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Jayakumar K, Bansal S, Markan A, Agarwal A, Bansal R, Mahajan S, Agrawal R, Gupta V. Reversibility of retinochoroidal vascular alteration in patients with obstructive sleep apnea after continuous positive air pressure and surgical intervention. Indian J Ophthalmol 2021; 69:1850-1855. [PMID: 34146042 PMCID: PMC8374762 DOI: 10.4103/ijo.ijo_3150_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The aim of this work was to study various retinochoroidal parameters in patients with obstructive sleep apnea syndrome (OSAS) and the effect of interventions on these parameters at 6 months follow-up. Methods A total of 36 patients were recruited prospectively from the otorhinolaryngology clinics of a large tertiary center between September 2018 to March 2020. The subjects were divided into three groups depending upon intervention chosen for OSAS: Group A (surgery, i.e., uvulopalatopharyngoplasty), group B (medical therapy, i.e., continuous positive air pressure) and group C (no intervention). Various retinochoroidal parameters which were studied included retinal thickness (RT), choroidal thickness (CT), choroidal vascularity index (CVI), arteriovenous ratio (AVR), capillary density index (CDI) in superficial and deep retina, at baseline and 6 months of follow-up after the intervention. Results In group A, CT increased significantly at 6 months (332.76 ± 86.41 um) compared to baseline (306.28 ± 78.19) (P = 0.0004). Similarly, CDI at both superficial and deep capillary plexus increased significantly at 6 months (superficial CDI: 0.65 ± 0.04, deep CDI: 0.38 ± 0.01) compared to baseline (superficial CDI: 0.62 ± 0.03, deep CDI: 0.36 ± 0.02) (P = 0.004 and 0.002 respectively). In group B, CT increased significantly at 6 months (361.38 ± 78.63 um) compared to baseline (324.21 ± 76.97 um) (P = 0.008). Also, CVI showed a significant decrease at 6 months (65.74 ± 1.84%) compared to baseline (67.36 ± 1.57%) (P = 0.019). In group C, all except CDI in deep capillary plexus showed a significant decrease at 6 months (0.35 ± 0.01) compared to baseline (0.36 ± 0.02) (P = 0.003). Conclusion OSAS alters various retinochoroidal parameters and timely intervention in patients with OSAS can prevent these alterations. Also, these retinochoroidal parameters could serve as one of the markers to monitor the disease progression.
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Affiliation(s)
- Kalaivani Jayakumar
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Bansal
- Otorhinolaryngology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Markan
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reema Bansal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sarakshi Mahajan
- School of Medicine, St Joseph Mercy Hospital, Oakland, Pontiac, Michigan, USA
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital; Singapore Eye Research Institute, Singapore
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Morelli MS, Vanello N, Callara AL, Hartwig V, Maestri M, Bonanni E, Emdin M, Passino C, Giannoni A. Breath-hold task induces temporal heterogeneity in electroencephalographic regional field power in healthy subjects. J Appl Physiol (1985) 2021; 130:298-307. [PMID: 33300854 DOI: 10.1152/japplphysiol.00232.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We demonstrated that changes in CO2 values cause oscillations in the cortical activity in δ-and α-bands. The analysis of the regional field power (RFP) showed evidence that different cortical areas respond with different time delays to CO2 challenges. An opposite behavior was found for the end-tidal O2. We suppose that the different cortical time delays likely expresse specific ascending pathways to the cortex, generated by chemoreceptor nuclei in the brain stem. Although the brain stem is in charge of the automatic control of ventilation, the cortex is involved in the voluntary control of breathing but also receives inputs from the brain stem, which influences the perception of breathing, the arousal state and sleep architecture in conditions of hypoxia/hypercapnia. We evaluated in 11 healthy subjects the effects of breath hold (BH; 30 s of apneas and 30 s of normal breathing) and BH-related CO2/O2 changes on electroencephalogram (EEG) global field power (GFP) and RFP in nine different areas (3 rostrocaudal sections: anterior, central, and posterior; and 3 sagittal sections: left, middle, and right) in the δ- and α-bands by cross correlation analysis. No significant differences were observed in GFP or RFP when comparing free breathing (FB) with the BH task. Within the BH task, the shift from apnea to normal ventilation was accompanied by an increase in the δ-power and a decrease in the α-power. The end-tidal pressure of CO2 ([Formula: see text]) was positively correlated with the δ-band and negatively with the α- band with a positive time shift, whereas