Comparing respiratory polygraphy with pulse transit time analysis versus overnight polysomnography in the diagnosis of obstructive sleep apnoea in children.

OBJECTIVE: Obstructive sleep apnea syndrome in children is associated with significant morbidity. Polysomnography is the main diagnostic tool but is time consuming and requires skilled manpower to supervise the patient overnight and hence long referral to diagnosis time. However, there are limitations and underestimation of the apnoea hyponea index (AHI) with alternative home sleep apnoea testing (HSAT), such as type 3 respiratory polygraphy (RP). Prior studies have demonstrated pulse transit time (PTT) to be a reliable indicator of cortical arousals. In this study, the use of PTT together with RP will be studied to determine whether the derived AHI is comparable to that of PSG. METHOD: Forty-five patients with suspected OSA met the inclusion criteria underwent PSG in the sleep laboratory for analysis. The raw data for either PSG or RP analysis were allocated separately to two different accredited sleep technicians. The primary outcome AHI derived from PTT with RP was compared to the AHI derived from PSG. Secondary outcomes compared were obstructive apnoea index (OAI), total hypopnoea index (THI) and arousal index (AI). Bland Altman analysis was used to compare the agreement of AHI derived from the 2 modalities and demonstrate whether RP is non inferior or equivalent to the gold standard for diagnosing OSAS. RESULTS: The patients studied had a median age of 8.8 years (range 3-17 years). The patients were not limited to certain spectrum of severity OSA and had AHI results spread from mild to severe OSA (AHI 0.4/hr to 72.2/hr). The RP with PTT-derived AHI was strongly correlated to the PSG derived AHI as seen on the Spearman plot (r = 0.98). The Bland Altman plot showed no evidence of underestimation of the AHI due to missed arousal related hypopneas. The difference of AHI derived from RP and PSG results were clinically insignificant. The differences between the PSG and RP total hypopnoea index (THI) and arousal index (AI) were also statistically insignificant. CONCLUSION: The study shows that RP with PTT can be considered a reliable diagnostic alternative compared with PSG. The role of PTT incorporated with RP was to minimize underestimation of AHI due to missed arousal associated hypopnea events. The results were apparent across mild to severe severity of OSA. There are advantages of RPs particularly in paediatrics. Overall this study offers promising preliminary insights that RP incorporated with PTT can be further explored as an acceptable home diagnostic tool for diagnosing OSA in children.

Estimation of exhaust emission from ocean-going vessels in Hong Kong.

As one of the busiest port in the world, ship emissions have become of great concern in Hong Kong. In this study, a detailed maritime emission inventory for ocean-going vessels (OGVs) in Hong Kong with the base year of 2007 was developed. The high-resolution vessel speed profiles determined using the Automatic Identification System (AIS) during 2009 were adopted for the speed data in the estimation. It was obtained that the total ship emissions from 37,150 voyages of OGVs in 2007 were 17,097, 8190, and 1035 tonnes accounting for 17%, 11%, and 16% of the total emissions of NO(x), SO(2), and PM(10), respectively. The contribution of ship emissions during transiting was 60-68% for three pollutants while the emissions during hotelling were responsible for the remaining portions. From the emission spatial allocation, the shipping route along the East Lamma Channel and the berthing location of the Kwai Chung and Tsing Yi Container Port comprised the regions with the highest emissions. The OGV emissions in Hong Kong contributed 0.07% NO(x), 0.05% SO(2), and 0.06% PM(10) out of the global total shipping emissions in 2007.

Characteristics and source apportionment of PM1 emissions at a roadside station.

The mass concentrations of PM(1) (particles less than 1.0 µm in aerodynamic diameter), organic carbon (OC), elemental carbon (EC), water-soluble ions, and up to 25 elements were reported for 24h aerosol samples collected every sixth day at a roadside sampling station in Hong Kong from October 2004 to September 2005. Annual average PM(1) mass concentration was 44.5 ± 19.5 µg m(-3). EC, OM (organic matter, OC × 1.2), and SO(4)(=) were the dominant components, accounting for ∼ 36%, ∼ 26%, and ∼ 24% of PM(1), respectively. Other components, i.e., NO(3)(-), NH(4)(+), geological material, trace elements and unidentified material, comprised the remaining ∼ 14%. Annual average OC/EC ratio (0.6 ± 0.3) was low, indicating that primary vehicle exhaust was the major source of carbonaceous aerosols. The seasonal variations of pollutants were due to gas-particle partitioning processes or a change in air mass rather than secondary aerosol produced locally. Vehicle exhaust, secondary aerosols, and waste incinerator/biomass burning were dominant air pollution sources, accounting for ∼ 38%, ∼ 22% and ∼ 16% of PM(1), respectively. Pollution episodes during summer (May-August) which were frequently accompanied by tropical storms or typhoons were dominated by vehicle emissions. During winter (November-February) pollution episodes coincided with northeasterly monsoons were characterized by secondary aerosols and incinerator/biomass burning emissions.

Physical parameters effect on ozone-initiated formation of indoor secondary organic aerosols with emissions from cleaning products.

The effect of air exchange rate (ACH), temperature (T), and relative humidity (RH) on the formation of indoor secondary organic aerosols (SOAs) through ozonolysis of biogenic organic compounds (BVOCs) emitted from floor cleaner was investigated in this study. The total particle count (with D(p) of 6-225 nm) was up to 1.2 × 10(3)#cm(-3) with ACH of 1.08 h(-1), and it became much more significant with ACH of 0.36 h(-1) (1.1 × 10(4)#cm(-3)). This suggests that a higher ventilation rate can effectively dilute indoor BVOCs, resulting in a less ultrafine particle formation. The total particle count increased when temperature changed from 15 to 23 °C but it decreased when the temperature further increased to 30 °C. It could be explained that high temperature restrained the condensation of formed semi-volatile compounds resulting in low yields of SOAs. When the RH was at 50% and 80%, SOA formation (1.1-1.2 × 10(4)#cm(-3)) was the more efficient compared with that at RH of 30% (5.9 × 10(3)#cm(-3)), suggesting higher RH facilitating the initial nucleation processes. Oxidation generated secondary carbonyl compounds were also quantified. Acetone was the most abundant carbonyl compound. The formation mechanisms of formaldehyde and acetone were proposed.