The effect of buprenorphine vs methadone on sleep breathing disorders

Opioids are used widely as analgesics and can play an important role in agonist maintenance therapy for opium dependence. Despite their benefits, the negative effects on the respiratory system remain an important side effect to be considered. Ataxic breathing, obstructive sleep apnea, and most of all central sleep apnea are among these concerns. Obstructive sleep apnea leads to various metabolic, cardiovascular, cognitive, and mental side effects and may result in abrupt mortality. Buprenorphine is a semisynthetic opioid, a partial mu-opioid agonist with limited respiratory toxicity preferably used by these patients, as it is accompanied by significantly lower risk factors in the development of obstructive and central sleep apnea. In this manuscript, the case of a patient is reported who underwent methadone maintenance therapy which was shifted to buprenorphine in order to observe possible changes in sleep-related breathing disorders. The results of this study indicate a reduction in these problems through the desaturation and apnea hypopnea index of methadone substituted by buprenorphine while no change in sleepiness was observed

Usefulness of pulmonary artery diameter in diagnosing pulmonary hypertension in patients admitted to tuberculosis intensive care unit

AbstractObjective/backgroundPulmonary hypertension (PH) can be a complication of patients with severe pulmonary tuberculosis (TB). We aimed to study the correlation between pulmonary artery (PA) diameter (PAD) as measured by computed tomography (CT) and mean PA pressure (mPAP) as measured by echocardiography. We also aimed to determine the accuracy of PAD in diagnosing PH in patients with pulmonary TB.MethodsWe retrospectively investigated the correlation between PAD measured using CT and mPAP measured using echocardiography in 132 patients with TB and PH, and 68 patients with TB but without PH, admitted to the TB intensive care unit at Masih Daneshvari Hospital in Tehran, Iran. We used logistic regression analysis to determine the relationships between PAD, PA diameter to ascending aorta (AA) ratio, and area of PA to area of AA ratio with mPAP. Using receiver operating characteristic analysis, we examined the utility of the PAD in predicting PH (mPAP ⩾25mmHg).ResultsPAD had a significant correlation with mPAP (p<0.005 and r=0.47). Also, PA:AA ratio and area of PA to area of AA ratio had significant correlation with mPAP (r=0.48 and r=0.47, respectively; p<0.001). The threshold of 29mm for PAD was determined using ROC. This index had a sensitivity of 0.55, specificity of 70.2 and area under curve of 0.66.ConclusionAlthough PAD and PA:AA ratio are useful in assessing of presence of PH, we conclude that these CT parameters are not sufficient for ruling in or ruling out PH in this group of patients

Oral l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and Eisenmenger Syndrome: A clinical trial

AbstractBackground and purposeCitrulline is an amino acid which is produced by the urea cycle and also a precursor for NO, that is, a vasodilator for normal function of pulmonary vasculature. Thereby, enhancing l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and those with congenital heart disease identified as Eisenmenger Syndrome results in reduction of pulmonary hypertension.Methods and subjectsIn this clinical trial before and after study, we assigned 25 patients with arterial pulmonary hypertension (idiopathic or Eisenmenger Syndrome) to receive l-citrulline malate 1g three times daily for two weeks. The primary measurement was the change in exercise capacity, as considered as a result of the total distance walked in six minutes, from baseline to week 2. We also assessed mean pulmonary artery pressure, the change in the quality of life, and the change in pro-brain natriuretic peptide (BNP) level. The study was not powered to evaluate mortality.ResultsThe mean walking distance in six minutes was significantly increased by about 44m (p=0.005) after receiving l-citrulline malate. Mean pulmonary artery pressure significantly reduced from 83.34mmHg before receiving l-citrulline malate to 79.1mmHg after that (p=0.01). All dimensions of the quality of life had statistical differences after receiving l-citrulline malate except limit due to physical health, limit due to emotional health and social functioning (p>0.05). Finally, pro-BNP difference was not statistically significant (p=0.9).Conclusionl-Citrulline malate improves the distance walk in six minutes and also the quality of life of patients with idiopathic arterial pulmonary hypertension and Eisenmenger Syndrome and also reduced mean arterial pulmonary hypertension

Exhaled nitric oxide is not a biomarker for idiopathic pulmonary arterial hypertension or for treatment efficacy

