Annals of the American Thoracic Society最新文献

{"title":"Right Ventricular Dysfunction Patterns among Patients with COVID-19 in the Intensive Care Unit: A Retrospective Cohort Analysis.","authors":"Pablo A Sanchez, Christian T O'Donnell, Nadia Francisco, Everton J Santana, Andrew R Moore, Ana Pacheco-Navarro, Jonasel Roque, Katherine M Lebold, Caitlin M Parmer-Chow, Shaun M Pienkos, Bettia E Celestin, Joseph E Levitt, William J Collins, Michael J Lanspa, Euan A Ashley, Jennifer G Wilson, Francois Haddad, Angela J Rogers","doi":"10.1513/AnnalsATS.202303-235OC","DOIUrl":"10.1513/AnnalsATS.202303-235OC","url":null,"abstract":"<p><p><b>Rationale:</b> Right ventricular (RV) dysfunction is common among patients hospitalized with coronavirus disease (COVID-19); however, its epidemiology may depend on the echocardiographic parameters used to define it. <b>Objectives:</b> To evaluate the prevalence of abnormalities in three common echocardiographic parameters of RV function among patients with COVID-19 admitted to the intensive care unit (ICU), as well as the effect of RV dilatation on differential parameter abnormality and the association of RV dysfunction with 60-day mortality. <b>Methods:</b> We conducted a retrospective cohort study of ICU patients with COVID-19 between March 4, 2020, and March 4, 2021, who received a transthoracic echocardiogram within 48 hours before to at most 7 days after ICU admission. RV dysfunction and dilatation, respectively, were defined by guideline thresholds for tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, RV free wall longitudinal strain (RVFWS), and RV basal dimension or RV end-diastolic area. Association of RV dysfunction with 60-day mortality was assessed through logistic regression adjusting for age, prior history of congestive heart failure, invasive ventilation at the time of transthoracic echocardiogram, and Acute Physiology and Chronic Health Evaluation II score. <b>Results:</b> A total of 116 patients were included, of whom 69% had RV dysfunction by one or more parameters, and 36.3% of these had RV dilatation. The three most common patterns of RV dysfunction were the presence of three abnormalities, the combination of abnormal RVFWS and TAPSE, and isolated TAPSE abnormality. Patients with RV dilatation had worse RV fractional area change (24% vs. 36%; <i>P</i> = 0.001), worse RVFWS (16.3% vs. 19.1%; <i>P</i> = 0.005), higher RV systolic pressure (45 mm Hg vs. 31 mm Hg; <i>P</i> = 0.001) but similar TAPSE (13 mm vs. 13 mm; <i>P</i> = 0.30) compared with those with normal RV size. After multivariable adjustment, 60-day mortality was significantly associated with RV dysfunction (odds ratio, 2.91; 95% confidence interval, 1.01-9.44), as was the presence of at least two parameter abnormalities. <b>Conclusions:</b> ICU patients with COVID-19 had significant heterogeneity in RV function abnormalities present with different patterns associated with RV dilatation. RV dysfunction by any parameter was associated with increased mortality. Therefore, a multiparameter evaluation may be critical in recognizing RV dysfunction in COVID-19.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1465-1474"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/84/AnnalsATS.202303-235OC.PMC10559129.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race-Specific Interpretation of Spirometry: Impact on the Lung Allocation Score.","authors":"J Henry Brems, Aparna Balasubramanian, Kevin J Psoter, Pali Shah, Errol L Bush, Christian A Merlo, Meredith C McCormack","doi":"10.1513/AnnalsATS.202212-1004OC","DOIUrl":"10.1513/AnnalsATS.202212-1004OC","url":null,"abstract":"<p><p><b>Rationale:</b> Interpretation of spirometry using race-specific reference equations may contribute to health disparities via underestimation of the degree of lung function impairment in Black patients. The use of race-specific equations may differentially affect patients with severe respiratory disease via the use of percentage predicted forced vital capacity (FVCpp) when included in the lung allocation score (LAS), the primary determinant of priority for lung transplantation. <b>Objectives:</b> To determine the impact of a race-specific versus a race-neutral approach to spirometry interpretation on the LAS among adults listed for lung transplantation in the United States. <b>Methods:</b> We developed a cohort from the United Network for Organ Sharing database