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Sleep Apnea Syndromes: HELP
Articles from West Midlands
Based on 39 articles published since 2008
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These are the 39 published articles about Sleep Apnea Syndromes that originated from West Midlands during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Ethnic differences in the pathogenesis of obstructive sleep apnoea: Exploring non-anatomical factors. 2017

Tahrani, Abd A. ·Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK. · Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK. · Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK. ·Respirology · Pubmed #28417583.

ABSTRACT: -- No abstract --

2 Editorial CSA Is Not Beneficial Long Term in Heart Failure Patients with Reduced Ejection Fraction. 2017

Oldenburg, Olaf / Coats, Andrew. ·Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany. Electronic address: akleemeyer@hdz-nrw.de. · Monash University, Australia and University of Warwick, UK. ·Int J Cardiol · Pubmed #27825728.

ABSTRACT: Central sleep apnea (CSA) affects many patients, with heart failure and results in hypoxia and nor-epinephrine release and is associated with high morbidity and mortality. Recent trials in the treatment of CSA using positive airway pressure therapies have failed to demonstrate improvement in mortality and as a result, the compensatory nature of CSA has been questioned. The detrimental effects from CSA are clear. While there may be a short term compensatory effect, the long term effects cause chronic insult to the cardiovascular system indicating that CSA should be treated, but alternative treatment options need to be considered.

3 Editorial Central sleep apnoea in heart failure--An important issue for the modern heart failure cardiologist. 2016

Coats, Andrew J Stewart / Abraham, William T. ·Monash University, Australia; University of Warwick, Coventry, UK. Electronic address: ajscoats@aol.com. · Ohio State University, Columbus, OH, USA. ·Int J Cardiol · Pubmed #26971184.

ABSTRACT: -- No abstract --

4 Review Obstructive sleep apnoea and polycystic ovary syndrome: A comprehensive review of clinical interactions and underlying pathophysiology. 2017

Kahal, Hassan / Kyrou, Ioannis / Tahrani, Abd A / Randeva, Harpal S. ·Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, UK. · Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. · Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK. · Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Centre of Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK. · Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK. ·Clin Endocrinol (Oxf) · Pubmed #28640938.

ABSTRACT: Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age. PCOS is associated with multiple comorbidities including, obesity, insulin resistance and type 2 diabetes, as well as mood disorders and impaired quality of life (QoL). Obstructive sleep apnoea (OSA) is also a common medical condition that is often undiagnosed, particularly in women. OSA is associated with a similar spectrum of comorbidities to that observed in PCOS, including manifestations of the metabolic syndrome and impaired QoL, whilst obesity frequently constitutes a common denominator in the pathophysiology of both OSA and PCOS. Hence, it is not surprising that OSA and PCOS may coexist in women of reproductive age, and the current clinical guidelines on the management of PCOS recommend screening for OSA symptoms in overweight/obese women with PCOS. In this review, we examine the relationship between OSA and PCOS and explore the potential underlying mechanisms that link these two conditions.

5 Review Obstructive sleep apnoea in diabetes: Does it matter? 2017

Tahrani, Abd A. ·1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK. · 2 Department of Diabetes & Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK. · 3 Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK. ·Diab Vasc Dis Res · Pubmed #28610436.

ABSTRACT: Obstructive sleep apnoea (OSA) is very common in patients with Type 2 diabetes (T2D), which is not surprising considering that obesity is a common risk factor for both conditions. In general population studies, OSA has been shown to be associated with several comorbidities including increased risk of road traffic accidents, T2D, hypertension and lack of nocturnal dipping of blood pressure, hyperlipidaemia, increased inflammation, increased risk of cardiovascular disease and mortality, increased risk of atrial fibrillation, worse quality of life, and erectile dysfunction. However, the impact of OSA on diabetes-related vascular and metabolic outcomes remains unclear. Furthermore, the impact of continuous positive airway pressure (CPAP) treatment in patients with T2D is also unclear. This unclarity regarding the impact of OSA and CPAP in patients with T2D has possibly contributed to the lack of screening for OSA in patients with T2D in the UK despite the high prevalence of OSA in patients with T2D. In this commentary, I provide an overview about OSA with a particular focus on its role and impact in patients with T2D.

6 Review Measuring therapeutic efficacy in the treatment of central sleep apnoea in patients with heart failure. 2016

Coats, Andrew J Stewart / Shewan, Louise G. ·Monash University, Australia; University of Warwick, Coventry, UK. ·Int J Cardiol · Pubmed #26971185.

ABSTRACT: The goal of treating sleep disordered breathing (SDB) has traditionally focused on improving daytime sleepiness and fatigue. In heart failure (HF) patients with SDB, this is not as easy to ascertain as their symptoms overlap with HF. Thus, improvement in treating SDB in HF patients must focus more on overall quality of life. Over the past 5 years, there has been a shift in sleep medicine from only improving symptoms in SDB, to preventing the long term consequences. The specialist Heart Failure community is, however, desirous of also seeing benefit in reduction of major clinical events for their patients with interventions, such as effects on mortality or re-hospitalisation rates and so may wish to see other benefits beyond a reduction in sleep apnea events before either commencing therapy or referring their patients for sleep study evaluation and further management. To expect lower mortality as well may be asking for too much. Consequently, success in the treatment in SDB should focus on three items: 1) proof that the underlying disease is treated, 2) symptomatic benefit and 3) demonstration that the pathological consequences are prevented. These benefits must then be balanced with a strong safety profile. Here we evaluate a variety of end-points of value to our CSA patients, in an effort to see what may reasonably be required for treating physicians to recommend an intervention for their CHF patients with CSA by looking at candidate measures of treatment success in CSA within a heart failure population.

