BACKGROUND:Tuberculosis (TB) remains the leading infectious cause of death globally, disproportionately affecting people living with HIV and those with drug-resistant TB. In Portugal, TB incidence and notification rates exceed the European average, with diagnostic delays affecting underserved populations. RESEARCH QUESTION:This study investigated factors contributing to total diagnostic delay among people with TB in Portugal, particularly underserved groups, and identified strategies to reduce these delays. STUDY DESIGN AND METHODS:A convergent-parallel mixed-methods approach was used. Quantitative data came from 55 surveys, and qualitative data through 27 semi-structured interviews and two focus group discussions. Descriptive statistics and thematic analysis identified patterns of total diagnostic delay, contributing factors, and potential interventions. RESULTS:Median total diagnostic delay was 45 days (IQR 21-60 days). In exploratory comparisons, underserved groups reported longer total diagnostic delay than the general population. Key person-related barriers included symptom normalisation, financial and logistical constraints, stigma, and fragmented referral pathways. System-level obstacles such as complex paperwork, limited clinic hours, staff indifference, and language barriers compounded delays. Proposed solutions included clear and non-judgemental communication, mobile screening units, integrated electronic records, anti-stigma campaigns, and social support teams for healthcare navigation. CONCLUSION:Diagnostic delays remain a major challenge in TB control in Portugal, especially among underserved populations. Reducing these delays requires multi-level interventions, including enhanced primary care awareness, stigma reduction, compensation for indirect costs, and simpler administrative procedures. Addressing these barriers is essential to reduce preventable morbidity, limit ongoing transmission, and tackle health inequities, while supporting progress towards national and global TB targets.
BACKGROUND:Excessive sleepiness while driving is a public safety concern. The Bordeaux Sleepiness Scale (BOSS) is a brief patient-reported measure designed to assess driving-related sleepiness. However, a Portuguese version is not currently available. OBJECTIVE:To cross-culturally adapt the BOSS and evaluate its internal consistency and construct validity in a Portuguese population, in accordance with COSMIN recommendations. STUDY DESIGN AND METHODS:We conducted a cross-sectional observational study of adults attending a Sleep Disorders Clinic. The BOSS was translated into Portuguese following a standardised cross-cultural adaptation process. Participants completed the Portuguese BOSS, the Epworth Sleepiness Scale (ESS) and two questions assessing driving-related sleepiness. Internal consistency was evaluated using Cronbach's alpha. Construct validity was assessed through Spearman correlations with the ESS (convergent validity) and by comparing scores between participants with and without a history of sleepiness-related accidents or near-misses (criterion-related validity). ROC curve analysis further assessed criterion validity. RESULTS:A total of 234 patients were included; 94.4% had obstructive sleep apnoea and 9.4% reported sleepiness-related accidents or near-misses in the previous year. The BOSS demonstrated moderate internal consistency (α = 0.683) and acceptable accuracy in identifying patients with sleepiness-related events (AUC = 0.895), compared with the ESS (AUC = 0.842). Both scales showed significantly higher scores in participants with sleepiness-related accidents or near-misses than in those without (p < 0.001). A moderate correlation with ESS (ρ = 0.551, p < 0.001) was observed. CONCLUSION:The Portuguese BOSS shows moderate internal consistency and evidence of construct validity. These findings provide preliminary support for its use in identifying driving-related sleepiness in patients with sleep disorders.
