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Background Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstruction of the upper airways during sleep. Conscious sedation for flexible bronchoscopy (FB) places patients in a sleep-like condition. We hypothesize that oxygen desaturation during flexible bronchoscopy may help to detect undiagnosed sleep apnea. Methods Single-centre, investigator-initiated and driven study including consecutive patients undergoing FB for clinical indication. Patients completed the Epworth Sleepiness Scale (ESS), Lausanne NoSAS score, STOP-BANG questionnaire and the Berlin questionnaire and underwent polygraphy within 7 days of FB. FB was performed under conscious sedation with propofol. Oxygen desaturation during bronchoscopy was measured with continuous monitoring of peripheral oxygen saturation with ixTrend (ixellence GmbH, Germany). Results 145 patients were included in the study, 62% were male, and the average age was 65.8 ± 1.1 years. The vast majority of patients (n = 131, 90%) proved to fulfill OSA criteria based on polygraphy results: 52/131 patients (40%) had mild sleep apnea, 49/131 patients (37%) moderate sleep apnea and 30/131 patients (23%) severe sleep apnea. Patients with no oxygen desaturation had a significantly lower apnea–hypopnea index than patients with oxygen desaturation during bronchoscopy (AHI 11.94/h vs 21.02/h, p = 0.011). This association remained significant when adjusting for the duration of bronchoscopy and propofol dose (p = 0.023; 95% CI 1.382; 18.243) but did not hold when also adjusting for age and BMI. Conclusion The severity of sleep apnea was associated to oxygen desaturation during flexible bronchoscopy under conscious sedation. Patients with oxygen desaturation during bronchoscopy might be considered for sleep apnea screening. Trial registration: The Study was approved by the Ethics Committee northwest/central Switzerland, EKNZ (EK 16/13) and was carried out according to the Declaration of Helsinki and Good Clinical Practice guidelines. Due to its observational character, the study did not require registration at a clinical trial registry.

Twelve isolates of entomopathogenic fungi belonging to Metarhizium robertsii, M. pinghaense, M. brunneum, Beauveria bassiana, and Isaria fumosorosea were screened against tarnished plant bug. All isolates were pathogenic, causing mortality from 28.8 ± 3.4 to 96.3 ± 2.7%. The LT50 values ranged from 2.7 to 6.0 d while the LT90 values varied between 6.6 and 15.0 d. Metarhizium robertsii isolate CPD6 (will be under the trade name NoVil) was among the isolates that caused high mortality within shorter times and was selected for study on developmental stages and greenhouse trial. The third-, fourth-, and fifth-instar nymphs, and adults were inoculated with 106, 107, and 108 conidia per ml of NoVil. All the stages were susceptible to fungal infection. However, third and fourth instars were the most susceptible with no significant differences in mortality across the three concentrations. On the other hand, mortality was dose-dependent with fifth-instar nymph and adult stages. The LT50 and LT90 values were also dose-dependent, with higher concentrations having shorter lethal-time values as compared to the lower concentrations. In the greenhouse, pepper plants were sprayed with NoVil and chemical insecticide Flonicamid (as industrial standard), before releasing adult tarnished plant bug. Mortality of 37.3, 75.5, and 76.3% was recorded in the control, NoVil, and Flonicamid, respectively. This study has identified NoVil as a potential mycoinsecticide candidate for the control of tarnished plant bug under greenhouse conditions. Further field testing on juvenile and adults is needed to evaluate the potential for in-field control.

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