Try a new search

Format these results:

Searched for:

person:bursco01

in-biosketch:true

Total Results:

25


Sleep scoring using a limited montage: Forehead EEG and chin EMG [Meeting Abstract]

Chua, C; Fenigsohn, G; Ayappa, I; Rapoport, D M; Burschtin, O
Introduction: Sleep scoring performed using the 10-20 system is usually performed in the laboratory with a trained technician applying electrodes. Home monitoring of sleep is made easier by self-application of limited number of electrodes positioned only on the face. We evaluated moving the F4 lead to the forehead and scoring sleep using this and a bipolar chin EMG only. This study examines agreement for sleep scoring using full polysomnography compared to scoring using these modiied leads. Methods: 21 subjects (11M/10F) who were undergoing full in-laboratory polysomnography for evaluation of obstructive sleep apnea had one frontal lead moved to the forehead. Conventional sleep scoring from the unmodiied F4, C4, EOG and EMG was performed by an experienced sleep technologist using AASM rules. Limited monitoring (LM) sleep scoring was done independently by 2 scorers while viewing only the modiied F4 and chin EMG. For each study, epoch-by-epoch agreement was tabulated (i) between each scorer's LM scoring and full PSG AASM scoring and (ii) between scorers LM scoring. Results: 17,786 epochs were scored (669-990 epochs/subject). The mean agreement between LM and full PSG was 78% (range 59-88%/ subject) for scorer 1 and 80% (range 66-92%/subject) for scorer 2. For both scorers agreement between LM and full PSG for epochs scored as sleep or wake scoring only was 93% (range 75-98%) and for REM vs NREM was 93% (83-99%). For LM alone, inter-scorer agreement was 78% (range 63-88%), 91% for sleep-wake (range 76-97%) and 88% for REM vs NREM (range 78-90%). Conclusion: Repositioning of F4 EEG to the forehead and scoring from this and chin EMG resulted in excellent discrimination of sleep from wake and REM from NREM sleep. Inter-scorer LM epoch-by-epoch agreement across all stages is similar to that seen between scorers using full polysomnograpy and suggests its utility in the home
EMBASE:71510185
ISSN: 0161-8105
CID: 1069332

Mandibular advancement device titration using a remotely controlled mandibular positioner [Meeting Abstract]

Burschtin, O; Binder, D S; Lim, J W; Malis, S; Marsiliani, R; Ayappa, I; Rapoport, D M
Introduction: In obstructive sleep apnea (OSA) treated with a mandibular advancement device Remmers et al recently showed that therapeutic outcome was predicted by a titration study in the laboratory using a remotely controlled mandibular positioner (RCMP, SomnoMed MATRxTM, Zephyr Sleep Technologies Inc., Canada). Furthermore this study showed that optimal titration could be established in a single night. We report on use of the RCMP in a clinical sleep practice. Methods: 30 patients (22M/8F, BMI 26 + 3 kg/m2) with pre-treatment AHI (AHIDx) < 30/hr (n = 18), or AHIDx > 30/hr who refused CPAP (n = 12) were studied with RCMP during a full night polysomnography (PSG). Baseline and maximum jaw advancement (ADVmax) was determined prior to study by a dentist. During PSG, RCMP was progressively advanced past baseline to ADVmax until all obstructive events were eliminated (ADVopt), or until the patient expressed discomfort. AHIRCMP was calculated as the sum of apneas and hypopneas (30% reduction in low with 3% O2 desaturation or arousal) divided by the sleep time limited to the section of the RCMP study with optimal/maximal advancement. Successful titration was deined as AHIRCMP < 15. If pre-treatment AHIDx was < 20, a 50% reduction was also required. Results: Titration was successful in 20 subjects. (AHIDx = 34 + 9/hr vs AHIRCMP = 9 + 7/hr). ADVopt was within 2 mm of ADVmax in 15/20 patients. In the remaining 5 patients the ADVopt was 2-5 mm lower than ADVmax. Titration resulted in no beneit in 10 subjects (AHIDx = 27 + 26/hr vs AHIRCMP = 24 + 11/hr). Conclusions: The RCMP system was used to advance the dental device over a range of jaw advancements and was tolerated by all subjects. In 20/30 subjects successful titration was obtained during the one night titration, with 25% of these subjects requiring less than maximal advancement. Lack of beneit was predicted in 10/30 subjects. The long-term utility of suboptimal advancement, prediction of futility and sustained eficacy need to be addressed separate!
EMBASE:71509559
ISSN: 0161-8105
CID: 1069442

Signal loss of pulse oximetry by forehead reflectance and finger transmittance in home sleep studies [Meeting Abstract]