BACKGROUND:In the general population, supernormal lung function is associated with a lower risk of all-cause mortality. RESEARCH QUESTION:It remains unclear whether sleep-disordered breathing (SDB) affects this relationship. METHODS:This cohort analysis included 4,839 adults. Lung function was categorised as supernormal (FEV1 > ULN), normal (LLN ≤ FEV1 ≤ ULN), and below normal (FEV1 < LLN). SDB severity was classified using apnoea-hypopnoea index categories: no SDB (<5 events/hour), mild SDB (5-<15 events/hour), moderate SDB (15-<30 events/hour), and severe SDB (≥30 events/hour). The association between lung function and all-cause mortality was assessed using Cox proportional hazards models with subgroup analyses according to SDB severity and formal testing for interaction. Analyses were repeated using FVC-defined lung function groups as an alternative definition of supernormal lung function. RESULTS:Among the included participants, 4,068 (84.1%) had normal lung function, 369 (7.6%) had supernormal lung function, and 402 (8.3%) had below normal lung function. During 52 421.5 person-years of follow-up (median 11.72 years; IQR, 10.46-12.56), 1,188 deaths occurred. Compared with the normal lung function group, the supernormal lung function group had a lower prevalence of baseline hypertension and cardiovascular disease. The association between lung function and all-cause mortality varied across SDB severity strata (P for interaction = 0.034). A lower mortality risk associated with supernormal lung function was observed in participants without SDB (HR: 0.24, 95% CI: 0.06-0.97), whereas this association was not statistically significant in the mild, moderate, or severe SDB strata. Below normal lung function was generally associated with an increased all-cause mortality risk. Sensitivity analyses using FVC-defined lung function groups yielded broadly consistent findings. CONCLUSION:Supernormal lung function was associated with lower all-cause mortality primarily among individuals without SDB. These findings underscore the importance of considering SDB severity when assessing the health implications of lung function.
BACKGROUND:Cone-beam CT-guided navigation bronchoscopy (CBCT-NB) is a minimally invasive technique for diagnosing pulmonary nodules combining endoscopic navigation with real-time 3D imaging. The procedure requires advanced bronchoscopic skills and interpretation of multiple imaging modalities. Despite evidence that simulation-based education enhances procedural safety and performance, no standardised training programmes for CBCT-NB have yet been established. This study describes the development and evaluation of a structured training programme for pulmonologists new to CBCT-NB. METHODS:A multidisciplinary expert panel developed a stepwise CBCT-NB training programme comprising online theoretical e-learning, live case observation at an expert centre, a structured one-day hands-on simulation session, and on-site supervision during the initial clinical procedures. Pulmonologists from Dutch hospitals preparing to implement CBCT-NB were enrolled. Participants' expectations, perceived learning needs, and post-training experiences were explored through semi-structured interviews and analysed using thematic analysis. RESULTS:Nine pulmonologists from five hospitals participated. Participants expressed a strong need for structured, practical instructions, particularly regarding procedural workflow, multimodal image interpretation, equipment handling, and use of augmented fluoroscopy software. Following completion of the programme, all reported increased self-confidence and improved perceived competency. Hands-on simulation was consistently identified as a key component for developing technical and cognitive skills and was considered essential preparation before independent clinical practice. CONCLUSION:The structured multimodal CBCT-NB training programme facilitates confidence and addresses learner-identified competency needs among novice navigation bronchoscopists. The findings offer practical guidance for the structured implementation and training of novel medical technological interventions. Future research should evaluate long-term skill retention, objective competency outcomes, and clinical effectiveness.
BACKGROUND:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with pulmonary hypertension (PH) worsen outcomes, yet reliable prognostic biomarkers remain lacking. RESEARCH QUESTION:We aimed to determine the prognostic value of serum high-mobility group Box 1 (HMGB1) in individuals experiencing AECOPD with concurrent PH and to examine its relationship with inflammatory and vascular markers. STUDY DESIGN AND METHODS:Total 127 patients were divided into AECOPD-non-PH group (n = 71) and AECOPD-PH group (n = 56). Serum levels of HMGB1, interleukin-6 (IL-6), endothelin-1, tumour necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) were measured. Predictive performance was evaluated using receiver operating characteristic and multiple logistic regression analyses. RESULTS:The AECOPD-PH group had significantly higher serum HMGB1, endothelin-1 and PaCO2 than the AECOPD-non-PH group. The combination of HMGB1, endothelin-1 and PaCO2 demonstrated superior diagnostic accuracy for PH, with an area under the curve of 0.751. HMGB1 levels correlated positively with IL-6 (ρ=0.295, p = 0.001) and TNF-α (ρ=0.302, p = 0.001), but negatively with VEGF (ρ=-0.232, p = 0.009). In risk stratification, HMGB1 ≥ 38.24 ng/mL predicted intermediate-high risk PH with 69.2% sensitivity, 64.7% specificity and an area under the curve of 0.700. CONCLUSION:Serum HMGB1 was moderately associated with PH in patients with AECOPD, demonstrating its utility in risk assessment. However, these findings are specific to the acute exacerbation setting and should not be extrapolated to stable-phase COPD-associated PH; further studies in stable COPD populations are warranted.
