心肺耦合分析在评估OSAHS睡眠质量的价值

目的 OSAHS漏诊率高,许多便携式设备不能评估OSAHS的睡眠质量,本文旨在评价心肺耦合分析在评估OSAHS睡眠质量的价值.方法 回顾性分析2010年2月至2011年10月于北京协和医院睡眠呼吸中心进行整晚多导睡眠监测的患者110例,根据呼吸暂停低通气指数(AHI)分为AHI正常组、OSAHS组;OSAHS组分为轻度、中度和重度OSAHS组.比较各组的多导睡眠图和心肺耦合谱,并分析多导睡眠图和心肺耦合谱的相关关系;应用ROC曲线确定睡眠质量正常的阈值.结果 OSAHS组的高频耦合(HFC)、高频耦合/低频耦合(HFC/LFC)比正常AHI组减少,而低频耦合(LFC)、抬高型的低频耦合(e-LFC)比正常AHI组增多.HFC与AHI呈强负相关(r=-0.791,P＜0.01),LFC、e-LFC与AHI呈强正相关(LFC:r=0.791;e=LFC:r=0.791,P＜0.01);当HFC≥44.55％时,判断睡眠质量正常敏感度是73.3％,特异度是68.8％.结论 OSAHS的心肺耦合谱表现为高频耦合减少,低频耦合增多,心肺耦合谱结果与OSAHS的严重程度相关.心肺耦合分析可以辅助便携式设备评估OSAHS患者的睡眠质量.     

Urinary levels of catecholamines among individuals with and without sleep bruxism

Introduction  Sleep bruxism (SB) is characterized by repetitive and coordinated mandible movements and non-functional teeth contacts during sleep time. Although the etiology of SB is controversial, the literature converges on its multifactorial origin. Occlusal factors, smoking, alcoholism, drug usage, stress, and anxiety have been described as SB trigger factors. Recent studies on this topic discussed the role of neurotransmitters on the development of SB. Objective  Thus, the purpose of this study was to detect and quantify the urinary levels of catecholamines, specifically of adrenaline, noradrenaline and dopamine, in subjects with SB and in control individuals. Materials and methods  Urine from individuals with SB (n = 20) and without SB (n = 20) was subjected to liquid chromatography. The catecholamine data were compared by Mann–Whitney’s test (p ≤ 0.05). Results  Our analysis showed higher levels of catecholamines in subjects with SB (adrenaline = 111.4 μg/24 h; noradrenaline = 261,5 μg/24 h; dopamine = 479.5 μg/24 h) than in control subjects (adrenaline = 35,0 μg/24 h; noradrenaline = 148,7 μg/24 h; dopamine = 201,7 μg/24 h). Statistical differences were found for the three catecholamines tested. Conclusion  It was concluded that individuals with SB have higher levels of urinary catecholamines.     

Cholangiocarcinoma in young individuals with and without primary sclerosing cholangitis

OBJECTIVES: We aimed at characterizing the clinical presentation and prognosis of cholangiocarcinoma in youth with and without primary sclerosing cholangitis (PSC). METHODS: Thirteen patients < or =25 yr of age with cholangiocarcinoma with or without PSC seen at the Mayo Clinic in Rochester, MN from 1980 to 2005 were identified. RESULTS: Of the 13 patients with cholangiocarcinoma, 8 had concomitant PSC and 5 did not. PSC was the associated risk factor in 8/13 (61.5%) whereas PSC was present in only 321/2,014 (15.9%) cases with cholangiocarcinoma in patients older than 25 (P < 0.0001) seen in the same period of time. Seven of the eight (88%) patients with cholangiocarcinoma and PSC had IBD and 5 of the 7 (71%) had Crohn's disease. A mean 11 months transplant free survival was observed (range 3-20 months) in cholangiocarcinoma with PSC versus 8 months in cholangiocarcinoma patients without PSC (NS). CONCLUSIONS: Cholangiocarcinoma is a rare disorder in young adults and it seems not to exist in children. The youth group of cholangiocarcinoma plus PSC seems to have a higher prevalence of Crohn's disease whereas the prognosis of cholangiocarcinoma in youth seems to be similarly poor as described in older patients with cholangiocarcinoma.     

