System for monitoring and supporting the treatment of sleep apnea using IoT and big data

[EN] Sleep apnea has become in the sleep disorder that causes greater concern in recent years due to its morbidity and mortality, higher medical care costs and poor people quality of life. Some proposals have addressed sleep apnea disease in elderly people, but they have still some technical limitations. For these reasons, this paper presents an innovative system based on fog and cloud computing technologies which in combination with IoT and big data platforms offers new opportunities to build novel and innovative services for supporting the sleep apnea and to overcome the current limitations. Particularly, the system is built on several low-power wireless networks with heterogeneous smart devices (i.e, sensors and actuators). In the fog, an edge node (Smart IoT Gateway) provides IoT connection and interoperability and pre-processing IoT data to detect events in real-time that might endanger the elderly's health and to act accordingly. In the cloud, a Generic Enabler Context Broker manages, stores and injects data into the big data analyzer for further processing and analyzing. The system's performance and subjective applicability are evaluated using over 30 GB size datasets and a questionnaire fulfilled by medicals specialist, respectively. Results show that the system data analytics improve the health professionals' decision making to monitor and guide sleep apnea treatment, as well as improving elderly people's quality of life. (C) 2018 Elsevier B.V. All rights reserved.This research was supported by the Ecuadorian Government through the Secretary of Higher Education, Science, Technology, and Innovation (SENESCYT) and has received funding from the European Union's "Horizon 2020'' research and innovation program as part of the ACTIVAGE project under Grant 732679 and the Interoperability of Heterogeneous IoT Platforms project (INTER-IoT) under Grant 687283.Yacchirema-Vargas, DC.; Sarabia-Jácome, DF.; Palau Salvador, CE.; Esteve Domingo, M. (2018). System for monitoring and supporting the treatment of sleep apnea using IoT and big data. Pervasive and Mobile Computing. 50:25-40. https://doi.org/10.1016/j.pmcj.2018.07.007S25405

Obstructive sleep apnea : the relationship to cardiovascular disease, diabetes mellitus, motor vehicle driving and ambient temperature

Background: Obstructive sleep apnea is a common disorder, especially in men. Patients with this condition often snore and suffer from excessive daytime sleepiness. It is a treatable condition related to cardiovascular disease, road traffic accidents and obesity. Aims: To study whether snoring and witnessed sleep apnea are related to diabetes mellitus and whether sleepy subjects who snore or report sleep apneas drive more than others. To investigate whether sleep apnea is related to stroke, mortality and myocardial infarction in patients with coronary artery disease. To study the effect of ambient temperature on sleep apnea, morning alertness and sleep quality in patients with obstructive sleep apnea. Methods and results: Questions on snoring, sleep apnea, daytime sleepiness and yearly driving distance were included in the northern Sweden component of the WHO MONICA study. Analyzed were 7905 randomly selected men and women aged 25-79 years. Snoring and witnessed sleep apnea were related to diabetes mellitus in women, (OR 1.58, p = 0.041 and OR 3.29, p = 0.012 respectively), independent of obesity, age and smoking, but not in men. Sleepy snoring men drove a mean of 22566 km per year which was more than others who drove 17751 km per year independent of age, BMI, smoking and physical activity (p = 0.02). Sleepy men reporting sleep apnea also drove more (p = 0.01). 392 men and women with coronary artery disease referred for coronary angiography were examined with overnight sleep apnea recordings and followed for 10 years. Sleep apnea was recorded in 211 (54%) of patients at baseline. Stroke occurred in 47 (12%) patients at follow up. Sleep apnea was associated with an increased risk of stroke (HR 2.89, 95% CI 1.37 - 6.09, p = 0.005) independent of age , BMI, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or TIA and smoking. The risk of stroke increased with the severity of sleep apnea. 40 patients with obstructive sleep apnea were investigated with overnight polysomnography in ambient temperatures of 16°C, 20°C and 24°C in random order. Total sleep time was a mean of 30 minutes longer (p = 0.009), sleep efficiency higher (p = 0.012), patients were more alert in the morning (p = 0.028), but sleep apnea was more severe when sleeping in 16°C (p = 0.001) and 20°C (p = 0.033) vs. 24°C. The AHI was 30 ± 17 in 16ºC room temperature, 28 ± 17 in 20°C and 24 ± 18 in 24°C. Conclusions: Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Sleepy men who snore or report sleep apnea drive more than others. Sleep apnea is independently associated with the risk of stroke among patients with coronary artery disease. Subjects with obstructive sleep apnea sleep longer, are more alert in the morning after a night’s sleep, but sleep apnea is more severe when sleeping in a colder environment