This study aimed to identify the key concepts involved in designing epidemiological surveys to estimate the prevalence of second-hand tobacco smoke (SHS) exposure in Portugal and Brazil. A two-round Delphi study was conducted. Firstly, a group of experts was asked for their opinions on the relevance of various concepts (exposure scenarios, recall, time, environmental context, exposure intensity, and relationship to smoking) and domains. Based on their responses, a new questionnaire was developed. The experts ranked the importance of different questions. A thematic analysis was carried out. The experts considered it important to evaluate SHS exposure in general, as well as in specific settings, such as the home, workplace, public and private transport (with or without children), and leisure settings. They reported that recalling the number of hours of exposure spent indoors and outdoors on working and non-working days, and in the last month, provided a more detailed assessment. They also stated that exposure intensity should be assessed either by the presence and number of smokers or by the perception of a smoke-heavy environment. Differences in responses according to the country in which experts reside were minimal. The researchers provided clear, precise, and consistent recommendations for collecting comparable data across studies to enact smoke-free policies. This reinforces the feasibility of using standardised questionnaires to evaluate SHS exposure across countries.
BACKGROUND:Respiratory symptoms such as cough and shortness of breath are prevalent among patients with pneumoconiosis. These symptoms reduce their engagement in daily activities and induce psychological distress. RESEARCH QUESTION:Did a 6-week acceptance-based healthy lifestyle programme reduce psychological inflexibility (primary outcome) and enhance the health outcomes among community-dwelling patients with pneumoconiosis? STUDY DESIGN AND METHODS:A two-arm, prospective, multicenter, waitlist pilot randomised controlled trial was conducted. Patients with pneumoconiosis were randomly assigned to either an intervention group or waitlist group at a 1:1 ratio, with intervention group receiving the programme first. The intervention consisted of four biweekly interactive sessions on integrating acceptance-based components into pneumoconiosis management. Psychological inflexibility and health outcomes were assessed at baseline, Week 6, and Week 14 by trained research assistants. A generalized estimating equations model was used to examine the effects of the intervention effect between groups. RESULTS:Eighty patients were recruited and randomly assigned to the two groups. Compared to the waitlist group, the participants in the intervention group showed significant reduction in psychological inflexibility (β = -5.83, p = 0.002) and improvement in exercise self-efficacy (β = 11.68, p = 0.007) at Week 6, and reduction in body weight (β = -1.09, p < 0.001) at Week 14. No significant differences were observed for other outcomes. Moderate effect size was noted on the outcomes of psychological inflexibility and exercise self-efficacy at Week 6. CONCLUSION:The integration of acceptance-based components into pneumoconiosis management may reduce psychological inflexibility and promote engagement in exercise.
INTRODUCTION:Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder caused by defective ciliary structure and function, leading to chronic respiratory and systemic manifestations. Diagnostic pathways have evolved over time, but no single standalone test exists. METHODS:Retrospective study of PCD patients followed at a Portuguese tertiary hospital, between 2001-2024. RESULTS:Thirty-five patients with a confirmed diagnosis were included: 13 children and 22 adults. Median age at diagnosis was 7 years (0-16) in children and 38.5 years (12-64) in adults. Time to diagnosis decreased over the years, coinciding with a shift in the hierarchy of methods from high-speed video microscopy and transmission electron microscopy to genetic testing. The most frequent mutations were DNAH5 (31.3%) and DNAH11 (12.5%). Pulmonary function tended to be better in children (p = 0.085), whereas bronchiectasis were more extensive and bilateral in adults (p = 0.044 and p = 0.002, respectively). Children more frequently received treatment with hypertonic saline (p = 0.003) and adults with bronchodilators (p = 0.035). Pseudomonas aeruginosa was only identified in adults; inhaled antibiotics were only prescribed in this age group (18.2%). CONCLUSION:This represents the largest Portuguese cohort to date and provides relevant clinical and diagnostic insight into age-related differences, supporting the importance of early detection and intervention to limit lung damage.
