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Pnina Weiss, Meir Kryger
Positive airway pressure (PAP) is considered first-line therapy for moderate to severe obstructive sleep apnea and may also be considered for mild obstructive sleep apnea, particularly if it is symptomatic or there are concomitant cardiovascular disorders. Continuous PAP is most commonly used. Other modes, such as bilevel airway pressure, autotitrating positive airway pressure, average volume assured pressure support, and adaptive support ventilation, play important roles in the management of sleep-related breathing disorders...
October 6, 2016: Otolaryngologic Clinics of North America
Gyambo Sithey, Li Ming Wen, Patrick Kelly, Mu Li
STUDY OBJECTIVES: Our aim was to identify clinical predictors associated with changes in settings for pediatric invasive and noninvasive positive airway pressure therapy, which could help inform the allocation of limited polysomnogram (PSG) resources. METHODS: A retrospective review was conducted in children who underwent one or more PSGs for technology titration. Children were included if they were using continuous positive airway pressure (CPAP) therapy, bilevel positive airway pressure (BPAP) therapy, or invasive positive pressure ventilation (IPPV) the night of the PSG...
September 29, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Rita Machaalani, Carla A Evans, Karen A Waters
PURPOSE: This study aimed to objectively measure adherence (compliance) and effectiveness of CPAP and BiLevel pressure support in an Australian paediatric population and determine factors associated with adherence outcomes. METHODS: Data was collected as part of routine clinical care from 2011 to 2013. Adherence was recorded by downloads from the PAP device. "Adequate" adherence was defined as ≥4 h/night for 70 % of days used. Effectiveness of therapy was measured by polysomnography (PSG) pre- and post-PAP initiation...
September 3, 2016: Sleep & Breathing, Schlaf & Atmung
Marilyn Moro, Karen Gannon, Kathy Lovell, Margaret Merlino, James Mojica, Matt T Bianchi
PURPOSE: Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%-15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management. METHODS: We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split-night; n=306 two-night)...
2016: Nature and Science of Sleep
Sitian Qin, Xinyi Le, Jun Wang
This paper presents a neurodynamic optimization approach to bilevel quadratic programming (BQP). Based on the Karush-Kuhn-Tucker (KKT) theorem, the BQP problem is reduced to a one-level mathematical program subject to complementarity constraints (MPCC). It is proved that the global solution of the MPCC is the minimal one of the optimal solutions to multiple convex optimization subproblems. A recurrent neural network is developed for solving these convex optimization subproblems. From any initial state, the state of the proposed neural network is convergent to an equilibrium point of the neural network, which is just the optimal solution of the convex optimization subproblem...
August 19, 2016: IEEE Transactions on Neural Networks and Learning Systems
Anna Lavizzari, Mariarosa Colnaghi, Francesca Ciuffini, Chiara Veneroni, Stefano Musumeci, Ivan Cortinovis, Fabio Mosca
Importance: Heated, humidified high-flow nasal cannula (HHHFNC) has gained increasing popularity as respiratory support for newborn infants thanks to ease of use and improved patient comfort. However, its role as primary therapy for respiratory distress syndrome (RDS) of prematurity needs to be further elucidated by large, randomized clinical trials. Objective: To determine whether HHHFNC provides respiratory support noninferior to nasal continuous positive airway pressure (nCPAP) or bilevel nCPAP (BiPAP) as a primary approach to RDS in infants older than 28 weeks' gestational age (GA)...
August 8, 2016: JAMA Pediatrics
Justin Robison, Nicholas B Slamon
OBJECTIVES: Critical care physicians' standard for arrival to a rapid response team activation is 10 minutes or less at this institution. This study proposes that a FaceTime (Apple, Cupertino, CA) video call between the staff at the bedside and the critical care physician will allow the implementation of potentially life-saving therapies earlier than the current average response (4.5 min). DESIGN: Prospective cohort study. SETTING: Freestanding, tertiary-care children's hospital...
