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Patel SR. Enduring Value of the (UK-) COMPASS. Eur J Vasc Endovasc Surg 2024; 67:856-857. [PMID: 38588777 DOI: 10.1016/j.ejvs.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
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Vallabhaneni SR, Patel SR, Campbell B, Boyle JR, Cook A, Crosher A, Holder SM, Jenkins MP, Ormesher DC, Rosala-Hallas A, Jackson RJ. Editor's Choice - Comparison of Open Surgery and Endovascular Techniques for Juxtarenal and Complex Neck Aortic Aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) - Peri-operative and Midterm Outcomes. Eur J Vasc Endovasc Surg 2024; 67:540-553. [PMID: 38428672 DOI: 10.1016/j.ejvs.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Treatment of juxtarenal and complex neck abdominal aortic aneurysms (AAAs) is now commonly by endovascular rather than open surgical repair (OSR). Published comparisons show poor validity and scientific precision. UK-COMPASS is a comparative cohort study of endovascular treatments vs. OSR for patients with an AAA unsuitable for standard on label endovascular aneurysm repair (EVAR). METHODS All procedures for AAA in England (November 2017 to October 2019) were identified, AAA anatomy assessed in a Corelab, peri-operative risk scores determined, and propensity scoring used to identify patients suitable for either endovascular treatment or OSR. Patients were stratified by aneurysm neck length (0 - 4 mm, 5 - 9 mm, or ≥ 10 mm) and operative risk; the highest quartile was considered high risk and the remainder standard risk. Death was the primary outcome measure. Endovascular treatments included fenestrated EVAR (FEVAR) and off label standard EVAR (± adjuncts). RESULTS Among 8 994 patients, 2 757 had AAAs that were juxtarenal, short neck, or complex neck in morphology. Propensity score stratification and adjustment method comparisons included 1 916 patients. Widespread off label use of standard EVAR devices was noted (35.6% of patients). The adjusted peri-operative mortality rate was 2.9%, lower for EVAR (1.2%; p = .001) and FEVAR (2.2%; p = .001) than OSR (4.5%). In standard risk patients with a 0 - 4 mm neck, the mortality rate was 7.4% following OSR and 2.3% following FEVAR. Differences were smaller for patients with a neck length ≥ 5 mm: 2.1% OSR vs. 1.0% FEVAR. At 3.5 years of follow up, the overall mortality rate was 20.7% in the whole study population, higher following FEVAR (27.6%) and EVAR (25.2%) than after OSR (14.2%). However, in the 0 - 4 mm neck subgroup, overall survival remained equivalent. The aneurysm related mortality rate was equivalent between treatments, but re-intervention was more common after EVAR and FEVAR than OSR. CONCLUSION FEVAR proves notably safer than OSR in the peri-operative period for juxtarenal aneurysms (0 - 4 mm neck length), with comparable midterm survival. For patients with short neck (5 - 9 mm) and complex neck (≥ 10 mm) AAAs, overall survival was worse in endovascularly treated patients compared with OSR despite relative peri-operative safety. This warrants further research and a re-appraisal of the current clinical application of endovascular strategies, particularly in patients with poor general survival outlook owing to comorbidity and age.
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Patel SR, Lip GYH, Vallabhaneni SR. Response to 'Re. Comparison of open, standard, and complex endovascular aortic repair treatments for juxtarenal/short neck aneurysms: a systematic review and network meta-analysis'. Eur J Vasc Endovasc Surg 2023; 65:455-456. [PMID: 36574566 DOI: 10.1016/j.ejvs.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
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Miller P, Patel SR, Skinner R, Dignan F, Richter A, Jeffery K, Khan A, Heath PT, Clark A, Orchard K, Snowden JA, de Silva TI. Joint consensus statement on the vaccination of adult and paediatric haematopoietic stem cell transplant recipients: Prepared on behalf of the British society of blood and marrow transplantation and cellular therapy (BSBMTCT), the Children's cancer and Leukaemia Group (CCLG), and British Infection Association (BIA). J Infect 2023; 86:1-8. [PMID: 36400155 DOI: 10.1016/j.jinf.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Haematopoietic stem cell transplant (HSCT) recipients have deficiencies in their adaptive immunity against vaccine preventable diseases. National and International guidance recommends that HSCT recipients are considered 'never vaccinated' and offered a comprehensive course of revaccination. This position statement aims to draw upon the current evidence base and existing guidelines, and align this with national vaccine availability and licensing considerations in order to recommend a pragmatic and standardised re-vaccination schedule for adult and paediatric HSCT recipients in the UK.