7 Review The Association between Obstructive Sleep Apnea on Diabetic Kidney Disease: A Systematic Review and Meta-Analysis. 2016

Leong, Wen Bun / Jadhakhan, Ferozkhan / Taheri, Shahrad / Thomas, G Neil / Adab, Peymané. ·School of Health and Population Sciences, University of Birmingham. · Primary Care Clinical Sciences, University of Birmingham, UK. · Department of Medicine and Clinical Research Core, Weill Cornell Medical College, New York and Doha Qatar. · Department of Medicine, King's College London, London, UK. · Public Health, Epidemiology and Biostatistics, University of Birmingham, UK. · Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany. ·Sleep · Pubmed #26414891.

ABSTRACT: STUDY OBJECTIVE: This systematic review aims to investigate the association between obstructive sleep apnea (OSA) and diabetic kidney disease (DKD). METHODS: MeSH terms and free text searches were performed on MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception to April 2015. Zetoc and OpenGrey databases were queried for grey literature, and lastly, hand searches were carried out. Study selection and quality assessment were conducted by two authors. One author carried out data extraction, which was checked by other authors. The relationships between apneahypopnea index (AHI), oxygen desaturation index (ODI), time spent under 90% oxygen saturation (%TST < 90), and minimum and mean oxygen saturation (O2) on DKD were examined. RESULTS: Two longitudinal and ten cross-sectional studies were included for our narrative synthesis, and seven studies for meta-analysis. Studies that performed multi-variable analysis demonstrated significant associations between OSA (assessed using either apnea-hypopnea index or ODI) and DKD in type 2 diabetes mellitus (T2DM). This was confirmed by meta-analysis (pooled OR 1.73, 95% CI: 1.13-2.64). There was some evidence to suggest that %TST < 90 may have an association with DKD. There was insufficient evidence to conclude on the relationship between minimum and mean oxygen saturation on DKD. There was no evidence available on the associations between OSA and other respiratory parameters in type 1 diabetes mellitus populations. CONCLUSIONS: There is moderate evidence that OSA is associated with DKD in patients with T2DM. Large prospective studies with long-term follow up are needed to assess the possible bi-directional mechanisms between OSA and DKD.

8 Review Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. 2016

Sharples, Linda D / Clutterbuck-James, Abigail L / Glover, Matthew J / Bennett, Maxine S / Chadwick, Rebecca / Pittman, Marcus A / Quinnell, Timothy G. ·University of Leeds Clinical Trials Research Unit, Leeds, United Kingdom; Medical Research Council Biostatistics Unit, Cambridge, United Kingdom. Electronic address: l.sharples@leeds.ac.uk. · Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom. · Health Economics Research Unit, Brunel University, Uxbridge, Middlesex, United Kingdom. · Medical Research Council Biostatistics Unit, Cambridge, United Kingdom. · University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom. ·Sleep Med Rev · Pubmed #26163056.

ABSTRACT: Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness, impairs quality-of-life, and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment and mandibular advancement devices (MAD) have been shown to be effective in individual trials but their effectiveness particularly relative to disease severity is unclear. A MEDLINE, Embase and Science Citation Index search updating two systematic reviews to August 2013 identified 77 RCTs in adult OSAH patients comparing: MAD with conservative management (CM); MAD with CPAP; or CPAP with CM. Overall MAD and CPAP significantly improved apnoea-hypopnoea index (AHI) (MAD -9.3/hr (p < 0.001), CPAP -25.4 (p < 0.001)). In direct comparisons mean AHI and Epworth sleepiness scale score were lower (7.0/hr (p < 0.001) and 0.67 (p = 0.093) respectively) for CPAP. There were no CPAP vs. MAD trials in mild OSAH but in comparisons with CM, MAD and CPAP reduced ESS similarly (MAD 2.01 (p < 0.001); CPAP 1.23 (p = 0.012). Both MAD and CPAP are clinically effective in the treatment of OSAH. Although CPAP has a greater treatment effect, MAD is an appropriate treatment for patients who are intolerant of CPAP and may be comparable to CPAP in mild disease.

9 Review Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis. 2016

Leong, W B / Jadhakhan, F / Taheri, S / Chen, Y F / Adab, P / Thomas, G N. ·School of Clinical and Experimental Medicine and Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK. · Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK. · Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. · Department of Medicine, Weill Cornell Medical College in New York, NY, USA and Doha, Qatar. · Department of Medicine, King's College London, London, UK. · Division of Health Sciences, University of Warwick, Coventry, UK. · Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. · Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany. ·Diabet Med · Pubmed #26031931.

