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Changsiripun C, Chirakalwasan N, Dias S, McDaid C. Management of primary snoring in adults: A scoping review examining interventions, outcomes and instruments used to assess clinical effects. Sleep Med Rev 2024; 77:101963. [PMID: 38889620 DOI: 10.1016/j.smrv.2024.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
While various treatment options for primary snoring are available, evidence-based recommendations to determine the optimal intervention remain unestablished. To inform future directions of research to guide clinical decision-making, this scoping review was conducted to map the existing evidence on interventions for primary snoring, the outcomes and instruments used to assess their clinical effects in adults. The feasibility of conducting further systematic reviews and comparing outcomes across these therapies using network meta-analysis was also assessed. Of the 1673 records identified, 38 interventional studies met the inclusion criteria with three-fifths of them being before-after studies. The most common reason for study exclusion was results being reported for patients with primary snoring and obstructive sleep apnoea (OSA) combined. Interventions were surgical (73 %), behavioural and the use of devices/medications. Twenty-six common outcomes were identified and categorised into six domains. Fifty-nine instruments were used to assess the outcomes and based mainly on non-validated questionnaires. Our findings indicated (1) the need for randomised controlled trials with strict discrimination between patients with primary snoring and OSA, (2) further network meta-analyses using some outcomes is feasible, and (3) a core outcome set to inform standardised reporting for future research should be developed.
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Affiliation(s)
- Chidsanu Changsiripun
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; Department of Health Sciences, University of York, York, UK.
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
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Chen Y, Alhozgi AI, Almeida FR. Dentoskeletal changes of long-term oral appliance treatment in patients with obstructive sleep apnea: A systematic review and meta-analysis. J Prosthodont 2024. [PMID: 39327689 DOI: 10.1111/jopr.13946] [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: 05/21/2024] [Accepted: 08/17/2024] [Indexed: 09/28/2024] Open
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the dental and skeletal effects of the long-term oral appliance (OA) treatment in patients with obstructive sleep apnea (OSA) and provide insights for clinicians in treatment planning and decision-making for OSA patients undergoing OA treatment. MATERIALS AND METHODS A comprehensive literature search was conducted in major databases up to April 2024. Studies were included if they assessed long-term OA treatment (≥6 months) in adults with OSA using any type of mandibular advancement device (MADs) or tongue retaining device (TRD). Dental and skeletal changes, measured by dental cast and cephalometric analysis, were the primary outcomes. RESULTS A total of 42 studies were included in the systematic review, with 23 included in the meta-analysis. Long-term OA treatment was associated with a significant decrease in overbite (0.87 mm, 95% CI: 0.69-1.05) and overjet (0.86 mm, 95% CI: 0.69-1.03). Subgroup analyses showed the decrease of overbite and overjet progressively changed over the years intervals. There was a significant retroclination of the upper incisors (U1-SN, 2.58°, 95% CI: 1.07-4.08) and proclination of the lower incisors (L1-MP, -2.67° (95% CI: -3.78-1.56). Skeletal changes were not significant. CONCLUSION Overbite and overjet gradually decreased in the long-term OA treatment, which might predominantly result from the retroclination of the upper incisors and the proclination of the lower incisors. The skeletal patterns in the anteroposterior and vertical direction might remain relatively stable over time. There was a tendency for the clockwise rotation of the mandible.
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Affiliation(s)
- Yanlong Chen
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdalgader I Alhozgi
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fernanda R Almeida
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Wang Y, Zhang W, Ye H, Xiao Y. Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy. Sleep Med Rev 2024; 78:101997. [PMID: 39243682 DOI: 10.1016/j.smrv.2024.101997] [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: 10/11/2023] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024]
Abstract
There remains an unmet need for a targeted treatment to address residual excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) after primary treatment. This network meta-analysis evaluated the efficacy and safety of wake-promoting agents (WPAs), namely solriamfetol, pitolisant, modafinil, and armodafinil, for treating residual EDS in patients with OSA. We conducted a comprehensive search which ultimately included 18 studies in the final analysis. All 4 WPAs demonstrated significant therapeutic benefits for the Epworth sleepiness scale (ESS) and maintenance of wakefulness test (MWT). Based on the surface under the cumulative ranking curve (SUCRA) score, solriamfetol, pitolisant, modafinil and armodafinil were ranked from highest to lowest for the ESS. A similar ranking was observed for MWT, where pitolisant was not included in the analysis. The subgroup analysis also evaluated the efficacy of WPAs in the primary treatment adherent and nonadherent subgroups. Regarding adverse reactions, solriamfetol demonstrated the lowest risk of all-cause discontinuation, whereas pitolisant exhibited minimal risks of adverse events leading to treatment discontinuation and treatment-emergent adverse events. Our analysis comprehensively compared the effects and adverse reactions of different WPAs in treating residual EDS in treated patients with OSA. This has significant implications for the practical clinical use of WPAs and future research.
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Affiliation(s)
- Yuxin Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Weijia Zhang
- Ignis Therapeutics (Shanghai) Limited, Shanghai, 200000, China
| | - Hui Ye
- Ignis Therapeutics (Shanghai) Limited, Shanghai, 200000, China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Siebenhofer A, Loder C, Avian A, Platzer E, Zipp C, Mauric A, Spary-Kainz U, Berghold A, Rosenkranz AR. Prevalence of undetected chronic kidney disease in high-risk middle-aged patients in primary care: a cross-sectional study. Front Med (Lausanne) 2024; 11:1412689. [PMID: 39193016 PMCID: PMC11347449 DOI: 10.3389/fmed.2024.1412689] [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: 04/11/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction The global health burden of chronic kidney disease (CKD) results from both the disease itself and the numerous health problems associated with it. The aim of this study was to estimate the prevalence of previously undetected CKD in middle-aged patients with risk factors for CKD. Identified patients were included in the Styrian nephrology awareness program "kidney.care 2.0" and data on their demographics, risk factors and kidney function were described. Methods Cross-sectional analysis of baseline data derived from the "kidney.care 2.0" study of 40-65 year old patients with at least one risk factor for CKD (hypertension, diabetes, cardiovascular disease, obesity or family history of end-stage kidney disease). Participants were considered to have previously undetected CKD if their estimated glomular filtration rate (eGFR) was less than 60 ml/min/1.73 m2 and/or albumin creatinine ratio (ACR) ≥ 30 mg/g. We calculated the prevalence of previously undetected CKD and performed multivariate analyses. Results A total of 749 participants were included in this analysis. The prevalence of previously undetected CKD in an at-risk population was estimated at 20.1% (95%CI: 17.1-23.6). Multivariable analysis showed age (OR 1.06, 95%CI: 1.02-1.09), diabetes mellitus (OR 1.65, 95%CI: 1.12-2.30) and obesity (OR: 1.55, 95%CI: 1.04-2.30) to be independent predictors of CKD. The majority of patients with previously undetected CKD had category A2-A3 albuminuria (121 out of 150). Most patients with previously undetected eGFR < 60 ml/min/1.73 m2 were in stage G3 (36 out of 39 patients). Discussion Pragmatic, targeted, risk-based screening for CKD in primary care successfully identified a significant number of middle-aged patients with previously undetected CKD and addressed the problem of these patients being overlooked for future optimized care. The intervention may slow progression to kidney failure and prevent related cardiovascular events.
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Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for General Practice, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Christine Loder
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Elisabeth Platzer
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Carolin Zipp
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Astrid Mauric
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ulrike Spary-Kainz
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander R. Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Adewuyi HA, Kabiru AY, Muhammad HL, Lukman HY, Owolabi MS, Jonathan I, El-Gazzar AM, Mahmoud MH, Batiha GES, Lawal B. Pre-clinical protective potentials of Carica papaya constituents in experimentally induced anemia. Am J Transl Res 2024; 16:3259-3272. [PMID: 39114700 PMCID: PMC11301493 DOI: 10.62347/zqdc9694] [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: 10/06/2023] [Accepted: 02/08/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Anemia is a pathological condition characterized by reduced oxygen bioavailability and/or changes in hematological parameters. This study investigated the anti-anemic activities of Carica papaya (CP) phytoconstituents in aluminium-chloride-induced anemic rats. METHOD Twenty-seven rats were randomized into nine groups of three rats as follows; group 1 was the normal (non-induced) group, 2-9 were anemic rats administered 1 mL distilled water, standard drug (3 mg/kg body weight (bw) ferrous sulphate), 100, 300 and 500 mg/kg bw of crude methanolic extract of CP (CMECP) of the leaf and 100, 300 and 500 mg/kg bw of CMECP of the seed respectively in the first stage of the study. In the second stage, thirty-three rats were randomized into eleven groups of three rats as follows; group 1 was the normal group, 2-11 were anemic rats treated with 1 mL distilled water, standard drug, 75 mg/kg bw, 150 mg/kg of alkaloid fraction of CP seed, 75 mg/kg bw, 150 mg/kg bw of flavonoid fraction of CP seed, 75 mg/kg bw and 150 mg/kg of alkaloid fraction of CP leaf, 75 mg/kg bw and 150 mg/kg bw of flavonoid fraction of CP leaf respectively. RESULTS Treatment of anemic rats with CP extracts and fractions of the seed and leaf significantly reversed the hematological parameters and body weight of anemic rats in a dose independent fashion. The CMECP leaf at 100 and 500 mg/kg gave PCV of 42.50±0.50 and 47.00±0.50, while the seed gave 49.50±0.50 and 42.50±0.50 respectively after 2 weeks of treatment. However, the alkaloid and flavonoid fraction of CP presented better anti-anemic properties probably due to constituents' synergism. CONCLUSION This study concluded that CP possesses phytoconstituents which potentiates it as a safe anti-anemic drug candidate.
