Psychiatric disorder does not preclude adequate continuous positive airway pressure titration.

Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with significant morbidity and multiple complications. A large proportion of patients with OSA also have a coexisting primary psychiatric disorder. The effect of psychiatric disorders on the ability to tolerate continuous positive airway pressure (CPAP) titration is not known. In this study, whether the presence of psychiatric disorders precludes the patients' ability to tolerate CPAP titration for OSA was investigated. A retrospective chart review on a sample of 284 patients who underwent sleep studies in a single-center, university-based Veterans Affairs hospital was performed. A total of 143 patients with OSA who underwent titration of CPAP therapy were identified. The prevalence of psychiatric disorders between patients who tolerated titration and those who did not tolerate it was compared using the χ² test. The percentages of patients with psychiatric disorders who tolerated and did not tolerate CPAP were 33.6% and 33.3%, respectively. No statistically significant difference between the 2 groups (χ² = 0.051 with 1 degree of freedom; P = 0.82) was found. The predominantly male patient population, exclusion of mild OSA, lack of data about the level of control of the psychiatric symptoms and the sleep technicians not being blinded to the patients' psychiatric diagnoses were some of the limitations of this study. No significant difference existed in the prevalence of psychiatric disorders between patients intolerant to CPAP titration and those who tolerated CPAP for OSA.

Abdominal pathology in patients with diabetes ketoacidosis.

INTRODUCTION: The objective is to describe the incidence and nature of significant abdominal pathologies in patients with diabetes ketoacidosis (DKA) and abdominal pain. METHODS: Retrospective chart review (N = 86) of patients with DKA from January 1, 2005, to January 31, 2010, was performed. Data included demographics, co-morbidities, compliance, chief complaints and physical findings, blood count, metabolic profile, lactic acid, glycosylated hemoglobin (HbAlC), amylase, lipase, anion gap, arterial gases, imaging and final diagnosis. Continuous variables were described as mean ± standard deviation and compared with the Student's t test. Categorical variables were expressed as percentages (%) and compared with the Mantel-Haenszel χ test. Univariate analysis was conducted among patients with and without significant abdominal pain and also with and without significant abdominal pathology. Two lipase strata were created at 400 U. Multivariate model to identify limits (confidence interval) of the estimated risk imposed by the predictor found significant in univariate analysis. A P value of ≤ 0.05 was considered significant. Stat View 5.0 (SAS Institute, Cary, NC) was used for the statistical analysis. RESULTS: In patients with abdominal pain, 17% had significant abdominal pathology mainly acute pancreatitis (AP). Serum amylase and lipase level were found to be an indicator of significant underlying pathology (both P values ≤0.001). The logistic model created showed that patients with lipase level ≥400 U have a 7% increased risk of having AP with confidence interval of 0.01 to 0.6. CONCLUSION: Patients with DKA and abdominal pain with lipase >400 U have an increased risk of significant underlying abdominal pathology (AP).

Obstructive sleep apnea and immunity: relationship of lymphocyte count and apnea hypopnea index.

OBJECTIVES: The impact of chronic poor quality sleep on immunity as seen in obstructive sleep apnea (OSA) has not been evaluated. We aim to explore the relationship between lymphocytes, neutrophil, and total leukocyte counts with severity stratified apnea hypopnea index (AHI) in patients with OSA. METHODS: A retrospective review of 119 patients' medical records diagnosed with OSA from October 2005 to July 2006 was performed. Data collected included demographics, comorbidities, total leukocyte, neutrophil, and lymphocyte count, body mass index (BMI), AHI, and Epworth sleepiness scores (ESS). Three AHI strata were constructed: mild (5-14), moderate (15-29), and severe (>30). Data were fitted in a linear regression model on which lymphocyte counts were the dependent variable against age, BMI, and AHI. An interaction product was also explored (age*BMI). All tests were two-sided; a P < 0.05 was considered statistically significant. We used Statview Version 5.01 (SAS Institute, Inc., Cary, NC) for the analysis. RESULTS: Our study showed a linear association among AHI and BMI (P = 0.0017), but did not show association between lymphocyte count with either BMI (P = 0.33) or AHI (P = 0.90). A negative association between lymphocytes and age (P = 0.02) that persisted after adjustments for BMI and AHI was found. An interaction product (age*AHI) was not associated with lymphocyte count (P = 0.87). No correlation was found between peripheral blood count (P = 0.29) or neutrophil counts (P = 0.38) and AHI. CONCLUSION: We found OSA-induced sleep interruption not associated with lymphocyte, neutrophil, or peripheral blood cell count alterations. This information is useful for researchers evaluating the influence of sleep disruption on immunity.

Restless legs syndrome in lung transplant recipients.

BACKGROUND: Given the increased incidence of steroid-induced diabetes and drug-induced anemia, renal dysfunction and neuropathy, we believed that lung transplant recipients would be at an increased risk of developing restless legs syndrome (RLS). We performed a cross-sectional, observational study to determine the prevalence and characteristics of RLS in this population. METHODS: Patients filled out two questionnaires during a routine visit: (1) a diagnostic tool for RLS, based on the core clinical features; and (2) a 10-question rating scale used to assess severity. Data were obtained by medical record review with regard to demographics, lung transplant characteristics and known risk factors for RLS. RESULTS: Forty-two lung transplant recipients (age 46.6 +/- 15.4 years [mean +/- SD]; 24 women, 18 men) without a family history of RLS were recruited. RLS was found in 47.6% (20 of 42) of the patients and 80% had moderate or severe RLS. Seventy-five percent of those with RLS were women (p = 0.03). RLS patients had a serum calcium level that was higher than those without RLS (p = 0.05) and were more likely to be recipient (p = 0.02) or donor positive (p = 0.07) for cytomegalovirus (CMV). All 4 hypothyroid patients on replacement therapy were in the RLS group. The prevalence of diabetes mellitus and chronic renal failure were not significantly different between the RLS and non-RLS groups. CONCLUSIONS: There was a very high prevalence of RLS in our lung transplant population and most patients had moderate or severe symptoms. RLS patients were more likely to be women, donor or recipient positive for CMV, hypothyroid, and to have an elevated serum calcium level.

Restless legs syndrome: keys to recognition and treatment.

Restless legs syndrome (RLS) is a common and clinically significant motor disorder increasingly recognized by physicians and the general public, yet still underdiagnosed, underreported, and undertreated. Effective therapies are available, but a high index of suspicion is required to make the diagnosis and start treatment quickly. We now have enough data to support the use of dopaminergic agents, benzodiazepines, antiepileptics, and opioids in these patients.

Pleural effusions: evaluation and management.

Pleural effusions are very common, and physicians of all specialties encounter them. A pleural effusion represents the disruption of the normal mechanisms of formation and drainage of fluid from the pleural space. A rational diagnostic workup, emphasizing the most common causes, will reveal the etiology in most cases.