Study Objectives: This study aimed to examine the effect of sleep state (rapid eye movement [REM] versus non-rapid eye movement [NREM]) and position (supine versus non-supine position) on obstructive respiratory events distribution in adolescent population (ages 12 to 18 y). Methods: This was a retrospective study that included 150 subjects between the ages of 12 to 18 y with an apnea-hypopnea index (AHI) > 1/h. Subjects using REM sleep-suppressant medications and subjects with history of genetic anomalies or craniofacial syndromes were excluded. Results: The median age was 14 y with interquartile range (IQR) of 13 to 16 y, 56% of patients were males and the median body mass index (BMI) z-score was 2.35 (IQR: 1.71-2.59) with 77.3% of patients fulfilling obesity criteria. Respiratory obstructive events were more common in REM sleep. The median REM obstructive AHI (OAHI) was 8.9 events per hour (IQR: 2.74-22.8), whereas the median NREM OAHI was 3.2 events per hour (IQR: 1.44-8.29; p < 0.001). African American adolescents had more REM obstructive events with median REM OAHI of 13.2 events per hour (IQR: 4.88-30.6), which was significantly higher than median REM OAHI of 4.94 (IQR: 2.05-11.36; p = 0.004) in white adolescents. Obstructive events were more common in supine position with higher median supine OAHI of 6.55 (IQR: 4-17.73) when compared to median non-supine OAHI of 2.94 (IQR: 1-6.54; p < 0.001).Conclusions: This study shows that sleep related obstructive respiratory events in the adolescents (12 to 18 y of age) occur predominantly in REM sleep and in supine position. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a sleep related breathing disorder that can affect up to 5% of children.1 It is characterized by partial or complete upper airway obstruction that can disrupt normal sleep ventilation and sleep pattern.2 This upper airway obstruction can occur in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. In REM sleep, the withdrawal of excitatory noradrenergic and serotonergic inputs to upper airway motor neurons further reduces pharyngeal muscle activity, which together with reduced arousal threshold and reduced ventilatory responses to hypoxia and hypercapnia increase the propensity for upper airway obstruction in REM sleep, with more prolonged obstructions accompanied by severe desaturations. Although obstructive respiratory events in children, unlike adults, is thought to be REM predominant, a subset of pediatric population may have NREM predominance of their obstructive respiratory events. [4][5][6] Also, the effect of position on the distribution of obstructive respiratory events in the pediatric population is not consistent among different studies. [7][8][9][10][11][12] Furthermore, previous studies assessing the effect of sleep stage and position on the distribution of obstructive respiratory events did not explore such effects in a pediatric adolescent population. ObjectiveThe objective of this study was to examine the distribution of obstructive respiratory events in REM versu...

Introduction: National guidelines endorse that eligible acute ischemic stroke (AIS) patients should be treated with intravenous tissue plasminogen activator (IV tPA) within 60 minutes of arrival to an emergency department (ED). We participated in the American Heart Association’s Target: Stroke program which successfully reduced door to needle (DTN) times through 10 best practices, but academic hospitals face a unique challenge as junior residents evaluate and manage AIS patients. We hypothesized that a “stroke boot camp” could improve resident efficiency during stroke codes and shorten DTN times through faster stroke code to tPA times. Methods: A neurology resident educational protocol was developed and implemented in April 2013 using a Socratic case-based discussion to emphasize focused history and exam, medication history, and tPA exclusion criteria. We distributed cards with IV tPA risks/benefits and a checklist for tPA exclusion criteria. We compared pre-intervention (January 2010-April 2013) to post-intervention (April 2013-April 2014) patient demographics, comorbidities, resident level, relevant times, and outcomes using appropriate tests. Results: We analyzed 122 consecutive AIS patients treated with IV tPA in our ED during the study period. Pre and post intervention groups did not differ by demographics except gender (p = 0.005). There were no difference in comorbidities, baseline NIHSS, or resident post graduate year (PGY). After the intervention, stroke-code-to-tPA was significantly reduced (75 min vs. 45 min; p < 0.001), whereas door-to-stroke-code (7 min vs. 6 min, p = 0.56) and door-to-CT (18 min vs. 19 min, p = 0.44) did not change. The proportion of patients treated within 60 minutes increased (16.4% vs. 51.4%, P < 0.001) and median DTN time decreased (81 min vs. 60 min P < 0.001) significantly after the intervention. Time reductions were consistent across PGY levels without increased adverse outcomes. Conclusion: Reduction in stroke code-to-tPA times after implementation of a “stroke boot camp” led to a significant reduction in DTN time. Focused neurology resident acute stroke education should be implemented at academic institutions to improve rapid IV tPA administration