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a fatal illness. Despite many improvements in the treatment of these patients, there is no unique prognostic variable available to track these patients. The aim of this study was to evaluate the association between fractional exhaled nitric oxide (FeNO) levels, as a noninvasive biomarker, with disease severity and treatment outcome. METHODS: Thirty-six patients (29 women and 7 men, mean age 38.4 ± 11.3 years) with IPAH referred to the outpatient's clinic of Masih Daneshvari Hospital, Tehran, Iran, were enrolled into this pilot observational study. Echocardiography, six-minute walking test (6MWT), FeNO, brain natriuretic peptide (BNP) levels and the functional class of patients was assessed before patients started treatment. Assessments were repeated after three months. 30 healthy non-IPAH subjects were recruited as control subjects. RESULTS: There was no significant difference in FeNO levels at baseline between patients with IPAH and subjects in the control group. There was also no significant increase in FeNO levels during the three months of treatment and levels did not correlate with other disease measures. In contrast, other markers of disease severity were correlated with treatment effect over the three months. CONCLUSION: FeNO levels are a poor non-invasive measure of IPAH severity and of treatment response in patients in this pilot study

Eighty Kilograms Weight Reduction in a Case of Obstructive Sleep Apnea with Several Comorbidities: Did the Conditions Improve?

Obstructive sleep apnea (OSA) together with metabolic disorders is common in severely obese patients. Weight reduction is considered as a treatment modality in these cases while few of them can succeed in considerable weight loss. Here, we present a severely obese man with body mass index of 54 suffered from OSA, type 2 diabetes, hypothyroidism, and hypertension. He intentionally lost 80 kilograms weight during the 2-year follow-up. Diabetes and hypertension completely resolved with considerable improvement in OSA syndrome after this huge weight reduction

The Effect of Buprenorphine vs. Methadone on Sleep Breathing Disorders

Opioids are used widely as analgesics and can play an important role in agonist maintenance therapy for opium dependence. Despite their benefits, the negative effects on the respiratory system remain an important side effect to be considered. Ataxic breathing, obstructive sleep apnea, and most of all central sleep apnea are among these concerns. Obstructive sleep apnea leads to various metabolic, cardiovascular, cognitive, and mental side effects and may result in abrupt mortality. Buprenorphine is a semisynthetic opioid, a partial mu-opioid agonist with limited respiratory toxicity preferably used by these patients, as it is accompanied by significantly lower risk factors in the development of obstructive and central sleep apnea. In this manuscript, the case of a patient is reported who underwent methadone maintenance therapy which was shifted to buprenorphine in order to observe possible changes in sleep-related breathing disorders. The results of this study indicate a reduction in these problems through the desaturation and apnea hypopnea index of methadone substituted by buprenorphine while no change in sleepiness was observed

Coarse-to-fine optical MEMS accelerometer design and simulation

In this paper, a novel coarse-to-fine optical MEMS accelerometer based on the Fabry Perot (FP) interferometer is proposed. The mechanical structure consists of a proof mass that is suspended by four L-shaped springs. The deflection of the proof mass due to the applied acceleration is detected using two FP cavities which comprise the optical system of the device. Using coarse-to-fine measurement and the dual-wavelength method increases the sensitivity of the accelerometer as well as the linear measurement range simultaneously. The optical simulation shows that the sensitivity of the proposed device is 10 times as high as that of a similar optical MEMS accelerometer with one FP cavity. In addition, the proposed optical system is insensitive to the displacements of the proof mass in orthogonal directions as a result of which cross-axis sensitivity is considerably reduced. The minimum feature size of the structure is 15 um and the optical signal is conducted completely through the optical fibers, facilitating the fabrication of the device. The simulation results are as follows: mechanical sensitivity of 190 nm/g, optical sensitivity of 8 nm/g, linear measurement of 5 g, and first resonance frequency of 1141 Hz

Effect of pulmonary hypertension on outcome of pulmonary tuberculosis

Objectives: Pulmonary hypertension is a serious disorder with catastrophic outcomes. This study aimed to evaluate the effect of pulmonary arterial hypertension on the outcome among new cases of pulmonary tuberculosis. Novel modalities are available as therapeutic options, so early diagnosis of pulmonary arterial hypertension may be important. Methods: In a cross-sectional study, 777 new cases of pulmonary tuberculosis were recruited in the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. Pulmonary arterial pressure was measured by resting transthoracic echocardiography on the beginning of tuberculosis treatment. Echocardiography was performed by a cardiologist expert in the field. Patients with systolic pulmonary arterial pressure more than 35 mmHg were defined as pulmonary hypertensive. The relationship between pulmonary arterial hypertension and mortality was assessed during six months of tuberculosis treatment. Results: Seventy-four (9.5%) of 777 new cases of pulmonary tuberculosis had pulmonary arterial hypertension. Among them, 10 (13.5%) died during the treatment period. In comparison with 5% mortality among cases without pulmonary arterial hypertension, death was significantly associated with pulmonary hypertension (p = 0.007). Logistic regression analysis showed that pulmonary arterial pressure more than 35 mmHg is an independent predictor of death among tuberculosis patients. Conclusion: Among new cases of pulmonary tuberculosis, a significant association between mortality and pulmonary arterial pressure >35 mmHg was found. Therapeutic intervention may change the outcome of these patients

