Schön Klinik Bad Aibling

PurposeSnoring is the most common symptom in patients experiencing obstructive sleep apnea (OSA) and is reported by up to 94% of those affected. It has already been extensively proven that snoring of patients with OSA acoustically differs significantly from habitual snoring. For this study, snoring in patients with OSA is analyzed by its different components: pitch, formants (F1-F3), formant-ratio F2/F1, harmonic-noise-ratio (HNR), spectral energy ratio (SER). The objective of this study is to determine whether one or more acoustic parameters exhibit significant alterations or distinctive features immediately preceding an apneic episode, as compared to the patterns observed during simple snoring in individuals with obstructive sleep apnea (OSA). Identifying such preapneic indicators could facilitate the prediction of subsequent apnea events. With further technological advances and greater standardization, acoustical analysis could play a central role in the diagnosis and treatment of snoring and sleep apnea.MethodsBased on the “Munich-Passau Snore Sound Corpus” (MPSSC) as one of the world’s largest data sets for snoring sounds, retrospective data, consisting of 219 patients with OSA, were obtained using drug-induced sleep endoscopy (DISE). The mentioned components were retrieved and analyzed with the open source software „Praat“. Statistical testing was done with t-tests (Student and Welch) and Mann-Whitney-U-test.ResultsFor four parameters (F1, F2/F1, HNR, logSER) there are statistically significant differences between continuous/simple and preapneic snoring sounds.ConclusionsPreapneic snoring sounds seem to have different characteristics than continuous/simple snoring sounds. With further research, a simple acoustic differentiation for various diagnostic purposes could become possible.

ObjectiveTo evaluate a multidisciplinary therapy program with a neurological focus for individuals with post-COVID-19 condition, aiming to reduce symptom burden and improve functioning.DesignNon-experimental prospective before–after study.Subjects/patientsIndividuals diagnosed with post-COVID-19 condition, defined as experiencing persistent signs and symptoms for more than 12 weeks after initial SARS-CoV-2 infection.MethodsWe conducted a 2 week multidisciplinary rehabilitation program at the Schoen Clinic Bad Aibling, Germany. The intervention included multi-professional therapies. Assessments were conducted at six time points: baseline at the start of the 2-week control period, pre- and post-intervention, and at 2, 8, and 24 weeks post-intervention. Mixed-effects regression models were used to analyze changes over time. Outcome measures included health-related quality of life (HRQoL; EQ-5D-5L), fatigue, anxiety, depression, symptom severity, breathing difficulties, cognitive function, functional disability, and performance measures.ResultsA total of 47 participants (60% female; mean age 49 years; range 21–80) were enrolled, with a median of 220 days (Q1: 156–Q3: 376) since initial infection. No significant improvement in HRQoL, grip strength, cognitive function, walking capacity, or balance was observed during the intervention compared to the control period. Fatigue, anxiety, depression, symptom severity, functional disability, and dyspnea improved significantly.ConclusionThis study indicates beneficial effects of a 2 week multidisciplinary therapy program on symptom burden and functional outcomes of the post-COVID-19 condition. Further research including randomized controlled trials is warranted.Trial registrationGerman Clinical Trials Register, DRKS00029415. Registered 04 July, 2022. Retrospectively registered. https://drks.de/search/en/trial/DRKS00029415Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-026-13693-5.

interACTN Case #44: Available: https://interactn.org/2025/01/30/case-44-the-case-of-a-96-year-old-woman-with-tilt-of-subjective-vertical-axis/ A 96-year-old woman presents to the University Hospital Emergency Department by ambulance with hypertension and a tendency to fall to the left. The latter symptom had been present for 11 days and had worsened in the last few days. On clinical examination, the patient had a blood pressure of 230/110 mmHg, a tendency to fall to the left, and an inability to walk independently. Testing the subjective visual vertical (SVV) perception with the bucket test, the vertical visual axis was tilted about 20 degrees to the left. Brain MRI showed an ischemic infarct in the left dorsal spinocerebellar tract responsible for the SVV tilt.1, 2 The patient was transferred to the neuro-geriatric unit for 2 weeks. Early rehabilitation geriatric complex treatment focused on training of vertical axis perception and gait. She could be discharged home without any need for additional support. A tilt of the SVV can be caused by central lesions in different locations. The main structures in the network for verticality perception are graviceptive pathways running from the inner ear via vestibular nuclei, midline midbrain, the dorsolateral thalamus to the parieto-insular vestibular cortex (PIVC). Besides the vestibular system, a modulating network of different cerebral structures that integrates visual, spinal, and cerebellar information contributes to verticality perception. Depending on the lesion site, the tilt of the SVV can be ipsilateral (medullary brainstem lesions) or contralateral (midbrain lesions). Lesions of the vestibular thalamus, cerebellum, vestibulo-cerebellar tracts, and cortical areas can cause ipsilateral or contralateral tilt.1 Ischemic infarcts in the left dorsal spinocerebellar tract and subinsular right (see Fig. 1) close to the parieto-insular vestibular cortex (PIVC). The medullary lesion was likely causing the tilt in verticality perception.2 Video S1. Caption S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

BackgroundThe Comprehensive Geriatric Assessment (CGA) records geriatric syndromes in a standardized manner, allowing individualized treatment tailored to the patient’s needs and resources. Its use has shown a beneficial effect on the functional outcome and survival of geriatric patients. A recently published German S1 guideline for level 2 CGA provides recommendations for the use of a broad variety of different assessment instruments for each geriatric syndrome. However, the actual use of assessment instruments in routine geriatric clinical practice and its consistency with the guideline and the current state of literature has not been investigated to date.MethodsAn online survey was developed by an expert group of geriatricians and sent to all licenced geriatricians (n = 569) within Germany. The survey included the following geriatric syndromes: motor function and self-help capability, cognition, depression, pain, dysphagia and nutrition, social status and comorbidity, pressure ulcers, language and speech, delirium, and frailty. Respondents were asked to report which geriatric assessment instruments are used to assess the respective syndromes.ResultsA total of 122 clinicians participated in the survey (response rate: 21%); after data cleaning, 76 data sets remained for analysis. All participants regularly used assessment instruments in the following categories: motor function, self-help capability, cognition, depression, and pain. The most frequently used instruments in these categories were the Timed Up and Go (TUG), the Barthel Index (BI), the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Visual Analogue Scale (VAS). Limited or heterogenous assessments are used in the following categories: delirium, frailty and social status.ConclusionsOur results show that the assessment of motor function, self-help capability, cognition, depression, pain, and dysphagia and nutrition is consistent with the recommendations of the S1 guideline for level 2 CGA. Instruments recommended for more frequent use include the Short Physical Performance Battery (SPPB), the Montreal Cognitive Assessment (MoCA), and the WHO-5 (depression). There is a particular need for standardized assessment of delirium, frailty and social status. The harmonization of assessment instruments throughout geriatric departments shall enable more effective treatment and prevention of age-related diseases and syndromes.