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1.
J Clin Sleep Med ; 20(6): 947-957, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38318821

RESUMO

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with an increased risk of diabetes-related complications. Hence, it is plausible that continuous positive airway pressure (CPAP) could have a favorable impact on these complications. We assessed the feasibility of conducting a randomized control trial in patients with type 2 diabetes and OSA over 2 years. METHODS: We conducted an open-label multicenter feasibility randomized control trial of CPAP vs no CPAP in patients with type 2 diabetes and OSA. Patients with resting oxygen saturation < 90%, central apnea index > 15 events/h, or Epworth Sleepiness Scale ≥ 11 were excluded. OSA was diagnosed using a multichannel portable device (ApneaLink Air, ResMed). The primary outcome measures were related to feasibility and the secondary outcomes were changes in various clinical and biochemical parameters related to diabetes outcomes. RESULTS: Eighty-three (40 CPAP vs 43 no CPAP) patients were randomly assigned, with a median (interquartile range) follow-up of 645 (545, 861) days. CPAP compliance was inadequate, with a median usage of approximately 3.5 hours/night. Early CPAP use predicted longer-term compliance. The adjusted analysis showed a possible favorable association between being randomly assigned to CPAP and several diabetes-related end points (chronic kidney disease, neuropathy, and quality of life). CONCLUSIONS: It was feasible to recruit, randomly assign, and achieve a high follow-up rate over 2 years in patients with OSA and type 2 diabetes. CPAP compliance might improve by a run-in period before randomization. A full randomized control trial is necessary to assess the observed favorable association between CPAP and chronic kidney disease , neuropathy, and quality of life in patients with type 2 diabetes. CLINICAL TRIAL REGISTRATION: Registry: ISRCTN; Name: The impact of sleep disorders in patients with type 2 diabetes; URL: https://www.isrctn.com/ISRCTN12361838; Identifier: ISRCTN12361838. CITATION: Makhdom EA, Maher A, Ottridge R, et al. The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial. J Clin Sleep Med. 2024;20(6):947-957.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Diabetes Mellitus Tipo 2 , Estudos de Viabilidade , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso , Cooperação do Paciente/estatística & dados numéricos
2.
Eur J Emerg Med ; 11(4): 225-7, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15249812

RESUMO

A 61-year-old woman presented to the emergency department with acute-onset breathlessness, fever, sore throat and confusion. Her initial investigations revealed hyponatremia and middle lobe consolidation. In view of the atypical symptoms and signs, erythromycin was commenced. Urinary legionella antigen was requested and that tested positive. She was one of the first few patients whose findings alerted us to a possible outbreak of legionnaire' disease. We drew the following conclusions from our experience with this and other cases that we saw during the legionnaires' outbreak: an atypical presentation is common, as seen in this lady with confusion. If two cases of atypical pneumonias test positive for legionella within a period of a week, we suggest that public health authorities should be notified to identify the source and contain it. There is a need for continuous and high vigilance for legionnaires' disease.


Assuntos
Confusão/microbiologia , Diarreia/microbiologia , Dispneia/microbiologia , Doença dos Legionários/diagnóstico , Diagnóstico Diferencial , Notificação de Doenças , Dispneia/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Doença dos Legionários/complicações , Pessoa de Meia-Idade
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