Self-setup of home respiratory polygraphy for the diagnosis of sleep apnea syndrome: cost-efficiency study.

PURPOSE: To evaluate the differences in reliability and costs of home respiratory polygraphy (HRP) when installed by the patient and by a nurse, in order to determine the factors affecting and to consider the possible generalization of self-setup procedure. Several HRP devices have been validated for obstructive sleep apnea (OSA) diagnosis but convenience of a nurse intervention in HRP installation has been scarcely studied. METHODS: This is a prospective and interventional study. About 301 participants were assigned to 2 groups: self-setup and nurse intervention. Sleep study, questionnaires, and diagnostic procedures were performed following the clinical practice in 2016. Signals were considered lost above 3 min, and success of the test was established according to guidelines. Costs were calculated according to a previous multicenter study. RESULTS: Both groups (self-setup and nurse intervention) resulted homogeneous in age, gender, BMI, and final diagnosis of OSA. Signal losses during the test were similar in both groups. Slightly higher percentage of unsuccessful tests were obtained in the self-setup procedure (5.3 vs 2.0%, p = 0.121). The costs were similar (107 vs 105 €) in the self-setup group as compared to the nurse setup group. CONCLUSIONS: The setup of HRP by either the patient or nurse had similar costs and data acquisition. Both installation procedures of HRP were similar regarding test reliability and costs. Main findings are that self-installation by the patient could be similarly reliable and economic as installation by a nurse, as far as consensus guidelines are followed. This study demonstrates that self-setup of HRP is a potentially viable option for the diagnosis of OSA.

International descriptive and interventional survey for oxycholesterol determination by gas- and liquid-chromatographic methods.

Increasing numbers of laboratories develop new methods based on gas-liquid and high-performance liquid chromatography to determine serum concentrations of oxygenated cholesterol metabolites such as 7α-, 24(S)-, and 27-hydroxycholesterol. We initiated a first international descriptive oxycholesterol (OCS) survey in 2013 and a second interventional survey 2014 in order to compare levels of OCS reported by different laboratories and to define possible sources of analytical errors. In 2013 a set of two lyophilized serum pools (A and B) was sent to nine laboratories in different countries for OCS measurement utilizing their own standard stock solutions. In 2014 eleven laboratories were requested to determine OCS concentrations in lyophilized pooled sera (C and D) utilizing the same provided standard stock solutions of OCS. The participating laboratories submitted results obtained after capillary gas-liquid chromatography-mass selective detection with either epicoprostanol or deuterium labelled sterols as internal standards and high-performance liquid chromatography with mass selective detection and deuterated OCS as internal standard. Each participant received a clear overview of the results in form of Youden-Plots and basic statistical evaluation in its used unit. The coefficients of variation of the concentrations obtained by all laboratories using their individual methods were 58.5-73.3% (survey 1), 56.8-60.3% (survey 2); 36.2-35.8% (survey 1), 56.6-59.8, (survey 2); 61.1-197.7% (survey 1), 47.2-74.2% (survey 2) for 24(S)-, 27-, and 7α-hydroxycholesterol, respectively. We are surprised by the very great differences between the laboratories, even under conditions when the same standards were used. The values of OCS's must be evaluated in relation to the analytical technique used, the efficiency of the ample separation and the nature of the internal standard used. Quantification of the calibration solution and inappropriate internal standards could be identified as major causes for the high variance in the reported results from the different laboratories. A harmonisation of analytical standard methods is highly needed.

Oxysterols formation: A review of a multifactorial process.

Dietary sterols are nutritionally interesting compounds which can suffer oxidation reactions. In the case of plant sterols, they are being widely used for food enrichment due to their hypocholesterolemic properties. Besides, cholesterol and plant sterols oxidation products are associated with the development of cardiovascular and neurodegenerative diseases, among others. Therefore, the evaluation of the particular factors affecting sterol degradation and oxysterols formation in foods is of major importance. The present work summarizes the main results obtained in experiments which aimed to study four aspects in this context: the effect of the heating treatment, the unsaturation degree of the surrounding lipids, the presence of antioxidants on sterols degradation, and at last, oxides formation. The use of model systems allowed the isolation of some of these effects resulting in more accurate data. Thus, these results could be applied in real conditions.

Unsaturated lipid matrices protect plant sterols from degradation during heating treatment.

