Association of vitamin B12, methylmalonic acid, and functional parameters.

INTRODUCTION: Diagnosis of vitamin B12 deficiency is difficult, as there is no conclusive single test for this disorder. We evaluated the association of serum B12 and methylmalonic acid (MMA) with haematologic parameters and physical and cognitive functioning in an effort to use such clinical parameters to improve the interpretation of serum values. METHODS: We used data of participants > 19 years of age from NHANES 2011-2012 and 2013-2014, a cross-sectional survey in the United States. Functional status was assessed with questionnaires on current health condition, disability, hospital utilisation, cognitive functioning, mental health and depression, and physical functioning. Muscle strength assessed with a handgrip dynamometer was used as a performance parameter. Results were evaluated both for the entire population and participants of Western European descent. Because renal function influences MMA concentrations and is a proxy for both frailty and comorbidity, all results were additionally stratified for individuals with normal vs impaired renal function (eGFR < 60 ml/min). RESULTS: In total, data of 9645 participants (mean age 49 (SD 17) years, 49.3% males) were included. Out of all participants with serum B12 < 140, 140-300, and 301-1000 pmol/l, 56.2%, 13.5%, and 4.1%, respectively had elevated MMA. MMA concentrations were more strongly associated with poor functional status and physical performance than serum B12. We identified a significant and independent association of MMA concentrations, as well as haemoglobin and co-morbidity with muscle strength. CONCLUSIONS/INTERPRETATIONS: A large proportion of individuals with a decreased serum B12 concentration still has normal MMA concentrations. Elevated MMA concentrations were more strongly associated with poor functional performance than serum B12.

Increased daytime sleepiness and snoring--obstructive sleep apnea syndrome caused by webbing of the soft palate.

A case report is presented of a man with increased daytime sleepiness and snoring due to an obstructive sleep apnea syndrome caused by webbing of the soft palate narrowing the velopharyngeal aperture. The diagnosis obstructive sleep apnea syndrome was confirmed by polysomnography. After uvulopalatopharyngoplasty there was a marked objective and subjective improvement of patient's complaints. The authors stress the importance of sleep monitoring in patients with excessive daytime sleepiness and snoring. Otorhinolaryngologic examination is necessary in patients with obstructive sleep apnea syndrome to search for anatomic abnormalities of the oropharynx.

[Sleep apnea syndrome, snoring and uvulopalatopharyngoplasty]. / Das Schlaf-Apnoe-Syndrom, das Schnarchen und die Uvulopalatopharyngoplastik.

Sleep-related closure of the upper airways is the key feature of the obstructive sleep apnoea syndrome (OSAS). Excessive daytime sleepiness and loud snoring are the major signs. It is not possible to differentiate patients with the single complaint of habitual snoring from patients with sleep apnoea by their history alone; polysomnography is a mandatory procedure. Recently, uvulopalatopharyngoplasty (UPPP) has been introduced as a surgical procedure to treat OSAS and excessive snoring. This paper presents the results of UPPP in eleven patients evaluated by means of postoperative polysomnography.

[Obstructive sleep apnea syndrome in children; an indication for tonsillectomy and adenoidectomy]. / Het obstructief slaap-apnoesyndroom bij kinderen; een indicatie voor tonsillectomie en adenotomie.

A 3-year-old girl with obstructive sleep apnea syndrome associated with tonsillar and adenoid hypertrophy is discussed. Nocturnal sleep registration, 4 months after adeno-tonsillectomy revealed complete arrest of apnea episodes and there was improvement in sleep pattern. In the early detection of obstructive sleep apnea in children a careful history and nocturnal sleep registration are essential. In children, tonsillar and adenoid hypertrophy are the main causes of obstructive sleep apnea.