Behavioural and emotional disturbances associated with sleep-disordered breathing symptomatology in children with Down's syndrome

BACKGROUND

Down's syndrome (DS) predisposes to sleep-disordered breathing (SDB). In children with DS, behavioural and emotional disturbances secondary to SDB are often assumed to result from cognitive impairment alone. Our aim was to explore the relationship of behavioural and emotional disturbances with SDB in a population of children with DS.

METHODS

A modified sleep questionnaire, Epworth Sleepiness Scale (ESS), Paediatric ESS and the short form of the developmental behaviour checklist (DBC-P24) were sent to 261 carers of children aged 4 to 15 years with DS in 2012.

RESULTS

Of 120 participants, 25% had probable SDB. In children with probable SDB compared to those without nocturnal symptoms, the total behaviour problem score (TBPS) was significantly higher (20.3 ± 8.6/48 vs. 12 ± 7.5/48; P = 0.002) as was the PaedESS (7.7 ± 5.6/24 vs. 2.8 ± 3.5/24; P = 0.002). For every increase in frequency of choking attacks, snoring and night awakenings, the TBPS increased by 1.37, 1.28 and 1.75 points, respectively, indicating worsening behaviour. The TBPS was found to decrease by 1.31 points for every hour more of self-reported sleep duration (r = -0.25, P = 0.017).

CONCLUSIONS

SDB symptoms and shorter self-reported sleep duration are highly prevalent among children with DS and are independently associated with worsening behaviour using the TBPS.

0573 Screening for Obstructive Sleep Apnea at Home Based on Deep Learning Features Derived from Respiration Sounds

Introduction

Analysis of sleep breathing sounds has been employed to screen obstructive sleep apnea (OSA). However, most current methods rely on specialized equipment (e.g., tracheal microphones), require additional physiological data (e.g., oxygen saturation), are rule-based, or are trained on data collected in-lab, making them less suitable for home use. In this study, deep learning methods were leveraged to explore the hypothesis that sleep audio recordings collected via smartphones can be used alone to screen for OSA by exploiting the temporal pattern of respiration sounds.

Methods

Adult participants with suspected sleep-disordered breathing of varying degrees of severity were recruited from the general population and from GP referrals to sleep clinic. Audio recordings were collected via smartphones during home sleep apnea testing (HSAT). HSAT data were scored by a registered polysomnographic technologist in accordance with current international guidelines (AASM V2.5, 2018) and used as reference. To exploit acoustic respiration temporal pattern, time interval histograms were computed for sequences of audio-words that were automatically learned from spectral features with a deep neural network. Means and standard deviations of the time intervals for each audio-word were employed by a Gaussian mixture model to classify 2-minute audio recording segments as either containing OSA events or not.

Results

Preliminary data from 4 valid nights’ recordings obtained from 2 consented participants was analysed. 550 segments were used for training, with 180 segments used for evaluation. Audio recording demonstrated a sensitivity of 0.71 and specificity of 0.66 when compared with manually-scored HSAT.

Conclusion

Preliminary results suggest that an approach to OSA screening based on deep learning with inter-audio-word intervals to capture information about respiration temporal pattern may be a useful tool in diagnosis of OSA. Further model development is underway using data collected from up to 200 patients and full study data will be presented.

Support

The project is supported by an Innovate UK grant (project number 157358). HR is supported by a joint scholarship from Passion for Life Healthcare Ltd and University of Sheffield. LH acknowledges the financial support of NHS Research Scotland (NRS), through NHS Lothian.

Co-suppression of AtMIPS demonstrates cooperation of MIPS1, MIPS2 and MIPS3 in maintaining myo-inositol synthesis

Co-suppressed MIPS2 transgenic lines allow bypass of the embryo lethal phenotype of the previously published triple knock-out and demonstrate the effects of MIPS on later stages of development. Regulation of inositol production is of interest broadly for its effects on plant growth and development. The enzyme L-myo-inositol 1-phosphate synthase (MIPS, also known as IPS) isomerizes D-glucose-6-P to D-inositol 3-P, and this is the rate-limiting step in inositol production. In Arabidopsis thaliana, the MIPS enzyme is encoded by three different genes, (AtMIPS1, AtMIPS2 and AtMIPS3), each of which has been shown to produce proteins with biochemically similar properties but differential expression patterns. Here, we report phenotypic and biochemical effects of MIPS co-suppression. We show that some plants engineered to overexpress MIPS2 in fact show reduced expression of AtMIPS1, AtMIPS2 and AtMIPS3, and show altered vegetative phenotype, reduced size and root length, and delayed flowering. Additionally, these plants show reduced inositol, increased glucose levels, and alteration of other metabolites. Our results suggest that the three AtMIPS genes work together to impact the overall synthesis of myo-inositol and overall inositol homeostasis.

