Obstructive sleep apnea is associated with alterations in markers of fetoplacental wellbeing

Background: Obstructive sleep apnea (OSA) has been associated with adverse fetal outcomes in some studies. Second trimester Down syndrome screening markers reflect fetal and fetoplacental wellbeing. We aimed to compare markers of fetal and feto-placental wellbeing in women with OSA and low risk controls.

Methods: A retrospective case-control study of pregnant women with OSA and available second trimester markers was performed. Controls were screened for sleep disordered breathing (SDB) at the time of delivery using a questionnaire. Women at low risk for OSA were selected. Marker levels were adjusted for gestational age and race and reported as multiples of median and later adjusted for body mass index (BMI).

Results: Twenty-four OSA cases and 166 controls were identified. Women with OSA had a higher mean BMI when compared to controls (37.1?±?12.7 versus 24.1?±?5.1, p?=?0.03). Estriol (uE3) multiples of the median (MoM) levels were lower in women with OSA compared to controls, even after adjusting for BMI, 0.74 (interquartile range (IQR) 0.45) versus 1.06 (IQR 0.38), respectively, p?=?0.026. Once adjusted for BMI, alpha feto-protein (AFP) MoM levels were no longer significantly different in women with OSA compared to controls.

Conclusion: OSA is associated with reduced serum uE3 levels, independently of BMI, possibly indicating fetal distress.     

Developmental cholinotoxicity of lead: loss of septal cholinergic neurons and long-term changes in cholinergic innervation of the hippocampus in perinatally lead-exposed rats

The effects of perinatal lead exposure on choline acetyltransferase-immunoreactive (ChAT-IR) cell counts in the medial septum and AChE-positive fiber counts in the hippocampus were examined in relation to changes in cholinergic markers in the septohippocampal pathway of the rat. Maternal exposure to 0.2% lead acetate in drinking water from gestational day 16 through weaning at post-natal day 21 (P21) induced in the offspring a 30% reduction in septal ChAT activity and a 20% reduction in ChAT-IR cell profile counts in the medial septum/vertical diagonal band (MS/vDB). These changes were seen as early as P7, persisted through 2 months post-exposure (P81), and were followed by recovery of ChAT activity but not the ChAT-IR cell numbers, at 3 months post-exposure (P112). The loss of ChAT activity and ChAT-IR neurons in the septum was temporally associated with a reduction of ChAT activity (30%), hemicholinium-3 (HC-3) binding (40%), and AChE-positive fiber counts (13–15%) in the hippocampus. The hippocampal ChAT activity and AChE-positive fiber counts returned to control levels by P112 whereas HC-3 binding was restored to normal levels by P200. These results indicate that perinatal, low-level lead exposure induces loss of septohippocampal cholinergic projection neurons in neonate animals, resulting in a deficit in hippocampal cholinergic innervation that persists into young adulthood. The disruption of cholinergic septohippocampal system may be an important factor in lasting cognitive impairments associated with early Pb exposure.     

Excessive daytime sleepiness in late pregnancy may not always be normal: results from a cross-sectional study

Purpose

Many changes that normally occur during pregnancy disrupt sleep and may lead to excessive daytime sleepiness (EDS). However, given that pregnancy may also predispose to the development of sleep-disordered breathing (SDB), we sought to investigate whether EDS may be associated with snoring, gasping, or apneas, further suggesting SDB.

Methods

A cross-sectional survey of women in the immediate postpartum period was conducted. Participants answered questions from the multivariable apnea prediction index regarding snoring, gasping, and witnessed apneas in the last 3 months of pregnancy. Participants were also asked to answer Epworth Sleepiness Scale (ESS) questions, and a score 0–24 was calculated (>10 considered abnormal). Medical history and medication use were obtained both by history and review of the medical record.

Results

Out of 1,000 women recruited, 990 women answered the ESS questionnaire completely. Mean prepregnancy body mass index (BMI) was 26.1?±?6.2 with 21.7 % of the sample having a prepregnancy BMI ≥30. Mean ESS score was 7.1?±?3.9, and 1.7 % of the total sample scored 16 or greater. ESS increased significantly with age, BMI, and neck circumference. All three symptoms of SDB were associated with higher mean ESS scores. In a multiple linear regression analysis, loud snoring, gasping, and apneas were statistically significant independent predictors of mean ESS score.

Conclusions

EDS measured by ESS is a common finding in pregnancy. Snoring, gasping, and apneas appear to be independent predictors of mean ESS scores.     

The use of the PleurX catheter in the management of non-malignant pleural effusions

Purpose: To evaluate the effectiveness of the PleurX catheter in the management of recurrent non-malignant pleural effusions. Methods: All subjects who underwent a PleurX catheter placement between 2003 and 2009 were evaluated. General demographic data, time to pleurodesis, complications, and a satisfaction questionnaire were collected. The subjects were divided into two groups. Group I included patients with non-malignant effusions and group II included patients with malignant effusions. Results: A total of 64 subjects were included in the final data analysis. A total of 23 subjects were included in group I and 41 subjects were included in group II. The diagnoses in group I included congestive heart failure (CHF; 13), hepatic hydrothorax (8), traumatic bloody (1), and idiopathic exudative (1). The diagnoses in group II included lung cancer (20), breast cancer (11), colon cancer (5), prostate cancer (2), B-cell lymphoma (2), and mesothelioma (1). The time to pleurodesis was 36 ± 12 days for group II compared to 110.8 ± 41 days for group I (p < 0.0001). The mean satisfaction score was similar in both groups (3.8 ± 0.4). Time to pleurodesis was significantly shorter in hepatic hydrothorax compared to CHF (73.6 ± 9 days vs. 113 ± 36 days, p = 0.006). There was one case of exit site infection in a patient with hepatic hydrothorax. Among subjects who were alive at 3 months after the catheter removal, none had recurrence of their pleural effusion. Conclusion: The Denver catheter was effective in achieving pleurodesis in non-malignant pleural effusions. The complication rate was low and patient satisfaction was high.