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So Truma um you have to flow. Mm good, please. Can I can you hear me? Yes, we can hear you. OK, good evening everyone. Uh My name is so uh good evening to our special guest. Thank you for joining us. So I'll be reviewing the article, influence of sleep stage on the determination of positional dependency in patients with obstructive sleep apnea. And my name is so I want to be sure we can still see my slight, please. Yes, we can see as well. OK. Thank you very much. So I'll be following the outline in this article, I follow, I will discussing on the type two and abstract, the introduction and methodology results, discussions limitations as well as making some recommendations among others. Now, the title for this um a article is um influence of sleep stage on determination of patient dependency in patients with obstructive sleep apnea. And um if you count the word which is usually within the recommended um ward counting and you know, most um authors or journals, we recommend that OK, that the title of a prison could be left within the range of 7 to 20. So this is within the that particular range and, and the topic by my understanding and from the paper is appropriate and relevant to the content of the paper. Now, the abstract contains 245 ft which is still within the, although it's somewhat lesser than the recommended of 250 to 300. But as you felt that is still at least just from 5 ft shy away from it, um the author made use of objective methods, result and conclusion and they were clearly stated relevant and concise. However, um they are, I would have preferred that they use um background rather than objective in the in the abstract. You know, because from from the abstract, they are more like discuss more than a background and did not really clearly speak much on the on the objective. So afraid they are used a background in the context of an introduction rather than using objected as they have used introduction. This is now for the, this is a retrospective study that was published earlier this year on the 20th of June 2024 by clinical and experimental journal that could aim to assess the impact of sleep stage on positional dependency in no sleep apnea. That is oc obsessive apnea is a disorder characterized by repetitive collapse of the upper airway during sleep leading to hypoxia and frequent awakening, osa disease equal and can lead to complications such as myocardiac infarction stroke, arrhythmias and other cardiovascular diseases. Oc is diagnosed when the apnea apnea index as A A I derived from a standard poly soy is five or more. The severity of O SA is also graded based on the apnea index score with an A I of 15 or I are indicating moderate OSC and an A I of 30 or I are indicating severe O SA. The severity of OSA is affected by various factors including sleep position, sleep state, body weight, alcohol consumption and drug use. Patients who exhibit a marked increase in oc severity when sleeping in the supine position are considered to have positional dependency. This usually this is usually the supine A is at least twice higher than that of non supine A H I individual diagnosed with RM dependency or rapid eye movement dependency or have a significant elevation in the eh I during rem sleep related to non rem sleep. That is and rem it is possible to, to underestimate the super A and overestimate the non A if A rather if a patient per experiences rem in the non supine position and in the supine position in a patient who has P dos E, this may give rise to the misconception that PD is missing. In contrast, the super A H I may be, it may be inflated and the nonsupine A I may be understated. If rem sleep takes place mostly in the super position, this could lead to the incorrect diagnosis of non PD OSC as PD OSC Therefore, in this present study, the auto analyzes or analyze the prevalence of changes in PD status when the influence of sleep stage is considered using data from patients who underwent phd that is per soy for OS a diagnosis. Additionally, they develop a modified parameter that incorporates the influence of sleep stage. Now, the introduction was comprehensive and clearly analyzed the other objective which are specific and achievable. The author commented on the treatment for moderate or severe, which for me, I did not it when necessary. So in some part, in the direction, the author at some point for me digressed to speaking about the treatment where I felt they should have just more like focused on just introducing the topic more on the and the purpose to why they are undergoing this particular study mathias and methodology. Now, for this particular school, the author acquired um their ethical approval from the National University Hospital Internal Review Board and this review board actually exempted the order from requiring patient consent. Now, they were retrospectively analyzed from adult patients that is age 18 years and above who underwent in laboratory poly soy that his phd at Gunson National University Hospital and we diagnosed with OSC with an H I greater than five. It was difficult in such cases. Data set included 111 patients, 96 of them were males and red female. Not consistent with the conventional definition. They define PD as a ratio of no Supine A I to supine A I that is the NS to SA I ratio of less of 4.5 or less. So the cast duro ns to S HIV show during the entire sleep total sleep time and that during the rem sleep and doing the no rem sleep for validating the agreement among these three en I ratio good price comprising were performed between each period of ratios that is overall non Supine supine H I ratios, the non Supine supine H I ratio in uh in RV, the nos super A I ratio vaso the non H I ratio in non rem and the non supine A ratio in rem versus the non Supine A. In further, they calculated the weight no SA I ratio by multiplying the proportion of rem and the total sleep time by the by the respective non A ra in each state as shown in the