Oxygen-dependent autoaggregation in Shewanella oneidensis MR-1

In aerobic chemostat cultures maintained at 50% dissolved O(2) tension (3.5 mg l(-1) dissolved O(2)), Shewanella oneidensis strain MR-1 rapidly aggregated upon addition of 0.68 mM CaCl(2) and retained this multicellular phenotype at high dilution rates. Confocal microscopy analysis of the extracellular matrix material contributing to the stability of the aggregate structures revealed the presence of extracellular DNA, protein and glycoconjugates. Upon onset of O(2)-limited growth (dissolved O(2) below detection) however, the Ca(2+)-supplemented chemostat cultures of strain MR-1 rapidly disaggregated and grew as motile dispersed cells. Global transcriptome analysis comparing aerobic aggregated to O(2)-limited unaggregated cells identified genes encoding cell-to-cell and cell-to-surface adhesion factors whose transcription increased upon exposure to increased O(2) concentrations. The aerobic aggregated cells also revealed increased expression of putative anaerobic electron transfer and homologues of metal reduction genes, including mtrD (SO1782), mtrE (SO1781) and mtrF (SO1780). Our data indicate that mechanisms involved in autoaggregation of MR-1 are dependent on the function of pilD gene which encodes a putative prepilin peptidase. Mutants of S. oneidensis strain MR-1 deficient in PilD and associated pathways, including type IV and Msh pili biogenesis, displayed a moderate increase in sensitivity to H(2)O(2). Taken together, our evidence indicates that aggregate formation in S. oneidensis MR-1 may serve as an alternative or an addition to biochemical detoxification to reduce the oxidative stress associated with production of reactive oxygen species during aerobic metabolism while facilitating the development of hypoxic conditions within the aggregate interior.

Incidence of keratitis of varying severity among contact lens wearers

AIM

To determine the incidence of non-severe keratitis (NSK) and severe keratitis (SK) among wearers of current generation contact lenses.

METHODS

A 12 month, prospective, hospital based epidemiological study was conducted by examining all contact lens wearers presenting with a corneal infiltrate/ulcer to a hospital centre in Manchester. A clinical severity matrix was used to differentiate between NSK and SK, based on the severity of signs and symptoms. The size of the hospital catchment population and the wearing modalities (daily wear (DW) or extended wear (EW)) and lens types being used were estimated from relevant demographic and market data.

RESULTS

During the survey period, 80 and 38 patients presented with NSK and SK, respectively. The annual incidences (cases per 10,000 wearers) for each wearing modality and lens type were: DW rigid--NSK 5.7, SK 2.9; DW hydrogel daily disposable--NSK 9.1, SK 4.9; DW hydrogel (excluding daily disposable)--NSK 14.1, SK 6.4; DW silicone hydrogel--NSK 55.9, SK 0.0; EW rigid--NSK 0.0, SK 0.0; EW hydrogel--NSK 48.2, SK 96.4; EW silicone hydrogel--NSK 98.8, SK 19.8. The difference in SK between EW hydrogel and EW silicone hydrogel was significant (p = 0.04).

CONCLUSIONS

A clinical severity matrix has considerable utility in assessing contact lens related keratitis. There is a significantly higher incidence of SK in wearers who sleep in contact lenses compared with those who only use lenses during the waking hours. Those who choose to sleep in lenses should be advised to wear silicone hydrogel lenses, which carry a five times decreased risk of SK for extended wear compared with hydrogel lenses.

Dosage uniformity in hydrocortisone ointment B.P

The content uniformity of hydrocortisone in seven commercially available brands of hydrocortisone ointment B.P. 1% has been investigated. Fifty 5 mg samples were assayed by high pressure liquid chromatography and the results indicated that for 95% confidence levels only two of the ointments exhibited no positive skewness, one exhibited a significant degree of positive skewness and four exhibited a highly significant degree of positive skewness. The extent of the skewed distributions is discussed in relation to previously published particle/agglomerate distributions for these ointments. The content uniformity in terms of the coefficient of variation CE calculated from the h.p.l.c. data is compared with the coefficient of variation CP that can be predicted from mixing theory on the basis of the particle/agglomerate distribution of the hydrocortisone. The departure from normality in drug content uniformity in the ointment is attributed to the hydrocortisone particles not being individually available for randomization, a large number being in an agglomerated form. That is, the manufacturing process is failing to achieve the full potential of the formulation by dispersing all of the agglomerates. Theoretical and experimental models predict that percutaneous absorption of drug may be enhanced over areas, where agglomerates are located, possibly not only resulting in localized toxicity but increased systemic availability. Drug content variability in small samples (5 mg) of topical steroid formulations could also effect the degree of skin blanching response in Mackenzie-Stoughton type tests since 5 mg portions containing in excess of twice the labelled strength were found. Regulatory control of content uniformity should be considered for certain topical steroids if unintentional over-dosage on small discrete areas is to be avoided.

Identification of strains of herpes simplex virus by comparison of the density of their DNA using the preparative ultracentrifuge

The buoyant densities of the DNA of herpes simplex virus type 1, type 2 and Pseudorabies virus, as determined in the analytical ultracentrifuge, are 1.725, 1.727 and 1.731 correlating with G+C contents of 67, 69 and 73 per cent respectively. The density differences for the DNA's of type 1 and type 2 herpes simplex viruses have been confirmed in experiments with isotopically labelled DNA from four type 1 and six type 2 strains by preparative CsCl gradient ultracentrifugation. The DNA of all the type 2 strains was denser than that of any of the type 1 strains examined. Despite these differences in DNA base composition of type 1 and type 2 strains, nearest neighbour analysis of their DNA's disclosed no obvious differences in doublet pattern or general design.