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Biomedical subjects

L E Kapuniai

Publications and source records attributed to L E Kapuniai.

18 recordsLinked to original sources
PubMed2001

Telephone subsidy: an effective incentive for successful participation in home memory monitor study.

CONTEXT: The Collaborative Home Infant Monitoring Evaluation (CHIME) study enrolled healthy term infants and 3 groups of infants considered to be at increased risk for sudden infant death syndrome to evaluate apnea and bradycardia events in the home. Mother-infant pairs without a telephone were ineligible for enrollment. OBJECTIVE: To determine whether mother-infant pairs who were offered a telephone subsidy would agree to enroll in CHIME and achieve protocol compliance rates comparable with those of matched subjects able to afford telephones. DESIGN: Thirty-one telephone subsidy subjects were retrospectively compared with 55 control subjects matched for study group, site, birth weight, and maternal race, age, and education. SETTING: Collaborative Home Infant Monitoring Evaluation clinical research centers in Honolulu, Hawaii, and Toledo, Ohio. INTERVENTION: Provision of telephone subsidy to otherwise eligible enrollees for CHIME. MAIN OUTCOME MEASURES: Frequency of compliance with protocol requirements for follow-up evaluations and for extent of home monitoring. RESULTS: Subsidy subjects achieved protocol completion rates that were comparable with those of control subjects, for developmental assessments at 56 and 92 weeks postconceptional age (PCA), and for the polysomnogram. Unexpectedly, however, subsidy subjects were more likely to have a developmental assessment at 44 weeks PCA (P =.02), as well as a cry analysis (P =.04). They were also more likely to use the CHIME home monitor for more hours during weeks 2 through 5 (P =.004), have a higher percentage using the monitor for 10 or more hours per week during weeks 2 through 5 (P =.009), and have a higher total number of days of monitor use throughout 6 months (P <.001). Mean cost of the subsidy was $3.25 per day of monitor use, and monitor use per day was directly related to total cost of the subsidy (P =.02). CONCLUSIONS: Telephone subsidy is an effective financial incentive. At least within the context of the CHIME study, telephone subsidy enhanced access to health care, and in some categories it resulted in enhanced protocol compliance.

Adult↗
PubMed1997

Infant polysomnography: reliability. Collaborative Home Infant Monitoring Evaluation (CHIME) Steering Committee.

Infant polysomnography (IPSG) is an increasingly important procedure for studying infants with sleep and breathing disorders. Since analyses of these IPSG data are subjective, an equally important issue is the reliability or strength of agreement among scorers (especially among experienced clinicians) of sleep parameters (SP) and sleep states (SS). One basic issue of this problem was examined by proposing and testing the hypothesis that infant SP and SS ratings can be reliably scored at substantial levels of agreement, that is, kappa (kappa) > or = 0.61. In light of the importance of IPSG reliability in the collaborative home infant monitoring evaluation (CHIME) study, a reliability training and evaluation process was developed and implemented. The bases for training on SP and SS scoring were CHIME criteria that were modifications and supplements to Anders, Emde, and Parmelee (10). The kappa statistic was adopted as the method for evaluating reliability between and among scorers. Scorers were three experienced investigators and four trainees. Inter- and intrarater reliabilities for SP codes and SSs were calculated for 408 randomly selected 30-second epochs of nocturnal IPSG recorded at five CHIME clinical sites from healthy full term (n = 5), preterm (n = 4), apnea of infancy (n = 2), and siblings of the sudden infant death syndrome (SIDS) (n = 4) enrolled subjects. Infant PSG data set 1 was scored by both experienced investigators and trained scorers and was used to assess initial interrater reliability. Infant PSG data set 2 was scored twice by the trained scorers and was used to reassess inter-rater reliability and to assess intrarater reliability. The kappa s for SS ranged from 0.45 to 0.58 for data set 1 and represented a moderate level of agreement. Therefore, rater disagreements were reviewed, and the scoring criteria were modified to clarify ambiguities. The kappa s and confidence intervals (CIs) computed for data set 2 yielded substantial inter-rater and intrarater agreements for the four trained scorers; for SS, the kappa = 0.68 and for SP the kappa s ranged from 0.62 to 0.76. Acceptance of the hypothesis supports the conclusion that the IPSG is a reliable source of clinical and research data when supported by significant kappa s and CIs. Reliability can be maximized with strictly detailed scoring guidelines and training.

Humans↗
PubMed1988

Identifying sleep apnea from self-reports.