September 2016: Pediatric Critical Care Medicine
Steven Goudy, Pawina Jiramongolchai, Sivakumar Chinnadurai
OBJECTIVES/HYPOTHESIS: Determine predictive patient characteristics that guide the decision to proceed with surgical management of tongue-based airway obstruction (TBAO) in Pierre Robin sequence (PRS) patients. STUDY DESIGN: Retrospective review of PRS patients between 2005 and 2014 requiring observation in the neonatal intensive care unit (NICU). METHODS: Patient charts were reviewed for prenatal diagnoses, clinical course, and need for surgical intervention (tracheotomy or mandibular distraction osteogenesis), and the nonsurgical and surgical group were compared with a logistic regression model...
July 5, 2016: Laryngoscope
Hatice Yağlıoğlu, Güniz Meyancı Köksal, Emre Erbabacan, Birsel Ekici
OBJECTIVE: The aim of our study is to investigate the effect of two different methods of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP) and oxygen support under spontaneous ventilation on respiration mechanics, gas exchange, dry mouth and face mask lesion during an early postoperative period in patients undergoing upper abdominal surgery. METHODS: Eighty patients undergoing elective abdominal surgery with laparotomy, between the age of 25 and 75 years and American Society of Anesthesiologists Physical Status score (ASA) II-III with chronic obstructive pulmonary disease (COPD) diagnosis were included to the study...
August 2015: Turkish Journal of Anaesthesiology and Reanimation
Ting-Huei Chen, Wei Sun
SummaryA large number of cancer drugs have been developed to target particular genes/pathways that are crucial for cancer growth. Drugs that share a molecular target may also have some common predictive omic features, e.g., somatic mutations or gene expression. Therefore, it is desirable to analyze these drugs as a group to identify the associated omic features, which may provide biological insights into the underlying drug response. Furthermore, these omic features may be robust predictors for any drug sharing the same target...
June 20, 2016: Biostatistics
Jean-Bernard Michotte, Enrico Staderini, Deborah Le Pennec, Jonathan Dugernier, Rares Rusu, Jean Roeseler, Laurent Vecellio, Giuseppe Liistro, Grégory Reychler
UNLABELLED: Backround: Coupling nebulization with noninvasive ventilation (NIV) has been shown to be effective in patients with respiratory diseases. However, a breath-synchronized nebulization option that could potentially improve drug delivery by limiting drug loss during exhalation is currently not available on bilevel ventilators. The aim of this in vitro study was to compare aerosol delivery of amikacin with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes...
August 2016: Journal of Aerosol Medicine and Pulmonary Drug Delivery
Jens Bräunlich, Marcus Köhler, Hubert Wirtz
BACKGROUND: Nasal highflow (NHF) provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD. MATERIALS AND METHODS: This interventional clinical study was performed with patients suffering from severe COPD...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Aylin Özsancak Uğurlu, Huriye Berk Takır, Begüm Ergan, Erdal İn, Ezgi Özyilmaz, Özlem Ertan Edipoğlu, Eylem Acartürk, Ege Güleç Balbay, Aslı Görek Dilektaşlı, Tülay Kıvanç, Pervin Korkmaz Ekren, Sevinç Sarınç Ulaşlı, Ilgaz Doğrul, Elif Yılmazel Uçar, Şehnaz Olgun, Özkan Devran, Recai Ergun, Zuhal Karakurt
INTRODUCTION: To define approach of pulmonologists in Turkey to noninvasive mechanical ventilation (NIV) use for chronic respiratory failure (CRF), the most currently applied technique for home mechanical ventilation. PATIENTS AND METHODS: A 38-question survey, developed and tested by the authors, was distributed throughout Turkey to 2205 pulmonologists by e-mail. RESULT: Twenty-seven percent of the pulmonologists responded (n=596). Domiciliary NIV was reported to be prescribed by 340 physicians [57...
March 2016: Tüberküloz Ve Toraks
L Nava-Guerra, W H Tran, P Chalacheva, S Loloyan, B Joshi, T G Keens, K S Nayak, S L Davidson Ward, M C K Khoo
Obstructive sleep apnea (OSA) involves the interplay of several different factors such as an unfavorable upper airway anatomy, deficiencies in pharyngeal muscle responsiveness, a low arousal threshold, and ventilatory control instability. Although the stability of ventilatory control has been extensively studied in adults, little is known about its characteristics in the pediatric population. In this study, we developed a novel experimental setup that allowed us to perturb the respiratory system during natural non-rapid eye movement (NREM) sleep conditions by manipulating the inspiratory pressure, provided by a bilevel pressure ventilator, to induce sighs after upper airway stabilization...
