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Sleep Apnea Syndromes: HELP
Articles from Germany
Based on 816 articles published since 2010
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These are the 816 published articles about Sleep Apnea Syndromes that originated from Germany during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
226 Article The Effects of Eplerenone on the Circadian Blood Pressure Pattern and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea and Resistant Hypertension-A Randomized, Controlled Trial. 2019

Krasińska, Beata / Cofta, Szczepan / Szczepaniak-Chicheł, Ludwina / Rzymski, Piotr / Trafas, Tomasz / Paluszkiewicz, Lech / Tykarski, Andrzej / Krasiński, Zbigniew. ·Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland. beata.bkrasinska@gmail.com. · Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland. s.cofta@gmail.com. · Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland. l.vinnie@wp.pl. · Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland. rzymskipiotr@ump.edu.pl. · Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland. tomasztrafas@wp.pl. · Bad Oeynhausen, Heart and Diabetes Center NRW, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany. lpalusz@poczta.onet.pl. · Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland. tykarski@o2.pl. · Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland. zbigniew.krasinski@gmail.com. ·J Clin Med · Pubmed #31614891.

ABSTRACT: The obstructive sleep apnea (OSA) is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH). Despite this, as of now the relationship between high night-time blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with OSA and RAH is not fully understood. The aim of this study was to assess the influence of the addition of eplerenone to a standard antihypertensive therapy on parameters of 24-h ambulatory blood pressure measurement (ABPM) as well as on the results of echocardiography and polysomnography in patients with OSA and RAH. The patients were randomly assigned to one of the two study groups: the treatment group, receiving 50 mg/d eplerenone orally for 6 months (

227 Article Self-Reported Daytime Sleepiness and Sleep-Disordered Breathing in Patients With Atrial Fibrillation: SNOozE-AF. 2019

Kadhim, Kadhim / Middeldorp, Melissa E / Elliott, Adrian D / Jones, Dione / Hendriks, Jeroen M L / Gallagher, Celine / Arzt, Michael / McEvoy, R Doug / Antic, Nick A / Mahajan, Rajiv / Lau, Dennis H / Nalliah, Chrishan / Kalman, Jonathan M / Sanders, Prashanthan / Linz, Dominik. ·Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. · Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany. · Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia. · Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia. · Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: Dominik.Linz@adelaide.edu.au. ·Can J Cardiol · Pubmed #31604670.

ABSTRACT: BACKGROUND: Atrial fibrillation (AF) management guidelines recommend screening for symptoms of sleep-disordered breathing (SDB). We aimed to assess the role of self-reported daytime sleepiness in detection of patients with SDB and AF. METHODS: A total of 442 consecutive ambulatory patients with AF who were considered candidates for rhythm control and underwent polysomnography comprised the study population. The utility of daytime sleepiness (quantified by the Epworth Sleepiness Scale [ESS]) to predict any (apnea-hypopnea index [AHI] ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB on polysomnography was tested. RESULTS: Mean age was 60 ± 11 years and 69% patients were men. SDB was present in two-thirds of the population with 33% having moderate-to-severe SDB. Daytime sleepiness was low (median ESS = 8/24) and the ESS poorly predicted SDB, regardless of the degree of SDB tested (area under the curve: 0.48-0.56). Excessive daytime sleepiness (ESS ≥ 11) was present in 11.9% of the SDB population and had a negative predictive value of 43.1% and a positive predictive value of 67.5% to detect moderate-to-severe SDB. Male gender (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.8, P = 0.001), obesity (OR: 3.5, 95% CI: 2.3-5.5, P < 0.001), diabetes (OR: 2.3, 95% CI: 1.2-4.4, P = 0.08), and stroke (OR: 4.6, 95% CI: 1.7-12.3, P = 0.002) were independently associated with an increased likelihood of moderate-to-severe SDB. CONCLUSIONS: In an ambulatory AF population, SDB was common but most patients reported low daytime sleepiness levels. Clinical features, rather than daytime sleepiness, were predictive of patients with moderate-to-severe SDB. Lack of excessive daytime sleepiness should not preclude patients from being investigated for the potential presence of concomitant SDB.

228 Article The prediction of obstructive sleep apnea severity based on anthropometric and Mallampati indices. 2019

Amra, Babak / Pirpiran, Mohsen / Soltaninejad, Forogh / Penzel, Thomas / Fietze, Ingo / Schoebel, Christoph. ·Bamdad Respiratory and Sleep Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. · Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. · Center of Sleep Medicine, Charité - Berlin University of Medicine, Berlin, Germany. · Department of Cardiology and Pulmonology, Center of Sleep Medicine, Charité - Berlin University of Medicine, Berlin, Germany. · Department of Cardiology and Angiology, Center of Sleep Medicine, Charité - Berlin University of Medicine, Berlin, Germany. ·J Res Med Sci · Pubmed #31523252.

ABSTRACT: Background: Obstructive sleep apnea (OSA) is a common health issue with serious complications. Regarding the high cost of the polysomnography (PSG), sensitive and inexpensive screening tools are necessary. The objective of this study was to evaluate the predictive value of anthropometric and Mallampati indices for OSA severity in both genders. Materials and Methods: In a cross-sectional study, we evaluated anthropometric data and the Mallampati classification for the patients ( Results: About 54.1% of the patients were male. Mallampati, age, and NCs are important factors in predicting moderate OSA. The likelihood of moderate OSA severity based on Model 1 was 94.16%. In severe OSA, Mallampati, BMI, age, AC, and gender are more predictive. In Model 2, gender had a significant role. The likelihood of severe OSA based on Model 2 in female patients was 89.98% and in male patients was 90.32%. Comparison of the sensitivity and specificity of both models showed a higher sensitivity of Model 1 (93.5%) and a higher specificity of Model 2 (89.66%). Conclusion: For the prediction of moderate and severe OSA, anthropometric and Mallampati indices are important factors.

229 Article Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients. 2019

Gehrke, T / Scherzad, A / Hagen, R / Hackenberg, S. ·Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Germany. ·Anaesthesia · Pubmed #31508815.