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Patel SR, Ormesher DC, Griffin R, Jackson RJ, Lip GYH, Vallabhaneni SR. Editor's Choice - Comparison of Open, Standard, and Complex Endovascular Aortic Repair Treatments for Juxtarenal/Short Neck Aneurysms: A Systematic Review and Network Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 63:696-706. [PMID: 35221243 DOI: 10.1016/j.ejvs.2021.12.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysms (AAAs) with adverse morphology of the aneurysm neck are "complex". Techniques employed to repair complex aneurysms include open surgical repair (OSR) and a number of on label endovascular techniques such as fenestrated endovascular aneurysm repair (FEVAR) and endovascular aneurysm repair (EVAR) with adjuncts (including chimneys and endo-anchors), as well as off label use of standard EVAR. The aim was to conduct a network meta-analysis (NMA) of published comparative outcomes. DATA SOURCES An electronic search was performed in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). These databases were interrogated using the PubMed interface and the Healthcare Databases Advanced Search (HDAS) interface developed by the National Institute of Health and Care Excellence. REVIEW METHODS Online databases were interrogated up to April 2020. Studies were included if they compared outcomes between at least two methods of repair for complex aneurysms (those with at least one adverse neck feature: absent/short neck, conicality, angulation, calcification, large diameter, and thrombus). The primary outcome measure was peri-operative death. Pre-registration was done in PROSPERO (CRD42020177482). RESULTS The search identified 24 observational studies and 7854 patients who underwent OSR, FEVAR, off label EVAR, or chimney EVAR. No comparative studies included EVAR with endo-anchors. NMA was performed on 23 studies that reported outcomes of aneurysms with short/absent infrarenal neck. Compared with OSR, off label EVAR (relative risk [RR] 0.10, 95% confidence interval [CI] 0.01 - 0.41) and FEVAR (RR 0.62, 95% CI 0.32-0.94) were associated with lower peri-operative mortality. This difference was not seen at the midterm follow up (30 months). Compared with OSR, FEVAR was associated with a lower peri-operative myocardial infarction (MI) rate (RR 0.37, 95% CI 0.16 - 0.62) but a higher midterm re-intervention rate (hazard ratio 1.65, 95% CI 1.04 - 2.66). All studies had a "moderate" or "high" risk of bias. Confidence in the network findings (GRADE) was generally "low". CONCLUSION This NMA demonstrated a peri-operative survival benefit for off label EVAR and FEVAR compared with OSR, potentially due to reduced risk of MI. FEVAR carries a greater midterm re-intervention risk than OSR, with potential implications for cost effectiveness. There is paucity of comparative data for cases with adverse neck features other than short length.