BACKGROUND:Evidence for hypertonic saline (HS) in nontuberculous mycobacterial lung disease (NTM-LD) remains limited, particularly during watchful waiting when non-antibiotic strategies are needed. We evaluated inhaled 3% HS as a potential adjunct in antibiotic-naïve NTM-LD. METHODS:In this prospective cohort study, antibiotic-naïve NTM-LD patients were enrolled between September 2024 and December 2025. Patients receiving daily inhaled 3% HS were compared with contemporaneous controls. Symptom burden (visual analog scale, 0-60) and sputum smear status at month 3 were analysed using generalised estimating equations. In vitro experiments assessed HS effects on Mycobacterium abscessus growth and macrophage function, including intracellular bacterial burden, viability, phagocytosis, and pro-inflammatory gene expression. RESULTS:Among 45 patients (HS: n = 22; control: n = 23), 3% HS was associated with a significant reduction in symptom burden from baseline (coefficient -4.40, 95% CI -6.43 to -2.37; p < 0.001) and a lower odds of sputum smear positivity at month 3 (odds ratio 0.15, 95% CI 0.03-0.64; p = 0.011) in adjusted analyses. In vitro, HS inhibited extracellular M. abscessus growth in a concentration-dependent manner. Pretreatment of macrophages with 3% HS reduced intracellular M. abscessus burden by 51% (p = 0.021) without impairing viability or phagocytosis, while upregulating pro-inflammatory gene expression, including TNF-α (p = 0.004), IL-6 (p = 0.030), and IL-1β (p = 0.058). CONCLUSIONS:In antibiotic-naïve NTM-LD, inhaled 3% HS was associated with improved symptom burden and reduced progression to sputum smear positivity. Complementary in vitro findings support both direct antimycobacterial effects and enhanced macrophage-mediated control, supporting HS as a biologically active adjunct during conservative management of NTM-LD.
BACKGROUND:Tuberculosis infection (TBI) diagnosis in BCG-vaccinated, high-burden settings remains challenging. RESEARCH QUESTION:We aimed to assess the sensitivity, specificity, and safety of the C-tuberculin skin test (C-TST), compared with PPD RT-23, for tuberculosis infection in BCG-vaccinated adults. STUDY DESIGN AND METHODS:Randomised, double-blind clinical trial in Brazil. Adults with pulmonary tuberculosis (PTB) and asymptomatic controls without known TB exposure or prior TB/TPT underwent C-TST, PPD RT-23, and QuantiFERON-TB Gold Plus (QFT-Plus). Skin tests were read by two strategies: (a) induration only or (b) induration or erythema, at a ≥5-mm cut-off. Sensitivity was assessed in PTB; specificity for C-TST and PPD RT-23 was estimated against QFT-Plus. Adverse events were monitored. RESULTS:Among 446 participants (141 PTB; 305 controls), at the 5-mm cut-off, C-TST showed lower sensitivity but higher specificity than PPD RT-23. With strategy (a) and (b), C-TST sensitivity was 0.67 and 0.68, specificity was 0.92 and 0.9, compared to 0.74 sensitivity and 0.78 specificity for PPD RT-23. Adverse events were more frequent in PTB: 12.1% (C-TST) and 6.4% (PPD RT-23); none were serious. CONCLUSION:In BCG‑vaccinated adults, C-TST showed a trade-off of higher specificity and lower sensitivity than PPD RT-23 at the 5-mm cut-off; and a favourable safety profile. Adding erythema to readings did not improve accuracy, suggesting that C-TST may be a useful alternative for programmatic TBI screening in high-burden settings. TRIAL REGISTRATION:Trial registry number RBR-7tn2ysw (https://ensaiosclinicos.gov.br/ registered on 25 January 2021).
