Search Results (26)

Epilepsy is a complex and ancient neurological disorder affecting approximately 50 million individuals globally. Despite significant advancements in pharmacological treatments, surgical procedures, and neurostimulation techniques, a substantial subset of patients remains pharmacoresistant or experiences intolerable side effects, highlighting the need for novel, safe, and effective interventions. In this review, we examine a promising non-invasive technique known as the Exchange Breathing Method (EBM), developed through the observations of Gemma Herbertson, a British mother who discovered that exhaling gently into her son’s nostrils could consistently interrupt ongoing seizures. The EBM has since gained anecdotal support from a growing international community reporting similar positive outcomes. This paper situates the EBM within the broader historical and clinical context of epilepsy treatment, tracing its evolution from ancient practices to modern therapeutic strategies. We explore the neurophysiological mechanisms that may underlie the EBM, particularly its interaction with autonomic and respiratory pathways implicated in seizure modulation. By integrating emerging grassroots data with current scientific knowledge, this review proposes a rationale for further empirical investigation into the EBM and its potential role in the personalized, emergency management of epilepsy. Full article

Background/Objectives: Mechanical ventilation is essential in the management of acute respiratory failure (RF); however, prolonged use increases the risk of complications. Accurate predictors are therefore needed to guide timely weaning. The Rapid Shallow Breathing Index (RSBI), the dead space to tidal volume ratio (VD/VT), and the Integrative Weaning Index (IWI) are among the key indices used to assess weaning readiness. This study aimed to examine whether these indices differ between patients with Type 1 (hypoxemic) and Type 2 (hypercapnic) respiratory failure who were successfully extubated in the emergency department, in order to explore their physiologic variability across respiratory failure phenotypes. Methods: This cross-sectional study included 35 adult patients (23 with Type 1 RF, 12 with Type 2 RF) who were successfully weaned from mechanical ventilation in the Emergency Department of a tertiary care hospital between 2022 and 2024. RSBI, VD/VT, IWI, and arterial blood gas parameters were recorded. Descriptive and comparative statistical analyses were performed, with significance set at p < 0.05. Results: There were no significant differences in age, gender, or comorbidities between the groups. Type 2 RF patients had higher FiO₂ requirements (37.5% vs. 30.0%; p = 0.03) and PaCO₂ levels (49.1 ± 9.65 mmHg vs. 40.3 ± 4.49 mmHg; p < 0.001). The PaO₂/FiO₂ ratio was lower in the Type 2 group (169 ± 49.6) compared to the Type 1 group (244 ± 95.6; p = 0.017). VD/VT ratios were significantly higher in Type 2 RF patients (0.37 ± 0.04 vs. 0.29 ± 0.13; p = 0.046). RSBI values were identical between groups (40.0 in both; p = 1.00), and IWI values showed no significant difference (70.8 ± 30.7 vs. 79.3 ± 32.5; p = 0.45). Conclusions: Although RSBI and IWI values were similar across respiratory failure types, patients with Type 2 RF demonstrated higher VD/VT ratios and lower PaO₂/FiO₂, indicating reduced gas exchange and alveolar ventilation efficiency. These findings suggest that VD/VT may be a more useful parameter for assessing weaning readiness in hypercapnic patients. Full article

Background/Objectives: Myotonic dystrophy type 1 (DM1) is a rare neuromuscular disorder characterized by respiratory dysfunction that significantly impacts quality of life and longevity. This study aimed to explore the outcomes of pulmonary function tests and sleep-disordered breathing (SDB) workups in children with DM1 and to identify the factors contributing to SDB. Methods: A retrospective study examined patients’ medical records, including genetic analyses, clinical characteristics, and noninvasive pulmonary function testing (PFT), when possible. The Pediatric Sleep Questionnaire (PSQ), arterial blood gases, polygraphy, and overnight transcutaneous capnometry (PtcCO₂) were used to assess SDB. Results: The size of CTG expansion in the DMPK gene directly correlated with the severity of respiratory complications and the need for early tracheostomy tube insertion in 7/20 (35%) patients. A total of 13/20 (65%) children were available for respiratory evaluation during spontaneous breathing. While moderate/severe obstructive sleep apnea syndrome (OSAS) and hypoventilation were confirmed in 4/13 (31%) children, none of the patients had mixed or dominantly central sleep apnea syndrome. There was no correlation between apnea–hypopnea index (AHI) or PtcCO₂ and the presence of SDB-related symptoms or the PSQ score. Although a significant correlation between AHI and PtcCO₂ was not confirmed (p = 0.447), the oxygen desaturation index directly correlated with PtcCO₂ (p = 0.014). Conclusions: While SDB symptoms in children with DM1 may not fully correlate with observed respiratory events or impaired gas exchange during sleep, a comprehensive screening for SDB should be considered for all patients with DM1. Further research into disease-specific recommendations encompassing the standardization of PFT, as well as overnight polygraphic and capnometry recordings, could help to guide timely, personalized treatment. Full article