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Patel SR, Ormesher DC, Smith SR, Wong KHF, Bevis P, Bicknell CD, Boyle JR, Brennan JA, Campbell B, Cook A, Crosher AP, Duarte RV, Flett MM, Gamble C, Jackson RJ, Juszczak MT, Loftus IM, Nordon IM, Patel JV, Platt K, Psarelli EE, Rowlands PC, Smyth JV, Spachos T, Taggart L, Taylor C, Vallabhaneni SR. A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms-the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol. BMJ Open 2021; 11:e054493. [PMID: 34848524 PMCID: PMC8634354 DOI: 10.1136/bmjopen-2021-054493] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In one-third of all abdominal aortic aneurysms (AAAs), the aneurysm neck is short (juxtarenal) or shows other adverse anatomical features rendering operations more complex, hazardous and expensive. Surgical options include open surgical repair and endovascular aneurysm repair (EVAR) techniques including fenestrated EVAR, EVAR with adjuncts (chimneys/endoanchors) and off-label standard EVAR. The aim of the UK COMPlex AneurySm Study (UK-COMPASS) is to answer the research question identified by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme: 'What is the clinical and cost-effectiveness of strategies for the management of juxtarenal AAA, including fenestrated endovascular repair?' METHODS AND ANALYSIS UK-COMPASS is a cohort study comparing clinical and cost-effectiveness of different strategies used to manage complex AAAs with stratification of physiological fitness and anatomical complexity, with statistical correction for baseline risk and indication biases. There are two data streams. First, a stream of routinely collected data from Hospital Episode Statistics and National Vascular Registry (NVR). Preoperative CT scans of all patients who underwent elective AAA repair in England between 1 November 2017 and 31 October 2019 are subjected to Corelab analysis to accurately identify and include every complex aneurysm treated. Second, a site-reported data stream regarding quality of life and treatment costs from prospectively recruited patients across England. Site recruitment also includes patients with complex aneurysms larger than 55 mm diameter in whom an operation is deferred (medical management). The primary outcome measure is perioperative all-cause mortality. Follow-up will be to a median of 5 years. ETHICS AND DISSEMINATION The study has received full regulatory approvals from a Research Ethics Committee, the Confidentiality Advisory Group and the Health Research Authority. Data sharing agreements are in place with National Health Service Digital and the NVR. Dissemination will be via NIHR HTA reporting, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER ISRCTN85731188.
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Patel SR, Roy IN, McWilliams RG, Brennan JA, Vallabhaneni SR, Neequaye SK, Smout JD, Fisher RK. Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR). JRSM Cardiovasc Dis 2021; 10:20480040211012503. [PMID: 34211706 PMCID: PMC8217896 DOI: 10.1177/20480040211012503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/20/2021] [Accepted: 04/01/2021] [Indexed: 12/05/2022] Open
Abstract
Background In FEVAR, visceral stents provide continuity and maintain perfusion between
the main body of the stent and the respective visceral artery. The aim of
this study was to characterise the incidence and mode of visceral stent
failure (type Ic endoleak, type IIIa endoleak, stenosis/kink, fracture,
crush and occlusion) after FEVAR in a large cohort of patients at a
high-volume centre. Methods A retrospective review of visceral stents placed during FEVAR over 15 years
(February 2003-December 2018) was performed. Kaplan-Meier analyses of
freedom from visceral stent-related complications were performed. The
outcomes between graft configurations of varying complexity were compared,
as were the outcomes of different stent types and different visceral
vessels. Results Visceral stent complications occurred in 47/236 patients (19.9%) and 54/653
stents (8.3%). Median follow up was 3.7 years (IQR 1.7–5.3 years). There was
no difference in visceral stent complication rate between renal, SMA and
coeliac arteries. Visceral stent complications were more frequent in more
complex grafts compared to less complex grafts. Visceral stent complications
were more frequent in uncovered stents compared to covered stents. Visceral
stent-related endoleaks (type Ic and type IIIa) occurred exclusively around
renal artery stents. The most common modes of failure with SMA stents were
kinking and fracture, whereas with coeliac artery stents it was external
crush. Conclusion Visceral stent complications after FEVAR are common and merit continued and
close long-term surveillance. The mode of visceral stent failure varies
across the vessels in which the stents are located.
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Alcantara C, Wallace M, Sotres-Alvarez D, Vetter C, Phillips AJ, Shafazand S, Johnson DA, Wallace D, Gallo LC, Ramos AR, Penedo F, Wohlgemuth WK, Zee PC, Redline S, Patel SR. 1097 Sleep Disturbances, Sleep Burden, And Depressive Symptoms In US Hispanics/Latinos: Results From The HCHS/SOL Sueño Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
While sleep disturbances and depression often co-occur, these associations are understudied among Hispanics/Latinos. We examined the associations of sleep disturbances and sleep burden with depressive symptoms among Hispanic/Latino adults in the United States.