BACKGROUND AND OBJECTIVES:Severe eosinophilic asthma (SEA) is often inadequately controlled. The BETREAT study evaluated the real-world effectiveness of benralizumab, an anti-IL-5 receptor monoclonal antibody, in Portugal, focusing on treatment persistence, asthma control, exacerbation rates, and quality of life (QoL). STUDY DESIGN AND METHODS:Retrospective, observational study including SEA adults who received benralizumab between July 2019 and October 2020 across 16 sites in Portugal. Data from electronic medical records were analysed over 24 months, with evaluations at 3, 6, 12, and 24 months after treatment initiation. Key outcomes included exacerbation rates, oral corticosteroid use, asthma and lung function, and QoL. RESULTS:Of the 74 patients (mean ± SD age 56 ± 11 years and 73.0% female), 66.2% were biologic-naïve. After initiating benralizumab, median eosinophil counts decreased to 0 cells/µL after 3 months. Exacerbation rates decreased from a mean annual rate of 3.12 at baseline to 0.48 by 24 months. Patient-reported asthma control and QoL improved, with ACT and CARAT scores reaching well-controlled levels in most patients by 24 months. Notably, 20.0% of patients achieved clinical remission by the end of the study. CONCLUSIONS:Benralizumab significantly improved SEA outcomes and contributed to clinical remission over a 24-month period, demonstrating potential for long-term disease control and QoL improvement.
BACKGROUND:Cognitive impairment is a relatively prevalent comorbidity in chronic obstructive pulmonary disease (COPD), yet its neuropathological mechanism remains poorly understood. METHODS:We enrolled 48 stable COPD patients, categorized into cognitively normal (CogN, n = 22) and impaired (Cog, n = 26) groups based on Montreal Cognitive Assessment (MoCA) scores, along with 34 matched healthy controls. All participants underwent 3T MRI with quantitative susceptibility mapping (QSM) to quantify regional brain iron content. Group comparisons of whole-brain and region-of-interest susceptibility were performed. Mediation analysis was then used to test whether specific brain iron deposition mediates the relationship of both COPD status and peripheral inflammatory markers with cognitive performance. RESULTS:Cog patients showed increased total iron in the right cerebellum crus I, while CogN patients exhibited higher paramagnetic susceptibility (χpara) in the left orbitofrontal cortex (OFC), right precentral gyrus, and right brainstem. χpara in the left OFC and right brainstem were positively correlated with total MoCA, abstraction, and orientation scores. Mediation analysis demonstrated that χpara of the left OFC mediated the effects of both COPD status and systemic neutrophil counts on impaired abstraction. Additionally, right brainstem χpara mediated the relationship between COPD and deficits in orientation. CONCLUSIONS:COPD patients with cognitive impairment exhibited distinct patterns of brain iron deposition. Importantly, deposition in several key regions served as a potential mediator, linking both COPD and systemic inflammation to specific cognitive deficits. These preliminary findings suggest a possible association between brain iron accumulation and cognitive impairment in COPD, offering candidate neuroimaging markers for early identification. .
BACKGROUND:For patients with acute pulmonary embolism (PE), assessment of prognosis helps with risk stratification, triage for level of care, management strategy, and communication among healthcare workers and patients. We sought to identify prognostic models and individual factors associated with short-term outcomes after acute symptomatic PE. METHODS:We performed a systematic review of prognostic factors for PE, searching MEDLINE, Embase, and Web of Science for records up to 1 June 2024. Studies of any design evaluating potential prognostic models or individual variables (not contained in the models) associated with short-term mortality after acute PE were included. RESULTS:We identified 314 studies that included 2,495,115 patients. Of these, 225 studies included 2,267,952 patients and evaluated 24 prognostic models for patients with acute PE. The most frequently used validated models were the simplified Pulmonary Embolism Severity Index (sPESI) (127 studies), the original PESI (79 studies), and the European Society of Cardiology risk schema (34 studies). Each model-development study had a c-index ≥ 0.7. Individual factors associated with prognosis included older age, presence of coexisting conditions, abnormal clinical signs and symptoms, clot burden, markers of right‑ventricle dilatation/dysfunction and myocardial injury, altered laboratory results indicating impaired haemodynamics, and tests that assess for systemic inflammation. Pooled odds ratios for variables not contained in any eligible prognostic model ranged from 1.43 (for D-dimer) to 2.65 (for right heart thrombi). CONCLUSIONS:This systematic review identified 24 prognostic models and 18 individual variables distinct from the prognostic models associated with short-term mortality after acute PE.