ABSTRACT: Adenotonsillectomies are commonly performed procedures and sleep-disordered breathing is becoming increasingly important as an indication for surgery. Because of the higher risks in patients with obstructive sleep apnoea, the required level of postoperative care for these patients is currently under discussion, and better identification of patients at risk may reduce unnecessary postoperative monitoring. To evaluate the influence of obstructive sleep apnoea, and other risk factors, on peri-operative complications in children requiring adenotonsillectomy, we performed a retrospective case-control study that included 1995 patients treated between January 2009 and June 2017. In our analysis, young age (OR 3.8, 95%CI 2.1-7.1), low body weight (OR 2.6, 95%CI 1.5-4.4), obstructive sleep apnoea (OR 2.4, 95%CI 1.5-3.8), pre-existing craniofacial or syndromal disorders (OR 2.3, 95%CI 1.4-3.8) and adenotonsillectomy, compared with adenoidectomy alone, (OR 7.9, 95%CI 4.7-13.1) were identified as risk factors for complications during or after surgery, p < 0.001. All 13 patients suffering from complications more than 3 h postoperatively had obstructive sleep apnoea plus at least one more of these risk factors. Patients at risk of postoperative complications can therefore be identified by several criteria pre-operatively, and should be monitored postoperatively using pulse oximetry overnight. For all other patients, postoperative observation on a surgical ward without extra monitoring is sufficient. Admission to paediatric intensive care should be reserved for patients suffering serious intra-operative complications.

230 Article Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives. 2019

Boentert, Matthias. ·Department of Neurology, University Hospital Muenster, Muenster, Germany. ·Nat Sci Sleep · Pubmed #31496852.

ABSTRACT: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease inevitably leading to generalized muscle weakness and premature death. Sleep disturbances are extremely common in patients with ALS and substantially add to the burden of disease for both patients and caregivers. Disruption of sleep can be caused by physical symptoms, such as muscle cramps, pain, reduced mobility, spasticity, mucus retention, and restless legs syndrome. In addition, depression and anxiety may lead to significant insomnia. In a small subset of patients, rapid eye movement (REM) sleep behavioral disorder may be present, reflecting neurodegeneration of central nervous system pathways which are involved in REM sleep regulation. With regard to overall prognosis, sleep-disordered breathing (SDB) and nocturnal hypoventilation (NH) are of utmost importance, particularly because NH precedes respiratory failure. Timely mechanical ventilation is one of the most significant therapeutic measures to prolong life span in ALS, and transcutaneous capnometry is superior to pulse oxymetry to detect NH early. In addition, it has been shown that in patients on home ventilatory support, survival time depends on whether normocapnia, normoxia, and elimination of apneic events during sleep can be reliably achieved. Several studies have investigated sleep patterns and clinical determinants of sleep disruption in ALS, but exact prevalence numbers are unknown. Thus, constant awareness for sleep-related symptoms is appropriate. Since no curative treatment can be offered to affected patients, sleep complaints should be thoroughly investigated in order to identify any treatable etiology and improve or stabilize quality of life as much as possible. The use of hypnotics should be confined to palliation during the terminal phase and refractory insomnia in earlier stages of the disease, taking into account that most compounds potentially aggravate SDB.

231 Article Long-term follow-up of the German post-market study for upper airway stimulation for obstructive sleep apnea. 2019

Steffen, Armin / Sommer, Ulrich J / Maurer, Joachim T / Abrams, Nils / Hofauer, Benedikt / Heiser, Clemens. ·Department of Otorhinolaryngology, University of Lübeck, Klinik für HNO-Heilkunde, Ratzeburger Allee 160, 23538, Lübeck, Germany. armin.steffen@uksh.de. · Department of Otorhinolaryngology, Head and Neck Surgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany. · Department of Otorhinolaryngology, Head and Neck Surgery, University-Hospital Mannheim, Mannheim, Germany. · Department of Otorhinolaryngology, University of Lübeck, Klinik für HNO-Heilkunde, Ratzeburger Allee 160, 23538, Lübeck, Germany. · Department of Otorhinolaryngology, University of Freiburg, Kilianstraße 5, 79106, Freiburg, Germany. · Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany. ·Sleep Breath · Pubmed #31485853.

ABSTRACT: PURPOSE: Upper airway stimulation (UAS) is an effective treatment for obstructive sleep apnea (OSA) in positive airway pressure (PAP) failure. Most reports have presented short-term data, so long-term safety and efficacy reports are rare. The German post-market study (G-PMS) has followed approximately 60 patients from three implanting centers for several years. METHODS: Patients with OSA and PAP failure qualified for the G-PMS by the absence of obesity class 2 an AHI between 15 and 65 events/h and absence of complete concentric collapse at the velum during drug-induced sleep endoscopy. Optional 2- and 3-year follow-ups after implantation were collected during routine clinical practice. We measured respiratory parameters such as apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) and daytime sleepiness using the Epworth sleepiness scale (ESS) in a per protocol analysis. Usage was calculated from device-downloaded reports. Device-related complications were documented. RESULTS: Of the 60 original patients, 41 returned for 2-year follow-up, and 38 for 3 years. About 76% at 2 years and 68% at 3 years met the criterion of therapy success defined as an AHI below 15/h. The median AHI was reduced from 28.6/h (baseline) to 9.0/h (2 years) and 10.0/h (3 years); whereas median ODI decreased from 27.0 to 6.3/h (2 years), and 8.3/h (3 years). Median ESS improved from baseline 13 points to 4 (2 years) and 6 (3 years). Usage was stable at approximately 45 h per week at 2 and 3 years. Serious device-related adverse events were rare, with two-device explantation between 12 to 36 months postoperatively. CONCLUSIONS: The German multi-center long-term outcomes compare favorably with previously published studies. Respiratory and sleepiness efficacy outcomes were sustained over 2 and 3 years, with a favorable safety profile, supporting the safety and efficacy of a chronic implantable therapy.

232 Article Phenotypes to Predict Response to Mandibular Advancement Device Therapy. 2019

Heiser, Clemens. ·Klinikum rechts der Isar, Technical University of Munich, Germany. ·J Clin Sleep Med · Pubmed #31482825.

