Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P24
James Di Michiel, G. Cossa, R. Brillante, L. Laks
Introduction: The aetiology of central sleep apnea (CSA) remains incompletely understood. While proposed mechanisms exist for those with secondary causes, a complete understanding of primary CSA remains lacking. Here we describe the characteristics of patients in our centre with primary and secondary CSA, and the possible role of arousal threshold. Methods: A retrospective study was conducted across patients undergoing full overnight diagnostic polysomnography (PSG) at Concord Repatriation General Hospital (CRGH) in Sydney, Australia from October 2013 to July 2018 with predominant CSA based on AASM criteria. Patients were classified as having either primary or secondary CSA after review of medical records to identify any known contributing co-morbidities or medication/substance use. Patient demographics, PSG characteristics and arousal threshold (Edwards, B.A. et al. AJRCCM 2014; 190(11):1293-300) were recorded. Results: 33 patients meeting criteria for predominant CSA were identified, 32 (97.0%) of which were male. 14 patients (42.4%) had primary CSA and 19 (57.6%) secondary CSA. Comparison between groups showed patients with primary CSA were more likely to be younger (54.6 years vs 74.1 years, p Conclusion: Patients with primary CSA were more likely to be significantly younger in age and have a lower arousal threshold, possibly contributing to instability of ventilatory control and propagation of central events.
{"title":"Patient characteristics and arousal threshold in central sleep apnea","authors":"James Di Michiel, G. Cossa, R. Brillante, L. Laks","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P24","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P24","url":null,"abstract":"Introduction: The aetiology of central sleep apnea (CSA) remains incompletely understood. While proposed mechanisms exist for those with secondary causes, a complete understanding of primary CSA remains lacking. Here we describe the characteristics of patients in our centre with primary and secondary CSA, and the possible role of arousal threshold. Methods: A retrospective study was conducted across patients undergoing full overnight diagnostic polysomnography (PSG) at Concord Repatriation General Hospital (CRGH) in Sydney, Australia from October 2013 to July 2018 with predominant CSA based on AASM criteria. Patients were classified as having either primary or secondary CSA after review of medical records to identify any known contributing co-morbidities or medication/substance use. Patient demographics, PSG characteristics and arousal threshold (Edwards, B.A. et al. AJRCCM 2014; 190(11):1293-300) were recorded. Results: 33 patients meeting criteria for predominant CSA were identified, 32 (97.0%) of which were male. 14 patients (42.4%) had primary CSA and 19 (57.6%) secondary CSA. Comparison between groups showed patients with primary CSA were more likely to be younger (54.6 years vs 74.1 years, p Conclusion: Patients with primary CSA were more likely to be significantly younger in age and have a lower arousal threshold, possibly contributing to instability of ventilatory control and propagation of central events.","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125078096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P29
J. Spiesshoefer, S. Becker, P. Young, M. Boentert, A. Giannoni
Background: Although the effect of hyperventilation on hemodynamics and sympathetic nerve activity (SNA) is known in healthy subject, the effects of a Cheyne-Stokes breathing pattern (CSR) in condition of decreased cardiac output and feedback resetting as in heart failure (HF) and pulmonary arterial hypertension (PAH) is currently unknown. Methods: Hemodynamics and SNA (spectral analysis of heart rate, blood pressure variability and baroreceptor reflex sensitivity by sequence method) were noninvasively (TaskForce Monitor, CNSystems, Graz) evaluated in 20 volunteers (13 male, 49±22 years), 20 systolic HF patients (15 male, 68±12 years, LVEF 35±11%) and 20 patients with PAH (8 male, 56±14 years, systolic pulmonary pressure 55±6 mmHg) both at baseline and during a simulation of CSR with a short and with a long cycle length. Results: Simulation of CSR elicited neutral effects on both hemodynamics and SNA in all groups (all p>0.05) except for a 17% (p Conclusions: Voluntary CSR leads to a hyperventilation length dependent decrease in SNA in healthy volunteers but otherwise has neutral effects on hemodynamic and SNA in both HF and PAH.
