Comparison of Home Sleep Devices and Sleep Study Testing in Hypoglossal Nerve Stimulation Patients.

Objective: Hypoglossal nerve stimulation (HGNS) is an implantable therapy for obstructive sleep apnea (OSA). Therapy efficacy is currently confirmed by a formal sleep study after empiric adjustment by the patient at home based on their subjective experience with the device. Home-based longitudinal apnea hypopnea index (AHI) measurements have the potential to refine HGNS therapeutic amplitude selection with objective data.

Comparison of clinical pathways for hypoglossal nerve stimulation management: in-laboratory titration polysomnography vs home-based efficacy sleep testing.

Study Objectives: We conducted this study to evaluate whether laboratory or home-based hypoglossal nerve stimulation (HNS) management would have equivalent objective and subjective obstructive sleep apnea outcomes 6 months after activation.

Methods: Patients undergoing standard-of-care HNS implantation were randomly assigned in a prospective, multicenter clinical trial to either a 3-month postactivation in-laboratory titration polysomnography (tPSG) or an efficacy home sleep study (eHST) with tPSG by exception for eHST nonresponders at 5 months. Both groups underwent an eHST 6 months postactivation.

Personalized multimodal management for severe obstructive sleep apnea in a patient intolerant of positive airway pressure with hypoglossal nerve stimulator and mandibular advancement device.

Unlabelled: Treatment of moderate to severe obstructive sleep apnea poses clinical challenges in persons with intolerance or inadequate response to traditional treatment modalities, including positive airway pressure and mandibular advancement devices. Hypoglossal nerve stimulation is a new treatment option, but few management guidelines exist when it is intolerable or ineffective. Combining several treatment modalities has been an effective strategy for improving symptoms, tolerance, and efficacy.

Obstructive sleep apnea basics.

Obstructive sleep apnea (OSA) is a condition caused by repeated episodes of upper airway collapse and obstruction during sleep associated with arousal from sleep with or without oxygen desaturation. OSA is a highly prevalent condition, particularly in individuals with established risk factors and comorbid conditions. Screening for OSA includes a sleep history, review of symptoms, and physical examination, the results of which can identify patients that need testing for OSA.

Polysomnography.

Polysomnography refers to a systematic process used to collect physiologic parameters during sleep. A polysomnogram (PSG) is a procedure that utilizes electroencephalogram, electro-oculogram, electromyogram, electrocardiogram, and pulse oximetry, as well as airflow and respiratory effort, to evaluate for underlying causes of sleep disturbances. PSG is considered to be the gold standard for diagnosing sleep-related breathing disorders, which include obstructive sleep apnea (OSA), central sleep apnea, and sleep-related hypoventilation/hypoxia.

Metabolism of Ca and Sr in late adult life.

Data are presented on the metabolism of Ca and Sr in a healthy male volunteer who, in a series of investigations conducted between the ages of 53 and 82 y, received controlled intakes of 45Ca, 47Ca, or 85Sr. No age-related trends were established, either in factors affecting the skeletal deposition of the tracers or in their subsequent retention studied for up to 462 d after intake. The data thus lend support to an important working postulate in the ICRP's model of alkaline earth metabolism.

Postmenopausal loss of Ra acquired in adolescence or young adulthood: quantitative relationship to radiation-induced skeletal damage and dosimetric implications.

From the results of serial measurements of body 226Ra activity in 13 former luminous dial workers 30-60 y after relatively brief periods of intake of luminous compounds in adolescence or young adulthood, we determined the postmenopausal rate of elimination of Ra in percent of contemporary body Ra content per year. This rate was negatively correlated with the "reduced x-ray score," a measure of radiation osteonecrosis observed radiographically in the 13 subjects (r = -0.85, P less than 0.

Metabolism of ingested U and Ra.

The literature on metabolism of U and Ra for man relevant to deriving drinking water standards has been reviewed and summarized. Radium is well understood, but significant gaps remain in our knowledge about U metabolism. Limits should be based on an equilibrium model where a constant relationship between intake and organ burden is established, using the best and most likely metabolic parameters.

Distribution and retention in bone of 226Ra and comparison with the ICRP 20 model.

Analyses are presented of the ratios of 226Ra to calcium in over 650 samples of compact and cancellous bone from 66 female and 26 male subjects who had died from less than 1 to 60 yr after first exposure to radium. The 226Ra/Ca ratios were normalized to the terminal 226Ra skeletal content. The 226Ra/Ca ratios for vertebrae were essentially identical to those for other cancellous bone for a given subject.

Leukaemia incidence in the U.S. dial workers.

Late biological effects of radium deposited in the human skeleton have manifested themselves unequivocally as osteogenic sarcomas or carcinomas of the mastoid air cells or paranasal sinuses. On the basis of current estimated risk factors, it might be expected that an excess of certain other malignancies could occur in a population of the size of the group exposed to radium (some 3500 cases located, which more than 2000 have measured 226Ra and 228Ra burdens), compared with the incidence in the population at large. An increased incidence of breast cancer has already been reported in female dial workers and it was related to the initial radium intake.

Measurement techniques for radium and the actinides in man at the Center for Human Radiobiology.

Various techniques are employed to determine the amounts, retention, and distribution of radioactivity in human subjects in vivo. The principal method is gamma-ray spectrometry with large NaI(Tl) scintillation crystals ("whole-body counting"). The geometries used include an arc of 1.

Radioactivity measurements of former military personnel exposed to weapon debris.

Sixteen former military personnel who were present at the "Smoky" atmospheric nuclear weapon test have been investigated for internal deposits of radioactivity. Whole-body and thorax gamma-ray measurements, thorax and skeletal actinide measurements, and urinalyses for plutonium-239 and strontium-90 indicated no evidence of radioactivity in excess of that found in the general population.