Annals of the American Thoracic Society最新文献

{"title":"Real-world generalizability of sleep apnea-related polysomnographic metrics and their associations with clinical comorbidities.","authors":"Raichel M Alex, Le Li, Salma Batool-Anwar, Lawrence J Epstein, Daniel Mobley, Milena K Pavlova, Ali Azarbarzin, Susan Redline, Scott A Sands, Brian E Cade","doi":"10.1093/annalsats/aaoag087","DOIUrl":"10.1093/annalsats/aaoag087","url":null,"abstract":"<p><strong>Rationale: </strong>Advanced polysomnographic (PSG) metrics reflecting the physiological causes and consequences of sleep apnea may enable precision medicine in research settings, but their feasibility in routine clinical practice has yet to be demonstrated.</p><p><strong>Objective: </strong>Assess (1) the generalizability of PSG metrics from research to clinical cohort and (2) their associations with a broad range of comorbid diseases, many of which have not been previously examined.</p><p><strong>Methods: </strong>Polysomnographic metrics, including endotypes (eg, loop gain) and physiological burdens (eg, hypoxic burden), were estimated from diagnostic polysomnographs of 6427 participants at Mass General Brigham (MGB). Comorbid conditions analyzed from MGB's medical record system included 9 representative cardiometabolic and respiratory diseases, as well as 408 prevalent diseases. Associations were assessed using modified Poisson and least absolute shrinkage and selection operator (LASSO) regression.</p><p><strong>Results: </strong>The sample included 62% females, aged 52.9 ± 16.8 years, and an apnea-hypopnea index (AHI) of 21.4 ± 15.9 events/h. Associations between endotypes and demographics/obesity-related factors were consistent with prior observational studies (median difference in β = 0.03 SD). After adjusting for AHI, older age was associated with lower heart rate (-0.40 SD) and arousal burdens (-0.23 SD), while higher body mass index was associated with increased hypoxic burden (0.25 SD). Having demonstrated reasonable concordance with published data, our subsequent analysis identified distinct and clinically meaningful associations between advanced PSG metrics and comorbid conditions. Specifically, elevated loop gain, ventilatory burden, and hypoxic burden were associated with hypertension, diabetes, and renal failure; increased ventilatory instability was associated with cardiovascular disease; and reduced collapsibility and ventilatory instability were associated with chronic airway obstruction. Even after LASSO-based selection, no single PSG metric consistently predicted risk across all comorbidities; ventilatory instability showed the most associations among endotypic traits and heart rate burden among physiological burdens, underscoring the heterogeneity of obstructive sleep apnea pathophysiology.</p><p><strong>Conclusions: </strong>Phenome-wide analyses of a large clinical cohort demonstrate the real-world feasibility and clinical relevance of extracting advanced PSG metrics, supporting their potential to identify personalized, mechanism-specific intervention targets for sleep apnea.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1518-1531"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary specialist health coach consultation model: a randomized controlled trial.","authors":"Rachel Willard-Grace, Abby Cabrera, Stephanie Tsao, Michael B Potter, Danielle Hessler, Marianna Kong, David H Thom, Joan F Hilton, George Su","doi":"10.1093/annalsats/aaoag097","DOIUrl":"10.1093/annalsats/aaoag097","url":null,"abstract":"<p><strong>Rationale: </strong>Socioeconomically disadvantaged patients with asthma and/or chronic obstructive pulmonary disease (COPD) face barriers to evidence-based care that are difficult to overcome in health care settings with limited resources.</p><p><strong>Objectives: </strong>Evaluate the efficacy of a pulmonary-specialist-health coach consultation model (intervention) for patients with asthma and/or COPD, relative to usual care (control).</p><p><strong>Methods: </strong>Randomized-controlled trial of 16 weeks of intervention versus control for adult English- or Spanish-speaking, low-income patients. Intervention: a lay health coach gathered information from the patient and medical record for remote review by a pulmonary specialist, who provided general recommendations to the primary care clinician. The coach supported implementation of recommendations.</p><p><strong>Measurements: </strong>Primary outcomes were receipt of guideline-based care and medications. Secondary outcomes were receipt of chronic lung disease education, breathing-related quality of life and symptoms, patient-rated quality of care, and adherence to inhaler therapy. Longitudinal models for count data were used to estimate Intervention: Control relative rates. Parallel models for continuous data estimated relative means.