Keywan Sohrabi

Combined lung-sound and reflux-monitoring: a pilot study of a novel approach to detect nocturnal respiratory symptoms in gastro-oesophageal reflux disease.

Aliment Pharmacol Ther 2011; 33: 592–600

Autonomic dysfunction and cardiac arrhythmia in patients with obstructive and central sleep apnea

Obstructive sleep apnea and central sleep apnea with Cheyne-Stokes respiration are associated with an increased risk of cardiac arrhythmia. Apnea- associated arrhythmia may contribute to sudden cardiac death and premature mortality in those patients. Both forms of sleep apnea excert strong modulatory effects on the autonomic system with a special autonomic profile. Profound vagal activity is leading to bradyarrhythmias, and sypathico-excitation to tachyarrhythmias. Atrial fibrillation and ventricular arrhythmias in obstructive and central sleep apnea patients are mainly found in combination with cardiovascular comorbidity (coronary heart disease, hypertensive heart disease, chronic heart failure). Bradyarrhythmias in OSA are induced by a cardioinhibitory vagal reflex due to obstructed airway. CPAP-therapy has been demonstrated to reduce arrhythmias.

Die Langzeit-Sauerstoff-Therapie (LTOT) – Was sollten Arzt, Versorger und Krankenkasse wissen?

Long-term oxygen treatment (LTOT) has been demonstrated to improve prognosis in patients with chronic respiratory insufficiency. In terms of pathogenesis, improved oxygenation, reduction of pulmonary artery pressure as well as reduction of respiratory work are important. Since there are considerable differences between the LTOT systems, individually tailored therapy is needed. In particular, the mobility aspects of the patients must be taken into consideration. It is important to distinguish between stationary/mobile devices with a liquid oxygen system and stationary/mobile devices with oxygen concentrator. Oxygen titration should be performed in relation to rest and activity phases (e. g. 6 minute walk test) as well as in relation to the sleep phase. Employing devices with demand-controlled valves should be critically examined. This can be undertaken only under physician orders and requires continuous monitoring.

Overnight documentation of respiratory sounds in patients with chronic sinusitis

BACKGROUND AND PURPOSE Nocturnal worsening of respiration in patients with chronic sinusitis is most likely induced by creeping of mucus from the parasinuses down to the pharynx. The aim of this study was to document respiratory symptoms such as deglutition, wheezing and cough in patients with chronic sinusitis using long-term recording of respiratory sounds. PATIENTS AND METHODS According to the CORSA (computerized respiratory sound analysis) criteria, long-term recording of respiratory sounds was performed in 20 patients with chronic sinusitis. RESULTS Wheezing was detected in 30%, (excessive) cough was found in 40%. Deglutition was measured with a frequency of ten per hour. CONCLUSION Long-term recording of respiratory sounds is a practical and noninvasive method for the documentation of clinical symptoms like wheezing, coughing and deglutition during sleep.ZusammenfassungHintergrund und Ziel:Eine waagerechte Körperposition begünstigt bei Patienten mit chronischer Sinusitis ein nächtliches Abfließen von Schleim und Sekret über den Oropharynx. Dies kann zu einer häufig nur während der Nachtstunden auftretenden respiratorischen Symptomatik wie Giemen, Husten und Atemnot führen, die in dieser Studie dokumentiert werden sollte.Patienten und Methodik:Im Rahmen einer Pilotstudie wurde bei 20 volljährigen Patienten mit chronischer Sinusitis eine nächtliche Langzeitregistrierung von Atemgeräuschen in Analogie zu den CORSA-Kriterien („computerized respiratory sound analysis“) durchgeführt.Ergebnisse:In 30% der Fälle (sechs Patienten) konnte Giemen, in 40% (acht Patienten) teils exzessives Husten dokumentiert werden. Schlucken wurde mit einer Häufigkeit von zehn Schluckereignissen pro Stunde detektiert.Schlussfolgerung:Die Langzeitregistrierung von Atemgeräuschen kann zur Objektivierung nächtlicher Symptome wie Giemen, Husten oder Luftnot einen wichtigen Beitrag leisten.AbstractBackground and Purpose:Nocturnal worsening of respiration in patients with chronic sinusitis is most likely induced by creeping of mucus from the parasinuses down to the pharynx. The aim of this study was to document respiratory symptoms such as deglutition, wheezing and cough in patients with chronic sinusitis using long-term recording of respiratory sounds.Patients and Methods:According to the CORSA (computerized respiratory sound analysis) criteria, long-term recording of respiratory sounds was performed in 20 patients with chronic sinusitis.Results:Wheezing was detected in 30%, (excessive) cough was found in 40%. Deglutition was measured with a frequency of ten per hour.Conclusion:Long-term recording of respiratory sounds is a practical and noninvasive method for the documentation of clinical symptoms like wheezing, coughing and deglutition during sleep.