including all White and Black adults listed for lung transplantation between January 7, 2009, and February 18, 2015. The LAS at listing was calculated for each patient under race-specific and race-neutral approaches, using the FVCpp generated from the Global Lung Function Initiative equation corresponding to each patient's race (race-specific) or from the Global Lung Function Initiative \"other\" (race-neutral) equation. Differences in LAS between approaches were compared by race, with positive values indicating a higher LAS under the race-neutral approach. <b>Results:</b> In this cohort of 8,982 patients, 90.3% were White and 9.7% were Black. The mean FVCpp was 4.4% higher versus 3.8% lower among White versus Black patients (<i>P</i> < 0.001) under a race-neutral compared with a race-specific approach. Compared with White patients, Black patients had a higher mean LAS under both a race-specific (41.9 vs. 43.9; <i>P</i> < 0.001) and a race-neutral (41.3 vs. 44.3; <i>P</i> < 0.001) approach. However, the mean difference in LAS under a race-neutral approach was -0.6 versus +0.6 for White versus Black patients (<i>P</i> < 0.001). Differences in LAS under a race-neutral approach were most pronounced for those in group B (pulmonary vascular disease) (-0.71 vs. +0.70; <i>P</i> < 0.001) and group D (restrictive lung disease) (-0.78 vs. +0.68; <i>P</i> < 0.001). <b>Conclusions:</b> A race-specific approach to spirometry interpretation has potential to adversely affect the care of Black patients with advanced respiratory disease. Compared with a race-neutral approach, a race-specific approach resulted in lower LASs for Black patients and higher LASs for White patients, which may have contributed to racially biased allocation of lung transplantation. The future use of race-specific equations must be carefully considered.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1408-1415"},"PeriodicalIF":6.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10559135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9667719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile Mindfulness for Psychological Distress and Burnout among Frontline COVID-19 Nurses: A Pilot Randomized Trial.","authors":"Elias H Pratt,&nbsp;Levant Hall,&nbsp;Christina Jennings,&nbsp;Maren K Olsen,&nbsp;Adina Jan,&nbsp;Alice Parish,&nbsp;Laura S Porter,&nbsp;Christopher E Cox","doi":"10.1513/AnnalsATS.202301-025OC","DOIUrl":"10.1513/AnnalsATS.202301-025OC","url":null,"abstract":"<p><p><b>Rationale:</b> The coronavirus disease (COVID-19) pandemic exacerbated psychological distress and burnout in frontline healthcare workers. Interventions addressing psychological distress and burnout among these workers are lacking. <b>Objectives:</b> To determine the feasibility and explore the impact of mobile mindfulness to treat psychological distress and burnout among nurses in frontline COVID-19 units. <b>Methods:</b> We conducted a pilot randomized trial of 102 nurses working in COVID-19 units at a single hospital between May 2021 and January 2022. Participants were randomized to mobile mindfulness (intervention) or waiting list (control). The primary outcome was feasibility, assessed by comparing rates of randomization, retention, and intervention completion to predefined targets. Secondary outcomes were changes in psychological distress (Patient Health Questionnaire-9, General Anxiety Disorder-7, Perceived Stress Scale-4) and burnout symptoms (Maslach Burnout Inventory) after 1 month. <b>Results:</b> We randomized 102 of 113 consented individuals (90%, target 80%), and 88 completed follow-up (86%, target 80%). Among 69 intervention participants, 19 completed ⩾1 mindfulness session per week (28%, target 60%), and 13 completed ⩾75% of mindfulness sessions (19%, target 50%). Intervention participants had greater decreases in Patient Health Questionnaire-9 scores than control subjects (difference in differences, -2.21; 95% confidence interval, -3.99, -0.42; <i>P</i> = 0.016), but the Maslach Burnout Inventory depersonalization scores decreased more in the control arm than in the intervention arm (difference in differences, 1.60; 95% confidence interval, 0.18, 3.02; <i>P</i> = 0.027). There were no other changes in emotional distress or burnout symptoms. <b>Conclusions:</b> This trial of mobile mindfulness in frontline nurses met feasibility targets for randomization and retention, but participants had modest intervention use. Intervention participants had a reduction in depression symptoms, but not in burnout. Clinical trial registered with www.clinicaltrials.gov (NCT04816708).