Search Results (56)

Background: Flexible bronchoscopy (FB) is a widely used diagnostic and therapeutic procedure in patients with pulmonary disease, many of whom are at risk of gas exchange impairment. FB may exacerbate hypoxaemia due to increased airway resistance, alveolar derecruitment, and haemodynamic fluctuations. Objectives: To assess the effectiveness of non-invasive respiratory support strategies in preventing oxygen desaturation and respiratory complications during FB. Methods: A systematic review and meta-analysis were conducted using PubMed and Cochrane databases, covering studies from 2000 to 2024. Inclusion criteria focused on adult patients undergoing FB with any form of non-invasive oxygen support. Twelve high-quality studies were selected, including randomised trials and prospective cohorts. Results: High-flow therapy (HFT) was more effective than conventional oxygen therapy (COT) in maintaining oxygenation and reducing procedure interruptions, especially in patients with moderate hypoxaemia or risk factors such as obesity and obstructive sleep apnoea. Continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) offered superior oxygenation and ventilatory support in patients with more severe respiratory or cardiac compromise. Conclusions: Non-invasive respiratory support should be individualised based on patient risk and procedural complexity. HFT benefits mild-to-moderate cases, while CPAP or NIV is preferable in more severe conditions. Further multicentre randomised trials are needed to establish formal guidelines. Full article

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder in middle-aged and elderly populations, marked by breathing interruptions during sleep. Diagnosis faces challenges due to the absence of specific biomarkers and increasing screening demands. This study aims to identify salivary biomarkers for the diagnosis and monitoring of OSAS using a simplified, rapid, and non-invasive method. Saliva from 51 OSAS patients and 34 healthy controls (CTR) was analyzed using Raman spectroscopy, which identified disease-specific biochemical fingerprints. Raman analysis revealed differences between the OSAS and CTR groups. The area under the curve of the lactic acid peak (920 cm⁻¹) appeared higher in the OSAS group compared to the CTR group, suggesting potential diagnostic relevance. Significant correlations were found between biomolecular and clinical data, and a final linear model indicated that the lactate concentration significantly influenced the canonical variable. The Raman-based approach and the lactic acid peak represent a promising tool for OSAS diagnosis, monitoring, and supporting decisions in pulmonary rehabilitation. However, further investigation with a larger cohort is needed to clarify the observed discrepancies. Full article

Sleep in intensive care unit (ICU) patients is frequently disrupted, which may adversely affect their overall health and recovery. Despite the implementation of various strategies to promote sleep, accurately assessing its quality remains complex. This pilot study aimed to evaluate both the quality and quantity of sleep in ICU patients using actigraphy (ACT) and the Richards–Campbell Sleep Questionnaire (RCSQ) and to compare the diagnostic performance of these two tools. We conducted a prospective observational study including 228 ICU patients. Sleep was assessed using both RCSQ and ACT. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the discriminative ability of each tool (Area Under the Curve [AUC], sensitivity, specificity), with optimal cut-off points determined using Youden’s Index. The Mann–Whitney U test was used to compare sleep parameters between patients classified as having good or poor sleep based on ACT measurements. The mean RCSQ score was 38.16 ± 17.09, indicating poor perceived sleep quality. Sleep onset latency (based on RCSQ) was 35.71 ± 21.44 min, with a mean of 40.32 ± 20.03 awakenings. According to ACT, sleep latency was 39.23 ± 22.09 min, and total sleep duration was 198.15 ± 128.42 min (approximately 3 h and 18 min), which is significantly below recommended levels. The average number of awakenings recorded was 24.85. In terms of diagnostic performance, the RCSQ demonstrated excellent discriminative ability (AUC = 1.00 for the total score), while ACT showed more variable results: total sleep duration had a good AUC of 0.91, while sleep latency showed a lower performance with an AUC of 0.50. The RCSQ proved to be more reliable than ACT in assessing sleep quality in ICU patients, providing consistent results across multiple parameters, including sleep depth, latency, and number of awakenings. Conversely, ACT yielded less consistent findings, particularly regarding sleep latency and nighttime interruptions. Further studies are warranted to refine objective tools for evaluating sleep in critically ill patients. Full article

