Annals of the American Thoracic Society最新文献

{"title":"Association of Preserved Ratio Impaired Spirometry (PRISm) with All-Cause Mortality: A Longitudinal Cohort Study.","authors":"Yunjoo Im, Taeyun Kim, Jung Hye Hwang, Hyunsoo Kim, Seokmin Hyun, So Rae Kim, Sun Hye Shin, Juhee Cho, Danbee Kang, Hye Yun Park","doi":"10.1513/AnnalsATS.202403-250OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202403-250OC","url":null,"abstract":"<p><strong>Rationale: </strong>Numerous studies indicate that preserved ratio impaired spirometry (PRISm) is associated with adverse clinical outcomes. However, the impact of PRISm severity, particularly about FVC, on mortality risk remains unclear.</p><p><strong>Objectives: </strong>To determine whether PRISm was associated with mortality and to identify specific groups with particularly increased mortality rates.</p><p><strong>Methods: </strong>This retrospective study enrolled individuals older than 40 years who underwent comprehensive health screening at the Center for Health Promotion, Samsung Medical Center, between 2003 and 2020. PRISm was characterized by FEV₁/FVC ≥ 0.7 and FEV₁ <80% of predicted values. Participants were classified into three groups: normal lung function, PRISm with normal FVC, and PRISm with low FVC (FVC <80% predicted). We compared all-cause mortality rates using the Kaplan-Meier method and the Cox proportional hazard ratio model.</p><p><strong>Results: </strong>Among 106,458 individuals, 86,208 exhibited normal lung function, while 6,249 had PRISm with normal FVC, and 14,001 had PRISm with low FVC. Over a median follow-up of 10.1 years, 2,219 participants succumbed. Individuals with PRISm experienced a higher cumulative mortality rate compared to those with normal lung function (39 vs. 16 per 10,000 person-years; adjusted HR 1.43, 95% CI 1.31-1.56). The fully-adjusted HRs for all-cause mortality in PRISm with normal and low FVC were 1.25 (95% CI 1.03-1.52) and 1.47 (95% CI 1.33-1.62) relative to those with normal lung function, respectively.</p><p><strong>Conclusions: </strong>PRISm is associated with an increased risk of death, particularly when accompanied by low FVC.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633411","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":"Prognosis of Equivocal Interstitial Lung Abnormalities in a Health Check-up Population.","authors":"Ryosuke Imai, Yutaka Tomishima, Tomoaki Nakamura, Daisuke Yamada, Shosei Ro, Clara So, Kohei Okafuji, Atsushi Kitamura, Naoki Nishimura, Torahiko Jinta","doi":"10.1513/AnnalsATS.202408-867OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-867OC","url":null,"abstract":"<p><strong>Rationale: </strong>Equivocal interstitial lung abnormality (ILA) involves less than 5% of any lung zone or presents unilaterally without satisfying the diagnostic criteria for ILA; however, the prevalence and prognosis of equivocal ILA are unknown.</p><p><strong>Objectives: </strong>To investigate the prevalence and long-term prognosis of equivocal ILA.</p><p><strong>Methods: </strong>This retrospective cohort study included individuals who underwent chest CT as part of a health check-up program in 2010 at St. Luke's International Hospital in Tokyo, Japan. ILA and equivocal ILA were diagnosed using the Fleischner Society criteria. The primary outcome was the annual rate of forced vital capacity (FVC) decline in the ILA, Equivocal ILA, and No ILA groups, evaluated using a mixed-effects model. Radiological progression was also evaluated.</p><p><strong>Results: </strong>Among the 20,896 individuals included in the study, ILA and equivocal ILA were present in 2.0% (95% CI: 1.8-2.2%) and 0.4% (95% CI: 0.4-0.5%) of individuals, respectively. Follow-up pulmonary function tests were available for 18,101 (87%) individuals, with a median follow-up time of 8.3 (interquartile range: 4.0-9.0) years. Individuals with equivocal ILA showed a significantly greater rate of FVC decline than those without ILA (-36.7 vs. -27.7 mL/year, P = 0.008). Of the 86 individuals with equivocal ILA, 20 (23%) exhibited progression during the follow-up period; of these, 19 progressed to definite ILA.</p><p><strong>Conclusions: </strong>Individuals with equivocal ILA showed a significant tendency for FVC decline compared to those without ILA. A considerable number of cases progressed to definite ILA, warranting careful attention. Clinicians should be aware that even mild interstitial changes that do not meet the current criteria for ILA may deteriorate.