Measuring nuclear factor-KB--who cares?
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Continuous Positive Airway Pressure↗
Biomedical subjects
Arn H Eliasson
Publications and source records attributed to Arn H Eliasson.
Silent upper airway resistance syndrome: prevalence in a mixed military population.
STUDY OBJECTIVES: The upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which transient increases in upper airway resistance result in repetitive EEG arousals. UARS is not associated with apnea or diminished airflow, although snoring and excessive daytime somnolence (EDS) are common. This report describes a subset of patients with UARS diagnosed by polysomnography who do not manifest snoring, which we define as silent upper airway resistance syndrome (SUARS). DESIGN: A retrospective review of all polysomnographies performed at our sleep disorders center during 2000. SETTING: Sleep disorders center of a large, academic, military hospital. PATIENTS: Our center serves military personnel, military retirees, and their dependent families. INTERVENTIONS: Esophageal manometry during polysomnography was routinely performed on patients with hypersomnolence (Epworth sleepiness scale > 10) who demonstrated a total arousal index >or= 10/h and a respiratory disturbance index of < 5/h on prior polysomnography. UARS was definitely diagnosed in patients who demonstrated repetitive increased upper airway resistance (IUAR) associated with brief EEG arousals followed by normalization of esophageal pressure (Pes). IUAR was defined by a pattern of crescendo negative inspiratory Pes of <or= - 12 cm H(2)O. RESULTS: During calendar year 2000, we performed 724 polysomnographies in 527 patients. Obstructive sleep apnea was diagnosed in 383 patients (72.6%), and 44 patients (8.4%) were found to have UARS. In four patients with UARS (0.8% of total and 9.1% of UARS), snoring was not reported by history or observed during polysomnography, and SUARS was ultimately diagnosed. CONCLUSIONS: UARS may occur in the absence of clinically significant snoring and may be an occult cause of EDS. We report a prevalence of SUARS of 9% among UARS patients and nearly 1% of all patients studied for hypersomnolence by polysomnography.
District of Columbia↗
Women with sleep apnea have lower levels of sex hormones.
BACKGROUND: Low levels of sex hormones, especially progesterone, are suspected as a risk factor for sleep-disordered breathing (SDB). OBJECTIVE: To test the hypothesis that serum levels of progesterone, estradiol, and 17-OH progesterone are lower in those women with clinically significant SDB. DESIGN: Clinical cohort of convenience. SETTING: University Hospital Sleep Laboratory. METHODS: We investigated sleep and breathing parameters and serum levels of sex hormones in 53 consecutive women (ages 24 to 72 years) being evaluated for symptoms of daytime sleepiness. Analysis of hormonal status by specific radioimmunoassays and fluorescence immunoassays was done from blood samples taken after an overnight polysomnography. RESULTS: Across the cohort, taking account of age and cycle time or postmenopausal status, those with an apnea-hypopnea index (AHI) greater than 10/hrs of sleep had significantly lower levels of 17-OH progesterone, progesterone, and estradiol than those with an AHI less than 10. CONCLUSION: We conclude that reductions in female sex hormones are associated with an increased probability of SDB in women with daytime sleepiness.
Adult↗
On "Misinterpretation of sleep-breathing disorder by periodic limb movement disorder" (Sleep Breath 2001;5:131-138).
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Diagnosis, Differential↗
Do specialists differ on do-not-resuscitate decisions?
STUDY OBJECTIVE: Opinions regarding do-not-resuscitate (DNR) decisions differ between individual physicians. We attempted to determine whether the strength of DNR recommendations varies with medical specialty and experience. DESIGN: Written survey. PARTICIPANTS: Physicians from the pulmonary/critical-care medicine (PCCM), cardiology, internal medicine, gastroenterology, hematology/oncology, and infectious disease services as well as the Department of Medicine house staff at our tertiary-care referral center participated in the study. INTERVENTIONS: Physicians were asked confidentially to quantify the strength of their opinions on discussing and recommending DNR orders for each of 20 vignettes made from the summaries of actual cases. Reasons for their opinions and demographic data also were recorded. MEASUREMENTS AND RESULTS: One hundred fifteen of 155 physicians (74%) responded. PCCM physicians (mean [+/- SD] DNR score, 157 +/- 22) more strongly recommended DNR orders than cardiologists (mean DNR score, 122 +/- 32; p = 0.006), house staff (mean DNR score, 132 +/- 24; p = 0.014), and general internists (mean DNR score, 129 +/- 30; p = 0.043). PCCM physicians also trended toward recommending DNR orders for more of the 20 patients described in the vignettes compared to cardiologists (mean DNR number, 16.5 +/- 3.0 vs 11.9 +/- 5.8, respectively; p = 0.066). There were no differences between PCCM physicians and hematology/oncology, infectious disease, and gastroenterology specialists. Among the house staff, the likelihood of recommending a DNR order correlated significantly with increasing years of experience (r = 0.45; p = 0.002). The opposite trend was present in the specialty staff groups. No significant differences in opinion by gender, religion, or personal experiences were found. CONCLUSIONS: The strength of DNR order recommendations varies with medicine specialty and years of training and experience. An awareness of these differences and the determination of the reasons behind them may help to target educational interventions and to ensure effective collaboration with colleagues and communication with patients.
Adult↗