34 research outputs found
Obstructive Sleep Apnea in Heart Failure: Current Knowledge and Future Directions
No full textObstructive sleep apnea (OSA) is highly prevalent among patients with asymptomatic left ventricular systolic and diastolic dysfunction and congestive heart failure, and if untreated may contribute to the clinical progression of heart failure (HF). Given the health and economic burden of HF, identifying potential modifiable risk factors such as OSA and whether appropriate treatment improves outcomes is of critical importance. Identifying the subgroups of patients with OSA and HF who would benefit most from OSA treatment is another important point. This focused review surveys current knowledge of OSA and HF in order to provide: (1) a better understanding of the pathophysiologic mechanisms that may increase morbidity among individuals with HF and comorbid OSA, (2) a summary of current observational data and small randomized trials, (3) an understanding of the limitations of current larger randomized controlled trials, and (4) future needs to more accurately determine the efficacy of OSA treatment among individuals with HF
Effects of continuous positive airway pressure on blood pressure in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES)
No full textObstructive sleep apnea is associated with hypertension, and short-term studies have demonstrated a modest reduction in blood pressure with continuous positive airway pressure therapy. We evaluated the effects of continuous positive airway pressure versus sham continuous positive airway pressure on blood pressure in 1,101 participants with obstructive sleep apnea from the Apnea Positive Pressure Long-term Efficacy Study, a randomized, sham-controlled double-blinded study designed to assess the impact of continuous positive airway pressure on neurocognition. Participants with apnea-hypopnea index >= 10 were randomly assigned to continuous positive airway pressure or sham continuous positive airway pressure. Blood pressures measured in the morning and evening at baseline, 2 months and 6 months were analysed post hoc using a mixed-model repeated-measures analysis of variance. The largest magnitude reduction was approximately 2.4 mmHg in morning systolic pressure that occurred at 2 months in the continuous positive airway pressure arm as compared with an approximate 0.5 mmHg reduction in the sham group (continuous positive airway pressure effect -1.9 mmHg, p = .008). At 6 months, the difference between groups was diminished and no longer statistically significant (continuous positive airway pressure effect -0.9 mmHg, p = .12). Sensitivity analysis with use of multiple imputation approaches to account for missing data did not change the results. Treatment with continuous positive airway pressure for obstructive sleep apnea reduces morning but not evening blood pressure in a population with well-controlled blood pressure. The effect was greater after 2 than after 6 months of treatment.12 month embargo; published online: 14 November 2019This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
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Measurement of the severity of sleep-disordered breathing: a moving target
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iCare: Providing Patient Advocates with an Integrated Supportive Mobile System
Get PDFThe implementation of restorative design solutions in mobile healthcare is an emerging field in design practice. There is, however, a significant knowledge deficit in family/patient-centric designs and systems. This paper describes the importance of implementing restorative and stress reducing solutions for patient advocates and caregivers. This research investigates the potential of a mobile iOS application and the benefits it could have for families and friends caring for chronically ill patients. The application allows the patient advocate to input and recover patient health data and provides social support via an integrated networking platform. The design of the application enables a holistic experience that draws attention to the often neglected emotional and social needs of the patient advocate. Its purpose is to improve health related outcomes and communication between patients, caretakers, and care providers. Empathic and User Experience (UX) design tools are triangulated with mHealth practices in the development of the platform. Designer John Maeda’s Laws of Simplicity, Nathan Shedroff’s Experience Design and Donald A. Norman’s Human Centered Design processes are described in detail as they identify some of the fundamentals of usability, aesthetics, cognition and interaction with operating systems. Conclusions are drawn from the analysis of six co-design attendees, thirty semi-structured interviews and three user testing focus groups
Numerical modelling of Cone Penetration Test in Clay using Coupled Eulerian Lagrangian Method
No full textThe Cone Penetration Test (CPT) has been extensively used in geotechnical engineering, to evaluate the properties of wide range of soils. Numerical simulations of CPT involves large deformations in the soil domain which causes numerical difficulties in traditional finite element analysis. Early numerical studies used simplifying assumptions such as wished-in-place condition and in-situ stress distribution as the initial stress state of the soil domain. Recent developments in finite element analysis allow large deformation analyses to be performed. This paper presents the results of the continuous penetration of cone in single-layer and double-layer clay using the Coupled Eulerian Lagrangian (CEL) method. Performance of the CEL technique was in modelling the cone penetration test was validated against the existing studies. Then, a parametric study was performed to develop a correlation between the cone bearing factor and rigidity index of the clay. The proposed correlation showed a very good agreement with the existing experimental and numerical correlations. The cone penetration test in double-layer clay was simulated. The results suggested that CEL analysis is a reliable technique in modelling large deformation problem of cone penetration test.Geo-engineerin
Association between central sleep apnea and left ventricular structure: the Multi-Ethnic Study of Atherosclerosis
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