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Study Objectives: The COVID-19 pandemic has challenged the population of affected areas in multiple dimensions. Adolescents have been especially affected with school closure and home confinement. The impact of the pandemic on sleep habits and quality of sleep and quality of life among adolescents has not been adequately characterized. We hypothesized that the COVID-19 pandemic has induced an evening shift of the daily rhythm among adolescents and adversely affected sleep quality and quality of life of high school students. Methods: Students were questioned about their usual bed and wake-up times and answered the Pittsburgh Sleep Quality Index Questionnaire, the Epworth Sleepiness Scale, the Horne-Osteberg Morningness-Eveningness Questionnaire, and the World Health Organization Quality of Life Questionnaire-abbreviated version before and during the pandemic. Results: Ninety-four students (64% females, aged 15 ± 1 years) participated in both phases of the study. Students delayed bed and wake-up times by 1.5 (0.5–2.0) and 2.0 (1.5–2.5) hours, respectively. Chronotype (per the Morningness-Eveningness Questionnaire) shifted toward eveningness during the pandemic. Sleep duration increased and quality of sleep (per the Pittsburgh Sleep Quality Index) improved only among those students with shorter sleep duration before the pandemic. During the pandemic, the physical and psychological domains of the World Health Organization Quality of Life Questionnaire worsened but the environmental domain improved as compared with the study before the pandemic. Conclusions: High school students have delayed bed and wake-up times and shifted chronotype toward eveningness during the COVID-19 pandemic. The worsening of the physical and psychological World Health Organization Quality of Life Questionnaire domains and improvement in the environmental domain highlight the conflicting experiences that high school students are facing during the COVID-19 pandemic. Citation: Genta FD, Rodrigues Neto GB, Sunfeld JPV, et al. COVID-19 pandemic impact on sleep habits, chronotype, and health-related quality of life among high school students: a longitudinal study. J Clin Sleep Med . 2021;17(7):1371–1377.

Obstructive sleep apnea (OSA) is extremely common and has several consequences. However, most cases remain undiagnosed. One limitation is the lack of simple and validated methods for OSA diagnosis at home. The aim of this study was to validate a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis (Biologix) that was compared with a home sleep test (HST, Apnea Link Air) performed on the same night. We recruited 670 patients out of a task force of 1013 patients with suspected OSA who were referred to our center for diagnosis. The final sample consisted of 478 patients (mean age: 56.7 ± 13.1 years, mean body mass index: 31.9 ± 6.3 kg/m 2 ). To estimate the night-to-night OSA severity variability, 62 patients underwent HST for two consecutive nights. The HST-apnea–hypopnea index (AHI) and the Biologix-oxygen desaturation index (ODI) was 25.0 ± 25.0 events/h and 24.9 ± 26.5 events/h, respectively. The area under the curve—sensibility/specificity to detect at least mild (HST-AHI > 5), moderate-to-severe (HST-AHI > 15), and severe OSA (HST-AHI > 30) were (0.983)—94.7/92.8, (0.986)—94.8/93.9, and (0.990)—95.8/94.3, respectively. The limits of agreement originating from the Bland–Altman plot and the correlation between HST-AHI and Biologix-ODI were lower than the night-to-night HST-AHI variability (25.5 and 34.5 events/h, respectively, p  = 0.001). We conclude that Biologix is a simple and reliable technique for OSA diagnosis at home.

Purpose The purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5°) on obstructive sleep apnea (OSA) severity and sleep quality. Methods OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE. Results Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8 kg/m 2 , neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3–22.5] to 10.7 [6.6–16.5] events/h; p  < 0.001 and increased minimum oxygen saturation from 83.5 [77.5–87] to 87 [81–90]%; p  = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7–90.7] vs 88.8 [81.6–93.3]; p  = 0.005). The AHI obtained at the third PSG without HOBE ( n  = 7) returned to baseline values. Conclusions Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.