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Affiliation(s)
- Hassan Abdulsalam Adewuyi
- Department of Biochemistry, Federal University of TechnologyP.M.B. 65, Minna 920001, Niger State, Nigeria
| | - Adamu Yusuf Kabiru
- Department of Biochemistry, Federal University of TechnologyP.M.B. 65, Minna 920001, Niger State, Nigeria
| | - Hadiza Lami Muhammad
- Department of Biochemistry, Federal University of TechnologyP.M.B. 65, Minna 920001, Niger State, Nigeria
| | - Halimat Yusuf Lukman
- Department of Chemical Sciences, College of Natural and Applied Sciences, Summit UniversityOffa 250101, Kwara State, Nigeria
| | | | - Ibrahim Jonathan
- Department of Biochemistry, Federal University of TechnologyP.M.B. 65, Minna 920001, Niger State, Nigeria
| | - Ahmed M El-Gazzar
- Department of Veterinary Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Alexandria UniversityAlexandria 21526, Egypt
| | - Mohamed H Mahmoud
- Department of Biochemistry, College of Science, King Saud UniversityRiyadh 12372, Kingdom of Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour UniversityDamanhour 22511, AlBeheira, Egypt
| | - Bashir Lawal
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, and Academia SinicaTaipei 11529, Taiwan
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Pordzik J, Petrowski K, Ludwig K, Seifen C, Matthias C, Gouveris H. Difficulty Falling Asleep is Associated with Poorer Therapeutic Outcomes in Unilateral Hypoglossal Nerve Stimulation. Nat Sci Sleep 2024; 16:813-821. [PMID: 38911316 PMCID: PMC11192637 DOI: 10.2147/nss.s459690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose The coexistence of insomnia and obstructive sleep apnea (OSA) is very prevalent. Hypoglossal nerve stimulation (HGNS) is an established second-line therapy for patients suffering OSA. Studies investigating the effect of the different aspects of insomnia on the therapeutic outcome are largely missing. Therefore, this study aimed to understand the impact of the different aspects of insomnia on the therapeutic outcome under HGNS therapy in clinical routine. Patients and Methods This is a retrospective study including 30 consecutive patients aged 55.40 ± 8.83 years (8 female; 22 male) undergoing an HGNS implantation in our tertiary medical center between 2020 and 2023. All patients underwent preoperative polysomnography (PSG) according to AASM. First follow-up PSG was performed 95.40 ± 39.44 days after activation (30 patients) and second follow-up PSG was performed 409.89 ± 122.52 days after activation (18 patients). Among others, the following PSG-related parameters were evaluated: apnea-hypopnea index (n/h) (AHI) and oxygen desaturation index (n/h) (ODI). Insomnia was assessed by the insomnia severity index (ISI) questionnaire. Preoperatively, all patients included filled out each ISI item. Spearman's-rho correlation coefficient was calculated for correlations. Results Preoperative score of ISI item 1 (difficulty falling asleep) was 1.93 ± 1.34 and preoperative cumulative ISI score (item1-7) was 18.67 ± 5.32. Preoperative AHI was 40.61 ± 12.02 (n/h) and preoperative ODI was 38.72 ± 14.28 (n/h). In the second follow-up, the mean difference in AHI was ∆ 10.47 ± 15.38 (n/h) and the mean difference in ODI was ∆ 8.17 ± 15.67 (n/h). Strong significant correlations were observed between ISI item 1 (difficulty falling asleep) and both ∆ AHI (r: -0.65, p=0.004) and ∆ ODI (r: -0.7; p=0.001) in the second follow-up. Conclusion Difficulty falling asleep may hence negatively influence HGNS therapeutic outcome. Insomnia-related symptoms should be considered in the preoperative patient evaluation for HGNS.
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Affiliation(s)
- Johannes Pordzik
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, Mainz, 55131, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katharina Ludwig
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, Mainz, 55131, Germany
| | - Christopher Seifen
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, Mainz, 55131, Germany
| | - Christoph Matthias
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, Mainz, 55131, Germany
| | - Haralampos Gouveris
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, Mainz, 55131, Germany
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Alexiuk M, Tangri N. Prediction models for earlier stages of chronic kidney disease. Curr Opin Nephrol Hypertens 2024; 33:325-330. [PMID: 38420892 DOI: 10.1097/mnh.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW Identifying patients with risk of developing progressive chronic kidney disease (CKD) early is an important step in improving kidney care. This review discusses four recently developed models, two which predict risk of new onset disease, and two which predict progression earlier in the course of disease. RECENT FINDINGS Several models predicting CKD incidence and progression have been recently developed and externally validated. A connecting theme across these models is the use of data beyond estimated glomerular filtration rate, allowing for greater accuracy and personalization. Two models were developed with stratification by diabetes status, displaying excellent model fit with and without variables like use of diabetes medication and hemoglobin A1C. Another model was designed to be patient facing, not requiring the knowledge of any laboratory values for use. The final model was developed using lab data and machine learning. These models demonstrated high levels of discrimination and calibration in external validation, suggesting suitability for clinical use. SUMMARY Models that predict risk of CKD onset and progression have the potential to significantly reduce disease burden, financial cost, and environmental output from CKD through upstream disease prevention and slowed progression. These models should be implemented and evaluated prospectively in primary care settings.
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Affiliation(s)
- Mackenzie Alexiuk
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Navdeep Tangri
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
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Yeo SC, Wang H, Ang YG, Lim CK, Ooi XY. Cost-effectiveness of screening for chronic kidney disease in the general adult population: a systematic review. Clin Kidney J 2024; 17:sfad137. [PMID: 38186904 PMCID: PMC10765095 DOI: 10.1093/ckj/sfad137] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Chronic kidney disease (CKD) is a significant public health problem, with rising incidence and prevalence worldwide, and is associated with increased morbidity and mortality. Early identification and treatment of CKD can slow its progression and prevent complications, but it is not clear whether CKD screening is cost-effective. The aim of this study is to conduct a systematic review of the cost-effectiveness of CKD screening strategies in general adult populations worldwide, and to identify factors, settings and drivers of cost-effectiveness in CKD screening. Methods Studies examining the cost-effectiveness of CKD screening in the general adult population were identified by systematic literature search on electronic databases (MEDLINE OVID, Embase, Cochrane Library and Web of Science) for peer-reviewed publications, hand-searched reference lists and grey literature of relevant sites, focusing on the following themes: (i) CKD, (ii) screening and (iii) cost-effectiveness. Studies comprising health economic evaluations performed for CKD screening strategies, compared with no CKD screening or usual-care strategy in adult individuals, were included. Study characteristics, model assumptions and CKD screening strategies of selected studies were identified. The primary outcome of interest is the incremental cost-effectiveness ratio (ICER) of CKD screening, in cost per quality-adjusted life year (QALY) and life-year gained (LYG), expressed in 2022 US dollars equivalent. Results Twenty-one studies were identified, examining CKD screening in general and targeted populations. The cost-effectiveness of screening for CKD was found to vary widely across different studies, with ICERs ranging from $113 to $430 595, with a median of $26 662 per QALY and from $6516 to $38 372, with a median of $29 112 per LYG. Based on the pre-defined cost-effectiveness threshold of $50 000 per QALY, the majority of the studies found CKD screening to be cost-effective. CKD screening was especially cost-effective in those with diabetes ($113 to $42 359, with a median of $27 471 per QALY) and ethnic groups identified to be higher risk of CKD development or progression ($23 902 per QALY in African American adults and $21 285 per QALY in Canadian indigenous adults), as indicated by a lower ICER. Additionally, the cost-effectiveness of CKD screening improved if it was performed in older adults, populations with higher CKD risk scores, or when setting a higher albuminuria detection threshold or increasing the interval between screening. In contrast, CKD screening was not cost-effective in populations without diabetes and hypertension (ICERs range from $117 769 to $1792 142, with a median of $202 761 per QALY). Treatment effectiveness, prevalence of CKD, cost of CKD treatment and discount rate were identified to be the most common influential drivers of the ICERs. Conclusions Screening for CKD is especially cost-effective in patients with diabetes and high-risk ethnic groups, but not in populations without diabetes and hypertension. Increasing the age of screening, screening interval or albuminuria detection threshold, or selection of population based on CKD risk scores, may increase cost-effectiveness of CKD screening, while treatment effectiveness, prevalence of CKD, cost of CKD treatment and discount rate were influential drivers of the cost-effectiveness.
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Affiliation(s)
- See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Hankun Wang
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Yee Gary Ang
- Health Services & Outcome Research, National Healthcare Group, Singapore
| | | | - Xi Yan Ooi
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
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Carson JL, Stanworth SJ, Guyatt G, Valentine S, Dennis J, Bakhtary S, Cohn CS, Dubon A, Grossman BJ, Gupta GK, Hess AS, Jacobson JL, Kaplan LJ, Lin Y, Metcalf RA, Murphy CH, Pavenski K, Prochaska MT, Raval JS, Salazar E, Saifee NH, Tobian AAR, So-Osman C, Waters J, Wood EM, Zantek ND, Pagano MB. Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA 2023; 330:1892-1902. [PMID: 37824153 DOI: 10.1001/jama.2023.12914] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Importance Red blood cell transfusion is a common medical intervention with benefits and harms. Objective To provide recommendations for use of red blood cell transfusion in adults and children. Evidence Review Standards for trustworthy guidelines were followed, including using Grading of Recommendations Assessment, Development and Evaluation methods, managing conflicts of interest, and making values and preferences explicit. Evidence from systematic reviews of randomized controlled trials was reviewed. Findings For adults, 45 randomized controlled trials with 20 599 participants compared restrictive hemoglobin-based transfusion thresholds, typically 7 to 8 g/dL, with liberal transfusion thresholds of 9 to 10 g/dL. For pediatric patients, 7 randomized controlled trials with 2730 participants compared a variety of restrictive and liberal transfusion thresholds. For most patient populations, results provided moderate quality evidence that restrictive transfusion thresholds did not adversely affect patient-important outcomes. Recommendation 1: for hospitalized adult patients who are hemodynamically stable, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). In accordance with the restrictive strategy threshold used in most trials, clinicians may choose a threshold of 7.5 g/dL for patients undergoing cardiac surgery and 8 g/dL for those undergoing orthopedic surgery or those with preexisting cardiovascular disease. Recommendation 2: for hospitalized adult patients with hematologic and oncologic disorders, the panel suggests a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (conditional recommendations, low certainty evidence). Recommendation 3: for critically ill children and those at risk of critical illness who are hemodynamically stable and without a hemoglobinopathy, cyanotic cardiac condition, or severe hypoxemia, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). Recommendation 4: for hemodynamically stable children with congenital heart disease, the international panel suggests a transfusion threshold that is based on the cardiac abnormality and stage of surgical repair: 7 g/dL (biventricular repair), 9 g/dL (single-ventricle palliation), or 7 to 9 g/dL (uncorrected congenital heart disease) (conditional recommendation, low certainty evidence). Conclusions and Relevance It is good practice to consider overall clinical context and alternative therapies to transfusion when making transfusion decisions about an individual patient.