Other cultures in the history of litterature : A stydy of teaching aids in the history of litterature

Jag har gjort en diskursanalys utav tre läromedel i svenska avsedda för gymnasieskolans B-kurs.Analysens syfte är att se hur läromedlen i gymnasieskolans svenskundervisning tar upp utomvästerländska författare, såsom afrikanska, sydamerikanska och asiatiska författare, med utgångspunkt i postkolonial teori. Hur motiveras de utomvästerländska författarnas medverkan i läromedlen, huruvida upprätthålls den världsbild som har västerlandets överlägsenhet som utgångsläge i val av författare och verk?Min slutsats blir att läromedlen inte uppfyller de krav läroplanen ställer på dem när det gäller att lyfta in ett internationellt perspektiv i undervisningen. Jag anser även att det sätt, som läromedelsförfattarna många gånger tar upp utomvästerländska författare på, bidrar till att maktstrukturerna i samhället vidmakthålls

Who would want me as a swede? : An analysis of the concept of immigrant writers

Uppsatsen är en litteraturstudie som problematiserar begreppet invandrarförfattare/invandrarlitteratur med utgångspunkten att denna typ av kategorisering är diskriminerande. Litteraturstudien är kompletterad med två analyser av romanerna Utlänningar (Kallifatides, 1970) och Kan du säga Schibbolet? (Bakhtiari, 2008). Resultatet av litteraturstudien visar att det finns många problem med denna kategorisering och att den ger en mycket enkel bild av en författares verk. Denna förenkling förstärker bilden av vi och dem. Resultatet av analyserna ger de som har försökt definiera begreppet invandrarförfattare/invandrarlitteratur rätt till viss del men de olika författarnas olika definitioner belyser även hur komplicerat det är, att sätta en stämpel på hur invandrade författare skriver. Det finns inte heller något som säger att dessa teman inte är typiska även för svenskfödda författare inom samma genrer

Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function

Aims: Impaired renal function is a major contributor to the low proportion of mineralocorticoidreceptor antagonist (MRA) treatment in patients with heart failure with reduced ejection fraction(HFrEF). Our aims were to investigate the impact of MRA treatment on all-cause mortalityand worsening renal function (WRF) in patients with HFrEF and moderately impairedrenal function. Methods: Retrospective data between 2010–2018 on HFrEF patients from a single-centre hospitalwith estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR > 20%. Results: 416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128patients (32%) experienced WRF, 25% in the MRA group and 30% in patients without MRA(p = 0.293). In multivariable analysis, hospitalization for heart failure and systolic blood pressurewere associated with WRF (p = 0.015 and p = <0.001), but not use of MRA (p = 0.421).MRA treatment had no impact on the risk of adjusted all-cause mortality (HR 0.93; 95% CI,0.66–1.32 p = 0.685). WRF was associated with increased adjusted risk of all-cause mortality(HR 1.43; 95% CI, 1.07–1.89 p = 0.014). Use of MRA did not increase the adjusted overallrisk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81–1.63 p = 0.422). Conclusion: In this cohort of elderly HFrEF patients with moderately impaired renal function, MRA didnot increase risk for WRF or all-cause mortality

Experiences of living with symptomatic atrial fibrillation

AIM: To explore the experiences of living with symptomatic atrial fibrillation. DESIGN: This study, with a descriptive qualitative adesign, was performed using semi-structured individual interviews. METHOD: Six women and nine men with symptomatic atrial fibrillation were included. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was followed. RESULTS: The analysis resulted in a main theme, namely balancing life and included the themes striving for illness control, becoming a receiver or an active partner in care and dealing with changed self-image. The participants strived to understand their illness, prevent attacks and manage anxiety. Some of the participants were not involved in decision-making, were uninformed about self-care measures, reported a lack of continuity in care and felt that the doctors focused on information about the medical part of care

