No abstract

Study Objectives: Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals. Methods: Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas.Results: Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen's kappa coefficient of 0.96. Conclusions: Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors.

Understanding of people’s landscape preferences is important for decision-making about land planning, particularly in the disturbance patterns that usually occur in rural-urban gradients. However, the use of different types of images concerning the same landscape may influence social preferences and thus perceptions of landscape management and planning decisions. We evaluated landscape preferences and perceptions in four landscapes of southern Chile. We specifically: (1) compared people’s perceptions related to living in, visiting, the scenic beauty, well-being, risks, and level of landscape disturbance; and (2) evaluated the influence of the type of scene (i.e., eye-level or aerial images) in these preferences and perceptions. Preferences and perceptions resulted to be better when using eye-level (4.0 ± 1.1) than aerial (3.7 ± 0.6) images. In general, we observed a negative association between preferences and perceptions and the landscape disturbance; however, it was consistent when using aerial images but was masked when valuing landscape through eye-level images. Implications of these results are relevant because by far, most landscape preference studies use traditional eye-level images. Different types of scenes should be considered in order to embrace the landscape preferences and perceptions of all those involved and help decision-making in landscape planning.