NREM Sleep Parasomnias Commencing in Childhood:Trauma and Atopy as Perpetuating Factors

Objective/Background: Phenotyping of non-rapid-eye-movement (NREM) parasomnias is currently poorly undertaken. This study aimed to determine whether there are differences phenotypically among childhood-, adolescent-, and adult-onset NREM parasomnias continuing into and presenting in adulthood. Patients/Methods: A retrospective, cohort study of patients presenting with NREM parasomnia between 2008 and 2019 (n = 307) was conducted. Disorders included sleepwalking (n = 231), night terrors (n = 150), sexualised behaviour in sleep (n = 50), and sleep-related eating disorder (n = 28). Results: Compared to the adult-onset NREM behaviours group, the childhood- and adolescent-onset groups were more likely to have a family history of NREM behaviours (p < 0.001), experience a greater spectrum of NREM disorders (p = 0.001), and report a history of sleep-talking significantly more frequently (p = 0.014). Atopy was most prevalent in the childhood-onset group (p = 0.001). Those with childhood-onset NREM parasomnias were significantly more likely to arouse from N3 sleep on video polysomnography (p = 0.0003). Psychiatric disorders were more likely to be comorbid in the adult-onset group (p = 0.012). A history of trauma coinciding with onset of NREM behaviours was significantly more common in the childhood- and adolescent-onset groups (p < 0.001). Conclusions: Significant differences exist across childhood-, adolescent-, and adult-onset NREM parasomnia presenting in adulthood. This study suggests that adult-onset slow-wave sleep disorders may be confounded by psychiatric disorders resulting in nocturnal sleep disruption and that unresolved traumatic life experiences perpetuate NREM disorders arising in childhood and comprise one of the strongest external risk factors for triggering and perpetuating these disorders in adolescence

Detection of squawks in respiratory sounds of mechanically ventilated COVID-19 patients

Mechanically ventilated patients typically exhibit abnormal respiratory sounds. Squawks are short inspiratory adventitious sounds that may occur in patients with pneumonia, such as COVID-19 patients. In this work we devised a method for squawk detection in mechanically ventilated patients by developing algorithms for respiratory cycle estimation, squawk candidate identification, feature extraction, and clustering. The best classifier reached an F1 of 0.48 at the sound file level and an F1 of 0.66 at the recording session level. These preliminary results are promising, as they were obtained in noisy environments. This method will give health professionals a new feature to assess the potential deterioration of critically ill patients.publishe

Acute effects of electronic cigarette on pulmonary function and on exhaled inflammatory mediators in patients with bronchial asthma