ABSTRACT: AIMS: To summarize the association between obstructive sleep apnoea and diabetic retinopathy and diabetic maculopathy, and to examine the effects of oxygen desaturation index, mean and minimum oxygen saturation and time spent with < 90% oxygen saturation on diabetic retinopathy and diabetic maculopathy. METHODS: A systematic search was performed for papers published from inception to January 2014 in MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews using indexed terms and free text. Additional searches were carried out for grey literature. Two authors conducted the study selection and quality assessment. Data extraction was performed by the main author and checked by the other authors. RESULTS: One cohort study and 15 cross-sectional studies were included for narrative synthesis and three for meta-analyses. There was no convincing evidence that obstructive sleep apnoea was associated with diabetic retinopathy, although some evidence suggested that obstructive sleep apnoea was associated with greater severity of diabetic retinopathy and advanced diabetic retinopathy in people with Type 2 diabetes. Only six studies examined the impact of obstructive sleep apnoea on diabetic maculopathy and our narrative review suggests there is an association in Type 2 diabetes. Oxygen desaturation index, mean oxygen saturation or time spent with < 90% oxygen saturation were not associated with diabetic retinopathy, and insufficient evidence was available to draw conclusions on their effects on diabetic maculopathy; however, there was evidence from both narrative synthesis and meta-analysis that minimum oxygen saturation had an impact on diabetic retinopathy (pooled odds ratio 0.91, 95% CI 0.87-0.95; I(2) = 0%). CONCLUSIONS: There is a need for large cohort studies with long-term follow-up data to examine the long-term effects of obstructive sleep apnoea and other sleep variables on advanced retinal disease in diabetes.

10 Review Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. 2013

Araghi, Marzieh Hosseini / Chen, Yen-Fu / Jagielski, Alison / Choudhury, Sopna / Banerjee, Dev / Hussain, Shakir / Thomas, G Neil / Taheri, Shahrad. ·Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK ; School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK. ·Sleep · Pubmed #24082315.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined. OBJECTIVES: To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4). METHODS: A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data. RESULTS: Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I(2) = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]). CONCLUSIONS: Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.

11 Review Obstructive sleep apnoea and diabetes: an update. 2013

Tahrani, Abd A / Ali, Asad / Stevens, Martin J. ·aCentre of Endocrinology, Diabetes and Metabolism, University of Birmingham bDepartment of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham cDepartment of Respiratory Medicine, University Hospital of Coventry and Warwickshire, Coventry, West Midlands, UK. ·Curr Opin Pulm Med · Pubmed #24048079.

ABSTRACT: PURPOSE OF REVIEW: The relationship between obstructive sleep apnoea (OSA) and dysglycaemia is well established. However, uncertainty remains as to the extent that obesity mediates this relationship. The impact of OSA treatment on glucose metabolism and the consequences of having OSA in patients with diabetes is unclear. This review aims to summarize the latest evidence regarding the links between OSA and dysglycaemia. RECENT FINDINGS: OSA is associated with insulin resistance in lean individuals and predicts insulin resistance worsening longitudinally. Continuous positive airway pressure (CPAP) lowers insulin resistance in CPAP-compliant patients. OSA is associated with impaired β-cell function. In patients with type 2 diabetes (T2D), the association between OSA and glycosylated haemoglobin (HbA1c) is related to nocturnal hypoxaemia. Apnoea hypopnoea index (AHI) during rapid eye movement (REM) (not non-REM) sleep is associated with HbA1c. In-laboratory, supervised CPAP improves glycaemia. OSA is associated with and predicts the progression of some diabetic vascular complications. Intensive lifestyle intervention in patients with T2D improves OSA independent of weight loss. SUMMARY: OSA is associated with insulin resistance and β-cell dysfunction independent of obesity. OSA is associated with HbA1c and vascular complications in patients with T2D. CPAP might improve insulin resistance and glycaemic measures. Lifestyle intervention has a significant impact on AHI in patients with T2D.

12 Review The role of obesity and type 2 diabetes mellitus in the development of male obesity-associated secondary hypogonadism. 2013

Saboor Aftab, S A / Kumar, S / Barber, T M. ·Clinical Sciences Research Laboratories, Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, University Hospitals Coventry and Warwickshire, Coventry, UK. ·Clin Endocrinol (Oxf) · Pubmed #23121123.

ABSTRACT: Obesity, secondary (hypogonadotrophic) hypogonadism (SH), sleep disorders [such as obstructive sleep apnoea (OSA)] and type 2 diabetes mellitus (T2DM) in men have complex interlinks both with respect to mutual aetiopathogenesis as well as therapeutics. Correction of the attendant hypogonadism in obese men may serve to break this link and have beneficial effects beyond restoration of normal sexual function. Male obesity-associated secondary hypogonadism (MOSH) should be regarded as a distinct clinical entity and subtype of SH. A high index of suspicion for the presence of MOSH must be maintained by clinicians when assessing obese men. The pathogenesis of MOSH remains incompletely understood. Furthermore, the optimal management of MOSH and its associated sequelae will require long-term prospective studies that in turn will inform the development of future clinical guidelines for this important and prevalent condition.

13 Review Idiopathic intracranial hypertension in otolaryngology. 2009

Jindal, Mudit / Hiam, Lucinda / Raman, Ashok / Rejali, Darius. ·Department of Otolaryngology, University Hospital Coventry and Warwick Hospital, Coventry, UK. Mjindal@doctors.org.uk ·Eur Arch Otorhinolaryngol · Pubmed #19352689.