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633365","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":"Nutrition and Diet Quality in Pulmonary Arterial Hypertension.","authors":"Nadine Al-Naamani, Melanie Prakash, Steven Pugliese, Jason S Fritz, K Akaya Smith, Harold I Palevsky, Charlene Compher","doi":"10.1513/AnnalsATS.202405-563RL","DOIUrl":"10.1513/AnnalsATS.202405-563RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606768","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":"The Great Controversy of Obstructive Sleep Apnea Treatment for Cardiovascular Risk Benefit: Advancing the Science Through Expert Consensus. An Official American Thoracic Society Workshop Report.","authors":"Oren Cohen, Vaishnavi Kundel, Ferran Barbé, Yüksel Peker, Doug McEvoy, Manuel Sánchez-de-la-Torre, Daniel J Gottlieb, T Douglas Bradley, Mayte Suárez-Fariñas, Andrey Zinchuk, Ali Azarbarzin, Atul Malhotra, Helena Schotland, David Gozal, Sanja Jelic, Alberto R Ramos, Jennifer L Martin, Sushmita Pamidi, Dayna A Johnson, Reena Mehra, Virend K Somers, Camilla M Hoyos, Chandra L Jackson, Carmela Alcantara, Martha E Billings, Deepak L Bhatt, Sanjay R Patel, Susan Redline, Henry K Yaggi, Neomi A Shah","doi":"10.1513/AnnalsATS.202409-981ST","DOIUrl":"10.1513/AnnalsATS.202409-981ST","url":null,"abstract":"<p><p>The prevalence of obstructive sleep apnea (OSA) is on the rise, driven by various factors including more sensitive diagnostic criteria, increased awareness, enhanced technology through at-home testing enabling easy and cost-effective diagnosis, and a growing incidence of comorbid conditions such as obesity. Treating symptomatic patients with OSA syndrome to enhance quality of life remains a cornerstone approach. However, there is a lack of consensus regarding treatment to improve cardiovascular disease (CVD) outcomes, particularly in light of overall negative results from several randomized controlled trials (RCT) indicating no benefit of positive airway pressure (PAP) therapy on primary and secondary CVD events. These RCTs were limited by suboptimal PAP adherence, use of composite CVD outcomes, and limited diversity and generalizability to Sleep Clinic patients. As such, this workshop assembled clinical experts, as well as researchers in basic and translational science, epidemiology, clinical trials, and population health to discuss the current state, and future research directions to guide personalized therapeutic strategies and future research directions in OSA. There was overall consensus among workshop participants that OSA represents a heterogeneous disease with variable endotypes and phenotypes, and heterogeneous responses to treatment. Future research should prioritize employing multi-modal therapeutic approaches within innovative and adaptive trial designs, focusing on specific subgroups of OSA patients hypothesized to benefit from a CVD perspective. Future work should also be inclusive of diverse populations and consider the life-course of OSA to better comprehend treatment strategies that can address the disproportionate impact of OSA on racially minoritized groups. Further, a more holistic approach to sleep must be adopted to include broader assessments of symptoms, sleep duration, and comorbid sleep and circadian disorders. Finally, it is imperative to establish a sleep research consortium dedicated to collecting raw data and biospecimens categorized by OSA subtypes. This will facilitate mechanistic determinations, foster collaborative research, and help bolster the pipeline of early-career researchers.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606786","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":"Rural Residence Associated with Receipt of Recommended Post-Discharge COPD Care among a Cohort of U.S. Veterans.","authors":"Fernando Picazo, Kevin I Duan, Travis Hee Wai, Sophia Hayes, Aristotle G Leonhard, Giuseppe A Fonseca, Robert Plumley, Kristine A Beaver, Lucas M Donovan, David H Au, Laura C Feemster","doi":"10.1513/AnnalsATS.202405-493OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202405-493OC","url":null,"abstract":"<p><strong>Rationale: </strong>Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care.</p><p><strong>Objective: </strong>To assess whether rural residence is associated with receipt of recommended post-discharge COPD care.</p><p><strong>Methods: </strong>We conducted a cohort study of all U.S. Veterans discharged from a VA Medical Center following COPD hospitalization from 2010 to 2019. Rural residence was defined by Rural Urban Commuting Area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including: smoking cessation therapy; appropriate management of supplemental oxygen; appropriate prescription of inhaled therapy; and pulmonary rehabilitation. We conducted multi-variable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multi-variable linear probability models for each of the recommended therapies.