Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive ; Anesthetics ; Apnea ; Consensus ; Paper ; Patients ; Pharmaceutical Preparations ; Research Report ; Sleep ; Sleep Apnea Syndromes ; World Health Organization

BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

This study explores the impact of perceived stress on the academic performance of orthopaedic surgery residents in the Philippines. Conducted as a cross-sectional investigation, it involved 126 residents who participated in the 2024 Philippine Board of Orthopaedics In-Service Training Examination (ITE). Stress levels were assessed using the Perceived Stress Scale-10 (PSS-10), while ITE scores served as the measure of academic performance. A significant negative correlation was identified between stress and academic performance (r = -0.3138, p = 0.00010). Residents experiencing high stress achieved lower scores (55.2%) compared to those with low to moderate stress (61.8%). Other demographic variables such as sex, age, marital status and type of training institution (public and private) were not significantly associated with stress level findings. On the other hand, key factors contributing to elevated stress included insufficient sleep (0–4 hours nightly; OR = 5.83, p = 0.0289) and limited awareness of mental health issues (OR = 13.34, p = 0.0014). These results highlight the pressing need for stress reduction initiatives, improved mental health education and strategies to address challenges posed by sleep deprivation and extensive work hours. This study provides a foundation for improving both academic outcomes and overall well-being in residency programs.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; World Health Organization ; Sleep Deprivation ; Internship And Residency ; Health Education ; Cross-sectional Studies ; Marital Status

Background: Diet is an important modifiable factor that may influence sleep quality, with several foods, nutrients, and dietary patterns reported to affect sleep-related outcomes. However, evidence regarding the relationship between Halal dietary practices and sleep quality remains limited. This study aimed to determine the association between the frequency of consumption of Halal-certified food groups and sleep quality among adult Filipino Muslims. Methods: An analytical cross-sectional study was conducted among 323 adult Filipino Muslim members of the Greenhills Muslim Traders Association in San Juan City, Philippines. Participants were selected using purposive sampling based on predefined inclusion and exclusion criteria. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while dietary intake was measured using a structured questionnaire on the frequency of consumption of Halal-certified food groups. Descriptive statistics were used to summarize participant characteristics, dietary patterns, and sleep quality. Multivariable logistic regression analysis was performed to determine the association between Halal-certified food group consumption and sleep quality. Results: Halal-certified grain products were the most frequently consumed food group (mean = 2.39), while Halal-certified combination foods were the least frequently consumed (mean = 1.21). The mean global PSQI score was 4.62, indicating generally good sleep quality, and 67.8% of participants were classified as good sleepers (PSQI ≤5). Sleep efficiency had the highest mean component score (1.16), whereas subjective sleep quality had the lowest (0.00). Multivariable logistic regression showed no significant association between the frequency of consumption of most Halal-certified food groups and sleep quality (p > 0.05). However, more frequent consumption of Halal-certified combination foods was significantly associated with lower odds of good sleep quality (OR = 0.697, 95% CI: 0.529–0.919, p = 0.010). Conclusion The frequency of consumption of most Halal-certified food groups was not significantly associated with sleep quality among adult Filipino Muslims. However, increased consumption of Halal-certified combination foods was associated with lower odds of good sleep quality. Further studies should explore other dietary and behavioral factors that may influence sleep outcomes.
Sleep quality ;

Objective:To determine the sensitivity, specificity and positive predictive value of the STOP BANG questionnaire in diagnosing Obstructive Sleep Apnea (OSA) in adults admitted for polysomnography at the Rizal Medical Center from January 2019 to June 2024

Methods:
Design:Review of Records
Setting:Tertiary Government Training Hospital
Participants:166 adult patients

Results:A total of 166 patient records were included with an average age of 35.6 ± 12 years, BMI of 29.3 ± 6.44 and 67% were male. The STOP-BANG questionnaire had a sensitivity of 77% to screen for all (AHI ≥ 5), mild (AHI = 5-14.9), moderate (AHI = 15-19.9), and severe OSA (AHI > 30), respectively. The specificity was 62% and the area under the curve was 0.717 for all, mild, moderate and severe OSA

Conclusion:A STOP-BANG score of 3/8 can predict the presence of OSA with a sensitivity of 77% and specificity of 62% with AUC of 0.717. The increase in score does not predict the severity. Further research can be done to identify other co-morbidities associated with OSA.