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by a reduction or complete interruption of airflow during sleep, with episodes lasting at least 10 s. In severe cases, blood oxygen saturation can drop significantly, reaching levels as low as 40%. The aim of this study was to compare CAD/CAM-assisted maxillomandibular advancement (MMA) with traditional surgical techniques in the treatment of obstructive sleep apnea (OSA). We conducted a retrospective analysis of patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2022 and 2024 at the Maxillofacial Surgery of Policlinico Hospital San Camillo-Forlanini, Rome, Italy. This study included 18 patients with severe obstructive sleep apnea syndrome (OSAS) who underwent maxillomandibular advancement (MMA) surgery. The patients had a mean age of 38 years; 11 were male and 7 were female. Patients were divided into two groups: Group A, treated using a CAD/CAM-assisted surgical approach (five male and four female), and Group B, treated with conventional surgical techniques (six male and three female). Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions using dedicated software, demonstrated a significant increase in airway volume following the skeletal repositioning. Notably, airway volume increased from 19.25 ± 0.5 mm³ to 26.14 ± 1.264 mm³ in group A and 20.564 ± 0.71 mm³ to 25.425 ±1.103 mm³ in group B. Conclusion: No significant differences were observed between the CAD/CAM-assisted and conventional surgical techniques for maxillomandibular advancement (MMA) in the treatment of severe obstructive sleep apnea (OSA). Both approaches led to a reduction in the apnea–hypopnea index (AHI) and an increase in posterior airway space (PAS). However, the use of software and digital planning through CAD/CAM technology allows for greater precision and shorter operative times, making the procedure more efficient overall. Full article

Background/Objectives: The vestibulo-respiratory reflex regulates the tension of the respiratory muscles, which prevents apneas and awakenings during sleep. This study aimed to determine whether functional deficits in the inner ear disturb sleep quality. Methods: We compared sleep parameters in patients with their first episode of acute inner ear deficit (Group A: sudden idiopathic vertigo attack, sudden sensorineural hearing loss), chronic functional inner ear impairment (Group B: chronic peripheral vertigo, permanent hearing loss), and in healthy individuals (Group C). Polygraphy recordings were performed twice, in Group A at the onset of acute otoneurological symptoms and the second time after their withdrawal with an interval of 1 to 13 days, in Group B after 1 to 6 days, and in Group C after 1 to 8 days. Results: In Group A during the symptomatic night, overall and central apnea-hypopnea indices were significantly higher and snoring time was longer. Group A also had higher central apnea-hypopnea index on the first night compared to healthy individuals. In chronic disorders, sleep recordings showed lower autonomic arousal index than in controls or symptomatic nights in Group A. Conclusions: These findings highlight the severity of sleep apnea indicators in Group A. Our results suggest that acute dysfunction of the inner ear substantially impacts central neuronal signaling responsible for regulating normal sleep-related breathing and leads to a deterioration in sleep quality in contrast to individuals with chronic inner ear impairments. It can also be assumed that people with chronic vertigo or hearing loss experience less interrupted sleep than healthy individuals. Full article

