Diagnosis of Glaucoma Based on Few-Shot Learning with Wide-Field Optical Coherence Tomography Angiography

This study evaluated the utility of incorporating deep learning into the relatively novel imaging technique of wide-field optical coherence tomography angiography (WF-OCTA) for glaucoma diagnosis. To overcome the challenge of limited data associated with this emerging imaging, the application of few-shot learning (FSL) was explored, and the advantages observed during its implementation were examined. A total of 195 eyes, comprising 82 normal controls and 113 patients with glaucoma, were examined in this study. The system was trained using FSL instead of traditional supervised learning. Model training can be presented in two distinct ways. Glaucoma feature detection was performed using ResNet18 as a feature extractor. To implement FSL, the ProtoNet algorithm was utilized to perform task-independent classification. Using this trained model, the performance of WF-OCTA through the FSL technique was evaluated. We trained the WF-OCTA validation method with 10 normal and 10 glaucoma images and subsequently examined the glaucoma detection effectiveness. FSL using the WF-OCTA image achieved an area under the receiver operating characteristic curve (AUC) of 0.93 (95% confidence interval (CI): 0.912-0.954) and an accuracy of 81%. In contrast, supervised learning using WF-OCTA images produced worse results than FSL, with an AUC of 0.80 (95% CI: 0.778-0.823) and an accuracy of 50% (p-values < 0.05). Furthermore, the FSL method using WF-OCTA images demonstrated improvement over the conventional OCT parameter-based results (all p-values < 0.05). This study demonstrated the effectiveness of applying deep learning to WF-OCTA for glaucoma diagnosis, highlighting the potential of WF-OCTA images in glaucoma diagnostics. Additionally, it showed that FSL could overcome the limitations associated with a small dataset and is expected to be applicable in various clinical settings.

Clinical Perspectives of Parkinson's Disease for Ophthalmologists, Otorhinolaryngologists, Cardiologists, Dentists, Gastroenterologists, Urologists, Physiatrists, and Psychiatrists

Parkinson's disease (PD) is a multisystemic disorder characterized by various non-motor symptoms (NMS) in addition to motor dysfunction. NMS include sleep, ocular, olfactory, throat, cardiovascular, gastrointestinal, genitourinary, or musculoskeletal disorders. A range of NMS, particularly hyposmia, sleep disturbances, constipation, and depression, can even appear prior to the motor symptoms of PD. Because NMS can affect multiple organs and result in major disabilities, the recognition and multidisciplinary and collaborative management of NMS by physicians is essential for patients with PD. Therefore, the aim of this review article is to provide an overview of the organs that are affected by NMS in PD together with a brief review of pathophysiology and treatment options.

Lifetime coffee consumption, pineal gland volume, and sleep quality in late life

Study Objectives

Previous studies have shown that coffee consumption may suppress the production of melatonin in pinealocytes through competitive inhibition of adenosine A2 receptors by caffeine. We investigated the impact of lifetime coffee consumption on pineal gland volume and the resulting effects on sleep quality.

Methods

We enrolled 162 cognitively normal elderly individuals among the participants in the Korean Longitudinal Study on Cognitive Aging and Dementia. We evaluated the patterns and amounts of coffee consumption using a study-specific standardized interview and assessed sleep quality using the Pittsburgh Sleep Quality Index. We measured the volume of pineal parenchyma (VPP) by manually segmenting the pineal gland on high-resolution three-dimensional T1-weighted magnetic resonance images. We examined the impact of lifetime coffee consumption on the VPP and the resulting effects on sleep quality using analysis of covariance, multiple linear regression, and mediation analyses.

Results

We found that smaller VPP was associated with higher cumulative lifetime coffee consumption. Participants who consumed more than 60 cup-years of coffee had VPPs that were smaller by about 20% than individuals who consumed less than 60 cup-years of coffee. The VPP mediated the association between lifetime coffee consumption and sleep efficiency and quality.

Conclusions

Our findings suggest that high lifetime coffee consumption may reduce VPP, and that this reduction in VPP may impair the quality of sleep in late life.

Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases

Background

We aimed to investigate the prevalence of unrecognized depression in patients with chronic pain, but with no history of psychiatric diseases.

Methods

Patients with chronic pain who did not have a history of psychiatric disease were selected for this study. The Beck Depression Index (BDI) was used to evaluate depression. Participants' socio-demographic characteristics and pain-related characteristics were also recorded.