Background/Objectives: The induction of general anesthesia leads to the development of atelectasis and redistribution of ventilation to non-dependent lung regions with subsequent impairment of gas exchange. However, it remains unclear how rapidly atelectasis occurs after the induction of anesthesia in obese patients. We therefore investigated the extent of atelectasis formation in obese patients in the first few minutes after the induction of general anesthesia and initiation of mechanical ventilation in the operating room. Methods: In 102 patients with morbid obesity (BMI ≥ 35 kg m⁻²) scheduled for laparoscopic intrabdominal surgery, induction of general anesthesia was performed while continuously monitoring regional pulmonary ventilation using electrical impedance tomography. Distribution of ventilation to non-dependent lung areas as a surrogate for atelectasis formation was determined by taking the mean value of five consecutive breaths for each minute starting five minutes before to five minutes after intubation. Ventilation inhomogeneity was assessed using the Global Inhomogeneity Index. Results: Median tidal volume in non-dependent lung areas was 58.3% before and 71.5% after intubation and increased by a median of 13.79% after intubation (p < 0.001). Median Global Inhomogeneity Index was 49.4 before and 71.4 after intubation and increased by a median of 21.99 units after intubation (p < 0.001). Conclusions: Atelectasis forms immediately after the induction of general anesthesia and increases the inhomogeneity of lung ventilation. Full article

Breathing is the process of exchanging gases between the human body and the surrounding environment. It plays a vital role in maintaining human health, sustaining life, and supporting various bodily functions. Unfortunately, current methods for monitoring respiration are impractical for medical applications because of their high costs and need for bulky equipment. When measuring changes in moisture during respiration, we observed a slow response time for 2D nanomaterial-based resistance measurement methods used in respiration sensors. Through thermal annealing, the crystal structure of MoS₂ is transformed from 1T@2H to 2H, allowing the measurement of respiration at more than 30 cycles per minute and enabling analysis of the response. This study highlights the potential of two-dimensional nanomaterials for the development of low-cost and highly sensitive humidity and respiration sensors for various applications. Full article

Assessing respiratory frequency (f_R) is practical in monitoring training progress in competitive athletes, especially during exercise. This study aimed to validate a new wearable chest strap (wCS) to estimate f_R against ergospirometry as a criterion device in soccer players. A total of 26 elite professional soccer players (mean [standard deviation]: 23.6 [4.8] years; 180.6 [5.7] cm; 77.2 [5.4] kg) from three Italian Serie A League teams participated in this cross-sectional study. The sample included attackers, midfielders, and defenders. f_R was assessed during a maximal cardiopulmonary exercise test (CPET) on a treadmill using (i) a breath-by-breath gas exchange analyzer (Vyntus^® CPX, Vyaire Medical) and (ii) a novel wCS with sensors designed to assess breath frequency following chest expansions. Pearson’s correlation coefficient (r), adjusted coefficient of determination (aR²), Bland–Altman plot analysis, and Lin’s concordance correlation coefficient (ρ_c) were used for comparative analysis (correlation and concordance) among the methods. The repeated measures correlation coefficient (r_rm) was used to assess the strength of the linear association between the methods. The intraclass correlation coefficient (ICC) and the Finn coefficient (r_F) were used for inter-rater reliability. All statistical analyses were performed within the R statistical computing environment, with 95% confidence intervals (95% CIs) reported and statistical significance set at p < 0.05. A total of 16529 comparisons were performed after collecting the CPET data. The robust time series analysis with Hodges–Lehmann estimation showed no significant differences between both methods (p > 0.05). Correlation among devices was statistically significant and very large (r [95% CI]: 0.970 [0.970, 0.971], p < 0.01; aR² [95% CI]: 0.942 [0.942, 0.943], p < 0.01) with strong evidence supporting consistency of the new wCS (BF₁₀ > 100). In addition, a high concordance was found (ρ_c [95% CI]: 0.970 [0.969, 0.971], bias correction factor: 0.999). Vyntus^TM CPX, as a standard criterion, showed moderate agreement with wCS after Bland–Altman analysis (bias [95% lower to the upper limit of agreement]; % agree: 0.170 [−4.582 to 4.923] breaths·min⁻¹; 69.9%). A strong association between measurements (r_rm [95% CI]: 0.960 [0.959, 0.961]), a high absolute agreement between methods (ICC [95% CI]: 0.970 [0.970, 0.971]), and high inter-rater reliability (r_F: 0.947) were found. With an RMSE = 2.42 breaths·min⁻¹, the new wCS seems to be an valid and reliable in-field method to evaluate f_R compared to a breath-by-breath gas exchange analyzer. Notwithstanding, caution is advised if methods are used interchangeably while further external validation occurs. Full article