</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1475-1482"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/59/AnnalsATS.202301-025OC.PMC10559143.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Definitions and Cancer Prevalence on Diagnostic Yield Estimates of Bronchoscopy: A Simulation-based Analysis.","authors":"Anil Vachani,&nbsp;Fabien Maldonado,&nbsp;Balaji Laxmanan,&nbsp;Meijia Zhou,&nbsp;Iftekhar Kalsekar,&nbsp;Philippe Szapary,&nbsp;Lisa Dooley,&nbsp;Septimiu Murgu","doi":"10.1513/AnnalsATS.202302-182OC","DOIUrl":"10.1513/AnnalsATS.202302-182OC","url":null,"abstract":"<p><p><b>Rationale:</b> Studies of bronchoscopy have reported diagnostic yield (DY) using different calculation methods, which has hindered comparisons across studies. <b>Objectives:</b> To quantify the effect of the variability of four methods on DY estimates of bronchoscopy. <b>Methods:</b> We performed a simulation-based analysis of patients undergoing bronchoscopy using variations around base case assumptions for cancer prevalence (60%), distribution of nonmalignant findings, and degree of follow-up information at a fixed sensitivity of bronchoscopy for malignancy (80%). We calculated DY, the rate of true positives and true negatives (TNs), using four methods. Method 1 considered malignant and specific benign findings at index bronchoscopy as true positives and TNs, respectively. Method 2 included nonspecific benign findings as TNs. Method 3 considered nonspecific benign findings cases as TNs only if follow-up confirmed benign disease. Method 4 counted all cases with a nonmalignant diagnosis as TNs if follow-up confirmed benign disease. A scenario analysis and probabilistic sensitivity analysis were conducted to demonstrate the effect of parameter estimates on DY. A change in DY of >10% was considered clinically meaningful. <b>Results:</b> Across all pairwise comparisons of the four methods, a DY difference of >10% was observed in 76.7% of cases (45,992 of 60,000 comparisons). Method 4 resulted in DY estimates that were >10% higher than estimates made with other methods in >90% of scenarios. Variation in cancer prevalence had a large effect on DY. <b>Conclusions:</b> Across a wide range of clinical scenarios, the categorization of nonmalignant findings at index bronchoscopy and cancer prevalence had the largest impact on DY. The large variability in DY estimates across the four methods limits the interpretation of bronchoscopy studies and warrants standardization.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1491-1498"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beneficial Effects of Early Intervention Telemedicine-based Follow-Up in Sleep Apnea: A Randomized Controlled Multicenter Trial.","authors":"Benedikt Fridriksson,&nbsp;Marianne Berndtson,&nbsp;Henrik Hamnered,&nbsp;Erik Faeder,&nbsp;Ding Zou,&nbsp;Jan Hedner,&nbsp;Ludger Grote","doi":"10.1513/AnnalsATS.202208-723OC","DOIUrl":"10.1513/AnnalsATS.202208-723OC","url":null,"abstract":"<p><p><b>Rationale:</b> Positive airway pressure (PAP) is standard treatment for obstructive sleep apnea. Telemedicine has been introduced for improved PAP follow-up. <b>Objectives:</b> Our study aim was to evaluate the clinical utility of and patient satisfaction with PAP follow-up with an early intervention telemedical protocol. <b>Methods:</b> A randomized controlled trial was conducted at four sleep clinics of the same county. Treatment-naive patients with obstructive sleep apnea were randomized to standard PAP follow-up (203 patients, fixed follow-up procedures) or early intervention telemedical follow-up (AirView, ResMed; 206 patients, continuous follow-up) for 3 months. Evaluated variables included PAP adherence at 3 months, patient-reported outcome measures (Epworth Sleepiness Scale, 36-item Short Form Health Survey, Insomnia Severity Index, Hospital Anxiety and Depression Scale), and staff time. Group differences were analyzed with linear mixed regression models adjusted for age, body mass index, apnea-hypopnea index, and study center. <b>Results:</b> The study groups were comparable at baseline (<i>N</i> = 409; mean age, 59 ± 12 yr; body mass index, 31.9 ± 6 kg/m², apnea-hypopnea index, 41.5 ± 21 events/h). PAP