Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology, characterized by ... more Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology, characterized by recurrent episodes of diffuse alveolar hemorrhage and sideropenic anemia. IPH occurs most commonly in children. During an acute episode, a constellation of cough, dyspnea, and hemoptysis with alveolar infiltrates and worsening anemia should raise the suspicion for intrapulmonary bleeding. Sputum, bronchoalveolar lavage (BAL), and eventually lung tissue examination show numerous hemosiderin-laden macrophages in the alveoli, without evidence of capillaritis/vasculitis, granulomatous inflammation, deposition of immunoglobulins, or immune complexes. Glucocorticoids and other immunosuppressive drugs seem to be effective during IPH exacerbations and, possibly, also during the remission phase. The significant improvement in morbidity and mortality of IPH during the past several decades is probably due to the long-term use of immunosuppressive therapy.
Study Objectives:The objective of this meta-analysis was to analyze agreement in apnea-hypopnea i... more Study Objectives:The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography (PSG) studies.Methods:Mean AHI bias and standard deviation extracted from Bland-Altman plots reported in studies were pooled in a meta-analysis, which was then used to calculate percentage errors of limit agreement in AHI determination by PAT using PSG AHI as the reference. Individual participant data (where reported in studies) were used to compute Cohen’s kappa to assess agreement between PSG and PAT on sleep apnea severity and for computing the sensitivity and specificity of PAT at different AHI thresholds using PSG AHI as the reference.Results:From 17 studies and 1,318 participants (all underwent simultaneous PSG and use of the WatchPAT device), a pooled mean AHI bias of 0.30 (standard error [SE], 0.74) and a WatchPAT AHI percentage error of 230% was calculated. The meta-analysis of Cohen’s kappa for agreement between PSG and WatchPAT studies for classifying patients with no sleep apnea, mild, moderate, or severe sleep apnea severity was 0.45 (SE, 0.06), 0.29 (SE, 0.05), 0.25 (SE, 0.07), and 0.64 (SE, 0.05), respectively. At AHI thresholds of 5, 15 and 30 events/h, WatchPAT studies showed pooled sensitivities and specificities of 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively. Likelihood ratios were not significant at any AHI threshold.Conclusions:The results of this meta-analysis suggest clinically significant discordance between WatchPAT and PSG measurements of AHI, significant sleep apnea severity misclassification by PAT studies, and poor diagnostic test performance.Citation:Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. J Clin Sleep Med. 2022;18(4):1093–1102.
Each year, hundreds of millions of individuals are affected by respiratory disease leading to app... more Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology, characterized by ... more Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology, characterized by recurrent episodes of diffuse alveolar hemorrhage and sideropenic anemia. IPH occurs most commonly in children. During an acute episode, a constellation of cough, dyspnea, and hemoptysis with alveolar infiltrates and worsening anemia should raise the suspicion for intrapulmonary bleeding. Sputum, bronchoalveolar lavage (BAL), and eventually lung tissue examination show numerous hemosiderin-laden macrophages in the alveoli, without evidence of capillaritis/vasculitis, granulomatous inflammation, deposition of immunoglobulins, or immune complexes. Glucocorticoids and other immunosuppressive drugs seem to be effective during IPH exacerbations and, possibly, also during the remission phase. The significant improvement in morbidity and mortality of IPH during the past several decades is probably due to the long-term use of immunosuppressive therapy.
Study Objectives:The objective of this meta-analysis was to analyze agreement in apnea-hypopnea i... more Study Objectives:The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography (PSG) studies.Methods:Mean AHI bias and standard deviation extracted from Bland-Altman plots reported in studies were pooled in a meta-analysis, which was then used to calculate percentage errors of limit agreement in AHI determination by PAT using PSG AHI as the reference. Individual participant data (where reported in studies) were used to compute Cohen’s kappa to assess agreement between PSG and PAT on sleep apnea severity and for computing the sensitivity and specificity of PAT at different AHI thresholds using PSG AHI as the reference.Results:From 17 studies and 1,318 participants (all underwent simultaneous PSG and use of the WatchPAT device), a pooled mean AHI bias of 0.30 (standard error [SE], 0.74) and a WatchPAT AHI percentage error of 230% was calculated. The meta-analysis of Cohen’s kappa for agreement between PSG and WatchPAT studies for classifying patients with no sleep apnea, mild, moderate, or severe sleep apnea severity was 0.45 (SE, 0.06), 0.29 (SE, 0.05), 0.25 (SE, 0.07), and 0.64 (SE, 0.05), respectively. At AHI thresholds of 5, 15 and 30 events/h, WatchPAT studies showed pooled sensitivities and specificities of 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively. Likelihood ratios were not significant at any AHI threshold.Conclusions:The results of this meta-analysis suggest clinically significant discordance between WatchPAT and PSG measurements of AHI, significant sleep apnea severity misclassification by PAT studies, and poor diagnostic test performance.Citation:Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. J Clin Sleep Med. 2022;18(4):1093–1102.
Each year, hundreds of millions of individuals are affected by respiratory disease leading to app... more Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.
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