Background and Objectives: To investigate the parameter daytime sleepiness in patients with the sleep apnea syndrome (SAS), a test for measurement of sustained attention was developed. The present studies were performed on volunteers undergoing preemployment medical examinations and SAS patients to determine the extent to which test results are in agreement with the symptoms of SAS and traffic accident reports, and also with daytime sleepiness, and whether learning or therapeutic effects can be seen with repeated tests prior to and following treatment with nasal continuous positive airway pressure (nCPAP). Methods: Participants: 125 healthy volunteers, and two groups of 28 SAS patients each. Design: Study A: The volunteers underwent a single attention test and completed a questionnaire concerned with traffic accidents and symptoms of sleep-related breathing disorders. Study B: SAS patients underwent two attention tests before treatment. Study C: SAS patients underwent one attention test before and one after nCPAP therapy. Results: Study A: The error rate in volunteers without symptoms of sleep-related breathing disorders (51 persons) was 4.7 ± 4.3% (number of errors 14.1 ± 12.9), 95% CI: 1.2 (number of errors 3.6). No dependence of the error rate on age, BMI or sex was found. In persons with a history of apneic events (n = 10), the error rate was 10.6 ± 10.0% (number of errors 31.8 ± 30), in those with more than two accidents during the last 5 years (n = 4), it was increased to 15.3 ± 9.7% (number of errors 45.9 ± 29.1). Study B: Among SAS patients, no significant learning effect was seen, and prolongation of the test duration beyond 30 min had no effect on the test results. Study C: The error rate improved significantly with nCPAP [10.6 ± 13.5 vs. 6.4 ± 8.9% (number of errors 31.8 ± 40.5 vs. 19.2 ± 26.7), p < 0.001]. Conclusions: The attention test can be helpful for the measurement of daytime sleepiness, and CPAP therapy can improve test performance.

Trotz der Effektivit~it der Therapie des obstruktiven Schlafapnoe-Syndroms (OSAS) mit konstantem nasalen Positivdruck (nCPAP) wenden bis zu 30 % der Patienten die Behandlung nicht an. Es wurden daher automatische nCPAP-Systeme entwickelt, die den Druck senken und so Beeintrfichtigungen der Patienten mindern sollen. Die forcierte Oszillationstechnik (FOT) ist ein sensitives Verfahren zur Erfassung der Widerstande der oberen Atemwege, auch bei OSAS. Ziel dieser Studie war es, die Effektivit~it eines automatischen nCPAP-Systems auf der Basis von FOT hinsichtlich polysomnographischer Parameter und des notwendigen Druckprofils zu untersuchen. Nach diagnostischer Polysomnographie (PSG) wurden 21 Patienten zun~chst einer manuellen CPAP-Titration zur Findung eines Druckes zur konstanten nCPAP-Therapie und anschlieBend einer Therapienacht mit APAPFoT unterzogen. Im Vergleich zum Ausgangswert nafimen der Apnoe-Hypopnoe-Index (AHI [Diagnose] 25,2 -+ 21,9/h, AHI [APAPFoa-] 3,0 -+ 3,4/h, p < 0,001), die Gesamtzahl der Arousals (Arousals [Diagnose] 35,.8 _+ 15,3/h, Arousals [APAPFo-r] 21,7 + 11,3/h, p < 0,01) und die Zahl der respiratorisch bedingten Arousals (resp. Arousals [Diagnose] 20,9_+16,6/h, resp. Arousals [APAPFoa-] 3,0_+ 3,7/h, p < 0,001) ab. Es kam zu einer Verbesserung des Schlafprofils mit Zunahme des REM-Schlafs (REM [Diagnose] 14,6_+ 5,2 %TST, REM [APAPFoT] 20,8 -+ 5,7 %TST, p < 0,01). Der mittlere Therapiedruck konnte unter APAPFoT im Vergleich zum manuell titrierten konstanten nCPAP deutlich gesenkt werden (manuell titrierter Druck 8,6+ 1,8 mbar, P mean [APAPFoT] 5,4-+ 1,6 mbar, p < 0,0001). Wir schliessen daraus, dab APAPFoT eine effektive Therapie des OSAS bei deutlich verringertem Druck erlaubt.

Study question Is it possible to reduce the number of oocytes per recipient, thus reducing treatment costs and without compromising pregnancy rates? Summary answer Costs derived from egg donation techniques can be reduced without compromising pregnancy rates What is known already In the literature there is no limitation or optimal number of oocytes for performing techniques based on egg donation. Despite this, we see that the norm is to use between 6 and 8 oocytes per recipient woman. Study design, size, duration This is a cost-effectiveness study and a retrospective descriptive study of 75 patients undergoing IVF with egg donation (102 cycles) between the years 2014 and 2019 in the Assisted Human Reproduction Unit of the Virgen del Rocío University Hospital. Seville. Participants/materials, setting, methods We have proceeded to create a database, with the collection of different data: number of reserved oocytes, number of fresh embryos, number of vitrified embryos, number of clinical pregnancies achieved and budget. Main results and the role of chance Between 2014-2019, 102 cycles were performed, achieving a total of 52 clinical pregnancies, 45 with fresh embryos (44.1% of the total cycles) and 7 with vitrified embryos (6.9%). This reports a global percentage of clinical pregnancy of 51%. Analyzing the data per patient, a success rate of 69.3% in achieving clinical pregnancy has been demonstrated. Between 2014-2017, 5 or more donated oocytes have been used for each patient, with a total figure of 285 oocytes. On average, 5.7 oocytes per patient have been requested. 50 IVF cycles have been performed. 22 of these cycles with fresh embryos have achieved clinical pregnancy (44%) and only one cycle with vitrified embryos has achieved pregnancy, giving an overall success rate of 46%. This costs €142,500, €6,195 for each clinical pregnancy achieved. Between 2018-2019, donated oocytes per patient has been reduced to 3-4, with a total number of 188. On average, 3.6 oocytes per patient have been requested. 52 IVF cycles have been performed. 23 of these cycles with fresh embryos have achieved clinical gestation (44.2%), adding 5 more cycles when counting the cycles with vitrified embryos. All this has achieved a 53.8% clinical gestation. This costs €94,000, €3,357 for each clinical pregnancy achieved. Limitations, reasons for caution Over the years, IVF techniques have been perfected. This can be reflected in the percentage of clinical gestations achieved. Wider implications of the findings With an average reduction of 2.1 oocytes, a reduction in the cost per cycle of €1050 (36%) is achieved and for each clinical pregnancy achieved of €2,838. These savings could make it possible to expand inclusion criteria for cycles with oocyte donation, for example, including patients with poor ovarian reserve. Trial registration number Not applicable

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