significantly (p < 0.05) improved after the training in the subscales Bbodily pain'' (79 +/- 21 vs. 90 +/- 12) and Bchange of health'' (3.1 +/- 0.3 vs. 2.4 +/- 0.5). Conclusions There is no evidence that AHI, pulmonary function or daytime sleepiness are affected by 5 weeks of RMT. Nevertheless, there is an improvement of parameters of quality of life