Key Points Question Does COVID-19 convalescent plasma (CCP), compared with placebo, improve the clinical status of hospitalized patients with COVID-19 requiring noninvasive supplemental oxygen? Findings In this randomized clinical trial including 941 patients, based on the World Health Organization 11-point Ordinal Scale for Clinical Improvement, CCP did not benefit 468 participants randomized to CCP compared with 473 randomized to placebo from April 2020 to March 2021. However, in exploratory analyses, CCP appeared to benefit those enrolled from April to June 2020, the period when most participants received high-titer CCP and were not receiving remdesivir and corticosteroids at randomization. Meaning In this trial, CCP did not meet prespecified outcomes for efficacy, but high-titer CCP may have benefited hospitalized patients with COVID-19 early in the pandemic when other treatments were not in use, suggesting a heterogenous treatment effect over time.

Study Objectives:The study was performed to evaluate the hypothesis that the extremely obese manifest sleep disordered breathing with a preponderance of hypopneas and relative paucity of obstructive apneas. Methods: Retrospective review of 90 adults with obstructive sleep apnea-hypopnea syndrome (OSAHS) matched for age and gender, comparing two groups, Group A: body mass index (BMI) < 35, Group B: BMI ≥ 45. Exclusion criteria: age < 18 years, pregnancy, ≥ 5 central apneas/hour, BMI ≥ 35 < 45. Primary Outcome Measure: Hypopnea/apnea ratio (HAR); secondary measures: obstructive apnea-hypopnea index (AHI), obstructive and central apnea indices, hypopnea index (HI), oxygen saturation (SpO 2 ) nadir, end-tidal carbon dioxide tension (PetCO 2 ), and presence of obesity-hypoventilation syndrome (OHS). Statistical methods: t-test for independent samples; Mann-Whitney, linear regression with natural log transformation, and Kruskal-Wallis χ 2 . Descriptive statistics were expressed as interquartile range, median and mean ± standard deviation, p < 0.05 considered signifi cant.Results: Group A (n = 45): age = 50.6 ± 11.5 years, BMI = 28.9 ± 4 kg/m 2 ; Group B (n = 45): age = 47.4 ± 12.7 years, BMI = 54.5 ± 8 kg/m 2 . HAR was signifi cantly higher in Group B (38.8 ± 50.7) than Group A (10.6 ± 16.5), p = 0.0006, as was HI (28.7 ± 28.6 in B vs 12.6 ± 8.4 in A, p = 0.0005) and AHI (35.5 ± 33.8 vs 22 ± 23, p = 0.03), but not apnea index. HAR was signifi cantly higher in Group B regardless of race, gender, or presence of OHS. The BMI was the only signifi cant predictor of HAR (adjusted r 2 = 0.138; p = 0.002) in a linear regression model with natural log transformation of the HAR performed for age, gender, race, BMI, and PetCO 2 . Conclusion: Extremely obese patients manifest OSAHS with a preponderance of hypopneas. Keywords: Obesity, obstructive sleep apnea, hypopnea, obesity-hypoventilation syndrome, gender differences, sleepdisordered breathing, hypopnea/apnea ratio. Citation: Mathew R; Castriotta RJ. High hypopnea/apnea ratio (HAR) in extreme obesity. J Clin Sleep Med 2014;10(4):391-396.http://dx.doi.org/10.5664/jcsm.3612 S C I E N T I F I C I N V E S T I G A T I O N SO besity is one of the major risk factors for obstructive sleep apnea-hypopnea syndrome (OSAHS), 1 which may be defi ned as an apnea-hypopnea index (AHI) ≥ 5 apneas+ hypopneas/hour of sleep, accompanied by symptoms of excessive sleepiness, diffi culty sleeping, or non-refreshing sleep. The prevalence of obesity in the USA has increased by 33% during the last decade, with 40% of men and 55% of women aged 25 years or older being overweight or obese.2 OSAHS has a higher prevalence among obese subjects than among the general population.3 The prevalence of OSAHS (AHI ≥ 15) in obese (body mass index [BMI] ≥ 32-59 kg/m 2 ) adults is 32% 4 and is signifi cantly higher in men with morbid obesity (BMI ≥ 39 kg/ m 2 ) with 40% having an apnea index > 20 apneas/hour. 5 The prevalence of OSAHS among hospitalized patients has been reported to be 60% in the morbidly obese.6 Com...