adherence was higher in the proactive telemedicine group than in the control group (4.3 ± 2.4 and 4.1 ± 2.6 h/night; <i>P</i> = 0.01, respectively), and mean mask pressure at follow-up was significantly lower in the telemedicine group than in the control group (8.7 ± 2.1 cm H₂O vs. 9.2 ± 2.5 cm H₂O; <i>P</i> = 0.028). In <i>post hoc</i> analysis, the difference in PAP adherence between groups was most pronounced in patients with depression (4.8 ± 2.6 h/night vs. 2.7 ± 2.3 h/night; <i>P</i> = 0.03). Relevant mask leakage (>24 L/min) was lower in the telemedicine group (5.4% vs. 12.1%, <i>P</i> = 0.024). Improvement of patient-reported outcome measures and patient satisfaction was equivalent between groups. <b>Conclusions:</b> Proactive telemedical management of the initial follow-up of PAP treatment compared favorably with conventional follow-up in terms of adherence, pressure level, and mask leakage. Patients with depression may particularly benefit from telemedical follow-up. Specific clinical routines are required to establish this practice in sleep clinics. Clinical trial registered with www.clinicaltrials.gov (NCT03446560).</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1499-1507"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Medicine's Best-kept Secret That Could Save Medicare a Billion Dollars a Year.","authors":"Christopher L Mosher,&nbsp;Michael Belman,&nbsp;Chris Garvey,&nbsp;Richard Casaburi","doi":"10.1513/AnnalsATS.202304-366VP","DOIUrl":"10.1513/AnnalsATS.202304-366VP","url":null,"abstract":"Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Medicine’s Best-kept Secret That Could Save Medicare a Billion Dollars a Year Christopher L. Mosher, Michael Belman, Chris Garvey, and Richard Casaburi Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; American Thoracic Society Pulmonary Rehabilitation ReimbursementWorking Group (virtual), United States; and Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at HarborUniversity of California, Los Angeles (UCLA)Medical Center, Torrance, California","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1397-1399"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/db/AnnalsATS.202304-366VP.PMC10559142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9687112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease.","authors":"Donald A Mahler,&nbsp;David M G Halpin","doi":"10.1513/AnnalsATS.202304-384CME","DOIUrl":"10.1513/AnnalsATS.202304-384CME","url":null,"abstract":"<p><p>It can be challenging for healthcare professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) because of the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on the selection of an inhaled delivery system has received limited attention compared with the emphasis on prescribing the class of the inhaled molecule(s). Although numerous recommendations and algorithms have been proposed to guide the selection of an inhaled delivery system for patients with COPD, no specific approach has been endorsed in COPD guidelines/strategies or by professional organizations. To provide recommendations for an inhaler selection strategy at initial and follow-up appointments, we examined the impact of patient errors using handheld inhalers on clinical outcomes and performed a focused narrative review to consider patient factors (continuity of the inhaled delivery system, cognitive function, manual function/dexterity, and peak inspiratory flow) when selecting an inhaled delivery system. On the basis of these findings, five questions are proposed for HCPs to consider in the initial selection of an inhaler delivery system and three questions to consider at follow-up. We propose that HCPs consider the inhaled medication delivery system as a unit and to match appropriate medication(s) with the unique features of the delivery system to individual patient factors. Assessment of inhaler technique and adherence together with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication delivery system is providing benefits. Continued and repeated education on device features and correct technique is warranted to optimize efficacy.</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1389-1396"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/24/AnnalsATS.202304-384CME.PMC10559134.