Publications by authors named "David Gozal"

679 Publications

Design of Clinical Trials Evaluating Sedation in Critically Ill Adults Undergoing Mechanical Ventilation: Recommendations From Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research (SCEPTER) Recommendation III.

Crit Care Med 2021 Apr 28. Epub 2021 Apr 28.

1 Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. 2 University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3School of Health Sciences, University of London, London, United Kingdom. 4 School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia. 5 Center of Healthy Aging, Self-Management, and Complex Care, The Ohio State University, College of Nursing, Columbus, OH. 6 Clear Consults, LLC, Hayward, WI. 7 Leslie Dan Faculty of Pharmacy, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. 8 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD. 9 Departments of Anesthesiology and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. 10 School of Pharmacy, Northeastern University, Boston, MA 11 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA. 12 Department of Anesthesia, University of Iowa, Iowa City, IA. 13 Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. 14 Department of Anesthesiology, University of Utah, Salt Lake City, UT. 15 Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia. 16 Intensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 17 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA. 18 Department of Medicine, Tufts University School of Medicine, Maine Medical Center, Portland, ME. 9 Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 20 Division of Anesthesiology and CCM, Hadassah Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel. 21 Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT. 22 Center for Humanizing Critical Care, Intermountain Medical Center, Murray, UT. 23 Department of Medicine, Section of Pulmonary and Critical Care, The University of Chicago, Chicago, IL. 24 Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA. 25 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD. 26 Department of Anesthesiology and the Critical Illness, Vanderbilt University Medical Center, Nashville, TN. 27 Department of Critical Care Services, Maine Medical Center, Portland, ME. 28 Department of Outcomes Research, Cleveland Clinic, Cleveland, OH. 29 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA. 30 Monash Health School of Clinical Sciences - Department of Intensive Care Medicine - Critical Care Research, Melbourne, VIC, Australia. 31 Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte & Campus Virchow-Klinikum, Berlin, Germany. 32 Department of Anesthesiology, Columbia University Medical Center, New York, NY. 33 Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL. 34 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Objectives: Clinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators.

Design: A 2-day in-person meeting was held in Washington, DC, on March 28-29, 2019, followed by a three-round, online modified Delphi consensus process.

Participants: Thirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process.

Measurements And Main Results: The final recommendations were iteratively refined based on the survey results, participants' reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization.

Conclusions: These recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.
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http://dx.doi.org/10.1097/CCM.0000000000005049DOI Listing
April 2021

Gestational sleep apnea perturbations induce metabolic disorders by divergent epigenomic regulation.

Epigenomics 2021 May 30;13(10):751-765. Epub 2021 Apr 30.

Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65212, USA.

Late-gestational sleep fragmentation (LG-SF) and intermittent hypoxia (LG-IH), two hallmarks of obstructive sleep apnea, lead to metabolic dysfunction in the offspring. We investigated specific biological processes that are epigenetically regulated by LG-SF and LG-IH. We analyzed DNA methylation profiles in offspring visceral white adipose tissues by MeDIP-chip followed by pathway analysis. We detected 1187 differentially methylated loci (p < 0.01) between LG-SF and LG-IH. Epigenetically regulated genes in LG-SF offspring were associated with lipid and glucose metabolism, whereas those in LG-IH were related to inflammatory signaling and cell proliferation. While LG-SF and LG-IH will result in equivalent phenotypic alterations in offspring, each paradigm appears to operate through epigenetic regulation of different biological processes.
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http://dx.doi.org/10.2217/epi-2020-0435DOI Listing
May 2021

Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea.

J Clin Med 2021 Apr 1;10(7). Epub 2021 Apr 1.

CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain.

In the treatment of obstructive sleep apnea (OSA), the current standard of "CPAP titration" in the laboratory or at home is a resource demanding and costly approach that, in developed economies, markedly augments healthcare costs and in low resource economies precludes access to care altogether. Here, we discuss that current guidelines for titration of CPAP could be obviated by taking a different route that in many ways is similar to the institution of treatment in many other medical conditions. To this effect, we present novel population based data from 16,780 patients, showing that after individualized and labor-intensive and expensive CPAP titration, 86.4% of OSA patients are treated with nasal pressure settings within the range of 9 ± 2 cmHO, and review the literature to justify the potential adoption of a standard therapeutic CPAP setting as the initial intervention which would be subsequently followed by any necessary adjustments in only a minority of patients who would not derive the necessary benefit from such standardized intervention. Assuming an 80-85% success rate as derived from our analyses, our personal view if extensively adopted could radically reduce healthcare costs and enable markedly improve access to diagnostics.
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http://dx.doi.org/10.3390/jcm10071453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037765PMC
April 2021

Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-lab titration?

J Clin Sleep Med 2021 Apr 28. Epub 2021 Apr 28.

Department of Child Health, University of Missouri School of Medicine, Columbia, MO.

Study Objectives: The first-choice therapy for adults with moderate/severe obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration.

Methods: This cross-sectional study was conducted in adults diagnosed with moderate/severe OSA (baseline apnea-hypopnea index [AHI] ≥ 15.0/h), who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep-lab setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95 percentile pressure).

Results: A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values as delineated during the titration; all p-values > 0.005. However, the median residual AHI was significantly higher in males versus females: 2.7/h versus 2.2/h (p = 0.008). Body mass index [BMI] (β: 0.292, p < 0.001), baseline AHI (β: 0.167, p < 0.001), and age (β: 0.065, p = 0.035) were independent predictors of the therapeutic CPAP level settings.