</p><p><strong>Results: </strong>Of 67,649 patients, 7,370 (10.8%) resided in rural areas, and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean 15.0%, standard deviation 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted % difference (95% CI)]: -1.1 (-1.6, -0.6); highly rural estimate: -1.2 (-2.1, -0.3)). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate: -4.0 (-5.1, -3.0); highly rural estimate: -3.0 (-5.0, -1.1)) and pulmonary rehabilitation referral (rural estimate: -1.2 (-1.6, -0.9); highly rural estimate: -2.1 (-2.7, -1.4)), but a higher likelihood of receiving smoking cessation therapy (rural estimate: 5.4 (3.3, 7.5); highly rural estimate: 7.2 (3.3, 11.2)). There was no significant difference in appropriate oxygen management (rural estimate: -1.0 (-2.8, 0.9); highly rural estimate: 3.1 (-0.7, 6.9)).</p><p><strong>Conclusions: </strong>Patients across the rural-urban spectrum received few recommended post-discharge COPD treatments. Health systems approaches are needed to address widespread underutilization of evidence-based COPD care.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606783","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":"Prognostic Awareness and Knowledge of Acute Exacerbation in Patients Dying with Interstitial Lung Disease: A Nationwide Survey.","authors":"Takafumi Koyauchi, Tomoyuki Fujisawa, Mitsunori Miyashita, Masanori Mori, Tatsuya Morita, Shusuke Yazawa, Norimichi Akiyama, Satoshi Hagimoto, Yoshinobu Matsuda, Ryo Tachikawa, Hideki Yasui, Masaru Suzuki, Yuichiro Asai, Manabu Ono, Yuichiro Kimura, Shinya Ohkouchi, Yoshinori Tanino, Keishi Sugino, Tomoya Tateishi, Motoyasu Kato, Atsushi Miyamoto, Yoshinobu Saito, Susumu Sakamoto, Masato Kono, Koshi Yokomura, Shiro Imokawa, Koji Sakamoto, Yuko Waseda, Tomohiro Handa, Noboru Hattori, Kazuki Anabuki, Kazuhiro Yatera, Yuki Shundo, Tomoaki Hoshino, Noriho Sakamoto, Yasuhiro Kondoh, Hiromi Tomioka, Keisuke Tomii, Yoshikazu Inoue, Takafumi Suda","doi":"10.1513/AnnalsATS.202405-495OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202405-495OC","url":null,"abstract":"<p><strong>Rationale: </strong>Accurate prognostic awareness (PA) and knowledge of the disease are critical for decision-making regarding treatment options, advance care planning, and end-of-life care. However, they have not been investigated in patients with interstitial lung disease (ILD).</p><p><strong>Objectives: </strong>To determine the prevalence of patients with ILD who have accurate PA and/or knowledge of acute exacerbation. In addition, to determine whether accurate PA is associated with end-of-life medical interventions and quality of dying and death.</p><p><strong>Methods: </strong>Through a nationwide bereavement survey, we examined the prevalence of accurate PA and knowledge of acute exacerbation (AE) in patients with ILD who died in acute general hospitals between January 2018 and February 2020. Patients' PA and knowledge were assessed from the perspective of the bereaved. We also quantified the quality of dying and death from the perspective of the bereaved using three scales, the Good Death Inventory, the Quality of Dying and Death (QODD) questionnaire, and the single-item QODD overall score, and obtained information on end-of-life interventions from the electronic medical record. We examined the associations of accurate PA with end-of-life interventions and quality of dying and death.</p><p><strong>Results: </strong>A total of 296 patients whose caregivers completed questionnaires were analyzed. One hundred sixty-three patients (55.1%, 95% confidence interval [CI] = 49.2-60.8) who died of ILD had accurate PA and 138 (46.9%, 95% CI = 35.9-47.4) recognized that their disease could have AE. Multivariate regression analysis showed that accurate PA was associated with significantly fewer intensive care unit (ICU) deaths (odds ratio = 0.28, 95% CI = 0.10-0.82, P = 0.02). Patients with accurate PA had better quality of dying and death on all the three scales.</p><p><strong>Conclusions: </strong>Approximately half of the patients who died of ILD did not recognize that their disease could lead to death or AE. The lower number of ICU deaths and better quality of dying and death in patients with accurate PA suggest the potential benefits of obtaining accurate PA in patients with ILD.