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Affiliation(s)
- Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- NHSBT, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Transfusion Medicine, NHS Blood and Transplant, Oxford, United Kingdom
| | - Gordon Guyatt
- Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stacey Valentine
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester
| | - Jane Dennis
- Cochrane Injuries Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California, San Francisco
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | | | - Brenda J Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Gaurav K Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison
| | - Jessica L Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York
- NYC Health + Hospitals/Bellevue, New York, New York
| | - Lewis J Kaplan
- Department of Surgery, Division of Trauma, Surgical Critical Care and Surgical Emergencies, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City
| | - Colin H Murphy
- Pathology Associates of Albuquerque, Albuquerque, New Mexico
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto and St Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque
| | - Eric Salazar
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Nabiha H Saifee
- Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia So-Osman
- Department of Unit Transfusion Medicine (UTG), Sanquin Blood Bank, Amsterdam, the Netherlands
- Department Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jonathan Waters
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erica M Wood
- Department of Haematology, Monash Health, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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11
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Han L, Li L, Linghu H, Zheng L, Gou D. Cardiopulmonary bypass in a rat model may shorten the lifespan of stored red blood cells by activating caspase-3. PLoS One 2023; 18:e0290295. [PMID: 37729139 PMCID: PMC10511131 DOI: 10.1371/journal.pone.0290295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/04/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Red blood cell transfusion is required for many types of surgery against cardiovascular disease, and the function of transfused cells appears to decline over time. The present study examined whether transfusion also reduces red blood cell lifespan in a rat model. MATERIAL AND METHODS Bypass in rats were established by connecting a roll pump to the femoral artery and vein. Then FITC-labeled stored red blood cells from rats were transfused in the animals, and the cells in circulation were counted after transfusion. In separate experiments, stored red blood cells were incubated with bypass plasma in vitro, and the effects of incubation were assessed on cell morphology, redox activity, ATP level, caspase-3 activity, and phosphatidylserine exposure on the cell surface. These in vivo and in vitro experiments were also performed after pretreating the stored red blood cells with the caspase-3 inhibitor Z-DEVD-FMK. RESULTS Bypass significantly decreased the number of circulating FITC-labeled stored red blood cells and increased the proportions of monocytes, neutrophils and splenic macrophages that had phagocytosed the red blood cells. In vitro, bypass plasma altered the morphology of red blood cells and increased oxidative stress, caspase-3 activity and phosphatidylserine exposure, while decreasing ATP level. Pretreating stored red blood cells with Z-DEVD-FMK attenuated the effects of bypass on caspase-3 activity, but not oxidative stress, in stored red blood cells. DISCUSSION Bypass appears to shorten the lifespan of stored red blood cells, at least in part by activating caspase-3 in the cells.
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Affiliation(s)
- Lu Han
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Department of Anesthesiology, KweiChow Moutai Hospital, Renhuai, Guizhou, China
| | - Lianlian Li
- Department of Anesthesiology, Hospital of Banan District, Chongqing, China
| | - Hangya Linghu
- Department of Anesthesiology, Bishan Maternity and Child Hospital of Chongqing, Chongqing, China
| | - Lei Zheng
- Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Daming Gou
- Department of Anesthesiology, KweiChow Moutai Hospital, Renhuai, Guizhou, China
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12
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Bae E. Preoperative risk evaluation and perioperative management of patients with obstructive sleep apnea: a narrative review. J Dent Anesth Pain Med 2023; 23:179-192. [PMID: 37559666 PMCID: PMC10407451 DOI: 10.17245/jdapm.2023.23.4.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.
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Affiliation(s)
- Eunhye Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Republic of Korea
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13
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Hao Y, Liu S, Liu T, Huang X, Xie M, Wang D. Pulmonary Function Test and Obstructive Sleep Apnea Hypopnea Syndrome in Obese Adults: A Retrospective Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1019-1030. [PMID: 37304766 PMCID: PMC10253010 DOI: 10.2147/copd.s409383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Objective We explore risk factors related to severe obstructive sleep apnea (OSA) in obese patients, including pulmonary ventilation function, diffusion function, and impulse oscillometry (IOS) data. Methods The medical records of 207 obese patients who were prepared to undergo bariatric surgery in a hospital from May 2020 to September 2021 were retrospectively reviewed. Polysomnography (PSG), pulmonary ventilation function, diffusion function, and IOS parameters were collected according to the ethical standards of the institutional research committee (registration number: KYLL-202008-144). Logistic regression analysis was used to analyze the related independent risk factors. Results There were significantly statistical difference in a number of pulmonary ventilation and diffusion function parameters among the non-OSAHS group, the mild-to-moderate OSA group, and the severe OSA group. However, only airway resistance parameters R5%, R10%, R15%, R20%, R25%, and R35% increased with increasing OSA severity and were positively correlated with apnea hypopnea index (AHI). Age (P = 0.012, 1.104 (1.022, 1.192)), body mass index (P< 0.0001, 1.12 (1.057, 1.187)), gender (P = 0.003, 4.129 (1.625, 10.49)), and R25% (P = 0.007, 1.018 (1.005, 1.031)) were independent risk factors for severe OSA. In patients aged 35 to 60, RV/TLC (P = 0.029, 1.272 (1.025, 1.577)) is an independent risk factor for severe OSA. Conclusion R25% was an independent risk factor for severe OSA in obese individuals, while RV/TLC was also an independent risk factor in those aged 35 to 60. Pulmonary function tests (PFTs), particularly IOS levels, are recommended to assess severe OSA in obese patients.
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Affiliation(s)
- Yijia Hao
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Shaozhuang Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Teng Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Xin Huang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Mengshuang Xie
- Department of Geriatrics & Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Dexiang Wang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
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14
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Cusick MM, Tisdale RL, Chertow GM, Owens DK, Goldhaber-Fiebert JD. Population-Wide Screening for Chronic Kidney Disease : A Cost-Effectiveness Analysis. Ann Intern Med 2023; 176:788-797. [PMID: 37216661 PMCID: PMC11091494 DOI: 10.7326/m22-3228] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 (SGLT2) inhibitors have the potential to alter the natural history of chronic kidney disease (CKD), and they should be included in cost-effectiveness analyses of screening for CKD. OBJECTIVE To determine the cost-effectiveness of adding population-wide screening for CKD. DESIGN Markov cohort model. DATA SOURCES NHANES (National Health and Nutrition Examination Survey), U.S. Centers for Medicare & Medicaid Services data, cohort studies, and randomized clinical trials, including the DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease) trial. TARGET POPULATION Adults. TIME HORIZON Lifetime. PERSPECTIVE Health care sector. INTERVENTION Screening for albuminuria with and without adding SGLT2 inhibitors to the current standard of care for CKD. OUTCOME MEASURES Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually. RESULTS OF BASE-CASE ANALYSIS One-time CKD screening at age 55 years had an ICER of $86 300 per QALY gained by increasing costs from $249 800 to $259 000 and increasing QALYs from 12.61 to 12.72; this was accompanied by a decrease in the incidence of kidney failure requiring dialysis or kidney transplant of 0.29 percentage points and an increase in life expectancy from 17.29 to 17.45 years. Other options were also cost-effective. During ages 35 to 75 years, screening once prevented dialysis or transplant in 398 000 people and screening every 10 years until age 75 years cost less than $100 000 per QALY gained. RESULTS OF SENSITIVITY ANALYSIS When SGLT2 inhibitors were 30% less effective, screening every 10 years during ages 35 to 75 years cost between $145 400 and $182 600 per QALY gained, and price reductions would be required for screening to be cost-effective. LIMITATION The efficacy of SGLT2 inhibitors was derived from a single randomized controlled trial. CONCLUSION Screening adults for albuminuria to identify CKD could be cost-effective in the United States. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality, Veterans Affairs Office of Academic Affiliations, and National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- Marika M. Cusick
- Department of Health Policy, School of Medicine, and
Stanford Health Policy, Freeman Spogli Institute for International Studies, Stanford
University, Stanford, CA, USA
| | - Rebecca L. Tisdale
- VA Palo Alto Health Care System, Center for Innovation to
Implementation (Ci2i), Menlo Park, CA, USA
| | - Glenn M. Chertow
- Department of Health Policy, School of Medicine, and
Stanford Health Policy, Freeman Spogli Institute for International Studies, Stanford
University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford
University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford
University School of Medicine, Stanford, CA, USA
| | - Douglas K. Owens
- Department of Health Policy, School of Medicine, and
Stanford Health Policy, Freeman Spogli Institute for International Studies, Stanford
University, Stanford, CA, USA
| | - Jeremy D. Goldhaber-Fiebert
- Department of Health Policy, School of Medicine, and
Stanford Health Policy, Freeman Spogli Institute for International Studies, Stanford
University, Stanford, CA, USA
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15
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Holmstrom L, Christensen M, Yuan N, Weston Hughes J, Theurer J, Jujjavarapu M, Fatehi P, Kwan A, Sandhu RK, Ebinger J, Cheng S, Zou J, Chugh SS, Ouyang D. Deep learning-based electrocardiographic screening for chronic kidney disease. COMMUNICATIONS MEDICINE 2023; 3:73. [PMID: 37237055 DOI: 10.1038/s43856-023-00278-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Undiagnosed chronic kidney disease (CKD) is a common and usually asymptomatic disorder that causes a high burden of morbidity and early mortality worldwide. We developed a deep learning model for CKD screening from routinely acquired ECGs. METHODS We collected data from a primary cohort with 111,370 patients which had 247,655 ECGs between 2005 and 2019. Using this data, we developed, trained, validated, and tested a deep learning model to predict whether an ECG was taken within one year of the patient receiving a CKD diagnosis. The model was additionally validated using an external cohort from another healthcare system which had 312,145 patients with 896,620 ECGs between 2005 and 2018. RESULTS Using 12-lead ECG waveforms, our deep learning algorithm achieves discrimination for CKD of any stage with an AUC of 0.767 (95% CI 0.760-0.773) in a held-out test set and an AUC of 0.709 (0.708-0.710) in the external cohort. Our 12-lead ECG-based model performance is consistent across the severity of CKD, with an AUC of 0.753 (0.735-0.770) for mild CKD, AUC of 0.759 (0.750-0.767) for moderate-severe CKD, and an AUC of 0.783 (0.773-0.793) for ESRD. In patients under 60 years old, our model achieves high performance in detecting any stage CKD with both 12-lead (AUC 0.843 [0.836-0.852]) and 1-lead ECG waveform (0.824 [0.815-0.832]). CONCLUSIONS Our deep learning algorithm is able to detect CKD using ECG waveforms, with stronger performance in younger patients and more severe CKD stages. This ECG algorithm has the potential to augment screening for CKD.