ABSTRACT: Idiopathic intracranial hypertension (IIH) is defined as increased intracranial pressure in the absence of intracranial mass or obstructive hydrocephalus. Over 80% of patients are overweight women. IIH is usually encountered in the neurology and ophthalmology practise as headaches, visual disturbance and papilloedema are the characteristic features of this syndrome. Patients with IIH also experience tinnitus, hearing loss, balance disturbance, cerebrospinal fluid (CSF) otorrhoea or rhinorrhoea and in some cases these otorhinological symptoms can be presenting features of this syndrome. IIH is also associated with obstructive sleep apnoea. Otolaryngologists should be familiar with this important condition as it can manifest a variety of symptoms that are more frequently seen in their clinics. Sometimes otolaryngologists may be involved in the surgical management of this condition, such as repair of CSF rhinorrhoea or otorrhoea or endoscopic optic nerve decompression. The aim of this review article is to familiarise the otolaryngologists with the important features of this unusual syndrome which may remain unrecognised in the otolaryngology practice.

14 Article The use of cardiopulmonary exercise testing in identifying the presence of obstructive sleep apnea syndrome in patients with compatible symptomatology. 2019

Stavrou, Vasileios / Boutou, Afroditi K / Vavougios, George D / Pastaka, Chaido / Gourgoulianis, Konstantinos I / Koutedakis, Yiannis / Daniil, Zoe / Karetsi, Eleni. ·Laboratory of Cardiopulmonary Testing, Department of Respiratory Medicine, University of Thessaly, Larissa, Greece. Electronic address: vasileiosstavrou@hotmail.com. · Department of Respiratory Medicine, "G. Papanikolaou" General Hospital, Thessaloniki, Greece. Electronic address: afboutou@yahoo.com. · Department of Respiratory Medicine, University of Thessaly School of Medicine, University Hospital of Larissa, Greece; Department of Neurology, Athens Naval Hospital, Deinokratous 70, Athens, Greece. Electronic address: dantevavougios@hotmail.com. · Department of Respiratory Medicine, University of Thessaly School of Medicine, University Hospital of Larissa, Greece; Sleep Apnea Laboratory, Department of Respiratory Medicine, University of Thessaly, Larissa, Greece. Electronic address: cpastaka@gmail.com. · Laboratory of Cardiopulmonary Testing, Department of Respiratory Medicine, University of Thessaly, Larissa, Greece; Department of Respiratory Medicine, University of Thessaly School of Medicine, University Hospital of Larissa, Greece; Sleep Apnea Laboratory, Department of Respiratory Medicine, University of Thessaly, Larissa, Greece. Electronic address: kgourg@med.uth.gr. · School of Physical Education and Sports Sciences, University of Thessaly, Trikala, Greece; Institute of Sport, Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK. Electronic address: y.koutedakis@pe.uth.gr. · Laboratory of Cardiopulmonary Testing, Department of Respiratory Medicine, University of Thessaly, Larissa, Greece; Department of Respiratory Medicine, University of Thessaly School of Medicine, University Hospital of Larissa, Greece. Electronic address: zdaniil@med.uth.gr. · Laboratory of Cardiopulmonary Testing, Department of Respiratory Medicine, University of Thessaly, Larissa, Greece; Department of Respiratory Medicine, University of Thessaly School of Medicine, University Hospital of Larissa, Greece. Electronic address: ekaretsi@med.uth.gr. ·Respir Physiol Neurobiol · Pubmed #30684645.

ABSTRACT: The aim of this study was to investigate the relationship between cardiopulmonary exercise testing (CPET) and the presence of obstructive sleep apnea syndrome (OSAS) in order to provide an innovative tool to identify patients with OSAS. A prospective nested case control design was adopted. A consecutive population of male volunteers referred to a Sleep Unit was subjected to nocturnal polysomnography, full lung function testing and maximal CPET. A stepwise linear discriminant function analysis (DFA) was applied to construct a model which could identify individuals with moderate-to-severe OSAS from healthy controls. The total of 30 volunteers formed the OSAS and 24 the non-OSAS groups. Demographic and somatometric parameters were similar between groups. Patients presented with lower Expiratory Reserve Volume (ERV: 106.7 ± 28.3 vs. 123.9 ± 22.1, p < 0.001), Leg Fatigue

15 Article Phrenic nerve stimulation to treat patients with central sleep apnoea and heart failure. 2018

Costanzo, Maria Rosa / Ponikowski, Piotr / Coats, Andrew / Javaheri, Shahrokh / Augostini, Ralph / Goldberg, Lee R / Holcomb, Richard / Kao, Andrew / Khayat, Rami N / Oldenburg, Olaf / Stellbrink, Christoph / McKane, Scott / Abraham, William T / Anonymous811103. ·Advocate Heart Institute, Naperville, IL, USA. · Medical University, Military Hospital, Wroclaw, Poland. · University of Warwick, Coventry, UK. · Bethesda North Hospital, Cincinnati, OH, USA. · The Ohio State University, Columbus, OH, USA. · University of Pennsylvania, Philadelphia, PA, USA. · Independent Biostatistician, Minneapolis, MN, USA. · Mid America Heart Institute, Kansas City, MO, USA. · Bad Oeynhausen Heart and Diabetes Center, Bad Oeynhausen, Germany. · Bielefeld Medical Center, Bielefeld, Germany. · Respicardia, Inc., Minnetonka, MN, USA. ·Eur J Heart Fail · Pubmed #30303611.

