Respiratorische Ereigniserkennung unter nichtinvasiver Beatmung (NIV) in Abhängigkeit von der genutzten Flowmessung

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Hintergrund</jats:title> <jats:p>Beim chronisch hyperkapnischem Atemversagen stellt die nächtliche nichtinvasive Beatmung (NIV) die Standardtherapie dar. Die Einstellung auf die NIV erfordert jedoch viel Erfahrung. Nur eine Polysomnografie (PSG) im Schlaflabor ermöglicht die genaue Analyse von residualen Obstruktionen der oberen Atemwege, zentralen Apnoen, Triggerfehlfunktionen und Leckagen. Die Flowmessung unter NIV ist technisch jedoch nicht einfach, insbesondere da normierte Schnittstellen zur Einbindung der Respiratoren in die PSG fehlen.</jats:p> </jats:sec><jats:sec> <jats:title>Ziel der Arbeit</jats:title> <jats:p>Vergleich eines Druck‑/Flow-Monitors mit den Signalen aus den Schnittstellen der Respiratoren bezüglich der Erkennung sowohl von Apnoen/Hypopnoen als auch von NIV-spezifischen Ereignissen in der PSG.</jats:p> </jats:sec><jats:sec> <jats:title>Methoden</jats:title> <jats:p>Retrospektiv wurden 20 Aufzeichnungen von Patienten unter NIV, die unter einem standardisierten Protokoll aufgezeichnet worden waren, erneut verblindet ausgewertet. Es erfolgte ein Vergleich der Auswertung dreier verschiedener Verfahren der Flowmessung (effortbasiert, Staudruckmessung, Schnittstelle) hinsichtlich der Häufigkeit von respiratorischen Ereignissen.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnisse</jats:title> <jats:p>Durch eine einfach zu integrierende Staudruckmessung mittels Druck‑/Flow-Monitor waren signifikant weniger Ereignisse diagnostizierbar, als wenn der Flow über die Abdomen- und Thoraxgurte oder über die Schnittstelle zu den Respiratoren ermittelt wurde. Auch die NIV-induzierten Ereignisse wie Fehltriggerungen oder Leckagen ließen sich nur mittels der Schnittstelle zuverlässig erkennen.</jats:p> </jats:sec><jats:sec> <jats:title>Schlussfolgerung</jats:title> <jats:p>Eine Messung des Flows mit einem Standard Druck‑/Flow-Monitor bietet keine ausreichend nachvollziehbaren Ergebnisse. Eine Einbindung des Beatmungsgeräts in die PSG über eine Schnittstelle ist daher zu fordern.</jats:p> </jats:sec&gt

Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction

Purpose A nocturnal non-dipping or rise in blood pressure (BP) is associated with poor cardiovascular outcome. This study aimed to test whether continuous positive airway pressure (CPAP) therapy can reduce nocturnal BP and normalize the 24-h BP profile in patients with severe obstructive sleep apnea (OSA) and erectile dysfunction as a surrogate for endothelial dysfunction (ED). Patients and methods Eighteen consecutive patients with OSA and ED on stable antihypertensive medication (age 55.8 +/- 9.5 years, body mass index 35.5 +/- 3.8 kg/m(2), apnea-hypopnoea index 66.1 +/- 27.4/h) were treated with CPAP for 6 months (average daily use 5.8 +/- 2.3 h). Twenty-four hour BP recordings were performed using a portable monitoring device. Rising was defined as an increase, whereas non-dipping was defined as a fall in nocturnal BP of less than 10% compared to daytime values. Serum noradrenaline levels as markers of sympathetic activity were measured at baseline and at 6 month follow up. Results Compared to baseline, nocturnal systolic and diastolic BP were significantly reduced after CPAP therapy (128.5 +/- 14 to 122.9 +/- 11 mmHg,p = 0.036; 76.2 +/- 9 to 70.5 +/- 5 mmHg,p = 0.007). The frequency of non-dipping and rising nocturnal systolic BP, as well as mean nocturnal heart rate, was reduced after CPAP treatment (73 to 27%,p = 0.039;20 to 7%,p = 0.625; from 81.5 +/- 10 to 74.8 +/- 8 beats per minutep = 0.043). Serum levels of noradrenaline were significantly lower after CPAP therapy (398 +/- 195 ng/l vs. 303 +/- 135 ng/l,p = 0.032). Conclusion In patients with severe OSA and clinically apparent ED, CPAP therapy was associated with a decrease in nocturnal BP and serum noradrenaline levels, as well as a normalization of the 24-h BP profile

Water Sorption and Structural Properties of Human Airway Mucus in Health and Muco-Obstructive Diseases.

