The effects of body position on the distribution of obstructive, mixed and central sleep apnoea

BACKGROUND. Obstructive sleep apnoea is commonly aggravated by the supine body position. The impact of body position on the severity of mixed and central sleep apnoeas is understudied. OBJECTIVES. To evaluate the impact of body position on obstructive, mixed and central apnoea indices in subjects presenting with this triform of sleep apnoea during a single polysomnogram. METHODS. We retrospectively analysed 26 polysomnograms where obstructive, mixed and central apnoeas each occurred at a rate >5/hr. Comparisons between lateral and supine body positions were made for obstructive apnoea index (OAI), mixed apnoea index (MAI), central apnoea index (CAI), apnoea-hypopnoea index (AHI) and obstructive apnoea-hypopnoea index (OAHI). RESULTS. Mean (SD) apnoea indices were significantly lower in lateral v. supine positions, respectively: MAI 15.06 (18.34) v. 32.09 (17.05); p<0.001, CAI 11.82 (11.77) v. 23.82 (14.18); p<0.001, AHI 79.46 (31.17) v. 99.47 (26.33); p<0.001, OAHI 67.87 (28.25) v. 76.00 (23.21); p=0.039. Unexpectedly, the converse was seen for OAI when comparing the lateral v. supine position: 53.10 (30.64) v. 43.58 (25.83); p=0.009, respectively. CONCLUSION. It may be beneficial for subjects with a combination of obstructive, mixed, and central apnoeas to avoid the supine body position. In this triform phenotype, mixed apnoeas are neither purely obstructive nor purely centrally mediated. Furthermore, obstructive, mixed, and central apnoeas may be different representations of a single respiratory abnormality.First author, GC, funded the study.http://www.ajtccm.org.za/index.php/SARJam2020School of Health Systems and Public Health (SHSPH

R code for analyzing data

R code for analyzing data. All analyses and figures are generated from this file

Isotopic evidence for oligotrophication of terrestrial ecosystems

Human societies depend on an Earth system that operates within a constrained range of nutrient availability, yet the recent trajectory of terrestrial nitrogen (N) availability is uncertain. Examining patterns of foliar N concentrations and isotope ratios (δ¹⁵N) from more than 43,000 samples acquired over 37 years, here we show that foliar N concentration declined by 9% and foliar δ¹⁵N declined by 0.6-1.6‰. Examining patterns across different climate spaces, foliar δ¹⁵N declined across the entire range of mean annual temperature and mean annual precipitation tested. These results suggest declines in N supply relative to plant demand at the global scale. In all, there are now multiple lines of evidence of declining N availability in many unfertilized terrestrial ecosystems, including declines in δ¹⁵N of tree rings and leaves from herbarium samples over the past 75-150 years. These patterns are consistent with the proposed consequences of elevated atmospheric carbon dioxide and longer growing seasons. These declines will limit future terrestrial carbon uptake and increase nutritional stress for herbivores

Data from: Isotopic evidence for oligotrophication of terrestrial ecosystems

Human societies depend on an Earth System that operates within a constrained range of nutrient availability, yet the recent trajectory of terrestrial nitrogen (N) availability is uncertain. Examining patterns of foliar N concentrations ([N]) and isotope ratios (15N) from more than 42,000 samples acquired over 37 years, here we show that foliar [N] declined by 8% and foliar 15N declined by 0.8 – 1.9 ‰. Examining patterns across different climate spaces, foliar 15N declined across the entire range of MAT and MAP tested. These results suggest declines in N supply relative to plant demand at the global scale. In all, there are now multiple lines of evidence of declining N availability in many unfertilized terrestrial ecosystems, including declines in 15N of tree rings and leaves from herbarium samples over the past 75-150 years. These patterns are consistent with the proposed consequences of elevated atmospheric CO2 and longer growing seasons. These declines will limit future terrestrial C uptake and increase nutritional stress for herbivores