ABSTRACT: AIMS: The presence of central sleep apnoea (CSA) is associated with poor prognosis in patients with heart failure (HF). The aim of this analysis was to evaluate if using phrenic nerve stimulation to treat CSA in patients with CSA and HF was associated with changes in HF-specific metrics. METHODS AND RESULTS: All patients randomized in the remedē System Pivotal Trial and identified at baseline with HF were included (n = 96). Effectiveness data from treatment and former control groups were pooled based on months since therapy activation. Changes from baseline to 6 and 12 months in sleep metrics, Epworth Sleepiness Scale, patient global assessment health-related quality of life, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and echocardiographic parameters are reported. HF hospitalization, cardiovascular death, and the composite of HF hospitalization or cardiovascular death within 6 months are reported by the original randomized group assignment for safety assessment. Sleep metrics and quality of life improved from baseline to 6 and 12 months. At 12 months, MLHFQ scores changed by -6.8 ± 20.0 (P = 0.005). The 6-month rate of HF hospitalization was 4.7% in treatment patients (standard error = 3.3) and 17.0% in control patients (standard error = 5.5) (P = 0.065). Reported adverse events were as expected for a transvenous implantable system. CONCLUSIONS: Phrenic nerve stimulation reduces CSA severity in patients with HF. In parallel, this CSA treatment was associated with benefits on HF quality of life.

16 Article The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis. 2018

Kahal, Hassan / Kyrou, Ioannis / Uthman, Olalekan / Brown, Anna / Johnson, Samantha / Wall, Peter / Metcalfe, Andrew / Tahrani, Abd A / Randeva, Harpal S. ·Division of Translational and Experimental Medicine, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom. · Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom. · Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B4 7ET, United Kingdom. · Centre of Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, United Kingdom. · Division of Health Sciences, Warwick - Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom. · Library and Knowledge Services, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom. · University of Warwick Library, University of Warwick, Coventry CV4 7AL, United Kingdom. · Department of Warwick Orthopaedics, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom. · Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom. · Centre of Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham United Kingdom. · Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, United Kingdom. ·Sleep · Pubmed #29722890.

ABSTRACT: Study Objectives: In this systematic review and meta-analysis, we aimed to examine the relationship between obstructive sleep apnea (OSA) and metabolic abnormalities in women with polycystic ovary syndrome (PCOS). Methods: Electronic databases (Medline, Embase, Cinahl, PsycInfo, Scopus, Web of Science, Opengrey, and CENTRAL), conference abstracts, and reference lists of relevant articles were searched. No restriction was applied for language or publication status. Results: Six studies involving 252 participants were included. Women with PCOS and OSA had significantly higher body mass index (mean difference [MD]: 6.01 kg/m2, 95% confidence intervals [CI]: 4.69-7.33), waist circumference (MD: 10.93 cm, 95% CI: 8.03-13.83), insulin resistance, systolic and diastolic blood pressure, and worse lipids' profile and impaired glucose regulation compared with women with PCOS without OSA. Most studies did not adjust for weight in their between-groups analysis. Total and free testosterone levels were not significantly different between the two groups. The majority of studies were found to be at high risk of selection bias, did not account for important confounders, were conducted in one country (United States), and used different methodologies to assess testosterone levels (preventing a meta-analysis for this specific outcome). Conclusions: OSA is associated with obesity and worse metabolic profiles in women with PCOS. However, whether the effects of OSA are independent of obesity remain unclear. As OSA is a treatable condition, research focused on the independent effects of OSA on key clinical outcomes in women with PCOS, including fertility, psychological health, type 2 diabetes, and cardiovascular risk, is lacking and needed. PROSPERO registration number: CRD42016048587.

17 Article Validation of a New System Using Tracheal Body Sound and Movement Data for Automated Apnea-Hypopnea Index Estimation. 2017

Kalkbrenner, Christoph / Eichenlaub, Manuel / Rüdiger, Stefan / Kropf-Sanchen, Cornelia / Brucher, Rainer / Rottbauer, Wolfgang. ·Faculty of Medical Engineering, University of Applied Science Ulm, Ulm, Germany. · School of Engineering, University of Warwick, Coventry, United Kingdom. · Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany. ·J Clin Sleep Med · Pubmed #28859722.

ABSTRACT: STUDY OBJECTIVES: The current gold standard for assessment of obstructive sleep apnea is the in-laboratory polysomnography. This approach has high costs and inconveniences the patient, whereas alternative ambulatory systems are limited by reduced diagnostic abilities (type 4 monitors, 1 or 2 channels) or extensive setup (type 3 monitors, at least 4 channels). The current study therefore aims to validate a simplified automated type 4 monitoring system using tracheal body sound and movement data. METHODS: Data from 60 subjects were recorded at the University Hospital Ulm. All subjects have been regular patients referred to the sleep center with suspicion of sleep-related breathing disorders. Four recordings were excluded because of faulty data. The study was of prospective design. Subjects underwent a full-night screening using diagnostic in-laboratory polysomnography and the new monitoring system concurrently. The apnea-hypopnea index (AHI) was scored blindly by a medical technician using in-laboratory polysomnography (AHI RESULTS: AHI CONCLUSIONS: The proposed sleep monitor accurately estimates AHI and diagnoses sleep apnea and its severity. This minimalistic approach may address the need for a simple yet reliable diagnosis of sleep apnea in an ambulatory setting. CLINICAL TRIAL REGISTRATION: Trial name: Validation of a new method for ambulant diagnosis of sleep related breathing disorders using body sound; URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011195; Identifier: DRKS00011195.

