Due to the high prevalence of obstructive sleep apnea (OSA), it is recommended to use in‐laboratory polysomnography (PSG) or a home sleep apnea test (HSAT) in uncomplicated adult subjects at high ...risk of OSA. The aims of the present study were to compare a HSAT device, a wrist worn peripheral arterial tone signal device (WatchPAT™‐200 WP) with PSG and respiratory polygraphy (RP) in a low‐risk population of OSA. A total of 47 adult subjects at low risk of OSA were simultaneously examined with the three different approaches in a single night. The sleep studies were scored independently and in a blinded fashion, then the results and the parameters (Respiratory Disturbance Index, apnea–hypopnea index AHI and oxygen desaturation index of 3%) were compared with several statistical analyses. The agreement between the sleep tools and correlation for the assessed parameters were analysed and compared with Bland and Altman plots and Pearson’s coefficient (WP versus PSG, r = 0.86). For the severity of OSA ranked according to PSG, the Cohen’s k was 0.60 and 0.82 for WP and RP, respectively. Specificity was higher for RP compared to WP for identifying the presence of OSA (AHIPSG cut‐off ≥5 events/hr: 0.85 versus 0.73), while was quite similar in identifying patients who were more likely to be treated (AHIPSG cut‐off ≥15 events/hr: 0.94 versus 0.96). Assessing the costs and the simplicity of the examination, the results of our present study demonstrate the usefulness of WP compared to PSG, especially in screening and follow‐up for the ability to exclude subjects from treatment with continuous positive airway pressure (AHI <15 events/hr) in a population with a low pre‐test risk of moderate‐to‐severe OSA.
Background and objective
Nocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the ...therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A‐CPAP). The aim of the present study was to compare the titration effectiveness of two A‐CPAP devices using different flow‐based algorithms in patients with OSA.
Methods
This is a randomized study; 79 subjects underwent two consecutive unattended home A‐CPAP titration nights with two different devices (Autoset Resmed; Remstar Auto Respironics); during the third and the fourth night, patients underwent portable monitoring in the sleep laboratory during fixed CPAP at the A‐CPAP recommended pressure.
Results
Bland Altman plots showed good agreement between the recommended median and maximal pressure levels obtained with the two devices. A significant improvement was observed in all the sleep parameters by both A‐CPAP machines to a similar degree.
Conclusions
It was observed that the two A‐CPAP devices using different algorithms are equally effective in initial titration of CPAP.
The present study tested the effectiveness of two different A‐CPAP devices to titrate CPAP pressures in patients with OSA. This work demonstrated that two different A‐CPAP devices driven by different algorithms are equally effective in initial titration of CPAP.
Obstructive sleep apnea is a disorder characterized by recurrent obstruction of the upper airways during sleep. The high prevalence of this disease led to proposed new strategies based on the home ...evaluation and management of patients.
To compare home unattended portable monitoring and automatic CPAP titration with attended in-laboratory analysis, in a sample of patients with high risk for moderate to severe obstructive sleep apnea.
We enrolled 131 subjects, who were randomly divided into 2 groups: the home group (n = 66) was diagnosed and titrated at home; the laboratory group (n = 65) was analyzed in the sleep laboratory of our hospital. Diagnostic evaluations were carried out with portable monitoring at home, and with polysomnography in the sleep laboratory. Titration of CPAP was performed with the same automatic CPAP device in both groups.
At the end of the study, 13 (19%) subjects had dropped out of the home group, and 9 (14%) of the laboratory group (P = .50). There were no significant differences among groups in both baseline and with-CPAP values of apnea-hypopnea index, oxygen desaturation index, and total sleep time with SpO2 below 90%. In the home group, the therapeutic pressure values reached at the end of each unattended home titration night were similar.
A home diagnosis and titration approach should be considered in a subset of patients with obstructive sleep apnea. A single unattended titration night is sufficient to determine the therapeutic pressure.
