ContextPhysiological growth hormone is secreted during slow-wave sleep. Traditionally, growth hormone (GH) therapy is given in daily GH injections before sleep. While morning and evening GH injections produce comparable effects on growth and IGF-1 levels, the evening schedule better imitates the physiological diurnal pattern of GH secretion and action. However, the inflexibility of bedtime injection schedules, coupled with the discomfort and psychological distress associated with the injection and local reaction, may cause sleep disturbances in patients, and may significantly burden them and their families.ObjectiveOur objective was to evaluate evening vs. morning daily GH injections with respect to sleep-wake pattern, duration, and activity index in children treated with growth hormone.DesignAn open-label, randomized crossover trial of 20 children (11 boys) 5–14 years of age with isolated growth hormone deficiency (n=12) and idiopathic short stature (n=8) treated with daily injections of median GH dose 33 (range13-46) mcg/kg/d was performed. Each subject received 2 weeks of evening injections and 2 weeks of morning injections. Patients' sleep-wake patterns and activity index were assessed by a 7-day actigraph covering the second week of each treatment schedule.ResultsAll subjects slept well, within recommended ranges for sleep parameters, regardless of whether they were receiving morning or evening GH injections. Results were comparable for all measures: total time in bed (min), 526.0 ± 51.8 vs 516.9 ± 57.4 for evening and morning GH injections, respectively; total sleep time (min), 512.4 ± 51.1 vs 504.3 ± 57.7; sleep efficiency (%), 93.6 ± 2.6 vs 94.2 ± 2.3; sleep onset latency (min), 8.9 ± 8.1 vs 7.4 ± 6.8; number of arousals per night, 14.5 ± 5.4 vs 12.5 ± 5.2; and 24-hour activity index, 68.3 ± 4.0 vs 67.0 ± 5.0, respectively. No difference was found between the growth hormone deficient and idiopathic short stature group. No difference was found between boys and girls.ConclusionsSleep-wake patterns and activity index were not affected by treatment schedules. We recommend that growth hormone injections take place at any regular time according to the family's convenience.

Background:Sleep disorders are common in childhood and are recognized as a significant public health concern, particularly due to their association with childhood obesity. However, their impact on growth disturbances has been only minimally explored. In the present study, we investigate the association between sleep disorders and linear growth and excess weight in children. Study Design:Data were collected retrospectively (January 2012-December 2022) from computerized medical records of 3,210 patients (newborn-18 years) diagnosed with sleep disorders who underwent sleep analysis at the Sleep Clinic of Carmel Medical Center. A control group (n =12,840), matched for age and ethnic background, was selected from the same healthcare database. Additionally, subgroup analyses were performed by sex and across three age groups. Results:A higher rate of short stature, defined as height at or below the 3rd percentile, was observed in the study group compared to controls (8.66% vs. 6.25%, p < 0.001). This difference was primarily seen in the 0-6 years age group (girls: OR 1.49, p = 0.003; boys: OR 1.57, p < 0.001). The diagnosis of short stature and growth hormone deficiency was documented in 10.1% and 2.1% of the study group, respectively, compared to 7.5% and 1.15% in the control group (p < 0.001 for both). Rates of overweight and obesity were higher among children in the study group compared to controls (overweight: 25.9% vs. 22.2%; obesity: 14.6% vs. 10.4%; p < 0.001). This difference was primarily observed in children aged 6-18 years, with the strongest effects seen in adolescent boys. Notably, children with obstructive sleep apnea had a significantly higher prevalence of short stature compared to those with other sleep disorders (13.4% vs. 7.7%; p < 0.001).Conclusions: Our findings of a higher prevalence of growth disturbances and excess weight among children with sleep disorders highlight the importance of early recognition and timely intervention for pediatric sleep disorders. Such measures may improve sleep quality and daily functioning and potentially benefit growth and weight outcomes.