{"title":"Impact of voluntary periodic breathing on hemodynamics and autonomic nervous system function in patients with and without heart failure","authors":"J. Spiesshoefer, S. Becker, P. Young, M. Boentert, A. Giannoni","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P29","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P29","url":null,"abstract":"Background: Although the effect of hyperventilation on hemodynamics and sympathetic nerve activity (SNA) is known in healthy subject, the effects of a Cheyne-Stokes breathing pattern (CSR) in condition of decreased cardiac output and feedback resetting as in heart failure (HF) and pulmonary arterial hypertension (PAH) is currently unknown. Methods: Hemodynamics and SNA (spectral analysis of heart rate, blood pressure variability and baroreceptor reflex sensitivity by sequence method) were noninvasively (TaskForce Monitor, CNSystems, Graz) evaluated in 20 volunteers (13 male, 49±22 years), 20 systolic HF patients (15 male, 68±12 years, LVEF 35±11%) and 20 patients with PAH (8 male, 56±14 years, systolic pulmonary pressure 55±6 mmHg) both at baseline and during a simulation of CSR with a short and with a long cycle length. Results: Simulation of CSR elicited neutral effects on both hemodynamics and SNA in all groups (all p>0.05) except for a 17% (p Conclusions: Voluntary CSR leads to a hyperventilation length dependent decrease in SNA in healthy volunteers but otherwise has neutral effects on hemodynamic and SNA in both HF and PAH.","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121674177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p31
J. Spiesshoefer, C. Henke, S. Herkenrath, W. Randerath, P. Young, M. Boentert
{"title":"Diaphragm involvement in hereditary motor and sensory neuropathy type IA: insights from diaphragm ultrasound and phrenic nerve stimulation studies","authors":"J. Spiesshoefer, C. Henke, S. Herkenrath, W. Randerath, P. Young, M. Boentert","doi":"10.1183/23120541.sleepandbreathing-2019.p31","DOIUrl":"https://doi.org/10.1183/23120541.sleepandbreathing-2019.p31","url":null,"abstract":"","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130000279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p30
J. Spiesshoefer, Nora Hegerfeld, P. Young, A. Giannoni, M. Boentert
Background: Idiopathic central sleep apnea (ICSA) is a rare condition in which CSA occurs at night and in the absence of heart failure (HF). While it has been reported to occur in neurological patients in particular its impact on autonomic nervous system function at night has not yet been studied. Methods: 10 patients without HF and diagnosed ICSA (9 male, 5 with a history of stroke, 58 ± 13 years) were enrolled. Autonomic nervous system function (spectral analysis of heart rate –HRV-, blood pressure variability –BPV- and baroreceptor reflex sensitivity by sequence method) and hemodynamics were monitored noninvasively (TaskForce Monitor, CNSystems, Graz) and beyond 12 channel polysomnography (PSG) throughout an entire (attended) night in a sleep laboratory. Mean values were recorded at baseline and both during 10 miunutes of ICSA and normal breathing in stable Non REM II sleep. Results: Stable segments of an ICSA breathing pattern were consistently available during NonREM II sleep in all patients. Therein mean heart rate and low frequency component of diastolic BPV (considered to reflect sympathetic nerve activity -SNA-) revealed less SNA during ICSA compared to normal breathing (56 ± 5 vs. 58 ± 6 bpm, p Conclusions: ICSA leads to less SNA even if adjusted for sleep stage in neurological patients. ICSA might present a compensatory mechanism in neurological patients.
