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Weight loss is one of the first line treatments for people with obstructive sleep apnea (OSA); however, people with OSA may have difficulties losing weight. Few studies have investigated the factors underlying these challenges in people with OSA. The aim of this study was to compare dietary intake, eating behavior and physical activity data in people with OSA and without OSA. Seventy-four patients referred to a sleep disorders clinic for suspected OSA underwent a standard clinical overnight polysomnography and completed questionnaires assessing dietary intake, physical activity and eating behavior prior to treatment. On the Three Factor Eating Questionnaire-R18 patients with OSA (n = 49, AHI 19.5 [13.0-55.4] events/h) had higher levels of uncontrolled eating (adjusted means, 19.7 (0.7) vs 16.1 (1.0): F (1, 69) = 7.103, p = 0.010 partial eta2 = 0.093), than those who did not have OSA (n = 25, AHI 3.3 [0.8-4.4] events/h) after adjusting for age, fat mass % and depression. There were no differences between groups in dietary intake measures or physical activity. These results suggest that people with OSA may need specific attention to eating behavior when undergoing weight loss interventions.Copyright © 2020, Japanese Society of Sleep Research.

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved.

With advances in digital stethoscopes, internet of things, signal processing and machine learning, chest sounds can be easily collected and transmitted to the cloud for remote monitoring and diagnosis. However, low quality of recordings complicates remote monitoring and diagnosis, particularly for neonatal care. This paper proposes a new method to objectively and automatically assess the signal quality to improve the accuracy and reliability of heart rate (HR) and breathing rate (BR) estimation from noisy neonatal chest sounds. A total of 88 10-second long chest sounds were taken from 76 preterm and full-term babies. Six annotators independently assessed the signal quality, number of detectable beats, and breathing periods from these recordings. For quality classification, 187 and 182 features were extracted from heart and lung sounds, respectively. After feature selection, class balancing, and hyperparameter optimization, a dynamic binary classification model was trained. Then HR and BR were automatically estimated from the chest sound and several approaches were compared. The results of subject-wise leave-one-out cross-validation, showed that the model distinguished high and low quality recordings in the test set with 96% specificity, 81% sensitivity and 93% accuracy for heart sounds, and 86% specificity, 69% sensitivity and 82% accuracy for lung sounds. The HR and BR estimated from high quality sounds resulted in significantly less median absolute error (4bpm and 12bpm difference, respectively) compared to those from low quality sounds. The methods presented in this work, facilitates automated neonatal chest sound auscultation for future telehealth applications.Copyright IEEE

Rationale: Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objective(s): We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months. Method(s): Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration-aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months. Measurements and Main Results: Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9-10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1-6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038). Conclusion(s): Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD.Copyright © ERS 2021.

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved.

Study objectives: Unobtrusive monitoring of sleep and sleep disorders in children presents challenges. We investigated the possibility of using Ultra-Wide band (UWB) radar to measure sleep in children. Methods: Thirty-two children scheduled to undergo a clinical polysomnography participated; their ages ranged from 2 months to 14 years. During the polysomnography, the children's body movements and breathing rate were measured by an UWB-radar. A total of 38 features were calculated from the motion signals and breathing rate obtained from the raw radar signals. Adaptive boosting was used as machine learning classifier to estimate sleep stages, with polysomnography as gold standard method for comparison. Results: Data of all participants combined, this study achieved a Cohen's Kappa coefficient of 0.67 and an overall accuracy of 89.8% for wake and sleep classification, a Kappa of 0.47 and an accuracy of 72.9% for wake, rapid-eye-movement (REM) sleep, and non-REM sleep classification, and a Kappa of 0.43 and an accuracy of 58.0% for wake, REM sleep, light sleep and deep sleep classification. Conclusion: Although the current performance is not sufficient for clinical use yet, UWB radar is a promising method for non-contact sleep analysis in children., Mechanical, Maritime and Materials Engineering, Bio-Electronics

