Sex Differences in Excessive Daytime Sleepiness Among Patients With Obstructive Sleep Apnea

Background@#and Purpose To identify sex differences in daytime sleepiness associated with apnea severity and periodic limb movements during sleep (PLMS) in subjects with obstructive sleep apnea (OSA). @*Methods@#This study used the Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Sleep Hygiene Index (SHI) in logistic regression analyses with interaction terms. Severe OSA, excessive daytime sleepiness (EDS), and PLMS were defined as an apnea-hypopnea index of ≥30, an ESS score of ≥11, and a periodic limb movements index of >15, respectively. @*Results@#The 1,624 subjects with OSA (males, 79.1%) comprised 45.3%, 38.2%, and 16.4% with severe OSA, EDS, and PLMS, respectively. Multiple logistic regression without interaction terms showed that sex, severe OSA, and PLMS were not significantly associated with EDS. However, significant interactions were noted between sex and severe OSA and PLMS in EDS in both crude and adjusted models (all p values<0.05). In the adjusted model, severe OSA was associated with EDS in males (p=0.009) but not in females. PLMS were more likely to be associated with EDS in females (p=0.013), whereas PLMS were less likely to be associated with EDS in males (p=0.041). The models were adjusted by the BDI score, SHI, and presence of medical comorbidities. @*Conclusions@#There are significant sex differences in subjective daytime sleepiness in subjects with severe OSA and PLMS. Severe OSA and PLMS may influence daytime sleepiness more in males and females, respectively.

Cerebral Infarction Caused by Direct Cardiac Tumor Emboli Mixed with Thrombus

Cerebral infarction in cancer patients is often caused by thrombosis due to hypercoagulability, and in some cases, caused by direct tumor embolism. We report the case of cerebral infarction due to direct tumor embolism mixed with thrombus. Biopsy of blood clots obtained during thrombectomy is important for diagnosis. If there is a high risk of thrombosis among cancer patients with cerebral infarction, the use of appropriate antithrombotic agents along with maintaining a certain level of platelets should be considered.

Aneurysmal Subarachnoid Hemorrhage Following Intravenous Thrombolysis in Acute Ischemic Stroke

BACKGROUND: An incidental finding of unruptured aneurysm, which is a contraindication to the recombinant tissue plasminogen activator (rtPA), is common in patients with acute ischemic strokes. However, reports describing the rupture of intracranial aneurysm following the administration of rtPA are extremely rare. CASE REPORT: A 51-year-old man presented to the emergency room with global aphasia. A computed tomography (CT) of the brain revealed no intracranial hemorrhage. Since global aphasia occurred in an hour, rtPA was administrated intravenously. A CT angiography was performed 2 hours after an infusion of rtPA, which despite the absence of neurological deterioration and blood pressure surge, revealed subarachnoid hemorrhage in the right cerebral hemisphere, in addition to a 3-mm saccular aneurysm with a bleb in the right middle cerebral artery. CONCLUSIONS: Aneurysmal subarachnoid hemorrhage can develop following the infusion of rtPA. Hence, unruptured aneurysm may not simply be an “incidental finding” in stroke patients receiving rtPA.

Comparing the Effect of Botulinum Toxin Type B Injection at Different Dosages for Patient with Drooling due to Brain Lesion

OBJECTIVE: To investigate Botulinum toxin type B (BNT-B) injection's effect and duration depending on dose for patients with brain lesion. METHOD: Twenty one patients with brain lesion and severe drooling were included and divided into three groups. All patients received conventional dysphagia therapy. Group A patients (n=7) received an injection of 1,500 units and group B patients (n=7) received an injection of 2,500 units of BNT-B in submandibular gland under ultrasound guidance. Group C patients (n=7) received conventional dysphagia therapy. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 2, 4, 8, and 12. The severity and frequency of drooling was assessed using the Drooling Quotient (DQ) by patients and/or caregivers. RESULTS: Group A and B reported a distinct improvement of the symptoms within 2 weeks after BNT-B injection. Compared to the baseline, the mean amount of saliva decreased significantly throughout the study. However, there was no meaningful difference between the two groups. The greatest reductions were achieved at 2 weeks and lasted up to 8 weeks after BNT-B injection. Group C did not show any differences. CONCLUSION: Local injection of 1,500 units of BNT-B into salivary glands under ultrasonic guidance proved to be a safe and effective dose for drooling in patient with brain lesion, as did 2,500 units.

Factors Associated with Depressive Symptoms in Patients with Chronic Low Back Pain

OBJECTIVE: To investigate depressive symptoms and their related factors in patients with chronic low back pain in Korea. METHOD: A cross-sectional study using data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2009 was undertaken. The sample consisted of 1,426 participants with chronic low back pain. Multifactorial regression analysis was used to identify the association between depressive symptoms and socioeconomic demographics and other chronic diseases. RESULTS: Among the 371 (26.0%) patients with depression, significant factors associated with depressive symptoms were female gender (odds ratio [OR], 2.691; 95% confidence interval [CI], 1.724-4.199), medical aid beneficiary (OR, 1.371; 95% CI, 1.039-1.810), a dependent group for activities of daily living (OR, 1.570; 95% CI, 1.180-2.087), 'not good' in the perceived health category (OR, 2.309; 95% CI, 1.730-3.081) and in a cancer group (OR, 1.803; 95% CI, 1.051-3.093). CONCLUSION: This study provides the foundation for managing patients with chronic low back pain and depressive symptoms. Clinicians managing chronic low back pain should consider risk factors for depressive symptoms.