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...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.