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Biomedical subjects

Reena Mehra

Publications and source records attributed to Reena Mehra.

8 recordsLinked to original sources
PubMed2006

Soluble interleukin 6 receptor: A novel marker of moderate to severe sleep-related breathing disorder.

BACKGROUND: Given the previously described association between sleep-related breathing disorder (SRBD) and markers of inflammation, we assessed the relationship of SRBD with levels of both interleukin 6 (IL-6) and soluble IL-6 receptor (sIL-6R), a marker with more expansive physiologic effects than IL-6. The objectives were to explore the relationship between moderate to severe sleep apnea with IL-6 and sIL-6R levels and to examine morning and evening variability for each cytokine. METHODS: A total of 385 adult participants (> or =18 years of age) in the Cleveland Family Study, Cleveland, Ohio, underwent sleep studies and determination of IL-6 and sIL-6R levels in samples obtained in the evening and morning of polysomnography. Moderate to severe SRBD was defined as a respiratory disturbance index greater than or equal to 30. RESULTS: The subjects were aged 44.9 +/- 16.7 (mean +/- SD) years, 44% were male, and 48% were African American, with a body mass index (weight in kilograms divided by the height in meters squared) of 32.5 +/- 8.1 (mean +/- SD). Linear regression analysis showed that after adjustment for subject characteristics, waist circumference, and comorbidities, SRBD was not significantly associated with morning IL-6 levels. In contrast, linear regression analyses showed that, compared with the participants without SRBD, those with SRBD had significantly higher morning sIL-6R levels (mean +/- SD, 4.60 +/- 1.42 ng/mL [P = .001]), even after adjustment for subject characteristics, waist circumference, and comorbidities, which persisted after adjustment of evening sIL-6R levels. CONCLUSIONS: Morning sIL-6R levels demonstrated stronger associations with moderate to severe SRBD than morning IL-6 levels. Associations with SRBD and morning sIL-6R levels persisted even after adjustment for waist circumference, cardiovascular disease, and evening sIL-6R levels, suggesting the potential utility of sIL-6R as a marker for measuring overnight SRBD stresses. Further investigation of this biomarker may provide insight into SRBD-related inflammation.

Adult↗
PubMed2006

Sleep apnea in acute coronary syndrome: high prevalence but low impact on 6-month outcome.

BACKGROUND AND PURPOSE: We postulate that the prevalence of sleep-disordered breathing (SDB) in subjects admitted with acute coronary syndrome (ACS) is high, self-report of SDB symptoms is helpful in identifying patients with ACS at risk for SDB, and prospective risk for adverse ACS outcomes is associated with SDB. PATIENTS AND METHODS: Consecutive patients admitted to the VA hospital with ACS over approximately 1 year were invited to participate. The Cleveland sleep habits questionnaire was administered, and a portable sleep study (Eden-trace, Level 3 monitoring) was performed within 72h of admission. RESULTS: Of 104 patients with complete and adequate sleep studies, 66.4% had an apnea-hypopnea index (AHI) >10/h, and 26.0%, an AHI>30 with the prevalent apnea pattern being obstructive (72.1%). Neither pre-test probability for sleep apnea per questionnaire (P=0.67) nor degree of subjective sleepiness (P=0.83) predicted SDB. Although symptoms of dyspnea and paroxysmal nocturnal dyspnea were significantly higher in SDB (AHI> or =10) compared to non-SDB (AHI<10) 6 months after admission for ACS, odds of readmission were not significantly different, and this lack of association persisted after covariate adjustment. The factors predicating readmission, but only at 1 month, were age and diabetes. CONCLUSIONS: In the setting of ACS, the prevalence of SDB was very high in this population and was not detected by self-reports of sleepiness or composite risk for SDB. The odds of adverse outcome for ACS up to 6 months were no different in patients with SDB compared to those without SDB, as compared to effects of an older age or presence of diabetes.

Acute Disease↗
PubMed2006

The association between marijuana smoking and lung cancer: a systematic review.

