Obstructive Sleep Apnea in Hypertension.

Introduction About one-half of patients who have essential hypertension have obstructive sleep apnea (OSA), and about one-half of patients who have obstructive sleep apnea have essential hypertension. OSA can cause even resistant hypertension if left untreated. These two entities often co-exist and are seen as a continuum of the same process. Eighty percent to 90% of OSA cases are undiagnosed mostly because of a lack of awareness. Material and methods This was a cross-sectional study done over a period of one year in a tertiary care hospital. After taking informed consent, 179 hypertensive patients of >18 years were included in the study. All patients were screened for OSA by the STOP-BANG questionnaire. Patients having scores of ≥3 were subjected to overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Patients with a STOP-BANG score ≤2 or score ≥3 with AHI <5, were considered non-OSA. Results More than half (53.1%) of the patients enrolled in the study had OSA. Their age ranged from 18 to 78 years and the mean age was 52.07±11.40 years. The mean age of OSA cases was found to be slightly higher than that of non-OSA. The majority of OSA cases were males (73.7%). There was an increase in the prevalence, as well as the severity of OSA, with an increase in BMI. Most of the cases had snoring and a history of tiredness. Triglyceride (TG) and low-density lipoprotein (LDL) levels of the OSA group were found to be significantly higher and high-density lipoprotein (HDL) levels were significantly lower than that of the non-OSA group. Conclusion More than half of our hypertensive patients had OSA. These two conditions often co-exist and are known as a dangerous pair. Physicians ought to have increased suspicion for early diagnosis and treatment to improve cardiovascular outcomes, reduce road traffic accidents, and improve quality of life.

Prevalence of obstructive sleep apnea in diabetic patients.

Context: Obstructive sleep apnea (OSA)-related hypoxemia stimulates release of acute-phase proteins and reactive oxygen species that exacerbate insulin resistance and lipolysis and cause an augmented prothrombotic and proinflammatory state which can leads to premature death. Aims: This study aims to study the prevalence of OSA in diabetic patients. Setting and Design: It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods: A total of 149 type 2 diabetic patients were enrolled after taking written consent. All patients were subjected to STOP BANG questionnaire and patients falling in intermediate-high risk (score 3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea hypopnea index ≥ 5). Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) Version 21.0 statistical analysis software. Results: Fifty-five percent of our diabetic population were having OSA. The age of patients enrolled in the study ranged between 30 and 86 years and prevalence increases with an increase in age groups. Majority (61.7%) of our cases were males. Incremental trend in weight, body mass index (BMI), neck circumference, and waist circumference of OSA cases were found with increasing in severity of OSA. Mean levels of raised blood sugar and HbA1c were higher in severe OSA cases. Conclusions: OSA has a high prevalence in patients with type 2 diabetes mellitus. Patients with type 2 diabetes should be screened for OSA, even in the absence of symptoms, especially in individuals with higher waist circumference and BMI.

RésuméContexte: L'hypoxémie liée à l'apnée obstructive du sommeil (AOS) stimule la libération de protéines de phase aiguë et d'espèces réactives de l'oxygène qui exacerber la résistance à l'insuline et la lipolyse et provoquer un état prothrombotique et pro-inflammatoire accru qui peut conduire à un décès. Objectifs: Cette étude vise à étudier la prévalence de l'AOS chez les patients diabétiques. Cadre et conception: il s'agissait d'une étude transversale, réalisée sur une période d'un an dans un hôpital de soins tertiaires. Matériels et méthodes: Un total de 149 patients diabétiques de type 2 ont été recrutés après avoir pris consentement écrit. Tous les patients ont été soumis au questionnaire STOP BANG et les patients à risque intermédiaire-élevé (score 3-8), ont été prise pour une polysomnographie nocturne pour confirmer le diagnostic d'AOS (index d'apnée hypopnée ≥ 5). Analyse statistique utilisée: statistique Package for Social Sciences (SPSS) Version 21.0 du logiciel d'analyse statistique. Résultats: Cinquante-cinq pour cent de notre population diabétique étaient souffrant d'AOS. L'âge des patients inclus dans l'étude variait entre 30 et 86 ans et la prévalence augmente avec l'augmentation des tranches d'âge. La majorité (61,7 %) de nos cas étaient des hommes. Tendance progressive du poids, de l'indice de masse corporelle (IMC), du tour de cou et du tour de taille des cas d'AOS ont été trouvés avec une augmentation de la sévérité de l'AOS. Les taux moyens de glycémie élevée et d'HbA1c étaient plus élevés dans les cas graves d'AOS. Conclusions: L'AOS a une prévalence élevée chez les patients atteints de diabète de type 2. Les patients atteints de diabète de type 2 doivent subir un dépistage de l'AOS, même en l'absence de symptômes, en particulier chez les personnes ayant un tour de taille et un IMC plus élevés.

A Rare Location of a Repeat Ectopic Pregnancy: A Case Report.

Ectopic pregnancies often recur in the same patients as its etiology is tubal damage, which is rarely unilateral. In the setting of a well-documented history of ectopic pregnancy in the past where a salpingectomy was performed, and the clinical picture now suggests another ectopic, it can be reasonably concluded that the ectopic is in the remaining tube. In the case we present here, the ultrasound findings also suggested a tubal pregnancy in the remaining tube. Therefore, it was a surprise to find a profusely bleeding ectopic gestation in the stump of the same tube (where salpingectomy was performed earlier) on laparoscopy.

Thoracic Endometriosis: Still a Diagnostic Dilemma.

We report a case of thoracic endometriosis syndrome (TES) presenting with a five-week history of progressive shortness of breath, cough, and wheezing. Investigations revealed a large, right-sided pleural effusion that was bloody on aspiration. A diagnosis of TES was one of the diagnoses entertained and eventually confirmed on finding evidence of pelvic endometriosis on laparotomy. The management of TES should include hormonal therapy, surgical management, or a combination of both.

Pontine Infarct Presenting with Atypical Dental Pain: A Case Report.

Orofacial pain' most commonly occurs due to dental causes like caries, gingivitis or periodontitis. Other common causes of 'orofacial pain' are sinusitis, temporomandibular joint(TMJ) dysfunction, otitis externa, tension headache and migraine. In some patients, the etiology of 'orofacial pain' remains undetected despite optimal evaluation. A few patients in the practice of clinical dentistry presents with dental pain without any identifiable dental etiology. Such patients are classified under the category of 'atypical odontalgia'. 'Atypical odontalgia' is reported to be prevalent in 2.1% of the individuals. 'Atypical orofacial pain' and 'atypical odontalgia' can result from the neurological diseases like multiple sclerosis, trigeminal neuralgia and herpes infection. Trigeminal neuralgia has been frequently documented as a cause of 'atypical orofacial pain' and 'atypical odontalgia'. There are a few isolated case reports of acute pontine stroke resulting in 'atypical orofacial pain' and 'atypical odontalgia'. However, pontine stroke as a cause of atypical odontalgia is limited to only a few cases, hence prevalence is not established. This case is one, where a patient presented with acute onset atypical dental pain with no identifiable dental etiology, further diagnosed as an acute pontine infarct on neuroimaging. A 40 years old male presented with acute onset, diffuse teeth pain on right side. Dental examination was normal. Magnetic resonance imaging(MRI) of the brain had an acute infarct in right pons near the trigeminal root entry zone(REZ). Pontine infarct presenting with dental pain as a manifestation of trigeminal neuropathy, has rarely been reported previously. This stresses on the importance of neuroradiology in evaluation of atypical cases of dental pain.