BACKGROUND:High-flow nasal cannula (HFNC) is standard therapy for acute hypoxaemic respiratory failure and is increasingly used in hypercapnic COPD. Comparative data between the asymmetrical and conventional HFNC interfaces regarding respiratory muscle work of breathing is limited. This study aimed to compare the effects of both HFNC interfaces on diaphragm and parasternal intercostal thickening fraction (TFdi and TFpi), and other physiological variables. METHODS:This randomised crossover study enrolled two cohorts: 20 subjects with acute hypoxaemic respiratory failure and 18 subjects with COPD exacerbation. At baseline, subjects received low-flow oxygen cannula for 15 min then underwent randomised 15 min-sequences of asymmetrical and symmetrical HFNC at flow rates of 40 and 60 L/min, with 5-min washouts. Primary outcome was change in TFdi. Secondary outcomes were TFpi, power of breathing (TFdi × respiratory rate), and other physiological variables. RESULTS:TFdi, TFpi, power of breathing, and PtcCO2 were significantly lower than baseline with both HFNC interfaces at 40 and 60 L/min in both groups (p < 0.05). In acute hypoxaemic respiratory failure, compared to symmetrical HFNC, asymmetrical HFNC was associated with greater reduction in respiratory rate (p < 0.001) and power of breathing (p < 0.001) at both flow rates. In COPD exacerbation, compared to symmetrical HFNC, asymmetrical HFNC reduced respiratory rate at both flow rates (p < 0.001). CONCLUSIONS:Both HFNC interfaces reduced respiratory muscle workload compared to baseline in both cohorts. In acute hypoxaemic respiratory failure, asymmetrical HFNC reduced respiratory rate and power of breathing more than symmetrical HFNC. In COPD exacerbation, the asymmetrical HFNC lowered respiratory rate more than the symmetrical HFNC. CLINICAL TRIAL REGISTRATION:This study was registered with ClinicalTrial.gov (registration number: NCT06204276) before enrolment and approved by the Siriraj Institutional Review Board (certificate of approval - Si873/2023).
BACKGROUND:Although smoking is a well-established risk factor for idiopathic pulmonary fibrosis (IPF) development, its impact on clinical outcomes remains unclear. RESEARCH QUESTION:Is smoking associated with clinical outcomes of IPF? METHODS:A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies reporting associations between smoking status and IPF outcomes, including mortality, acute exacerbation (AE), lung cancer development, and baseline lung function. Summary estimates with 95% confidence intervals (CIs) were pooled using random-effects model. Subgroup analyses were conducted by study region. RESULTS:Forty-nine studies comprising 32 974 patients were included. Overall mortality did not differ by smoking status. However, significant regional differences were observed, with ever smokers demonstrating higher mortality in non - East Asian studies (Hazard ratio [HR] 1.17, 95% CI: 1.03-1.33) but lower mortality in East Asian studies (HR 0.75, 95% CI: 0.62-0.91, p-for-interaction < 0.001) compared with never smokers. Current smokers had a higher risk of developing lung cancer compared with non-current smokers (HR 1.88, 95% CI: 1.24-2.87). No significant associations were observed between smoking and the risk of AEs or baseline forced vital capacity. CONCLUSION:Smoking was not associated with overall mortality in IPF, although significant regional differences were observed.