Global Proprioceptive Resonance (GPR) is a recently developed approach conceived to solicit the various cutaneous mechanoreceptors, through application of mechanical multifocal vibration at low amplitude and at definite body sites, limiting the stimulation of the profound structures. This interventional study evaluated the effects of GPR on cardiorespiratory function during the post-exertional recovery period. A group of volunteers involved in Triathlon (a multisport discipline consisting of sequential swim, cycle, and run disciplines higly demanding in terms of metabolic engagment), underwent two maximal incremental exercise tests until exhaustion followed alternatively to (a) a 13 minutes section of GPR or (b) a standard low intensity exercise acute trend of the same duration. These effects of these two approaches were compared in terms of recovery of: heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2) and venous lactate concentration (Lac). The physiological parameters (HR, RR, SpO2 and Lac) recorded in the pre-exertion session showed similar values between the 40 volunteers while several differences were recorded in the post-exertion phase. After 6 min of GPR recovery it was recorded a drop in RR below baseline (19.4±4.15 min-1 vs. 12.2± 0.4 min-1; p<0.001) coupled with an increase in peripheral oxygen saturation above the baseline (GPR: 99.0%±0.16% vs. 96.6%±0.77%, p<0.001). Moreover, the most striking result was the drop in lactate concentration measured after 13 min of GPR recovery: 84.5±3.5% in GPR vs 2.9±7.6% reduction in standard recovery (p<0.001). Notably no differences were recorded recovery of heart rate. GPR has promising effects on post-exercise recovery on RR, SpO2 and lactate level on young athletes. © 2020 PAGEPress Publications. All rights reserved.

This work presents a seat-occupancy detection system based on a PCR (Pulsed Coherent Radar) at the unlicensed 60 GHz ISM band. The radar can measure distances with sub-millimeter resolution. Therefore, the system can detect the presence of people occupying the seats by measuring small movements of the body, such as those produced by breathing. In consequence, the system not only measures seat-occupancy but also breathing rate, which is estimated from the amplitude peaks after filtering the amplitude measured by the radar to remove the noise. The effect of the car vibrations and random body movement is experimentally studied. Measurements performed with adults, as well as with a baby emulator sitting in a child seat, are presented. Comparison of the system with another that measures the breath based on airflow shows good agreement and permits its validation.

The COVID-19 pandemic has highlighted a large amount of challenges to address. To combat the spread of the virus, several safety measures, such as wearing face masks, have been taken. Temperature controls at the entrance of public places to prevent the entry of virus carriers have been shown to be inefficient and inaccurate. This paper presents a smart mask that allows to monitor body temperature and breathing rate. Body temperature is measured by a non-invasive dual-heat-flux system, consisting of four sensors separated from each other with an insulating material. Breathing rate is obtained from the temperature changes within the mask, measured with a thermistor located near the nose. The system communicates by means of long-range (LoRa) backscattering, leading to a reduction in average power consumption. It is designed to establish the relative location of the smart mask from the signal received at two LoRa receivers installed inside and outside an access door. Low-cost LoRa transceivers with WiFi capabilities are used in the prototype to collect information and upload it to a server. Accuracy in body temperature measurements is consistent with measurements made with a thermistor located in the armpit. The system allows checking the correct placement of the mask based on the recorded temperatures and the breathing rate measurements. Besides, episodes of cough can be detected by sudden changes in thermistor temperature.

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Method(s): Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate <=100 bpm), desaturation (oxygen saturation <=80%), and apnea (pause in respiratory rate >=10 s) episodes were analyzed. Result(s): Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusion(s): Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.Copyright © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.

Objective The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. Patients and methods An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED. Results A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients. Conclusion Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.Copyright © 2019 Lippincott Williams and Wilkins. All rights reserved.

