A man in his seventies with fatigue and renal failure. / En mann i 70-årene med utmattelse og nyresvikt.

A man in his seventies underwent routine heart examinations as part of workup for kidney transplantation. Unexpected findings led to more extensive investigations and revealed two rare systemic diseases as causes of his heart failure.

Association of excessive daytime sleepiness with migraine and headache frequency in the general population.

BACKGROUND: Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. METHODS: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. RESULTS: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. CONCLUSIONS: In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.

Eltrombopag in Good's Syndrome.

Good's syndrome is a rare acquired immunodeficiency associated with thymoma. Eltrombopag is a thrombopoietin receptor agonist and has been shown to be a valuable supplement to the treatment of several types of refractory cytopenias. In this paper, we describe a male patient suffering from Good's syndrome with immune-mediated T-cell driven pancytopenia and absence of megakaryopoiesis. He was successfully treated with eltrombopag resulting in a multilineage clinical response.

Sleep apnoea headache in the general population.

BACKGROUND: The objective was to investigate the prevalence and clinical characteristics of sleep apnoea headache. METHODS: A postal questionnaire was received by 40,000 Norwegians from the general population. A total of 376 and 157 persons with high and low risk of sleep apnoea according to the Berlin Questionnaire had a polysomnography, and a clinical interview and examination by physicians. RESULTS: Sleep apnoea headache was diagnosed in 11.8% of the participants with obstructive sleep apnoea (OSA), while morning headache with similar symptomatology was diagnosed in 4.6% of the participants without OSA (p = 0.002). After adjusting for potential confounders the odds ratio for OSA remained significantly increased among participants with morning headache with an adjusted odds ratio of 2.92 (1.31-6.51). When using a cut-off of moderate (apnoea hypopnea index, AHI ≥ 15) and severe (AHI ≥ 30) OSA, the prevalence of sleep apnoea headache was 11.6% and 13.3%, respectively. Average oxygen desaturation and lowest oxygen saturation was not significantly different in participants with OSA with and without morning headache. CONCLUSION: Morning headaches were significantly more frequent among participants with OSA than those without OSA. Sleep apnoea headache is less common in the general population than has previously been reported in clinic populations. The relation of hypoxia and morning headache is questioned.

Tension-type headache and sleep apnea in the general population.

The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders. Results showed the prevalence of frequent and chronic tension-type headache was 18.7 and 2.1% in the participants with obstructive sleep apnea. The logistic regression analyses showed no significant relationship between tension-type headache and obstructive sleep apnea, with adjusted odds ratios for frequent tension-type headache of 0.95 (0.55-1.62) and chronic tension-type headache of 1.91 (0.37-9.85). The results did not change when using cut-off of moderate (AHI ≥15) and severe (AHI ≥30) obstructive sleep apnea. Thus, we did not find any significant relationship between tension-type headache and the AHI. The presence and severity of sleep apneas seem not to influence presence and attack-frequency of tension-type headache in the general population.

Migraine and sleep apnea in the general population.

Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and MA occurred in 12.5 and 6.8% of the participants with obstructive sleep apnea. The logistic regression analyses showed no relationship between the two types of migraine and obstructive sleep apnea, with adjusted odds ratios for MO 1.15 (0.65-2.06) and MA 1.15 (0.95-2.39). Further, estimates using cutoff of moderate (AHI ≥ 15) and severe (AHI ≥ 30) obstructive sleep apnea, did not reveal any significant relationship between migraine and the AHI. Migraine and obstructive sleep apnea are unrelated in the general population.

Otitis media history, surgery and allergy in 60-year perspective: a population-based study.

OBJECTIVES: To assess the relationship between recurrent otitis media (OM), OM surgery and allergy in a 60-years perspective in the general population. METHODS: A cross-sectional questionnaire study of 40,000 randomly selected Norwegians aged 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 and 80 years stratified by age and gender in 2005, i.e. each age group 30-60 years included 2000 and the remaining age groups 1000 persons of each gender. Main outcome measures were recurrent childhood OM, childhood myringotomy, ventilation tubes or adenoidectomy and lifetime allergy. RESULTS: The prevalence of recurrent OM was 24.3% (n=4823) and OM surgery 12.4% (n=2499). An increase in the proportion of OM surgery by age cohort was found, with the highest surgery rate of 0.52 for the 1955 age cohort, followed by a gradual decrease until the 1980 age cohort, when surgery stabilized at 0.42. Recurrent OM and OM surgery was more common in respondents with allergy. Among the latter, the probability for OM surgery was almost threefold when the age cohort 1945 was compared to 1920, OR(adj) at 2.95 (1.59-5.48). The latter tendency remained strong until 1965. Among non-allergics, the increase in surgery probability by age cohort showed the same tendency, but the relationship was less strong than for those with allergy. CONCLUSIONS: Despite a twofold increase in recurrent OM and OM surgery from 1925 to 1945, the proportion of OM and OM surgery have been stable since 1945. Our findings suggest a shift in clinical practice, most likely indicating a change in surgery from acute infections to otitis media with effusion (OME).

A cross-sectional population-based survey of migraine and headache in 21,177 Norwegians: the Akershus sleep apnea project.

The objective was to investigate the prevalence and interrelation of migraine and headache in the general population. Forty thousand men and women aged 20-80 years from the Norwegian general population received a mailed questionnaire with questions about migraine and headache. The questionnaire response rate was 54.5%. The lifetime prevalence of migraine was 26.5% (95% CI 25.9-27.1%), i.e., 18.1% (95% CI 17.3-18.9%) in men and 34.1% (95% CI 33.2-35.0%) in women. The prevalence of migraine decreased slightly in both men and women after an age of 45. The 1 year prevalence of headache was 77.2%, i.e., 69.6% (95% CI 68.7-70.6%) in men and 84.0% (95% CI 83.3-84.7%) in women. The frequency of headache decreased with age, but some of the elders aged 70 or above experienced more frequent headache. The prevalence of being headache free increased from 19.1% (95% CI 14.2-25.6%) to 74.7% (95% CI 70.0-78.8%) in 20 and 80 years old men without co-occurrence of migraine, and from 5.1% (95% CI 2.9-8.8%) to 61.4% (95% CI 54.9-67.6%) in 20 and 80 years old women without co-occurrence of migraine. Co-occurrence of migraine significantly increased the frequency of headache and decreased the prevalence of being headache free.