Results

The study included 94 consecutive patients with chronic pain (28 men and 66 women). Based on the BDI scores, 33/94 (35.1%) patients with chronic pain had comorbid depression. The prevalence of depression was significantly higher in our cohort than it was in the general population (P < 0.001). The standardized incidence ratio, adjusted for age and sex, was 2.77 in men and 2.60 in women. Patients who were unmarried (odds ratio [OR] = 3.714, P = 0.044), and who had subjective sleep disturbance (OR = 8.885, P < 0.001), were more likely to have moderate to severe depression. Patients with high education levels (OR = 0.244, P = 0.016), and who were economically active (OR = 0.284, P = 0.023), were less likely to have moderate to severe depression.

Conclusions

Our results indicate that unrecognized depression in patients with chronic pain is common. Therefore, pain physicians should actively seek to identify these problems rather than relying on the patient to volunteer such information.

Mortality of patients with obstructive sleep apnea in Korea

BACKGROUND

Obstructive sleep apnea (OSA) is associated with diverse health risks, including death. However, the role of OSA as a risk factor for death has never been studied in Asians. This study is aimed at evaluating the influence of OSA on the mortality in Korean sleep clinic population.

METHODS

A total of 2,240 patients who underwent in-laboratory full-night polysomnography due to snoring or sleep apnea were included. The patients were categorized based on apnea-hypopnea index (AHI)/hour. Death records were provided from the Statistics Korea. A Cox-proportional hazard regression model and Kaplan-Meier survival curve were used for analysis and demonstration of the all-cause mortality and cardiovascular mortality.

RESULTS

The all-cause mortality risk adjusted for age, sex, body mass index, diabetes, hypertension, cardiovascular diseases, and previous history of stroke was significantly associated with the increased severity of OSA. The adjusted hazard ratio (HR) for all-cause mortality in the severe OSA group (AHI ≥ 30) vs. reference group (5 < AHI) was 2.47 (95% confidence interval [CI], 1.09-5.57) and the adjusted HR for cardiovascular mortality was 4.66 (CI 1.03-21.08). After adjusting for whether the patients were treated or untreated, the HR for all-cause and cardiovascular mortality in the severe OSA group vs. reference group were 2.14 (p = 0.079) and 4.19 (p = 0.076), respectively.

CONCLUSIONS

The present study showed that the increased mortality was also associated with the increased severity of OSA in Koreans as shown in the studies performed in the Western countries.

Comparison between tongue base and soft palate obstruction in obstructive sleep apnea

CONCLUSIONS

In obstructive sleep apnea syndrome (OSAS), respiratory disturbances are more serious in tongue base-associated obstructions (TBOs) than in soft palate-associated obstructions (SPOs), and the proportion of TBO was predicted by average duration of apnea and hypopnea, and inversely by percentage time of snoring.

OBJECTIVE

To compare the polysomnographic characteristics of two main obstruction sites of OSAS, the soft palate and tongue base, and to identify those variables correlated with tongue base obstructions in patients with OSAS.

PATIENTS AND METHODS

Thirty-one patients (28 men and 3 women) with OSAS were enrolled in this study. To identify airway obstruction levels upper airway pressure manometry was applied during polysomnography. Airway obstructions were categorized as SPO and TBO by observing pressure patterns. All analyses of events were performed in the supine position.

RESULTS

Average duration of apnea and hypopnea, percentage of apnea among apnea-hypopneas, average O(2) desaturation, and percentage of event-related arousals were significantly higher in TBOs compared with SPOs (all p<0.05). The percentage of TBO among total obstructions (TBO%) was independently associated with average duration of apnea and hypopnea (=0.38, p<0.05) and percentage time of snoring (=-0.44, p<0.01) (adjusted R(2)=30%, p<0.01).

Evaluation of soft palate changes using sleep videofluoroscopy in patients with obstructive sleep apnea

OBJECTIVE

To quantitatively evaluate the changes in the soft palate (SP) by sleep videofluoroscopy (SVF).

DESIGN

Retrospective analysis.

SETTING

Academic tertiary referral center.

PATIENTS

A total of 63 consecutive patients with snoring or sleep apnea (53 with obstructive sleep apnea [OSA] and 10 simple snorers).

INTERVENTIONS

All the subjects underwent SVF and nocturnal polysomnography. Sleep videofluoroscopy was performed before and after sleep induction by intravenous injection of low-dose midazolam (2 mg per person) and was recorded during 3 kinds of events: awake, normoxygenation sleep, and desaturation sleep events.

