Snoring, daytime sleepiness and stroke: a case-control study of first-ever stroke

Previous reports have shown an association between snoring and stroke but it is not clear whether this reflects confounding factors nor whether the association is attributable to obstructive sleep apnoea (OSA). We performed a case-control study of 181 patients admitted to hospital with first-ever stroke and community control subjects matched individually for age, sex and general practitioner. Subjects were interviewed with a structured questionnaire to identify snoring, daytime sleepiness and stroke risk factors. The association between snoring alone and stroke was not statistically significant: odds ratio (95% CI) 1.44 (0.88, 2.41). Daytime sleepiness was, however, significantly associated with stroke: odds ratio 3.07 (1.65, 6.08). Multiple logistic regression showed that hypertension, current smoking, taking alcohol regularly (negatively) and a higher Epworth sleepiness score were independently associated with stroke. The results suggest that the previously reported association between 'simple' snoring and stroke might have been due to poor controlling for confounding variables. Our study suggests an association with greater sleepiness prestroke, the cause of which is unclear, although OSA is a possible candidate.     

Snoring & sleep apnea: a population study in Italian women

The aim of this cross-sectional study was to evaluate the prevalence of sleep-disordered breathing by means of a validated portable instrument (MESAM IV) and to investigate the relationship between snoring and sleep apnea in a sample of Italian middle-aged female population. We randomly chose 750 subjects aged 40 to 65 years and 365 agreed to participate to the study. In this group, 19.7% of subjects were every-night snorers according to the questionnaire; when recorded, 54.2% snored for more than 10% of the night, and 7.1% for more than 50% of the night. Sleep apnea was also common: 10.7% of subjects had a respiratory disturbances per hour (RDI) between 5 and 9, 7.7% an RDI between 10 and 19, and 2.2% had an RDI > or =20. Snoring percentage and RDI were significantly correlated. However, 50% of subjects who snored for more than half the night had no evidence of sleep apnea. Snoring amount >50% resulted influenced by body mass index, while RDI>10 was influenced by neck diameter. We concluded that in middle-aged women, both snoring and sleep apnea are very common. A high percentage of snoring is not essential for the occurrence of sleep apnea, nor it necessarily indicates the presence of sleep apnea.     

Molecular and epidemiological study of Salmonella clinical isolates

A survey of Salmonella infections was carried out over a 1-year period in the rural community covered by the Hospital Reina Sofía (Tudela, Spain). The 255 strains that were collected were studied by serotyping, antimicrobial resistance, and plasmid profile analysis. The predominant serotype was S. enteritidis (85.90%), followed by S. typhimurium (7.06%) and S. virchow (2.36%). Only 7.84% of the strains were resistant to antimicrobial agents. The most common resistance was to beta-lactam antibiotics. This resistance was due to the presence of one of two types of beta-lactamases, TEM-1 or TEM-2. Resistance to kanamycin was associated with the synthesis of a 3'-O-phosphotransferase. The resistance to streptomycin and chloramphenicol was either not enzymatic or was due to a 3"-O-phosphotransferase and a chloramphenicol acetyltransferase, respectively. Analysis of total plasmid DNA content revealed the presence of plasmids in 96.08% of the isolates. According to their plasmid profile, the strains could be classified into different groups. The three main groups, which accounted for 50.19, 20.78, and 4.70% of the isolates, respectively, corresponded to the antimicrobial-susceptible S. enteritidis serotype. These results suggested that plasmid profile analysis in conjunction with antimicrobial resistance determination can be useful for subtyping resistant Salmonella isolates.     

风疹病毒分子流行病学研究

目的 阐述风疹病毒(RV)的遗传变异规律及分子流行病学特点。方法 利用RT-PCR扩增RVE1基因，然后测序，并用DNA STAR软件包绘制系统发生树，以分析RV的分子流行病学特点。结果 测得RV JR23株E1基因的序列，与GenBank中包括3株中国株在内的不同时间、地点分离的30株病毒株一起绘制了系统发生树，比较了各株可产生HI抗体和中和抗体区的氨基酸变异情况。(1)总体上RV的核酸、氨基酸序列高度保守。中国的4株分离株遗传性质差别相对较大，其中379株和BRD株构成了不同于其他29株的基因Ⅱ型，就其遗传来源及生物学性状需进一步研究。(2)JR23株与英、美、日20世纪60年代流行株序列相近，其遗传来源可能为20世纪60年代世界流行株的中国衍生株，但具体的初始流行时间未知。结论 RV的流行有地域的差异，其分子流行病学特点与时间有关。因为人是RV的惟一宿主，所以人员的流动性，影响了RV的流行特点。     

Glucose-induced or postprandial hyperinsulinemia in mild essential hypertension--an underestimated biochemical risk indicator?

Even if glucose tolerance is normal, a glucose-stimulated or postprandial hyperinsulinemia can frequently be observed in patients with early stages and mild forms of essential hypertension. Numerous epidemiological, clinical and experimental data suggest that hyperinsulinemia might be an independent risk factor for atherosclerosis which should be paid more attention. It could be hypothesized that, apart from the haemodynamic phenomenon of high blood pressure, the postprandial hyperinsulinemia of patients with mild essential hypertension might be relevant to their cardiovascular risk.     