French Romantic Ballets Letellier, Robert Ignatius; Letellier, Introduced by Robert Ignatius; Letellier, Introduced By Robert Ignatius
2012
eBook
This collection presents music from three of the most important scores of the Golden Age of ballet in Paris from 1830-1870. The Romantic ballet had been inaugurated by Meyerbeer''s opera Robert le ...Diable (21 November 1831) with its ghostly Ballet of the Nuns, risen from their graves and dancing in the moonlight, led by their spectral Abbess; a role created by Marie Taglioni (1804-1884) to her father''s choreography. La Sylphide (1832), inspired by this situation, was the first fully fledged Romantic ballet. Its graceful and atmospheric score was written by the first violinist at the Opéra, Jean Schneitzhoeffer. The story, devised by the great tenor Adolphe Nourrit, similarly introduces spirits and elemental beings, which dominated ballet scenarios for the following decades. Filippo Taglioni''s creation provided the fullest realization of the Romantic ideal, especially in the leading character of the story, and its perfect incarnation in the original interpreter, Marie Taglioni, whose stage personality seemed to be made for the part of the Sylphide. The ballet became the source of theatrically romantic fantasies centred around the hopeless and fatal love between a human being and a supernatural creature. It was performed in Paris until 1860, when the work was abandoned. Only in the late 20th century was Taglioni''s original version revived in a literal reconstruction by Pierre Lacotte at the Paris Opéra on 7 June 1972.Giselle is a central work in the ballet repertory all over the world. It is regarded as the absolute masterpiece of Romantic dance theatre; a wonderful synthesis of style, technique, and dramatic feeling, with an exceptional score. The ballet was devised in 1841 as a result of the collaboration of some of the major talents in literature, choreography and music in the Paris of the time. The author, critic and poet Théophile Gautier,
overwhelmed by the art of the ballerina Carlotta Grisi (1819-1899), discovered what he felt would be the perfect theme for her while reading a translation of Heinrich Heine''s book on German legend and folklore, D''Allemagne. Here he found the legend of the wilis--maidens who die before their wedding day and who come out of their graves at night in bridal dress to dance until dawn. Should any man be caught in the wood while the wilis are about their rituals, he is doomed to dance on and on until he drops dead from exhaustion. The choreography was created by Jean Coralli and Jules Perrot. The first act is on a realistic level, with an evocation of a medieval rusticity and emotional-sentimental intrigue, while the second act conjures up the supernatural, an ethereal world of magic symbolism. Both public and the critics greeted the work as a triumph. The score was praised for its "elegance, the freshness and clarity of the melodies, the vigour and novelty of the harmonic combinations, and the vivacity that pervades the musical texture from start to finish". The ballet has come down the years in a more-or-less unbroken tradition. Perrot emphasized his own special creative imprint in the productions he supervised in London (1842) and St Petersburg (1856). In Russia he collaborated with Marius Petipa who made his own reconstruction of the ballet in 1884. This version became the model for all later revivals in Russia, as well as for Mikhail Fokine''s production for the Ballet Russes in Paris (1910).Byron''s famous narrative poem The Corsair inspired several ballets, with Joseph Mazilier''s proving the most important (1856). Jules-Henri Vernoy de Saint-Georges''s scenario was of a superior quality. Mazilier was maître de ballet at the Paris Opéra between 1853 and 1859, the years of his fullest creativity. The solo parts were infused with an intense
dramatic expressiveness, and there was a splendid mise-en-scène. But the great success of the work was due primarily to the quality of the chief performers: the ballerina Carolina Rosati (1826-1905) and the mime Domenico Segarelli (1820-1860). The spectacular shipwreck finale was a sensational feat engineered by the chief mechanist of the Opéra, Victor Sacré, and his crowning glory. Adam''s score--consistently rich in melodic inspiration, engaging in the set dances, imaginative in the many extended mime sequences, and more richly symphonic than ever before in his work--reached a height of inspiration in this last music he ever wrote for the stage. Mazilier''s ballet gained a world-wide popularity, and became a favourite of the leading ballerinas for decades. Marius Petipa produced his own version in St Petersburg in 1868, with additional music by Cesare Pugni and Léo Delibes. In 1899 Petipa revived the ballet again, for the Maryinsky Theatre in St Petersburg, this time completely re-choreographing it for Pierina Legnani, with additional music by Riccardo Drigo. Performances in the USSR and contemporary Russia derive from this version. Drigo''s music for the spectacular pas de deux in act 2 is still performed all over the world as an independent piece.
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