{"title":"Idiopathic central sleep apnea: friend or foe of autonomic nervous system function in neurology?","authors":"J. Spiesshoefer, Nora Hegerfeld, P. Young, A. Giannoni, M. Boentert","doi":"10.1183/23120541.sleepandbreathing-2019.p30","DOIUrl":"https://doi.org/10.1183/23120541.sleepandbreathing-2019.p30","url":null,"abstract":"Background: Idiopathic central sleep apnea (ICSA) is a rare condition in which CSA occurs at night and in the absence of heart failure (HF). While it has been reported to occur in neurological patients in particular its impact on autonomic nervous system function at night has not yet been studied. Methods: 10 patients without HF and diagnosed ICSA (9 male, 5 with a history of stroke, 58 ± 13 years) were enrolled. Autonomic nervous system function (spectral analysis of heart rate –HRV-, blood pressure variability –BPV- and baroreceptor reflex sensitivity by sequence method) and hemodynamics were monitored noninvasively (TaskForce Monitor, CNSystems, Graz) and beyond 12 channel polysomnography (PSG) throughout an entire (attended) night in a sleep laboratory. Mean values were recorded at baseline and both during 10 miunutes of ICSA and normal breathing in stable Non REM II sleep. Results: Stable segments of an ICSA breathing pattern were consistently available during NonREM II sleep in all patients. Therein mean heart rate and low frequency component of diastolic BPV (considered to reflect sympathetic nerve activity -SNA-) revealed less SNA during ICSA compared to normal breathing (56 ± 5 vs. 58 ± 6 bpm, p Conclusions: ICSA leads to less SNA even if adjusted for sleep stage in neurological patients. ICSA might present a compensatory mechanism in neurological patients.","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126147837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P33
J. Spiesshoefer, M. Runte, M. Dreher, P. Young, M. Boentert
Background: Patients with adult onset type I myotonic dystrophy (DM 1) may develop nocturnal hypoventilation (NH), and initiation of nocturnal positive non-invasive ventilation (NIV) therapy may be indicated and clinically useful. Studies assessing long term adherence to and benefit from NIV in terms of improvements in objective sleep and breathing parameters in DM 1 patients with NH have not yet been published. Methods: We retrospectively collected data on full polysomnography and capnometry results along with clinical data and sleep-related symptom scores in adult patients with genetically proven DM 1 and an initiation of NIV due to proven NH between 2010 and 2017. Follow up studies in our sleep laboratory were scheduled and data was collected therein. Results: Twenty eight patients (age 41.2 ± 11.7 years, BMI 25.8 ± 7.0 kg/m², 50% male) with DM 1 and proven NH were initiated on NIV and hence included into this study. NIV led to significant improvement of ventilation and oxygenation in the first night of treatment. Follow-up sleep studies revealed stable normoxia and normocapnia without deterioration of sleep outcomes. Conclusions: In DM 1 NIV significantly improves sleep and breathing already in the first night of treatment. NIV warrants nocturnal long-term normoventilation without deterioration of sleep quality.
{"title":"Impact of non-invasive ventilation on objective sleep and nocturnal respiration in patients with type I myotonic dystrophy","authors":"J. Spiesshoefer, M. Runte, M. Dreher, P. Young, M. Boentert","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P33","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P33","url":null,"abstract":"Background: Patients with adult onset type I myotonic dystrophy (DM 1) may develop nocturnal hypoventilation (NH), and initiation of nocturnal positive non-invasive ventilation (NIV) therapy may be indicated and clinically useful. Studies assessing long term adherence to and benefit from NIV in terms of improvements in objective sleep and breathing parameters in DM 1 patients with NH have not yet been published. Methods: We retrospectively collected data on full polysomnography and capnometry results along with clinical data and sleep-related symptom scores in adult patients with genetically proven DM 1 and an initiation of NIV due to proven NH between 2010 and 2017. Follow up studies in our sleep laboratory were scheduled and data was collected therein. Results: Twenty eight patients (age 41.2 ± 11.7 years, BMI 25.8 ± 7.0 kg/m², 50% male) with DM 1 and proven NH were initiated on NIV and hence included into this study. NIV led to significant improvement of ventilation and oxygenation in the first night of treatment. Follow-up sleep studies revealed stable normoxia and normocapnia without deterioration of sleep outcomes. Conclusions: In DM 1 NIV significantly improves sleep and breathing already in the first night of treatment. NIV warrants nocturnal long-term normoventilation without deterioration of sleep quality.","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129240853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P27
J. Spiesshoefer, M. Runte, P. Young, M. Dreher, B. Matthias
Background: Patients with severe facioscapulohumeral dystrophy (FSHD) are at risk of sleep-disordered breathing (SDB) which may comprise obstructive sleep apnea (OSA) or nocturnal hypoventilation (NH). Transcutaneous capnometry allows for detection of NH in patients with respiratory muscle weakness but concerning FSHD, capnometric data have not yet been published. Methods: We collected sleep study and capnometry results in 31 adult patients with proven FSHD and 31 insomnic control subjects. Results: OSA was present in 17 patients (55%), and 8 patients (26%) showed NH. NH would have been missed in up to 7/8 patients if onlyoxymetric criteria of hypoventilation had been applied. Capnographic measures were correlated with disease severity in FSHD patients as reflected by the Clinical Severity Score (CSS). Non-invasive ventilation (NIV) was initiated in 6 patients with NH and 3 patients with OSA. Positive airway pressure (PAP) treatment was started in 2 patients, and positional therapy was sufficient in 4 individuals. In patients initiated on NIV, gas exchange significantly improved in the very first night of treatment. Conclusions: SDB is common in adult patients with FSHD, and nocturnal carbon dioxide tension is associated with disease severity. Transcutaneous capnometry is superior to pulse oxymetry in detecting NH.