Human ; Apnea ; Obstructive Sleep Apnea ; Sleep

INTRODUCTION: Obstructive sleep apnoea (OSA) is a serious but underdiagnosed condition. Demand for the gold standard diagnostic polysomnogram (PSG) far exceeds its availability. More efficient diagnostic methods are needed, even in tertiary settings. Machine learning (ML) models have strengths in disease prediction and early diagnosis. We explored the use of ML with oximetry, demographic and anthropometric data to diagnose OSA. METHODS: A total of 2,996 patients were included for modelling and divided into test and training sets. Seven commonly used supervised learning algorithms were trained with the data. Sensitivity (recall), specificity, positive predictive value (PPV) (precision), negative predictive value, area under the receiver operating characteristic curve (AUC) and F1 measure were reported for each model. RESULTS: In the best performing four-class model (neural network model predicting no, mild, moderate or severe OSA), a prediction of moderate and/or severe disease had a combined PPV of 94%; one out of 335 patients had no OSA and 19 had mild OSA. In the best performing two-class model (logistic regression model predicting no-mild vs. moderate-severe OSA), the PPV for moderate-severe OSA was 92%; two out of 350 patients had no OSA and 26 had mild OSA. CONCLUSION Our study showed that the prediction of moderate-severe OSA in a tertiary setting with an ML approach is a viable option to facilitate early identification of OSA. Prospective studies with home-based oximeters and analysis of other oximetry variables are the next steps towards formal implementation.
Humans ; Oximetry/methods* ; Sleep Apnea, Obstructive/diagnosis* ; Male ; Female ; Middle Aged ; Machine Learning ; Polysomnography ; Adult ; Anthropometry ; ROC Curve ; Aged ; Algorithms ; Predictive Value of Tests ; Sensitivity and Specificity ; Neural Networks, Computer ; Demography

INTRODUCTION: Social lockdowns and quarantines have been enforced in various populations to mitigate the spread of coronavirus disease 2019 (COVID-19) in the community. This study investigated the impact of COVID-19 lockdown, known as circuit breaker movement restrictions (CBMR), on physical activity (PA) and sedentary time (ST) distribution patterns among Singapore residents aged 21-65 years. METHODS: This was a cross-sectional retrospective study that utilised a 44-item questionnaire that included sections to determine PA and ST distribution patterns before and during CBMR. It also included information on sleep duration, PA preference and routine, awareness of local initiatives and perceptions on barriers towards PA during the CBMR period. RESULTS: There was an overall decrease in PA and a significant increase in physical inactivity and ST during the CBMR period. A greater proportion of participants reported sleeping for longer hours, suggesting positive adaptations in sleep habits during CBMR. Majority were unaware of online exercise initiatives and programmes offered during the CBMR period, and >50% of the respondents never used an online resource for exercise. Singapore residents seemed to prefer outdoor and facility-based venues for exercise and PA, and closure of facilities was the primary barrier for PA during the CBMR period. CONCLUSION Reduced PA and increased ST during CBMR reflect negative lifestyle adaptations and may have adverse public health implications. Increased sleep duration suggests successful coping, which may consequently lead to physical and mental health benefits. While Singapore adult residents may be flexible with certain aspects of being physically active, they seemed less adaptive to changes in type of exercise, facility and environment.
Humans ; COVID-19/epidemiology* ; Singapore/epidemiology* ; Exercise ; Adult ; Sedentary Behavior ; Cross-Sectional Studies ; Middle Aged ; Male ; Female ; Retrospective Studies ; Public Health ; Aged ; Surveys and Questionnaires ; SARS-CoV-2 ; Young Adult ; Quarantine ; Sleep

INTRODUCTION: Arrhythmias, especially atrial fibrillation (AF) and ventricular arrhythmias, are independent risk factors of mortality in patients with ischaemic heart disease (IHD). While there is a growing body of evidence that suggests an association between obstructive sleep apnoea (OSA) and cardiac arrhythmias, evidence on this relationship in patients with IHD has been scant and inconsistent. We hypothesised that in patients with IHD, severe OSA is associated with an increased risk of nocturnal arrhythmias. METHODS: We studied 103 consecutive patients with IHD who underwent an overnight polysomnography. Exposed subjects were defined as patients who had an apnoea-hypopnoea index (AHI) ≥30/h (severe OSA), and nonexposed subjects were defined as patients who had an AHI <30/h (nonsevere OSA). All electrocardiograms (ECGs) were interpreted by the Somte ECG analysis software and confirmed by a physician blinded to the presence or absence of exposure. Arrhythmias were categorised as supraventricular and ventricular. Arrhythmia subtypes (ventricular, atrial and conduction delay) were analysed as dichotomous outcomes using multiple logistic regression models. RESULTS: Atrial fibrillation and AF/flutter (odds ratio 13.5, 95% confidence interval 1.66-109.83; P = 0.003) were found to be more common in the severe OSA group than in the nonsevere OSA group. This association remained significant after adjustment for potential confounders. There was no significant difference in the prevalence of ventricular and conduction delay arrhythmias between the two groups. CONCLUSION In patients with IHD, there was a significant association between severe OSA and nocturnal AF/flutter. This underscores the need to evaluate for OSA in patients with IHD, as it may have important implications on clinical outcomes.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Atrial Fibrillation/diagnosis* ; Male ; Female ; Middle Aged ; Polysomnography ; Electrocardiography ; Myocardial Ischemia/complications* ; Aged ; Risk Factors ; Logistic Models