July 1, 2016: Journal of Applied Physiology
Misbah Baqir, Jay H Ryu, Eric J Sorenson, Eric J Olson
We describe the case of a 62-year-old man who presented with shortness of breath that had progressed over several years. He had a history of a paralyzed right hemidiaphragm for at least the previous 10 years. He also reported weakness in his proximal legs and daytime sleepiness. On examination, he was found to have thoracoabdominal paradox when in supine position. Pulmonary function testing revealed severe restriction; arterial blood gas showed chronic respiratory acidosis. Electromyography showed chronic phrenic neuropathy bilaterally, with mild proximal myopathy...
2016: Respiratory Medicine Case Reports
Paola Palazzo, Amy Brooks, David James, Randy Moore, Andrei V Alexandrov, Anne W Alexandrov
INTRODUCTION: In the hyperacute phase of ischemic stroke, a 0° position is recommended to increase cerebral perfusion in nonhypoxic patients able to tolerate lying flat. However, use of 0° positioning is not uniformly applied in clinical practice, most likely due to concerns of aspiration pneumonia. We aimed to determine the risk of pneumonia associated with 0° head of bed positioning in acute stroke patients treated with thrombolytic therapy. METHODS: A retrospective descriptive study was conducted using prospectively collected, consecutive acute ischemic stroke patients treated with IVtPA whose head of bed was positioned at 0° for the first 24 h...
February 2016: Brain and Behavior
Annabella Astorino, Antonio Fuduli
We propose a bilevel cross-validation scheme for support vector machine (SVM) model selection based on the construction of the entire regularization path. Since such path is a particular case of the more general proximal trajectory concept from nonsmooth optimization, we propose for its construction an algorithm based on solving a finite number of structured linear programs. Our methodology, differently from other approaches, works directly on the primal form of SVM. Numerical results are presented on binary data sets drawn from literature...
May 2016: IEEE Transactions on Neural Networks and Learning Systems
Romy Hoque
STUDY OBJECTIVES: The aim of this review is to review the literature on sleep-disordered breathing in Duchenne muscular dystrophy (DMD). METHODS: PubMed was searched with an array of search terms, including "OSA," "obstructive sleep apnea," "sleep-disordered breathing," "muscular dystrophy," "neuromuscular," "Duchenne muscular dystrophy," "polysomnography," and "portable monitoring." All relevant articles were discussed. RESULTS: Eighteen research articles and 1 consensus statement were reviewed, and assessed with relevant data presented...
2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Hyunju Yang, Amy M Sawyer
To summarize the current evidence for adaptive servo ventilation (ASV) in Cheyne-Stokes respiration (CSR) with central sleep apnea (CSA) in heart failure (HF) and advance a research agenda and clinical considerations for ASV-treated CSR-CSA in HF. CSR-CSA in HF is associated with higher overall mortality, worse outcomes and lower quality of life (QOL) than HF without CSR-CSA. Five databases were searched using key words (n = 234). Randomized controlled trials assessed objective sleep quality, cardiac, and self-reported outcomes in adults (≥18 years) with HF (n = 10)...
May 2016: Heart & Lung: the Journal of Critical Care
Diego Lacerda, Dirceu Costa, Michel Reis, Evelim Leal de F Dantas Gomes, Ivan Peres Costa, Audrey Borghi-Silva, Aline Marsico, Roberto Stirbulov, Ross Arena, Luciana Maria Malosá Sampaio
[Purpose] This study evaluated the effect of Bilevel Positive Airway (BiPAP) on the autonomic control of heart rate, assessed by heart rate variability (HRV), in patients hospitalized with decompensated heart failure. [Subjects and Methods] This prospective cross-sectional study included 20 subjects (age: 69±8 years, 12 male, left ventricular ejection fraction: 36 ±8%) diagnosed with heart failure who were admitted to a semi-intensive care unit with acute decompensation. Date was collected for HRV analysis during: 10 minutes spontaneous breathing in the resting supine position; 30 minutes breathing with BiPAP application (inspiratory pressure = 20 cmH2O and expiratory pressure = 10 cmH2O); and 10 minutes immediately after removal of BiPAP, during the return to spontaneous breathing...
January 2016: Journal of Physical Therapy Science
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