[Guideline for Long-Term Oxygen Therapy - S2k-Guideline Published by the German Respiratory Society]. / Leitlinie zur Langzeit-Sauerstofftherapie.

Long-term oxygen therapy is of great importance both for reducing mortality and for improving performance in patients with chronic lung diseases. The prerequisites for Long-term oxygen therapy are adequate diagnostics and clearly defined indication. A causal distinction into chronic hypoxaemic and hypercapnic respiratory failure is reasonable, from which the differential indication for non-invasive ventilation results.The revised guideline covers the diagnostics and indication of chronic lung and heart diseases, the role of oxygen in terminal illness and gives a detailed description of available oxygen devices. The guideline is intended to help avoid undersupply, oversupply and false prescriptions. Furthermore, the chapter "Postacute Oxygen Therapy" discusses the procedure, relevant in everyday life, but not yet clearly defined, for prescribing oxygen therapy for the home at the end of an inpatient stay. Another important point, the correct prescription of mobile oxygen systems, is also presented in the guideline. This document is a revised version of the guideline for longterm oxygen therapy and replaces the version of 2008.

[Digital respiratory sleep medicine-part I: diagnosis]. / Digitale respiratorische Schlafmedizin ­ Teil I: Diagnostik: Aktueller Stand, Perspektive, Vision.

Novel methods of eHealth already offer smart solutions for currently insufficiently addressed problems in the field of sleep-disordered breathing. Telemedical concepts, such as video consultation, help bring affected patients to sleep medical expertise at an early stage. Cloud-based diagnostics can help reduce existing inner- and intrasectoral problems and can improve interdisciplinary communication within established diagnostic pathways. New sensors and applications for digital devices (apps) open up opportunities for broad screening for the widespread disease of sleep apnea. However, in order to be able to use these methods clinically at all, they have to be certified as medical products. The Digital Supply Act (DVG) enables inclusion of health apps in the list of digital health applications (DiGA) after evaluation by the Federal Institute for Drugs and Medical Devices (BfArM). These "apps by prescription" are then reimbursable by the statutory health insurance. The vast amounts of collected data can only be analyzed for links and patterns using computer-based analysis methods. These findings are not intended to replace medical doctors, but rather to support them in their decision-making-in terms of real precision medicine including participation of the patient. The informed patient has to have data sovereignty at all times.

[Management of diagnostic procedures and treatment of sleep related breathing disorders in the context of the coronavirus pandemic]. / Diagnostik und Therapie schlafbezogener Atmungsstörungen im Zusammenhang mit der Corona­Pandemie: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP), Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM).

When providing sleep medical services special aspects must be taken into account in the context of the coronavirus pandemic. Despite all prevention, due to the high number of unrecognized cases, SARS-CoV2 contacts in the sleep laboratory must be expected and appropriate precautions are necessary. Nevertheless, the continuation or resumption of sleep medical services under the appropriate hygiene measures is strongly recommended to avoid medical and psychosocial complications. There is no evidence for a deterioration of COVID-19 through CPAP therapy. In principle, the application of positive pressure therapy via various mask systems can be accompanied by the formation of infectious aerosols. In the case of confirmed infection with SARS-CoV2, a pre-existing PAP therapy should be continued in an outpatient setting in accordance with the local guidelines for home isolation, since discontinuation of PAP therapy is associated with additional cardiopulmonary complications due to the untreated sleep-related breathing disorder. According to the current state of knowledge inhalation therapy, nasal high-flow (NHF), and PAP therapy can be carried out without increased risk of infection for health care workers (HCW) as long as appropriate personal protective equipment (eye protection, FFP2 or FFP-3 mask, gown) is being used.This position paper of the German Society for Pneumology and Respiratory Medicine (DGP) and the German Society for Sleep Medicine (DGSM) offers detailed recommendations for the implementation of sleep medicine diagnostics and therapy in the context of the coronavirus pandemic.

[Comorbidities of heart failure: sleep apnea]. / Schlafapnoe als Komorbidität bei Herzinsuffizienz.