Conclusions: Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95 percentile CPAP requirement during an auto-adjusting CPAP titration.
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http://dx.doi.org/10.5664/jcsm.9282DOI Listing
April 2021

Effects of the COVID-19 lockdown on sleep duration in children and adolescents: A survey across different continents.

Pediatr Pulmonol 2021 Apr 22. Epub 2021 Apr 22.

Department of Child Health and Child Health Research Institute, Women's and Children's Hospital, University of Missouri School of Medicine, Columbia, Missouri, USA.

Background: A parent survey was conducted to assess the sleep habits of children residing in various countries before and during the SARS-CoV-2 pandemic. It was hypothesized that lockdown would be associated with increased sleep duration.

Methods: Outcomes were changes in bedtime, wake time, and sleep duration in the pandemic compared to before. Logistic regression was applied to evaluate the effects of age and covariates on outcomes.

Results: A total of 845 questionnaires completed from May 1 to June 10, 2020 were analyzed (45.8% female; age 3-17 years). During the pandemic, 23.1% of preschoolers, 46.2% of school-age children, and 89.8% of adolescents were going to bed after 10 p.m. on weekdays compared to 7.1%, 9.4%, and 57.1% respectively before the pandemic, with these proportions being higher on weekends. Likewise, 42.5% of preschoolers, 61.3% of school-age children, and 81.2% of adolescents were waking after 8 a.m. on weekdays (11.6%, 4.9%, and 10.3%, before) with these proportions being greater on weekends. Sleep duration did not change in 43% of participants on weekdays and in 46.2% on weekends. The 14-17 years group had fourfold increased odds for longer sleep duration on weekdays (p < .01), and children aged 6-13 years had twofold increased odds for longer sleep duration on weekends relative to the 3-5 years age group (p = .01).

Conclusions: Although lockdown was associated with later bedtime and wake time, this shift did not alter sleep duration in more than 40% of children. Yet, compared to preschoolers, high school-aged children were more likely to sleep more on weekdays and primary school children on weekends.
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http://dx.doi.org/10.1002/ppul.25367DOI Listing
April 2021

Digital solutions for sleep problems in children: A pilot study.

Pediatr Pulmonol 2021 Apr 15. Epub 2021 Apr 15.

DrLullaby LLC, Chicago, Illinois, USA.

Children with sleep difficulties have limited options for treatment. Advancements in technology allow for the digital delivery of evidence-based sleep strategies developed with a focus on cognitive behavioral therapy (CBT) approaches for insomnia. An initial survey study was conducted to assess the need and current management of sleep problems in pediatric populations. A secondary pilot study evaluated the effect of a digitally-delivered sleep strategy for the treatment of pediatric sleep problems. In the pilot study, participants had access to a mobile application which provided individualized CBT-focused sleep solutions delivered over 6-10 weeks. A total of 218 participants were surveyed to determine their need and approach for pediatric sleep problems. Approximately 74% reported sleep problems in children aged 0-1 (46%), 2-4 (67%), 5-12 (85%), and 13-17 (73%). In the pilot study, 11 families with pediatric sleep problems (children categorized as baby, toddler and school-aged) were enrolled and received the DrLullaby digital intervention. An improvement in key sleep behavior was observed including "time to fall asleep" (n = 8; 72.7%), "total time asleep" (n = 6; 54.5%) and "time awake" (n = 7; 63.6%). Within group analysis for time awake and time to fall asleep showed a mean change from baseline of 75.6% and 31.3%, respectively. Within group analysis for total time asleep showed a mean improvement of 1 h and 3 min compared to baseline. The collective distress scale score was decreased by 35%. These results suggest viability of the digital delivery of evidence-based sleep strategies for treatment of pediatric sleep problems.
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http://dx.doi.org/10.1002/ppul.25402DOI Listing
April 2021

Reliability of machine learning to diagnose pediatric obstructive sleep apnea: Systematic review and meta-analysis.

Pediatr Pulmonol 2021 Apr 15. Epub 2021 Apr 15.

Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.

Background: Machine-learning approaches have enabled promising results in efforts to simplify the diagnosis of pediatric obstructive sleep apnea (OSA). A comprehensive review and analysis of such studies increase the confidence level of practitioners and healthcare providers in the implementation of these methodologies in clinical practice.

Objective: To assess the reliability of machine-learning-based methods to detect pediatric OSA.

Data Sources: Two researchers conducted an electronic search on the Web of Science and Scopus using term, and studies were reviewed along with their bibliographic references.

Eligibility Criteria: Articles or reviews (Year 2000 onwards) that applied machine learning to detect pediatric OSA; reported data included information enabling derivation of true positive, false negative, true negative, and false positive cases; polysomnography served as diagnostic standard.

Appraisal And Synthesis Methods: Pooled sensitivities and specificities were computed for three apnea-hypopnea index (AHI) thresholds: 1 event/hour (e/h), 5 e/h, and 10 e/h. Random-effect models were assumed. Summary receiver-operating characteristics (SROC) analyses were also conducted. Heterogeneity (I ) was evaluated, and publication bias was corrected (trim and fill).

Results: Nineteen studies were finally retained, involving 4767 different pediatric sleep studies. Machine learning improved diagnostic performance as OSA severity criteria increased reaching optimal values for AHI = 10 e/h (0.652 sensitivity; 0.931 specificity; and 0.940 area under the SROC curve). Publication bias correction had minor effect on summary statistics, but high heterogeneity was observed among the studies.
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http://dx.doi.org/10.1002/ppul.25423DOI Listing
April 2021

A Mouse Model Suggests That Heart Failure and Its Common Comorbidity Sleep Fragmentation Have No Synergistic Impacts on the Gut Microbiome.