an opposite behavior was found for the end-tidal pressure of O2 ([Formula: see text]). Notably, the time shift between [Formula: see text] / [Formula: see text] signals and cortical activity at RFP was heterogenous and seemed to follow a hierarchical activation, with the δ-band responding earlier than the α-band. Overall, these findings suggest that the effect of BH on the cortex may follow specific ascending pathways from the brain stem and be related to chemoreflex stimulation.NEW & NOTEWORTHY We demonstrated that the end tidal CO2 oscillation causes oscillations of delta and alpha bands. The analysis of the regional field power showed that different cortical areas respond with different time delays to CO2 challenges. An opposite behavior was found for the end-tidal O2. We can suppose that the different cortical time delay response likely expresses specific ascending pathways to the cortex generated by chemoreceptor nuclei in the brainstem.
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Affiliation(s)
- Maria Sole Morelli
- Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Nicola Vanello
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | | | - Valentina Hartwig
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | | | - Enrica Bonanni
- Departement of Neuroscience, University of Pisa, Pisa, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Passino
- Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Giannoni
- Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Selim B, Ramar K. Sleep-Related Breathing Disorders: When CPAP Is Not Enough. Neurotherapeutics 2021; 18:81-90. [PMID: 33150546 PMCID: PMC8116389 DOI: 10.1007/s13311-020-00955-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Three decades ago, continuous positive airway pressure (CPAP) was introduced to treat obstructive sleep apnea (OSA). Shortly after, bilevel positive airway pressure devices (BPAP) that independently adjusted inspiratory and expiratory positive airway pressure were developed to treat complex sleep-related breathing disorders unresponsive to CPAP. Based on the bilevel positive airway pressure platform (hardware) governed by propriety algorithms (software), advanced modes of noninvasive ventilation (NIV) were developed to address complex cardiorespiratory pathophysiology beyond OSA. This review summarizes key aspects of different bilevel PAP therapies (BPAP with/without backup rate, adaptive servoventilation, and volume-assured pressure support) to treat common sleep-related hypoventilation disorders, treatment-emergent central sleep apnea, and central sleep apnea syndromes.
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Affiliation(s)
- Bernardo Selim
- Pulmonary and Critical Care Division, Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kannan Ramar
- Pulmonary and Critical Care Division, Center for Sleep Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Validity of transit time–based blood pressure measurements in patients with and without heart failure or pulmonary arterial hypertension across different breathing maneuvers. Sleep Breath 2019; 24:221-230. [DOI: 10.1007/s11325-019-01848-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/19/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Analysis of generic coupling between EEG activity and P ETCO 2 in free breathing and breath-hold tasks using Maximal Information Coefficient (MIC). Sci Rep 2018. [PMID: 29540714 PMCID: PMC5851981 DOI: 10.1038/s41598-018-22573-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Brain activations related to the control of breathing are not completely known. The respiratory system is a non-linear system. However, the relationship between neural and respiratory dynamics is usually estimated through linear correlation measures, completely neglecting possible underlying nonlinear interactions. This study evaluate the linear and nonlinear coupling between electroencephalographic (EEG) signal and variations in carbon dioxide (CO2) signal related to different breathing task. During a free breathing and a voluntary breath hold tasks, the coupling between EEG power in nine different brain regions in delta (1–3 Hz) and alpha (8–13 Hz) bands and end-tidal CO2 (PET CO2) was evaluated. Specifically, the generic associations (i.e. linear and nonlinear correlations) and a “pure” nonlinear correlations were evaluated using the maximum information coefficient (MIC) and MIC-ρ2 between the two signals, respectively (where ρ2 represents the Pearson’s correlation coefficient). Our results show that in delta band, MIC indexes discriminate the two tasks in several regions, while in alpha band the same behaviour is observed for MIC-ρ2, suggesting a generic coupling between delta EEG power and PETCO2 and a pure nonlinear interaction between alpha EEG power and PETCO2. Moreover, higher indexes values were found for breath hold task respect to free breathing.