Validation of a portable monitoring device for the diagnosis of obstructive sleep apnea: electrocardiogram-based cardiopulmonary coupling

Sleep and Breathing - We aimed to evaluate the validity of the cardiopulmonary coupling (CPC) device, a limited-channel portable monitoring device for obstructive sleep apnea (OSA) screening in one...     

Poor sleep quality and prevalence of probable sleep bruxism in primary and mixed dentitions: a cross-sectional study

Purpose

To investigate the prevalence of probable sleep bruxism (SB) in the primary and mixed dentitions using non-instrumental approach and evaluate whether sleep quality is associate with probable SB in different age ranges.

Methods

School-based cross-sectional study with children aged 2–5 (primary dentition, n?=?372) and 8–10 years old (mixed dentition, n?=?563) enrolled in public schools at Florianopolis and their parents. The sleep characteristics, socioeconomic status, and presence of probable SB were assessed using questionnaires. Seven trained examiners (Kappa?>?0.7) assessed tooth wear. Children were selected following a stratified sample (2–5); and a system of the proportionality, first the schools of the sanitary districts and after the classrooms (8–10). Unadjusted and adjusted Poisson regression was performed with probable SB as a dependent variable. Independent variables were as follows: family income, parent schooling, drooling, tooth wear, and sleep quality. The independent variables presenting p value ≤?0.20 were included in the adjusted model.

Results

The prevalence of probable SB was 22.3% in primary and 32.7% in mixed dentition. Probable SB was significantly associated with poor sleep quality (p?<?0.001) in mixed dentition (PR 1.80; 95% CI 1.34–2.44) adjusting for age and drooling. In the primary dentition, the adjusted regression did not show association between analyzed characteristic and probable SB. Sex, socioeconomic, head of the household educational status, drooling, and tooth wear were not associated with probable SB in both dentitions.

Conclusion

Prevalence of probable SB is higher in mixed than in primary dentition and poor sleep quality is associated with probable SB in children aged 8–10 years.

     

Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia

Objective

It is a matter of debate whether patients with primary insomnia require a polysomnographic examination in order to exclude specific sleep disorders such as sleep apnea syndrome (SAS) or periodic limb movements (PLM). Using a prospective design, we investigated the prevalence of organic sleep disorders by means of polysomnography (PSG) in a series of patients who were previously diagnosed with primary insomnia. This diagnosis was based on a clinical exam and an ambulatory monitoring device or previous PSG.

Methods

Seventy-seven women and 16 men (mean age 55.12?±?13.21?years) who were admitted for cognitive behavioral therapy for insomnia were evaluated by PSG including cardiorespiratory parameters and tibialis EMG. Among them, 50 patients had undergone a clinical exam by a sleep specialist; in 18 patients, actigraphy or portable monitoring had been performed to exclude SAS or PLM; 25 patients had undergone PSG in another sleep lab previously.

Results

In 32 patients (34% of the sample), a PSG revealed a specific sleep disorder (SAS 16; PLMD 11; both 5), resulting in therapeutic consequences for 21 patients (SAS 10; PLMD 9; both 2). SAS and PLM patients were older and SAS patients had a higher body mass index than insomnia patients without additional findings.

Conclusion

Indications for a PSG should be handled less restrictively in the diagnostic workup of older insomnia patients since they have a higher risk of comorbid sleep disorders even in the absence of the clinical signs of SAS or PLM.     