Microorganisms 2021 Mar 19;9(3). Epub 2021 Mar 19.

Barcelona Supercomputing Centre (BSC-CNS), 08034 Barcelona, Spain.

Heart failure (HF) is a common condition associated with a high rate of hospitalizations and adverse outcomes. HF is characterized by impairments of either the cardiac ventricular filling, ejection of blood capacity or both. Sleep fragmentation (SF) involves a series of short sleep interruptions that lead to fatigue and contribute to cognitive impairments and dementia. Both conditions are known to be associated with increased inflammation and dysbiosis of the gut microbiota. In the present study, mice were distributed into four groups, and subjected for four weeks to either HF, SF, both HF and SF, or left unperturbed as controls. We used 16S metabarcoding to assess fecal microbiome composition before and after the experiments. Evidence for distinct alterations in several bacterial groups and an overall decrease in alpha diversity emerged in HF and SF treatment groups. Combined HF and SF conditions, however, showed no synergism, and observed changes were not always additive, suggesting preliminarily that some of the individual effects of either HF or SF cancel each other out when applied concomitantly.
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http://dx.doi.org/10.3390/microorganisms9030641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003359PMC
March 2021

Adverse impact of polyphasic sleep patterns in humans: Report of the National Sleep Foundation sleep timing and variability consensus panel.

Sleep Health 2021 Mar 29. Epub 2021 Mar 29.

Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Polyphasic sleep is the practice of distributing multiple short sleep episodes across the 24-hour day rather than having one major and possibly a minor ("nap") sleep episode each day. While the prevalence of polyphasic sleep is unknown, anecdotal reports suggest attempts to follow this practice are common, particularly among young adults. Polyphasic-sleep advocates claim to thrive on as little as 2 hours of total sleep per day. However, significant concerns have been raised that polyphasic sleep schedules can result in health and safety consequences. We reviewed the literature to identify the impact of polyphasic sleep schedules (excluding nap or siesta schedules) on health, safety, and performance outcomes. Of 40,672 potentially relevant publications, with 2,023 selected for full-text review, 22 relevant papers were retained. We found no evidence supporting benefits from following polyphasic sleep schedules. Based on the current evidence, the consensus opinion is that polyphasic sleep schedules, and the sleep deficiency inherent in those schedules, are associated with a variety of adverse physical health, mental health, and performance outcomes. Striving to adopt a schedule that significantly reduces the amount of sleep per 24 hours and/or fragments sleep into multiple episodes throughout the 24-hour day is not recommended.
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http://dx.doi.org/10.1016/j.sleh.2021.02.009DOI Listing
March 2021

Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions.

J Clin Sleep Med 2021 Mar 22. Epub 2021 Mar 22.

School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Study Objectives: To analyze differences in mandibular cortical width (MCW) among children diagnosed with Obstructive sleep apnea (OSA) or at high- or low-risk for OSA.

Methods: 161 children were assessed: 60 children with polysomnographically (nPSG) diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low-risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire (PSQ). MCW was calculated from panoramic radiograph images available from all subjects using ImageJ software. Differences between MCW measurements in the three groups were evaluated using ANCOVA and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis.

Results: The participants' mean age was 9.6±3.1 years (59% male and 41% female). The mean BMI z-score was 0.62±1.3. The nPSG-OSA group presented smaller MCW than at low-risk for OSA group (mean difference= -0.385 mm, p=0.001), but no difference with the at high-risk for OSA group (nPSG-OSA vs. high-risk OSA: p=0.085). In addition, the MCW in the at high-risk for the OSA group was significantly smaller than the at low-risk for the OSA group (mean difference= -0.301 mm, p=0.014). The cephalometric variables (SNA and FMA) explained only 8% of the variance in MCW.

Conclusions: Reductions in MCW appear to be present among children with OSA or those at high risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA.
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http://dx.doi.org/10.5664/jcsm.9262DOI Listing
March 2021

A Reappraisal on the Associations Between Sleep-Disordered Breathing, Insomnia and Cardiometabolic Risk.

Am J Respir Crit Care Med 2021 Mar 19. Epub 2021 Mar 19.

University of Missouri School of Medicine, Columbia, MO 65201, USA, Department of Child Health, Columbia, Missouri, United States.

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http://dx.doi.org/10.1164/rccm.202102-0337LEDOI Listing
March 2021

Association between obstructive sleep apnea and health-related quality of life in untreated adults: a systematic review.

Sleep Breath 2021 Mar 11. Epub 2021 Mar 11.

Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.

Purpose: The objective of this systematic review was to answer the question: "Is there association between obstructive sleep apnea (OSA) and health-related quality of life (HRQoL) in untreated adults?"

Methods: We included observational studies that evaluated the health-related quality of life of patients with OSA vs control groups, through generic and disease-specific questionnaires. The searches were conducted in six databases: Embase, Lilacs, PsycINFO, PubMed, Scopus, and Web of Science. Additional search in the grey literature and hand search were performed, and also experts were consulted. Risk of bias was performed by using Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional, cohort, and case-control studies. We analyzed the data using a narrative synthesis. The Grading of Recommendations Assessment, Development, and Evaluation evidence profile was used to verify the overall certainty of the assessed evidence.

Results: Nineteen studies were included for qualitative analysis. Generic questionnaires showed worse HRQoL in the OSA group compared to the control group in at least one domain of the HRQoL questionnaires. The affected domains that showed statistical and clinically relevant differences were physical functioning, physical role, pain, general health, vitality, emotional role, and mental health. The certainty of evidence assessment was very low.

