Jenad, Hussam

Abstract Introduction In-laboratory polysomnography (PSG) is the gold standard diagnostic test for sleep-disordered breathing (SDB). WatchPAT® is a type of home sleep apnea testing (HSAT) that utilizes peripheral arterial tone (PAT) signals and other sensors to evaluate for SDB. There is an abundance of data to support the use of a PAT-based HSAT for obstructive sleep apnea (OSA), though data to support its use in central sleep apnea (CSA) in the general population undergoing PSG is lacking. We therefore aimed to compare the agreement of a PAT-based HSAT and PSG in detecting central disordered breathing events in the general population undergoing PSG. Methods A prospective cross-sectional study was conducted in eligible adult participants with suspected sleep apnea who were scheduled to undergo diagnostic or split-night PSG at the Center for Sleep Medicine at Mayo Clinic in Rochester, MN, between May 2021 and October 2022. The PAT-based HSAT was applied during the night of PSG to obtain simultaneous recording. Subjects were excluded if they had chronic atrial fibrillation, permanent pacemaker, or finger deformity precluding finger probe use or if they were on alpha- antagonists or short-acting nitrates. The PAT-based HSAT data were automatically scored with the use of proprietary software, and the PSG data were manually scored by registered polysomnography technologists. All studies were reviewed by board-certified sleep medicine providers. Results A total of 147 subjects (53% female) were included in the final analysis after excluding 18 subjects due to malfunction of the PAT-based HSAT. The subjects had a mean age of 58±15 yrs and BMI of 34±9 kg/m². 95 (65%) subjects underwent split-night studies. OSA was diagnosed in 81% with a mean PSG AHI of 28±27 events per hour. CSA was diagnosed in 3% of subjects with a mean PSG AHI of 33±27 events per hour. Of the total 2120 central disordered breathing events reported by the PAT-based HSAT (mean pAHIc 3±5 events per hour), 365 (17%) correlated with central apneas and 78 (3.7%) correlated with central hypopneas found on PSG. Conclusion In our prospective study, the PAT-based HSAT demonstrated low positive predictive value in detecting central disordered breathing events when compared to PSG. Support (if any)

Abstract Introduction: Blastomycosis is an uncommon; potentially life threatening granulomatous fungal infection. The aim of this study is to report hospital and intensive care unit (ICU) outcomes of patients admitted with blastomycosis. Methods: All patients admitted for treatment of blastomycosis at the Mayo Clinic-Rochester, Minnesota between 01/01/2006 and 09/30/2019 were included. Demographics, comorbidities, clinical presentation, ICU admission, and outcomes were reviewed.Results: A total of 84 Patients were identified with 93 unique hospitalizations primarily for blastomycosis. The median age at diagnosis was 49 (IQR 28.1-65, range: 6-85) years and 56 (66.7%) were male. The most frequent comorbidities incl­uded hypertension (n=28, 33.3%); immunosuppressed state (n=25, 29.8%) and diabetes mellitus (n=21, 25%). The lungs were the only organ involved in 56 (66.7%) cases and the infection was disseminated in 19 (22.6%) cases. A total of 29 patients (34.5%) underwent ICU admission due to complications of blastomycosis. ICU related events included mechanical ventilation (n=21, 25%), acute respiratory distress syndrome (ARDS) (n=13, 15.5%), tracheostomy (n=9, 10.7%), renal replacement therapy (n=8, 9.5%), and extracorporeal membrane oxygenation (ECMO) (n=4, 4.8%). A total of 12 patients (14.3%) died in the hospital; all of whom had undergone ICU admission. In-hospital mortality was associated with renal replacement therapy (RRT) (P=0.0255).Conclusions: Blastomycosis is a serious, potentially life-threatening infection that results in significant morbidity and mortality with a 34.5% ICU admission rate. Renal replacement therapy was associated with in-hospital mortality.