Subjective and objective sleep quality in elderly individuals: The role of psychogeriatric evaluation

Aging affects sleep and sleep problems are common in older individuals. However, the relationship between objective and subjective tools for analysing sleep and psycho-geriatric variables have not been tested in institutionalised older individuals. This work analyses sleep quality by using actigraphy as an objective tool and validates the Athens and Oviedo sleep questionnaires in octogenarian elderly individuals as subjective scales of sleep perception. All patients wore an actigraph device for one week and then completed the Athens and Oviedo clinical sleep-evaluation questionnaires. Morning cortisol levels in blood plasma and saliva samples were also measured to assess the association between objective and reported sleep patterns. Age, gender, and psycho-geriatric evaluations, including Barthel, Tinetti, and Mini-Mental scale measurements were analysed as variables with the potential to confound the strength of any such associations. There was a significant inverse correlation between the number of awakenings and the time spent awake during night assessed by actigraphy and the total Oviedo questionnaire score, but no significant associations for the other parameters. The blood cortisol concentration appears to be a marker of insomnia related to sleep times of less than four hours and diagnosis of insomnia based on Athens scale and thus, represents a potential marker for sleep interventions.     

Polysomnographic study of the effect of melatonin on sleep in elderly patients with chronic primary insomnia

The effect of 3-mg melatonin capsules p.o. on sleep in ten elderly patients suffering from chronic primary insomnia was assessed by polysomnographic recordings. In general, melatonin significantly reduced wake time after sleep onset and increased total sleep time and sleep efficiency during the 2-week treatment period. In five of the ten patients treated with melatonin, the increase in total sleep time was clinically significant. Side effects were absent during the period of drug administration. A slight increase of power density in the delta and the theta regions was found during the early phase (i.e. nights 4-5) of melatonin administration, whereas the opposite changes were observed at a late phase of treatment (i.e. nights 15-16). No strict correlation was found between prior 6-sulphatoxymelatonin levels in urine and subsequent sleep improvement after receiving melatonin. Our results further support the proposal that melatonin is beneficial for sleep disturbances in elderly insomniacs.     

Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests

OBJECTIVES: To compare balance in individuals with symptomatic knee osteoarthritis (OA) and in age-, gender- and body-mass-matched controls using simple clinical measures. METHODS: Thirty-three people with OA and 33 controls participated. Static postural sway [antero-posterior (AP), lateral and total] was measured using a swaymeter on two different surfaces and under two visual conditions. Dynamic standing balance was assessed using the 'step test'. RESULTS: Both groups displayed similar postural sway on most variables measured. Significantly greater sway was noted in the OA group on a firm surface in both lateral (eyes open) and AP directions (eyes closed), as well as total sway (eyes closed) (P < 0.05). Poorer dynamic standing balance was observed in the OA group as evidenced by the step test (P < 0.0001). CONCLUSIONS: Balance deficits can be identified in the osteoarthritic population using simple, inexpensive measures. However, the clinical relevance of the small deficits identified remains unknown and warrants further investigation.     

Clinical usefulness of a cardiopulmonary sleep study in patients with sleep apnea syndrome]

Although polysomnography is indispensable in the diagnosis of sleep apnea syndrome (SAS), a common disease in Japan, it is a time-consuming procedure. We therefore assessed the clinical usefulness of a cardiopulmonary sleep study (CPSS), which monitors indices of respiratory and circulatory kinetics during sleep. Of ninety male patients (50 +/- 11 years old, BMI: 27 +/- 4), those with apnea indices (AI) > 5, as determined using an apnomonitor, underwent CPSS with a Night Watch System. Sixty-nine patients with indications for nasal CPAP (NCPAP) therapy underwent overnight CPSS and the optimum pressure was determined. AI was 31 +/- 17, whereas CPSS showed an apnea-hypopnea index of 49 +/- 24, a mean SaO2 of 93 +/- 3%, and a minimum SaO2 of 71 +/- 11%, indicating severe OSAS. The mean optimum pressure was 10 +/- 2 cm H2O, and the compliance was 86%, which was comparatively good. As CPSS can be performed on many patients in a short time, it may be useful for the early diagnosis and initial treatment of SAS.     

Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens)

Background

An accurate diagnosis of pancreatic fibrosis is clinically important and may have potential for staging chronic pancreatitis. The aim of this study was to diagnose the grade of pancreatic fibrosis through a quantitative analysis of endoscopic ultrasound elastography (EUS-EG).