Objectives: "WKUP GT", a low caffeine beverage consisting of carob, Guarana, Green Tea and Elderberry extracts was studied on attention and cognitive functions post-lunch in a pilot randomized double blind placebo controlled trial. Methods: Thirty healthy volunteers were included in a crossover design trial, presenting five beverages randomly assigned to the following groups: placebo, "WKUP GT" (single, double or triple doses), or "caffeine" as an active control. Hemodynamic measurements were assessed as safety outcomes. The Cambridge Neuropsychological Test Automated Battery (CANTAB), was used to evaluate the patients when beverages were consumed 30 and 120 min after lunch (respectively Delta30 and Delta120 considering baseline). Results: Drinking "caffeine" or "WKUP GT" after lunch, showed significant improvement (p < 0.05) in rapid visual information processing compared to placebo (Delta120 of "caffeine", "WKUP" single and double). In addition, improvement in Multitasking Test (Delta30 for "WKUP" double, and Delta120 for "caffeine" and "WKUP" triple compared to placebo) was observed. "WKUP" triple also showed significant improvement for "memory" when compared to placebo (Delta120). Compared to "caffeine", WKUP GT did not increase systolic blood pressure. Conclusion: "WKUP GT" showed improvements for attention, memory, psychomotor and executive function tasks after lunch without increase in pulse rate.

This study aimed to investigate differences in pediatric healthcare utilization in Israel over 10 years by examining differences across populations defined by living environment and ethnicity. Data was obtained from the Clalit Health Care data warehouse, covering over 250,000 children residing in Haifa and Western Galilee districts. The population groups were categorized based on ethnicity (Jewish vs Arab) and residential settings (urban vs rural). Healthcare utilization was consistently higher among Jewish than Arab children, irrespective of the specific dimension analyzed. Additionally, urban-dwelling children exhibited higher usage rates than those residing in rural areas in all investigated dimensions. However, Jewish children showed significantly about 18

Intervention by medical clowns was proven to have a positive effect in reducing stress and anxiety, increasing cooperation and improving the child's experience prior to a medical procedure and during the various stages of hospitalization. Sleep has long been known to be essential for recovery from injury and sickness, improving immune functions, and there is an emerging understanding of the restorative role quality sleep has on health and diseases. Hospitalized children are more exposed to sleep disorders and sleep deprivation due to the hospitalized environment, anxiety, and illness. Different behavioral interventions to promote sleep were previously studied in hospitalized children, some showing potential benefits. In this study, we sought to examine the ability of medical clowns to positively impact the child's sleep during hospitalization. The study is an observational matching (case–control) interventional study which took place at the department of pediatrics in Carmel Medical Center. Forty-two hospitalized children ages 2–17 were included in two equal groups of intervention or control. Children in the control group were recruited based on a method of matching the chief complaint plus the medical diagnosis and age of the children in the intervention group in a 1:1 matching. The children's sleep parameters were objectively evaluated for two consecutive nights using an Actigraph device and subjectively by parent's questionnaire. Additional factors such as hospital length of stay and demographics were also monitored. The study group had an encounter with a medical clown (15–30 min) before bedtime on either the first or the second night, and the control group was not exposed to a medical clown at all. We then compared the data from both groups using unpaired t-tests. Hospitalized children exposed to a medical clown prior to bedtime (n = 21) and children not exposed to a medical clown (n = 21) were comparable in age and clinical characteristics. The study group had a significantly delayed wake-up time compared to the control group (06:59 ± 46 min vs. 07:26 ± 42 min, p < 0.05) (mean difference of 27 min). Night's duration (from bedtime to wake-up) was significantly longer in the study versus the control group (570 ± 76 vs. 500 ± 66.1 min, p < 0.05), a total mean increase of 70 min, and sleep efficiency were significantly increased (92.3 ± 4.6% vs. 87.9 ± 8.7%, p < 0.05). Within the clown group, when comparing nights with and without exposure to a medical clown, total sleep time was prolonged by a mean of 54 min on the night of the intervention (518 ± 74 min vs. 464 ± 59 min, p < 0.01), and the total wake time during the night were reduced (52 ± 27 min vs. 77 ± 61 min, P < 0.05), mean difference of 25 min), mainly by reduction of wake period after sleep onset (WASO) (42 ± 25 min vs. 66 ± 58 min, p < 0.05), mean difference of 24 min). Regarding general medical outcomes, hospital stay was significantly shorter in the clown group vs. control (104 ± 42 h vs. 128 ± 42 h, p < 0.05), a mean reduction of 23 h—nearly an entire day. An encounter with a medical clown before bedtime in hospitalized children positively affects sleep parameters, which may be of great importance for healing in general. The clown intervention was also shown to shorten the hospital stay. Larger scale studies are warranted to establish these findings.