{"title":"Sleep-disordered breathing in facio-scapulo-humeral dystrophy: A case-control study","authors":"J. Spiesshoefer, M. Runte, P. Young, M. Dreher, B. Matthias","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P27","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P27","url":null,"abstract":"Background: Patients with severe facioscapulohumeral dystrophy (FSHD) are at risk of sleep-disordered breathing (SDB) which may comprise obstructive sleep apnea (OSA) or nocturnal hypoventilation (NH). Transcutaneous capnometry allows for detection of NH in patients with respiratory muscle weakness but concerning FSHD, capnometric data have not yet been published. Methods: We collected sleep study and capnometry results in 31 adult patients with proven FSHD and 31 insomnic control subjects. Results: OSA was present in 17 patients (55%), and 8 patients (26%) showed NH. NH would have been missed in up to 7/8 patients if onlyoxymetric criteria of hypoventilation had been applied. Capnographic measures were correlated with disease severity in FSHD patients as reflected by the Clinical Severity Score (CSS). Non-invasive ventilation (NIV) was initiated in 6 patients with NH and 3 patients with OSA. Positive airway pressure (PAP) treatment was started in 2 patients, and positional therapy was sufficient in 4 individuals. In patients initiated on NIV, gas exchange significantly improved in the very first night of treatment. Conclusions: SDB is common in adult patients with FSHD, and nocturnal carbon dioxide tension is associated with disease severity. Transcutaneous capnometry is superior to pulse oxymetry in detecting NH.","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121736538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P25
B. Conde, N. Martins, E. Matos, I. Rodrigues, J. Winck
Amyotrophic Lateral Sclerosis (ALS) represents the most common and severe motor neuron disease, with inevitable respiratory failure development. Ventilatory support (VS) has shown a valuable prognostic impact, even in bulbar-onset ALS. To analyse, ALS patients` outcomes related with VS, phenotypes or functional parameters, a prospective study was conducted in 81 patients, with confirmed or probable ALS diagnosis, according to El Escorial criteria, sent to a pulmonology clinic for functional evaluation and/or VS prescription. From 81 patients enrolled, 11 dropped out, being only considered 70 patients (mean age 66.6±11.3 years, 64.3% males, 52.9% ALS bulbar-onset) for analysis. At admission was found hypoventilation and bulbar dysfunction symptoms, respectively, in 43 and 44 patients. During follow-up, VS was established in 50 (71.4%) patients, in almost all noninvasive ventilation (96%). A good compliance was seen in 39 patients, with residual nocturnal events only observed in 10 patients. Regarding VS initiation criteria, 24 patients were eligible by functional criteria, 14 by nocturnal hypoventilation (HV) and 12 by daytime hypercapnia. After 3-6 months of VS start, there was functional improvement in 17 patients, mainly if HV criteria. Survival after VS, was 26.3 months, but higher in compliant spinal-onset ALS patients (42.4±28.0 months; p=0.022). VS had a marked functional and survival impact, most evident in compliant spinal-onset ALS patients and when nocturnal HV was the VS criteria.
