Effectiveness of Narval CC™ device in the treatment of obstructive sleep apnea.

Mandibular advancement devices (MAD) are used in sleep apnea with varying results. We aimed to examine whether or not a MAD should be an integral treatment modality in the care of our patients with obstructive sleep apnea. We designed a feasibility study and included 32 patients after meeting inclusion criteria. Only 3 patients did not finish the second sleep study exam. The intervention was an individually designed MAD and a sleep study exam was performed prior and post treatment. The outcome objective was an apnea-hypopnea index of under 10 and with a 50% reduction. Patient population had a baseline AHI of 19.0 and mean reduction of AHI with MAD treatment to 13.3 yielding a MAD efficacy rate of 31% when outcome objectives were applied. The average reduction in AHI was 24.8% with 9 of the 29 patients actually experiencing an increase in AHI with MAD treatment. When there was a reduction in AHI using the MAD device the AHI reduction rate was 49.1% and there was a tendency for better treatment outcome when apnea-hypopnea was predominantly supine. A mandibular advancement device serves as an important treatment modality in the care of patients with obstructive sleep apnea due to patient satisfaction and compliance. The broad range of treatment response to our MAD device highlights the importance of performing a sleep study exam after initiation of treatment with a MAD but also illustrates the complexity and need for individually tailored treatment for patients with obstructive sleep apnea.

Self-Collected versus Healthcare Worker-Collected Swabs in the Diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2.

The aim of this study was to compare the sensitivity of self-collected versus healthcare worker (HCW)-collected swabs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. Symptomatic individuals referred for SARS-CoV-2 testing were invited to provide mobile-phone video-instructed self-collected oropharyngeal and nasal samples followed by a HCW-collected oropharyngeal sample. All samples were sent for analysis to the same microbiology laboratory, and the number of SARS-CoV-2-positive participants in the two tests was compared. A total of 109 participants were included, and 19 participants had SARS-CoV-2-positive results. The diagnostic sensitivity of the self-collected and HCW-collected swabs was 84.2% and 89.5%, respectively, with an acceptable agreement, Cohens kappa 0.82, p < 0.001. Further, results from a questionnaire answered by the participants found that loss of smell as a self-reported symptom was a strong predictor for a SARS-CoV-2-positive test. In conclusion, we found that self-collected oropharyngeal and nasal swabs for SARS-CoV-2 testing can be reliable compared to HCW-collected oropharyngeal samples.