Comparison of creatinine-based methods for estimating glomerular filtration rate in patients with heart failure

Aims: Glomerular filtration rate is an important factor in management of heart failure (HF). Our objective was to validate eight creatinine-based equations for estimating glomerular filtration rate (eGFR) in an HF population against measured glomerular filtration rate. Methods and results: One hundred forty-six HF patients (mean age 68 +/- 13 years, mean left ventricular ejection fraction 45% +/- 15) within a single-centre hospital that underwent Cr-51-EDTA clearance between 2010 and 2018 were included in this retrospective study. eGFR was estimated by means of Cockcroft-Gault ideal and actual weight, the Modification of Diet in Renal Disease Study (MDRD), simplified MDRD with isotope dilution mass spectroscopy traceable calibration, the Chronic Kidney Disease Epidemiology Collaboration, revised Lund-Malmo, full age spectrum, and the Berlin Initiative Study 1. Mean measured glomerular filtration rate was 42 mL/min/1.73 m(2). Pearson's correlation coefficient (r) had the highest precision for MDRD (r = 0.9), followed by revised Lund-Malmo (r = 0.88). All equations except MDRD (mean difference -4.8%) resulted in an overestimation of the renal function. The accuracy was below 75% for all equations except MDRD. Conclusions: None of the exclusively creatinine-based methods was accurate in predicting eGFR in HF patients. Our findings suggest that more accurate methods are needed for determining eGFR in patients with HF

Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population

Introduction: Mineralocorticoid receptor antagonists (MRAs) reduce mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF), but are largely underused. We evaluated the frequency, motives, predictors and outcomes of MRA discontinuation in a real-world heart failure population. Methods and results: This was a single-centre, retrospective cohort study where medical record-based data were collected on patients with HFrEF between 2010 and 2018. In the final analysis, 572 patients were included that comprised the continued MRA group (n=275) and the discontinued MRA group (n=297). Patients that discontinued MRA were older, had a higher comorbidity index and a lower index estimated glomerular filtration rate (eGFR). Predictors of MRA discontinuations were increased S-potassium, lower eGFR, lower systolic blood pressure, higher frequency of comorbidities and a higher left ventricular ejection fraction. The most common reason for MRA discontinuation was renal dysfunction (n=97, 33%) with 59% of these having an eGFR <30 mL/min/1.73m 2, and elevated S-potassium (n=71, 24%) with 32% of these having an S-potassium >5.5 mmol/L. Discontinuation of MRA increased the adjusted risk of all-cause mortality (HR 1.48; 95% CI 1.07 to 2.05; p=0.019). Conclusions: Half of all patients with HFrEF initiated on MRA discontinued the treatment. A substantial number of patients discontinued MRA without meeting the guideline-recommended levels of eGFR and S-potassium where mild to moderate hyperkalaemia seems to be the most decisive predictor. Further, MRA discontinuation was associated with increased adjusted risk of all-cause mortality

Simple snoring: Not quite so simple after all?

Simple snoring (SS), in the absence of obstructive sleep apnoea (OSA), is a common problem, yet our understanding of its causes and consequences is incomplete. Our understanding is blurred by the lack of consistency in the definition of snoring, methods of assessment, and degree of concomitant complaints. Further, it remains contentious whether SS is independently associated with daytime sleepiness, or adverse health outcomes including cardiovascular disease and metabolic syndrome. Regardless of this lack of clarity, it is likely that SS exists on one end of a continuum, with OSA at its polar end. This possibility highlights the necessity of considering an otherwise ‘annoying’ complaint, as a serious risk factor for the development and progression of sleep apnoea, and consequent poor health outcomes. In this review, we: 1) highlight variation in prevalence estimates of snoring; 2) review the literature surrounding the distinctions between SS, upper airway resistance syndrome (UARS) and OSA; 3) present the risk factors for SS, in as far as it is distinguishable from UARS and OSA; and 4) describe common correlates of snoring, including cardiovascular disease, metabolic syndrome, and daytime sleepiness