Background: Elexacaftor/tezacaftor/ivacaftor (ETI) treatment is showing remarkable beneficial effects in people with Cystic Fibrosis (pwCF) harboring the F508del mutation in the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene. Although this therapy is generally well tolerated in pwCF, some adverse events (AEs) have been recently described both in controlled studies and in post-marketing observations. Methods: We followed 414 pwCF carrying F508del CFTR that initiated ETI treatment, recording AEs for a period of 5 years. Results: A total of 142 AEs were reported. The most frequent AEs in the whole cohort were liver marker elevation, skin rush, epigastric pain, headache, and depression. Considering pediatric subjects, psychiatric and gastrointestinal disorders were the most frequent AEs. Only one patient reported a severe AE, leading to treatment discontinuation. In case of AEs, different decisions on ETI treatment were made, including temporary interruption and temporary or permanent dosage modification. Conclusions: Throughout the long-term observational period, almost 21% of pwCF experienced at least one AE. Psychiatric disorders, in particular attention deficit, were the most prevalent issue in our pediatric cohort, whereas adult patients mainly reported depression, anxiety and sleep disorders. This study therefore strengthen the recommendation of screening for changes in mental health during ETI treatment. AEs led to the permanent reduction of ETI dosage in 32% of cases, raising the issue of safety in relation to dosage reduction, efficacy, and minimum ETI levels. Eventually, this study highlights the need for a longitudinal monitoring of ETI safety since a significant number of AEs occurred after one year of treatment. Full article

Background/Objectives: Continuous positive airway pressure (CPAP) is the standard approach for treating obstructive sleep apnea syndrome (OSAS), but patient adherence is often low due to various influencing factors. Recently, researchers have increasingly begun to explore the influence of partner support on adherence to CPAP therapy. This systematic review seeks to consolidate current evidence regarding the impact of partner support on CPAP adherence in individuals with OSAS. Methods: A comprehensive literature search was carried out across PubMed, Scopus, Medline, PsycINFO, and Web of Science databases under PRISMA guidelines. Stringent inclusion criteria were used, and at least two independent reviewers screened all studies. The mixed methods appraisal tool (MMAT) was used to assess selected articles for quality. Data relevant to the review’s objectives were extracted and presented through narrative synthesis. The review protocol was preregistered (Prospero CRD420251016574). Results: Nine studies met the inclusion criteria. Findings highlighted the significant influence of adherence to CPAP. Partner support, relationship quality, and collaborative efforts emerged as facilitators of adherence, with partnered individuals exhibiting higher adherence to CPAP use. However, barriers such as anxiety, interruption in intimacy, and conflict in relationships were also identified. Conclusions: To the best of our knowledge, this is the first systematic review to synthesize evidence on the partner’s role in CPAP adherence and inform clinicians on the importance of providing personalized care based on biopsychosocial characteristics of patients; for example, assessing the partner support in the management of the illness. Furthermore, the findings emphasize the need for further research—particularly randomized controlled trials and dyadic designs—to deepen understanding of how partner dynamics influence effects of CPAP treatment. Full article

Background/Objectives: Pediatric obstructive sleep apnea (POSA) is a long-term sleep disorder characterized by repeated interruptions in breathing during sleep among children. These interruptions result from blockages in the upper airways, causing decreased oxygen intake and disturbed sleep. Assessing parents’ awareness level and the factors affecting their knowledge is vital for enhancing early diagnosis and management of POSA. Methods: This was a cross-sectional study that utilized data from a sample of 838 parents in the Central Region of the Kingdom of Saudi Arabia. The participants completed self-administered online surveys, which ensured anonymity. Results: Only 320 (38.2%) of the parents demonstrated good knowledge about POSA, while the majority, 518 (61.8%), had poor knowledge. Nearly a third, 261 (31.2%), of the parents indicated that their primary sources of information on POSA were the internet and social media platforms. The prevalence of OSA among children was quite significant, with nearly a quarter, 236 (28.2%), of parents having a child affected by the condition. Commonly recognized symptoms included snoring, reported by 425 (50.7%), and mouth breathing, reported by 156 (18.6%). Frequently cited risk factors included obesity, mentioned by 373 (44.5%), and enlarged tonsils, mentioned by 175 (20.9%). A statistically significant association was found between age, gender, marital status, education level, specialization/work, source of knowledge about POSA, knowing someone with OSA, and having a child with OSA and the level of knowledge about POSA (p < 0.05). The study identified several significant factors predicting poor parental awareness of pediatric obstructive sleep apnea (POSA) including gender [AOR = 1.65; 95% CI = 1.220–2.223; p = 0.001], source of knowledge about pediatric obstructive sleep apnea [AOR = 1.35; 95% CI = 1.167–1.572; p < 0.001], and knowing someone with OSA [AOR = 1.92; 95% CI = 1.301–2.832; p = 0.001]. Conclusions: The study revealed that parents in the Central Region had limited knowledge about POSA. There were notable gaps in recognizing and understanding the symptoms of POSA and its impact on children’s mental health and academic performance. This underscores the importance of introducing targeted educational programs and initiatives for both parents and healthcare providers to enhance children’s mental health and overall well-being. Full article

