Sputum bacteriology in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease and concomitant pneumonia in Hong Kong.

AIM: To study the sputum microbiology of patients admitted to a teaching hospital with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with concomitant pneumonia. METHODS: This was a retrospective study in a tertiary university hospital in Hong Kong. All episodes of AECOPD with pneumonia, patient demographics, length of stay, sputum culture and radiological results admitted in the first half of the year 2000 were retrieved from hospital records. RESULTS: There were 118 patients (91 male) with 150 episodes of AECOPD with concomitant pneumonia. The age of the patients was 74.8 +/- 10.0 years. Positive routine sputum culture was detected in 45.6% of the patients. Among these hospital admissions, 8.7, 4.0 and 12.0%, respectively, required intensive care unit admissions, mechanical ventilation and non-invasive positive pressure ventilation. Haemophilus influenzae was the commonest organism found in sputum (26.0%), followed by Pseudomonas aeruginosa (5.5%), Streptococcus pneumoniae (3.4%), and Moraxella catarrhalis (3.4%). Mycobacterium tuberculosis was found in 1.5% of the admissions. The presence of P. aeruginosa in sputum was associated with a longer hospital length of stay (9.1 +/- 3.1 vs. 7.1 +/- 4.2 days, P = 0.03). CONCLUSION: In contrast to most other studies reporting S. pneumoniae as the most likely bacterial pathogen, H. influenzae was the commonest bacterium isolated in sputum in our patients with AECOPD and concomitant pneumonia.

Cephalometric assessment of craniofacial morphology in Chinese patients with obstructive sleep apnoea.

OBJECTIVE: To compare the differences in craniofacial morphology in Chinese patients with and without obstructive sleep apnoea (OSA). METHOD: We performed lateral cephalometric radiographs on 94 consecutive patients (77 males) referred with snoring or other symptoms suggestive of OSA for polysomnography (PSG). Significant OSA was defined as an apneoa-hypopnoea index (AHI) > or = 10/h of sleep on overnight PSG. The cephalometric data were compared between those with and without significant OSA. RESULTS: (mean +/- SD) There were 69 (56 males) with significant OSA with mean age 53 +/- 12 years, body mass index (BMI) 28.6 +/- 5.0 kg/m2, AHI 36.5 +/- 20.6/h, and minimum SaO2 76 +/- 14%. There were 25 controls (21 males) without significant OSA with similar age and BMI. The mandibular plane to hyoid bone distance (MPH) and the perpendicular distance from hyoid bone to the line connecting C3 vertebra and retrognathion (HHI) were significantly longer in the OSA patients. The angle measurement from sella to nasion to point A (SNA) was smaller in the OSA group. MPH distance was the only independent variable for significant OSA with an odds ratio of 3.47 (95% CI 1.39-8.66). Abnormalities of the MPH and SNA were more marked in the OSA patients with BMI > or = 30 kg/m2. CONCLUSIONS: Significant differences in craniofacial morphology are noted between OSA patients and non-apnoeic controls. An inferiorly positioned hyoid bone and a retropositioned maxilla may predispose obese patients to more severe OSA.

Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong.

OBJECTIVES: To assess the prevalence of sleep-disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong. METHODS: Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at-home sleep study using the Mesam IV device (Madaus Medizin-Elektronik, Freiburg, Germany). RESULTS: There were 207 men and nine women (mean age 42.4 +/- 7.5 years; body mass index (BMI) 25.4 +/- 4.5 kg/m2; ESS 5.3 +/- 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring > or = 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at-home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) > or = 5 per hour of sleep, (ii) 21 subjects (41%) had RDI > or = 10 per hour of sleep, (iii) 12 subjects (24%) had RDI > or = 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively > or = 10% of the night. Ten subjects (20%) had RDI > or = 5 and sleepiness at work, while five subjects (9.8%) had RDI > or = 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI. CONCLUSIONS: This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self-reported sleepiness nor the ESS could identify subjects with SDB.