An apnea score (AS) was developed as a potential screening tool for sleep apnea. This was based on self-report questionnaire responses of 76 sleep disorder center patients and 20 sleep survey volunteers. Twenty volunteers and 23 patients (group I) comprised the initial AS development group. Their questionnaire responses were compared to polysomnographic apnea indexes (AI) and apnea plus hypopnea indexes (AHI). Stepwise multivariate discriminant analysis was used to test whether or not selected group I questionnaire responses could be used to correctly classify respondents into apnea (AI or AHI greater than 5) or nonapnea (AI, AHI less than or equal to 5) groups. Self-reports of "stops breathing during sleep," "loud snoring," and history of adenoidectomy best discriminated normal (AI less than or equal to 5) from apnea (AI greater than 5) cases. The AS derived from group I responses to these three variables was then computed for group II (n = 53). After examination of the AS results, the AS was modified to include just "stops breathing" and "loud snoring" and the AI criterion was raised to 10 per hour. This revised AS correctly identified 100% of the cases with moderate-severe sleep apnea (AI or AHI greater than 40) and 70-76% of all sleep apnea cases with AI or AHI greater than 5. Predictive accuracy was 88% for AI greater than 10. The two questions that comprise the AS should be incorporated into risk appraisal instruments or interviews to screen for sleep apnea.

Adenoidectomy↗
PubMed1987

Auditory responsivity and intrauterine growth retardation in small for gestational age human newborns.

Auditory responsivity in term small for gestational age (SGA) compared to term appropriate for gestational age (AGA) human newborns reflects functional differences which may be attributable to intrauterine growth retardation (IUGR). Between-group comparisons of percent of responses of averaged late component auditory evoked events (AEEs) to pure tone stimuli (500, 1000, 2000, 4000, 6000 and 8000 Hz) at 63 and 80 dB SPL revealed significantly greater AGA responsivity at 80 dB SPL. Conversely, the AEE mean latencies were significantly shorter for SGA infants at both intensity levels. Between-group responsivity differences suggest developmental retardation in term (38-42 weeks) SGA newborns, but the faster SGA latencies may reflect 'induced' acceleration in auditory neurophysiologic function.

Auditory Perception↗
PubMed1982

Daytime sleep stage organization in three-month-old infants.

Sleep monitoring at 3 months post term of clinically normal term infants, pre-term infants with no demonstrable pathologic clinical signs, and pre-term and term infants with a history of metabolic disorders show that these infants have EEG sleep stages resembling those seen in adults, as well as the adult pattern of sleep stage organization. The presence of NREM stage organization and stage sequencing suggest that sleep regulatory mechanisms are approaching a level of functional maturity in the human infant at 3 months post term. There is a significant relationship between sleep staging at 3 months post term and mental and motor performance at 12 months post term. In light of this, it is hypothesized that early bioelectric maturation may reflect the development of neural mechanisms which are also the substrate for later cognitive and behavioral functioning. Sleep stage organization at 3 months post term may be utilized as a benchmark of CNS development and for research on the pathophysiology of sleep disorders.

Brain↗
PubMed1980

Effects of induction of labor on the neurophysiologic functioning of newborn infants.

Neurophysiologic responses of newborn infants delivered after normal onset of labor are compared with those of newborn infants whose mothers had labor induced with oxytocin or prostaglandin F2 alpha. No differences in brain activity or heart rate were detected between groups in terms of frequency of response to auditory, visual, tactile, or olfactory stimulation. Significant differences were found for resting brain activity defined in terms of autoregressive spectral estimates or coefficients. The largest differences were between the groups with normal onset of labor and prostaglandin F2 alpha.

Autonomic Nervous System↗
PubMed1980

Autoregressive analysis: a method for detecting electroencephalic changes in newborns to tones.

This report presents an autoregressive technique for detectiong statistically significant changes in brain activity to tones. The change detectin model is applied to stationary time series electroencephalogram samples from sleeping newborn infants. The electroencephalic responses of neonates to tones are quantified and analyzed in terms of t-statistics. Confidence limits applied to averaged t-statistics objectively and reliably defined statistically significant late components in newborns.

Acoustic Stimulation↗
PubMed1979

A comparison of clinical behavioral audiometry and autoregression analysis of EEG and heart rate in hearing-impaired children.

Autoregressive analysis, a statistical technique for detecting changes in electroencephalic (EEG) and heart rate (HR) data was compared with clinical behavioral audiometric results on 10 hearing-impaired children in schools for the hard of hearing and deaf. EEG and HR data were collected in a screening paradigm involving tones of .5, 1, and 4 kc/s at 80 db SPL in a free field. An index of reliability, or acceptable level of agreement, was set at 70%. This criterion was met 5 out of 6 times. For the EEG, agreements exceeded 70% at 1 and at 4 kc/s, and for HR at all 3 frequencies. Results suggest that the autoregressive approach yields data very similar to behavioral audiometry in this population. Continued exploration of autoregressive analysis of electrophysiologic indices in determining reactivity to tones is warranted, particularly since the statistical method can be used with younger infants.

Audiometry↗