Muco-obstructive diseases change airway mucus properties, impairing mucociliary transport and increasing the likelihood of infections. To investigate the sorption properties and nanostructures of mucus in health and disease, we investigated mucus samples from patients and cell cultures (cc) from healthy, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) airways. Atomic force microscopy (AFM) revealed mucin monomers with typical barbell structures, where the globule to spacer volume ratio was the highest for CF mucin. Accordingly, synchrotron small-angle X-ray scattering (SAXS) revealed more pronounced scattering from CF mucin globules and suggested shorter carbohydrate side chains in CF mucin and longer side chains in COPD mucin. Quartz crystal microbalance with dissipation (QCM-D) analysis presented water sorption isotherms of the three types of human airway mucus, where, at high relative humidity, COPD mucus had the highest water content compared to cc-CF and healthy airway mucus (HAM). The higher hydration of the COPD mucus is consistent with the observation of longer side chains of the COPD mucins. At low humidity, no dehydration-induced glass transition was observed in healthy and diseased mucus, suggesting mucus remained in a rubbery state. However, in dialyzed cc-HAM, a sorption-desorption hysteresis (typically observed in the glassy state) appeared, suggesting that small molecules present in mucus suppress the glass transition

Telemedicine improves continuous positive airway pressure adherence in stroke patients with obstructive sleep apnea in a randomized trial

$\bf Background:$ The prevalence of obstructive sleep apnea (OSA) is very high in stroke patients, whereas the acceptance of positive airway pressure (PAP) therapy is low. Although telemedicine offers new options to increase acceptance, effective concepts and patient groups are not yet known. $\bf Objective:$ The aim of this study was to investigate the effect of a telemedicine concept consisting of telemonitoring and support when usage time drops. $\bf Methods:$ PAP naive stroke patients with apnea-hypopnea index (AHI) >15 were randomized in a prospective parallel design comparing home therapy with standard care (SC) as opposed to telemedicine care (TC) over a period of 6 months. The TC group received a standardized phone call to offer help and advice if the average weekly usage of PAP fell below 4 h/night. $\bf Results:$ Eighty patients were included, 5 were lost to follow-up, 75 (20 females, age: 57.0 $\pm$ 9.9, body mass index: 30.9 $\pm$ 6.0 kg/m$^{2}$, AHI: 39.4 $\pm$ 18.6) were evaluated. While inpatient usage was similar in both groups, a significant difference was identified after 6 months of receiving home therapy (TC: 4.4 $\pm$ 2.5 h, SC: 2.1 $\pm$ 2.2 h; $\it p$ < 0.000063). On average, 4.7 $\pm$ 3.1 interventional phone calls were needed (173 calls in total, ranging from 0 to 10 calls per patient), primarily for the purpose of motivation (61.3%), mask problems (16.2%), nasopharyngeal complaints or humidification issues (11.2%), and technical questions (10.6%). Sleepiness (Epworth Sleepiness Scale [ESS]) differed significantly (TC: 3.7 + 3.2, SC: 6.1 + 4.1; $\it p$ = 0.008), as well as systolic blood pressure, which was available in a subgroup of 55 patients (TC: 129.5 + 15.2 mm Hg, SC: 138.8 + 16.1 mm Hg; $\it p$ = 0.034). $\bf Conclusion:$ A concept of telemonitoring and short telephone calls from the sleep lab raised PAP therapy adherence significantly in a group of stroke patients with moderate to severe OSA

CPAP therapy improves erectile function in patients with severe obstructive sleep apnea

Objectives: Erectile dysfunction (ED) is highly prevalent in obstructive sleep apnea (OSA), however, the effect of continuous positive airway pressure (CPAP) therapy on erectile function has not yet been thoroughly investigated in these patients. Methods: Ninety-four men with severe OSA (ie, with an apnea-hypopnea-index >= 30/h of sleep) were prospectively evaluated for the presence and severity of ED before and after 6-12 months of CPAP therapy. The abbreviated version of the International Index of Erectile Function, (the IIEF-5) was used to rate erectile function. Furthermore, all study participants responded to standard questionnaires of daytime sleepiness (Epworth Sleepiness Scale), quality of life (WHO Wellbeing 5 questionnaire) and depression (Major Depression Inventory). Results: ED as defined by an IIEF-5 score of <= 21 was present in 64 patients (68.1%). CPAP treatment significantly improved erectile function in those patients suffering from moderate and severe ED. Additionally, a trend for a correlation between the improvement of erectile function under CPAP and the hours of its use was observed. Finally, this effect was associated with larger improvements of quality of life in affected patients. Conclusions: ED is very frequent in men with severe OSA and can at least partly be reversed by long-term CPAP therapy in most seriously affected patients. The beneficial effect on erectile function may depend on CPAP compliance and is accompanied by improvements of quality of life. Randomized controlled trials are needed to confirm these findings. (c) 2018 Elsevier B.V. All rights reserved