Sleep medicine
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Observational Study
Very early screening for sleep-disordered breathing in acute coronary syndrome in patients without acute heart failure.
Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS. ⋯ An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact.
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Increased left atrial (LA) size is linked to elevated mortality in end-stage renal disease (ESRD). In addition, the degree of overnight rostral fluid shift from the legs is associated with severity of obstructive sleep apnea (OSA). As rostral fluid shift might distend the left atrium and increase fluid accumulation in the neck, we postulated that LA size would be related to the degree of overnight rostral fluid shift and OSA severity in ESRD patients. ⋯ In ESRD patients, there are relationships between ΔLFV and both LA size and OSA severity. These findings suggest that the relationship between LA size and mortality in ESRD may be related to ΔLFV and severity of OSA.
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Adaptive servo-ventilation (ASV) is a well-established treatment of central sleep apnea (CSA) related to congestive heart failure (CHF). Few studies have evaluated the effectiveness and adherence in patients with CSA of other etiologies, and even less is known about treatment of CSA in patients of post ischemic stroke. ⋯ ASV was well tolerated and clinically effective in this group of patients with persistent CSA after ischemic stroke.
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Intermittent hypoxemia is a fundamental pathophysiological consequence of sleep-disordered breathing and may alter glucose metabolism. To characterize the association between sleep-related intermittent hypoxemia and glucose metabolism, overnight pulse-oximetry and an oral glucose tolerance test were completed in a cohort of middle-aged and older Japanese adults. ⋯ Among middle-aged and older Japanese adults, sleep-related intermittent hypoxemia is associated with glucose intolerance and insulin resistance, and may contribute to the development of type 2 diabetes mellitus.