ABSTRACT: CITATION: Heiser C. Phenotypes to predict response to mandibular advancement device therapy. JClin SleepMed. 2019;15(8):1073-1074.

233 Article Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis. 2019

Cuspidi, Cesare / Tadic, Marijana / Sala, Carla / Gherbesi, Elisa / Grassi, Guido / Mancia, Giuseppe. ·Department of Medicine and Surgery, University of Milano-Bicocca, 20036 Meda, Italy. · Istituto Auxologico Italiano, 20122 Milano, Italy. · Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany. marijana_tadic@hotmail.com. · Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, 20122 Milano, Italy. ·J Clin Med · Pubmed #31480717.

ABSTRACT: AIM: We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM). DESIGN: The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: "obstructive sleep apnea", "sleep quality", "non dipping", "reduced nocturnal BP fall", "circadian BP variation", "night-time BP", and "ambulatory blood pressure monitoring". RESULTS: Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0-90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0-65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07-1.89, CONCLUSIONS: The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping.

234 Article Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction. 2019

Bischof, Fabian / Egresits, Jozsef / Schulz, Richard / Randerath, Winfried J / Galetke, Wolfgang / Budweiser, Stephan / Nilius, Georg / Arzt, Michael / Hetzenecker, Andrea / Anonymous3751002. ·Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. · Department of Pneumology, Hospital Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany. · Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. · HELIOS-Klinik Hagen-Ambrock, University Hospital Witten/Herdecke, Solingen, Germany. · Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Center Rosenheim, Rosenheim, Germany. · Department of Pneumology and Allergology, Hospital Essen Mitte, Essen, Germany. · Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany. Andrea.Hetzenecker@klinik.uni-regensburg.de. ·Sleep Breath · Pubmed #31463779.

ABSTRACT: PURPOSE: A nocturnal non-dipping or rise in blood pressure (BP) is associated with poor cardiovascular outcome. This study aimed to test whether continuous positive airway pressure (CPAP) therapy can reduce nocturnal BP and normalize the 24-h BP profile in patients with severe obstructive sleep apnea (OSA) and erectile dysfunction as a surrogate for endothelial dysfunction (ED). PATIENTS AND METHODS: Eighteen consecutive patients with OSA and ED on stable antihypertensive medication (age 55.8 ± 9.5 years, body mass index 35.5 ± 3.8 kg/m RESULTS: Compared to baseline, nocturnal systolic and diastolic BP were significantly reduced after CPAP therapy (128.5 ± 14 to 122.9 ± 11 mmHg, p = 0.036; 76.2 ± 9 to 70.5 ± 5 mmHg, p = 0.007). The frequency of non-dipping and rising nocturnal systolic BP, as well as mean nocturnal heart rate, was reduced after CPAP treatment (73 to 27%, p = 0.039; 20 to 7%, p = 0.625; from 81.5 ± 10 to 74.8 ± 8 beats per minute p = 0.043). Serum levels of noradrenaline were significantly lower after CPAP therapy (398 ± 195 ng/l vs. 303 ± 135 ng/l, p = 0.032). CONCLUSION: In patients with severe OSA and clinically apparent ED, CPAP therapy was associated with a decrease in nocturnal BP and serum noradrenaline levels, as well as a normalization of the 24-h BP profile.

235 Article [Upper Airway Stimulation for obstructive sleep apnea-Can radiological position monitoring predict tongue motion one year after implantation? German version]. 2019

Steffen, A / Wozny, A S / König, I R / Goltz, J-P / Wollenberg, B / Hasselbacher, K. ·Klinik für Hals-Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. armin.steffen@uksh.de. · Klinik für Hals-Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. · Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Deutschland. · Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Lübeck, Deutschland. ·HNO · Pubmed #31414154.

ABSTRACT: BACKGROUND: Tongue motion patterns (TMP) can influence the outcome of upper airway stimulation (UAS) in the treatment of obstructive sleep apnea (OSA). As a postoperative control the cuff position of the stimulation lead is monitored via X‑ray imaging. A multidimensional X‑ray assessment system was established and the association between these positional assessments and TMP was investigated 1 year after implantation. MATERIAL AND METHODS: The study on TMP and the X‑ray assessments were carried out at a German ear nose and throat clinic as an implantation center. The TMPs were assessed under bipolar electrode configuration and were categorized according to the currently available literature as right-sided protrusion (RP), left-sided protrusion (LP), bilateral protrusion (BP) and mixed activation (MA). The X‑ray assessment was carried out in five dimensions: the position relative to the mandible and hyoid, cuff steepness in the lateral view of the neck, the cuff position based on the single electrode and the lead connection to the cuff in the anterior-posterior view. The analyses were performed by three raters with different medical backgrounds and knowledge regarding TMP. RESULTS: In approximately 60% of the patients the apnea-hypopnea index was reduced to below 15/h, 1 year after implantation. The most common TMPs were RP and BP (82.9%). The interrater variability of the X‑ray assessment was good except for one category. Furthermore, no relevant associations were found apart from the correlation between a favorable TMP and the cuff position with respect to the lateral position of the stimulation cable. CONCLUSION: Despite good interrater variability and convenient usage of the suggested X‑ray assessment system, this approach did not enable the identification of any associations, by which a TM and therefore a possible straightforward or complicated treatment pathway could be predicted. Attention should possibly be paid to a rotation of the cuff during implantation with a lateral position of the stimulation lead.

236 Article Interventional techniques to increase implantation success of transvenous phrenic nerve stimulation for central sleep apnea treatment. 2019

Gutleben, Klaus-Jürgen / Fox, Henrik / Sommer, Philipp / Rudolph, Volker / Nölker, Georg. ·Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany. · Medizinische Klinik III/Kardiologie, Klinikum Herford, Herford, Germany. · Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany. akleemeyer@hdz-nrw.de. · Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany. · Innere Klinik II, Kardiologie, Katharinen-Hospital Unna, Unna, Germany. ·Sleep Breath · Pubmed #31407159.