OBJECTIVE: To observe the clinical efficacy of acupuncture combined with bamboo-based medicinal moxibustion in the treatment of chronic insomnia complicated with mild depressive state. METHODS: A total of 60 patients with chronic insomnia complicated with mild depressive state were randomly divided into an observation group and a control group, 30 cases in each group. The control group was treated with acupuncture at bilateral Zhaohai (KI6), Shenmen (HT7), Sanyinjiao (SP6), Anmian (Extra) and Sishencong (EX-HN1), Baihui (GV20), etc. The observation group was treated with bamboo-based medicinal moxibustion based on the treatment in the control group, on the abdomen，Shenque (CV8), Guanyuan (CV4), Zhongwan (CV12) and bilateral Tianshu (ST25) were selected , on the back, the acupoints of governer vessel from Dazhui (GV14) to Yaoshu (GV2) were selected. Both groups were treated once every other day, 3 times a week for 4 weeks. The Pittsburgh sleep quality index (PSQI) score, Hamilton depression scale-17 (HAMD-17) score, insomnia severity index (ISI) score, fatigue assessment instrument (FAI) score before and after treatment and after 2 weeks of treatment completion (follow-up) were observed in the two groups, and the serum level of γ-aminobutyric acid (GABA) before and after treatment was detected in the two groups, and the clinical efficacy and safety were evaluated. RESULTS: After treatment and in the follow-up, the sub-item scores and total scores of PSQI in both groups were reduced compared with those before treatment (P<0.001); except for the score of daytime dysfunction in the follow-up, the scores of sleep quality, sleep duration, daytime dysfunction, and total scores of PSQI in the observation group were lower than those in the control group (P<0.05). After treatment and in the follow-up, the HAMD-17, ISI and FAI scores in both groups were reduced compared with those before treatment (P<0.001); the scores in the observation group were lower than those in the control group (P<0.05). After treatment，the serum levels of GABA in both groups were increased compared with those before treatment (P<0.05); the level in the observation group was higher than that in the control group (P<0.05). The total effective rate of treating chronic insomnia in the observation group was 96.7% (29/30), which was higher than 80.0% (24/30) in the control group (P<0.05); and the total effective rate of improving mild depressive state was 93.3% (28/30), which was higher than 66.7% (20/30) in the control group (P<0.001). During the treatment period, no serious adverse reactions occurred in both groups. CONCLUSION Acupuncture combined with bamboo-based medicinal moxibustion has definite efficacy in the treatment of chronic insomnia complicated with mild depressive state, and has synergistic efficacy in improving sleep quality, sleep duration, daytime dysfunction and depressive state, its action mechanism may be related to the increase of serum level of GABA.
Humans ; Moxibustion ; Sleep Initiation and Maintenance Disorders/therapy* ; Male ; Female ; Middle Aged ; Adult ; Depression/therapy* ; Acupuncture Therapy ; Combined Modality Therapy ; Treatment Outcome ; Aged ; Young Adult ; Acupuncture Points

OBJECTIVE: To observe the clinical efficacy of electroacupuncture combined with ear tip bloodletting for insomnia with phlegm-fire disturbing heart. METHODS: A total of 60 cases with insomnia of phlegm-fire disturbing heart were selected, and the treatment of electroacupuncture combined with ear tip bloodletting was delivered. Acupuncture was applied at Yintang (GV24⁺), Shenting (GV24), Sishencong (EX-HN1) and bilateral Shenmen (HT7), Quchi (LI11), Zhaohai (KI6), Shenmai (BL62), Fenglong (ST40), Neiting (ST4), Yintang (GV24⁺) and Shenting (GV24) were connected to electroacupuncture, continuous wave, 2 Hz in frequency. In addition, bloodletting was applied at ear tip. The treatment was given for 4 weeks. Before treatment, and after 1,4 weeks into treatment, the scores of Pittsburgh sleep quality index (PSQI), Athens insomnia scale (AIS), insomnia severity index (ISI) and TCM syndrome were compared, and the clinical efficacy was evaluated in the patients. RESULTS: After 1,4 weeks into treatment, the scores of PSQI, AIS, ISI and TCM syndrome were decreased compared with those before treatment in the patients (P<0.05). Of 60 cases, 30 cases were cured, 19 cases markedly effective, 9 cases effective and 2 cases failed, and the total effective rate was 96.7% (58/60). CONCLUSION Electroacupuncture combined with ear tip bloodletting can improve the sleep quality and clinical symptoms in patients with insomnia of phlegm-fire disturbing heart.
Humans ; Male ; Female ; Electroacupuncture ; Middle Aged ; Sleep Initiation and Maintenance Disorders/physiopathology* ; Adult ; Bloodletting ; Acupuncture Points ; Aged ; Combined Modality Therapy ; Treatment Outcome ; Young Adult