BACKGROUND: Since sleep apnea often occurs in heart failure, physicians regularly need to decide whether further diagnostic procedures and/or treatment are required. OBJECTIVES: Which types of sleep apnea occur in heart failure patients? When is treatment needed? Which treatments and treatment goals are appropriate? MATERIALS AND METHODS: Clinical trials and guidelines as well as their implementation in clinical practice are discussed. RESULTS: At least 40% of patients with heart failure, both with reduced and preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively), suffer from relevant sleep apnea. In heart failure patients both obstructive and central sleep apnea are associated with increased mortality. In HFrEF as well as in HFpEF patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) achieves symptomatic and functional improvements. In patients with HFpEF, positive airway pressure treatment of central sleep apnea may be beneficial. In patients with HFrEF and left ventricular ejection fraction ≤45%, adaptive servoventilation is contraindicated. CONCLUSIONS: Sleep apnea is highly prevalent in heart failure patients and its treatment in specific patient groups can improve symptoms and functional outcomes. Thus, testing for sleep apnea is recommended.

[Cardiac effects of noninvasive ventilation]. / Kardiale Wirkungen der nicht-invasiven Beatmung.

Noninvasive ventilation is becoming increasingly important in the treatment of acute and chronic respiratory failure. However, noninvasive ventilation not only influences respiratory failure but also cardiac (dys-)function. Furthermore, cardiac comorbidities are often present in systemic diseases with respiratory failure such as COPD or obesity hypoventilation syndrome. This review covers the (patho-)physiological causes of hypoxic and hypercapnic respiratory insufficiency and its treatment with noninvasive ventilation. A special focus on acute and chronic effects on cardiac function will be addressed.

[Modern therapy of sleep apnea]. / Moderne Therapie der Schlafapnoe.

There are different treatment options for obstructive sleep apnea, which are selectively used based on severity of sleep apnea, physical structure of the upper airway, and other medical aspects including co-morbidities. Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended. Positional training, oral appliances and surgery of the upper airways are used in selected cases. CPAP is the most effective method for treating obstructive sleep apnea irrespective of disease severity. In patients with central sleep apnea or Cheyne-Stokes respiration (CSA/CSR) diagnosis and treatment of the underlying cause is mandatory. Adaptive servo-ventilation appears to be an effective treatment modality for patients with complex sleep apnea and with CSA/CSR that is resistant to CPAP.

[Diagnosis and therapy of acute pancreatitis]. / Diagnostik und Therapie der akuten Pankreatitis.

In acute pancreatitis the evaluation of severity is as important as the diagnosis. If there is evidence for severe pancreatitis, an immediate intensive care of all organ systems is needed, to avoid complications. Besides clinical signs, serum CRP is the most valuable parameter to define severity. According to present knowledge, a CT-scan is only needed in sepsis or multiorgan failure. Non-invasive ventilation should be started early in case of hypoxia. Up to now, no general benefit was detected for antibiotic prophylaxis or enteral nutrition. No consensus exists whether and when endoscopic interventions are superior to surgery in the treatment of infected necrosis.

Pulmonary hemodynamics in obstructive sleep apnea: frequency and causes of pulmonary hypertension.

The association between nocturnal apneas and transient pulmonary hypertension (PHT) has been well documented. However, there is controversy over the frequency and pathophysiological mechanisms of daytime pulmonary hypertension in patients with obstructive sleep apnea (OSAS). The present study sought to evaluate frequency and mechanisms of pulmonary hypertension in patients with OSAS. It included 49 consecutive patients with polysomnographically proven OSAS without pathological lung function testing. All patients performed daytime measurements of pulmonary hemodynamics at rest and during exercise (50-75W). Six patients (12%) had resting PHT mean pulmonary of artery pressure (PAPM) of >20 mmHg), whereas 39 patients (80%) showed PHT during exercise (PAPM >30 mmHg). Multiple regression analysis revealed 3 independent contributing factors for mean pulmonary artery pressure during exercise (PAPMmax): body mass index, age and total lung capacity % of predicted. Twenty-five of the 39 patients with pathologically high PAPMmax (64%) showed elevated pulmonary capillary wedge pressures (PCWPmax > 20 mmHg), whereas no patient had elevated pulmonary vascular resistance (PVRmax > 120 dynes x s x cm(-5)). In conclusion, daytime PHT during exercise is frequently seen in patients with OSAS and normal lung function testing and is mainly caused by abnormally high PCWP, whereas PVR seems to play a minor role.