Snoring predicts hyperactivity four years later

STUDY OBJECTIVES: Cross-sectional studies implicate snoring and sleep-disordered breathing as potential contributors to hyperactive behavior in some children. However, no prospective cohort study has demonstrated that symptoms of sleep-disordered breathing precede development of hyperactivity. PARTICIPANTS: Parents of 229 children aged 2 to 13 years, recruited at 2 general pediatrics clinics, completed initial and 4-year follow-up surveys. MEASUREMENTS: Surveys included a validated Pediatric Sleep Questionnaire about snoring, sleepiness, and overall risk of sleep-disordered breathing, and the hyperactivity index (expressed as a T-score) within the Conners' Parent Rating Scale. RESULTS: Thirty children (13%) were rated as hyperactive (hyperactivity index > 60) at follow-up. After adjustment for hyperactivity at baseline and stimulant use at follow-up, hyperactivity at follow-up was predicted by baseline habitual snoring (odds ratio = 4.4, 95% confidence interval [1.3, 14.7]) or loud snoring (4.5, [1.2, 17.5]) and by top-quartile composite scores for snoring (5.3, [1.7, 16.8]), sleepiness (3.0, [1.0, 9.4]), or sleep-disordered breathing (4.0, [1.4, 11.6]). CONCLUSIONS: This 4-year prospective cohort study shows that snoring and other symptoms of sleep-disordered breathing are strong risk factors for future emergence or exacerbation of hyperactive behavior. These findings support the hypothesis that untreated childhood sleep-disordered breathing contributes to development of hyperactivity.     

An epidemiological study of histrionic personality disorder

In conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD, a two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria. This report details the observations on those subjects diagnosed with the DSM-III diagnosis Histrionic Personality Disorder. The results indicate that this condition can be diagnosed reliably and that it is a valid construct. It has a prevalence of 2.1% in a general population. Males and females are equally affected, suggesting that prior reports of an increased prevalence in females was an expression of ascertainment bias found in hospital-based studies. The diagnosis is associated with clear evidence of disturbance in the emotional, behavioural, and social realms. Individuals with this disorder tend to use health care facilities more frequently than others.     

An epidemiological study of haemagglutination in hepatitis

An epidemiological study of 36 U.S. Marines living in a barracks and exposed to infectious hepatitis was made, and the ability of their sera to agglutinate day-old chick erythrocytes was found to be abnormally high in 52.8% of the group. The other groups of American Servicemen similarly exposed showed no such deviation from the normally expected incidence of raised titres. An unexplained, abnormally high incidence of raised titres was found in several control groups. The titres appeared to be unaffected to any significant degree by gamma globulin prophylaxis or yellow fever immunization.     

An epidemiological study of atopy in children

A sample of 930 children, between 9 years and 15 years old from six Italian towns, were studied. Their family history of allergy, personal allergy and medical history, current allergy symptoms, exposure to environmental allergens, feeding as infants, and their parents' occupations were recorded. They were skin-prick tested (SPT) with a range of common allergens. A subject was defined as atopic if at least one SPT caused a weal greater than 3 mm diameter. The association between the recorded information and atopy was investigated by logistic multiple regression. Atopy was positively associated with: high density housing; medium or high exposure to environmental allergens; a history of rhinitis, asthma or atopic eczema; male gender; and a history of breast-feeding. It was independent of infectious diseases, vaccinations and operations, social class and family history. Thus, there was no evidence of a genetic factor in atopy, other than sex.     

Parental obesity combined with hypertension--an indicator of excess risk of hypertension in offspring. A case-control study in a Swedish primary care district

A case-control study was performed to estimate the excess risk of hypertension in a defined population. The study comprised 121 hypertensive patients, aged 40-59 years, and 138 non-hypertensive controls selected from the same primary care district. Parental obesity combined with hypertension proved to be a stronger risk indicator of hypertension in offspring than parental hypertension itself. Other risk indicators were obesity, hypertension in siblings and a positive family history of myocardial infarction. In order to study the size of the problem we estimated the prevalence of hypertension and borderline hypertension in the district. Patients with these diagnoses amounted to about one fourth of the middle-aged population in the district. More than 80% of the hypertensives had been diagnosed before this study, but only about 20% of the borderline hypertensives were previously known.     

An epidemiological study of REM latency and psychiatric disorders.

In an epidemiological population study 87 subjects were studied with home sleep recordings. Nineteen subjects had minor psychiatric disorders: six subjects had a minor depression, six subjects had a generalized anxiety disorder, and seven subjects had a mild vegetative discomfort syndrome. Syndrome profiles of the three groups, using the AMDP system, showed a significantly higher degree of insomnia in the anxiety group than in the depressive group. The mean rapid eye movement (REM) latency in the anxiety group was significantly longer than in the other groups, including normals. The study showed a slight tendency towards a reduced REM latency in the minor depressives, but no statistical significance was obtained.