Severe obstructive sleep apnea increases mortality in patients with ischemic heart disease and myocardial injury.

OBJECTIVES: We hypothesized that obstructive sleep apnea(OSA) has a dose-dependent impact on mortality in those with ischemic heart disease or previous myocardial injury. METHODS: We performed a retrospective cohort study of 281 consecutive OSA patients with a history of myocardial injury as determined by elevated troponin levels or with known existing ischemic heart disease. We compared survival between those with severe OSA [apnea­hypopneaindex (AHI) ≥30] and those with mild to moderate OSA(AHI >5 and <30). RESULTS: Of the 281 patients (mean age 65 years, mean BMI34, 98% male, 58% with diabetes), 151 patients had mild moderate OSA and 130 had severe OSA. During a mean follow-up of 4.1 years, there were significantly greater deaths in the severe OSA group compared to the mild moderate OSA group [53 deaths (41%) vs. 44 deaths(29%), respectively, p00.04]. The adjusted hazard ratio for mortality with severe OSA was 1.72 (95% confidence interval1.01­2.91, p00.04). CONCLUSIONS: The severity of obstructive sleep apnea is associated with increased risk of death, and risk stratification based on OSA severity is relevant even in the diseased cardiac patient.

Sleep and rheumatologic disorders.

Arthritis is the leading cause of chronic illness in the United States. Seventy-two percent of the adults aged 55 years and older with arthritis report sleep difficulties. This review discusses sleep disorders associated with rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia. We describe the inter-relationship between sleep complaints, disease activity, depression, sleep deprivation, and cytokines. An algorithm for evaluation and treatment of sleep disorders associated with rheumatologic diseases is proposed.

Brucellosis.

Brucellosis is an old disease, revisited because of its past use in biological warfare programs and its potential use in bioterrorism. Early recognition and management of this systemic disease in its acute or chronic form is vital to current antibioterrorism defense programs. This article focuses on the causative organism, as well as the clinical presentation, diagnosis, and therapeutic challenges of Brucellosis.

Achieving tobacco cessation: current status, current problems, future possibilities.

Assisting smokers to achieve tobacco cessation has always been difficult. The development of pharmacological approaches to the attainment of abstinence from tobacco usage has been very helpful, although our understanding of optimal clinical use is still incomplete and imperfect. Bupropion and nicotine therapy (NT) will help reduce the severity of nicotine withdrawal symptoms, whether used separately or in combination. Effectiveness is greater with the combination of drugs than with either drug alone. Nevertheless, the initial 'quit rate' is usually less than 50%, and there is a considerable decrease in the abstinence rate after the course of therapy has been completed. Effectiveness is increased if higher doses of NT are employed, with or without concomitant bupropion. Much remains to be learned about optimal doses, preferred durations of therapy and tapering, prevention and management of relapses, and selection of modes of delivery of NT. The discovery that nicotine dependence has a major genetic component has stimulated much interest and many research studies. The preliminary results are interesting, to say the least.

PET and SPECT in the management of lung cancer.

Lung cancer is the leading cause of cancer deaths in men and women. Most recently in 2001, the Health Care Financing Administration has expanded Medicare coverage for positron emission tomography (PET) to include the diagnosis, staging, and restaging of lung cancer. This review discusses the current metabolic imaging techniques, including the role of PET, single-photon emission computed tomography (SPECT), and the new hybrid PET in the diagnosis, staging, and treatment of lung cancer. The technological advantages, disadvantages, and benefits are compared. PET has the highest detection efficiency than gamma camera based devices. PET when merged with computed tomography (CT) forms the powerful hybrid PET-CT system, capable both of metabolic and anatomic imaging. Clinical imaging pathways based on these newer modalities for the management of lung cancer are proposed. Technological advances in metabolic imaging linked with therapy driven protocols and outcomes may further provide cutting edge modalities that positively impact on dismal lung cancer mortality statistics.

Recent advances in diagnosis and management of chronic bronchitis and emphysema.

Chronic obstructive pulmonary disease is a progressive inflammatory disease of the airways and lung parenchyma. Expiratory airflow limitation is the hallmark of chronic obstructive pulmonary disease. It is a significant cause of morbidity and mortality in the United States and worldwide and results in a large consumption of health care resources. Unfortunately, despite efforts to curb this disease, its prevalence is increasing. The diagnosis is usually made when the patient complains of dyspnea on exertion; by this time, irreversible structural damage to the lung has already occurred. Given the nonspecific symptoms of the disease and the inability to effectively treat and reverse the damage, it is essential to diagnose the disease in its early stages and take the necessary preventive measures, thus avoiding disability or death. This review summarizes the latest developments in the diagnosis and management of chronic obstructive pulmonary disease. The first half of the review discusses functional, radiographic, biochemical, and cellular/histopathologic issues in the diagnosis of chronic obstructive pulmonary disease. The second half focuses on the current pharmacologic and nonpharmacologic advances in chronic obstructive pulmonary disease, including the role of respiratory support and surgical treatment. Based on the research on the cellular mechanisms of chronic obstructive pulmonary disease, the review also makes a reference to novel and experimental therapies for chronic obstructive pulmonary disease.