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Mlakar M, Puddu PE, Somrak M, Bonfiglio S, Luštrek M. Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients. PLoS One 2018; 13:e0190323. [PMID: 29494601 PMCID: PMC5832202 DOI: 10.1371/journal.pone.0190323] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022] Open
Abstract
This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.
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Affiliation(s)
- Miha Mlakar
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenija
| | - Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Maja Somrak
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenija
| | | | - Mitja Luštrek
- Department of Intelligent Systems, Jožef Stefan Institute, Ljubljana, Slovenija
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Development and validation of a Score for Preoperative Prediction of Obstructive Sleep Apnea (SPOSA) and its perioperative outcomes. BMC Anesthesiol 2017; 17:71. [PMID: 28558716 PMCID: PMC5450400 DOI: 10.1186/s12871-017-0361-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/17/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postoperative respiratory complications (PRCs) are associated with significant morbidity, mortality, and hospital costs. Obstructive sleep apnea (OSA), often undiagnosed in the surgical population, may be a contributing factor. Thus, we aimed to develop and validate a score for preoperative prediction of OSA (SPOSA) based on data available in electronic medical records preoperatively. METHODS OSA was defined as the occurrence of an OSA diagnostic code preceded by a polysomnography procedure. A priori defined variables were analyzed by multivariable logistic regression analysis to develop our score. Score validity was assessed by investigating the score's ability to predict non-invasive ventilation. We then assessed the effect of high OSA risk, as defined by SPOSA, on PRCs within seven postoperative days and in-hospital mortality. RESULTS A total of 108,781 surgical patients at Partners HealthCare hospitals (2007-2014) were studied. Predictors of OSA included BMI >25 kg*m-2 and comorbidities, including pulmonary hypertension, hypertension, and diabetes. The score yielded an area under the curve of 0.82. Non-invasive ventilation was significantly associated with high OSA risk (OR 1.44, 95% CI 1.22-1.69). Using a dichotomized endpoint, 26,968 (24.8%) patients were identified as high risk for OSA and 7.9% of these patients experienced PRCs. OSA risk was significantly associated with PRCs (OR 1.30, 95% CI 1.19-1.43). CONCLUSION SPOSA identifies patients at high risk for OSA using electronic medical record-derived data. High risk of OSA is associated with the occurrence of PRCs.
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Management of Mechanical Ventilation in Decompensated Heart Failure. J Cardiovasc Dev Dis 2016; 3:jcdd3040033. [PMID: 29367576 PMCID: PMC5715720 DOI: 10.3390/jcdd3040033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 02/04/2023] Open
Abstract
Mechanical ventilation (MV) is a life-saving intervention for respiratory failure, including decompensated congestive heart failure. MV can reduce ventricular preload and afterload, decrease extra-vascular lung water, and decrease the work of breathing in heart failure. The advantages of positive pressure ventilation must be balanced with potential harm from MV: volutrauma, hyperoxia-induced injury, and difficulty assessing readiness for liberation. In this review, we will focus on cardiac, pulmonary, and broader effects of MV on patients with decompensated HF, focusing on practical considerations for management and supporting evidence.
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Jaster JH. Interfacing pathophysiology of respiratory sleep disorders, cardiac dysfunction, and focal autonomic medullary brain ischemia. J Thorac Dis 2016; 7:E646-7. [PMID: 26793382 DOI: 10.3978/j.issn.2072-1439.2015.12.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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