Comorbidities in Clinical and Polysomnographic Features of Obstructive Sleep Apnea: A Single Tertiary Care Center Experience.

BACKGROUND: Research on obstructive sleep apnea (OSA) is inadequate in Saudi Arabia, particularly among patients with comorbidities. This study investigates comorbidities in patients with different severity of apnea based on the Apnea-Hypopnea Index (AHI). METHODS: The retrospective charts review that included a cohort of 4391 patients who underwent polysomnography (PSG) between 2003 and 2019. The AHI is classified into four ordinal groups: normal, mild, moderate, and severe. Ordinal logistic regression was used to model proportional odds of a higher AHI category. RESULTS: Gender was distributed equally in the study sample. The average age was 49.6 ± 14.8 years and the average AHI was 16.1 ± 22 per hour. Hypertension (43.2%) and diabetes mellitus (37.3%) were the most common comorbidities: Mild OSA 28.9%, Moderate OSA 15.6%, and severe 16.4%. The severity of apnea increased with age and BMI classes. The prevalence of hypertension increased with the severity of apnea: 42.9% in mild, 47.4% in moderate, and 54.6% in severe AHI. The prevalence of coronary artery disease (CAD), congestive heart failure (CHF), and diabetes mellitus (DM) increased with the severity of apnea. Comorbidities was more among OSA patients with excessive sleepiness. After adjustment for age and gender, greater proportional odds of severe AHI were observed in males (aOR = 1.8), 30-59 years (aOR = 2.064), 60 years or above (aOR = 2.873), obese class II (aOR = 2.016), obese class III (aOR = 2.527), and in patients with hypertension (aOR = 1.272). CONCLUSION: Hypertension and obesity were highly prevalent in the study cohort and were associated with greater proportional odds of severe AHI.

Adherence to the American Society for Colposcopy and Cervical Pathology guidelines: an observational study

Objective@#The 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines were developed to provide guidance regarding cervical pathology and to minimize overtreatment of lesions that may resolve spontaneously. We aimed to evaluate the adherence to these guidelines with referrals for colposcopy at a large academic center and to understand the factors associated with incorrect referrals. @*Methods@#This retrospective observational study involved women referred to the Virginia Commonwealth University for colposcopy or loop electrosurgical excision procedure from January 2015 to December 2016. @*Results@#Referral requests from 430 women were reviewed. Among these, 17.4% were discordant with the ASCCP guidelines. The most common discordant colposcopy referrals were low-grade squamous intraepithelial lesions (48%) and atypical squamous cells of undetermined significance (29%). The possibility of incorrect referrals was decreased among highgrade lesions (odds ratio [OR], 0.03), while it was increased in women aged <25 years (OR, 31.6) and in those referred by family medicine (OR, 3.6) or internal medicine (OR, 4.4). Ten patients were referred for cervical cytology results of samples collected from the vaginal cuffs despite hysterectomies performed for benign lesions. @*Conclusion@#Patients referred outside of the guidelines were most often women aged <25 years with low-grade lesions. Referrals outside evidence-based guidelines may lead to unnecessary procedures and additional healthcare expenses. Our results help identify the areas for provider education and potential areas of concern regarding the implementation of the 2019 ASCCP guideline updates.