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Affiliation(s)
- Lauri Holmstrom
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew Christensen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Neal Yuan
- Department of Medicine, Division of Cardiology, San Francisco VA, UCSF, San Francisco, CA, USA
| | - J Weston Hughes
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
| | - John Theurer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Melvin Jujjavarapu
- Enterprise Information Service, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pedram Fatehi
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Alan Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Zou
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Sumeet S Chugh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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16
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Lv R, Liu X, Zhang Y, Dong N, Wang X, He Y, Yue H, Yin Q. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct Target Ther 2023; 8:218. [PMID: 37230968 DOI: 10.1038/s41392-023-01496-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.
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Affiliation(s)
- Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xueying Liu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yue Zhang
- Department of Geriatrics, the 2nd Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Na Dong
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xiao Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Yao He
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Hongmei Yue
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| | - Qingqing Yin
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Pordzik J, Seifen C, Ludwig K, Hackenberg B, Huppertz T, Bahr-Hamm K, Matthias C, Gouveris H. Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes. J Pers Med 2023; 13:jpm13030532. [PMID: 36983714 PMCID: PMC10059915 DOI: 10.3390/jpm13030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Hypoglossal-nerve stimulation (HGNS) is an established second-line therapy for patients with obstructive sleep apnea (OSA). Existing studies investigating the effect of preoperative drug-induced sleep endoscopic (DISE) findings on HGNS outcomes have mainly focused on the apnea/hypopnea index (AHI) among polysomnography (PSG) parameters, and have less frequently tested other PSG parameters such as the apnea index (AI), hypopnea index (HI), oxygen desaturation index (ODI), snoring index, and arousal index, or patient-reported excessive daytime sleepiness. The aim of this study was to investigate the correlation between DISE findings and the above-mentioned metrics after HGNS therapy. We only included patients with DISE findings providing detailed information about the degree of the anteroposterior velar (APV), oropharyngeal lateral wall (OPLW), or tongue-base (BT) obstruction based on the velum, oropharynx, base of tongue, and epiglottis (VOTE) classification. The data of 25 patients (9 female (36%)) were retrospectively evaluated. The mean age at the date of implantation was 54.52 ± 9.61 years, and the mean BMI was 29.99 ± 3.97 kg/m2. Spearman’s rho correlation coefficients were calculated. Significant correlations were found between the degree of APV obstruction and postoperative HI (r = −0.5, p < 0.05), and between the degree of OPLW obstruction and postoperative snoring index (r = 0.42, p < 0.05). BT obstruction was strongly correlated with postoperative metrics such as AHI (r = −0.57, p < 0.01), AI (r = −0.5, p < 0.05), ODI (r = −0.57, p < 0.01), ∆ AHI (r = 0.58, p < 0.01), ∆ AI (r = 0.54, p < 0.01) and ∆ ODI (r = 0.54, p < 0.01). No significant correlation was found between DISE findings and postoperative Epworth Sleepiness Scale values. These findings suggest that preoperative DISE findings, especially the degree of BT obstruction, are important for predicting an HGNS therapy outcome.
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18
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Wang J, Campos AI, García-Marín LM, Rentería ME, Xu L. Causal associations of sleep apnea and snoring with type 2 diabetes and glycemic traits and the role of BMI. Obesity (Silver Spring) 2023; 31:652-664. [PMID: 36746760 DOI: 10.1002/oby.23669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Sleep apnea and snoring have been associated with type 2 diabetes, with BMI playing a role in the pathway, but the directions of causality are unclear. This study examined the causal associations of sleep apnea and snoring with type 2 diabetes while assessing the role of BMI using multiple genetic methods. METHODS Five genetic methods were used: two-sample; bidirectional univariable Mendelian randomization (MR) inverse variance-weighted (MR-IVW); multivariable MR-IVW; network MR; and latent causal variable method. RESULTS Compared with univariable MR-IVW, the odds ratio (95% CI) of type 2 diabetes for genetically predicted sleep apnea and snoring using the largest genome-wide association study decreased dramatically, from 1.61 (95% CI: 1.16-2.23) to 1.08 (95% CI: 0.59-1.97) and from 1.98 (95% CI: 1.25-3.13) to 1.09 (95% CI: 0.64-1.86) after adjustment for BMI. Network MR showed that BMI accounts for 67% and 62% of the total effect of sleep apnea and snoring on type 2 diabetes, respectively. The latent causal variable suggested that sleep apnea and snoring have no direct causal effect on type 2 diabetes. CONCLUSIONS These results first suggest that the associations of sleep apnea and snoring with type 2 diabetes were mainly driven by BMI. The possible indirect effects of sleep apnea and snoring on type 2 diabetes through BMI cannot be ruled out.
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Affiliation(s)
- Jiao Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Adrian I Campos
- Department of Genetics & Computational Biology, Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Luis M García-Marín
- Department of Genetics & Computational Biology, Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lin Xu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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19
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A Concise Review of Polysomnography and Obstructive Sleep Apnea for the Neurophysiologist. J Clin Neurophysiol 2023; 40:191-197. [PMID: 36872497 DOI: 10.1097/wnp.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
SUMMARY Sleep as an electrical phenomenon in the brain was first recorded in 1875. Over the next 100 years, recordings of sleep evolved into modern-day polysomnography, which includes not only electroencephalography but also combinations of electro-oculography, electromyography, nasal pressure transducers, oronasal airflow monitors, thermistors, respiratory inductance plethysmography, and oximetry. The most common usage of polysomnography is to identify obstructive sleep apnea (OSA). Research has demonstrated that subjects with OSA have distinctive patterns detected by EEG. The evidence indicates that increased slow activity is seen in both sleep and wake for subjects with OSA and that these changes are reversible with treatment. This article reviews normal sleep, changes in sleep that result from OSA, and the effect that treatment of OSA via continuous positive airway pressure therapy has on normalizing the EEG. A review of alternative OSA treatment options is included, although their effects on EEG in OSA patients have not been studied.
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Zuckerman J, Coburn N, Callum J, Mahar AL, Lin Y, Turgeon AF, McLeod R, Pearsall E, Martel G, Hallet J. Evaluating variation in perioperative red blood cell transfusion for patients undergoing elective gastrointestinal cancer surgery. Surgery 2023; 173:392-400. [PMID: 36336508 DOI: 10.1016/j.surg.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/22/2022] [Accepted: 09/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients undergoing gastrointestinal cancer surgery often receive packed red blood cell transfusions. Understanding practice variation is critical to support efforts working toward responsible transfusion use. We measured the extent and importance of variation in perioperative packed red blood cell transfusion use across physicians and hospitals among gastrointestinal cancer surgery patients. METHODS We identified patients who underwent elective gastrointestinal cancer resection between 2007 and 2019 using linked administrative health data sets in Ontario, Canada. We used funnel plots to describe variation in transfusion use, adjusted for patient case mix. Hierarchical regression models quantified patient-level, between-physician, and between-hospital variation in transfusion use with R2 measures, variance partition coefficients, and median odds ratios. RESULTS Of 59,964 included patients (median age 69 years; 43.2% female; 75.8% colorectal resections), 18.0% received perioperative packed red blood cell transfusions. Funnel plots showed variation in transfusion use among physicians and hospitals. Patient characteristics, such as age, comorbidity, and procedure type, combined to explain 12.8% of the variation. After adjusting for case mix, systematic between-physician and between-hospital differences were responsible for 2.8% and 2.1% of the variation, respectively. This translated to an approximately 30% difference in the odds of transfusion for 2 similar patients treated by distinct physicians (median odds ratio: 1.35, 95% confidence interval 1.30-1.40) and hospitals (median odds ratio: 1.30, 95% confidence interval 1.23-1.42). We observed comparable effects across procedure-type subgroups. CONCLUSION Transfusion provision is highly driven by patient factors. Yet the impact of the treating physician and hospital on variation relative to other factors is important and reflects opportunities to target modifiable processes of care to standardize perioperative packed red blood cell transfusion practice.
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Affiliation(s)
- Jesse Zuckerman
- Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Natalie Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada; Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Robin McLeod
- Department of Surgery, University of Toronto, Canada
| | | | | | - Julie Hallet
- Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada; Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.