The interest in plant sterols enriched foods has recently enhanced due to their healthy properties. The influence of the unsaturation degree of different fatty acids methyl esters (FAME: stearate, oleate, linoletate and linolenate) on a mixture of three plant sterols (PS: campesterol, stigmasterol and ß-sitosterol) was evaluated at 180 °C for up to 180 min. Sterols degraded slower in the presence of unsaturated FAME. Both PS and FAME degradation fit a first order kinetic model (R(2)>0.9). Maximum oxysterols concentrations were achieved at 20 min in neat PS and 120 min in lipid mixtures and this maximum amount decreased with increasing their unsaturation degree. In conclusion, the presence of FAME delayed PS degradation and postponed oxysterols formation. This protective effect was further promoted by increasing the unsaturation degree of FAME. This evidence could help industries to optimize the formulation of sterol-enriched products, so that they could maintain their healthy properties during cooking or processing.

Cholesterol and stigmasterol within a sunflower oil matrix: Thermal degradation and oxysterols formation.

The characteristics of the lipid matrix surrounding sterols exert a great influence in their thermal oxidation process. The objective of this work was to assess the oxidation susceptibility of equal amounts of cholesterol and stigmasterol within a sunflower oil lipid matrix (ratio 1:1:200) during heating (180°C, 0-180min). Remaining percentage of sterols was determined and seven sterol oxidation products (SOPs) were analysed for each type of sterol along the heating treatment. Evolution of the fatty acid profile and vitamin E content of the oil was also studied. Overall oxidation status of the model system was assessed by means of Peroxides Value (PV) and TBARS. PV remained constant from 30min onwards and TBARS continued increasing along the whole heating treatment. Degradation of both cholesterol and stigmasterol fitted a first order curve (R(2)=0.937 and 0.883, respectively), with very similar degradation constants (0.004min(-1) and 0.005min(-1), respectively). However, higher concentrations of oxidation products were found from cholesterol (79µg/mg) than from stigmasterol (53µg/mg) at the end of the heating treatment. Profile of individual oxidation products was similar for both sterols, except for the fact that no 25-hydroxystigmasterol was detected. 7α-Hydroxy and 7-keto-derivatives were the most abundant SOPs at the end of the treatment. PUFA and vitamin E suffered a significant degradation along the process, which was correlated to sterols oxidation.

Thermo-oxidation of cholesterol: effect of the unsaturation degree of the lipid matrix.

The influence of the unsaturation degree of different triacylglycerols (tristearin, triolein, trilinolein and trilinolenin) on cholesterol oxidation at 180 °C, was evaluated. Cholesterol degraded faster when heated alone than in the presence of triacylglycerols; moreover, the more unsaturated the matrix, the slower the degradation of cholesterol. Both cholesterol and triacylglycerols degradation fit a first order kinetic model (R(2)>0.9), except for the tristearin sample. Cholesterol oxidation products (COPs) and peroxides were formed during the heating treatment. The presence of any type of lipid matrix postponed and decreased the maximum concentration of both oxidation parameters. Maximum total COPs concentrations were achieved at 20 min in neat cholesterol, 120 min in tristearin and triolein and 180 min in polyunsaturated matrix samples. 7-Ketocholesterol was the main COP in most cases during the whole heating treatment. Both the presence of triacylglycerols and their unsaturation degree inhibited cholesterol thermooxidation at 180 °C.

Sterols heating: degradation and formation of their ring-structure polar oxidation products.

Cholesterol and phytosterols can be oxidised under heating conditions to give sterol oxidation products (SOPs), known by their toxic effects. This paper studied the degradation of cholesterol and three plant sterols during a 360 min heating treatment (180 °C). The formation and further degradation of SOPs was also analysed by GC-MS. Results revealed a sterol susceptibility to degradation according to the following decreasing order: campesterol≈ß-sitosterol≥stigmasterol>cholesterol. The degradation curve fit (R(2)=0.907-0.979) a logarithmic model. SOPs increased their concentration during the first 5-10 min and thereafter, their degradation rate was higher than their formation rate, resulting in a decrease over time. Irrespective of the sterol from which they had derived, 7-keto derivatives presented the highest levels throughout the entire process, and also SOPs with the same type of oxidation followed a similar degradation pattern (R=0.90-0.99).

Stability of avocado oil during heating: comparative study to olive oil.

The stability of the saponifiable and unsaponifiable fractions of avocado oil, under a drastic heating treatment, was studied and compared to that of olive oil. Avocado and olive oil were characterised and compared at time 0h and after different times of heating process (180°C). PUFA/SFA (0.61 at t=0) and ω-6/ω-3 (14.05 at t=0) were higher in avocado oil than in olive oil during the whole experiment. Avocado oil was richer than olive oil in total phytosterols at time 0h (339.64; 228.27mg/100g) and at 9h (270.44; 210.30mg/100g) of heating. TBARs was higher in olive oil after 3h, reaching the maximum values in both oils at 6h of heating treatment. Vitamin E was higher in olive oil (35.52 vs. 24.5mg/100g) and it disappeared earlier in avocado oil (at 4 vs. 5h). The stability of avocado oil was similar to that of olive oil.