Introduction: Electronic cigarette (EC) is a novel product that is marketed as an alternative to tobacco cigarette. Its effects on human health have not been investigated widely yet, especially in specific populations such as patients with asthma. Moreover, evidence suggests that many EC compounds might contribute in the pathogenesis of asthma. Lung function seems to deteriorate by the use of EC in this population, while airway inflammation alters, with the aggravation of T-helper-type-2 (Th2) inflammation being the most prominent but not the exclusive effect. EC also seems to worsen asthma symptoms and the rate and severity of exacerbations in asthmatics who are current vapers, whilst evidence suggests that its effectiveness as a smoking cessation tool might be limited. Aim: The aim of this study is to investigate the acute changes in pulmonary function and airway inflammation in asthma patients after the use of EC compared with healthy smokers. Methods: We randomly selected 25 smokers suffering from stable asthma receiving ‘‘step 3’’ treatment according to global initiative for asthma (GINA) guidelines with no other co-morbidities and 25 healthy smokers matched with the baseline characteristics of the asthmatic patients. The participants were subjected to pulmonary function tests (PFTs), impulse oscillometry (IOS), fraction of exhaled nitric oxide (FENO) measurement and exhaled breathe condensate (EBC) gathering before and after the use of one EC with nicotine for 5 minutes. From EBC, pH and the concentrations of interleukins 1b, 4, 5, 6, 8, 10, 13, 17A (IL-1b, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IL-17A), tumor necrosis factor-alpha (TNF-a), 8-isoprostane (ISO8) and leukotriene B4 (LTB4) were measured. Results: Forced expiratory volume in 1 second / forced vital capacity ratio (FEV1/FVC), peak expiratory flow (PEF) and expiratory reserve volume (ERV) declined in asthma patients after EC use by 0.61% (p = 0.040), 0.46 L/s (p = 0.003) and 0,15 L (p = 0.051) respectively. Diffusion lung capacity was also worsened after EC use. Impedance at 5 Hz and resistances at 5, 10, 15, 20, 25 and 35 Hz increased in both groups. FENO and EBC’s pH were increased in asthma patients after EC use by 3.60 ppb (p = 0.001) and 0.15 (p = 0.014), while they decreased in control group by 3.28 ppb (p < 0.001) and 0.12 (p = 0.064) respectively. The concentrations of IL-1b, IL-8, IL-10, IL-13, IL-17A, TNF-a and ISO8 in EBC were increased in asthma group after EC use, something that did not apply in control group, while the changes in concentrations of IL-1b and IL-4 before and after EC between the two groups differed significantly (p = 0.017 and p = 0.009 respectively). Conclusions: Both pulmonary function and airway inflammation deteriorated acutely after EC use in asthma patients, while in healthy controls the respective outcomes were not of the same gravity.Εισαγωγή: Το ηλεκτρονικό τσιγάρο είναι ένα νέο προϊόν που κυκλοφόρησε σαν εναλλακτική προς το συμβατικό τσιγάρο. Οι επιδράσεις του στην ανθρώπινη υγεία δεν έχουν διερευνηθεί ακόμα σε βάθος, ειδικά σε συγκεκριμένους πληθυσμούς όπως οι ασθενείς με άσθμα. Η τρέχουσα βιβλιογραφία υποδεικνύει ότι πολλά συστατικά του ηλεκτρονικού τσιγάρου μπορεί να συμβάλουν στην παθογένεση του άσθματος. Η πνευμονική λειτουργία φαίνεται να επιδεινώνεται με τη χρήση του ηλεκτρονικού τσιγάρου ενώ η φλεγμονή των αεραγωγών μεταβάλλεται, με την επιδείνωση της Th2 φλεγμονής να είναι η πιο προεξέχουσα. Το ηλεκτρονικό τσιγάρο επιδεινώνει τα συμπτώματα, το ρυθμό και τη σοβαρότητα των παροξύνσεων του άσθματος, ενώ τα στοιχεία υποδεικνύουν ότι η αποτελεσματικότητά του σαν εργαλείο διακοπής του καπνίσματος μάλλον είναι περιορισμένη. Σκοπός: Ο σκοπός αυτής της μελέτης ήταν να διερευνήσει τις οξείες μεταβολές στην πνευμονική λειτουργία και στη φλεγμονή των αεραγωγών μετά τη χρήση του ηλεκτρονικού τσιγάρου σε ασθενείς με άσθμα σε σύγκριση με υγιείς καπνιστές. Μέθοδοι: Επιλέξαμε τυχαία 25 καπνιστές που είχαν σταθερό άσθμα λαμβάνοντας ‘‘βήμα 3’’ θεραπεία σύμφωνα με τις κατευθυντήριες οδηγίες της Global Initiative for Asthma (GINA) χωρίς άλλες συννοσηρότητες και 25 υγιείς καπνιστές με αντίστοιχα βασικά χαρακτηριστικά με τους ασθματικούς ασθενείς. Οι συμμετέχοντες υπεβλήθησαν σε δοκιμασίες πνευμονικής λειτουργίας (PFTs), παλμική ταλαντωσιμετρία (IOS), μέτρηση του εκπνεόμενου μονοξειδίου του αζώτου τους (FeNO) και συγκέντρωση του εκπνεόμενου συμπύκνωμα του αέρα τους (EBC) πριν και μετά τη χρήση ενός ηλεκτρονικού τσιγάρου με νικοτίνη για 5 λεπτά. Από το EBC, μετρήθηκαν το pH του και οι συγκεντρώσεις των ιντερλευκινών 1b, 4, 5, 6, 8, 10, 13, 17A (IL-1b, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IL-17A), του παράγοντα νέκρωσης όγκων-άλφα (TNF-a), του 8-ισοπροστάνιου (ISO8) και του λευκοτριενίου B4 (LTB4). Αποτελέσματα: Ο λόγος του βίαια εκπνεόμενου όγκου στο 1 δευτερόλεπτο / τη βίαια ζωτική χωρητικότητα (FEV1 / FVC), η μέγιστη εκπνευστική ροή (PEF) και ο εφεδρικός εκπνευστικός όγκος (ERV) επιδεινώθηκαν στους ασθενείς με άσθμα μετά τη χρήση του ηλεκτρονικού τσιγάρου κατά 0.61% (p = 0.040), 0.46 L/s (p = 0.003) και 0,15 L (p = 0.051) αντίστοιχα. Η διαχυτική ικανότητα του πνεύμονα επίσης επιδεινώθηκε μετά τη χρήση του ηλεκτρονικού τσιγάρου. Οι ολικές αναπνευστικές αντιστάσεις στα 5 Hz και οι αντιστάσεις στα 5, 10, 15, 20, 25 και 35 Hz αυξήθηκαν και στις δύο ομάδες. Το FeNO και το pH του EBC αυξήθηκαν στους ασθενείς με άσθμα μετά τη χρήση του ηλεκτρονικού τσιγάρου κατά 3.60 ppb (p = 0.001) και 0.15 (p = 0.014), ενώ μειώθηκαν στην ομάδα ελέγχου κατά 3.28 ppb (p < 0.001) και 0.12 (p = 0.064) αντίστοιχα. Οι συγκεντρώσεις των IL-1b, IL-8, IL-10, IL-13, IL-17A, TNF-a και ISO8 στο EBC αυξήθηκαν στην ομάδα του άσθματος μετά τη χρήση του ηλεκτρονικού τσιγάρου, κάτι που δε συνέβη στην ομάδα ελέγχου, ενώ οι αλλαγές στις συγκεντρώσεις των IL-1b και IL-4 πριν και μετά το ηλεκτρονικό τσιγάρο μεταξύ των δύο ομάδων διέφεραν σημαντικά (p = 0.017 και p = 0.009 αντίστοιχα). Συμπεράσματα: Τόσο η πνευμονική λειτουργία όσο και η φλεγμονή των αεραγωγών επιδεινώνονται οξέως μετά τη χρήση του ηλεκτρονικού τσιγάρου από τους ασθματικούς ασθενείς, ενώ στην ομάδα ελέγχου των υγιών καπνιστών τα αντίστοιχα αποτελέσματα δεν ήταν της ίδιας βαρύτητας