This paper presents a novel technique for extracting the alveolar part of human breath. Gas exchange occurs between blood and inhaled air in the alveoli, which is helpful in medical diagnostics based on breath analysis. Consequently, the alveolar portion of the exhaled air contains specific concentrations of endogenous EVOC (exogenous volatile organic compound), which, among other factors, depend on the person’s health condition. As this part of the breath enables the screening for diseases, accurate sample collection for testing is crucial. Inaccurate sampling can significantly alter the composition of the specimen, alter the concentration of EVOC (biomarkers) and adversely affect the diagnosis. Furthermore, the volume of alveolar air is minimal (usually <350 mL), especially in the case of people affected by respiratory system problems. For these reasons, precise sampling is a key factor in the effectiveness of medical diagnostic systems. A new technique ensuring high accuracy and repeatability is presented in the article. It is based on analyzing the changes in carbon dioxide concentration in human breath using a fast and compensated non-dispersive infrared (NDIR) sensor and the simple moving adjacent average (SMAA) algorithm. Research has shown that this method accurately identifies exhalation phases with an uncertainty as low as 20 ms. This provides around 350 ms of breath duration for carrying out additional stages of the diagnostic process using various types of analyzers. Full article

Background: Repeated sprint ability (RSA) is defined as the ability to recover and maintain maximal effort during repeated sprints, recognised as a crucial performance component in team sports. The exercise mode used to test RSA may influence performance and the contributions of different energy systems. The primary aim of this study is to address the critical gap between traditional cycling-based anaerobic tests, such as the Wingate test, and the practical, sport-specific demands of running in field-based team sports. Methods: This study involved 32 professional soccer players (age: 21.2 ± 1.3 years; height: 177.8 ± 4.3 cm; and mass: 71.3 ± 6.4 kg). They performed cycling- and running-based repeated sprint tests, with similar total sprint numbers, durations, and recovery times, on different days. Contributions from adenosine triphosphate-phosphocreatine (ATP-PCr), glycolytic, and oxidative systems were estimated through body weight, oxygen uptake (VO₂), blood lactate (BLa), and the fast component of excess post-exercise oxygen consumption (EPOC). The VO₂ levels and heart rate (HR) were monitored during the rest (10 min), exercise, and recovery (15 min) phases in a breath-by-breath mode using a portable gas exchange system. BLa was measured before (at rest) and 1, 3, 5, 7, and 10 min after the running and cycling tests using a handheld portable analyser. A mono-exponential model estimated the ATP-PCr system contribution, calculated using the fast component of EPOC following the final sprint and the sum of the VO₂-time integral during rest intervals. Results: The cycling tests demonstrated significantly higher values for the peak power (PP), mean power (MP), and rate of perceived exertion (RPE) (p < 0.05), while the heart rate peak and blood lactate responses were similar across all modalities. The fatigue index was notably higher in the running tests (p < 0.05). Furthermore, the running tests showed greater contributions in both the percentage and absolute terms from the adenosine triphosphate-phosphocreatine (ATP-PCr) system (p < 0.01), total energy demand (p < 0.05), and total energy expenditure (TEE) (p < 0.01). Notably, the running tests resulted in an increased phosphocreatine breakdown (p < 0.05) and rapid phosphocreatine replenishment (p < 0.01). A simple linear regression analysis highlighted a significant determination coefficient between these performance variables and the contributions of the energy systems, affirming the robustness of the results. The correlation heatmaps further illustrated these relationships, with higher correlations for the PP and MP across modalities (0.41), emphasising the moderate association between cycling and running tests in these metrics. Conclusions: This study elucidated the similarities and differences in energy system contributions and performance outcomes between a cycling and a running repeated sprint protocol, with a comparable total sprint time and work–rest ratio. The findings reveal that a running repeated sprint test elicits a higher energy demand and a higher contribution from the PCr energy system compared to cycling. Performance variables were not associated between running and cycling tests, suggesting those tests cannot be used interchangeably. Full article