Methods
We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sueño Ancillary study (2010-2013). The study enrolled 2072 adults (ages 18-64; 51.5% females) who completed one-week wrist-actigraphy and sleep questionnaires. Sleep burden was operationalized as the total count of sleep disturbances across six domains (duration, efficiency, midpoint, variability, insomnia, sleepiness). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale (CESD-10). We used weighted survey linear regressions to evaluate the association of sleep disturbances and sleep burden with elevated depressive symptoms (CESD≥10) in individual models adjusted for age, gender, site, heritage, nativity, education, income, and employment. Sensitivity analyses further adjusted for behavioral health risk factors and apnea-hypopnea index.
Results
An estimated 28.3% had elevated depressive symptoms, 8.0% had short sleep duration (<6 hours of sleep), 10.9% had long sleep duration (>9 hours), 45.2% exhibited a later sleep midpoint (≥4:00AM), 38.4% had high sleep timing variability (upper third tertile for between day sleep midpoint), 15.3% had insomnia (ISI≥10), 17.3% had excessive daytime sleepiness (ESS ≥10), 21.5% had poor sleep efficiency (<85%), and 77.4% had a total sleep burden count of ≥0. Insomnia (ß=0.49,95%CI:.43,.56), later sleep timing (ß=0.10,95%CI:.04,.16), excessive daytime sleepiness (ß=0.19,95%CI:.11,.27), poor sleep efficiency (ß=0.09,95%CI:.02,.17), high variability (ß=0.07, 95%CI:.01,.12), and sleep burden (ß=0.11,95%CI:.09,.13), were each positively associated with elevated depressive symptoms in individual adjusted models and sensitivity analyses. Extreme sleep durations were not associated with elevated depressive symptoms.
Conclusion
Multiple inter-related sleep disturbances, particularly those pertaining to sleep quality and timing, are associated with depression and may be targets for future interventions aimed at improving mood among Hispanics/Latinos.
Support
HL127307, HL098927, HL125748
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Carmona ET, Nouraie SM, Bakker JP, Stitt CJ, Aloia MS, Patel SR. 0357 CPAP Adherence is Lower in Minority Neighborhoods. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The effectiveness of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) is limited by adherence. Small, single-center studies have reported CPAP adherence is lower in racial minorities suggesting disparities in OSA care. We used nationally representative data to assess racial differences in CPAP adherence at a neighborhood level.
Methods
Telemonitoring data were obtained from a therapy database maintained by a CPAP manufacturer. Usage over the first 90 days in patients initiated on CPAP between 11/01/2015 and 10/31/2018 who had at least one usage session, age 18-90 years, and valid U.S. zip code were mapped to a zip code tabulation area (ZCTA). Age- and sex-adjusted CPAP usage was calculated for each ZCTA with greater than 10 CPAP users. Ecologic analyses were performed to model the association of the proportion of blacks and Hispanics in each ZCTA (obtained from the 2013-2017 American Community Survey) on CPAP usage controlling for proportion of adults with bachelor’s degree and proportion of adults with household income below the poverty line.
Results
Our analysis included 13,118 ZCTAs averaging data over 737,274 patients. In adjusted analyses, each 10% increase in the proportion of blacks and Hispanics was associated with a 0.12 (95% CI 0.11-0.12) hour and 0.14 (95% CI 0.14-0.15) hour decrease in nightly CPAP use, respectively. Mean usage in ZCTAs with <1%, 1-2.5%, 2.5-10%, 10-25%, and 25-100% blacks were 4.96, 4.81, 4.67, 4.56, and 4.14 hours respectively (p<0.001). Mean usage in ZCTAs with <1%, 1-2.5%, 2.5-10%, 10-25%, and 25-100% Hispanics were 4.87, 4.86, 4.75, 4.50, and 4.10 hours respectively (p<0.001).
