News in brief: Prediction model matches OSA patients to oral appliances; IVIG ‘no benefit’ to COVID patients in respiratory distress; Tobacco sales ban is next step for smoke-free Australia

Thursday, 18 Nov 2021

Prediction model matches OSA patients to oral appliances

Sleep health researchers in South Australia have developed a model that uses standard polysomnography and clinical data to predict oral appliance treatment will work in individual  patients with obstructive sleep apnoea.

Flinders University Professor Danny Eckert and co-researchers assessed the technique  in 62 people who completed standard overnight sleep studies before and after treatment.

The sleep study data, plus the age and BMI of participants, was used in a machine learning-based model to predict the treatment response of the dental appliance to reduce the severity of sleep apnoea. According to results published in the Journal of Clinical Sleep Medicine, the modelling successfully predicted the treatment outcome in about 60%-100% of cases.

“A major clinical challenge with dental appliance or mandibular advancement therapy is the inability to accurately predict who will respond. At present it is a toss of the coin,” said Professor Eckert.

“An accurate model  that takes into account the different causes of sleep apnoea to match therapy to each person should produce much better results from a dental appliance, particularly when CPAP of other treatment aren’t appropriate or preferred,”

Intravenous IG ‘no benefit’ to COVID patients in respiratory distress, research shows

Intravenous immunoglobulins (IVIG) failed to significantly improve outcomes in patients with COVID-19-associated acute respiratory distress syndrome (ARDS), and were also linked to a numerical increase in severe adverse events, a study published in The Lancet Respiratory Medicine has shown.

Researchers from France undertook a multicentre, double-blind, placebo-controlled, Phase III trial, in which 146 patients with moderate-to-severe COVID-19-associated ARDS receiving invasive mechanical ventilation were randomised to receive either IVIG (n=69) or placebo (n=77).

The researchers found no statistical difference in the median number of ventilation-free days at day 28 between the IVIG group (0.0-0.8 days) and the placebo group (0.0-0.6 days), nor in the rate at day 28 (35% vs 26%, respectively).

The number of adverse events was also found to be similar between the two groups (152 in the IVIG group versus 154 in the placebo group). However, although not statically significant, serious adverse events did occur more frequently in the treatment group versus the control arm (32% versus 20%, respectively).

Also, ten (15%) patients in the IVIG group had deep vein thrombosis compared with three (4%) in the placebo group, while four of the ten patients in the IVIG group had pulmonary embolism versus one patient in the placebo group.

“Despite the results showing the absence of benefits of IVIG in patients with COVID-19-associated ARDS, our data might have an effect on public health: IVIG use should be reserved for inflammatory or autoimmune diseases, such as Kawasaki or chronic polyneuropathy,” the researchers concluded.

“Future work might identify subgroups of patients with acute COVID-19 who would benefit from IVIG, but the current evidence does not support use of IVIG in COVID-19-associated ARDS,” said US-based Drs Erin Wilfong and Michael Matthay, in an accompanying comment also published in The Lancet Respiratory Medicine. 

Tobacco retail ban is next step for smoke-free Australia

The government must set an ‘end date’ to phase out retail sales of tobacco altogether if it is to meet its goal of reducing smoking to below 5% by 2030, public health advocates say.

Writing in the MJA, Associate Professor Coral Gartner of the University of Queensland says the continuing availability of tobacco from retail outlets normalises smoking as a behaviour for young people and the only realistic action plan to reduce consumption is to reduce the number of retail outlets.

The authors say industry self‐regulation and other voluntary approaches will not reduce tobacco retailing, and there is a need to adopt approaches such as a restricting sales to a limited number of licensed dealers or putting tobacco on prescription.

Setting an end date for tobacco sales will also focus efforts on smoking cessation and force the government to plan for an end to tobacco tax revenue, they write.

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