Background: Oscillometry allows for the non-invasive measurements of lung mechanics. In COVID-19 ARDS patients treated with Non-Invasive Oxygen Support (NI-OS), we aimed to (1) observe lung mechanics at the patients’ admission and their subsequent changes, (2) compare lung mechanics with clinical and imaging data, and (3) evaluate whether lung mechanics helps to predict clinical outcomes. Methods: We retrospectively analyzed the data from 37 consecutive patients with moderate–severe COVID-19 ARDS. Oscillometry was performed on their 1st, 4th, and 7th day of hospitalization. Resistance (R5), reactance (X5), within-breath reactance changes (ΔX5), and the frequency dependence of the resistance (R5–R19) were considered. Twenty-seven patients underwent computed tomographic pulmonary angiography (CTPA): collapsed, poorly aerated, and normally inflated areas were quantified. Adverse outcomes were defined as intubation or death. Results: Thirty-two patients were included in this study. At the first measurement, only 44% of them had an abnormal R5 or X5. In total, 23 patients had measurements performed on their 3rd day and 7 on their 7th day of hospitalization. In general, their R5, R5–R19, and ΔX decreased with time, while their X5 increased. Collapsed areas on the CTPA correlated with the X5 z-score (ρ = −0.38; p = 0.046), while poorly aerated areas did not. Seven patients had adverse outcomes but did not present different oscillometry parameters on their 1st day of hospitalization. Conclusions: Our study confirms the feasibility of oscillometry in critically ill patients with COVID-19 pneumonia undergoing NI-OS. The X5 z-scores indicates collapsed but not poorly aerated lung areas in COVID-19 pneumonia. Our data, which show a severe impairment of gas exchange despite normal reactance in most patients with COVID-19 ARDS, support the hypothesis of a composite COVID-19 ARDS physiopathology. Full article

Tuberculosis-related lung damage is very different. Lung ventilation disorders have been studied in patients with pulmonary tuberculosis (TB) during the active process and after treatment, but the main causes of gas exchange changes have not been sufficiently studied. Investigation of diffusing lung capacity in combination with bodyplethysmography is useful for the interpretation of pulmonary gas exchange disorders. The aim was to determine the relationship of gas exchange with the value of alveolar volume (VA) and pulmonary poorly communicating fraction (PCF) in patients with pulmonary TB. A total of 292 patients (117/175 M/W) with verified pulmonary TB with smoking age less than 10 packs-years underwent spirometry, bodyplethysmography, and D_LCO by the single-breath method. PCF was estimated calculating the difference between total lung capacity (TLC) and VA (% TLC). Patients with low D_LCO had statistically significantly lower spirometric values (FVC, FEV₁, FEV₁/FVC, MMEF), lower TLC, higher airway resistance, RV/TLC, air-trapping volume, and PCF. The patients with low level of D_LCO were divided into four groups depending on level VA and PCF. In most patients with infiltrative tuberculosis (50%), the leading syndrome of the D_LCO decrease was alveolar-capillary damage. In patients with tuberculomas, the syndromes of alveolar capillary damage and pulmonary ventilation inhomogeneity were with the same frequency (43%). In patients with disseminated tuberculosis, the most frequent syndrome of the D_LCO decrease was pulmonary ventilation inhomogeneity (33%), then alveolar-capillary damage (29%) and mixed (24%). In patients with cavernous tuberculosis, the leading syndrome of the D_LCO decrease was mixed (39%), then alveolar capillary damage (25%) and pulmonary ventilation inhomogeneity (23%). The syndrome of gas exchange surface reduction in patients with disseminated and cavernous tuberculosis was less common (14%). In conclusion, an additional evaluation of the combination of PCF and VA increases the amount of clinical information obtained using the diffusion lung capacity measurements, since it allows identifying various syndromes of gas exchange impairment. The leading causes of diffusing capacity impairment vary by different types of pulmonary TB. Full article