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Prognostic importance of obstructive sleep apnea and CPAP treatment for cardiovascular and mortality outcomes in patients with resistant hypertension: a prospective cohort study. Hypertens Res 2023; 46:1020-1030. [PMID: 36690808 DOI: 10.1038/s41440-023-01193-2] [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: 11/11/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
The prognostic importance of obstructive sleep apnea (OSA) severity and other polysomnographic parameters in patients with resistant hypertension (RHT) has never been evaluated. We aimed to assess it in a prospective cohort of 422 individuals with RHT. OSA presence/severity was ascertained by complete polysomnography (PSG) at baseline. Multivariable Cox regressions assessed the risks associated with OSA severity and other PSG parameters (apnea-hypopnea index, sleep duration, nocturnal hypoxemia and periodic limb movements) for the primary (total cardiovascular events [CVEs] and all-cause mortality) and secondary outcomes (major CVEs). In the subgroup of patients with moderate/severe OSA, the risks associated with CPAP treatment were also estimated in relation to untreated individuals. One-hundred and eighty-six participants (44%) had no/mild OSA and 236 (56%) had moderate/severe OSA, and 67 of them were CPAP-treated. Over a mean follow-up of 5 years, there were 46 CVEs (37 major ones) and 44 all-cause deaths. Neither the presence of moderate/severe or severe OSA, nor being untreated during follow-up, was associated with significant excess risks for any outcome in relation to the subgroup with no/mild OSA. Similarly, no other PSG-derived parameter predicted any adverse outcome. Otherwise, CPAP treatment was associated with non-significant risk reductions of 37% for total CVEs, 49% for major CVEs and 63% for all-cause mortality in relation to those who remained untreated during follow-up. In conclusion, the presence/severity of OSA and its related PSG parameters were not associated with worse cardiovascular/mortality prognosis in patients with RHT. However, CPAP treatment might be protective in individuals with moderate/severe OSA.
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Role of Iron Deficiency in Heart Failure-Clinical and Treatment Approach: An Overview. Diagnostics (Basel) 2023; 13:diagnostics13020304. [PMID: 36673114 PMCID: PMC9857585 DOI: 10.3390/diagnostics13020304] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The association of chronic heart failure (CHF) and iron deficiency (ID) with or without anemia is frequently encountered in current medical practice and has a negative prognostic impact, worsening patients' exercise capacity and increasing hospitalization costs. Moreover, anemia is common in patients with chronic kidney disease (CKD) and CHF, an association known as cardio-renal anemia syndrome (CRAS) possessing a significantly increased risk of death. AIM This review aims to provide an illustrative survey on the impact of ID in CHF patients-based on physiopathological traits, clinical features, and the correlation between functional and absolute ID with CHF-and the benefit of iron supplementation in CHF. METHOD We selected the most recent publications with important scientific content covering the association of CHF and ID with or without anemia. DISCUSSIONS An intricate physiopathological interplay is described in these patients-decrease in erythropoietin levels, activation of the renin-angiotensin-aldosterone system, systemic inflammation, and increases in hepcidin levels. These mechanisms amplify anemia, CHF, and CKD severity and worsen patients' outcomes. CONCLUSIONS Anemia is frequently encountered in CHF and represents a negative prognostic factor. Data from randomized controlled trials have underlined the administration of intravenous iron therapy (ferric carboxymaltose) as the only viable treatment option, with beneficial effects on quality of life and exercise capacity in patients with ID and systolic heart failure.
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Pordzik J, Ludwig K, Seifen C, Huppertz T, Bahr-Hamm K, Matthias C, Gouveris H. Insomnia in Patients Undergoing Hypoglossal Nerve Stimulation Therapy for Obstructive Sleep Apnea. BIOLOGY 2023; 12:biology12010098. [PMID: 36671790 PMCID: PMC9856015 DOI: 10.3390/biology12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
Hypoglossal nerve stimulation (HGNS) is a treatment for obstructive sleep apnea (OSA) patients with intolerance of positive airway pressure therapy. Comorbid insomnia is quite prevalent in OSA patients. We investigated the impact of insomnia and excessive daytime sleepiness (EDS) on polysomnography metrics after HGNS treatment. Data of 27 consecutive patients (9 female; mean age 55.52 ± 8.6 years) were retrospectively evaluated. Insomnia was assessed using the ISI (insomnia severity index) and EDS using the Epworth sleepiness scale (ESS). The median ISI was reduced significantly 3 months after HGNS activation (preoperative: 19; postoperative: 14; p < 0.01). Significant correlations emerged between preoperative ISI and postoperative AHI (apnea/hypopnea index; Spearman’s rho = 0.4, p < 0.05), ∆ AHI (r = −0.51, p < 0.01) and ∆ ODI (oxygen desaturation index; r = −0.48, p < 0.05). ISI correlated strongly with EES both preoperatively (r = 0.46; p < 0.02) and postoperatively (r = 0.79; p < 0.001). Therefore, HGNS therapy is associated with a significant reduction of insomnia-related symptoms, in addition to the improvement in respiratory metrics in OSA. Nonetheless, the preoperative severity of patient-reported insomnia symptoms was inversely correlated with the respiratory PSG-outcomes after HGNS. Insomnia should be considered in studies of EDS in OSA patients, especially those treated with HGNS.
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Pordzik J, Seifen C, Ludwig K, Huppertz T, Bahr K, Matthias C, Gouveris H. Short-Term Outcome of Unilateral Inspiration-Coupled Hypoglossal Nerve Stimulation in Patients with Obstructive Sleep Apnea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16443. [PMID: 36554323 PMCID: PMC9779234 DOI: 10.3390/ijerph192416443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Hypoglossal nerve stimulation (HGNS) is a therapeutic option for patients with obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP) therapy. Most reported data are based on multicentre pivotal trials with selected baseline core clinical features. Our aim was to investigate polysomnography (PSG)-based outcomes of HGNS-therapy in a patient cohort with higher average AHI and BMI than previously reported. Data of 29 consecutive patients (nine female; mean age: 55.52 ± 8.6 years, mean BMI 30.13 ± 3.93 kg/m2) were retrospectively evaluated. Numerical values of PSG- based metrics were compared before and after intervention using Wilcoxon's rank-sum test. AHI (38.57/h ± 12.71, 24.43/h ± 13.3, p < 0.001), hypopnea index (24.05/h ± 9.4, 15.27/h ± 8.23, p < 0.001), apnea index (14.5/h ± 12.05, 9.17/h ± 10.86, p < 0.01), snoring index (262.68/h ± 170.35, 143.48/h ± 162.79, p < 0.001), cortical arousal index (20.8/h ± 10.34 vs. 14.9/h ± 8.36, p < 0.01) and cumulative duration of apnea and hypopnea during sleep (79.79 min ± 40.32 vs. 48.62 min ± 30.56, p < 0.001) were significantly lower after HGNS. HGNS provides an effective therapy option for selected patients not tolerating PAP-therapy with higher average AHI and BMI than usually reported. HGNS-therapy appears to suppress central nervous system arousal circuits while not eliciting peripheral autonomous sympathetic activation. Such metrics as the snoring index and the cumulative duration of respiratory events during sleep may be considered in future HGNS studies.
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Trenado Luengo B, García-Sierra R, Wilke Trinxant M, Naval Pulido M, Lleal Barriga C, Torán-Monserrat P. Epidemiología de la anemia en adultos: estudio observacional de base poblacional. Semergen 2022; 48:101818. [DOI: 10.1016/j.semerg.2022.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 10/14/2022]
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Friščić T, Perčić M, Vidović D, Štajduhar A, Galić E. Impact of CPAP Therapy on New Inflammation Biomarkers. J Clin Med 2022; 11:jcm11206113. [PMID: 36294433 PMCID: PMC9605452 DOI: 10.3390/jcm11206113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder leading to increased risk of developing cardiovascular diseases (CVDs) by supporting a low-grade chronic inflammation as one of the pathological mechanisms. The continuous positive airway pressure (CPAP) device is used as an effective treatment for moderate and severe OSA. Neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), white blood cell–mean platelet volume ratio (WMR), C-reactive protein–albumin ratio (CAR) and fibrinogen–albumin ratio (FAR) are new potential inflammatory biomarkers that are widely available and were shown to be possibly favorable screening or follow-up tools for moderate- or severe-grade OSA, as well as indirect indicators for cardiovascular risk. Our study evaluated the impact of CPAP therapy in patients with severe OSA and acceptable therapy adherence on NLR, PLR, WMR, FAR and CAR. Of 57 patients who were initially enrolled and had no exclusion criteria, 37 had a satisfactory CPAP adherence (usage of ≥4 h per night) after a minimum of 6 months of therapy. There was a statistically significant difference in NLR (2.122 ± 0.745 before therapy vs. 1.888 ± 0.735 after therapy) and FAR (86.445 ± 18.763 before therapy vs. 77.321 ± 19.133 after therapy) suggesting a positive effect of the CPAP therapy on chronic inflammatory states, thereby possibly reducing cardiovascular risk.
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Affiliation(s)
- Tea Friščić
- Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia
| | - Marko Perčić
- Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia
| | - Domagoj Vidović
- University Psychiatric Hospital Vrapče, 10000 Zagreb, Croatia
| | | | - Edvard Galić
- Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-98-311-222
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Mattiazzi AD, Cortesi CA, Patil RJ, Carias Martinez KG, Sedki M, Cabeza Rivera FH, Ruiz P, Salsamendi JT, Guerra G. Percutaneous Ultrasound-Guided Kidney Transplant Biopsy Outcomes: From the Nephrologist to the Radiologist Standpoint. KIDNEY360 2022; 3:1746-1753. [PMID: 36514719 PMCID: PMC9717654 DOI: 10.34067/kid.0000332022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 01/28/2023]
Abstract
Background Kidney transplant biopsies are the gold standard for evaluating allograft dysfunction. These biopsies are performed by nephrologists and radiologists under real-time ultrasound guidance. A few studies have examined the outcomes of ultrasound-guided kidney transplant biopsy in transplant recipients; however, none have compared these outcomes between both specialties. Methods We retrospectively analyzed a cohort of 678 biopsies performed in a single center during a 44-month study period. Biopsies were stratified into two groups based upon the specialist performing the procedure: interventional radiology (IR; N=447) and transplant nephrology (TN; N=231). Results There were 55 (8%) complications related to biopsies in the entire cohort: 37 (8.2%) in the IR group and 18 (7.7%) in the TN group, without statistical difference between the groups (P=0.94). Blood pressure control and prior use of anticoagulation were significant predictors of complicated biopsies (P=0.004 and 0.02, respectively). Being a woman and prior use of anticoagulation were significant predictors of transfusion of blood products (P=0.01 and 0.01, respectively). Being a woman and blood pressure control were significant predictors of overall perinephric hematoma (P=0.01 and 0.01, respectively), and Black race was a significant predictor of perinephric hematoma without worsening of renal function (P=0.005). The specialist team performing the procedure was not a statistically significant predictor of biopsy complications, transfusion of blood products, or perinephric hematoma with comparable sample yield. Conclusions Percutaneous ultrasound-guided kidney transplant biopsy performed by transplant nephrologists have similar complication rates when compared with interventional radiologists in an academic center.