Knowledge about sleep was very limited at the time when Freud published his seminal work on the interpretation of dreams. He was also not interested in sleep, which was considered a problem of physiology; however, sleep appears to have a central role in his model, since dreaming is considered the guardian of sleep. The function of dreaming, according to Freud, is to protect sleep from disruption, with the dream working to avoid repressed stimuli interrupting the “biological” function of sleep. Before neurophysiological studies provided evidence that sleep is not a passive state, Freud also recognized sleep as an active process, as human beings voluntarily withdraw their attention from the external world to actively move to sleep. The discovery of REM sleep in the 1950s led psychoanalysts to see sleep as the necessary background to the occurrence of dreaming. Although Freud dismissed the clinical importance of sleep disturbances, viewing them as the somatic expression of an instinctual disturbance which would disappear during psychoanalytic treatment, successive authors highlighted the fact that sleep disturbances might have a more specific psychological significance. The similarities between the loss of self that occurs during sleep and the fragmentation of the identity experienced during schizophrenia represent an interesting and yet not fully explored area of research. Thanks to Freud’s work, the desire to sleep assumes the important role of a psychological, active factor that contributes to the occurrence and function of sleep. Full article

Background: Ukrainian refugees fleeing the conflict between Russia and Ukraine may face significant challenges to their physical, psycho-emotional, social, and spiritual wellbeing. Aim: To identify the health needs of Ukrainian refugees seen in primary care facilities in Tenerife, Canary Islands, Spain. Methods: A mixed-methods design was employed. Quantitative data were obtained through a descriptive analysis of health records, while qualitative data were collected via focus group interviews and thematic analysis of testimonies. Results: The sample comprised 59 individuals (45.4% of all patients seen). Eight participants from five family groups took part in the focus group. The typical profile of a Ukrainian refugee in the Canary Islands is female (79.7%), relatively young, with a high socio-cultural background, generally in good health, travelling alone or with her minor children. The main reasons for consultation were routine health check-ups and control blood tests. The NANDA-I nursing diagnoses indicated a need for psycho-emotional care, with the most prevalent being Risk for Relocation Stress Syndrome (27.1%); Interrupted Family Processes, Disturbed sleep pattern, Risk for Impaired Resilience (13.6% each); and Anxiety (11.9%). Participants rated the healthcare system positively, but language barriers and long waiting times for access to specific services were noted as limitations. The primary social demands include seeking employment, learning the language, and increasing support groups among Ukrainians themselves. Conclusions: This study underscores the need for a tailored approach to refugee care, considering their unique circumstances and needs. Early provision of information about available healthcare services and protocols can facilitate access, manage expectations, and aid decision-making. Full article

