Newly diagnosed obstructive sleep apnoea and type 2 diabetes mellitus.

INTRODUCTION: Obstructive sleep apnoea (OSA) is frequent in type 2 diabetes mellitus (DM) and is seen in 12-30% of patients with newly diagnosed OSA according to previous studies. Our aim was to determine the referral pattern and prevalence of patients with self-reported type 2 DM in a Danish cohort of patients with newly diagnosed OSA. Furthermore, we compared clinical data related to the sleep disorder in patients with and without type 2 DM and different OSA severities. METHODS: This retrospective observational study was based on data from a cohort including all patients offered continuous positive airway pressure therapy in the course of a 14-month period after being referred to a sleep disorders clinic. RESULTS: A total of 54 of 696 (7.8%) patients had type 2 DM. The majority of the patients in the type 2 DM group were referred from a general practitioner and only 8% from diabetes clinics. BMI, age and cardiovascular morbidity in type 2 DM patients were significantly higher than in the group without diabetes, while the Epworth Sleepiness Scale (ESS) score, the Apnea Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI) were not statistically different. Daytime sleepiness was similar in patients with mild-to-moderate compared with severe OSA. CONCLUSIONS: AHI, ESS and ODI were similar in type 2 DM and the non-diabetic group. The prevalence of type 2 DM was lower than expected. Attention of healthcare providers to the association between type 2 DM and OSA is needed. FUNDING: The study was funded by the Central Region Denmark Region Research Fund. TRIAL REGISTRATION: not relevant.

Pseudomonas aeruginosa in patients without cystic fibrosis is strongly associated with chronic obstructive lung disease.

INTRODUCTION: The objective of this study was to investigate the occurrence and consequences of Pseudomonas aeruginosa infection in a group of non-cystic fibrosis (CF) patients with regard to clinical presentation, treatment and change in lung function. MATERIAL AND METHODS: This was a three-year retrospective study of 113 patients with P. aeruginosa-positive airway samples achieved from the Department of Clinical Microbiology, Aarhus University Hospital, Denmark. Medical records were reviewed in order to register patient demographics, symptoms, co-morbidity, pulmonary function tests (PFT), treatment, X-ray/computed tomography findings and mortality. Finally, deterioration of lung function was evaluated by comparing the first and last available PFT in the period of observation. RESULTS: Most patients had several co-morbidities and only seven patients had none. 62% had a diagnosis of chronic obstructive pulmonary disease (COPD). We found a significant decrease in lung function within the observation period among patients with P. aeruginosa-infection as evidenced by all measured PFT-parameters except the forced expiratory volume in the first second/forced vital capacity-ratio. A total of 27 patients (24%) died within the observation period. CONCLUSION: P. aeruginosa is an opportunistic bacterium infecting primarily patients with severe lung disease. Our data show a significant reduction in lung function among P. aeruginosa-positive non-CF patients over a three-year period of time. The reduction, however, is not different than otherwise reported in COPD patients in general leading to no conclusion as to whether this pathogen is a marker of disease progression or the cause for progression itself. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Increasing rate of angiotensin-converting enzyme inhibitor-related upper airway angio-oedema.

INTRODUCTION: The objective of this study was to evaluate whether the increased use of angiotensin-converting enzyme inhibitors (ACEI) has affected the rate of upper airway angio-oedema (AE). In addition, we evaluated the presentation and treatment of patients with upper airway AE. MATERIAL AND METHODS: This was a ten-year retrospective study of 112 patients presenting with upper airway AE at The Department of Otorhinolaryngology, Aarhus University Hospital, Denmark. Incidence, presentation and treatment in the 2000-2004-period were compared to those of the 2005-2009-period. RESULTS: In the ten-year period, we found 112 AE patients of whom 39% were using ACEI. The relative risk of AE was 7.7 (p < 0.0001) among ACEI users. We found a 67% increase in AE in 2005-2009 compared with 2000-2004 which corresponds to a similar increase in ACEI use in the Danish population. The most frequent anatomic sites of involvement were the floor of the mouth and/or oropharynx including the base of the tongue. Two patients required intubation upon their arrival to the hospital. None progressed in airway obstruction requiring intubation later. None died. CONCLUSION: We found an increasing rate of ACEI-related upper airway AE over a ten-year period corresponding to greater use of ACEI in the population. With a relative risk of 7.7 and continuously increasing ACEI consumption, this condition will certainly require future attention and resources as almost one third of patients are admitted to an intensive care unit.