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Affiliation(s)
- Adela D. Mattiazzi
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Camilo A. Cortesi
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California
| | - Rhea J. Patil
- School of Medicine, University of Miami, Miami, Florida
| | - Karla G. Carias Martinez
- Department of Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Mai Sedki
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Franco H. Cabeza Rivera
- Department of Medicine, Division of Nephrology, University of Mississippi, Oxford, Mississippi
| | - Phillip Ruiz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida,Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason T. Salsamendi
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Improvements in Plasma Tumor Necrosis Factor-Alpha Levels after a Weight-Loss Lifestyle Intervention in Patients with Obstructive Sleep Apnea. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081252. [PMID: 36013431 PMCID: PMC9410143 DOI: 10.3390/life12081252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) and systemic inflammation typically coexist within a vicious cycle. This study aimed at exploring the effectiveness of a weight-loss lifestyle intervention in reducing plasma tumor necrosis factor-alpha (TNF-a), a well-established modulator of systematic inflammation in OSA. Eighty-four adult, overweight patients with a diagnosis of moderate-to-severe OSA were randomized to a standard care (SCG, n = 42) or a Mediterranean lifestyle group (MLG, n = 42). Both groups were prescribed continuous positive airway pressure (CPAP), while the MLG additionally participated in a 6-month behavioral intervention aiming at healthier weight and lifestyle habits according to the Mediterranean pattern. Plasma TNF-a was measured by an immunoenzymatic method both pre- and post-intervention. Drop-out rates were 33% (n = 14) for the SCG and 24% (n = 10) for the MLG. Intention-to-treat analysis (n = 84) revealed a significant decrease in median TNF-a only in the MLG (from 2.92 to 2.00 pg/mL, p = 0.001). Compared to the SCG, the MLG exhibited lower follow-up TNF-a levels (mean difference adjusted for age, sex, baseline TNF-a and CPAP use: −0.97 pg/mL, p = 0.014), and further controlling for weight loss did not attenuate this difference (p = 0.020). Per protocol analyses (n = 60) revealed similar results. In conclusion, a healthy lifestyle intervention can lower plasma TNF-a levels in patients with OSA.
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Izquierdo-Ribas M, Cepas-Guillén P, Flores-Umanzor E, Andrea R. Anaemia and acute coronary syndrome: A complex clinical scenario. Med Clin (Barc) 2022; 159:447-452. [PMID: 35927104 DOI: 10.1016/j.medcli.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Marc Izquierdo-Ribas
- Acute Cardiac Care Section, Cardiovascular Institute, Hospital Clinic Barcelona, Barcelona, Spain
| | - Pedro Cepas-Guillén
- Acute Cardiac Care Section, Cardiovascular Institute, Hospital Clinic Barcelona, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eduardo Flores-Umanzor
- Acute Cardiac Care Section, Cardiovascular Institute, Hospital Clinic Barcelona, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Rut Andrea
- Acute Cardiac Care Section, Cardiovascular Institute, Hospital Clinic Barcelona, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain.
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Sun DS, Xu SK, Wang L, Zhang L, Yu HY, Shen JQ. The Weighted Combination of the Epworth Sleepiness Scale and the STOP-Bang Questionnaire Improved the Predictive Value of for OSAHS in Hypertensive Patients. Int J Gen Med 2022; 15:6909-6915. [PMID: 36061961 PMCID: PMC9439589 DOI: 10.2147/ijgm.s360544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Hypertension interrelated with obstructive sleep apnea hypopnea syndrome (OSAHS), worsening morbidity and mortality. It is urgent to screening OSAHS from hypertensive patients. An ideal effective questionnaire screening approach for OSAHS is lacking. In this study, we aimed to explore a new OSAHS screening method via weighted combining the current used Epworth sleepiness scale (ESS) and STOP-Bang questionnaire (SBQ) upon calculation. Patients and Methods Three hundred and sixteen hypertensive patients with suspicion of the OSAHS were enrolled and randomized in the study into ESS, SBQ and portable respiratory polysomnography (RP) tests. The predictive value of ESS, SBQ and weighted combination were evaluated by calculating the area under curve (AUC), sensitivity and specificity, positive and negative likelihood ratio. Results Both the two scales alone and weighted combination were closely related with apnea hypopnea index (AHI), minimum oxygen saturation and average oxygen saturation at night (P < 0.05). The AUC, sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) of ESS in predicting OSAHS were 79.0%, 74.8%, 75.6%, 80.1% and 57.5%, respectively. For SBQ, they were 73.6%, 67.0%, 68.6%, 65.1% and 75.2%, respectively. In contrast, the AUC, sensitivity, and specificity of the combined approach were 82.5%, 73.9% and 82.6%. Conclusion The weighted combination of ESS and SBQ could improve the diagnostic ability of OSAHS in patients with hypertension, not only in the accuracy and sensitivity, but also for its easy procedure and accessibility and in hospital. Therefore, the weighted combination approach of ESS and SBQ is promising for OSAHS screening.
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Affiliation(s)
- Dong-Sheng Sun
- Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Shao-kun Xu
- Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Lin Wang
- Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Li Zhang
- Geriatric Medicine Center, Department of Geriatric Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Hai-Yan Yu
- Department of Internal Medicine, Beiyuan District, Yiwu Hospital of Traditional Chinese Medicine, Yiwu, 322000, People’s Republic of China
| | - Juan-Qin Shen
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
- Correspondence: Juan-Qin Shen, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China, Tel +86 571 87312433, Fax +86 571 87091089, Email
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Hakim M, Miller R, Hakim M, Tumin D, Tobias JD, Jatana KR, Raman VT. Comparison of the Fitbit® charge and polysomnography for measuring sleep quality in children with sleep disordered breathing. Minerva Pediatr (Torino) 2022; 74:259-263. [DOI: 10.23736/s2724-5276.18.05333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rossing P, Epstein M. Microalbuminuria Constitutes a Clinical Action Item for Clinicians in 2021. Am J Med 2022; 135:576-580. [PMID: 34979095 DOI: 10.1016/j.amjmed.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 12/20/2022]
Abstract
Chronic kidney disease affects approximately 10% of the population or 800 million people globally, with diabetes being the leading cause. The presence of chronic kidney disease with impaired kidney function or with albuminuria is associated with an increased risk of a progressive loss of renal function and increased risk of cardiovascular disease and excess mortality. Screening for chronic kidney disease is critically important because during the initial stages patients often have no symptoms and because we now have available recently approved multiple interventions that can reduce the high risks dramatically. Screening should be performed with regular measurement of albumin in the urine and creatinine or cystatin C in blood for estimation of kidney function. Regretfully recent data indicates that screening for albuminuria is conducted in only 20%-50% of people at risk depending on the setting. Clinicians need to perform regular screening and concomitant management of risk factors. Recent therapeutic options must be implemented to improve outcomes. Finally, a reduction in albuminuria after initiation of intervention constitutes a treatment target because it indicates improved prognosis.
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Affiliation(s)
- Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Head of Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Murray Epstein
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Fla.
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Noubiap JJ, Effa E, Ekrikpo UE, Hamonic LN, Ashuntantang G, Bello AK, Donner JA, Figueiredo AE, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, Jha V. Early Identification of Chronic Kidney Disease – A Scoping Review of the Global Populations. Kidney Int Rep 2022; 7:1341-1353. [PMID: 35685314 PMCID: PMC9171699 DOI: 10.1016/j.ekir.2022.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. Results We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3–5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. Conclusion Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.
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Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea. Ann Am Thorac Soc 2022; 19:1185-1192. [PMID: 35254967 DOI: 10.1513/annalsats.202109-1050oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Mouth breathing increases upper airway collapsibility, leading to decreased efficacy of obstructive sleep apnea (OSA) treatments. We hypothesized that the use of mandibular advancement devices (MAD) increases mouth breathing and, thus, using an adhesive mouthpiece (AMT), to prevent mouth breathing, in combination with MAD can improve the treatment efficacy. OBJECTIVES To evaluate the efficacy of MAD + AMT in comparison to MAD alone. METHODS A prospective crossover pilot study was designed to test this hypothesis. Briefly, adult participants with an apnea-hypopnea index (AHI) between 10-50 events/h at the screening visit were randomized to no treatment (baseline), MAD treatment, AMT treatment, and MAD+AMT treatment. As a primary analysis, absolute AHI was compared between MAD and MAD + AMT arms. Secondary analyses included quantifying the percent change in AHI, percentage of complete (AHI < 5 events/h) and incomplete (AHI 5 - 10 events/h) responders, and the efficacy of AMT alone in comparison with other treatment arms. RESULTS A total 21 of participants were included. (Baseline AHI= 24.3±9.9 event/h) The median AHI (Interquartile [IQR]) in the MAD and MAD+AMT arms were 10.5 [5.4-19.6] events/h and 5.6 [2.2-11.7] events/h (p-value= 0.02), respectively. A total of 76% of individuals achieved an AHI < 10 events/h in the MAD + AMT arm vs. 43% in the MAD arm (p-value<0.01). Finally, the observed effect was similar in moderate to severe OSA (AHI ≥15 events/h) in terms of absolute reduction and treatment responders, and AMT alone did not significantly reduce the AHI compared to baseline. CONCLUSION Combination of an adhesive mouthpiece and MAD is a more effective therapy than MAD alone. These findings may help improve clinical decision-making in sleep apnea.