Background: The wearable cardioverter defibrillator (WCD) has emerged as a valuable tool used for temporary protection from sudden cardiac death. However, since the WCD uses surface electrodes to detect arrhythmias, it is susceptible to inappropriate detection. Although shock conversion rates for the WCD are reported to be high for detected events, its efficacy in clinical practice tends to be degraded by patient noncompliance. Reasons for this include wearer discomfort and frequent false alarms, which may interrupt sleep and generate anxiety. Up to now, data on the incidence of false alarms emitted by the WCD and their predictors are rare. Objectives: The aim of our study was to assess the relationship between both artifact sensing and episode misclassification burden and wearing compliance in patients with a WCD (ZOLL LifeVest™ 4000 system, ZOLL CMS GmbH, Cologne, Germany). Methods and Results: We conducted a single-center retrospective observational study, analyzing patients with a WCD prescribed at our institution. A total of 134 patients (mean age 51.7 ± 13.8 years, 79.1% male) were included. Arrhythmia recordings were analyzed and categorized as non-sustained ventricular tachycardia, sustained ventricular tachycardia or fibrillation, artifact sensing or misclassified episodes. Indication for WCD prescription was both primary and secondary prophylaxis. A total of 3019 false WCD alarms were documented in 78 patients (average number of false alarms 38.7 ± 169.5 episodes per patient) over a mean WCD wearing time of 71.5 ± 70.9 days (daily WCD wearing time 20.2 ± 5.0 h). In a total of 78 patients (58.2% of the study population), either artifact sensing (76.9%), misclassified episodes (6.4%), or both (16.7%) occurred. Misclassified episodes included sinus tachycardias, atrial flutter, atrial fibrillation, premature ventricular contractions (PVCs), and intermittent bundle branch block. A multiple linear regression identified loop diuretics (regression coefficient [B] −0.11; 95% CI −0.21–(−0.0001); p = 0.049), angiotensin receptor–neprilysin inhibitors (ARNIs) (B −0.11; 95% CI 0.22–(−0.01); p = 0.033), and a higher R-amplitude of the WCD baseline electrocardiogram (ECG) (B −0.17; 95% CI −0.27–(−0.07); p = 0.001) as independent predictors for a lower number of artifact episodes per day. In addition, atrial fibrillation (B 0.05; 95% CI 0.01–0.08; p = 0.010), and calcium antagonists (B 0.07; 95% CI 0.02–0.12; p = 0.012) were independent predictors for increased numbers of misclassified episodes per day, while beta-blockers seemed to reduce them (B −0.06; 95% CI −0.10–(−0.01); p = 0.013). Patients terminated 61.0% of all false alarms manually by pressing the response button on average 1.9 times per false alarm with overall 3.6 manual terminations per affected patient per month. Conclusions: In conclusion, false alarms from the ZOLL LifeVest™ system were frequent, with artifact sensing being the most common cause. Hence, the occurrence of false alarms represents a significant side effect of WCD therapy, and efforts should be made to minimize false alarms. Full article

Background: Infantile haemangiomas (IHs) sometimes require treatment with propranolol. Sleep disturbances are the most frequently reported side effects. Monitoring adverse drug events necessitates repeated hospital visits, which can be challenging during a pandemic. Objectives: To explore the effectiveness of a new electronic questionnaire in identifying sleep disturbances related to treatment with propranolol and potential confounding factors. To evaluate the response rate to the questionnaire. To report the proportion of patients on propranolol with sleep disturbances. Methods: In an observational, prospective cohort study, caregivers provided clinical information during ambulatory visits and via an electronic questionnaire after an 8-week treatment course with propranolol and at the time of treatment interruption. Adverse drug reaction reporting forms were assessed for causality. Results: The questionnaire response rate was 91%, and the completion rate was 100%. A total of 59% of patients experienced sleep disturbances during propranolol treatment, which were considered adverse reactions. Sleep disorders were frequent during sleep regression phases and in subjects who fell asleep during physical contact with caregivers or bed-sharing with parents. Conclusion: The application of this questionnaire allows for identifying adverse sleep events associated with propranolol in IHs and potential confounders. Counselling on sleep hygiene is recommended before treatment onset. Full article