ABSTRACT: PURPOSE: Central sleep apnea (CSA) is a highly common comorbidity in heart failure (HF) patients and is known to deteriorate quality of life and prognosis. Effective treatment options are scarce. Transvenous phrenic nerve stimulation (PNS) has been shown to be effective and safe in CSA treatment in HF. However, lead implantation may be difficult or fail due to anatomical or technical challenges. We report novel and innovative approaches applying different interventional techniques to enhance PNS implantation success, allowing otherwise missing CSA treatment. METHODS: Twenty-seven consecutive HF patients (86% male, mean age: 69 ± 11 years; reduced left ventricular ejection fraction in 16 patients (57%)) were included in this study who were unable to tolerate or had contraindications for mask-based therapy. We evaluated PNS total implantation success, procedural characteristics, and feasibility and success rates of intravascular interventions to facilitate PNS lead implantation in otherwise ineffective procedures. RESULTS: Seven lead implantation attempts (24%) required additional intravascular interventional action to facilitate successful implantation, mainly consisting of balloon angioplasties to allow optimal PNS lead placement. Two procedures remained unsuccessful and two patients underwent a second procedure due to stimulation side effects and lead fracture respectively. All over, no complications resulted from application of interventional techniques to achieve a 93% implantation success rate. CONCLUSION: Transvenous PNS lead placement for CSA treatment can be difficult and challenging. However, interventional intravascular techniques markedly increase implantation success and thereby allow application of this therapy for effective CSA treatment in most patients without additional complications.

237 Article Telemedicine Improves Continuous Positive Airway Pressure Adherence in Stroke Patients with Obstructive Sleep Apnea in a Randomized Trial. 2019

Nilius, Georg / Schroeder, Maik / Domanski, Ulrike / Tietze, Adam / Schäfer, Thorsten / Franke, Karl-Josef. ·Evang. Kliniken Essen Mitte, Essen, Germany. · Universität Witten/Herdecke, Witten, Germany. · Evang. Kliniken Essen Mitte, Essen, Germany, m.schroeder@kem-med.com. · Helios Klinik Hagen-Ambrock, Hagen, Germany. · Ruhr-Universität Bochum, Bochum, Germany. · MärkischeKliniken GmbH, Lüdenscheid, Germany. ·Respiration · Pubmed #31390641.

ABSTRACT: BACKGROUND: The prevalence of obstructive sleep apnea (OSA) is very high in stroke patients, whereas the acceptance of positive airway pressure (PAP) therapy is low. Although telemedicine offers new options to increase acceptance, effective concepts and patient groups are not yet known. OBJECTIVE: The aim of this study was to investigate the effect of a telemedicine concept consisting of telemonitoring and support when usage time drops. METHODS: PAP naive stroke patients with apnea-hypopnea index (AHI) >15 were randomized in a prospective parallel design comparing home therapy with standard care (SC) as opposed to telemedicine care (TC) over a period of 6 months. The TC group received a standardized phone call to offer help and advice if the average weekly usage of PAP fell below 4 h/night. RESULTS: Eighty patients were included, 5 were lost to follow-up, 75 (20 females, age: 57.0 ± 9.9, body mass index: 30.9 ± 6.0 kg/m2, AHI: 39.4 ± 18.6) were evaluated. While inpatient usage was similar in both groups, a significant difference was identified after 6 months of receiving home therapy (TC: 4.4 ± 2.5 h, SC: 2.1 ± 2.2 h; p < 0.000063). On average, 4.7 ± 3.1 interventional phone calls were needed (173 calls in total, ranging from 0 to 10 calls per patient), primarily for the purpose of motivation (61.3%), mask problems (16.2%), nasopharyngeal complaints or humidification issues (11.2%), and technical questions (10.6%). Sleepiness (Epworth Sleepiness Scale [ESS]) differed significantly (TC: 3.7 + 3.2, SC: 6.1 + 4.1; p = 0.008), as well as systolic blood pressure, which was available in a subgroup of 55 patients (TC: 129.5 + 15.2 mm Hg, SC: 138.8 + 16.1 mm Hg; p = 0.034). CONCLUSION: A concept of telemonitoring and short telephone calls from the sleep lab raised PAP therapy adherence significantly in a group of stroke patients with moderate to severe OSA.

238 Article Extended evaluation of the efficacy of a proactive forced oscillation technique-based auto-CPAP algorithm. 2019

Herkenrath, S D / Treml, M / Anduleit, N / Richter, K / Pietzke-Calcagnile, A / Schwaibold, M / Schäfer, R / Alshut, R / Grimm, A / Hagmeyer, L / Randerath, W J. ·Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Aufderhoeher Str. 169-175, 42699, Solingen, Germany. · Löwenstein Medical Technology GmbH + Co. KG, Karlsruhe, Germany. · Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Aufderhoeher Str. 169-175, 42699, Solingen, Germany. randerath@klinik-bethanien.de. ·Sleep Breath · Pubmed #31388800.

ABSTRACT: PURPOSE: Previous studies revealed substantially varying therapy efficacy of automatic continuous positive airway pressure (APAP) devices in the treatment of obstructive sleep apnea (OSA). We evaluated the efficacy of a new APAP device using the forced oscillation technique (FOT) to evaluate upper airway obstruction during apneas and flow contour analyses during hypopneas. METHODS: Forty-six initially diagnosed OSA patients were included and the pressure range was set from 5 to 20 hPa. Therapy efficacy was assessed based on the reduction of apnea-hypopnea index (AHI), improvement of objective sleep quality parameters, and the appropriateness of the device's pressure regulation. RESULTS: AHI and arousal index significantly decreased during APAP therapy (median [interquartile range]: AHI 36 [23-55] vs. 2 [1-6]/h, arousal index 30 [22-45] vs. 15 [10-19]/h, both p < 0.001). The amount of slow wave sleep (SWS) and rapid-eye-movement (REM) sleep significantly increased (SWS 20 [14-29] vs. 29 [19-34]%, REM 16 [11-21] vs. 24 [14-30]%, both p < 0.01). Most residual respiratory events during therapy were of central etiology and attributable to five patients, who presented with treatment-emergent central sleep apnea. The device's pressure regulation abolished most obstructive respiratory events (n = 6.7 residual obstructive events per patient). Of central respiratory events, 534/646 (83%) did not lead to pressure increases. CONCLUSION: This pilot study provides a proof of concept that the APAP device combining FOT and evaluation of flow contour allows for the suppression of obstructive events without relevant false reactions.