</p><p><strong>Main results: </strong>A total of 165 intervention participants received 1.61-fold more guideline-based care than 163 control participants (relative ratio; 95% CI: 1.37-1.90). They were not more likely to receive guideline-based medications in planned analysis using a pooled baseline rate, although post-hoc analysis using arm-specific baseline rates found significant improvement. Intervention patients received more chronic lung disease education and reported greater improvements in breathing-related quality of life, symptoms, and patient-reported quality of care.</p><p><strong>Conclusions: </strong>This intervention offers a scalable approach to improve uptake of clinical guidelines in resource-limited primary care practices managing most asthma and COPD care.</p><p><strong>Descriptor number: </strong>2.9 Racial, ethnic, or social disparities in lung disease and treatment.</p><p><strong>Clinical trial registration: </strong>NCT03695276.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1455-1465"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Dournes: PRAGMA-CF versus bronchus-artery pairs to assess the reversibility of bronchiectasis: which one is correct or wrong?","authors":"Paul McNally, Daan Caudri, Thomas Semple, Jane C Davies, Harm A W M Tiddens","doi":"10.1093/annalsats/aaoag224","DOIUrl":"10.1093/annalsats/aaoag224","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1568-1569"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food insecurity is associated with COPD prevalence and mortality: evidence from U.S. county-level data.","authors":"Katherine E Goodenberger, Swaraj Bose, Susan K Murray, Christopher B Bosma, MeiLan K Han, Jeffrey L Curtis, Wassim W Labaki","doi":"10.1093/annalsats/aaoag096","DOIUrl":"10.1093/annalsats/aaoag096","url":null,"abstract":"<p><strong>Rationale: </strong>Although unreliable access to healthy food has been linked to lower lung function, a higher burden of respiratory symptoms, and more frequent respiratory exacerbations in individuals with COPD, its association with COPD prevalence and mortality remains understudied.</p><p><strong>Objective: </strong>To determine the associations between food insecurity and COPD prevalence and COPD mortality at the county level in the United States.</p><p><strong>Methods: </strong>We obtained 2018 U.S. county-level data on food insecurity prevalence (FI%) and the Food Environment Index (FEI; lower values indicate worse food desert conditions) from County Health Rankings. We then queried the CDC's National Environmental Public Health Tracking and WONDER databases for county-level COPD prevalence (2018) and COPD-related mortality (2018-2020), respectively. We constructed negative binomial regression models adjusted for demographic, socioeconomic, and health factors to examine the associations of FI% and FEI with COPD prevalence and mortality. The mortality model was additionally adjusted for county COPD prevalence.</p><p><strong>Results: </strong>Counties with FI% at or above the median (13.2%) and those with FEI below the median (7.6) had lower median household income, lower primary care physician density, higher average daily PM2.5 concentration, and higher prevalence of poverty, uninsured status, rural residence, and cigarette smoking (P < .001 for all analyses). In fully adjusted models, a 1% higher FI% was associated with a 1.62% higher COPD prevalence (95% CI 1.40%-1.83%; P < .001), and a 1-unit lower FEI was associated with a 1.85% higher COPD prevalence (95% CI 1.17%-2.54%; P < .001). A 1% higher FI% was independently associated with a 3.54% increase in COPD-related mortality (95% CI 2.86%-4.22%; P < .001), and a 1-unit lower FEI with a 10.05% increase in COPD-related mortality (95% CI 7.82%-12.27%; P < .001).</p><p><strong>Conclusion: </strong>Unreliable food access is associated with higher COPD prevalence and mortality at the county level. These results suggest that improving food access may be a target for improving population-level COPD outcomes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1488-1496"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRAGMA-CF versus bronchus-artery pairs to assess the reversibility of bronchiectasis: which one is correct or wrong?","authors":"Gael Dournes","doi":"10.1093/annalsats/aaoag222","DOIUrl":"10.1093/annalsats/aaoag222","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1566-1567"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Seeley and Gesthalter: EBRT vs bronchoscopy for MCAO: apples and oranges are not the same.","authors":"Roshen Mathew, Nikhil Meena, Levent Dalar","doi":"10.1093/annalsats/aaoag227","DOIUrl":"10.1093/annalsats/aaoag227","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1576-1577"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quetiapine modestly improves sleep and breathing but impairs next-day performance in people with obstructive sleep apnea and difficulty maintaining sleep: a randomized controlled trial.","authors":"Cricket Fauska, Tarun Bastiampillai, Georgina Rawson, Barbara Toson, Andrew Vakulin, Robert Adams, Gary Wittert, Kelly A Loffler, Danny J Eckert","doi":"10.1093/annalsats/aaoag092","DOIUrl":"10.1093/annalsats/aaoag092","url":null,"abstract":"<p><strong>Rationale: </strong>Quetiapine is commonly prescribed \"off-label\" to people with insomnia symptoms. People with undiagnosed obstructive sleep apnea (OSA) frequently report insomnia symptoms, particularly difficulty maintaining sleep. In 2023, 10.7 million prescriptions were dispensed for quetiapine in the United States. Yet, there is limited information regarding the effects of quetiapine on sleep, breathing, and next-day performance in people with OSA.