18 Article Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study. 2017

Altaf, Quratul A / Dodson, Paul / Ali, Asad / Raymond, Neil T / Wharton, Helen / Fellows, Hannah / Hampshire-Bancroft, Rachel / Shah, Mirriam / Shepherd, Emma / Miah, Jamili / Barnett, Anthony H / Tahrani, Abd A. ·1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. · 2 Centre of Endocrinology, Diabetes, and Metabolism, Birmingham Heath Partners, Birmingham, United Kingdom. · 3 Department of Diabetes and Endocrinology and. · 4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. · 5 School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. · 6 Department of Respiratory Medicine, University Hospital of Coventry and Warwickshire, Coventry NHS Trust, United Kingdom; and. · 7 Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom. ·Am J Respir Crit Care Med · Pubmed #28594570.

ABSTRACT: RATIONALE: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR). OBJECTIVES: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression. METHODS: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using two-field 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. MEASUREMENTS AND MAIN RESULTS: A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR. CONCLUSIONS: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.

19 Article A prospective observational study to evaluate the effect of social and personality factors on continuous positive airway pressure (CPAP) compliance in obstructive sleep apnoea syndrome. 2017

Gulati, Atul / Ali, Masood / Davies, Mike / Quinnell, Tim / Smith, Ian. ·Consultant respiratory medicine, New Cross Hospital, Heath Road, Wolverhampton, West Midlands, WV10 0QP, UK. atulgulati@nhs.net. · Consultant respiratory medicine, Southend University Hospital, Prittlewell Chase, Westcliffe on Sea, Essex, SS0 0RY, UK. · Consultant respiratory medicine, Respiratory Support and Sleep Centre, Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, UK. ·BMC Pulm Med · Pubmed #28330459.

ABSTRACT: BACKGROUND: Compliance with CPAP treatment for OSAS is not reliably predicted by the severity of symptoms or physiological variables. We examined a range of factors which could be measured before CPAP initiation to look for predictors of compliance. METHODS: This was a prospective cohort-study of CPAP treatment for OSAS, recording; socio-economic status, education, type D personality and clinician's prediction of compliance. RESULTS: We recruited 265 subjects, of whom 221 were still using CPAP at 6 months; median age 53 years, M: F, 3.4:1, ESS 15 and pre-treatment ODI 21/h. Median compliance at 6 months was 5.6 (3.4- 7.1) hours/night with 73.3% of subjects using CPAP ≥4 h/night. No association was found between compliance and different socio-economic classes for people in work, type D personality, education level, sex, age, baseline ESS or ODI. The clinician's initial impression could separate groups of good and poor compliers but had little predictive value for individual patients. Compared to subjects who were working, those who were long term unemployed had a lower CPAP usage and were more likely to use CPAP < 4 h a night (OR 4.6; p value 0.011). A high Beck Depression Index and self-reported anxiety also predicted poor compliance. CONCLUSIONS: In our practice there is no significant association between CPAP compliance with socio-economic status, education or personality type. Long term unemployed or depressed individuals may need more intensive support to gain the optimal benefit from CPAP.

20 Article Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study. 2017

Amin, Amin / Ali, Asad / Altaf, Quratul A / Piya, Milan K / Barnett, Anthony H / Raymond, Neil T / Tahrani, Abd A. ·Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. · Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom. · Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. · Department of Diabetes, Derby Teaching Hospitals NHS Foundation NHS Trust, Derby, United Kingdom. · Warwick Medical School, University of Warwick, Coventry, United Kingdom. · Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom. · Independent Epidemiology and Statistical Consultant, Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom. ·J Clin Sleep Med · Pubmed #28162147.

ABSTRACT: STUDY OBJECTIVES: To assess and compare obstructive sleep apnea (OSA) prevalence in South Asians and White Europeans with type 2 diabetes mellitus (T2DM). Secondary aims included exploring possible causes for observed ethnic differences. METHODS: A cross-sectional study of patients with T2DM recruited from secondary care diabetes clinics. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h using home-based, multi-channel respiratory monitoring. RESULTS: Two hundred thirty-four patients (105 South Asian and 129 White Europeans) were studied. The prevalence of mild, moderate, and severe OSA in South Asians was 36.2% (n = 38/105), 9.5% (n = 10/105), and 5.7% (n = 6/105) respectively. After adjustment, OSA was associated with a higher body mass index in South Asians. OSA was significantly less common in South Asians compared to White Europeans (51.4% [54/105] versus 75.2% [97/129], CONCLUSIONS: South Asians with T2DM are at considerable risk of OSA. OSA in South Asians was associated with obesity. However, OSA prevalence was lower in South Asians than in White Europeans. Obesity measures accounted for the observed ethnic differences. Examining factors contributing to ethnic differences will be important to inform screening and treatment strategies.