Methods

From September 2004 to October 2010, 58 consecutive patients examined by EUS-EG for both pancreatic tumors and their upstream pancreas before pancreatectomy were enrolled. Preoperative EUS-EG images in the upstream pancreas were statistically quantified, and the results were retrospectively compared with postoperative histological fibrosis in the same area. For the quantification of EUS-EG images, 4 parameters (mean, standard deviation, skewness, and kurtosis) were calculated using novel software. Histological fibrosis was graded into 4 categories (normal, mild fibrosis, marked fibrosis, and severe fibrosis) according to a previously reported scoring system.

Results

The fibrosis grade in the upstream pancreas was normal in 24 patients, mild fibrosis in 19, marked fibrosis in 6, and severe fibrosis in 9. Fibrosis grade was significantly correlated with all 4 quantification parameters (mean r = ?0.75, standard deviation r = ?0.54, skewness r = 0.69, kurtosis r = 0.67). According to the receiver operating characteristic analysis, the mean was the most useful parameter for diagnosing pancreatic fibrosis. Using the mean, the area under the ROC curves for the diagnosis of mild or higher-grade fibrosis, marked or higher-grade fibrosis and severe fibrosis were 0.90, 0.90, and 0.90, respectively.

Conclusions

An accurate diagnosis of pancreatic fibrosis may be possible by analyzing EUS-EG images.     

Comorbid insomnia and sleep apnea: characterization of the syndrome and understanding its associations with comorbid sleep conditions

Sleep and Breathing - Obstructive sleep apnea (OSA) is traditionally associated with excessive daytime sleepiness. Insomnia is characterized by hyperarousal, and is seen as a predominant feature in...     

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes

Objective

Phenotypical comparisons between individuals with obesity without binge eating disorder (OB) and individuals with obesity and comorbid binge eating disorder (OB + BED) are subject to ongoing investigations. At the same time, gender-related differences have rarely been explored, raising the question whether men and women with OB and OB + BED may require differently tailored treatments.

Method

We retrospectively compared pre- versus post-treatment data in a matched sample of n = 180 men and n = 180 women with OB or OB + BED who received inpatient treatment.

Results

We found that men displayed higher weight loss than women independent of diagnostic group. In addition, men with OB + BED showed higher weight loss than men with OB after 7 weeks of treatment.

Conclusions

The present findings add to an emerging yet overall still sparse body of studies comparing phenotypical features and treatment outcomes in men and women with OB and OB + BED; implications for further research are discussed.

Clinical Trial Registration

The study was prospectively registered with the German Clinical Trial Register as part of application DRKS00028441.     

Frontline treatment of elderly non transplant-eligible multiple myeloma patients using CyBorD with or without thalidomide-based consolidation: a retrospective multi-centre analysis of real-world data

Bortezomib in combination with cyclophosphamide and dexamethasone (CyBorD, is a well-established frontline chemotherapy regimen for patients with multiple myeloma, but prospective data on elderly non-transplant eligible patients is limited. A total of 155 patients aged 70 years or older with newly diagnosed multiple myeloma who received at least one cycle of CyBorD chemotherapy in three centres across New Zealand were evaluated. Partial response or better was achieved in 79·4%, of whom 52·9% achieved at least a very good partial response. After a median follow-up of 31·9 months, the median event-free survival (EFS) was 17·0 months (age 70–80 years, 17·7 months; age above 80 years, 8·6 months; P = 0·002). The median overall survival was 45·1 months (age 70–80, 49·8 months; above 80, 33·3 months; P = 0·003). Amongst those who had seven or more cycles of treatment, those who had a pre-planned switch to bortezomib-thalidomide-dexamethasone (VTD) consolidation had a superior median EFS of 25·4 months, compared with 20·3 months in the CyBorD only group (P = 0·028). This is the largest real-world dataset on the efficacy of CyBorD in the elderly population, and pre-planned switch to VTD was associated with better outcomes.     

Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis

Purpose  

Leptomeningeal metastases (LM) are associated with very poor prognosis and data on outcome are limited. We evaluated prognostic factors and treatment options in patients (pts) with LM of different malignancies in a single center experience.