Conclusion
CPAP adherence is lower in neighborhoods with higher proportions of black and Hispanic residents independent of differences in education or poverty. These differences lead to lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.
Support
Philips Respironics, NIH R25HL130600 and K24HL127307.
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Kline CE, Egeler ME, Kubala AG, Patel SR, Lehrer HM, Duggan KA, Hall MH. 0402 Impact of Various Actigraphic Editing Approaches on Sleep/Wake Outputs in Adults with Insomnia and Healthy Sleepers. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Actigraphy data can be edited using a variety of approaches. However, whether time-intensive manual editing provides different sleep/wake estimates compared to other approaches is unknown. The purpose of this study was to compare sleep/wake data obtained from a standardized editing approach that incorporates multiple inputs versus three other common approaches.
Methods
72 adults (33.8±11.1 y, 74% female, 71% white) provided 1022 nights of data for analysis; 45 were healthy sleepers (678 nights) and 27 met DSM-5 criteria for insomnia. Participants wore an Actiwatch Spectrum on their nondominant wrist and completed a sleep diary for 3-24 nights. Each night’s rest interval was set using four different approaches: (1) a standardized process based upon published guidelines (Patel et al., Sleep 2015) that incorporates a hierarchical order of multiple inputs (event marker, light, diary, activity; STANDARD); (2) software-provided automated algorithm (AUTO); (3) automated algorithm with incorporation of event markers (AUTOE); and (4) sleep diary (DIARY). We used linear mixed-effects models to evaluate whether sleep/wake parameters differed between the STANDARD and other editing approaches, accounting for patient status (healthy sleeper, insomnia) and the possibility that differences among editing approaches may be dependent on patient status.
Results
All results are expressed relative to the STANDARD approach. Bedtime was 36.1±5.1 min earlier (P<.0001) and morning out-of-bed time was 13.6±5.7 min later (P=.02) using the AUTO (P<.0001) approach. Time in bed was 42.3±4.7 min longer with AUTO (P<.0001). Sleep onset latency was 11.7±1.4 min and 2.8±1.4 min longer for AUTO (P<.0001) and DIARY (P=.05), respectively. Sleep duration was 22.5±4.4 min longer with AUTO (P<.0001). Wake after sleep onset was 6.8±1.2 min greater with AUTO (P<.0001). Similar patterns were observed for all sleep/wake measures among healthy sleepers and adults with insomnia.
Conclusion
A standardized approach to editing actigraphy data leads to different sleep/wake estimates compared to other common approaches, though the differences were often small in magnitude and not dependent upon sleep status. Most notably, reliance upon the automated algorithm yielded longer time in bed, sleep duration, sleep onset latency, and wake after sleep onset compared to the standardized approach.
Support
NIH K23HL118318
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Borker PV, Wyland C, Patel SR. 0677 Patient Preferences On Initiating Treatment With Continuous Positive Airway Pressure. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Clinical guidelines recommend continuous positive airway pressure (CPAP) therapy be initiated in patients with obstructive sleep apnea (OSA) either at home using an auto-titrating device or following manual titration in the sleep laboratory. Patient preference between these two options is unknown.
Methods
Patients newly prescribed CPAP therapy for the treatment of OSA at an academic sleep medicine clinic were surveyed by telephone within one month of initiating treatment. Data on demographics, disease severity and CPAP adherence were obtained from the medical record.
Results
A total of 75 participants (56% male, mean age 52±15 yrs, 48% moderate to severe OSA) were surveyed. Physicians prescribed home initiation of CPAP in 51%, lab initiation in 23%, and allowed the patient to choose in 27% of cases. Overall, 67% of participants (95% CI [56%-77%]) reported preference for home initiation. Preference for home initiation did not vary by age, sex, AHI, degree of sleepiness, or type of diagnostic study (home vs. lab sleep study) performed (p>0.10 for all). Convenience (44%) and starting treatment faster (44%) were the most common reasons provided for those favoring home initiation, while sleep technician availability (40%), optimization of pressure settings (32%), and ability to try multiple masks (28%) were cited by those favoring lab initiation. The prevalence of CPAP adherence at 90 days tended to be higher in those whose treatment was initiated aligned to preference (79% in those whose treatment initiation was concordant with preference vs. 64% in those whose treatment initiation was discordant, p=0.16).