239 Article A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea. 2019

Levendowski, Daniel J / Hamilton, Garun S / St Louis, Erik K / Penzel, Thomas / Dawson, David / Westbrook, Philip R. ·Advanced Brain Monitoring, Inc. , Carlsbad, CA, USA. · Monash Health & School of Clinical Sciences, Monash University, Clayton, VIC, Australia. · Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. · Sleep Medicine Center, Charité Universitätsmedizin Berlin, GmbH, Berlin, Germany. · Department of Anesthesiology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK. ·Nat Sci Sleep · Pubmed #31372075.

ABSTRACT: Objective: Evaluate the concordance between overall and positional oxygen desaturation indices (ODI) and apnea-hypopnea indices (AHI) according to two different definitions for positional obstructive sleep apnea (POSA). Methods: A total of 184 in-home polysomnograms were edited to simulate Level III home sleep apnea tests (HSAT) with the auto-scored AHI and ODI based on recording time. POSA was determined using 132 records with an AHI≥5 and at least 20 mins of recording time in both supine and non-supine positions. POSA was defined independently for the AHI and ODI based on ratios of overall/non-supine event/h ≥1.4 (O/NS) and supine/non-supine event/h≥2.0 (S/NS). Results: Correlation between the AHI and ODI was 0.97 overall, 0.94 for supine, and 0.96 for non-supine recording times (all Conclusions: Auto-scored positional oximetry is a clinically viable alternative to an auto-scored Level III HSAT AHI in the characterization of POSA based on a 3% desaturation.

240 Article Morbidity and mortality in patients with cardiovascular risk factors and obstructive sleep apnoea: results from the DIAST-CHF cohort. 2019

Haarmann, Helge / Koch, Jennifer / Bonsch, Nina / Mende, Meinhard / Werhahn, Stefanie Maria / Lüers, Claus / Stahrenberg, Raoul / Edelmann, Frank / Holzendorf, Volker / von Haehling, Stephan / Pieske, Burkert / Andreas, Stefan / Lüthje, Lars / Wachter, Rolf. ·Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; German Cardiovascular Research Center, partner site Göttingen, Germany. · Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany. · Coordinating Centre for Clinical Trials, University of Leipzig, Leipzig, Germany. · University of Oldenburg, European Medical School Oldenburg-Groningen, Germany. · Helios Kliniken Northeim, Northeim, Germany. · Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; Charité Universitätsmedizin Berlin, Department of Cardiology, Campus Virchow Klinikum, Berlin, Germany; German Cardiovascular Research Center, partner site Göttingen, Germany; German Cardiovascular Research Center, partner site Berlin, Germany. · Charité Universitätsmedizin Berlin, Department of Cardiology, Campus Virchow Klinikum, Berlin, Germany. · Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; Lung Clinic Immenhausen, Immenhausen, Krs. Kassel, Germany. · Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany; Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; German Cardiovascular Research Center, partner site Göttingen, Germany. Electronic address: rolf.wachter@medizin.uni-leipzig.de. ·Respir Med · Pubmed #31252205.

ABSTRACT: STUDY OBJECTIVES: Aim of the study was to investigate the association between obstructive sleep apnoea (OSA) and cardiovascular morbidity and mortality in a cohort of patients with cardiovascular risk factors. METHODS: In this prospective study, 378 patients of the DIAST-CHF cohort were screened for OSA by home polygraphy. Inclusion criteria were risk factors for diastolic heart failure, such as hypertension, diabetes mellitus, atherosclerotic disease, or history of chronic heart failure. Patients were followed up after 1, 2, 5, 9 and 10 years for the occurrence of major adverse cardiac and cerebrovascular events (MACE and MACCE). RESULTS: 344 patients were included in the analysis, of which 60% were diagnosed with OSA (apnoea-hypopnoea index ≥5/h). Overall mortality was higher in the OSA group (14.9% vs. 5.9%; p = 0.007), but significance disappeared after adjustment for age and sex (hazard ratio (HR) 1.89, 95% confidence interval (CI) 0.86-4.16, p = 0.12). There was no significant difference in the occurrence of MACE or MACCE in patients with OSA compared to those without OSA (MACE: 31% vs. 30%; p = 0.61; MACCE: 32% vs. 30%; p = 0.53). CONCLUSION: We did not find evidence of an adverse effect of OSA on cardiovascular morbidity and mortality in a cohort of patients with cardiovascular risk factors.

241 Article Previous Surgery and Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. 2019

Kezirian, Eric J / Heiser, Clemens / Steffen, Armin / Boon, Maurits / Hofauer, Benedikt / Doghramji, Karl / Maurer, Joachim T / Sommer, J Ulrich / Soose, Ryan J / Schwab, Richard / Thaler, Erica / Withrow, Kirk / Kominsky, Alan / Larsen, Christopher G / Hsia, Jennifer / Mehra, Reena / Waters, Tina / Strohl, Kingman. ·Keck School of Medicine of the University of Southern California, Los Angeles, California, USA. · Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. · University of Lubeck, Lubeck, Germany. · Thomas Jefferson University, Philadelphia, Pennsylvania, USA. · University-Hospital Mannheim, Mannheim, Germany. · Helios University Hospital, Wuppertal, Germany. · University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · University of Pennsylvania, Philadelphia, Pennsylvania, USA. · University of Alabama, Birmingham, Alabama, USA. · Cleveland Clinic, Cleveland, Ohio, USA. · University of Kansas Medical Center, Kansas City, Kansas, USA. · University of Minnesota Fairview Hospital, Minneapolis, Minnesota, USA. · University Hospital, Cleveland, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #31234734.