Conclusion: The available literature suggests that OSA in untreated adults is associated with worse HRQoL. However, this association seems to disappear when we consider only studies adjusted for related covariates.

Registration: CRD42018114746.
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http://dx.doi.org/10.1007/s11325-021-02323-1DOI Listing
March 2021

Wavelet Analysis of Overnight Airflow to Detect Obstructive Sleep Apnea in Children.

Sensors (Basel) 2021 Feb 21;21(4). Epub 2021 Feb 21.

Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain.

This study focused on the automatic analysis of the airflow signal (AF) to aid in the diagnosis of pediatric obstructive sleep apnea (OSA). Thus, our aims were: () to characterize the overnight AF characteristics using discrete wavelet transform (DWT) approach, () to evaluate its diagnostic utility, and () to assess its complementarity with the 3% oxygen desaturation index (3). In order to reach these goals, we analyzed 946 overnight pediatric AF recordings in three stages: () DWT-derived feature extraction, () feature selection, and () pattern recognition. AF recordings from OSA patients showed both lower detail coefficients and decreased activity associated with the normal breathing band. Wavelet analysis also revealed that OSA disturbed the frequency and energy distribution of the AF signal, increasing its irregularity. Moreover, the information obtained from the wavelet analysis was complementary to 3. In this regard, the combination of both wavelet information and 3 achieved high diagnostic accuracy using the common OSA-positive cutoffs: 77.97%, 81.91%, and 90.99% (AdaBoost.M2), and 81.96%, 82.14%, and 90.69% (Bayesian multi-layer perceptron) for 1, 5, and 10 apneic events/hour, respectively. Hence, these findings suggest that DWT properly characterizes OSA-related severity as embedded in nocturnal AF, and could simplify the diagnosis of pediatric OSA.
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http://dx.doi.org/10.3390/s21041491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926995PMC
February 2021

Clinical validation of a mandibular movement signal based system for the diagnosis of pediatric sleep apnea.

Pediatr Pulmonol 2021 Mar 1. Epub 2021 Mar 1.

Department of Child Health, University of Missouri, Columbia, Missouri, USA.

Background: Given the high prevalence and risk for outcomes associated with pediatric obstructive sleep apnea (OSA), there is a need for simplified diagnostic approaches. A prospective study in 140 children undergoing in-laboratory polysomnography (PSG) evaluates the accuracy of a recently developed system (Sunrise) to estimate respiratory efforts by monitoring sleep mandibular movements (MM) for the diagnosis of OSA (Sunrise).

Methods: Diagnosis and severity were defined by an obstructive apnea/hypopnea index (OAHI) ≥ 1 (mild), ≥ 5 (moderate), and ≥ 10 events/h (severe). Agreement between PSG and Sunrise was assessed by Bland-Altman method comparing respiratory disturbances hourly index (RDI) (obstructive apneas, hypopneas, and respiratory effort-related arousals) during PSG (PSG_RDI), and Sunrise RDI (Sr_RDI). Performance of Sr_RDI was determined via ROC curves evaluating the device sensitivity and specificity at PSG_OAHI ≥ 1, 5, and 15 events/h.

Results: A median difference of 1.57 events/h, 95% confidence interval: -2.49 to 8.11 was found between Sr_RDI and PSG_RDI. Areas under the ROC curves of Sr_RDI were 0.75 (interquartile range [IQR]: 0.72-0.78), 0.90 (IQR: 0.86-0.92) and 0.95 (IQR: 0.90-0.99) for detecting children with PSG_OAHI ≥ 1, PSG_OAHI ≥ 5, or PSG_ OAHI ≥ 10, respectively.

Conclusion: MM automated analysis shows significant promise to diagnose moderate-to-severe pediatric OSA.
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http://dx.doi.org/10.1002/ppul.25320DOI Listing
March 2021

Prediction of obstructive sleep apnea using GOAL questionnaire in adults with or without excessive daytime sleepiness: A cross-sectional study.

Sleep Health 2021 Apr 22;7(2):212-218. Epub 2021 Feb 22.

Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, USA.

Objective: Obstructive sleep apnea (OSA) is a prevalent disorder and excessive daytime sleepiness (EDS) is a frequently associated complaint. Our objectives were (1) to evaluate the predictive performance of the GOAL questionnaire in patients with or without EDS and (2) to compare its discrimination with that of 3 other validated instruments: STOP-Bang, No-Apnea, and NoSAS.

Methods: A cross-sectional study from July 2019 to March 2020 was designed with consecutive adults undergoing full polysomnography. Participants were grouped into 2 cohorts according to the Epworth Sleepiness Scale (ESS): without EDS (ESS <11) or with EDS (ESS ≥11). Discrimination was assessed by area under the curve, while predictive parameters were calculated using contingency tables. OSA severity was classified based on apnea/hypopnea index thresholds: ≥ 5.0/h (OSA), ≥ 15.0/h (OSA), and ≥ 30.0/h (OSA).

Results: Overall, 2627 patients were enrolled. In 1477 individuals without EDS, for the screening of OSA, OSA, and OSA, GOAL showed sensitivities ranging from 79.3% to 91.5% and specificities ranging from 60.6% to 40.2%. In 1150 individuals with EDS, for the screening of OSA, OSA, and OSA, GOAL reported sensitivities ranging from 86.2% to 94.5% and specificities ranging from 63.9% to 36.0%. In both cohorts, GOAL showed similar discrimination to STOP-Bang, No-Apnea, and NoSAS for predicting OSA, OSA, and OSA (all P values >.05).