Invasive Pulmonary Aspergillosis in Coronavirus Disease 2019 Patients Lights and Shadows in the Current Landscape

Invasive pulmonary aspergillosis (IPA) presents a known risk to critically ill patients with SARS-CoV-2; quantifying the global burden of IPA in SARS-CoV-2 is extremely challenging. The true incidence of COVID-19-associated pulmonary aspergillosis (CAPA) and the impact on mortality is difficult to define because of indiscriminate clinical signs, low culture sensitivity and specificity and variability in clinical practice between centers. While positive cultures of upper airway samples are considered indicative for the diagnosis of probable CAPA, conventional microscopic examination and qualitative culture of respiratory tract samples have quite low sensitivity and specificity. Thus, the diagnosis should be confirmed with serum and BAL GM test or positive BAL culture to mitigate the risk of overdiagnosis and over-treatment. Bronchoscopy has a limited role in these patients and should only be considered when diagnosis confirmation would significantly change clinical management. Varying diagnostic performance, availability, and time-to-results turnaround time are important limitations of currently approved biomarkers and molecular assays for the diagnosis of IA. The use of CT scans for diagnostic purposes is controversial due to practical concerns and the complex character of lesions presented in SARS-CoV-2 patients. The key objective of management is to improve survival by avoiding misdiagnosis and by initiating early, targeted antifungal treatment. The main factors that should be considered upon selection of treatment options include the severity of the infection, concomitant renal or hepatic injury, possible drug interactions, requirement for therapeutic drug monitoring, and cost of therapy. The optimal duration of antifungal therapy for CAPA is still under debate

Smoking and Obstructive Sleep Apnea: Is There An Association between These Cardiometabolic Risk Factors?—Gender Analysis