We present the case of a patient who developed a severe systemic allergic reaction during initiation of hemodialysis. The reaction completely resolved by switching the dialysis filter sterilized by ethylene oxide to a steam sterilized filter. Ethylene oxide is used to sterilize heat sensitive medical devices, and although allergic reactions related to ethylene oxide have been reported before, awareness is lacking among providers in the inpatient setting, specifically in the intensive care unit setting.

type III home monitors are difficult for patients to set up and wearing the monitors is disruptive to patient's typical sleep pattern. The diagnostic value of an inexpensive easy-to-use light-weight flexible skin-adhesive patch (SomnaPatch) that minimally affects sleep was evaluated in this study. Methods: Simultaneous polysomnography (PSG) and the diagnostic patch recordings were made in 179 subjects (mean age 54.0 ± 13.6 y, 55% male) selected from the databases of patients previously tested with PSG to ensure even representation of the clinically important apnea-hypopnea index (AHI) ranges. The skin-adhesive diagnostic patch weighs less than one ounce and records nasal pressure, blood oxygen saturation, pulse rate, respiratory effort, sleep time and body position (S 3 C 4 O 2 P 2 E 3 R 2 category). To compare the apnea-hypopnea index of the diagnostic patch with polysomnography, all recordings were auto-scored with the Somnolyzer software (Respironics). BlandAltman analysis was performed. Sensitivity, specificity and accuracy were calculated and receiver operating characteristic (ROC) curves were constructed for six AHI thresholds (5, 10, 15, 20, 25 and 30 events per hour). The rate of clinical agreement and positive likelihood ratio were calculated. Results: Overnight recordings from 174 subjects were included in the final analysis. All six ROC curves had area under the curve of over 0.9. Sensitivity, specificity and accuracy for the optimal threshold of AHI≥15 were 0.86, 0.83 and 0.85 respectively. Positive likelihood ratio (LR+) was 7.4. Bland-Altman analysis showed that the bias was 0.9 events per hour and the limits of agreement were 18.1 and -16. Introduction: Hypermobility syndromes can be an important risk factor for Sleep Disordered Breathing (SDB). The risk factors for SDB, such as obesity, male gender, or post-menopausal status, are frequently absent in hypermobile populations, yet the impact of SDB on the quality of these patients' lives can be profound. Methods: Charts of 49 consecutive patients with a Beighton hypermobility score ≥5 from a Neurology Institute were retrospectively reviewed. All ± values reflect the standard error of the mean. Results: Eighty-four percent of these patients had sleep complaints. Thirty underwent Polysomnography (PSG), though PSG was requested for all. Five were denied by insurance, and 6 refused PSG. PSGs demonstrated SDB in 29 patients: 19 had Obstructive Sleep Apnea (G47.33) and 10 had Sleep Apnea -Unspecified (Upper Airway Resistance Syndrome) (G47.30). The average age was 33.4 ± 2.3 years, the average BMI was 26.9 ± 1.6, and the average Epworth Sleepiness Scale Score was 12.1 ± 0.98. Twenty-one of these 30 patients received an MRI of the cervical spine for symptoms and signs of cervical radiculopathy. On a T1-weighted, mid-sagittal section, the following measurements were made of the narrowest dimensions in centimeters: Retropalatal (0.47 ± 0.06), Retrolingual (0.86 ± 0.05), and Retroepiglottal (0.47 ± 0.04), and Epiglottal length (2.22 ± 0.06). These measureme...

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