Validation of the oxygen desaturation index in the diagnostic workup of obstructive sleep apnea

Introduction: Obstructive sleep apnea (OSA) is common, and diagnosis requires expensive and laborious testing to assess the apnea hypopnea index (AHI). We performed an analysis to explore the relationship between the oxygen desaturation index (ODI) as measured with pulse oximetry and the AHI in our large portable monitoring (PM) database to find an optimal cutoff value for the ODI in order to be able to exclude AHI ≥ 5 on PM. Methods: Three thousand four hundred thirteen PM recordings were randomly divided into a training set (N = 2281) and a test set (N = 1132). The optimal cutoff for the ODI to exclude an AHI ≥ 5 on PM was determined in the training set and subsequently validated in the test set. Results: Area under the curve of the ODI to exclude an AHI ≥ 5 on PM was 0.997 in the training set and 0.996 in the test set. In the training set, the optimal cutoff to predict an AHI < 5 was an ODI < 5. Using this cutoff in the test set provided a sensitivity of 97.7%, a specificity of 97.0%, a positive predictive value of 99.2%, and a negative predictive value of 91.4%. Conclusion: An ODI < 5 predicts an AHI < 5 with high sensitivity and specificity when measured simultaneously using the same oximeter during PM recording

Forearm Rotation Range of Motion and Its Velocity in Eating With Chopsticks : a Comparison Among Positions of Dish

The purpose of this study was to determine range of motion of forearm rotation and its velocity in eating. Six young students (age:20.5±0.5 years [range:20-21], 2 men and 4 women) participated in this study. To measure three-dimensional motions, we used an electromagnetic tracking device system. The first sensor was attached to the dorsal/distal of forearm with sprint, and the second sensor was attached to the dorsal/medial ulna with elastic belt. The subjects ate pickles with chopsticks. At a wooden desk with 70cm height they sat on a height-adjustable chair, so their olecranon was as high as the desk top. Three positions of a dish were measured; A: at the distance of length of distal to elbow, B: at the distance of length of the upper extremity, and C: at a middle position between A and B. The results revealed that forearm rotation, range of motion and its velocity were significantly different among three conditions (one-way repeated-measure ANOVA)(p<0.05). Characteristically the motion velocity of B was lower than C, and A was lower than C (p<0.05). Findings suggest that 1) limited forearm range of motion would decrease a burden of forearm by setting a dish at B or C than A, 2) the rotation (maximal pronation and supination: 11 and 49 degrees, respectively) was similar, to a fork (maximal pronation and supination: 10 and 51 degrees, respectively), 3) C may be efficiently operated, and 4) the system may be instructed as a good equipment for eating

Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study

Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studi

Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study

Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studies focusing on home treatment have suggested that 30% to 55% of acute PE patients could be treated at home, based on the HESTIA criteria, but data from day-to-day clinical practice are largely unavailable. Aim: To determine current practice patterns of home treatment of acute PE in the Netherlands. Method: We performed a post-hoc analysis of the YEARS study. The main outcomes were the proportion of patients who were discharged <24 h and reasons for admission if treated in hospital. Further, we compared the 3-month incidence of PE-related unscheduled readmissions between patients treated at home and in hospital. Results: Of the 404 outpatients with PE included in this post-hoc analysis of the YEARS study, 184 (46%) were treated at home. The median duration of admission of the hospitalized patients was 3.0 days. The rate of PE-related readmissions of patients treated at home was 9.7% versus 8.6% for hospitalized patients (crude hazard ratio 1.1 (95% CI 0.57–2.1)). The 3-month incidence of any adverse event was 3.8% in those treated at home (2 recurrent VTE, 3 major bleedings and two deaths) compared to 10% in the hospitalized patients (3 recurrent VTE, 6 major bleedings and fourteen deaths). Conclusions: In the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital

Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial

The Sleep Position Trainer (SPT) is a new option for treating patients with positional obstructive sleep apnea (POSA). This study investigated long-term efficacy, adherence, and quality of life during use of the SPT device compared with oral appliance therapy (OAT) in patients with POSA. This prospective, multicenter trial randomized patients with mild to moderate POSA (apnea-hypopnea index [AHI] 5-30/h) to SPT or OAT. Polysomnography was performed at baseline and after 3 and 12 months' follow-up. The primary endpoint was OSA severity; adherence, quality of life, and adverse events were also assessed. Ninety-nine patients were randomized and 58 completed the study (29 in each group). Median AHI in the SPT group decreased from 13.2/h at baseline to 7.1/h after 12 months (P < 0.001); corresponding values in the OAT group were 13.4/h and 5.0/h (P < 0.001), with no significant between-group difference (P = 1.000). Improvements throughout the study were maintained at 12 months. Long-term median adherence was also similar in the two treatment groups; the proportion of patients who used their device for ≥ 4 h for 5 days in a week was 100% in the SPT group and 97.0% in the OAT group (P = 0.598). The efficacy of SPT therapy was maintained over 12 months and was comparable to that of OAT in patients with mild to moderate POSA. Adherence was relatively high, and similar in the two groups. www.clinicaltrials.gov (NCT02045576

Airflow from nasal pulse oximetry in the screening of obstructive sleep apnea

Obstructive Sleep Apnea (OSA) is recognized as an increasing health risk, leading to daytime sleepiness and various medical conditions, such as hypertension and heart failure. Polysomnography (PSG), the gold standard to diagnose OSA, is a resource-intensive and expensive investigation confined to the hospital.Portable home monitoring, i.e. pulse oximetry, may become an acceptable OSA screening method. The novel nasal pulse oximeter sensor (Xhale Alar) adds the possibility of combining pulse oximetry (SpO2) with airflow analysis by an integrated thermistor, which might increase the diagnostic accuracy.In the Alar pilot study, 39 adults were measured during an overnight PSG recording together with the Alar sensor. This study aims to investigate the additional value of an airflow signal compared to SpO2 analysis in OSA screening. Both time and spectral features were extracted from SpO2 and airflow signals recorded with the Alar sensor. Leave one out cross-validation was used to develop Random Forest models in screening for apnea-hypopnea index (AHI) thresholds 5 and 10. Using both AHI ≥ 5 and AHI ≥ 10 as the diagnostic cutoff, the airflow signal shows respectively an AUC of 89% and 80% compared to 78% and 77% with SpO2 analysis, showing a higher performance using an airflow signal in screening adults for OSA