{"title":"Ventilatory support criteria in Amyotrophic Lateral Sclerosis (ALS) patients and outcomes.","authors":"B. Conde, N. Martins, E. Matos, I. Rodrigues, J. Winck","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P25","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P25","url":null,"abstract":"Amyotrophic Lateral Sclerosis (ALS) represents the most common and severe motor neuron disease, with inevitable respiratory failure development. Ventilatory support (VS) has shown a valuable prognostic impact, even in bulbar-onset ALS. To analyse, ALS patients` outcomes related with VS, phenotypes or functional parameters, a prospective study was conducted in 81 patients, with confirmed or probable ALS diagnosis, according to El Escorial criteria, sent to a pulmonology clinic for functional evaluation and/or VS prescription. From 81 patients enrolled, 11 dropped out, being only considered 70 patients (mean age 66.6±11.3 years, 64.3% males, 52.9% ALS bulbar-onset) for analysis. At admission was found hypoventilation and bulbar dysfunction symptoms, respectively, in 43 and 44 patients. During follow-up, VS was established in 50 (71.4%) patients, in almost all noninvasive ventilation (96%). A good compliance was seen in 39 patients, with residual nocturnal events only observed in 10 patients. Regarding VS initiation criteria, 24 patients were eligible by functional criteria, 14 by nocturnal hypoventilation (HV) and 12 by daytime hypercapnia. After 3-6 months of VS start, there was functional improvement in 17 patients, mainly if HV criteria. Survival after VS, was 26.3 months, but higher in compliant spinal-onset ALS patients (42.4±28.0 months; p=0.022). VS had a marked functional and survival impact, most evident in compliant spinal-onset ALS patients and when nocturnal HV was the VS criteria.","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129604495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P26
H. Woehrle, O. Munt, J. Pépin, R. Heinzer, M. Arzt
Rationale Little is known about the effects of ASV on quality of life (QoL), compliance and benefits in different medical conditions. The READ-ASV registry is a multi-center, prospective study on patients with newly initiated ASV therapy. Methods: The registry is running in 5 European countries (28 centers) to investigate effects of ASV on QoL, sleep (questionnaires FOSQ, EQ5D, PSQI) and sleepiness (ESS). Patients and therapy indications are characterized by demographics, comorbidities and underlying sleep disorder. ASV daily usage, hospitalizations and deaths are recorded. Results: Of 180 enrolled patients 16% (28) were female. Patients were 67 (+/-11,4) years of age with a BMI of 32 kg/cm2 (+/-5,6). 34 had a history of heart failure (LVEF 40-49% = 2; =50% = 32). 17 were NYHA I, 21 were NYHA II, 6 were NYHA III. The patients exhibited diabetes (48), hypertension (143), coronary artery disease (39) and atrial fibrillation (59). 12 took sedatives, 25 opioids, 28 antidepressives, 95 ACE inhibitors, 94 beta blocker, 19 antiarrhythmics. 32% (46) had mild or moderate to severe daytime sleepiness at baseline (ESS score ?10). 24% had OSA, 25% had CSA and 40% had mixed SA (diagnostic AHI of 5-14 (7), 15-29 (24), =30 (19)). Questionnaire scores from baseline to follow-up will be compared to determine the effects of ASV therapy on QoL and health status, connected to usage patterns and patient characteristics. The registry will enrol 1000 patients in the EU and US
在不同的医疗条件下，ASV对生活质量(QoL)、依从性和益处的影响知之甚少。READ-ASV注册是一项针对新开始ASV治疗的患者的多中心前瞻性研究。方法:在欧洲5个国家(28个中心)开展ASV对生活质量、睡眠(问卷FOSQ、EQ5D、PSQI)和嗜睡(ESS)的影响。患者和治疗适应症的特点是人口统计学，合并症和潜在的睡眠障碍。记录ASV的日常使用情况、住院情况和死亡情况。结果:180例入组患者中有16%(28例)为女性。患者年龄为67岁(+/-11,4)，BMI为32 kg/cm2(+/-5,6)。34例有心力衰竭史(LVEF 40-49% = 2;=50% = 32)。NYHA I 17例，NYHA II 21例，NYHA III 6例。糖尿病48例，高血压143例，冠状动脉疾病39例，房颤59例。12人服用镇静剂，25人服用阿片类药物，28人服用抗抑郁药，95人服用ACE抑制剂，94人服用受体阻滞剂，19人服用抗心律失常药物。32%(46人)在基线时有轻度或中度至重度日间嗜睡(ESS评分?10)。24%为OSA, 25%为CSA, 40%为混合性SA(诊断AHI为5-14(7)，15-29(24)，=30(19))。将比较从基线到随访的问卷得分，以确定ASV治疗对生活质量和健康状况的影响，并将其与使用模式和患者特征联系起来。该登记处将在欧盟和美国登记1000名患者