Long-term Recording of Night-Time Respiratory Symptoms in Patients with Stable COPD II–IV

ABSTRACT Introduction: Night-time respiratory symptoms have a considerable impact on sleep and life quality in patients with chronic obstructive pulmonary disease (COPD). Lack of awareness of night-time symptoms can lead to worsened COPD control. Automated long-term monitoring of respiratory symptoms with LEOSound enables assessment of nocturnal wheezing and cough. Methods: In this observational study we investigated the prevalence and severity of cough and wheezing in patients with stable COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II–IV] disease for two consecutive nights with the LEOSound system. 48 patients (30 males, 63%) were eligible for inclusion, median age was 67 years, and body mass index (BMI) was 25.3 kg/m2. Results: In 15 out of 48 patients (31%), we found wheezing periods for at least 10-minute duration. Wheezing periods >30 minutes were monitored in seven patients and wheezing periods >60 minutes were monitored in three patients. The maximum duration of wheezing was 470 minutes in one patient with COPD II. The median wheezing rate differed between the COPD stages and between active and non-active smokers. Cough was found in 42 patients (87.5%) with a range of 1–326 events. The cough-period-index in night one was 0.83 n/hour (P25:0.33||P75: 2.04) and night two 0.97 n/hour (P25:0.25||P75: 1.9). Most of the cough events were non-productive with a median of 0.86. Conclusions: Night-time symptoms are common in COPD patients. LEOSound offers an opportunity to evaluate objectively night-time symptoms like wheezing and cough in patients with COPD which remain otherwise unnoticed. We found a high incidence of night-time wheezing in these patients, which was related to persistant smoking.

Was ist für die Diagnostik und Therapieverlaufskontrolle von chronischem Husten wichtig

Within the last years there has been significant progress in the field of chronic cough. So far, the analysis and evaluation of chronic cough was done mainly on the basis of subjective methods such as manual counts of cough events, questionnaires and diaries. Testing cough hypersensitivity and monitoring 24 h cough represent objective criteria. Validated questionnaires on cough frequency and quality of life represent the impact of chronic cough. Cough frequency monitoring, the preferred tool to objectively assess cough, should be used as primary end-point in clinical trials. It will also be possible to discriminate between productive and non-productive cough. The relationship with subjective measures of cough is weak. In the future, cough and its therapy should therefore be assessed with a combination of subjective and objective tools.

Quantification of nasal respiratory flow by tracheal sound analysis

By now the pneumotachograph is the gold standard for quantitative measurement of the respiratory flow. However, for continuous quantitative monitoring of airflow or measuring flow within non-invasive ventilated patients an ideal solution is still missing. In this study we made an attempt to detect the nasal breathing with our newly developed system of measurement. This method allows the detection of nasal airflow by means of a sensor, which is placed on the trachea. In 20 pulmonary healthy male subjects the airflow was measured by a pneumotachograph. At the same time tracheal breathing sounds were recorded by a sensor placed paralaryngeal. Using a newly developed analysis system, tracheal breathing sounds can be transformed and the real respiratory flow curve can be calculated. For inspiration, as well as expiration, the estimated airflow showed a highly significant correlation (pearson correlation coefficient, r = 0.89 up to 0.92 with p< 0.01). The presented method is still being tested but has the potential to be applicable in polysomnography.

Digitales Gesundheitsmanagement bei Auszubildenden

Die Auszubildenden von heute sind die erste Generation, die mit digitalen Medien aufgewachsen ist. Die Verknupfung der neuen Medien mit Gesundheit im Rahmen des BGMs erscheint erfolgversprechend, da diese der Zielgruppe vertraut sind und eine hohe Akzeptanz besteht. Es werden Masnahmen der Gesundheitsforderung dargestellt, die mit Hilfe von digitalen Instrumenten, vornehmlich mit dem Smartphone, umgesetzt werden (z. B. Bewegungsforderung, Anti‐Raucher‐Training, Ernahrungsanalyse, Schlafanalyse, Onlinebefragungen, Onlinelernmaterialien). Das Angebot gesundheitsbezogener Informationen im Internet erfordert eine spezifische Medienkompetenz. Die Auszubildenden lernen, wie und wo sie sinnvolle und praxisrelevante Gesundheitsinformationen erhalten. Digitale Anwendungen wie Messungen gesundheitsrelevanter Parameter mit Smartphones oder Wearables werden kritisch hinterfragt. Zudem werden gesundheitliche Risiken, die von einem hohen und unreflektierten Medienkonsum ausgehen, thematisiert.

Description of nighttime cough epochs in patients with stable COPD GOLD II–IV

Purpose Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD. Materials and methods Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II–IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive). Results Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%). Conclusion We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively.

Integrating a Usability Engineering Process into a Consisting Risk Management

Abstract The complexity of medical devices and its user interactions increases. A growing number of incident reports are assumed to be associated primarily with user errors. This development is tackled through current modifications in standards, such as ISO 13485:2016 and legislations, such as the Medical Device Regulation. Both intensify the focus on use errors significantly. The aim of this paper was the development of a process orientated approach integrating usability engineering into a consisting risk management based on a classic V-model. An appropriate procedure was worked out. For each development step, risk and usability activities were cumulated. Thus, the present paper might help medical device manufacturers to reflect their risk management and usability management processes to find synergies. Prospectively, a step-by-step guide for the integration of risk management and usability engineering based on this approach should be developed.