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Respir Investig 2022; 60:3-32. [PMID: 34986992 DOI: 10.1016/j.resinv.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared in order to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Because sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rho Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, Tokyo, Japan; Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Japan.
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Memmolo P, Aprea G, Bianco V, Russo R, Andolfo I, Mugnano M, Merola F, Miccio L, Iolascon A, Ferraro P. Differential diagnosis of hereditary anemias from a fraction of blood drop by digital holography and hierarchical machine learning. Biosens Bioelectron 2022; 201:113945. [PMID: 35032844 DOI: 10.1016/j.bios.2021.113945] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 01/25/2023]
Abstract
Anemia affects about the 25% of the global population and can provoke severe diseases, ranging from weakness and dizziness to pregnancy problems, arrhythmias and hearth failures. About 10% of the patients are affected by rare anemias of which 80% are hereditary. Early differential diagnosis of anemia enables prescribing patients a proper treatment and diet, which is effective to mitigate the associated symptoms. Nevertheless, the differential diagnosis of these conditions is often difficult due to shared and overlapping phenotypes. Indeed, the complete blood count and unaided peripheral blood smear observation cannot always provide a reliable differential diagnosis, so that biomedical assays and genetic tests are needed. These procedures are not error-free, require skilled personnel, and severely impact the financial resources of national health systems. Here we show a differential screening system for hereditary anemias that relies on holographic imaging and artificial intelligence. Label-free holographic imaging is aided by a hierarchical machine learning decider that works even in the presence of a very limited dataset but is enough accurate for discerning between different anemia classes with minimal morphological dissimilarities. It is worth to notice that only a few tens of cells from each patient are sufficient to obtain a correct diagnosis, with the advantage of significantly limiting the volume of blood drawn. This work paves the way to a wider use of home screening systems for point of care blood testing and telemedicine with lab-on-chip platforms.
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Affiliation(s)
- Pasquale Memmolo
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy
| | - Genny Aprea
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy
| | - Vittorio Bianco
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy.
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II di Napoli, Italy; CEINGE-Biotecnologie Avanzate, Napoli, Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II di Napoli, Italy; CEINGE-Biotecnologie Avanzate, Napoli, Italy
| | - Martina Mugnano
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy
| | - Francesco Merola
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy
| | - Lisa Miccio
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II di Napoli, Italy; CEINGE-Biotecnologie Avanzate, Napoli, Italy
| | - Pietro Ferraro
- Istituto di Scienze Applicate e Sistemi Intelligenti "Eduardo Caianiello" (ISASI-CNR), via Campi Flegrei 34, 80078, Pozzuoli, Napoli, Italy
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Carballo Álvarez F, Albillos Martínez A, Llamas Silero P, Orive Calzada A, Redondo-Cerezo E, Rodríguez de Santiago E, Crespo García J. Consensus document of the Sociedad Española de Patología Digestiva on massive nonvariceal gastrointestinal bleeding and direct-acting oral anticoagulants. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:375-389. [DOI: 10.17235/reed.2022.8920/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Sleep Biol Rhythms 2022; 20:5-37. [PMID: 38469064 PMCID: PMC10900032 DOI: 10.1007/s41105-021-00353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/17/2022]
Abstract
The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610 Japan
- Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Yeh E, Chaudhary N, Strohl KP. Obstructive Sleep Apnea: Clinical Epidemiology and Presenting Manifestations. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Treatment-resistant hypertension assessed by home blood pressure monitoring: a new target for intervention? Hypertens Res 2021; 45:167-169. [PMID: 34789916 DOI: 10.1038/s41440-021-00801-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022]
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41
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Haase A, Stracke S, Chenot JF, Weckmann G. [Perspective of General Practitioners on Management of Non-dialysis Chronic Kidney Disease - a Qualitative Study]. Dtsch Med Wochenschr 2021; 146:e97-e102. [PMID: 34704237 DOI: 10.1055/a-1582-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a common diagnosis in older age due to age dependent kidney function decline, as well as an increase in causative diseases like diabetes mellitus and arterial hypertension. The condition knows a long asymptomatic phase in the early stages, and only a small part of the patient will progress to end stage renal disease requiring renal replacement therapy. Patients with CKD are generally managed by General Practitioners (GPs). OBJECTIVES The aim of the study was to evaluate the perspectives of German GPs on management of patients with non-dialysis CKD. METHODS There were 5 focus group discussions with a maximum of 5 GPs (n = 22). The material was recorded and transcribed to be analyzed by content analysis. RESULTS The most important treatment measures at the CKD were the optimization of causative diseases, medication adjustment and referral for nephrologist consultation. GPs stressed the individual management of their CKD patients. CONCLUSION GPs reported that their decisions about CKD management were based on Individual patient factors such as high age or multimorbidity.
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Affiliation(s)
- Annekathrin Haase
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Sylvia Stracke
- Bereich Nephrologie, Dialyse und Hochdruckkrankheiten der Klinik für Innere Medizin A, Universitätsmedizin Greifswald.,KfH Kuratorium für Dialyse und Nierentransplantation e. V., KfH-Nierenzentrum, Greifswald
| | - Jean-François Chenot
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Gesine Weckmann
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald.,Europäische Fachhochschule Rhein/Erft, Fachbereich Angewandte Gesundheitswissenschaften, Rostock
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42
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Padda J, Khalid K, Hitawala G, Batra N, Pokhriyal S, Mohan A, Cooper AC, Jean-Charles G. Acute Anemia and Myocardial Infarction. Cureus 2021; 13:e17096. [PMID: 34527482 PMCID: PMC8432420 DOI: 10.7759/cureus.17096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Various studies have established the prognosis of anemia in myocardial infarction (MI). Both chronic and acute anemia lead to poor outcomes in MI. Regardless, the association of anemia with MI and its management varies. In this study, the literature was analyzed to determine the association between acute anemia and MI based on the pathophysiology, outcomes, and management options. Acute anemia results in decreased blood supply and sudden hypoxia to the heart. Additionally, it exacerbates the preexisting compromised coronary blood supply in patients with MI. Thus, there is a disproportionate oxygen supply and demand ratio to the heart. It was found that anemia increases all-cause mortality in acute MI. However, it is unclear whether anemia is the direct contributor to mortality in these patients. For the management of MI, percutaneous coronary intervention (PCI) is commonly used. Increased incidence of hospital-acquired anemia (HAA) is reported in patients after PCI. However, the cause of HAA in these patients is not well established. Antiplatelet therapy in these patients is also considered to be the culprit for HAA. Nonetheless, no clear evidence is available. There is no consensus or criteria for the treatment of acute anemia in MI patients. Researchers have explored management options such as blood transfusion, erythropoietin-stimulating agent, and iron therapy. Further studies are warranted for a better understanding and management of MI in patients with anemia and vice versa.
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Affiliation(s)
- Jaskamal Padda
- Internal Medicine, JC Medical Center, Orlando, USA.,Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | | | | | - Nitya Batra
- Internal Medicine, JC Medical Center, Orlando, USA
| | | | - Ayushi Mohan
- Internal Medicine, JC Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, JC Medical Center, Orlando, USA.,Internal Medicine, Advent Health & Orlando Health Hospital, Orlando, USA
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Alfego D, Ennis J, Gillespie B, Lewis MJ, Montgomery E, Ferrè S, Vassalotti JA, Letovsky S. Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database. Diabetes Care 2021; 44:2025-2032. [PMID: 34353883 PMCID: PMC8740927 DOI: 10.2337/dc21-0723] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at risk for CKD. This study uses data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the U.S. RESEARCH DESIGN AND METHODS Patients with Laboratory Corporation of America Holdings (Labcorp) testing between 2013 and 2019 were defined as at risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) testing within the study year. RESULTS We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 years; 53.6% women): 16.2% had diabetes, 63.8% had hypertension, and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of patients with hypertension, and 41.4% of patients with both conditions. In a state-by-state comparison, annual testing rates ranged from 5 to 30%. The nationwide rate increased modestly each year between 2013 and 2018 (from 10.7% to 15.2%). CONCLUSIONS Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.
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Affiliation(s)
- David Alfego
- Laboratory Corporation of America Holdings, Burlington, NC
| | - Jennifer Ennis
- Laboratory Corporation of America Holdings, Burlington, NC
- Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, IL
| | - Barbara Gillespie
- Covance Inc., Princeton, NJ
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Joseph A Vassalotti
- National Kidney Foundation, New York, NY
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Sharma YP, Kaur N, Kasinadhuni G, Batta A, Chhabra P, Verma S, Panda P. Anemia in heart failure: still an unsolved enigma. Egypt Heart J 2021; 73:75. [PMID: 34453627 PMCID: PMC8403217 DOI: 10.1186/s43044-021-00200-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Anemia affects one-third of heart failure patients and is associated with increased morbidity and mortality. Despite being one of the commonest comorbidities associated with heart failure, there is a significant knowledge gap about management of anemia in the setting of heart failure due to conflicting evidence from recent trials. MAIN BODY The etiology of anemia in heart failure is multifactorial, with absolute and functional iron deficiency, decreased erythropoietin levels and erythropoietin resistance, inflammatory state and heart failure medications being the important causative factors. Anemia adversely affects the already compromised hemodynamics in heart failure, besides being commonly associated with more comorbidities and more severe disease. Though low hemoglobin levels are associated with poor outcomes, the correction of anemia has not been consistently associated with improved outcomes. Parenteral iron improves the functional capacity in iron deficient heart failure patients, the effects are independent of hemoglobin levels, and also the evidence on hard clinical outcomes is yet to be ascertained. CONCLUSION Despite all the research, anemia in heart failure remains an enigma. Perhaps, anemia is a marker of severe disease, rather than the cause of poor outcome in these patients. In this review, we discuss the current understanding of anemia in heart failure, its management and the newer therapies being studied.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India
| | - Navjyot Kaur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India
| | - Pulkit Chhabra
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India
| | - Samman Verma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, Sector-12, Chandigarh, India.