{"title":"Registry on the treatment of central and complex sleep disordered breathing with adaptive servo-ventilation – the READ-ASV registry","authors":"H. Woehrle, O. Munt, J. Pépin, R. Heinzer, M. Arzt","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P26","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P26","url":null,"abstract":"Rationale Little is known about the effects of ASV on quality of life (QoL), compliance and benefits in different medical conditions. The READ-ASV registry is a multi-center, prospective study on patients with newly initiated ASV therapy. Methods: The registry is running in 5 European countries (28 centers) to investigate effects of ASV on QoL, sleep (questionnaires FOSQ, EQ5D, PSQI) and sleepiness (ESS). Patients and therapy indications are characterized by demographics, comorbidities and underlying sleep disorder. ASV daily usage, hospitalizations and deaths are recorded. Results: Of 180 enrolled patients 16% (28) were female. Patients were 67 (+/-11,4) years of age with a BMI of 32 kg/cm2 (+/-5,6). 34 had a history of heart failure (LVEF 40-49% = 2; =50% = 32). 17 were NYHA I, 21 were NYHA II, 6 were NYHA III. The patients exhibited diabetes (48), hypertension (143), coronary artery disease (39) and atrial fibrillation (59). 12 took sedatives, 25 opioids, 28 antidepressives, 95 ACE inhibitors, 94 beta blocker, 19 antiarrhythmics. 32% (46) had mild or moderate to severe daytime sleepiness at baseline (ESS score ?10). 24% had OSA, 25% had CSA and 40% had mixed SA (diagnostic AHI of 5-14 (7), 15-29 (24), =30 (19)). Questionnaire scores from baseline to follow-up will be compared to determine the effects of ASV therapy on QoL and health status, connected to usage patterns and patient characteristics. The registry will enrol 1000 patients in the EU and US","PeriodicalId":103744,"journal":{"name":"Obesity Hypoventilation Syndrome, Central Sleep Apnoea and Neurologic Diseases","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126532263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P32
J. Spiesshoefer, C. Henke, S. Herkenrath, W. Randerath, P. Young, M. Boentert
Background: Cervical and cortical magnetic stimulation (CEMS and COMS) of the phrenic nerves using surface electrodes and transnasally inserted balloon catheters allows evaluation of contractile and electrophysiological properties of the diaphragm. Facioscapulohumeral muscular dystrophy (FSHD) is characterized by progressive weakness of facial and limb muscles but diaphragm involvement has been insufficiently explored. Methods: 12 patients with genetically proven FSHD (8 men, 4 women; 52±17 years) and 12 healthy controls matched for age and gender (7 men, 5 women; 51±14 years) underwent COMS and CEMS of the phrenic nerves with simultaneous recording of twitch oesophageal and gastric pressures (twPes, twPgas). Diaphragm motor evoked (dMEP) and compound muscle action potential (dcMAP) were simultaneously recorded from the lower costal margin using surface electrodes. Results: In FSHD patients (FVC 74.25 ±29.76 % vs. 111.50 ± 17.26 %, p Conclusions: There is diaphragm involvement in patients with FSHD, and it appears to be exclusively myopathic in nature.
背景:使用表面电极和经鼻插入球囊导管对膈神经进行颈椎和皮质磁刺激(CEMS和COMS)，可以评估膈神经的收缩和电生理特性。面肩肱骨肌营养不良症(FSHD)的特征是面部和肢体肌肉进行性无力，但膈肌的累及尚未充分探讨。方法:12例经遗传学证实的FSHD患者(男8例，女4例;52±17岁)和12名年龄和性别匹配的健康对照(男性7名，女性5名;51±14岁)行膈神经COMS和CEMS，同时记录食管和胃的抽搐压力(twPes, twPgas)。用表面电极同时记录下下肋缘膈肌运动诱发电位(dMEP)和复合肌动作电位(dcMAP)。结果:FSHD患者的FVC(74.25±29.76% vs. 111.50±17.26%)p结论:FSHD患者有横膈膜受累，在本质上似乎是完全的肌病。
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Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p28
J. Spiesshoefer, C. Henke, S. Herkenrath, W. Randerath, P. Young, M. Boentert
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