Conclusion
Overall, two-thirds of patients with OSA prefer initiation of CPAP be done at home. This preference does not vary by demographics, OSA severity or diagnostic modality. Initiating treatment concordant with patient preference may lead to greater adherence.
Support
American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship, K24 HL127307
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Agudelo C, Tarraf W, Wu B, Wallace DM, Patel SR, Redline S, Daviglus ML, Zee PC, Simonelli G, Levin BE, Mossavar-Rahmani Y, Sotres-Alvarez D, Zeng D, González HM, Ramos AR. 1144 Actigraphy-defined Sleep And Neurocognitive Decline In Middle-age Hispanic/Latino Adults. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Few studies have evaluated objective sleep measures and longitudinal neurocognitive decline, particularly in middle-age or Hispanic/Latino adults. We evaluated prospective associations between actigraphy-defined sleep and 7-year neurocognitive change among Hispanic/Latino adults. We hypothesized that sleep duration would be associated with neurocognitive decline.
Methods
We analyzed data from 1,036 adults 45-64 years of age from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center prospective cohort study of diverse community-dwelling Hispanic/Latino adults. At Visit 1 (2008-2011), participants underwent neurocognitive assessments, 7-days of actigraphy, home sleep testing, and sleep questionnaires (including the Insomnia Severity Index). Seven years later, participants repeated neurocognitive assessments. The neurocognitive battery included the Six-Item Screener, Brief Spanish-English Verbal Learning Test, phonemic word fluency test, and Digit Symbol Subtest. Survey linear regression was used to evaluate prospective associations between actigraphy-defined or self-reported sleep variables and neurocognitive change. Final models adjusted for objectively-defined variables (age, body-mass index, Field Center, and time between neurocognitive assessments), and self-reported variables (sex, education, Hispanic/Latino background, alcohol consumption, physical activity, heart failure, cerebrovascular events, depression and anxiety symptoms, and antidepressant use).
Results
At Visit 1, the sample was 55% female and mean age was 54.9±2.2 years. The mean sleep duration was 402.6±27.6 minutes, mean sleep-onset latency was 11.3±9.7 minutes, mean number of days with naps of ≥ 15 minutes duration was 1.1±0.7, and mean sleep-time per nap was 51±14.1 minutes. Increased sleep-onset latency was associated with 7-year declines in global neurocognitive function (β=-0.0026, p<0.01), verbal learning (β=-0.0028, p<0.001) and verbal memory (β=-0.036, p<0.05). Increased sleep-time per nap predicted better verbal memory (β=0.0038, p<0.05). In contrast, sleep duration, sleep fragmentation, and self-reported sleep measures were not associated with neurocognitive change.
Conclusion
Among middle-age adults, sleep-onset latency and nap duration were associated with neurocognitive change. These findings may serve as targets for intervention of neurocognitive decline.
Support
This work is supported by the National Institute on Aging: R01AG048642, RF1AG054548, R01AG061022, R21AG056952, and R21HL140437 (AR).
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Wu B, Tarraf W, Wallace DM, Stickel A, Schneiderman N, Redline S, Patel SR, Gallo LC, Mossavar-Rahmani Y, Daviglus M, Zee PC, Talavera GA, Sotres-Alvarez D, Gonzalez HM, Ramos AR. 0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Sleep 2020. [DOI: 10.1093/sleep/zsaa056.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias).
Methods
Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality.
Results
Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 <90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2<90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2<90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2<90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2<90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds.
Conclusion
We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities.
Support
5R01AG048642-05; R21AG056952; R21HL140437.