ABSTRACT: OBJECTIVE: To examine whether previous palate or hypopharyngeal surgery was associated with efficacy of treatment of obstructive sleep apnea with hypoglossal nerve stimulation. STUDY DESIGN: Cohort (retrospective and prospective). SETTING: Eleven academic medical centers. SUBJECTS AND METHODS: Adults treated with hypoglossal nerve stimulation were enrolled in the ADHERE Registry. Outcomes were defined by the apnea-hypopnea index (AHI), in 3 ways: change in the AHI and 2 definitions of therapy response requiring ≥50% reduction in the AHI to a level <20 events/h (Response20) or 15 events/h (Response15). Previous palate and hypopharyngeal (tongue, epiglottis, or maxillofacial) procedures were documented. Linear and logistic regression examined the association between previous palate or hypopharyngeal surgery and outcomes, with adjustment for age, sex, and body mass index. RESULTS: The majority (73%, 217 of 299) had no previous palate or hypopharyngeal surgery, while 25% and 9% had previous palate or hypopharyngeal surgery, respectively, including 6% with previous palate and hypopharyngeal surgery. Baseline AHI (36.0 ± 15.6 events/h) decreased to 12.0 ± 13.3 at therapy titration ( CONCLUSION: Previous upper airway surgery was not clearly associated with efficacy of hypoglossal nerve stimulation.

242 Article Mandibular growth in infants with Robin sequence treated with the Tübingen palatal plate. 2019

Wiechers, Cornelia / Buchenau, Wolfgang / Arand, Jörg / Oertel, Anne-Friederike / Peters, Katharina / Müller-Hagedorn, Silvia / Koos, Bernd / Poets, Christian F. ·Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany. · Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany. · Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany. · Department of Orthodontics, Rostock University Hospital, Rostock, Germany. · Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany. Christian-f.poets@med.uni-tuebingen.de. · Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany. Christian-f.poets@med.uni-tuebingen.de. ·Head Face Med · Pubmed #31228944.

ABSTRACT: BACKGROUND: Robin sequence (RS) is characterized by mandibular retrognathia, glossoptosis and upper airway obstruction. Whether mandibular catch-up growth may occur in RS is yet controversial. Our functional and less invasive treatment including the Tübingen Palatal Plate (TPP), early oral feeding and orofacial stimulation may promote mandibular catch-up growth. We evaluated the effect of the Tübingen Palatal Plate on mandibular growth, expressed by the Jaw index, sleep study results and weight gain in infants admitted with isolated and syndromic RS, born at or referred to our center between 6/2015 and 5/2018. METHODS: Retrospective analysis of our electronic patient database that included data on jaw index measurements, sleep study results and standard deviation (Z-)scores for weight. RESULTS: Of 31 patients referred for RS treatment (22 isolated, 9 syndromic), we had data on the above parameters, determined at admission, discharge and 3 months after discharge, in 20. Jaw index at admission and 3-month follow-up was 8.8 (6.3-11.3) and 2.1 (2.0-4.0), respectively (median (IQR); p < 0.0001). Mixed-obstructive apnea index (MOAI) decreased from 9.7 (4.8-24.2) to 0.0 (0-1.3; p < 0.002). No significant correlation was observed between MOAI and Jaw Index, but MOAI correlated with the Maxillary/Mandibular arch ratio (r = 0.58; p < 0.001). Z-scores for weight were similar at both time points at - 1.34 (- 1.76 - - 0.57) and - 1.50 (- 1.89 - - 0.54), while the proportion of infants requiring nasogastric tube feeding decreased from 84 to 8%. No infant had craniofacial surgery; one with syndromic RS required tracheostomy. CONCLUSION: These longitudinal cohort data suggest that the Tübingen Palatal Plate as used here may alleviate upper airway obstruction by promoting mandibular growth. TRIAL REGISTRATION: N.A.

243 Article [VOTE versus ACLTE: comparison of two snoring noise classifications using machine learning methods]. 2019

Janott, C / Schmitt, M / Heiser, C / Hohenhorst, W / Herzog, M / Carrasco Llatas, M / Hemmert, W / Schuller, B. ·Munich School of BioEngineering, Technische Universität München, Boltzmannstraße 11, 85748, Garching, Deutschland. c.janott@gmx.net. · ZD.B Lehrstuhl für Embedded Intelligence for Health Care and Wellbeing, Universität Augsburg, Augsburg, Deutschland. · Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. · Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Alfried Krupp Krankenhaus, Essen, Deutschland. · Klinik für HNO-Krankheiten, Kopf- und Halschirurgie, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland. · Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spanien. · Munich School of BioEngineering, Technische Universität München, Boltzmannstraße 11, 85748, Garching, Deutschland. · Department of Computing, Imperial College London, London, Großbritannien. ·HNO · Pubmed #31190193.

ABSTRACT: BACKGROUND: Acoustic snoring sound analysis is a noninvasive method for diagnosis of the mechanical mechanisms causing snoring that can be performed during natural sleep. The objective of this work is development and evaluation of classification schemes for snoring sounds that can provide meaningful diagnostic support. MATERIALS AND METHODS: Based on two annotated snoring noise databases with different classifications (s-VOTE with four classes versus ACLTE with five classes), identically structured machine classification systems were trained. The feature extractor openSMILE was used in combination with a linear support vector machine for classification. RESULTS: With an unweighted average recall (UAR) of 55.4% for the s‑VOTE model and 49.1% for the ACLTE, the results are at a similar level. In both models, the best differentiation is achieved for epiglottic snoring, while velar and oropharyngeal snoring are more often confused. CONCLUSION: Automated acoustic methods can help diagnose sleep-disordered breathing. A reason for the restricted recognition performance is the limited size of the training datasets.

244 Article [Sleep position trainers for treatment of supine obstructive sleep apnea : A comparison of two different training modalities]. 2019

Heiser, C / Strassen, U / Knopf, A / Leuchten, Y / Hofauer, B. ·Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland. b.hofauer@tum.de. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland. b.hofauer@tum.de. ·HNO · Pubmed #31190192.