MAIN OUTCOME MEASURES

Changes in SP length and the angle between inspiratory and expiratory efforts in each group were evaluated according to sleep events; changes in the SP was assessed according to obstruction sites and severity of OSA.

RESULTS

Desaturation sleep events were detected in all patients with OSA but not in simple snorers. In awake events, inspiratory efforts increased the length and angle of the SP in patients with OSA but not in simple snorers. Elongation and angulation were greatest during desaturation sleep events and least during awake events. In normoxygenation events, changes in the SP were significantly larger in patients with OSA than in simple snorers (P < .01 for SP length; P = .03 for SP angle). Elongation of the SP was the biggest in SP-type obstruction.

CONCLUSIONS

Sleep videofluoroscopy quantitatively showed that the SP was considerably elongated and angulated in patients with OSA even in an awake state. It is an easy way to measure the SP changes and may be a useful technique to differentiate OSA from simple snoring with short examination time.

Prevalence of narcolepsy-cataplexy in Korean adolescents

BACKGROUND

Narcolepsy typically begins between adolescence and early adulthood causing severe neuropsychiatric impairments, but few prevalence studies are available on adolescent narcoleptics. In the present study, we investigated the prevalence of narcolepsy-cataplexy in adolescents.

METHODS

In total 20,407 students, aged 14-19 years, participated in this study. Ullanlinna Narcolepsy Scale (UNS) was applied to all subjects and those with a UNS score of > or =14 were contacted by phone for semi-structured interview. Subjects then suspected of having narcolepsy participated in a laboratory investigation, which included polysomnography and HLA typing, or were interviewed in detail by telephone.

RESULTS

Three subjects were finally diagnosed as narcolepsy with cataplexy and seven subjects might be diagnosed as narcolepsy without cataplexy. Among three narcoleptics with cataplexy, two subjects were HLA-DQB1*0602 and DRB1*1501 positive, but one subject had no test of HLA typing. The prevalence of narcolepsy with cataplexy in Korean adolescence was thus determined to be 0.015% (95% confidence interval = 0.0-0.0313%).

CONCLUSION

This epidemiologic study is the first of its type on adolescent narcolepsy to use the International Classification of Sleep Disorders, 2nd edition (ICSD-2) diagnostic criteria. Considering those cases with an onset after adolescence were not included, the prevalence of narcolepsy with cataplexy determined in the present study is comparable with that of other studies in adults.

Obstructive site localization using multisensor manometry versus the Friedman staging system in obstructive sleep apnea

The aim of this study was to find the correlation between an anatomy-based staging system and pressure manometry performed during sleep. A retrospective study of 45 patients with obstructive sleep apnea (OSA) was carried out. All patients were evaluated by polysomnography, and obstruction sites were localized using a multisensor manometer during the full night. Obstruction sites were classified into retropalatal and retroglossal. The patients were also staged by anatomic findings of tonsil size and palate position. The % retroglossal obstruction was 29.4, 33.5 and 48.6% in stages I, II and III, respectively. There was no significant difference between stages. In contrast, when compared according to the Friedman tongue position (FTP), the mean % retroglossal obstruction of FTP grade 3 was significantly higher than that of FTP grade 1 (P = 0.009) although apnea hypopnea index, body mass index and lowest SpO2 were not different among FTP grades. It seems that FTP correlates with retroglossal obstruction and may be used to select patients in need of retroglossal modification of the airway.

Degree of arousal is most correlated with blood pressure reactivity during sleep in obstructive sleep apnea

We investigated blood pressure (BP) reactivity of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. The influences on BP reactivity of degree of arousal, the lowest O2 saturation (SaO2), and respiratory disturbance (RD) duration were compared. Ten normotensive or borderline hypertensive patients with OSA were studied with one-night polysomnography including non-invasive beat-to-beat BP monitoring (Finapres). We compared baseline BP, pre-apneic BP, and post-apneic BP during both REM and NREM sleep. Also, relationships between delta BP (post-apneic BP minus pre-apneic BP) and degree of arousal, the lowest SaO2, and RD duration were examined. During both REM and NREM sleep, pre-apneic BP was elevated compared with baseline BP. Post-apneic BP elevation was noted compared with pre-apneic BP. The degree of arousal was more significantly correlated with delta BP than the lowest SaO2. RD duration was hardly correlated with delta BP. Pre-apneic BP elevation seems to result from cumulation of sympathetic activation and sympathetic nervous system resetting. The correlation between delta BP and degree of arousal suggests that sympathetic activation causing post-apneic BP elevation may result mainly from an arousal response regardless of hypoxia.