To systematically review the effectiveness of different types of interfaces in the treatment of critically ill patients with respiratory failure requiring NIV. Parallel randomized controlled trials (RCTs) were identified through a search conducted in the MEDLINE, CENTRAL, EMBASE, and LILACS databases. Review Manager 5 software was used for direct comparisons. Risk ratios (RR) with 95% confidence interval (CI) or credible interval (CrI) were used for dichotomous outcomes. Continuous outcomes were reported as mean differences (MD) with 95% CIs. MetaInsight software was used for conducting network meta-analysis (NMA) with Bayesian random-effects models. A systematic search was conducted on August 4, 2022, and last updated on November 6, 2024. Seven studies were included, involving 406 patients, and four different interfaces (helmet, oronasal, nasal, and full-face) were utilized. Helmet may reduce intubation rate, ICU and hospital length of stay, when compared to oronasal mask (RR 0.38 [95% CrI 0.2 to 0.75], RR −3.34 [95% CrI −6.94 to 0.49] and RR −2.4 [95% CrI −6.23 to 1.62]), with low certainty of the evidence. Furthermore, the evidence is very uncertain regarding the effects of the helmet on reducing serious adverse events, with very low certainty of the evidence. The evidence remains uncertain for the outcomes of in-hospital mortality, serious adverse events, mild and moderate adverse events, comfort, and tolerance. The helmet interface probably reduces the length of stay and intubation rates when used for non-invasive ventilation in critically ill patients with respiratory failure. However, the findings should be interpreted with caution as it generates from RCT with small sample sizes. This network meta-analysis offers comparative evidence to guide clinical decision-making regarding interface selection during noninvasive ventilation, with the potential to enhance treatment effectiveness and patient outcomes.

Study Objectives: Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep. Methods: Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared. Results: The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference:14%; 95% confidence interval:−12% to 40%; P =.453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size:0.05 and 0.03, respectively), and negative effort dependence (difference:−6%; 95% confidence interval:−16% to 4%) were also similar in both procedures. Conclusions: In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep. Clinical Trial Registration: Registry: clinicaltrials.gov ; Name:Natural and Drug Sleep Endoscopy; URL: https://clinicaltrials.gov/ct2/show/study/NCT03004014 ; Identifier:NCT03004014. Citation: Ordones AB, Grad GF, Cahali MB, Lorenzi-Filho G, Sennes LU, Genta PR. Comparison of upper airway obstruction during zolpidem-induced sleep and propofol-induced sleep in patients with obstructive sleep apnea: A pilot study. J Clin Sleep Med . 2020;16(5):725–732.

Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a rare disease characterized by dilation of the trachea and the main bronchi within the thoracic cavity. The predominant signs and symptoms of the disease include coughing, purulent and abundant expectoration, dyspnea, snoring, wheezing, and recurrent respiratory infection. Symptoms of the disease in some patients are believed to be pathological manifestations arising due to resident tracheobronchomalacia. Although treatment options used for the management of this disease include inhaled bronchodilators, corticosteroids, and hypertonic solution, there is no consensus on the treatment. The use of continuous positive airway pressure (CPAP) has been reported as a potential therapeutic option for tracheobronchomalacia, but no prospective studies have demonstrated its efficacy in this condition. The purpose of this is to identify the presence of tracheobronchomalacia and an optimal CPAP pressure that reduces the tracheobronchial collapse in patients with Mounier-Kuhn syndrome and to analyze the repercussion in pulmonary ventilation. In parallel, we aim to evaluate the prevalence of obstructive sleep apnea/hypopnea syndrome. This interventional, open-label, single-arm clinical trial will enroll patients who are diagnosed Mounier-Kuhn syndrome. Patient evaluation will be conducted in an outpatient clinic and involve 3 visits. Visit 1 will involve the collection and registration of social demographic, clinical, and functional data. Visit 2 will entail polysomnography, bronchoscopy for the evaluation of tracheobronchomalacia, titration of the optimal pressure that reduces the degree of collapse of the airway, and electrical impedance tomography. In visit 3, patients exhibiting a reduction in collapse areas will be requested to undergo chest computed tomography during inspiration and forced expiration with and without positive pressure (titrated to determine optimal CPAP pressure). This protocol is a doctorate project. The project was submitted to the institutional review board on January 24, 2017, and approval was granted on February 2, 2017 (Brazilian Research database number CAAE 64001317.4.000.0068). Patient evaluations started in April 2018. Planned recruitment is based on volunteers' availability and clinical stability, and interventions will be conducted at least once a month to finish the project at the end of 2020. A preliminary analysis of each case will be performed after each intervention, but detailed results are expected to be reported in the first quarter of 2021. There is no consensus on the best treatment options for managing Mounier-Kuhn syndrome. The use of positive pressure could maintain patency of the collapsed airways, functioning as a \"pneumatic stent\" to reduce the degree of airflow obstruction. This, in turn, could promote mobilization of thoracic secretion and improve pulmonary ventilation. ClinicalTrails.gov NCT03101059; https://clinicaltrials.gov/ct2/show/NCT03101059. DERR1-10.2196/14786.