equation below. Now, they compare the differences between weight no sleep sleep A ratio and the overall. And the and the original overall non A I ratio analysis were conducted with the software version 4.12 the PT test and the link correlation CCC were employed to assess and quantify the agreement of the no I ratio between entire sleep and rem sleep e sleep and no rem sleep an original value weighted an original value and weighted value. The values for CCC were regarded as follows less than 0.9 as less than 0.9 as poor 0.9 to 0.95 as moderate 0.95 to 0.99. As substantial and greater than 0.99 almost perfect ap value of Z of less than 0.05 was considered statistically significant. No, this retrospective cross sectional study design in place for this study is appropriate for answering the research question. However, the ethical approval was not said to have been obtained from an ethical committee. Now, um for most of my knowledge, II really don't know how it is being practiced um in South Korea where this decision has been done for, for most of my knowledge, when um I think has has been sort it's usually been started for me more like an an organized or recognized technical committee um for which the author had not, they are just, they are just made of um um the the that you brought to more like um um consent. So II don't really, I didn't really consider that to be very appropriate. Now, 111 selected propose of the research I 96% by mail and which does not reflect the true general population for general population. Usually even in any country or most countries, they usually a more like 5050 to 50 ratio male to female or at least even not, not more like these component to this one. So for this particular research, we are like male to be 8.86 0.5% which is a vast majority of the study population. So uh which I felt there was more like which I felt which I did not to be very OK. Now, the collection collection method were not clearly mentioned. The other failed to comment on how far back the past scans were repeated. The inclusion and exclusion criteria were vague and nothing was stated as to whether certain mobilities were considered in including or excluding the participants. Now, what I mean by that was that now, the other clinic stated that we are um and they recruited patients that don't um put in sonography, the complete set of sonography, um sleep analysis at the hospital. Uh They didn state that they didn state for this particular experiment and the patient and the subjected were as far back as say maybe 2023 or 2022 or as far back as 2021. So we didn't have any, the the author did not clear. OK, we have obtained or we have obtained uh patients that performed POY sleep analysis test at from 2012 to 2024 or from 2013 to 2024 or from 2020 to 2024. So that was not clearly stated as I on that too. Um The author did not clearly state the inclusion criteria. All they just mention was that OK, as long as patients uh above 18 and the and the, and they meet the five criteria that that is what the recruitment criteria for me. That was not very, very clear since he also goes for the exclusion criteria, the, the actual criteria is not really OK, stated. However, the use of our um um software and they need um correlation for A A two. Actually, we are appropriate for the study and research question giving. That is more of and then complain to two variables as we find out that is the bar and no Supine and Supine A I ratio and the weighted no supine supine A I ratio. That was the result of the 11, well, the 1 111 patients, 36 did not have dependency that PD 75 did. Now there is there is very for me although the average non did not change substantially from rent, there was in agreement within the data for the for the individual patterns upon comparing these two ratio, eight outliers were found to be to to be more than plus or minus two standard divisions from the mean based on the total non A I ratio, three of these patients were having PD during rem sleep. Although this was not the case. So and this is the more like a a that um the picture showing um the S result and we have the case for, for the first one where we compared um individuals with non issue and in the R in the rem sleep and non rem sleep. And when we looked at both of them in terms of that overall for the normal and for the weight. So the, so for sleep is when we, when those complain the non H I ratio normal and when you compare in rem sleep for is when you, when you do nonsupine A I ratio, no. And when you check it in non rem sleep and this is where you do the or and non, you compare both re and non rem sleep. Although there were little differences between the two measures for individual for individuals. The weighted nonsupine A I ratio did not subside differ from the overall non supine sa I ratio three which more than two plus or minus two standard division from the mean were discovered when comparing this ratio, the total nos super A showed that none of them had dependency, the total and weighted no A agreements. Once these were when the weighted non H I ratio and the viral no, no A I issue were compared in terms of O ac severity patient, we might moderate oc show poor agreement where patients with severe O ac should substantial agreement. So this is the um picture showing the in between the viral non I ratio and the weighted nope A I ratio and not by A I ratio. So the diagram, they just basically explain what I said before that. So this there are no more significant duration. If you look at the weight as compared to when you look at your viral, the weighted more like do not substi digress from the from what they are expected. And also you see the um the more like the spotted graph, they also depict this. Now for the result, these are set up to compare the two variables that is the nonsupine A I ratio and the weighted nonsupine SUPT as well as the use of people are clear and easy to understand and better use in evaluating this result to be very constant that most often