</p><p><strong>Objectives: </strong>To determine the effects of 50 mg of quetiapine versus placebo on OSA severity and other polysomnographic parameters plus next-day vigilance and driving simulator performance in people with OSA who also reported difficulty maintaining sleep.</p><p><strong>Methods: </strong>We performed a double-blind, randomized, placebo-controlled, cross-over study (NCT05303935) in 15 people with OSA and difficulty maintaining sleep. Participants were studied overnight via polysomnography twice approximately 1 week apart and received either 50 mg of quetiapine or placebo (order randomized) just prior to sleep. A 10-minute psychomotor vigilance task (PVT) and 30-minute driving simulator test were performed each morning.</p><p><strong>Results: </strong>Compared to placebo, quetiapine reduced the apnea/hypopnea index (primary outcome) (mean ± SD: 27 ± 16 vs 20 ± 12 events/hour, P = .009), arousal index (32 ± 16 vs 25 ± 9 arousals/hour, P = .012), and increased sleep efficiency (80 ± 11 vs 87 ± 9%, P <.001) without worsening hypoxemia (mean overnight oxygen saturation: 94.7 ± 1.2% vs 94.5 ± 1.5%, P = .38). However, next-morning vigilance (median PVT reaction time: 336 ± 48 vs 382 ± 84 ms, P = .008) and driving simulator performance (steering deviation: 72 ± 38 vs 96 ± 53 cm, P <.01) were significantly impaired with quetiapine.</p><p><strong>Conclusions: </strong>Consistent with a hypnotic effect, a single night of low-dose quetiapine reduced OSA severity as measured via the apnea/hypopnea index and increased sleep efficiency without worsening overnight hypoxemia. However, there was evidence of next-day impairment in vigilance and driving simulator performance.</p><p><strong>Clinical trial registration: </strong>NCT05303935.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1532-1542"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human metapneumovirus: an underestimated cause of severe respiratory infection.","authors":"Catia Cilloniz, Antonia Ho, Chanu Rhee","doi":"10.1093/annalsats/aaoag172","DOIUrl":"10.1093/annalsats/aaoag172","url":null,"abstract":"<p><p>Since its identification in 2001, human metapneumovirus (hMPV) has been recognized as an important cause of acute respiratory tract infection in all age groups. Although infection is often mild in healthy adults, hMPV can cause severe lower respiratory tract disease, including pneumonia, in young children, older adults, individuals with chronic diseases and immunocompromising conditions, and residents of long-term care facilities. Accumulating evidence demonstrates that hMPV contributes substantially to hospitalization, intensive care unit admission, and mortality in these high-risk populations. Globally, hMPV circulates seasonally, most commonly in late winter and spring, contributing to both community- and healthcare-associated respiratory infections; however, the COVID-19 pandemic disrupted established epidemiology, resulting in shifts in epidemic timing, off-season resurgences, genotype replacement, and increased overlap with other respiratory viruses, while also providing insights into viral interference and multivirus cocirculation. Clinical manifestations of hMPV overlap with other respiratory viruses, including influenza virus and SARS-CoV-2, and selective diagnostic practices contribute to underrecognition and undertesting. Although no specific antiviral therapies or licensed vaccines are currently available, identification of hMPV has important implications for diagnostic accuracy, prognosis, antimicrobial stewardship, and infection prevention, particularly in hospital and long-term care settings. This review summarizes current evidence on the virology, epidemiology, post-COVID-19 trends, clinical manifestations, outcomes, diagnosis, and prevention of hMPV, with a particular focus on adults and other high-risk populations. We also review the current landscape of hMPV vaccine development and its potential implications for clinical practice and public health.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1414-1426"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we there yet? Moving beyond the apnea-hypopnea index and toward precision medicine in obstructive sleep apnea.","authors":"John C Carter, Vishesh K Kapur","doi":"10.1093/annalsats/aaoag169","DOIUrl":"10.1093/annalsats/aaoag169","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1441-1443"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social drivers in chronic obstructive pulmonary disease: securing better outcomes may start with food.","authors":"Brandon Peplinski, Cher X Huang, Russell G Buhr","doi":"10.1093/annalsats/aaoag180","DOIUrl":"10.1093/annalsats/aaoag180","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1437-1438"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}