There are several methods available to assess energy expenditure, all associated with inherent pros and cons that must be adequately considered for use in specific environments and populations. A requirement of all methods is that they must be valid and reliable in their capability to accurately measure oxygen consumption (VO₂) and carbon dioxide production (VCO₂). The purpose of this study was to evaluate the reliability and validity of the mobile CO₂/O₂ Breath and Respiration Analyzer (COBRA) relative to a criterion system (Parvomedics TrueOne 2400^®, PARVO) with additional measurements to compare the COBRA to a portable system (Vyaire Medical, Oxycon Mobile^®, OXY). Fourteen volunteers with a mean of 24 years old, body weight of 76 kg, and a VO_2peak of 3.8 L∙min⁻¹ performed four repeated trials of progressive exercises. Simultaneous steady-state measurements of VO₂, VCO₂, and minute ventilation (V_E) by the COBRA/PARVO and OXY systems were conducted at rest, while walking (23–36% VO_2peak), jogging (49–67% VO_2peak), and running (60–76% VO_2peak). Data collection was randomized by the order of system tested (COBRA/PARVO and OXY) and was standardized to maintain work intensity (rest to run) progression across study trials and days (two trials/day over two days). Systematic bias was examined to assess the accuracy of the COBRA to PARVO and OXY to PARVO across work intensities. Intra- and inter-unit variability were assessed with interclass correlation coefficients (ICC) and a 95% limit of agreement intervals. The COBRA and PARVO produced similar measures for VO₂ (Bias ± SD, 0.01 ± 0.13 L·min⁻¹; 95% LoA, (−0.24, 0.27 L·min⁻¹); R² = 0.982), VCO₂ (0.06 ± 0.13 L·min⁻¹; (−0.19, 0.31 L·min⁻¹); R² = 0.982), V_E (2.07 ± 2.76 L·min⁻¹; (−3.35, 7.49 L·min⁻¹); R² = 0.991) across work intensities. There was a linear bias across both the COBRA and OXY with increased work intensity. The coefficient of variation for the COBRA ranged from 7 to 9% across measures for VO₂, VCO₂, and V_E. COBRA was reliable across measurements for VO₂ (ICC = 0.825; 0.951), VCO₂ (ICC = 0.785; 0.876), and V_E (ICC = 0.857; 0.945) for intra-unit reliability, respectively. The COBRA is an accurate and reliable mobile system for measuring gas exchange at rest and across a range of work intensities. Full article

Ionic polymer–metal composites (IPMCs) have attracted attention in recent years due to their integration of actuation and sensing functions. As one of the main sensing functions of IPMCs, humidity sensing has been of consistent interest in wearable health monitors and artificial skin. However, there are still some technical challenges in that classical IPMCs have poor humidity sensing performance due to their dense surface electrode, and IPMCs are damaged easily due to an electrode/membrane mismatch. In this work, through the spraying and electrodepositing process, we developed an efficient method to rapidly prepare a Au-shell-Ag-NW (silver nanowire)-based IPMC with high strength, low surface resistance and excellent humidity sensing performance. Meanwhile, we optimized the preparation method by clarifying the influence of solvent type and electrodepositing time on the performance of the Au-shell-Ag-NW-based IPMC, thus effectively improving the humidity sensing effect and strength of the IPMC. Compared with previous research, the humidity electrical response (~9.6 mV) of the Au-shell-Ag-NW-based IPMC is at least two orders of magnitude higher than that of the classical IPMC (~0.41 mV), which is mainly attributed to the sparse gap structure for promoting the exchange of water molecules in the environment and Nafion membrane, a low surface resistance (~3.4 Ohm/sq) for transmitting the signal, and a seamless connection between the electrode and Nafion membrane for fully collecting the ion charges in the Nafion membrane. Additionally, the Au-shell-Ag-NW-based IPMC could effectively monitor the human breathing process, and the humidity sensing performance did not change after being exposed to the air for 4 weeks, which further indicates that the Au-shell-Ag-NW-based IPMC has good application potential due to its efficient preparation technology, high stability and good reproducibility. Full article