A surge in pediatric COVID-19 cases was observed during the fifth wave (Omicron) of the COVID-19 pandemic. Little is known about the clinical features and disease course in neonates and young infants. To describe the clinical and laboratory features, disease course and complications of COVID-19 in neonates and infants younger than 6 months. A retrospective descriptive study in which data were collected from the electronic medical records of infants younger than 6 months, with positive nasal swab tests for COVID-19. Fifty-two infants younger than 6 months who tested positive for COVID-19 were admitted to our pediatric ER/department during the omicron wave of the COVID-19 pandemic, between December 2021 and December 2022. Twenty-one percent were discharged from the ER, while the others were hospitalized predominantly for observation or supportive treatment, with an average duration of hospitalization of 1.3 ± 0.7 days. No major complications were observed. Conclusion : COVID-19 is a mild viral illness in young healthy infants with no major complications. What is Known: • Pediatric patients generally have a milder clinical presentation of COVID-19 but can also experience more severe symptoms and post-COVID phenomena. • Our knowledge of COVID-19 in neonates and young infants is limited, and guidelines for their diagnosis and management are lacking. What is New: • In neonates and young infants, COVID-19 infection is typically a mild viral illness with no major complications observed in the majority of cases. • Hospitalization may not be necessary for well-appearing infants with COVID-19, as long as their clinical and laboratory evaluations do not raise any concerns.

RATIONALE Inhaled nitric oxide (iNO) has potential anti-inflammatory, anti-microbial, and anti-viral properties for patients with lower respiratory tract infections. OBJECTIVES We compared the safety and efficacy of iNO administered in two concentrations in addition to standard supportive treatment (SST) compared to SST alone with the aim to improve clinical outcomes of infants with bronchiolitis. METHODS In this prospective, multicenter, double-blind, randomized-controlled study, 89 infants hospitalized with moderate-severe bronchiolitis were randomly assigned to three treatment groups: 150 parts per million (ppm) NO+SST(1); 85 ppm NO+SST(2); and the control treatment O2/air+SST(3). Treatment was given for 40 minutes, 4 times/day for up to 5 days. The primary endpoint was time to reach "fit for discharge". This was a composite endpoint comprised of both reaching a sustained oxygen saturation (SpO2) ≥92% in room air, and reaching a clinical score ≤5. Secondary endpoints included time to reach sustained SpO2 ≥92% in room air, time to clinical score ≤5, and time to hospital discharge. Safety was assessed by the number of treatment-related adverse-events (AEs) or serious adverse-events (SAEs). Time-to-event efficacy outcomes were analyzed by Cox proportional-hazards regression-model. Hazard ratio (HR) describes how many times more likely an individual is to experience an event, if such an individual receives the NO rather than the control treatment during the observational period. RESULTS Group 1 demonstrated significant efficacy for time to reach "fit to discharge" compared to Groups 2 (HR=2.11, p=0.041) and 3 (HR=2.32, p=0.049). Group 1 also demonstrated significant efficacy for time to hospital discharge compared to Groups 2 (HR=2.01, p=0.046) and 3 (HR=2.28, p=0.043). No significant differences were observed between Groups 2 and 3 for either endpoint. There were no differences between treatment groups in time to reach clinical score ≤5. The iNO therapy was well-tolerated with no treatment-related SAEs. CONCLUSION Treatment with high dose intermittent iNO at 150 ppm showed reduced time to clinical improvement when compared to 85 ppm or control treatment of hospitalized infants with acute bronchiolitis. The 150 ppm iNO dose is well-tolerated, with significant benefit compared to both standard therapy and 85 ppm iNO, improving respiratory outcome and reducing length of stay.