or not I usually used cut up blood, graphical representation of results are often used to when you are comparing two variables. Uh This is one auto has done and for most of the results, the auto stated they claim to know the confident as well as the P value discussion. According to report, the prevalence of P dos A ranges from 23 to 63%. After a study by Cutright review that many OSC patients had an A I in the position that is at least twice as high as their A I in the lateral position. The idea of positional therapy was born given that obesity was invasive. Correlated with this strength therapy was proposed as a potential treatment option for people with OA who exhibit PD and a normal body weight. The study also reported that 20.8% of patients with PD, achieve an A I below five when sleeping on their side. And also noted that differences in A I between sleep may be influenced by the sleep stage. However, it was presumed that the sleep position depends, dependent changes in A I are independent of sleep stage alteration because the ratio of sleep to no A I remains consistent despite the proportion of, of each of each sleep through the total this time, This is in contrast to this present study that shows poor agreement between the non and A I ratio during rem and non rem sleep. So you see that the prior assumption may not be valid. In addition, individual displays significant variation in the non A during rem and non rem sleep. The underlying causes for this variation could not be ascertained. Highlighting the need for further detailed research. PD does not only influence the selection of operational therapy but also impacts the outcome of other treatments for O OSC. For example, one study demonstrated that the effectiveness of mandibular attachment device use was more pronounced in patients with supine depend 25.9 compared to those with non Supine dependent O AC, among whom the media A I decreased from 44 to 21. As A as a result, patient with PD are likely to benefit from M AD that is a mandibular advancement device. Previous studies have shown that changes in sleep studies happen more frequently as osa severity increases indicating de de decreased sleep stability. Therefore, in cases of severe OSC, 1 may expect a large discrepancy between the weighted non non A I ratio and the total non A I ratio. The result I showed the reverse pattern. This may be explained by the fact that as O CC increases, there is a lower prevalence of PD and a greater percentage of rem sleep overall. As a result, treating patients with severe OSA could still be accurately diagnosed without the need for an exact formula to take sleep stage transition into consideration. Also using this no A HIV show the benefits a situation with where precise PD diagnosis is essential a limitations. The study has several limitations which included before that it was a retrospective study approach. This very small sample size, I mean the one than just 11 patient. And the and the study was based on a single point poly test which was performed in an own familiar environment. Now, this particular limitation where the limitation that were cited by the authors. Now discussion and limitation, limitation of the result by the others were logic and they supported most of the most of the discussion with the data they obtained from the um the research they conducted. They also they were also instance where they compared their studies with the existing findings as well as discussed that similar differences as well as the the implications the was stated. However, did not clearly highlight the conclusion. Now in the in the point of discussion there, there was no, there was not any point where they are clearly elected. Uh this um conclusion. Most most um at school, we usually have a section where you have a discussion. We within the discussion, the author will also state the as they are done. And you also have the concluding aspect where you will conclude as well as state. OK, where um your research has really come. And in this case, the author for this particular article did not clearly state the conclusion. So some of the recommendation I would like, I would love to make it that. But like I said earlier, in the after that, the author is where they were within no um good word range that where they are from 250 to 300. However, I would prefer that they just more like an in or a background instead of using an object because for most of what they are high in the structure objective, they are more like discussed more like the introduction or giving us an insight to the background, run an objective also as earlier stated. Um the in and in fact should, should be clear and the time period for personal recruitment should be alighted. As I said earlier, there was no, they didn't clearly state when the period, um the period of the time period for which the participants were recruited more like in the sense that like I stated earlier that they didn't clear the state that OK person are recruiting for this first class study where a person that performed the soy test with and within this and that period, I mean, within, for example, 2023 to 2024 or 2022 to 2024 social and I believe that that is very significant also to they agree that and, and subsequent they should try to clear the criteria some other in like that. Ok. Efficient criteria are this this this and this, however, they will know to see it more like a, a section on its own or like a more like and stop on his own. They can maybe the para of to clearly state the criteria that are used to select participants and also used to exclude also. And it's not yet did not really make any reference to as to whether there were any missing data during the course of the study. Not know that was state, I know one of my also major concern on when I was read the paper and when they were talking about um the old process for um for the study was that they didn state whether they are to consider whether there were was an absence or presence of mild in