Mantua, J; Twumasi, A; Chen, G; Burschtin, O E; Rapoport, D M; Ayappa, I
Introduction: During sleep studies, pulse oximetry using forehead relectance (R-ox) may have advantages over transmittance inger oximetry (T-ox) because of its ease of application. R-ox has been shown to be accurate and sensitive overall, but may be more subject to artifact from motion and changes in pressure on the sensor than T-ox. The purpose of the present study was to evaluate the signal loss of these two technologies using two commercially available devices used for home sleep testing of sleep-disordered breathing. Methods: We analyzed consecutive home studies performed in a cohort of 128 subjects (38% M, age 69+8 years, BMI 26.2+5.4kg/m2, 267 nights of data) who used the ARES Unicorder (with R-ox) for 1-3 nights as part of a research study and 50 additional subjects (72% M, age 46+12 years, BMI 27.5+5.0kg/m2, 50 nights of data) who used a Compumedics Somte (with T-ox) for one night as part of their clinical workup. The oximetry signal for each night was reviewed and oximet ry signal loss (%loss) was tabulated using automated detection followed by manual review. %loss between groups was compared by Mann-Whitney Rank Sum Test and Kolmogorov-Smirnov (KS-test). Results: In R-ox, TIB was 13.6+3.0 hr (over 2 nights); RDI was 24.5+15.2/hr. In T-ox, TIB was 7.6+1.0 hrs (1 night); RDI was 18.9+16.9/ hr. Overall, we could not show a signiicant difference for %loss between the two devices (%loss R-ox vs T-ox: median= 2.2% vs 3.1%; 25th %ile= 0% vs 0%; 75th %=13.7% vs 17.7%, p=ns by both statistical tests). In particular, there was no signiicant difference in the proportion of studies with <10% signal loss ("acceptable") between R-ox and T-ox (66% vs 68%). The two technologies also had similar proportion of studies with >40% signal loss (8% vs 8%). However, in the studies with 10- 40% loss (27% of R-ox and 24% of T-ox) there was signiicantly greater %loss in the R-ox studies (median =20% vs 15%, p=0.02 for rank-sum, p=0.004 KS-test). Conclusion: Overall, our data show equal num!
EMBASE:71514019
ISSN: 0161-8105
CID: 1074172

Changes in lung volume and upper airway using MRI during application of nasal expiratory positive airway pressure in patients with sleep-disordered breathing

Braga, C W; Chen, Q; Burschtin, O E; Rapoport, D M; Ayappa, I
Nasal expiratory positive airway pressure (nEPAP) delivered with a disposable device (Provent, Ventus Medical) has been shown to improve sleep-disordered breathing (SDB) in some subjects. Possible mechanisms of action are 1) increased functional residual capacity (FRC), producing tracheal traction and reducing upper airway (UA) collapsibility, and 2) passive dilatation of the airway by the expiratory pressure, carrying over into inspiration. Using MRI, we estimated change in FRC and ventilation, as well as UA cross-sectional area (CSA), in awake patients breathing on and off the nEPAP device. Ten patients with SDB underwent nocturnal polysomnography and MRI with and without nEPAP. Simultaneous images of the lung and UA were obtained at 6 images/s. Image sequences were obtained during mouth and nose breathing with and without the nEPAP device. The nEPAP device produced an end-expiratory pressure of 4-17 cmH(2)O. End-tidal Pco(2) rose from 39.7 +/- 5.3 to 47.1 +/- 6.0 Torr (P < 0.01). Lung volume changes were estimated from sagittal MRI of the right lung. Changes in UA CSA were calculated from transverse MRI at the level of the pharynx above the epiglottis. FRC determined by MRI was well correlated to FRC determined by N(2) washout (r = 0.76, P = 0.03). nEPAP resulted in a consistent increase in FRC (46 +/- 29%, P < 0.001) and decrease in ventilation (50 +/- 15%, P < 0.001), with no change in respiratory frequency. UA CSA at end expiration showed a trend to increase. During wakefulness, nEPAP caused significant hyperinflation, consistent with an increase in tracheal traction and a decrease in UA collapsibility. Direct imaging effects on the UA were less consistent, but there was a trend to dilatation. Finally, we showed significant hypoventilation and rise in Pco(2) during use of the nEPAP device during wakefulness and sleep. Thus, at least three mechanisms of action have the potential to contribute to the therapeutic effect of nEPAP on SDB
PMID: 21799124
ISSN: 1522-1601
CID: 141692

HIGH THROUGHPUT BRAIN-BEHAVIOR ASSAY. QUANTIFICATION OF EEG AND PERFORMANCE IN PATIENTS REFERRED FOR ASSESSMENT OF DAYTIME DROWSINESS [Meeting Abstract]

Berka, C; Ayappa, I; Burschtin, O; Piyathilake, H; Rapoport, DM; Westbrook, P; Johnson, R; Popovic, D; Behneman, A; Pojman, N
ISI:000265542000490
ISSN: 0161-8105
CID: 99157