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606772","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":"Bexotegrast Shows Dose-dependent Integrin α_vβ₆ Receptor Occupancy in Lungs of Participants with Idiopathic Pulmonary Fibrosis: A Phase 2, Open-Label Clinical Trial.","authors":"Joshua J Mooney, Susan Jacobs, Éric A Lefebvre, Gregory P Cosgrove, Annie Clark, Scott M Turner, Martin Decaris, Chris N Barnes, Marzena Jurek, Brittney Williams, Heying Duan, Richard Kimura, Gaia Rizzo, Graham Searle, Mirwais Wardak, H Henry Guo","doi":"10.1513/AnnalsATS.202409-969OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202409-969OC","url":null,"abstract":"<p><p><b>Rationale</b>: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease characterized by dyspnea and loss of lung function. Transforming growth factor-beta (TGF-β) activation mediated by α_v integrins is central to the pathogenesis of IPF. Bexotegrast (PLN 74809) is an oral, once-daily, dual-selective inhibitor of α_vβ₆ and α_vβ₁ integrins under investigation for the treatment of IPF. Positron emission tomography (PET) using an α_vβ₆-specific PET tracer could confirm target engagement of bexotegrast in the lungs of participants with IPF. <b>Objectives</b>: This Phase 2 study (NCT04072315) evaluated α_vβ₆ receptor occupancy in the lung, as assessed by changes from baseline in α_vβ₆ PET tracer uptake, following single dose administration of bexotegrast to participants with IPF. <b>Methods</b>: In this open-label, single-center, single-arm study, adults with IPF received up to 2 single doses of bexotegrast, ranging from 60 to 320 mg with or without background IPF therapy (pirfenidone or nintedanib). At baseline and approximately 4 hours after each orally administered bexotegrast dose, a 60-minute dynamic PET/CT scan was conducted following administration of an α_vβ₆-specific PET probe ([¹⁸F]FP-R₀1-MG-F2). α_vβ₆ receptor occupancy by bexotegrast was estimated from the changes in PET tracer uptake following bexotegrast. Pharmacokinetics, safety, and tolerability of bexotegrast were also assessed. <b>Results</b>: Eight participants completed the study. Total and unbound plasma bexotegrast concentrations increased in a dose-dependent manner, and regional PET volume of distribution (V_T) values decreased in a dose- and concentration-dependent manner. The V_T data fit a simple saturation model, producing an unbound bexotegrast EC₅₀ estimate of 3.32 ng/mL. Estimated maximum receptor occupancy was 35%, 53%, 71%, 88%, and 92% following single 60, 80, 120, 240, and 320-mg doses of bexotegrast, respectively. No treatment-emergent adverse events related to bexotegrast were reported. <b>Conclusions</b>: Dose- and concentration-dependent α_vβ₆ receptor occupancy by bexotegrast was observed by PET imaging, supporting once-daily 160 to 320 mg dosing to evaluate efficacy in clinical trials of IPF. Trial registration number: NCT04072315 Primary source of funding: Pliant Therapeutics, Inc. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585065","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":"Impact of Heat on Respiratory Hospitalizations among Older Adults in 120 Large US Urban Areas.","authors":"Cassandra R O'Lenick, Stephanie E Cleland, Lucas M Neas, Mallory W Turner, E Melissa Mcinroe, K Lloyd Hill, Andrew J Ghio, Meghan E Rebuli, Ilona Jaspers, Ana G Rappold","doi":"10.1513/AnnalsATS.202405-470OC","DOIUrl":"10.1513/AnnalsATS.202405-470OC","url":null,"abstract":"<p><strong>Rationale: </strong>Extreme heat exposure is a well-known cause of mortality among older adults. However, the impacts of exposure on respiratory morbidity across US cities and population subgroups is not well understood.</p><p><strong>Objectives: </strong>A nationwide study to determine the impact of high heat on respiratory disease hospitalizations among older adults (65+) living in the 120 largest US cities between 2000-2017.</p><p><strong>Methods: </strong>Daily rates of inpatient respiratory hospitalizations were examined with respect to variations in ZIP-code-level daily mean temperature and heat index. For each city, we estimated cumulative associations (lag-days 0-6) between warm-season heat (June-September) and cause-specific respiratory hospitalizations using time-stratified conditional quasi-Poisson regression with distributed lag non-linear models. We estimated nationwide associations using multivariate meta-regression and updated city-specific associations via best linear unbiased prediction. With stratified models, we explored effect modification by age, sex, and race (Black/white). Results were reported as percent change in hospitalizations at high temperatures (95th percentile) compared to median temperatures for each outcome, demographic group, and metropolitan area.