ABSTRACT: BACKGROUND: Many patients suffer from positional obstructive sleep apnea (POSA; 56%). In these cases, positional therapy may be an option. A sleep position trainer (SPT) is a small vibrating device that trains the patient to avoid sleeping in the supine position. This study aimed to compare the efficacy and tolerance of gradual and intensive training onset in POSA patients MATERIALS AND METHODS: Patients with mild to moderate POSA and incompliance with continuous positive airway pressure (CPAP) therapy were included in this prospective double-blind trail. Patients were randomized according to how training was initiated and the SPT was set to either a gradual or an intensive training program. Polygraphy was used to check respiratory parameters after 1 month, and subjective parameters and compliance were assessed prior to and after this time period using a questionnaire. RESULTS: A total of 38 patients were included (20 intensive; 18 gradual; 49 ± 13 years) of whom 31 completed the study protocol. After 1 month the apnea-hypopnea index (AHI) in both groups was significantly reduced, but there was no difference in AHI between the two training modalities (AHI intensive: 16.7 ± 6.3/h to 4.2 ± 3.2/h; AHI gradual: 18.9 ± 11.2/h to 8.4 ± 7.9/h). The same effect was observed for subjective sleepiness. CONCLUSION: The objective severity of OSA and the associated subjective daytime sleepiness was reduced in both groups. There was no difference in terms of clinical outcome or compliance between the gradual or intensive SPT therapy in POSA patients during the observation period. Both training modalities are highly successful and well tolerated.

245 Article Sleep-Disordered Breathing Is Associated with Metabolic Syndrome in Outpatients with Diabetes Mellitus Type 2. 2019

Neumann, K / Arzt, M / Heid, I / Böger, C / Stadler, S. ·Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. · Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany. · Department of Nephrology, University Hospital Regensburg, Regensburg, Germany. ·J Diabetes Res · Pubmed #31179343.

ABSTRACT: Background: Metabolic syndrome (MS) and sleep-disordered breathing (SDB) are highly prevalent in patients with diabetes mellitus type 2 (DM2). The present study examined whether there is an independent association between SDB and MS in a sample of outpatients with DM2. Methods: MS was determined in 679 patients of the DIACORE-SDB substudy, a study of outpatients with DM2. According to the National Cholesterol Education Program (NCEP) criteria, MS is defined by at least three of the following five criteria: waist circumference of >102 cm (men)/>88 cm (women), blood pressure of ≥130/85 mmHg, a fasting triglyceride level of >150 mg/dl, high-density lipoprotein (HDL) of <40 mg/dl (men)/<50 mg/dl (women), and a fasting glucose level of ≥110 mg/dl. The apnea-hypopnea index (AHI) was assessed with a 2-channel ambulatory monitoring device and used to define the severity of SDB (AHI < 15.0: no/mild SDB; AHI 15.0-29.9: moderate SDB; AHI ≥ 30.0: severe SDB). Results: 228 (34%) of the 679 participants (mean age 66 years, mean body mass index (BMI) 31.2 kg/m Conclusion: SDB is significantly and independently associated with MS in outpatients with DM2.

246 Article Compliance after switching from CPAP to bilevel for patients with non-compliant OSA: big data analysis. 2019

Benjafield, Adam V / Pépin, Jean-Louis / Valentine, Kate / Cistulli, Peter A / Woehrle, Holger / Nunez, Carlos M / Armitstead, Jeff / Malhotra, Atul. ·ResMed Science Center, San Diego, California, USA. · medXcloud Group, San Diego, California, USA. · HP2 Laboratory, INSERM U1042, Université Grenoble Alpes, Grenoble, France. · EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France. · Charles Perkins Centre, School of Medicine, University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia. · Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany. · ResMed Science Center, Sydney, New South Wales, Australia. · University of California San Diego, La Jolla, California, USA. ·BMJ Open Respir Res · Pubmed #31178999.

ABSTRACT: Introduction: For patients with obstructive sleep apnoea (OSA) who are initially non-compliant with continuous (automatic) positive airway pressure (CPAP/APAP) therapy, a bilevel PAP (Spont/VAuto) therapy transition pathway is available to improve therapy adherence. The aim of this retrospective study was to compare PAP therapy usage data of patients with non-compliant OSA (ncOSA) on CPAP/APAP who were switched to bilevel PAP. Methods: A PAP telemonitoring database was queried between 1 January 2015 and 31 July 2016 for eligible patients started on CPAP/APAP and non-CMS (United States Center for Medicare and Medicaid Services) compliant and switched to bilevel PAP within 90 days of starting CPAP/APAP therapy. PAP therapy data on all patients were compared before switch (CPAP/APAP) and after switch (VAuto/Spont). Results: Of the 1496 patients with ncOSA identified, 30.3% used CPAP, 62.3% APAP, and 7.4% both APAP and CPAP before switching to a bilevel mode. 47.8% patients switched to Spont mode and 52.2% to VAuto mode. PAP usage significantly improved by 0.9 h/day (p<0.001) and all other device metrics (residual apnoea-hypopnoea index and unintentional mask leak) also improved after the switch. No patients had achieved US CMS criteria for compliance before the switch, and 56.8% did after. Conclusion: This shows for the first time that there may be potential benefit from switching from CPAP/APAP to bilevel PAP for patients struggling with PAP adherence.

247 Article Economic burden of incident interstitial lung disease (ILD) and the impact of comorbidity on costs of care. 2019

Frank, Anna Lena / Kreuter, Michael / Schwarzkopf, Larissa. ·Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany. Electronic address: anna.frank@helmholtz-muenchen.de. · Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstraße 1, 69126, Heidelberg, Germany. · Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany. ·Respir Med · Pubmed #31128606.