Conclusions: The GOAL questionnaire, a practical 4-item instrument, showed adequate predictive performance for the prediction of OSA. Moreover, its discrimination was satisfactory and non-inferior to that of STOP-Bang, No-Apnea, and NoSAS.
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http://dx.doi.org/10.1016/j.sleh.2021.01.003DOI Listing
April 2021

Pierre Robin and breathing: What to do and when?

Pediatr Pulmonol 2021 Feb 13. Epub 2021 Feb 13.

Department of Child Health, University of Missouri, Columbia, Missouri, USA.

Robin sequence is characterized by mandibular retrognathia, airway obstruction, and glossoptosis; 80%-90% also have a cleft palate. Various treatment approaches exist, and although controlled studies are rare, objective assessment of treatment outcomes that address the leading clinical issues, namely obstructive sleep apnea and failure to thrive, are essential. Sleep-disordered breathing may be detected using cardiorespiratory polygraphy or polysomnography. Pulse oximetry alone may miss infants with frequent obstructive apneas, yet no intermittent hypoxia. Among conservative treatment options, the Tubingen Palatal Plate with a velar extension shifting the tongue base forward is the only approach that corrects the underlying anatomy and that has undergone appropriate evaluation. Of the surgical treatment options, which are not necessarily the first line of therapy, mandibular distraction osteogenesis (MDO) is effective and has been most extensively adopted. Notwithstanding, it is puzzling that MDO is frequently used in some countries, yet hardly ever in others, despite similar tracheostomy rates. Thus, prospective multicenter studies with side-by-side comparisons aimed at identifying an optimal treatment paradigm for this potentially life-threatening condition are urgently needed.
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http://dx.doi.org/10.1002/ppul.25317DOI Listing
February 2021

Clinical presentation and outcomes of the first patients with COVID-19 in Argentina: Results of 207079 cases from a national database.

PLoS One 2021 11;16(2):e0246793. Epub 2021 Feb 11.

Servicio de Neumonología, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.

Background: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina.

Research Question: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality?

Study Design And Methods: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens.

Results: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects.

Interpretation: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246793PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877635PMC
February 2021

Circulating exosomes and gut microbiome induced insulin resistance in mice exposed to intermittent hypoxia: Effects of physical activity.

EBioMedicine 2021 Feb 21;64:103208. Epub 2021 Jan 21.

Department of Child Health and the Child Health Research Institute, University of Missouri, School of Medicine, Columbia, 400N. Keene Street, Suite 010, MO 65201, United States. Electronic address:

Background: Gut microbiota (GM) contribute to obesity and insulin resistance (IR). Obstructive sleep apnea (OSA), characterized by intermittent hypoxia (IH), promotes IR and alters GM. Since circulating exosomes are implicated in IR, we examined the effects of IH and physical activity (PA) in mice on GM, colonic epithelium permeability, systemic IR, and plasma exosome cargo, and exosome effects on visceral white adipose tissues (vWAT) IR.

Methods: C57BL/6 mice were exposed to IH or room air (RA) for 6 weeks with and without PA (n = 12/group), and GM and systemic IR changes were assessed, as well as the effects of plasma exosomes on naïve adipocyte insulin sensitivity. Fecal microbiota transfers (FMT) were performed in naïve mice (n = 5/group), followed by fecal 16S rRNA sequencing, and systemic IR and exosome-induced effects on adipocyte insulin sensitivity were evaluated.

Findings: Principal coordinate analysis (PCoA) ordinates revealed B-diversity among IH and FMT recipients that accounted for 64% principal component 1 (PC1) and 12.5% (PC2) of total variance. Dominant microbiota families and genera in IH-exposed and FMT-treated were preserved, and IH-exposed GM and IH-FMT induced increased gut permeability. Plasma exosomes from IH-exposed and IH-FMT mice decreased pAKT/AKT responses to exogenous insulin in adipocytes vs. IH+PA or RA FMT-treated mice (p = 0.001).

Interpretation: IH exposures mimicking OSA induce changes in GM, increase gut permeability, and alter plasma exosome cargo, the latter inducing adipocyte dysfunction (increased IR). Furthermore, these alterations improved with PA. Thus, IH leads to perturbations of a singular GM-circulating exosome pathway that disrupts adipocyte homeostasis resulting in metabolic dysfunction, as reflected by IR.

Funding: This study was supported by grants from the National Institutes of Health grants HL130984 and HL140548 and University of Missouri Tier 2 grant. The study has not received any funding or grants from pharmaceutical or other industrial corporations.
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http://dx.doi.org/10.1016/j.ebiom.2021.103208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910674PMC
February 2021

Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology.

Methods Protoc 2021 Jan 19;4(1). Epub 2021 Jan 19.

Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain.

Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.
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http://dx.doi.org/10.3390/mps4010009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838960PMC
January 2021

The effect of chronic intermittent hypoxia in cardiovascular gene expression is modulated by age in a mice model of sleep apnea.

Sleep 2021 Jan 8. Epub 2021 Jan 8.

Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria; IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.

Study Objectives: Chronic intermittent hypoxia (CIH) is a major determinant in OSA cardiovascular morbidity and this effect is influenced by age. The objective of the present study was to assess the differential molecular mechanisms at gene level expression involved in the cardiovascular remodeling induced by CIH according to chronological age.

Methods: Two-month and 18-month old mice (N=8 each) were subjected to CIH or normoxia for 8-weeks. Total mRNA was extracted from left ventricle myocardium and aortic arch, and gene expression of 46 intermediaries of aging, oxidative stress and inflammation was measured by quantitative real time PCR.