Objectives Evidence supporting an occupational hypothesis for sarcoidosis remains limited. The hypothesis of the present study was that some occupational exposures might be more prevalent among sarcoidosis patients than in the French population.Methods A cross-sectional observational study design was used to collect occupational data from patients enrolled in the Epidemiology ofSarcoidosis (EpiSarc) cohort study with documented sarcoidosis. The data were initiallyclassified according to the occupational classification of the French National Institute ofStatistics and Economic Studies and then compared to employment data fromthe French population for the reference year 2016.Results Among the 1,512 sarcoidosis patients included, occupational data were avail- able for 1,177 patients (78%). Of these, 1,086 (92%) were employed at time of sarcoidosis diagnosis. Notably, manual workers were significantly overrepresented compared to the general French population (40% versus 20%, p < 0.0001). Among the 471 manual workers, the distribution of occupations was as follows: construction workers (n = 165, 35%), domestic helpers and cleaners (n = 109, 23%), transportation and handling workers (n = 82, 17.5%), manufacturing labourers and industrial operators (n = 67, 14%), textile indus- try workers (n = 25, 5.5%), and other occupations (n = 23, 5%). The frequency of patients with manual working occupations varied depending on the organ involvement, being the highest in patients with lung involvement.Conclusion We found that manual workers occupations with exposure to various environmental hazards that may trigger inflammation promoting an abnormal granulomatous immune response, including dust, were associated with sarcoidosis.
BACKGROUND:Remimazolam is a novel benzodiazepine increasingly used for procedural sedation and general anaesthesia. Its role in clinical use in flexible bronchoscopy remains under investigation. AIM:To evaluate the efficacy and safety of remimazolam in adults undergoing flexible bronchoscopy. METHODS:This meta-analysis followed PRISMA and Cochrane guidelines. A systematic search of PubMed, Scopus, and the Cochrane Library identified randomised controlled trials (RCT)comparing remimazolam with other sedatives. RESULTS:Fifteen RCTs including 2,243 patients were analysed. Procedural success was higher with remimazolam compared with overall sedatives (RR = 1.10; 95% CI: 1.02-1.19; p = 0.02). Remimazolam significantly reduced the risk of respiratory depression (risk ratio [RR] = 0.42; 95% CI: 0.25-0.69; p = 0.0007), hypoxaemia (RR 0.61, 95% CI 0.39-0.95; p = 0.03), hypotension (RR = 0.52; 95% CI: 0.35-0.77; p = 0.001), and bradycardia (RR = 0.38; 95% CI: 0.21-0.69; p = 0.002). Compared with midazolam, remimazolam had a faster onset, though not statistically significant. Compared with dexmedetomidine, it showed significantly faster onset (MD = -2.16 min, 95% CI: -2.65 to -1.67; p < 0.00001) and shorter recovery (MD =-1.84 min; 95% CI: -3.31 to -0.37; p = 0.01). Compared with propofol, it had lower rates of hypotension, hypoxaemia, and injection pain. CONCLUSION:Remimazolam is a safe and effective alternative for bronchoscopy sedation, offering improved cardiopulmonary safety and favourable procedural characteristics.
Background Traditional sleep metrics from polysomnography are often limited by the hypnogram, in which each 30-s epoch is classified into one of the five sleep stages. This oversimplifies sleep stage continuity and fragmented sleep, typical in sleep-disordered breathing (SDB). Deep learning offers more dynamic sleep modelling with a higher temporal resolution by providing probabilities for each sleep stage, known as hypnodensities.Research question and methods We investigated whether high-frequency (1/s) hypnodensities captured from nocturnal fingertip photoplethysmography (PPG) recordings better correlate with patient-reported outcomes in SDB than traditional metrics.Results Among 2,280 patients (65% male, mean age 62 years, mean apnoea-hypopnoea index (AHI) 23.5/h), we found that several PPG-derived hypnodensity metrics correlate with self-reported daytime fatigue and sleepiness. The level of correlation was better or similar compared to traditional hypnogram-based sleep metrics derived from manually scored polysomnography. Specifically, PPG-based hypnodensities for N1 and N3 sleep showed a stronger association (p < 0.005) with fatigue and sleepiness than manually scored N1 and N3 sleep. Multivariable logistic regression (adjusted for age, sex, body mass index, AHI, and total sleep time below 90% blood oxygen saturation) revealed significant associations (p < 0.01) between multiple PPG-based hypnodensity metrics and daytime sleepiness.Conclusion These findings suggest that PPG-based hypnodensities improve the characterisation of sleep quality and better predict patient-reported outcomes in SDB patients. Future uses may include tracking sleep quality with fingertip pulse oximeters outside of sleep centres, potentially over multiple nights due to their simplicity.