21 Article The relationship between obstructive sleep apnea and intra-epidermal nerve fiber density, PARP activation and foot ulceration in patients with type 2 diabetes. 2016

Altaf, Quratul-Ain Altaf / Ali, Asad / Piya, Milan K / Raymond, Neil T / Tahrani, Abd A. ·Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. · Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK; Warwick Medical School, University of Warwick, Coventry, UK. · Independent Epidemiology and Statistical Consultant, Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, UK. · Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. Electronic address: abd.tahrani@nhs.net. ·J Diabetes Complications · Pubmed #27324704.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is associated with increased nitrosative stress, endothelial dysfunction, and peripheral neuropathy in patients with type 2 diabetes. We hypothesized that OSA is associated with Poly ADP ribose polymerase (PARP) activation, lower intra-epidermal nerve fiber density (IENFD), and diabetic foot ulceration (DFU). METHODS: A cross-sectional study of adults with type 2 diabetes recruited from a secondary care hospital in the UK. OSA was assessed by multi-channel home-based cardio-respiratory device (Alice PDX, Philips Respironics). DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI). IENFD and % PAR stained nuclei were assessed using immunohistochemistry staining on skin biopsies. DFU was assessed based on MNSI. RESULTS: Skin biopsies and DFU data were available from 52 and 234 patients respectively. OSA was associated with lower IENFD (12.75±1.93 vs. 10.55±1.62 vs. 9.42±1.16 fibers/mm of epidermis for no OSA, mild OSA and moderate to severe OSA respectively, p<0.001). Following adjustment, mild (B=-2.19, p=0.002) and moderate to severe OSA (B=-3.45, p<0.001) were independently associated with IENFD. The apnea hypopnea index (AHI) was associated with IENFD following adjustment (B=-2.45, p<0.001). AHI was associated with percentage of PAR stained nuclei following adjustment (B=13.67, p=0.025). DFU prevalence was greater in patients with OSA (7.1% vs. 28.1% vs. 26.2% for patients with no OSA, mild OSA and moderate to severe OSA respectively, p=0.001). Following adjustment, OSA was associated with DFU (OR 3.34, 95% CI 1.19-9.38, p=0.022). CONCLUSIONS: OSA is associated with lower IENFD, PARP activation and DFU in patients with type 2 diabetes. Our findings suggest that OSA is associated with small fiber neuropathy. PARP activation is a potential mechanisms linking OSA to DPN and endothelial dysfunction in patients with type 2 diabetes. Whether OSA treatment will have a favorable impact on these parameters and DFU requires interventional studies.

22 Article Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. 2016

Sweeney, Joan / Patterson, Chris C / Menzies-Gow, Andrew / Niven, Rob M / Mansur, Adel H / Bucknall, Christine / Chaudhuri, Rekha / Price, David / Brightling, Chris E / Heaney, Liam G / Anonymous4320856. ·Centre for Infection and Immunity, Queen's University of Belfast, Belfast, UK. · Centre for Public Health, Queen's University of Belfast, Belfast, UK. · Royal Brompton Hospital, London, UK. · MAHSC, The University of Manchester & UHSM, Manchester, UK. · Severe and Brittle Asthma Unit, Birmingham Heartlands Hospital, Birmingham, UK. · Department of Respiratory Medicine, Royal Infirmary, Glasgow, UK. · Division of Immunology, Infection and Inflammation, Department of Respiratory Medicine, University of Glasgow and Gartnavel General, Glasgow, UK. · Academic Primary Care, University of Aberdeen, Aberdeen, UK. · Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, UK. ·Thorax · Pubmed #26819354.

ABSTRACT: OBJECTIVE: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma. DESIGN: Cross-sectional observational study. SETTING: The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry. PARTICIPANTS: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control). MAIN OUTCOME MEASURES: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group. RESULTS: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified. CONCLUSIONS: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

23 Article Regularity analysis of nocturnal oximetry recordings to assist in the diagnosis of sleep apnoea syndrome. 2016

Marcos, J Víctor / Hornero, Roberto / Nabney, Ian T / Álvarez, Daniel / Gutiérrez-Tobal, Gonzalo C / del Campo, Félix. ·Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain. Electronic address: jvmarcos@gmail.com. · Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain. Electronic address: robhor@tel.uva.es. · Non-linearity and Complexity Research Group, Aston University, Aston Triangle, Birmingham B4 7ET, United Kingdom. Electronic address: i.t.nabney@aston.ac.uk. · Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain. Electronic address: dalvgon@gmail.com. · Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain. Electronic address: gguttob@gmail.com. · Hospital Universitario Pío del Río Hortega de Valladolid, Dulzaina 2, Valladolid 47013, Spain. Electronic address: fsas@telefonica.net. ·Med Eng Phys · Pubmed #26719242.