Results: Cardiac gene expression of Nrf2 (2.05-fold increase, p<0.001), Sod2 (1.9-fold increase, p=0.035), Igf1r (1.4-fold increase, p=0.028), Mtor (1.8-fold increase, p=0.06), Foxo3 (1.5-fold increase, p=0.020), Sirt4, Sirt6, and Sirt7 (1.3-fold increase, p=0.012; 1.1-fold change, p=0.031; 1.3-fold change, p=0.029) was increased after CIH in young mice, but not in old mice. In aortic tissue, eNOS was reduced in young mice (p<0.001), Nrf2 was reduced in 80% (p<0.001) in young mice and in 45% (p=0.07) in old mice, as its downstream antioxidant target Sod2 (82% reduced, p<0.001). IL33.

Conclusions: CIH effect in gene expression is organ-dependent, and is modulated by age. CIH increased transcriptional expression of genes involved in cardioprotection and cell survival in young, but not in old mice. In aortic tissue, CIH reduced gene expression related to an antioxidant response in both young and old mice, suggesting vascular oxidative stress and a pro-aging process.
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http://dx.doi.org/10.1093/sleep/zsaa293DOI Listing
January 2021

A convolutional neural network architecture to enhance oximetry ability to diagnose pediatric obstructive sleep apnea.

IEEE J Biomed Health Inform 2021 Jan 6;PP. Epub 2021 Jan 6.

This study aims at assessing the usefulness of deep learning to enhance the diagnostic ability of oximetry in the context of automated detection of pediatric obstructive sleep apnea (OSA). A total of 3196 blood oxygen saturation (SpO2) signals from children were used for this purpose. A convolutional neural network (CNN) architecture was trained using 20-min SpO2 segments from the training set (859 subjects) to estimate the number of apneic events. CNN hyperparameters were tuned using Bayesian optimization in the validation set (1402 subjects). This model was applied to three test sets composed of 312, 392, and 231 subjects from three independent databases, in which the apnea-hypopnea index (AHI) estimated for each subject (AHICNN) was obtained by aggregating the output of the CNN for each 20-min SpO2 segment. AHICNN outperformed the 3% oxygen desaturation index (ODI3), a clinical approach, as well as the AHI estimated by a conventional feature-engineering approach based on multi-layer perceptron (AHIMLP). Specifically, AHICNN reached higher four-class Cohen's kappa in the three test databases than ODI3 (0.515 vs 0.417, 0.422 vs 0.372, and 0.423 vs 0.369) and AHIMLP (0.515 vs 0.377, 0.422 vs 0.381, and 0.423 vs 0.306). In addition, our proposal outperformed state-of-the-art studies, particularly for the AHI severity cutoffs of 5 e/h and 10 e/h. This suggests that the information automatically learned from the SpO2 signal by deep-learning techniques helps to enhance the diagnostic ability of oximetry in the context of pediatric OSA.
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http://dx.doi.org/10.1109/JBHI.2020.3048901DOI Listing
January 2021

Bispectral analysis of overnight airflow to improve the pediatric sleep apnea diagnosis.

Comput Biol Med 2021 Feb 7;129:104167. Epub 2020 Dec 7.

Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain.

Pediatric Obstructive Sleep Apnea (OSA) is a respiratory disease whose diagnosis is performed through overnight polysomnography (PSG). Since it is a complex, time-consuming, expensive, and labor-intensive test, simpler alternatives are being intensively sought. In this study, bispectral analysis of overnight airflow (AF) signal is proposed as a potential approach to replace PSG when indicated. Thus, our objective was to characterize AF through bispectrum, and assess its performance to diagnose pediatric OSA. This characterization was conducted using 13 bispectral features from 946 AF signals. The oxygen desaturation index ≥3% (ODI3), a common clinical measure of OSA severity, was also obtained to evaluate its complementarity to the AF bispectral analysis. The fast correlation-based filter (FCBF) and a multi-layer perceptron (MLP) were used for subsequent automatic feature selection and pattern recognition stages. FCBF selected 3 bispectral features and ODI3, which were used to train a MLP model with ability to estimate apnea-hypopnea index (AHI). The model reached 82.16%, 82.49%, and 90.15% accuracies for the common AHI cut-offs 1, 5, and 10 events/h, respectively. The different bispectral approaches used to characterize AF in children provided complementary information. Accordingly, bispectral analysis showed that the occurrence of apneic events decreases the non-gaussianity and non-linear interaction of the AF harmonic components, as well as the regularity of the respiratory patterns. Moreover, the bispectral information from AF also showed complementarity with ODI3. Our findings suggest that AF bispectral analysis may serve as a useful tool to simplify the diagnosis of pediatric OSA, particularly for children with moderate-to-severe OSA.
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http://dx.doi.org/10.1016/j.compbiomed.2020.104167DOI Listing
February 2021

Transcriptomic Changes of Murine Visceral Fat Exposed to Intermittent Hypoxia at Single Cell Resolution.

Int J Mol Sci 2020 Dec 29;22(1). Epub 2020 Dec 29.

Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65211, USA.