Background and Objectives: Studies have tried to establish a relationship between Obstructive Sleep Apnea syndrome (OSA) and smoking but data still remain controversial. We aimed: 1. To evaluate the relationship between smoking and OSA; 2. To explore potential differences according to gender, and 3. To analyze the prevalence of cardiovascular disease (CVD) co-morbidities according to gender and smoking status. Materials and Methods: This retrospective study included 3791 (70.6% males) adult patients who visited a Sleep Clinic. All participants underwent nocturnal polysomnography. Daytime somnolence and insomnia were assessed by using the Epworth Sleepiness Scale (ESS) and the Athens Insomnia Scale (AIS). Ever-smokers completed the Fagerstrom Test for Nicotine Dependence (FTND). Results: OSA was confirmed in 72.1% of participants with 62.2% suffering from moderate-to-severe disease. The number of cigarettes/day, Pack/Years, and FTND were significantly higher in patients with more severe OSA. The prevalence of current smokers was higher in those without OSA or with mild disease, whereas the prevalence of former smokers was higher in moderate and severe OSA. In univariate analysis, current smokers were found to be 1.2 times more likely to have OSA compared with never and former smokers combined and former smokers 1.49 times more likely compared with never smokers. In the multiple regression analysis, after adjusting for BMI, gender, age and number of alcoholic drinks per week, smoking was not found to be significantly associated with OSA. In gender stratified multivariate analyses, no significant associations were observed. CVD co-morbidities were more frequent in more severe OSA. Hypertension, coronary disease and diabetes were more prevalent in former smokers with AHI ≥ 15, compared with current smokers, especially in men. Conclusions: Even if an independent effect of smoking on OSA was not found, the number of cigarettes/day, Pack/Years, and FTND were higher in patients with more severe OSA with more prevalent CVD co-morbidities

Smoking and Obstructive Sleep Apnea: Is There An Association between These Cardiometabolic Risk Factors?—Gender Analysis

Background and Objectives: Studies have tried to establish a relationship between Obstructive Sleep Apnea syndrome (OSA) and smoking but data still remain controversial. We aimed: 1. To evaluate the relationship between smoking and OSA; 2. To explore potential differences according to gender, and 3. To analyze the prevalence of cardiovascular disease (CVD) co-morbidities according to gender and smoking status. Materials and Methods: This retrospective study included 3791 (70.6% males) adult patients who visited a Sleep Clinic. All participants underwent nocturnal polysomnography. Daytime somnolence and insomnia were assessed by using the Epworth Sleepiness Scale (ESS) and the Athens Insomnia Scale (AIS). Ever-smokers completed the Fagerstrom Test for Nicotine Dependence (FTND). Results: OSA was confirmed in 72.1% of participants with 62.2% suffering from moderate-to-severe disease. The number of cigarettes/day, Pack/Years, and FTND were significantly higher in patients with more severe OSA. The prevalence of current smokers was higher in those without OSA or with mild disease, whereas the prevalence of former smokers was higher in moderate and severe OSA. In univariate analysis, current smokers were found to be 1.2 times more likely to have OSA compared with never and former smokers combined and former smokers 1.49 times more likely compared with never smokers. In the multiple regression analysis, after adjusting for BMI, gender, age and number of alcoholic drinks per week, smoking was not found to be significantly associated with OSA. In gender stratified multivariate analyses, no significant associations were observed. CVD co-morbidities were more frequent in more severe OSA. Hypertension, coronary disease and diabetes were more prevalent in former smokers with AHI ≥ 15, compared with current smokers, especially in men. Conclusions: Even if an independent effect of smoking on OSA was not found, the number of cigarettes/day, Pack/Years, and FTND were higher in patients with more severe OSA with more prevalent CVD co-morbidities

Obstructive sleep apnoea in adult patients post-tonsillectomy

International audienceBackground: The impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations.Aims: To compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not.Methods: The 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18-80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe.Results: There were no differences between the two groups in terms of sex ratio and age (146 patients with previous tonsillectomy vs. 19565 patients without). Patients who had undergone tonsillectomy had a lower body mass index (29.3 ± 5.2 kg/m2 vs 32.2 ± 6.6 kg/m2, p < 0.001), lower subjective sleep latency (17.1 ± 17.8 min vs 25.5 ± 30.4 min, p = 0.001), lower ODI (15.7 ± 18.3 events/hour vs 30.7 ± 26.1 events/hour, p < 0.001), and SpO2<90% time during sleep (21.8 ± 47.5 min vs 52.6 ± 80.8 min, p < 0.001). OSA patients with tonsillectomy had a lower prevalence of Type II diabetes mellitus (p = 0.001), hypertension (p < 0.001) and a higher prevalence of hyperlipidemia (p < 0.001) and were less likely to be commenced on CPAP (p < 0.001).Conclusion: In a large population of almost 20,000 OSA patients from across Europe, patients who had undergone tonsillectomy presented with less severe OSA at time of diagnosis, and had a lower prevalence of Type II diabetes mellitus and cardiovascular co-morbidities

Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma

Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). This review summarizes the existing evidence on the addition of LAMAs in patients with persistently uncontrolled asthma despite ICS + LABA treatment based on clinical efficacy in the reduction of asthma symptoms and exacerbations, the improvement in lung function, and its safety profile