ABSTRACT: INTRODUCTION: Evidence about the economic burden related to interstitial lung diseases (ILDs) and the cost-driving factors is sparse. In the knowledge that distinct comorbidities affect the clinical course of ILDs, our study investigates their impact on costs of care within first year after diagnosis. METHODS: Using claims data of individuals diagnosed with Idiopathic Interstitial Pneumonia (IIP) (n = 14 453) or sarcoidosis (n = 9106) between 2010 and 2013, we calculated total and ILD-associated mean annual per capita costs adjusted by age, sex and comorbidity burden via Generalized Linear Gamma models. Then, we assessed the cost impact of chronic obstructive pulmonary disease (COPD), diabetes, coronary artery disease, depression, gastro-esophageal reflux disease, pulmonary hypertension (PH), obstructive sleep apnoea syndrome (OSAS) and lung cancer using the model-based parameter estimates. RESULTS: Total mean annual per capita costs were €11 131 in the pooled cohort, €12 111 in IIP and €8793 in sarcoidosis, each with a 1/3 share of ILD-associated cost. Most comorbidities had a significant cost-driving effect, which was most pronounced for lung cancer in total (1.989 pooled, 2.491 sarcoidosis, 1.696 IIP) and for PH in ILD-associated costs (2.606 pooled, 2.347 IIP, 3.648 sarcoidosis). The lung-associated comorbidities COPD, PH, OSAS more strongly affected ILD-associated than total costs. CONCLUSION: Comorbidities increase the already substantial costs of care in ILDs. To support patient-centred ILD care, not only highly cost-driving conditions that are inherent with high mortality themselves require systematic management. Moreover, conditions that are more rather restricting the patient's activities of daily living should be addressed - despite a low-cost impact.

248 Article [Sonographic evaluation of anatomic landmarks in patients with obstructive sleep apnea]. 2019

Hofauer, B / Knopf, A / Karl, J / Heiser, C. ·Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland. b.hofauer@tum.de. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland. b.hofauer@tum.de. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland. ·HNO · Pubmed #31119334.

ABSTRACT: BACKGROUND: In recent years, new key factors in the genesis of obstructive sleep apnea (OSA) have been described. This has led to investigation of individualized therapeutic approaches in sleep medicine. The aim of the current study is assessment of the upper respiratory tract by sonographic measurement of various anatomic landmarks. MATERIALS AND METHODS: Patients with rhonchopathy as well as OSA of different severity were included and compared to healthy volunteers. All patients underwent polygraphy for assessment of nocturnal respiratory disorders. Different landmarks were defined (extension of the tongue, thickness of the pharynx, hyoid bone-thyroid cartilage distance, extension of the geniohyoid muscle) which should be measured sonographically. RESULTS: A total of 155 patients were enrolled and assigned to one of five groups (control; rhonchopathy; mild, moderate, and severe OSA). There were significant differences in the parameters for measuring tongue size, the distance between the hyoid bone and thyroid cartilage, and the thickness of the pharynx between the groups. CONCLUSION: As part of this sonographic assessment of the upper respiratory tract, landmarks could be identified in patients with OSA that correlated with the severity of the disease.

249 Article An act of balance: Interaction of central and peripheral chemosensitivity with inflammatory and anti-inflammatory factors in obstructive sleep apnoea. 2019

Earing, Christopher / Owen, Julian / Griffith-Mcgeever, Claire / McKeon, Damian / Engeli, Stefan / Moore, Jonathan / Kubis, Hans-Peter. ·Pulmonary and Sleep Department, Ysbyty Gwynedd Hospital, Bangor, United Kingdom. · College of Human Sciences, Bangor University, United Kingdom. · Clinical Pharmacology, Medical School, Hanover, Germany. · College of Human Sciences, Bangor University, United Kingdom. Electronic address: pes203@Bangor.ac.uk. ·Respir Physiol Neurobiol · Pubmed #31059781.

ABSTRACT: OBJECTIVES: Central and peripheral chemosensitivity i.e. ventilatory response to CO METHODS: Ventilatory response to hypercapnic-hyperoxic and hypercapnic-hypoxic gas mixtures in patients with OSA (n = 46) and healthy individuals (n = 45) was measured. C-reactive protein (CRP), leptin, adiponectin, and endocannabinoids 2-arachidonoylglycerol (2-AG) and anandamide (AEA) were measured in blood samples. RESULTS: Mediation analysis revealed that association of chemoresponse to CO CONCLUSION: Inflammatory and anti-inflammatory factors could explain differential alterations in peripheral and central ventilatory chemoresponse in patients with OSA.

250 Article Sleep-related breathing disorders in facioscapulohumeral dystrophy. 2019

Runte, Maya / Spiesshoefer, Jens / Heidbreder, Anna / Dreher, Michael / Young, Peter / Brix, Tobias / Boentert, Matthias. ·Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. · Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany. · Medical Park Klinik Reithofpark, Neurology, Bad Feilnbach, Germany. · Institute of Medical Informatics, University of Muenster, Muenster, Germany. · Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. matthias.boentert@ukmuenster.de. ·Sleep Breath · Pubmed #31025273.

ABSTRACT: PURPOSE: Severe manifestations of facioscapulohumeral dystrophy (FSHD) may be associated with sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and nocturnal hypoventilation (NH), but prevalence data are scarce. In patients with respiratory muscle weakness, detection of NH can be facilitated by transcutaneous capnometry, but respective data derived from FSHD patients have not yet been published. METHODS: We collected sleep studies and capnometry recordings from 31 adult patients with genetically confirmed FSHD who were admitted to our sleep laboratory for first-ever evaluation of sleep-related breathing. Indications for admission included non-restorative sleep, morning headache, or excessive daytime sleepiness. In addition, sleep studies were initiated if symptoms or signs of respiratory muscle weakness were present. Thirty-one subjects with insomnia served as controls for comparison of respiratory measures during sleep. RESULTS: In the FSHD group, 17/31 (55%) patients showed OSA and 8 (26%) had NH. NH would have been missed in 7/8 patients if only oximetry criteria of hypoventilation had been applied. Capnography results were correlated with disease severity as reflected by the Clinical Severity Score (CSS). Non-invasive ventilation (NIV) was started in 6 patients with NH and 3 individuals with OSA. Nocturnal continuous positive airway pressure was administered to 2 patients, and positional therapy was sufficient in 4 individuals. In patients initiated on NIV, nocturnal gas exchange already improved in the first night of treatment. CONCLUSIONS: SDB is common in adult patients with FSHD complaining of sleep-related symptoms. It may comprise OSA, NH, and most often, the combination of both. Sleep-related hypercapnia is associated with disease severity. Transcutaneous capnometry is superior to pulse oximetry for detection of NH.

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