Sleep apnea, characterized by breathing interruptions or slow breathing at night, can cause various health issues. Detecting respiratory rate (RR) using Wireless Fidelity (Wi-Fi) can identify sleep disorders without physical contact avoiding sleep disruption. However, traditional methods using Network Interface Cards (NICs) like the Intel Wi-Fi Link 5300 NIC are often costly and limited in channel state information (CSI) resolution. Our study introduces an effective strategy using the affordable ESP32 single-board computer for tracking RR through detailed analysis of Wi-Fi signal CSI. We developed a technique correlating Wi-Fi signal fluctuations with RR, employing signal processing methods—Hampel Filtering, Gaussian Filtering, Linear Interpolation, and Butterworth Low Pass Filtering—to accurately extract relevant signals. Additionally, noise from external movements is mitigated using a Z-Score for anomaly detection approach. We also implemented a local peak function to count peaks within an interval, scaling it to bpm for RR identification. RR measurements were conducted at different rates—Normal (12–16 bpm), Fast (>16 bpm), and Slow (<12 bpm)—to assess the effectiveness in both normal and sleep apnea conditions. Tested on data from 8 participants with distinct body types and genders, our approach demonstrated accuracy by comparing modeled sleep RR against actual RR measurements from the Vernier Respiration Monitor Belt. Optimal parameter settings yielded an overall average mean absolute deviation (MAD) of 2.60 bpm, providing the best result for normal breathing (MAD = 1.38). Different optimal settings were required for fast (MAD = 1.81) and slow breathing (MAD = 2.98). The results indicate that our method effectively detects RR using a low-cost approach under different parameter settings. Full article

Sleep is a vital process that impacts biological functions such as cell renewal, bone regeneration, and immune system support. Disrupted sleep can interrupt erythropoiesis, leading to fewer red blood cells, reduced haemoglobin concentration, and decreased haematocrit levels, potentially contributing to haematological disorders. This is particularly concerning for shift workers for example firefighters. While previous studies have explored sleep’s adverse effects on various professions, research specific to firefighters is limited. This study investigates the relationship between sleep quality and haematological parameters among firefighters in Northeast Portugal. From a sample of 201 firefighters, variations in red blood cells, haemoglobin, and haematocrit values were linked to sleep quality. The study utilised non-parametric tests (Wilcoxon-Mann-Whitney, Spearman’s correlation) to explore the connection between sleep quality and haematological profile. The impact of covariates on haematological parameters was assessed using non-parametric ANCOVA (Quade’s). A multiple regression analysis was employed to further understand how sleep quality and various confounding variables impact haematological levels. Findings suggest a negative link between sleep quality and haematological levels, meaning that as sleep quality deteriorates, there is a tendency for haematological levels to decrease, as indicated by Spearman’s correlation (rRBC = −0.157, pRBC = 0.026; rHb = −0.158, pHb = 0.025; rHCT = −0.175, pHCT = 0.013). As observed in scientific literature, the correlation found suggests a possible inhibition of erythropoiesis, the process responsible for red blood cell production. Despite firefighters presenting a haematological profile within the reference range (RBC: 5.1 × 10⁶/mm³ (SD ± 0.4), Hb: 15.6 g/dL (SD ± 1.3), 47% (SD ± 1.0), there is already an observable trend towards lower levels. The analysis of co-variables did not reveal a significant impact of sleep quality on haematological levels. In conclusion, this study underscores the importance of sleep quality in determining haematological parameters among firefighters. Future research should investigate the underlying mechanisms and long-term implications of poor sleep quality on firefighter health. Exploring interventions to enhance sleep quality is vital for evidence-based strategies promoting firefighter well-being. Full article

Mental activity is capable of processing analytical data (mathematics, physics, socio-political science, philosophy, etc.) similar to computer software. At the same time, mental activity largely depends on the brain, which works like a hard component of a computer. While the computer stores data on a physical medium, mental activity and data are supported by physiological mechanisms that are constantly operating (both in wakefulness and sleep). For this reason, the lack of brain oxygenation even for short periods of time (5–10 minutes) causes the loss of all data, including the disappearance of the individual's existence as a mental entity. This means that psycho-physiological mechanisms that run continuously can accumulate malfunctions, but also that they can be interfered with, for example by coffee. We have presented in previous articles the similarity between computer operation and mental activity. This brief review is a synthesis of published articles and, at the same time, a preamble to an SSRI-based pharmacological approach capable of resetting mental activity (by restoring mental patterning) but without interrupting, losing or altering existing mental data. Full article