Time course of continuous positive airway pressure effects on central sleep apnoea in patients with chronic heart failure

Continuous positive airway pressure (CPAP) causes a variable immediate reduction in the frequency of central apnoeas and hypopnoeas in patients with congestive heart failure (CHF) and central sleep apnoea (CSA), but has beneficial mid-term effects on factors known to destabilize the ventilatory control system. We, therefore, tested whether CPAP therapy leads, in addition to its short-term effects on CSA, to a significant further alleviation of CSA after 12 weeks of treatment on the same CPAP level in such patients. CPAP therapy was initiated in 10 CHF patients with CSA. During the first night on CPAP, the pressure was stepwise increased to a target pressure of 8–12 cmH₂O or the highest level the patients tolerated (<12 cmH₂O). Throughout the second night (baseline CPAP), the achieved CPAP of the first night was applied. After 12 weeks of CPAP treatment, we performed a follow-up polysomnography (12 weeks CPAP) on the same CPAP level (8.6 ± 1.1 cmH₂0). We found a significant reduction of the apnoea-hypopnoea index (AHI) between the diagnostic polysomnography and baseline CPAP night (41.8 ± 19.2 versus 22.2 ± 12.6 events per hour; P  = 0.005). The AHI further significantly decreased between the baseline CPAP night and the 12 weeks CPAP night on the same CPAP level (22.2 ± 12.6 versus 12.8 ± 11.0 events per hour; P  = 0.028). We conclude that, in addition to its immediate effects, CPAP therapy leads to a time-dependent alleviation of CSA in some CHF patients, indicating that in such patients neither clinical nor scientific decisions should be based on a short-term trial of CPAP.     

MAGNETIC RESONANCE IMAGING IN ALCOHOLIC KORSAKOFF'S SYNDROME: EVIDENCE FOR AN ASSOCIATION WITH ALCOHOLIC DEMENTIA

A magnetic resonance imaging study of 19 alcoholic Korsakoffpatients, 17 non-amnesic alcoholics and 23 non-alcoholic controlswas undertaken. Several measures of ventricular size and interhemisphericarea were significantly greater in the Korsakoff patients. Interhemisphericfissure size was greater in the non-amnesic alcoholics thanthe non-alcoholic controls. Cortical grey matter T₁ values wereessentially the same for the three groups, whereas the deepgrey and the white matter T₁ values for the Korsakoff patientswere significantly greater than the non-alcoholic controls.These results indicate widespread cerebral atrophy in alcoholicKorsakoff patients, which is largely subcortical and does notdevelop independently of the diencephalic pathology. Alcoholicdementia may be a more severe form of alcoholic Korsakoff syndrome,aetiologically related to the nutritionally-induced diencephalicpathology, rather than the neurotoxic effects of alcohol onthe cortex.     

The predictive value of fetal breathing movements in the outcome of premature labour

Summary. Fetal breathing movements (FBM) were assessed in 28 pregnant women, presenting with uterine contractions before 34 weeks gestation. External tocometry was used to determine uterine contractions objectively. The first group consisted of 17 patients, treated by tocolytics after the ultrasound scanning showed absence of FBM. The second group comprised 11 patients with FBM present, who were observed only. In the first group nine women were delivered within 1 week, whereas in the second group no patient was delivered in that period, all of them being discharged. In patients with premature contractions the presence of FBM seems to indicate that the pregnancy will continue while absence of FBM foreshadows early delivery.