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Gonzalez KT, Tarraf W, Wallace DM, Stickel A, Schneiderman N, Redline S, Patel SR, Gallo LC, Mossavar-Rahmani Y, Daviglus M, Zee PC, Talavera GA, Sotres-Alvarez D, Gonzalez HM, Ramos AR. 0607 Clinical Phenotypes of OSA in Diverse Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent work on US non-Latino Whites and Europeans from clinical samples used obstructive sleep apnea (OSA) symptoms to generate OSA phenotypes for individuals with moderate-severe OSA and proposed between 3-5 clusters. Validating these clusters in a diverse Hispanic/Latino community-based population with different biopsychosocial characteristics is crucial for early OSA identification and more personalized treatment.
Methods
This work is based on baseline data from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is a prospective cohort study designed using a multisite (Bronx, NY, Chicago, IL, Miami, FL, San Diego, CA) multistage probability sample. The subpopulation of interest included adults 18-74 years (unweighted n=1,623) meeting criteria for moderate-severe OSA symptoms (≥15 Apnea-Hypopnea index (AHI) events per hour). We performed latent class analysis (LCA) using 15 common OSA symptoms to identify phenotype clusters.
Results
Average age was 52.4 ± 13.9 years and 34.1% were female. Mean AHI was 33.8 ± 22.5 events per hour. Fit statistics and clinical significance suggested that a three-class solution provided best fit to the data. The symptom profiles were consistent with (1) a Minimally Symptomatic group (46.8%), (2) a Disturbed Sleep group (38.1%), and (3) a Daytime Sleepiness group (15.1%). Validation analyses using alternative hierarchical and partitioning algorithms also suggested support for a three-class solution.
Conclusion
Sleep apnea phenotypes among diverse Hispanics/Latinos were consistent with recent findings from the Sleep Apnea Global Interdisciplinary Consortium. However, we found notable differences in the prevalence of these clusters relative to Whites. This suggests that other biopsychosocial factors may be contributing to OSA phenotypes among Hispanics/Latinos. Identification of OSA phenotypes in Hispanics/Latinos could inform better sleep interventions and therapeutics and help better align public health resources.
Support
5R01AG048642-05; R21AG056952; R21HL140437.
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Streeter KA, Sunshine MD, Patel SR, Gonzalez-Rothi EJ, Reier PJ, Baekey DM, Fuller DD. Mid-cervical interneuron networks following high cervical spinal cord injury. Respir Physiol Neurobiol 2019; 271:103305. [PMID: 31553921 DOI: 10.1016/j.resp.2019.103305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022]
Abstract
Spinal interneuron (IN) networks can facilitate respiratory motor recovery after spinal cord injury (SCI). We hypothesized that excitatory synaptic connectivity between INs located immediately caudal to unilateral cervical SCI would be most prevalent in a contra- to ipsilateral direction. Adult rats were studied following chronic C2 spinal cord hemisection (C2Hx) injury. Rats were anesthetized and ventilated and a multi-electrode array was used to simultaneously record INs on both sides of the C4-5 spinal cord. The temporal firing relationship between IN pairs was evaluated using cross-correlation with directionality of synaptic connections inferred based on electrode location. During baseline recordings, the majority of detectable excitatory IN connections occurred in a contra- to- ipsilateral direction. However, acute respiratory stimulation with hypoxia abolished this directionality, while simultaneously increasing the detectable inhibitory connections within the ipsilateral cord. We conclude that propriospinal networks caudal to SCI can display a contralateral-to-ipsilateral directionality of synaptic connections and that these connections are modulated by acute exposure to hypoxia.