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Goel H, Hirsch JR, Deswal A, Hassan SA. Anemia in Cardiovascular Disease: Marker of Disease Severity or Disease-modifying Therapeutic Target? Curr Atheroscler Rep 2021; 23:61. [PMID: 34374878 DOI: 10.1007/s11883-021-00960-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF THE REVIEW In this review paper, we examine the latest evidence regarding the use of iron supplementation, erythropoiesis-stimulating agents (ESAs), and blood transfusions as therapeutic targets for anemia to mitigate morbidity and mortality in patients with cardiovascular disease. RECENT FINDINGS Intravenous ferric carboxymaltose (FC) injections in heart failure (HF) have resulted in improved self-reported patient symptoms; higher exercise capacity, as measured by 6-min walk test distance in anemic patients; and lower re-hospitalization rates in iron deficient patients. Darbepoetin alfa has shown evidence of improved Kansas City Cardiomyopathy Questionnaire scores. No mortality benefits have been noted thus far with FC injections or darbepoetin in HF, with an increase in adverse events with darbepoetin. Aggressive transfusions (Hg < 10 g/dL) are not associated with improved outcomes in cardiovascular disease. Quality of life metrics, rather than mortality, appear to improve with IV FC and ESA use in HF. More studies are required to see if these treatments have a role in coronary artery disease. Current evidence suggests that anemia is a marker of underlying disease severity, with a limited role in disease modification. Further studies are required to solidify our understanding of this topic.
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Affiliation(s)
- Harsh Goel
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Joshua R Hirsch
- Division of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anita Deswal
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Saamir A Hassan
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Shin JI, Chang AR, Grams ME, Coresh J, Ballew SH, Surapaneni A, Matsushita K, Bilo HJG, Carrero JJ, Chodick G, Daratha KB, Nadkarni GN, Nelson RG, Nowak C, Stempniewicz N, Sumida K, Traynor JP, Woodward M, Sang Y, Gansevoort RT. Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium. Hypertension 2021; 78:1042-1052. [PMID: 34365812 DOI: 10.1161/hypertensionaha.121.17323] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Albuminuria is an under-recognized component of chronic kidney disease definition, staging, and prognosis. Guidelines, particularly for hypertension, conflict on recommendations for urine albumin-to-creatinine ratio (ACR) measurement. Separately among 1 344 594 adults with diabetes and 2 334 461 nondiabetic adults with hypertension from the chronic kidney disease Prognosis Consortium, we assessed ACR testing, estimated the prevalence and incidence of ACR ≥30 mg/g and developed risk models for ACR ≥30 mg/g. The ACR screening rate (cohort range) was 35.1% (12.3%-74.5%) in diabetes and 4.1% (1.3%-20.7%) in hypertension. Screening was largely unrelated to the predicted risk of prevalent albuminuria. The median prevalence of ACR ≥30 mg/g across cohorts was 32.1% in diabetes and 21.8% in hypertension. Higher systolic blood pressure was associated with a higher prevalence of albuminuria (odds ratio [95% CI] per 20 mm Hg in diabetes, 1.50 [1.42-1.60]; in hypertension, 1.36 [1.28-1.45]). The ratio of undetected (due to lack of screening) to detected ACR ≥30 mg/g was estimated at 1.8 in diabetes and 19.5 in hypertension. Among those with ACR <30 mg/g, the median 5-year incidence of ACR ≥30 mg/g across cohorts was 23.9% in diabetes and 21.7% in hypertension. Incident albuminuria was associated with initiation of renin-angiotensin-aldosterone system inhibitors (incidence-rate ratio [95% CI], diabetes 3.09 [2.71-3.53]; hypertension 2.87 [2.29-3.59]). In conclusion, despite similar risk of albuminuria to those with diabetes, ACR screening in patients with hypertension was low. Our findings suggest that regular albuminuria screening should be emphasized to enable early detection of chronic kidney disease and initiation of treatment with cardiovascular and renal benefits.
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Affiliation(s)
- Jung-Im Shin
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Alex R Chang
- Department of Nephrology and Kidney Health Research Institute, Geisinger Medical Center, Danville, Pennsylvania (A.R.C.)
| | - Morgan E Grams
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Josef Coresh
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Shoshana H Ballew
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Aditya Surapaneni
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Kunihiro Matsushita
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Henk J G Bilo
- Diabetes Centre, Isala, and Department of Internal Medicine, University of Groningen, University Medical Center Groningen, the Netherlands (H.J.G.B.)
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Huddinge, Sweden (J.J.C.)
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Israel (G.C.)
| | - Kenn B Daratha
- Providence St. Joseph Health on behalf of CURE-CKD Investigators, Spokane, WA (K.B.D.)
| | - Girish N Nadkarni
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York (G.N.N.)
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona (R.G.N.)
| | - Christoph Nowak
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden (C.N.)
| | - Nikita Stempniewicz
- AMGA (American Medical Group Association), Alexandria, Virginia and OptumLabs Visiting Fellow, Eden Prairie, MN (N.S.)
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN (K.S.)
| | - Jamie P Traynor
- Glasgow Renal Transplant Unit, Queen Elizabeth University Hospital Glasgow Scotland, United Kingdom (J.P.T.)
| | - Mark Woodward
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.).,George Institute for Global Health, Australia, and George Institute for Global Health, Imperial College, London, United Kingdom (M.W.)
| | - Yingying Sang
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.-I.S., M.E.G., J.C., S.H.B., A.S., K.M., M.W., Y.S.)
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, the Netherlands (R.T.G.)
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Giménez S, Altuna M, Blessing E, Osorio RM, Fortea J. Sleep Disorders in Adults with Down Syndrome. J Clin Med 2021; 10:3012. [PMID: 34300177 PMCID: PMC8306783 DOI: 10.3390/jcm10143012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Sleep disorders, despite being very frequent in adults with Down syndrome (DS), are often overlooked due to a lack of awareness by families and physicians and the absence of specific clinical sleep guidelines. Untreated sleep disorders have a negative impact on physical and mental health, behavior, and cognitive performance. Growing evidence suggests that sleep disruption may also accelerate the progression to symptomatic Alzheimer's disease (AD) in this population. It is therefore imperative to have a better understanding of the sleep disorders associated with DS in order to treat them, and in doing so, improve cognition and quality of life, and prevent related comorbidities. This paper reviews the current knowledge of the main sleep disorders in adults with DS, including evaluation and management. It highlights the existing gaps in knowledge and discusses future directions to achieve earlier diagnosis and better treatment of sleep disorders most frequently found in this population.
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Affiliation(s)
- Sandra Giménez
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.A.); (J.F.)
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.A.); (J.F.)
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
| | - Esther Blessing
- Department of Psychiatry, NYU Langone Health, New York, NY 10016, USA; (E.B.); (R.M.O.)
| | - Ricardo M. Osorio
- Department of Psychiatry, NYU Langone Health, New York, NY 10016, USA; (E.B.); (R.M.O.)
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (M.A.); (J.F.)
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, 08029 Barcelona, Spain
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1217] [Impact Index Per Article: 405.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Peñacoba P, Llauger MA, Fortuna AM, Flor X, Sampol G, Pedro Pijoan AM, Grau N, Santiveri C, Juvanteny J, Aoiz JI, Bayó J, Lloberes P, Mayos M. Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain. J Clin Sleep Med 2021; 16:1579-1589. [PMID: 32279702 DOI: 10.5664/jcsm.8492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists. METHODS This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test. RESULTS A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients. CONCLUSIONS Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.
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Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Antònia Llauger
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de la Salut, Barcelona, Spain
| | - Ana M Fortuna
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Flor
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Chafarinas, Institut Català de la Salut, Barcelona, Spain
| | - Gabriel Sampol
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Núria Grau
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
| | - Carme Santiveri
- Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Juvanteny
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Trinitat Vella, Institut Català de la Salut, Barcelona, Spain
| | | | - Joan Bayó
- CAP El Clot, Institut Català de la Salut, Barcelona, Spain
| | - Patricia Lloberes
- Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
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50
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Arnold M, Burgmann S, Bonitz L, Pugachev A, Janoske U. Experimental study on the influence of model variations on the airway occlusion of an obstructive sleep apnea patient. J Biomech 2021; 123:110529. [PMID: 34062349 DOI: 10.1016/j.jbiomech.2021.110529] [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: 05/18/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
This study deals with the analysis of model parameters to mimic the airway collapse of an obstructive sleep apnea patient during nasal breathing. Different material properties and geometry variations of a patient-specific airway model are analyzed in detail. The patient-specific airway geometry is obtained from MRI data. A completely rigid model is compared to two partly elastic variations with different elasticities. Furthermore, the influence of the nasal cavities and the treatment effect of a mandibular protrusion are studied. Rigid model parts are 3D-printed and elastic parts cast from silicone. The models are analyzed under the impact of a transient airflow which is realized through a computer controlled piston pump. The results suggest, that, for moderate deformations, the elasticity of the soft tissue replicate influences rather the level of the pressure drop inside the airway than the shape of the pressure curve. The same suggestion can be made for the influence of the nasal cavities. Often, the spatial location of the minimum pressure is taken as the collapse site of the airway geometry. This study demonstrates, that the spatial locations of the minimum pressure and the maximum deformation do not match. This reveals the importance of a coupled approach of soft tissue and airflow analysis in the search of the collapse site and therefore the best treatment option. A treatment effect of the mandibular protrusion can be anticipated with an accurate patient-specific airway model.
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Affiliation(s)
- M Arnold
- University of Wuppertal, School of Mechanical Engineering and Safety Engineering, Germany.
| | - S Burgmann
- University of Wuppertal, School of Mechanical Engineering and Safety Engineering, Germany
| | - L Bonitz
- Dortmund General Hospital, Germany
| | | | - U Janoske
- University of Wuppertal, School of Mechanical Engineering and Safety Engineering, Germany
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