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Background: In 2007 and 2012, the American Academy of Sleep Medicine (AASM) updated their scoring criteria for nocturnal respiratory events. We hypothesised that this could have led to changes in the apnoeahypopnoea index (AHI) of patients with chronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome. Methods: In a retrospective study, polysomnographic (PSG) recordings of 34 patients with COPD/OSA overlap syndrome were independently analysed using the AASM criteria from 2007 (AASM 2007 ) and 2012 (AASM 2012 ). The primary outcome was the difference in AHI, the secondary outcomes were frequency of hypopnoeas, diagnosis of overlap syndrome and differences between the AASM 2007 recommended (AASM 2007Rec ) and altered (AASM 2007Alt ) classifications. Data are presented as mean (standard deviation) if normally distributed, and as median (interquartile range) if non-normally distributed. Results: The PSGs of 34 elderly [aged 67 (7.0) years] and predominantly male (m:f, 31:3) patients with COPD [FEV 1 %pred 48.4% (19.6%)] were analysed. The AHI using AASM 2007Rec criteria was 5.9 (2.0, 15.1) events/hour vs. 20.4 (11.5, 28.0) events/hour using the 2012 criteria (P<0.001); with the AASM 2007Alt criteria, the AHI was 15.0 (9.3, 26.3) events/hour (P<0.001). Using the 2012 classification, the number of scored hypopnoeas increased by +48% compared to the AASM 2007Rec criteria (P<0.001), 92% of these events were associated with arousal. Although statistically non-significant, using the AASM 2007Alt classification, 12% of our cohort would not have been diagnosed with COPD/OSA overlap syndrome (P=0.114), this was also the case for 47% of the cohort when the AASM 2007Rec classification was used (P<0.01). Conclusions: The use of the AASM 2012 scoring rules results in a significantly higher AHI compared to the AASM 2007 criteria in patients with COPD/OSA overlap syndrome, mostly due to an increased number of arousal-associated hypopnoeas. These observations are important for the definition of the COPD/OSA overlap syndrome.

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Objectives We aimed to compare the effects of different aerobic exercise training (ET) programs on respiratory performance, exercise capacity, and quality of life in fibrosing interstitial lung diseases (f-ILD). Methods A case-control study where 31 patients with f-ILD diagnosis based on chest high-resolution computed tomography were recruited from Main Alexandria University hospital-Egypt. Ten patients were randomly assigned for only lower limbs (LL) endurance training program, and 10 patients for upper limbs, lower limbs, and breathing exercises (ULB) program for consecutive 18 sessions (3 sessions/week for 6 consecutive weeks). Eleven patients who refused to participate in the ET program were considered as control. All patients were subjected for St George’s respiratory questionnaire (SGRQ), 6-minute walk test (6-MWT), forced spirometry and cardiopulmonary exercise testing (CPET) before and after ET programs. Results Fibrosing non-specific interstitial pneumonia (NSIP) and collagenic associated-ILD were the commonest pathologies among the ET groups (30% each) with mean age of 44.4±12.25 and 41.90±7.58 years for LL and ULB groups respectively and moderate-to-severe lung restriction. 6-MWT and SGRQ significantly improved after both ET programs (p<0.001). Peak oxygen consumption (VO2) improved significantly after both LL training (median of 22 (interquartile range (IQR) = 17.0–24.0) vs. 17.5 (IQR = 13.0–23.0) ml/kg/min, p = 0.032) and ULB training (median of 13.5 (IQR = 11.0–21.0) vs. 10.5 (IQR = 5.0–16.0) ml/kg/min, p = 0.018). Further, maximal work load and minute ventilation (VE) significantly improved after both types of ET training (p<0.05); however, neither ventilation equivalent (VE/VCO2) nor FVC% improved after ET (p = 0.052 and 0.259 respectively). There were no statistically significant important differences between LL and ULB training programs regarding 6-MWT, SGRQ or CPET parameters (p>0.05). Conclusions ET was associated with improvements in exercise capacity and quality of life in f-ILD patients irrespective of the type of ET program provided.

INTRODUCTION: Obstructive sleep apnea (OSA) is a condition in which there is repetitive and intermittent occlusion of the upper airway (UA) during sleep. OSA can be treated through; continuous positive airway pressure (CPAP), surgery, or oral appliances. Mandibular Advancement Appliance (MAA) is considered a valid alternative, which can be the first choice in simple snorers and mild-moderate OSA. MAA can be either custom-made or non-custom-made, one-piece or two-piece, titratable or non-titratable. While Monoblock designs permit no mouth opening, two-piece appliances vary in permissible lateral jaw movement and in the coupling mechanisms which attach the two plates together. OBJECTIVES: measuring the change in UA volume after the use of two different designs of MAA (Monoblock and Biblock) MATERIALS AND METHODS: Twenty patients with diagnosed OSA were divided randomly into two equal groups: Monoblock group ; received Monoblock MAA fabricated using CAD/CAM technique at different advancement levels; 50% then 75% of maximum advancement, Biblock group; received Biblock MAA fabricated using CAD/CAM technique at different advancement levels; 50% then 75% of maximum advancement. UA volume of all patients were evaluated after three months of acclimatization of each stage of advancement through Cone-Beam Computed Tomography (CBCT). RESULTS: Biblock group showed statistically significant increase in UA volume at 75% mandibular advancement level, compared to Monoblock group (p=.001). There was statistically significant increase in UA volume percentage change from baseline to 50% advancement (p=.016), and also from baseline to 75% advancement (p=.001) in favor to Biblock MAA. CONCLUSIONS: Both Monoblock and Biblock MAA produced statistically significant increase in UA volume of OSA patients. Biblock MAA with elastics presented statistically significant favorable increase in UA volume in relation to Monoblock MAA.

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