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Saand AR, Genuardi MV, DeSensi RS, Ogilvie RP, Patel SR. 0330 Development And Validation Of An Algorithm To Quantify Obstructive Sleep Apnea Severity From The Electronic Medical Record. Sleep 2018. [DOI: 10.1093/sleep/zsy061.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Genuardi MV, Ogilvie RP, Saand A, Magnani JW, Patel SR. 0869 Short Sleep Time Is Associated With Increased Risk Of Incident Atrial Fibrillation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Genuardi MV, Althouse AD, Sharbaugh MS, Ogilvie RP, Patel SR. 0743 Race, Ethnicity, and Risk Factors Associated With Falling Asleep While Driving. Sleep 2018. [DOI: 10.1093/sleep/zsy061.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Cade BE, Lee J, Sofer T, Wang H, Chen H, Gharib SA, Mei H, Ochs-Balcom HM, Patel SR, Saxena R, Shah NA, Zhu X, Gottlieb DJ, Lin X, Redline S. 0018 Whole Genomic Associations of Transcription Factor Networks With Sleep Disordered Breathing Traits in Trans-Omics for Precision Medicine (TOPMed). Sleep 2018. [DOI: 10.1093/sleep/zsy061.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ogilvie RP, Simonelli G, Sotres-Alvarez D, St-Onge M, Mossavar-Rahmani Y, Perreira K, Petrov M, Kim Y, Balkin T, Wallace D, Reid KJ, Daviglus M, Zee PC, Patel SR. 0152 Caffeine Use And Sleep In U.S. Hispanic/Latinos: Findings From HCHS/SOL Sueño Ancillary Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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George J, Wang L, Nawabit R, Kaffashi F, Walia HK, Punjabi NM, Patel SR, Gottlieb DJ, Quan SF, Loparo K, Redline S, Mehra R. 0444 Impact of CPAP versus Supplemental Oxygen on Cardiac Electophysiological Indices in Obstructive Sleep Apnea: The HeartBEAT study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Kubala AG, Santos EC, Barone Gibbs B, Buysse DJ, Patel SR, Hall MH, Kline CE. 0322 Field-Based Sleep Measurement: Concordance Between Commercial Activity Monitors and an Actigraph. Sleep 2018. [DOI: 10.1093/sleep/zsy061.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Patel SR, Allen C, Grima MJ, Brownrigg JRW, Patterson BO, Holt PJE, Thompson MM, Karthikesalingam A. A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance. Vasc Endovascular Surg 2017; 51:417-428. [PMID: 28656809 DOI: 10.1177/1538574417712648] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current surveillance protocols after endovascular aneurysm repair (EVAR) are ineffective and costly. Stratifying surveillance by individual risk of reintervention requires an understanding of the factors involved in developing post-EVAR complications. This systematic review assessed risk factors for reintervention after EVAR and proposals for stratified surveillance. METHODS A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting on risk factors predicting reintervention after EVAR and proposals for stratified surveillance. RESULTS Twenty-nine studies reporting on 39 898 patients met the primary inclusion criteria for reporting predictors of reintervention or aortic complications with or without suggestions for stratified surveillance. Five secondary studies described external validation of risk scores for reintervention or aortic complications. There was great heterogeneity in reporting risk factors identified at the pre-EVAR, intraoperative, and post-EVAR stages of treatment, although large preoperative abdominal aortic aneurysm diameter was the most commonly observed risk factor for reintervention after EVAR. CONCLUSION Existing data on predictors of post-EVAR complications are generally of poor quality and largely derived from retrospective studies. Few studies describing suggestions for stratified surveillance have been subjected to external validation. There is a need to refine risk prediction for EVAR failure and to conduct prospective comparative studies of personalized surveillance with standard practice.
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Ye L, Kayser K, Gautam S, Malhotra A, Patel SR. 0511 SPOUSAL INVOLVEMENT IN ADHERENCE TO CPAP TREATMENT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Dudley KA, Johnson DA, Weng J, Wallace DM, Alcantara C, Wallace M, Ramos AR, Mossavar-Rahmani Y, Perreira K, Zee PC, Salazar ZU, Redline S, Reid KJ, Sotres-Alvarez D, Patel SR. 0838 ACCULTURATION AND SLEEP PATTERNS IN U.S. HISPANIC/LATINOS: THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL) SUEÑO ANCILLARY STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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