Can 6-minute walk test predict severity of obstructive sleep apnea syndrome?

Abstract Background When considering the benefits of the 6-min walking test (6-MWT) in research fields and the need of treatment for moderate to severe obstructive sleep apnea (OSA) patients, research in this field is of great advantage and may have a significant role in therapeutic grounds. Methods This cross-sectional study was conducted on 47 patients with confirmed diagnosis of OSA in the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital. The 6-MWT was performed the day after polysomnography. The correlation between the 6-MWT and paraclinical findings during polysomnography in OSA patients was investigated. Results In cases with moderate to severe OSA, the male sex displayed correlation with high PCO2. Ages of patients examined displayed reversed correlation with the distance in the 6-MWT by observing the O2 saturation (Sat) at the end of the 6-MWT, displaying direct correlation with the duration of O2 Sat <90% during sleep. The BMI also showed reversed correlation with the distance in the 6-MWT. Similarly, the severity of the OSA had reversed correlation with the expected distance in the test. However, patients with higher duration of O2 Sat <90% during sleep had a higher reduction in O2 Sat during and after the 6-MWT. Patients with higher duration of O2 Sat <90% during sleep also completed less overall distance in the 6-MWT (P values <0.05 for all). Conclusion It appears that the 6-MWT can be used in patients with OSA to predict severity of the desaturation in OSA beyond functional capacity. Also, it can help predict the severity of disease and assist in follow up of the OSA patients in terms of functional capacity and selection of the most appropriate treatment strategy to increase the physical ability of the patients

Useful variables during wake and sleep for prediction of positive airway pressure in obstructive sleep apnea titration

Abstract Background Positive airway pressure is the main treatment modality in obstructive sleep apnea. The level of pressure needed for each patient is defined by a positive airway pressure titration study. Predicting those who need higher pressure or bi-level instead of continuous pressure is of a great clinical significance. This study was designed to evaluate whether voluntary breath-holding maneuver could predict Bilevel Positive Airway Pressure (BiPAP) or Continuous Positive Airway Pressure (CPAP) as the final optimal pressure in a split night study of patients with obstructive sleep apnea. Polysomnography (PSG) parameters specially oxygen saturation (SaO2) during non-rapid eye movement (NREM), rapid eye movement sleep (REM), and duration of REM in diagnostic part may help determine the type of devices as soon as possible in split night study. Methods The present research was conducted as a cross-sectional study of adults diagnosed as obstructive sleep apnea patients undergoing positive airway pressure (PAP) titration. Demographic, anthropometric, and polysomnographic data were collected. Patients were instructed to hold their breath as long as they could after five tidal breaths in the supine position. Baseline, post breath-holding phase, and recovery SaO2 were recorded. These data were used to predict the pressure level and type of device. Results Seventy-eight participants (56.4% male) with the mean age of 55.7 ± 13.9 years were included in the study. Mean and SD of apnea hypopnea index (AHI) and oxygen desaturation index (ODI) were 55.9 ± 34.4 and 38.3 ± 24 per hour, respectively. Most of the participants (65.3%) were categorized as CPAP group. CPAP and BiPAP groups were similar in terms of age, gender distribution, body mass index (BMI), neck circumference, and certain polysomnographic variables. Voluntary breath-holding maneuver showed a significant correlation between minimum SaO2 and the need for changing to BiPAP during titration. Baseline and post breath-holding SaO2 were not significantly lower in either group. NREM minimum SaO2 and REM duration were the statistically significant correlated variables that predicted the need for BiPAP. Conclusion Minimum oxygen following voluntary breath-holding maneuver along with higher BMI and larger neck circumference are predictors of the need to use BiPAP. Shorter REM duration and NREM minimum SaO2 were other predictors of higher chance of BiPAP during titration of the present OSA participants