Dissection of a cervical artery is a well-known cause of stroke, especially in younger patients. We describe the case of a 39-year-old male, who presented to our emergency department after a one-day history of headache and vomiting, with associated sudden onset posterior neck pain and cerebellar signs following a massage. Computed tomography angiogram and brain demonstrated bilateral vertebral artery dissection and cerebellar stroke. He was admitted to hospital for monitoring and conservative management with antiplatelet therapy, resulting in a good outcome. This is the first reported case of bilateral vertebral artery dissection and stroke to be associated with massage. This case also suggests, unlike many reports in the literature, that significant vascular pathology can result from massage even without cervical spine manipulation.Copyright © NZMA

Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID-19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. Clinical presentation, pathophysiology, pulmonary mechanics, radiological and ultrasound findings of these two phenotypes are different. Consequently, the therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure.Copyright © 2020, Canadian Anesthesiologists' Society.

Objective: High-anion gap metabolic acidosis (HAGMA) most commonly results from excess urea, lactate, ketones and exposure to toxins such as salicylate and toxic alcohols. Accumulation of pyroglutamic acid (PGA) is a rare cause of HAGMA. The exact incidence of HAGMA caused by PGA accumulation is unknown. A recent prospective study reported that high urine PGA concentrations were associated with 10% of patients with HAGMA. PGA is processed by the glutamate-glutathione cycle. The commonest cause of PGA accumulation is glutathione depletion. This causes the loss of negative feedback on gamma-glutamylcysteine (PGA precursor) production. Other causes include malnutrition, alcoholism, liver failure and sepsis. Though rare, deficiency of either glutathione synthetase causing gamma-glutamylcysteine (PGA precursor) accumulation or 5-oxoprolinase resulting in reduced PGA metabolism, also cause PGA accumulation. We describe a case of confirmed PGA accumulation after repeated supratherapeutic paracetamol use. Case report: A 32-year-old female presented with ongoing pain from shingles despite having taken 96 x 665 mg modified-release paracetamol caplets over the preceding two days. Two years prior, she suffered a gastric ulcer perforation following excessive ibuprofen use for dysmenorrhea. She subsequently ceased using NSAIDs and substituted these with regular use of four modifiedrelease paracetamol tablets every 3-4 hours. On presentation vital signs were normal except a respiratory rate of 24/min. Venous blood gas showed pH 7.04, bicarbonate 5.0mmol/L, pCO2 19 mmHg, lactate 1.4mmol/L, sodium 150mmol/L, chloride 117 mmol/L and anion gap 28, indicating a partially compensated HAGMA. Serum ketones were 2.8mmol/L, salicylate undetected and normal osmolar gap. Serum paracetamol was 312 mumol/L, 2.5 hours after the last dose. Liver function, INR and creatinine were normal. PGA accumulation from chronic paracetamol misuse and glutathione depletion was suspected. Acetylcysteine was in

This work explores the use of a commodity ultra-wideband (UWB) radar based device to detect breathing rate for health monitoring applications. Health monitoring devices observe physiological signals to detect medical conditions. We focus on capturing the small mechanical movements caused by breathing. This is traditionally done via a strain gauge worn around the chest or stomach, but these systems limit user movement. Contactless systems provide a unique design that allows free user movement by eliminating all direct contact with the user. Additionally, these systems have the potential to support full health monitoring in a Smart Built Environment (SBE). In this work, a comparative evaluation is performed on a commodity UWB radar based device, the Walabot, to determine the accuracy and possible health monitoring applications. Based on results from a systematic review, six research challenges were identified: (1) high cost, functional limitations based on the user's (2) location, (3) orientation, and (4) movement, (5) dependency on system hardware placement, and (6) vulnerabilities in signal processing methods. A comparative evaluation was designed to test the Walabot against a medical grade wearable system in the context of these research challenges. The data was processed using two breathing rate derivation techniques: Fast Fourier Transformation (FFT) and Peak Detection. Results suggest great potential for the Walabot coupled with the FFT technique. However, the system requires further testing to address all of the research challenges. Overall, this work provides important steps toward using the Walabot in health monitoring applications.