</p><p><strong>Results: </strong>We identified 3,275,033 respiratory hospitalizations among Medicare beneficiaries across 120 large US cites between 2000 and 2017. Nationwide, 7-day cumulative associations at high temperatures, resulted in a 1.2% (0.4%, 2.0%) increase in hospitalizations for primary diagnoses of all-cause respiratory disease, primarily driven by increases in respiratory tract infections [1.8% (0.6%, 3.0%)], and chronic respiratory diseases/respiratory failure [1.2% (0.0%, 2.4%)]. Stronger associations were observed when exposure was defined using the heat index instead of temperature. Across the 120 cities, we observed considerable geographic variation in the relative risk of heat-related respiratory hospitalizations, and we observed disproportionate burdens of heat-related respiratory hospitalizations among the oldest beneficiaries (85+ years), and among Black beneficiaries living in South Atlantic cities. During the 18-year study period, there were an estimated 11,710 excess respiratory hospitalizations due to heat exposure.</p><p><strong>Conclusions: </strong>Results suggest that high temperature and humidity contribute to exacerbation of respiratory tract infections and chronic lung diseases among older adults. Geographic variation in heat-related hospitalization rates suggests that contextual factors largely account for disproportionate burdens, and area-level influences should be further investigated in multi-city studies. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585041","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":"Mouth Leak is Associated with Sleep Fragmentation During Nasal CPAP Treatment of OSA and May Be Detected by Leak Waveform Analysis.","authors":"Erika Matsumura, Gustavo F Grad, Fernanda Madeiro, Pedro R Genta, Geraldo Lorenzi-Filho","doi":"10.1513/AnnalsATS.202404-425OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202404-425OC","url":null,"abstract":"<p><strong>Rationale: </strong>Mouth air leak is a major cause of low adherence to nasal CPAP in patients with obstructive sleep apnea (OSA). However, CPAP reports do not distinguish mouth from mask leak. We hypothesized that mouth air leak is terminated abruptly by an arousal from sleep and mouth closing that can be detected by CPAP leak waveform analysis.</p><p><strong>Objective: </strong>Describe patterns of mouth air leak waveform during polysomnography (PSG) in patients with OSA treated with well-fitted nasal CPAP.</p><p><strong>Methods: </strong>PSG recordings with a jaw motion sensor to detect mouth opening were performed in OSA patients treated with nasal CPAP with suspected mouth air leak. Careful mask fitting and visual inspection excluded mask leak. Mouth leak episodes were characterized by an increase (≥ 20%) above the intentional leak. Leak episodes were classified as intermittent (< 5 minutes) or continuous (≥ 5 minutes).</p><p><strong>Results: </strong>Twenty patients (80% men; age: 63±11 years; body mass index: 29.9±6 kg/m2; baseline apnea hypopnea index: 46.9±19 events/h) treated with nasal CPAP and documented mouth leak completed the study. All but one patient experienced an overlap of intermittent and continuous mouth leak. Most mouth leak episodes ended with mouth closure (97.7%) and an arousal (52.7%) or awakening (38.6%). Only 34.9% of the leak episodes were associated with respiratory events. Intermittent mouth air leak was more common in sleep stages N1+ N2 (P<0.01), while continuous leak was more common in sleep stage N3 (P<0.01). Continuous episodes of air leak were associated with a higher amplitude of mouth opening. CPAP report waveform was able to detect only 29.6% of the leak episodes detected by PSG. Only 10 patients (50%) had a high unintentional leak according to the criterion adopted by ResMed and only 2 patients (10%) presented large leak according to the Philips criterion.</p><p><strong>Conclusions: </strong>Intermittent and continuous mouth leak during nasal CPAP frequently co-exist and contribute to sleep fragmentation. Identification of leak waveform patterns may help detect mouth air leak which in turn is an important cause of poor CPAP adherence.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585078","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":"A Unified Set of Patient-Inspired Health Concepts for COPD: A North Star for Understanding Treatment Benefit.","authors":"Alan Hamilton, Nancy Kline Leidy, Ashley I Duenas, Soren E Skovlund, Bruce E Miller","doi":"10.1513/AnnalsATS.202408-864IP","DOIUrl":"10.1513/AnnalsATS.202408-864IP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585058","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}