Background Medical clowning has been proven effective in reducing pain, anxiety, and stress in many sporadic, usually small-scale studies. Our meta-analysis aims to evaluate the efficiency of medical clowns in reducing pain and anxiety in hospitalized pediatric patients and their parents in different medical fields. Methods A thorough literature search was conducted from different databases, and only randomized controlled trials (RCTs) were included with children aged 0 to 18 years old. A total of 18 studies were included, and statistical analysis was performed on the combined data. Results A total of 912 children (14 studies) showed significantly reduced anxiety when procedures were performed with a medical clown compared with the controls (− 0.76 on anxiety score, P < 0.001). Preoperative anxiety was lower in 512 children (nine studies) with clown interventions than in the controls (− 0.78, P < 0.001). The pain scale was completed by 338 participants (six studies), indicating a trend toward reduced pain during procedures performed while the clown was acting compared to controls (− 0.49, P = 0.06). In addition, medical clown significantly (− 0.52, P = 0.001) reduced parental anxiety in 489 participants in ten studies; in six of the ten studies, with a total of 380 participants, medical clown significantly reduced parental preoperative anxiety ( P = 0.02). Conclusion Medical clowns have substantial positive and beneficial effects on reducing stress and anxiety in children and their families in various circumstances in pediatrics.

Abstract Purpose This study aimed to investigate the differences in healthcare utilization in children in Israel over ten years. While examining the differences between various populations. Methods Data were obtained from the Clalit Health Care data warehouse, covering over 250,000 children residing in the Haifa and Western Galilee district. The population groups were categorized based on ethnicity (Jewish vs Arab) and residential settings (urban vs rural). Results Healthcare utilization was consistently higher among Jewish children than Arab children, irrespective of the specific dimension analyzed. Additionally, urban-dwelling children exhibited higher usage rates than those residing in rural areas in all investigated dimensions. However, Jewish children showed significantly lower hospitalization rates than Arab children across all years. No significant differences in hospitalizations were observed between urban and rural children. Notably, the study observed reduced antibiotic usage and hospitalizations over the years for all populations. Furthermore, Arab children and those living in rural environments face reduced accessibility to health care, as evidenced by fewer physician visits, laboratory and imaging tests. Conclusion This study highlights the substantial population-based disparities in healthcare utilization among children in Israel, despite the equalizing effect of the national health insurance law. Consequently, it is imperative to address these disparities and implement targeted interventions to enhance healthcare accessibility for Arab children and rural communities. The decline in antibiotic usage and hospitalizations suggests positive trends in pediatric health care, necessitating ongoing efforts to ensure equitable access and quality of care for all populations.

Background The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea and is widely used worldwide as an ambulatory diagnostic tool. While it records peripheral arterial tone (PAT) and not electrocardiogram (ECG), the ability of it to detect arrhythmias is unknown and was not studied previously. Common arrhythmias such as atrial fibrillation (AF) or premature beats may be uniquely presented while recording PAT/pulse wave. Purpose To examine the potential detection of common arrhythmias by analyzing the PAT amplitude and pulse rate/volume changes. Patients and Methods Patients with suspected sleep disordered breathing (SDB) were recruited with preference for patients with previously diagnosed AF or congestive heart failure (CHF). They underwent simultaneous WP and PSG studies in 11 sleep centers. A novel algorithm was developed to detect arrhythmias while measuring PAT and was tested on these patients. Manual scoring of ECG channel (recorded as part of the PSG) was blinded to the automatically analyzed WP data. Results A total of 84 patients aged 57±16 (54 males) participated in this study. Their BMI was 30±5.7Kg/m2. Of them, 41 had heart failure (49%) and 17 (20%) had AF. The sensitivity and specificity of the WP to detect AF segments (of at least 60 seconds) were 0.77 and 0.99, respectively. The correlation between the WP derived detection of premature beats (events/min) to that of the PSG one was 0.98 (p<0.001). Conclusion The novel automatic algorithm of the WP can reasonably detect AF and premature beats. We suggest that when the algorithm raises a flag for arrhythmia, the patients should shortly undergo ECG and/or Holter ECG study.