Intermittent hypoxia (IH) is a hallmark of obstructive sleep apnea (OSA) and induces metabolic dysfunction manifesting as inflammation, increased lipolysis and insulin resistance in visceral white adipose tissues (vWAT). However, the cell types and their corresponding transcriptional pathways underlying these functional perturbations are unknown. Here, we applied single nucleus RNA sequencing (snRNA-seq) coupled with aggregate RNA-seq methods to evaluate the cellular heterogeneity in vWAT following IH exposures mimicking OSA. C57BL/6 male mice were exposed to IH and room air (RA) for 6 weeks, and nuclei from vWAT were isolated and processed for snRNA-seq followed by differential expressed gene (DEGs) analyses by cell type, along with gene ontology and canonical pathways enrichment tests of significance. IH induced significant transcriptional changes compared to RA across 14 different cell types identified in vWAT. We identified cell-specific signature markers, transcriptional networks, metabolic signaling pathways, and cellular subpopulation enrichment in vWAT. Globally, we also identify 298 common regulated genes across multiple cellular types that are associated with metabolic pathways. Deconvolution of cell types in vWAT using global RNA-seq revealed that distinct adipocytes appear to be differentially implicated in key aspects of metabolic dysfunction. Thus, the heterogeneity of vWAT and its response to IH at the cellular level provides important insights into the metabolic morbidity of OSA and may possibly translate into therapeutic targets.
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http://dx.doi.org/10.3390/ijms22010261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795619PMC
December 2020

Potential Effects of the COVID-19 Pandemic on Future Birth Rate.

Front Public Health 2020 10;8:578438. Epub 2020 Dec 10.

Department of Child Health, MU Women's and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, United States.

Here, we examine the potential effect of the COVID-19 pandemic on future birth rates. This highly contagious disease originated in China, and rapidly spread worldwide, leading to extensive lockdown policies being implemented globally with the aim of containing the infection rates and its serious attendant consequences. Based on previous extant literature, this paper overviews the potential demographic consequences of the current progressively widespread epidemic on conception and fertility as driven by the data obtained during similar prior incidents. In general, epidemics manifest a common pattern as far as their impact on population, which is remarkably similar to natural disasters, i.e., a steep decline in birth rates followed by gradual increases and then followed by a baby boom. Additionally, we have also depicted how economic conditions, mental health, fear, and mortality may also influence future birth rates.
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http://dx.doi.org/10.3389/fpubh.2020.578438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758229PMC
January 2021

Assessment of Airflow and Oximetry Signals to Detect Pediatric Sleep Apnea-Hypopnea Syndrome Using AdaBoost.

Entropy (Basel) 2020 Jun 17;22(6). Epub 2020 Jun 17.

Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain.

The reference standard to diagnose pediatric Obstructive Sleep Apnea (OSA) syndrome is an overnight polysomnographic evaluation. When polysomnography is either unavailable or has limited availability, OSA screening may comprise the automatic analysis of a minimum number of signals. The primary objective of this study was to evaluate the complementarity of airflow (AF) and oximetry (SpO) signals to automatically detect pediatric OSA. Additionally, a secondary goal was to assess the utility of a multiclass AdaBoost classifier to predict OSA severity in children. We extracted the same features from AF and SpO signals from 974 pediatric subjects. We also obtained the 3% Oxygen Desaturation Index (ODI) as a common clinically used variable. Then, feature selection was conducted using the Fast Correlation-Based Filter method and AdaBoost classifiers were evaluated. Models combining ODI 3% and AF features outperformed the diagnostic performance of each signal alone, reaching 0.39 Cohens's kappa in the four-class classification task. OSA vs. No OSA accuracies reached 81.28%, 82.05% and 90.26% in the apnea-hypopnea index cutoffs 1, 5 and 10 events/h, respectively. The most relevant information from SpO was redundant with ODI 3%, and AF was complementary to them. Thus, the joint analysis of AF and SpO enhanced the diagnostic performance of each signal alone using AdaBoost, thereby enabling a potential screening alternative for OSA in children.
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http://dx.doi.org/10.3390/e22060670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517204PMC
June 2020

Sleep Apnoea Adverse Effects on Cancer: True, False, or Too Many Confounders?

Int J Mol Sci 2020 Nov 20;21(22). Epub 2020 Nov 20.

Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain.

Obstructive sleep apnoea (OSA) is a prevalent disorder associated with increased cardiovascular, metabolic and neurocognitive morbidity. Recently, an increasing number of basic, clinical and epidemiological reports have suggested that OSA may also increase the risk of cancer, and adversely impact cancer progression and outcomes. This hypothesis is convincingly supported by biological evidence linking certain solid tumours and hypoxia, as well as by experimental studies involving cell and animal models testing the effects of intermittent hypoxia and sleep fragmentation that characterize OSA. However, the clinical and epidemiological studies do not conclusively confirm that OSA adversely affects cancer, even if they hold true for specific cancers such as melanoma. It is likely that the inconclusive studies reflect that they were not specifically designed to test the hypothesis or because of the heterogeneity of the relationship of OSA with different cancer types or even sub-types. This review critically focusses on the extant basic, clinical, and epidemiological evidence while formulating proposed directions on how the field may move forward.
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http://dx.doi.org/10.3390/ijms21228779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699730PMC
November 2020

Effects of Normoxic Recovery on Intima-Media Thickness of Aorta and Pulmonary Artery Following Intermittent Hypoxia in Mice.

Front Physiol 2020 22;11:583735. Epub 2020 Oct 22.

Department of Child Health and the Child Health Research Institute, MU Women's and Children's Hospital, University of Missouri, Columbia, MO, United States.

