Reliability of automatic detection of AHI during positive airway pressure treatment in obstructive sleep apnea patients: A "real-life study".

INTRODUCTION: Automatic event detection (AED) of residual apnea-hypopnea index (AHI) by ventilators is a current practice in sleep and mechanical ventilation Units but this methodology has not been validated in an unselected population of OSA patients. Aim of the present study was to assess in a "real-life" condition the reliability of AED during PAP therapy by the in-built software compared to full polysomnography during follow-up. METHODS: We enrolled 300 OSA patients (105 F; AHI 45.3 ± 27.8) already on Positive airway pressure (PAP) therapy: 53% of the patients were on CPAP while other modalities were used in the rest of the sample. RESULTS: Overall, the built-in software identified residual obstructive AHI (AHIPAP) > 5, 10 or 15 in 18.7, 8.6 or 4.6% of patients, respectively. By using AHIPAP, 28.4% of patients were wrongly classified as "well controlled" despite a residual AHIPSG>5 (6% considering a residual AHIVENT >15); 7% of patients were classified as not controlled while AHIPSG was <5 (1.4% considering a residual AHIVENT >15). Type of ventilation, ventilator parameters, adherence to treatment and level of baseline or follow-up Epworth Sleepiness Scale score were similar between groups. The sensitivity and positive predicted values were very low. Positive likelihood ratio appears adequate only for residual AHIPAP ≥10, but negative likelihood ratio was inconclusive for all the cut-off considered. DISCUSSION: The results of the present study suggest a more cautious approach in the follow-up of OSA patients, since a protocol based only on AED detection and symptoms assessment may not be accurate especially for AHIPAP<15.

The rate of OH- ion release from lining materials containing calcium hydroxide.

Four light-cured calcium hydroxide and three chemically cured resin-based lining materials were compared for hydoxil ion (OH-) release. Results indicated that the chemically cured calcium hydroxide cements were capable of OH- release for a longer period than the light-cured resin bases. Alkaliner (a chemically cured liner) produced and maintained the highest alkaline environment in the long-term, whereas calcium fluoride liner and Basic-L (both resin-based) showed the lowest values of OH- ion release.