1Sleep Laboratory, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel; 2Center of Sleep and Chronobiology, University of Toronto, Toronto, ON, Canada; 3UF Health Sleep Center, University of Florida, Gainesville, FL, USA; 4Cardiology Department, Soroka Medical Center, Be’er Sheva, Israel; 5Kaiser Permanente San Bernardino County Medical Center, Fontana, CA, USA; 6Cardiology Department, Rambam Medical Center, Haifa, Israel; 7Baruch Padeh Medical Center and the Azrieli Faculty of Medicine in the Galilee, Poriya, Israel; 8Sleep clinic, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA; 9Sleep Clinic, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA; 10Department of Neurology and Sleep Center, Stony Brook University Hospital, Stony Brook, NY, USA; 11Charite Universitätsmedizin Berlin, Sleep Medicine Center, Berlin, Germany; 12Sleep Disorders Center, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Objective: In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time.Methods: The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice.Results: 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). Conclusion: In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.(c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background : obstructive sleep apnea (OSA) is associated with different patient characteristics according to age groups. OSA in babies and in prepubertal children is usually accompanied by a failure to thrive (FTT) and underweight. Adenotonsillectomy (T&A) is the first line of treatment for obstructive sleep apnea (OSA) in childhood. In the adult population and partly in adolescents OSA is commonly associated with obesity and the metabolic syndrome. In adolescents with OSA managed with a T&A the change in BMI was only occasionally studied. Thus, we peruse to examine the BMI z-score change following T&A in adolescents. Methods: in Israel, Clalit Health Services is the largest health care organization with the largest patient registry (more than 50% of the population). From the Clalit registry, 242 adolescents aged 12-18 who underwent T&A between 2006-2015 were retrospectively studied. BMI z-score changes from up to 3 months prior to T&A were compared to BMI measures in the following 3 years post T&A. Results: there were changes to all directions with overall small increase, not statistically significant (P=0.26) in BMI Z-score with a median of 0.79 prior to and 0.835 following T&A. Overweight children (n=74) tended to reduce their BMI z-score from 1.508 to 1.48 following T&A (p=NS), and in obese children (n=33) BMI z-score decreased from 2.288 to 2.000 accordingly (P=0.06, 2 tailed). Interestingly thin individuals (n=6) increased their BMI z-score following T&A from -2.4 to -0.59 (p=0.046). Conclusions: adolescents managed with T&A show variable changes in their BMI z-score following the procedure. In this regard their BMI z-score change is closer to the change seen in adults treated for OSA and not young children. The changes observed show trend to normalize the BMI z-score such that overweight children tend to decrease their BMI z-score while thin individuals tend to increase it.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

