The association between sleep apnea and young adults with hypertension.

OBJECTIVES/HYPOTHESIS: To study the association between sleep apnea and hypertension in a younger age group than previously studied, adding upper airway sizes at endoscopy as important compounding variables not often included in the past. STUDY DESIGN: Case control. METHODS: We analyzed data on sleep-disordered breathing (based on polysomnography tests), body mass index (BMI), neck circumference, upper airway endoscopy sizes, and habitus and health history in 120 hypertensive and 120 nonhypertensive participants in a clinic-based setting. Independent t test, χ(2) , multivariate analysis, and binary logistic regression models were used for case-control comparison. RESULTS: The mean age of the participants was 27 years; 67.5% were male. The incidence and severity of sleep apnea were significantly higher in the hypertensive than the control subjects. Persons with hypertension had an OR of 2.7 times of having comorbid sleep apnea than patients without hypertension (95% confidence interval [CI] 1.2-6.1). Persons with sleep apnea (AHI [apnea-hypopnea index] ≥ 5) had an OR of 2.76 (95% CI 1.57-4.86), and persons with severe sleep apnea (AHI ≥ 30) had an OR 7.94 (95% CI 4.21-15.33) for having hypertension than did persons without sleep apnea. Although adjustments for the compounding factors, particularly BMI, decreased the OR to a large degree, subjects with severe sleep apnea were still 72% more likely to have hypertension than subjects without sleep apnea. CONCLUSIONS: Sleep apnea is related to hypertension in young adults aged 18 to 40 years. The association was more pronounced with the increasing severity of sleep apnea. Screening for sleep apnea should be considered in young adults with hypertension.

Rate of recurrent vestibular schwannoma after total removal via different surgical approaches.

OBJECTIVES: The objective of this study was to assess the differences in the recurrence rates of vestibular schwannoma (VS) after total tumor removal through enlarged translabyrinthine (ETL), retrosigmoid (RS), and middle cranial fossa (MCF) approaches. Our results were compared with previously published data, and literature reviews were done to identify the possible causes for the recurrence of VS. METHODS: We performed a retrospective analysis of 2,400 cases of VS that underwent removal at the Gruppo Otologico, Piacenza, Italy, from 1983 until 2010. The minimum postoperative follow-up was 12 months. We also reviewed the previously published data on recurrence rates of VS after ETL, RS, and MCF approaches. RESULTS: Total tumor removal was achieved in 2,252 cases (93.8%). The recurrence rate was 0.05% for the ETL approach, 0.7% for the RS approach, and 1.8% for the MCF approach. Literature reviews of 3 previously published case series utilizing the translabyrinthine approach showed that none of the primary tumors were less than 2.0 cm in size. Recurrences were seen between 1 and 13 years after the initial surgery. CONCLUSIONS: The rate of VS recurrence after total removal is exceptionally low in experienced hands. Undetected microscopic deposits left on crucial points such as the facial nerve, the preserved cochlea nerve, or the fundus of the internal auditory canal could be possible causes for the recurrence. A definite advantage of an ETL approach is the excellent internal auditory canal exposure, resulting in an extremely low rate of VS recurrence. The patients should be followed up to 15 years with gadolinium-enhanced magnetic resonance imaging (with fat suppression sequence in ETL approach cases). Recurrent VS may exhibit a faster growth rate than primary VS.