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive Sleep Apnea Is a Distinct Physiological Endotype in Individuals with Comorbid Insomnia and Sleep Apnea.","authors":"Elliot J Brooker,&nbsp;Shane A Landry,&nbsp;Luke D J Thomson,&nbsp;Garun S Hamilton,&nbsp;Pedro Genta,&nbsp;Sean P A Drummond,&nbsp;Bradley A Edwards","doi":"10.1513/AnnalsATS.202304-350OC","DOIUrl":"10.1513/AnnalsATS.202304-350OC","url":null,"abstract":"<p><p><b>Rationale:</b> With up to 40% of individuals with either insomnia or obstructive sleep apnea (OSA) demonstrating clinically significant symptoms of the other disorder, the high degree of comorbidity among the two most common sleep disorders suggests a bidirectional relationship and/or shared underpinnings. Although the presence of insomnia disorder is believed to influence the underlying pathophysiology of OSA, this influence is yet to be examined directly. <b>Objectives:</b> To investigate whether the four OSA endotypes (upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold) are different in patients with OSA with and without comorbid insomnia disorder. <b>Methods:</b> Using the ventilatory flow pattern captured from routine polysomnography, the four OSA endotypes were measured in 34 patients with OSA who met the diagnostic criteria for insomnia disorder (COMISA) and 34 patients with OSA without insomnia (OSA only). Patients demonstrated mild-to-severe OSA (apnea-hypopnea index, 25.8 ± 2.0 events/h) and were individually matched according to age (50.2 ± 1.5 yr), sex (42 male: 26 female), and body mass index (29.3 ± 0.6 kg/m²). <b>Results:</b> Compared with patients with OSA without comorbid insomnia, patients with COMISA demonstrated significantly lower respiratory arousal thresholds (128.9 [118.1 to 137.1] vs. 147.7 [132.3 to 165.0] % eupneic ventilation ([Formula: see text]); <i>U</i> = 261; 95% confidence interval [CI], -38.3 to -13.9; <i>d</i> = 1.1; <i>P</i> < 0.001), less collapsible upper airways (88.2 [85.5 to 94.6] vs. 72.9 [64.7 to 79.2] %[Formula: see text]; <i>U</i> = 1081; 95% CI, 14.0 to 26.7; <i>d</i> = 2.3; <i>P</i> < 0.001), and more stable ventilatory control (i.e., lower loop gain: 0.51 [0.44 to 0.56] vs. 0.58 [0.49 to 0.70]; <i>U</i> = 402; 95% CI, -0.2 to -0.01; <i>d</i> = 0.05; <i>P</i> = 0.03). Muscle compensation was similar between groups. Moderated linear regression revealed that the arousal threshold moderated the relationship between collapsibility and OSA severity in patients with COMISA but not in patients with OSA only. <b>Conclusions:</b> A low arousal threshold is an overrepresented endotypic trait in individuals with COMISA and may exhibit a greater relative contribution to OSA pathogenesis in these patients. Contrastingly, the prevalence of a highly collapsible upper airway in COMISA was low, suggesting that anatomical predisposition may contribute less to OSA development in COMISA. Based on our findings, we theorize that conditioned hyperarousal perpetuating insomnia may translate to a reduced arousal threshold to respiratory events, thereby increasing the risk or severity of OSA. Therapies that target increased nocturnal hyperarousal (e.g., through cognitive behavior therapy for insomnia) may be effective in individuals with COMISA. Clinical trial registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12616000586415).</p>","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1508-1515"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10086609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary Exercise Testing in Patients with Persistent Dyspnea after Pulmonary Embolism.","authors":"Louisa A Mounsey,&nbsp;Alison S Witkin,&nbsp;C Corey Hardin,&nbsp;Josanna Rodriguez-Lopez","doi":"10.1513/AnnalsATS.202302-108RL","DOIUrl":"10.1513/AnnalsATS.202302-108RL","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1528-1530"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Approach to Clinical Change Endpoints: A Win Ratio Analysis of the INCREASE Trial.","authors":"Steven D Nathan, Boris Medarov, Lawrence Ho, John Kingrey, Taekwon Hong, Youlan Rao, Eric Shen, Peter Smith, Chunqin Deng, Aaron Waxman","doi":"10.1513/AnnalsATS.202303-229RL","DOIUrl":"10.1513/AnnalsATS.202303-229RL","url":null,"abstract":"","PeriodicalId":8018,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1537-1540"},"PeriodicalIF":8.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/a6/AnnalsATS.202303-229RL.PMC10559141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9749465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}