BACKGROUND: The association between marijuana smoking and lung cancer is unclear, and a systematic appraisal of this relationship has yet to be performed. Our objective was to assess the impact of marijuana smoking on the development of premalignant lung changes and lung cancer. METHODS: Studies assessing the impact of marijuana smoking on lung premalignant findings and lung cancer were selected from MEDLINE, PSYCHLIT, and EMBASE databases according to the following predefined criteria: English-language studies of persons 18 years or older identified from 1966 to the second week of October 2005 were included if they were research studies (ie, not letters, reviews, editorials, or limited case studies), involved persons who smoked marijuana, and examined premalignant or cancerous changes in the lung. RESULTS: Nineteen studies met selection criteria. Studies that examined lung cancer risk factors or premalignant changes in the lung found an association of marijuana smoking with increased tar exposure, alveolar macrophage tumoricidal dysfunction, increased oxidative stress, and bronchial mucosal histopathologic abnormalities compared with tobacco smokers or nonsmoking controls. Observational studies of subjects with marijuana exposure failed to demonstrate significant associations between marijuana smoking and lung cancer after adjusting for tobacco use. The primary methodologic deficiencies noted include selection bias, small sample size, limited generalizability, overall young participant age precluding sufficient lag time for lung cancer outcome identification, and lack of adjustment for tobacco smoking. CONCLUSION: Given the prevalence of marijuana smoking and studies predominantly supporting biological plausibility of an association of marijuana smoking with lung cancer on the basis of molecular, cellular, and histopathologic findings, physicians should advise patients regarding potential adverse health outcomes until further rigorous studies are performed that permit definitive conclusions.

ErbB Receptors↗
PubMed2006

Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study.

RATIONALE: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development. OBJECTIVE: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing. METHODS: The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass index: (1) 228 subjects with sleep-disordered breathing (respiratory disturbance index>or=30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index<5). RESULTS: Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p=0.003) for atrial fibrillation; 5.3 versus 1.2% (p=0.004) for nonsustained ventricular tachycardia; 25.0 versus 14.5% (p=0.002) for complex ventricular ectopy. Compared with those without sleep-disordered breathing and adjusting for age, sex, body mass index, and prevalent coronary heart disease, individuals with sleep-disordered breathing had four times the odds of atrial fibrillation (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.03-15.74), three times the odds of nonsustained ventricular tachycardia (OR, 3.40; 95% CI, 1.03-11.20), and almost twice the odds of complex ventricular ectopy (OR, 1.74; 95% CI, 1.11-2.74). A significant relation was also observed between sleep-disordered breathing and ventricular ectopic beats/h (p<0.0003) considered as a continuous outcome. CONCLUSIONS: Individuals with severe sleep-disordered breathing have two- to fourfold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.

Aged↗
PubMed2004

Incidence of serious adverse events during nocturnal polysomnography.

OBJECTIVES: The purpose of the study was to verify whether minimal concern is warranted in regard to serious adverse effects in the sleep laboratory. DESIGN: A prospective multicenter study PARTICIPANTS: Three scoring teams for 17 sleep laboratories. METHODS: Reports of adverse events occurring during polysomnography or identified upon scoring a study were collected over an 18-month time period. Incidence of mortality and adverse events were evaluated using a binomial distribution based on the Bernoulli process. RESULTS: Of 16,084 studies, the mortality rate during or 2 weeks after an adverse event, as noted, was 0.006%, and the overall rate of adverse events was 0.35%. CONCLUSIONS: Adverse event rates are low; however, procedures for handling medical emergencies or adverse events during or after polysomnography are prudent, and those studies performed for research should include preparedness for the possibility of adverse events.

Adult↗
PubMed2003

Interpreting pulmonary function tests: recognize the pattern, and the diagnosis will follow.

When interpreting pulmonary function tests, one should first try to determine the pattern of abnormality: is it obstructive, restrictive, or normal? Pulmonary function tests cannot by themselves distinguish among the potential causes of abnormalities, and must be interpreted in light of the patient's history, physical examination, and ancillary studies. Once a pattern is recognized, the diagnosis will often follow.

Aged↗