patients more than better um um sleep apnea uh um has been known to or is known to have to be caused by some morbidities. For example, obesity has been, has been I as one of the causes of oasis. Now, the I think the doctor should have also stated that, ok, we are recruiting patients that done this and also the way the patient has one or two or three morbidities because this one way or that can significantly or, and one way or affect the results or the discussion. So these are my references. Thank you. Um At this point, we want to take comments from um uh dear professor Professor Missus. Oh, hello. Can you hear me? Yes, ma'am. Yes, ma'am. Yes, ma'am. Good evening ma. Well, I thought you should take questions. Good evening. Two of the student first present. Ok, mom, we'll do that now. Yeah. Ok. All right. Yes, ma'am. So if we have questions concerning um what I just been cried, please. You can, you have the floor now, you can raise up your hand and then I'll call, I'll call out names of um students in the other in which they re up your hand. Any questions uh concerns or contributions. Yeah. Ok. Ok. Any questions concerning what has been said? Thank you. Ok, ma we don't have any questions now. Ok. Uh we're done. Thank you for the uh presentation and the general review. Um O SA is a very important topic and then the position um would be used to treat. So those are to find there are devices that can be put to make them not to sleep on their back. Your slides were a bit too loaded and the article I find it difficult to understand um what you are trying to say. So, can you summarize um what are the key points? Maybe one or two from the paper? All the graphs were so complicated. So I'm not the statistic. So the, oh, presentation has to bring kids. No. Um Yeah. Hello, ma. Hello. Yes. From the paper. Yes, ma'am. What message are they trying to pass across? Yes. OK. Well, OK. Well, from what II got from the journal and I think one of the first things that people was trying to exercise is the fact that position tends to depress, tends to affect um the depression of patient tends to affect um obsessive sleep apnea. And that most often apart from the position, there's also the tendency that this, this stage two can affect um on obs sleep apnea. Now do the or try to emphasize the fact that um that sometimes when we make you can misdiagnose patients in the, if in the case, for example, I think the patient has rem or sleep um s sleep apnea in the sense that for example, they have rem to be very predominant in the non supine position. Now, so we might may not assume that that patient has PD rather than not, rather than that they do not have PD. What am I saying is is that for example, now we we know that supine things to cause supine sleep tends to cause or sleep apnea. Why not supine do not cause a or I tend to rate of apnea. Now, we also know that re from the study can also cause ops apnea. Why Norem will not cause or apnea. Now, they also emphasize the fact that in some cases, you can have one can have rem who is predominant in the non supine position. So given the, given the illustration, given the, and the feeling that the patient has a like the patient has a non dependent or non dependent um and non dependent apnea and also from the old result. And it also had some um understand the graph where they are used. Um Some um I think they also try to start to tell us the fact that there is no much difference if you, if you try to the to the condition, if not combine everything. Hello. Hello. Hello. Yes. OK. Months. So, so o other than the OK, I thought emphasizing on that now that using weighted average, using the weighted rather than the bar is more frustrated as the weighted things to um exclude things than the biases that might come from. OK. From the fact that some people may have more no fine and vice versa. So the other type ensure that OK, that from that OK, what we, we consider it to be ra or non, you can see that when we use the weight average 10 to reduce those bio much. Uh It's OK. Um Yeah, so re uh will not cause but will contribute because of relaxation of the muscles. So, um did you talk about to mitigate all the challenges? Uh If you are, if I uh did not clearly talk about um the problems of that, that it was a problem and that was it? Ok. Uh Well, uh they could suggest that that the protocol patients should be positioned on their side rather than on their back so that there will not be any effect of position on the results. So uh yes. So I think in a journal like this one should be able to get a key message. Some journals ask for summaries of the point. So this one, it was very difficult to get what the exact uh message was was all is a good uh paper uh which could be carried out here and could have the implications for diagnosis and treatment so that um position should be considered in the assessment of patients. So that's just what I can get from there. So well done. But your slides were too loaded. So you should try and use the powerpoint and a simple uh graphs trying to explain everything. OK. Mom. OK. So well done. I'm going to ask whether um whether we have a form of um that we can use on patients too we have in a we have in, in so we don't have here. So what we have are small devices, home sleep testing devices, which will give you the A IH I apnea index or the OD I. So we have the um devices that can be um mobile devices. So we don't have the full phd with the plus you get that. All right. A few months. Uh I spoke to your rehab. So well done that chair man. It's on my comments. Yes, ma'am. Yes, ma'am. Thank you very much uh for um I really know your time and those for helping us um in this review, we are very appreciative ma'am and to everyone who has um a time also to be available and also to join in this review. Thank you. Uh and we look forward to having our next review next month and we look forward to seeing all of us there. Thank you very much and thank you very much. Ok, thank you. Have a nice day. Yes, sir. Bye.