REM-associated nasal obstruction: a study with acoustic rhinometry during sleep

Morris, Luc G T; Burschtin, Omar; Setlur, Jennifer; Bommelje, Claire C; Lee, Kelvin C; Jacobs, Joseph B; Lebowitz, Richard A
OBJECTIVE: Obstructive sleep apnea events are more common in REM sleep, although there is no relationship between sleep phase and pharyngeal airway status. We studied the patency of the nasal airway during REM and non-REM sleep with the use of acoustic rhinometry. METHODS: Serial acoustic rhinometric assessment of nasal cross-sectional area was performed in 10 subjects, before sleep and during REM and non-REM sleep. All measurements were standardized to a decongested baseline with mean congestion factor (MCF). RESULTS: MCF in the seated position was 10.6% (+/-3.7) and increased with supine positioning to 16.2% (+/-2.3). In REM sleep, MCF was highest, at 22.3% (+/-1.7). In non-REM sleep, MCF was lowest, at 2.3% (+/-3.1). All interstage comparisons were statistically significant on repeated measures ANOVA (P < 0.05). CONCLUSION: REM sleep is characterized by significant nasal congestion; non-REM sleep, by profound decongestion. This phenomenon may be attributable to REM-dependent variation in cerebral blood flow that affects nasal congestion via the internal carotid system. REM-induced nasal congestion, an indirect effect of augmented cerebral perfusion, may contribute to the higher frequency of obstructive events in REM sleep
PMID: 18984253
ISSN: 0194-5998
CID: 102474

Rapid risk stratification for obstructive sleep apnea, based on snoring severity and body mass index

Morris, Luc G T; Kleinberger, Andrew; Lee, Kelvin C; Liberatore, Lisa A; Burschtin, Omar
OBJECTIVE: It is unclear whether all snoring patients require polysomnography, and there are no highly sensitive clinical predictors of sleep apnea. Our objective was to develop a simple clinical screening test for OSA in snoring patients. STUDY DESIGN: Prospective, IRB-approved study at a university sleep disorders center. SUBJECTS AND METHODS: In 211 patients undergoing polysomnography, snoring severity, Epworth sleepiness scale, body mass index, demographic, and sleep study data were collected. Receiver operating characteristic (ROC) analysis and Pearson correlation were used to develop a sensitive screening test for OSA. RESULTS: Snoring severity score (SSS) and BMI were the two most accurate predictors of OSA on the ROC curve. A bipartite threshold of SSS = 4 or BMI = 26 carried sensitivity of 97.4%, specificity of 40%, positive predictive value of 82.3%, and negative predictive value of 84.2% for moderate/severe OSA. Patients at high risk were those with BMI > or =32 (89% PPV) or SSS > or =7 (92% PPV). CONCLUSIONS: The statistic most predictive of OSA was snoring severity. Combining this with BMI yielded a highly sensitive screening test for moderate/severe OSA. This clinical assessment may be useful in risk-stratifying patients for polysomnography and therapy, facilitating deferred work-up in low-risk patients and expedited therapy in high-risk patients
PMID: 18984252
ISSN: 0194-5998
CID: 102475

Accuracy of automated sleep staging using signals from a single forehead site [Meeting Abstract]

Popovic, D; Levendowski, DJ; Ayappa, I; Hauri, P; Velimirovic, V; Burschtin, O; Yan, N; Rapoport, DM; Westbrook, PR
ISI:000255419001436
ISSN: 0161-8105
CID: 86966

Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: A pilot study

Morris, Luc G; Setlur, Jennifer; Burschtin, Omar E; Steward, David L; Jacobs, Joseph B; Lee, Kelvin C
BACKGROUND: Nasal continuous positive airway pressure (nCPAP) is usually the first-line intervention for obstructive sleep apnea, but up to 50% of patients are unable to tolerate therapy because of discomfort-usually nasal complaints. No factors have been definitively correlated with nCPAP tolerance, although nasal cross-sectional area has been correlated with the level of CPAP pressure, and nasal surgery improves nCPAP compliance. This study examined the relationship between nasal cross-sectional area and nCPAP tolerance. METHODS: We performed acoustic rhinometry on 34 obstructive sleep apnea patients at the time of the initial sleep study. Patients titrated to nCPAP were interviewed 18 months after starting therapy to determine CPAP tolerance. Demographic, polysomnographic, and nasal cross-sectional area data were compared between CPAP-tolerant and -intolerant patients. RESULTS: Between 13 tolerant and 12 intolerant patients, there were no significant differences in age, gender, body mass index, CPAP level, respiratory disturbance index, or subjective nasal obstruction. Cross-sectional area at the inferior turbinate differed significantly between the two groups (p = 0.03). This remained significant after multivariate analysis for possibly confounding variables. A cross-sectional area cutoff of 0.6 cm2 at the head of the inferior turbinate carried a sensitivity of 75% and specificity of 77% for CPAP intolerance in this patient group. CONCLUSION: Nasal airway obstruction correlated with CPAP tolerance, supporting an important role for the nose in CPAP, and providing a physiological basis for improved CPAP compliance after nasal surgery. Objective nasal evaluation, but not the subjective report of nasal obstruction, may be helpful in the management of these patients
PMID: 16686374
ISSN: 1050-6586
CID: 68713

Tolerance of nasal continuous positive airway pressure (NCPAP) correlates with nasal airway anatomy, but not with CPAP pressure or sleep study findings [Meeting Abstract]

Morris, LG; Burschtin, OE; Setlur, SJ; Lee, KC
ISI:000232800300282
ISSN: 0012-3692
CID: 59595