Obstructive sleep apnea (OSA) patients are at risk for increased blood pressure and carotid intima-media thickness (IMT), with pulmonary hypertension and right-sided heart failure potentially developing as well. Chronic intermittent hypoxia (IH) has been used as an OSA model in animals, but its effects on vascular beds have not been evaluated using objective unbiased tools. Previously published and current experimental data in mice exposed to IH were evaluated for IMT in aorta and pulmonary artery (PA) after IH with or without normoxic recovery using software for meta-analysis, Review Manager 5. Because IMT data reports on PA were extremely scarce, atherosclerotic area percentage from lumen data was also evaluated. IH significantly increased IMT parameters in both aorta and PA as illustrated by Forest plots ( < 0.01), which also confirmed that IMT values after normoxic recovery were within the normal range in both vascular beds. One-sided scarce lower areas in Funnel Plots were seen for both aorta and PA indicating the likelihood of significant publication bias. Forest and Funnel plots, which provide unbiased assessments of published and current data, suggest that IH exposures may induce IMT thickening that may be reversed by normoxic recovery in both aorta and PA. In light of the potential likelihood of publication bias, future studies are needed to confirm or refute the findings. In conclusion, OSA may induce IMT thickening (e.g., aorta and/or PA), but the treatment (e.g., nasal continuous positive airway pressure) will likely lead to improvements in such findings.
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http://dx.doi.org/10.3389/fphys.2020.583735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645053PMC
October 2020

Clinico-epidemiologic characteristics of the 2019 dengue outbreak in Bangladesh.

Trans R Soc Trop Med Hyg 2020 Nov 15. Epub 2020 Nov 15.

Department of Child Health, MU Women's and Children's Hospital University of Missouri School of Medicine, Columbia, MO, USA.

Background: Dengue fever shows a broad range of clinical presentations worldwide. Here we report on our clinical findings during the 2019 dengue outbreak in one of the largest tertiary care hospitals in Dhaka, the capital of Bangladesh.

Methods: A total of 747 suspected dengue cases (553 confirmed and 194 probable) were interviewed with a pro forma case record form. Statistical analyses were conducted using SPSS 20.0. Ethical clearance was obtained from the Dhaka Medical College.

Results: The mean age of the dengue cases was 27 y and approximately two-thirds were male. Positive tests for NS1 and anti-dengue immunoglobulin M antibody were present in 91.9% and 59.4% of the cases, respectively. Thrombocytopenia was present in 69% of cases and fever was present in 99.1% of cases. Gastrointestinal (GI) features, including anorexia and/or vomiting (69.4%), abdominal pain (39.8%) and diarrhoea (25.6%), were more prevalent than typical rash and pain symptoms. Hypotension was present in approximately one-quarter of patients (25.4%). Probable and confirmed dengue cases have shown similar clinical characteristics and laboratory findings.

Conclusions: The 2019 outbreak of dengue fever in Bangladesh was characterized by increased presentation with GI features. Recognition of this trend would permit early diagnosis and proper management of patients.
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http://dx.doi.org/10.1093/trstmh/traa126DOI Listing
November 2020

The gut microbiome as a target for adjuvant therapy in obstructive sleep apnea.

Expert Opin Ther Targets 2020 12 4;24(12):1263-1282. Epub 2020 Dec 4.

Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine , Columbia, MO, USA.

: Gut dysbiosis is assumed to play a role in obstructive sleep apnea (OSA)-associated morbidities. Pre- and probiotics, short chain fatty acids (SCFA) and fecal matter transplantation (FMT) may offer potential as novel therapeutic strategies that target this gut dysbiosis. As more mechanisms of OSA-induced dysbiosis are being elucidated, these novel approaches are being tested in preclinical and clinical development. : We examined the evidence linking OSA to gut dysbiosis and discuss the effects of pre- and probiotics on associated cardiometabolic, neurobehavioral and gastrointestinal disorders. The therapeutic potential of SCFA and FMT are also discussed. We reviewed the National Center for Biotechnology Information database, including PubMed and PubMed Central between 2000 - 2020. : To date, there are no clinical trials and only limited evidence from animal studies describing the beneficial effects of pre- and probiotic supplementation on OSA-mediated dysbiosis. Thus, more work is necessary to assess whether prebiotics, probiotics and SCFA are promising future novel strategies for targeting OSA-mediated dysbiosis.
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http://dx.doi.org/10.1080/14728222.2020.1841749DOI Listing
December 2020

Physical inactivity and sedentary behaviors in the Bangladeshi population during the COVID-19 pandemic: An online cross-sectional survey.

Heliyon 2020 Oct 30;6(10):e05392. Epub 2020 Oct 30.

Department of Child Health and the Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO 65201, USA.

This study aimed to determine the prevalence of physical inactivity and sedentary behaviors during the COVID-19 pandemic among Bangladeshi people. An online survey was conducted among 2,028 people over a period of 10 days on June, 2020 during the COVID-19 pandemic at a time that the number of newly diagnosed cases was increasing, lockdown was still in place. Survey questions included socio-demographics and an adapted version of the IPAQ-SF to assess physical activity and sedentary behaviors. The prevalence rates of physical inactivity (<600 MET-minutes/week) and high sedentary behaviors (≥8 h/day) among Bangladeshi people were 37.9% and 20.9%, respectively. Regression analyses revealed that young age, being a student, from a middle-class family, or upper-class family, living with nuclear family, urban living, and suffering from no chronic diseases were all associated with physical inactivity and high sedentary behaviors. Moreover, physical inactivity and high sedentary behavior were strongly interrelated. However, many of the univariate risk factors exhibited interdependency. During the COVID-19 pandemic coinciding with lockdown measures a sizeable proportion of Bangladeshi people were physically inactive and reported sedentary behaviors ≥8 h/day. Public campaigns and media-based interventions encouraging home-based physical activities should be promoted to attenuate the impact of lockdown measures during a pandemic.
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http://dx.doi.org/10.1016/j.heliyon.2020.e05392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598079PMC
October 2020