ABSTRACT: The relationship between sleep apnoea-hypopnoea syndrome (SAHS) severity and the regularity of nocturnal oxygen saturation (SaO2) recordings was analysed. Three different methods were proposed to quantify regularity: approximate entropy (AEn), sample entropy (SEn) and kernel entropy (KEn). A total of 240 subjects suspected of suffering from SAHS took part in the study. They were randomly divided into a training set (96 subjects) and a test set (144 subjects) for the adjustment and assessment of the proposed methods, respectively. According to the measurements provided by AEn, SEn and KEn, higher irregularity of oximetry signals is associated with SAHS-positive patients. Receiver operating characteristic (ROC) and Pearson correlation analyses showed that KEn was the most reliable predictor of SAHS. It provided an area under the ROC curve of 0.91 in two-class classification of subjects as SAHS-negative or SAHS-positive. Moreover, KEn measurements from oximetry data exhibited a linear dependence on the apnoea-hypopnoea index, as shown by a correlation coefficient of 0.87. Therefore, these measurements could be used for the development of simplified diagnostic techniques in order to reduce the demand for polysomnographies. Furthermore, KEn represents a convincing alternative to AEn and SEn for the diagnostic analysis of noisy biomedical signals.

24 Article Usefulness of the SAME-TT2R2 score to predict anticoagulation control on VKA in patients with atrial fibrillation and obstructive sleep apnea. 2016

Szymanski, Filip M / Lip, Gregory Y H / Filipiak, Krzysztof J / Platek, Anna E / Karpinski, Grzegorz. ·1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. Electronic address: filip.szymanski@wum.edu.pl. · City Hospital, University of Birmingham Institute of Cardiovascular Sciences, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. · 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. ·Int J Cardiol · Pubmed #26670173.

ABSTRACT: BACKGROUND: Oral anticoagulation is crucial for the prevention of stroke and thromboembolism in atrial fibrillation (AF). One of the comorbidities potentially affecting thromboembolic risk and anticoagulation effectiveness is obstructive sleep apnea (OSA). The objective of this study was to establish if presence of OSA is associated with poor expected benefit from vitamin K antagonist (VKA) therapy as assessed using the SAMe-TT2R2 score. METHODS: We studied AF patients planned for invasive electrophysiological procedures. All patients had a whole night polygraphy performed for the diagnosis of OSA, and their SAMe-TT2R2 score was calculated. RESULTS: We studied 211 AF patients (mean age = 57.1 ± 10.2 years, 62.6% males). OSA with apnea-hypopnea index (AHI) ≥ 15/h was found in 48 (22.7%) patients. Mean SAMe-TT2R2 score in non-OSA patients was 1.4 ± 0.9, compared to mild OSA patients, 1.5 ± 0.9; moderate OSA patients, 1.9 ± 1.1; and severe OSA patients, 2.8 ± 0.6. A significantly higher percentage of patients with SAMe-TT2R2 ≥ 2, indicating poor predicted INR control on VKAs, was found with increasing AHI category (37% vs. 41% vs. 57% vs. 100%, respectively). Patients with poor predicted anticoagulation control (SAMe-TT2R2 ≥ 2) had a higher prevalence of OSA. There was a lower proportion of patients with TTR > 70% among patients with moderate/severe OSA compared to no/mild OSA (13.6% vs. 29.6%, p = 0.03). CONCLUSION: SAMe-TT2R2 scores in patients with OSA are substantially higher than in those without sleep-disordered breathing. The mean SAMe-TT2R2 score, as well as the percentage of patients with SAMe-TT2R2 score ≥ 2, suggests poor predicted anticoagulation control on VKA rises along with the AHI. There was a lower proportion of patients with TTR > 70% among patients with moderate/severe OSA, compared to no/mild OSA.

25 Article Multicentre prospective clinical application of the T14 paediatric outcome tool. 2015

Hopkins, C / Almeyda, R / Alreefy, H / Ismail-Koch, H / Lim, J / Possamai, V / Powell, S / Sharma, R / Hore, I. ·Evelina London Children's Hospital,Guy's and St Thomas' NHS Trust,London,UK. · John Radcliffe Hospital,Oxford,UK. · Southampton Hospital,Gillingham,UK. · Medway Maritime Hospital,Gillingham,UK. · Birmingham Children's Hospital,Newcastle upon Tyne,UK. · Freeman Hospital,Newcastle upon Tyne,UK. · Alder Hey Children's Hospital,Liverpool,UK. ·J Laryngol Otol · Pubmed #26259840.

ABSTRACT: OBJECTIVE: This study aimed to measure changes in disease-specific quality of life in children following tonsillectomy or adenotonsillectomy. METHODS: A multicentre prospective cohort study was performed involving seven ENT departments in England. A total of 276 children entered the study over a 2-month period: 107 underwent tonsillectomy and 128 adenotonsillectomy. Forty-one children referred with throat problems initially managed by watchful waiting were also recruited. The follow-up period was 12 months. Outcome measures were the T14, parental impressions of their child's quality of life and the number of days absent from school. RESULTS: One-year follow-up data were obtained from 150 patients (52 per cent). The mean baseline T14 score in the non-surgical group was significantly lower (T14 = 23) than in the tonsillectomy group (T14 = 31) or the adenotonsillectomy group (T14 = 35; p < 0.001). There was a significant improvement in the T14 scores of responders in all groups at follow up. The effect size was 1.3 standard deviations (SD) for the non-surgical group, 2.1 SD for the tonsillectomy group and 1.9 SD for the adenotonsillectomy group. Between-group differences did not reach statistical significance. A third of children in the non-surgical group underwent surgery during the follow-up period. CONCLUSION: Children who underwent surgical intervention achieved a significant improvement in disease-specific quality of life. Less severely affected children were managed conservatively and also improved over 12 months, but 1 in 3 crossed over to surgical intervention.

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