SESSION TITLE: Pediatrics Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Bronchiolitis is an acute inflammatory injury of the bronchioles usually caused by a viral infection. Bronchiolitis is the leading cause for hospitalization in young children with an annual total inpatient cost of $1.73 billion. Currently, there are no approved treatments for acute bronchiolitis and thus the recommended approach by the American Academy of Pediatrics is supportive care. In two previous studies the safety and efficacy of intermittent NO inhalation was tested at a concentration of 160ppm in 111 infants with bronchiolitis. These studies showed the treatment to be safe and effective, presenting improvements in clinical outcomes including shortening of hospital Length of Stay (LOS). METHODS: In the current study two doses of NO, 85ppm and 150ppm, were investigated to test whether a lower dose could have a similar therapeutic effect or demonstrate a dose response. 89 infants were enrolled into this study in eight medical centers throughout Israel. Subjects were randomly assigned at a 1:1:1 ratio, stratified per site, into three treatment groups: Group 1- 150ppm NO treatment in addition to standard supportive treatment (SST). Group 2- 85ppm NO treatment + SST. Group 3 (Control)- O2/air + SST. Study treatment was given for 40 minutes, every 4.5 hours (±30 min), 4 times/day, for up to 5 days. The primary endpoint was to assess the improvement in respiratory function, measured by the time to reach the “fit for discharge” endpoint. This was a composite endpoint, comprised of modified Tal (mTal) clinical score ≤5 and sustained oxygen saturation (SpO2) ≥92% in room air. Secondary endpoints included time to sustained SpO2 ≥92% in room air, hospital LOS, and time to mTal score ≤5. Safety was assessed by the number of NO drug related adverse events (AEs) or serious adverse events (SAEs). RESULTS: For the primary endpoint, on an ITT basis, hazard ratios of 2.11 and 2.32 were obtained demonstrating significant efficacy of 150ppm when compared to 85ppm and to SST respectively (p=0.041 and p=0.049). For the key secondary endpoint of LOS, significant efficacy was demonstrated based on hazard ratios of 2.01 and 2.28 when comparing 150ppm to 85ppm and to SST respectively (p=0.046 and p=0.043). No significant differences were observed between the 85ppm NO arm and SST on either endpoint. NO therapy was generally well tolerated with no SAEs related to NO therapy, and no AEs leading to discontinuation of NO therapy. CONCLUSIONS: In infants with acute bronchiolitis, intermittent inhaled NO (iNO) at 150ppm, was found to be safe, well-tolerated, and statistically significant compared to both standard therapy and 85ppm iNO, reducing LOS and rapidly improving respiratory outcome. CLINICAL IMPLICATIONS: These results could be linked to the role of NO as a vasodilator, bronchodilator an anti-inflammatory and anti-microbial agent, opening a new approach in the treatment of viral lower respiratory tract infections. DISCLOSURES: No relevant relationships by Inbal Golan-Tripto, source=Web Response No relevant relationships by Aviv Goldbart, source=Admin input Owner/Founder relationship with Beyond air company Please note: $20001 - $100000 Added 06/11/2020 by David Greenberg, source=Web Response, value=Consulting fee No relevant relationships Added 05/26/2020 by Rinat Kalaora, source=Web Response, value=Salary Removed 07/16/2020 by Rinat Kalaora, source=Web Response No relevant relationships Added 05/26/2020 by Rinat Kalaora, source=Web Response, value=stocks Removed 07/16/2020 by Rinat Kalaora, source=Web Response No relevant relationships Added 07/16/2020 by Rinat Kalaora, source=Web Response, value=Salary Removed 07/16/2020 by Rinat Kalaora, source=Web Response No relevant relationships Added 07/16/2020 by Rinat Kalaora, source=Web Response, value=Shares Removed 07/16/2020 by Rinat Kalaora, source=Web Response No relevant relationships by Daniel Landau, source=Admin input No relevant relationships by Moran Lavie, source=Web Response No relevant relationships Added 06/10/2020 by Ronit Lubetzky, source=Web Response, value=clinical trial support Removed 06/10/2020 by Ronit Lubetzky, source=Web Response No relevant relationships by Amit Nahum, source=Admin input No relevant relationships by Giora Pillar, source=Admin input No relevant relationships by Yechiel Schlesinger, source=Web Response No relevant relationships by Ronen Spiegel, source=Admin input Consultant relationship with Beyond Air Please note: $1001 - $5000 Added 05/31/2020 by Asher Tal, source=Web Response, value=Consulting fee stock holder relationship with Beyond Air inc Please note: $1001 - $5000 Added 05/31/2020 by Asher Tal, source=Web Response, value=options

Sleep apnea has a very high prevalence in the general population. Sleep apnea can be the cause for cardiovascular disorders. An increased risk for suffering from hypertension, stroke, and myocardial infarction had been shown in large studies, like the Sleep Heart Health Study. Sleep related breathing disorders and sleep apnea had been diagnosed in sleep laboratories with polysomnography in the past. Today in view of the high prevalence of sleep disordered breathing, home sleep apnea testing (HSAT) has become the accepted test for the diagnosis of sleep apnea, if there are no other comorbidities, and if a high pretest probability was confirmed by a sleep physician. For home sleep apnea testing, the number of sensors needed should be reduced. Some methods use indirect means to derive features to detect sleep apnea and hypopnea events. A very well developed method is peripheral arterial tonometry (PAT). This method records the pulse wave on a finger and derives sleep and sleep apnea feature. The PAT method has been tested under many conditions. As an indirect method, it was long seen as a limitation that obstructive and central sleep apnea events could not be distinguished. A new multicenter trial was set up to develop algorithms, which could distinguish central and obstructive apnea events with sufficient accuracy.