Background: Patients with adolescent idiopathic scoliosis (AIS) are found to have a lower level of physical activity, and may have reduced exercise capacity due to spinal deformity. Previous study showed the benefits of high-intensity interval training (HIIT), named E-Fit, which is specifically designed for patients with AIS to improve musculoskeletal health and psychological well-being. To optimize the beneficial effects of training, the current study aimed to investigate the appropriate exercise intensity and metabolic demand in patients with AIS when performing E-Fit. Methods: In all, 22 female subjects, 10 diagnosed with AIS and 12 gender-matched healthy controls, aged between 10 and 16 years, were recruited. Subjects were instructed to perform two trials of a seven min E-Fit. Breath-by-breath gas exchange parameters including oxygen consumption (VO₂), heart rate (HR) and the rate of perceived exertion (PRE) were measured during exercise. Demographic data and clinical features of AIS and body composition were obtained. Metabolic demand between AIS and control groups was compared using MANOVA with covariates adjustment. Results: Patients with AIS had an earlier onset of menarche (p = 0.01), higher visceral adipose tissue (p = 0.04) and percentage body fat (p = 0.03) as compared to controls. Patients with AIS showed a significantly higher adjusted means of VO₂ average in both the first (p = 0.014) and second trials (p = 0.011) of E-Fit. The adjusted mean of the highest measured VO₂ was higher than healthy controls and reached statistical significance in the second trial (p = 0.004). Both the AIS and control group exercised at a similar percentage of VO₂ peak (64.26% vs. 64.60%). Conclusion: Patients with AIS showed higher oxygen consumption during E-Fit than heathy controls, which might indicate a higher metabolic cost. Patients with AIS could carry out exercise at a moderate exercise intensity similar to that of healthy controls, but special considerations in designing an exercise program, such as frequent rest intervals, would be useful to avoid fatigue among patients with AIS. Full article

The distribution and evolution of air in airliner cabins is an important basis for the study of cabin thermal environment and pollutant propagation. Due to the complex heat and mass transfer problems caused by forced and natural convection in a large-scale space, the accurate prediction of air distribution in airliner cabins still faces huge challenges. This study takes the cabin of the Airbus A320 as the research object. The accurate numerical simulation of the flow and heat transfer process in an airliner cabin under mixing ventilation mode was carried out using the Hybrid Thermal Lattice Boltzmann Method (HTLBM) combined with GPU (Graphics Processing Unit) acceleration technology, and the influence of human thermal plumes on air distribution and evolution characteristics in an airliner cabin was analyzed. The research shows that the human thermal plume changes the air distribution in the passenger cabin. The thermal plume slows down the jet attenuation, increases the energy exchange in the area near the passengers, and offsets the jet trajectory. The airflow self-locking effect is easier to form in the passenger breathing area, which increases the time for the flow field to develop into the steady state. The influence of human thermal plumes on the airflow distribution in the passenger cabin cannot be ignored. Full article

Background and Aim: Sleep-disordered breathing (SDB) is an extremely common disorder with a high impact on morbidity and mortality. The purpose of this study was to compare overlap syndrome (OS) and obesity hypoventilation syndrome (OHS) and to highlight and understand the differences between them. Material and Methods: The study was conducted retrospectively on 132 subjects selected by consecutive sampling from those attending our unit for suspected SDB. After clinical evaluation as well as functional and sleep investigations, the population was divided according to diagnosis in OS and OHS; then, the clinical parameters of two groups were compared with different statistical analysis. Results: The subjects with OHS were younger and reported higher rated daytime sleepiness (p = 0.005). In addition, they presented more nocturnal respiratory events (apnea-hypopnea index (AHI) 63.61 ± 22.79 events·h⁻¹ vs. AHI_OS 42.21 ± 22.91 events·h⁻¹, p < 0.0001) at the sleep investigation as worse gas exchange during sleep leading to a higher percentage of nocturnal hypoxemia (p < 0.0001). In contrast, subjects with OS had more an impaired respiratory function. With regard to night-time ventilatory therapy, more subjects with OS were effectively treated with continuous positive airway pressure (CPAP) (p = 0.011), while more OHS were treated with auto-adjusting PAP (APAP) (14% vs. 1%, p = 0.008). Conclusions: The present study tried to establish a framework for OS and OHS because proper management of the two disorders would reduce their burden on healthcare. Full article