Relationship between sleep disorders and the risk for developing type 2 diabetes mellitus.

Sleep is increasingly being recognized as an important factor in the homeostasis of multiple body functions, including blood glucose metabolism. One of the most common sleep disorders, obstructive sleep apnea, is not only highly prevalent in patients with type 2 diabetes mellitus, but may contribute to the development of abnormalities in blood glucose metabolism. Evidence suggests that effectively treating sleep apnea, specifically with continuous positive airway pressure, improves glycemic and nonglycemic outcomes. Other common sleep disorders, such as insufficient sleep, shift work disorder, and restless legs syndrome, may also have a significant influence on the development and management of diabetes and its complications. The purpose of this article is to review the recent literature on the relationship between sleep disorders and blood glucose metabolism.

Detection of postoperative sleep-disordered breathing using a portable monitoring device.

PURPOSE: Adverse surgical outcomes may occur more frequently in patients with sleep-disordered breathing (SDB). Despite this concern, there have been no prospective studies using objective measures of postoperative SDB to determine the scope of the problem. We designed a prospective study to determine the feasibility of identifying SDB in elective postoperative patients by the use of a type IV portable monitor (PM). METHODS: Patients >18 years old who presented for elective surgery with at least one postoperative hospital night on a non-monitored unit were enrolled and wore a type IV device that measured nasal flow, heart rate, and oxygen saturation on their first postoperative night. Respiratory disturbance index (RDI) and oxygen desaturation index (ODI) were generated for each patient. RESULTS: Data sufficient for interpretation were collected on 100/116 patients enrolled. SDB (RDI ≥5) was observed in 51% of the study group, and 17% had a RDI >15. An elevated ODI ≥5 was seen in 42%, while 17% had an ODI ≥15. Device malfunction occurred in 16% of the study participants. CONCLUSION: A type IV PM can be employed in the postoperative setting to detect and gauge the severity of SDB.

Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism.

STUDY OBJECTIVE: Ready availability of computed tomography (CT) angiography for evaluation of pulmonary embolism in emergency departments (EDs) is associated with a dramatic increase in the number of CT angiography tests. The aims of this study are to determine whether a validated prediction algorithm embedded in a computerized decision support system improves the positive yield rate of CT angiography for pulmonary embolism and is acceptable to emergency physicians. METHODS: This study was conducted as a prospective interventional study with a retrospective preinterventional comparison group. RESULTS: The implementation of the computerized physician order entry-based computerized decision support system was associated with an overall increase in the positivity rate of from 8.3% (95% confidence interval [CI] 4.9% to 12.9%) preintervention to 12.7% (95% CI 8.6% to 17.7%) postintervention, with a difference of 4.4% (95% CI -1.4% to 10.1%). A total of 404 patients were eligible for inclusion. Physician nonadherence to the computerized decision support system occurred in 105 (26.7%) cases. Fifteen patients underwent CT angiography despite low Wells score and negative D-dimer result, all of whose results were negative for pulmonary embolism. Emergency physicians did not order CT angiography for 44 patients despite high pretest probability, with one receiving a diagnosis of pulmonary embolism on a subsequent visit and another, of DVT. When emergency physicians adhered to the computerized decision support system for the evaluation of suspected pulmonary embolism, a higher yield of CT angiography for pulmonary embolism occurred, with 28 positive results of 168 CT angiography tests (16.7%; 95% CI 11.4% to 23.2%) and a difference compared with preintervention of 8.4% (95% CI 1.7% to 15.4%). Physicians cited the time required to apply the computerized decision support system and a preference for intuitive judgment as reasons for not adhering to the computerized decision support system. CONCLUSION: Use of an evidence-based computerized physician order entry-based computerized decision support system for the evaluation of suspected pulmonary embolism was associated with a higher yield of CT angiography for pulmonary embolism. The computerized decision support system, however, was poorly accepted by emergency physicians (partly because of increased computer time), leading to possibly selective use, reducing the effect on overall yield, and leading to removal of the computerized decision support system from the computer order entry. These findings emphasize the importance of facilitation of rule-based decisionmaking in the ED and attentiveness to the complex demands placed on emergency physicians.

Trends in use and yield of chest computed tomography with angiography for diagnosis of pulmonary embolism in a Connecticut hospital emergency department.

RATIONALE: We hypothesize that the ready availability of chest computed tomography (CT) scan, with angiography (CTA), for pulmonary embolism (PE) has resulted in its increased use in the emergency department (ED) with an associated decrease in positive studies. RESULTS: CTA for diagnosis of PE increased over 13-fold from 2000 to 2005. The diagnostic yield of CTA for PE decreased from 14% in 2000 to a mean (SD) of 7.2 (.91)% during subsequent years (P =.007). No significant change in yield occurred after 2001 (P = 0.51). Significantly more segmental and subsegmental embolisms were observed with the 16-slice CT in years 2004-2005 when compared to the single-slice CT used in years 2000-2003. CONCLUSIONS: CTA for PE in our hospital ED has a low-positive yield rate, suggesting overutilization. However, the positive-yield rate remained steady despite increasing numbers of CTA, suggesting increased detection of PE and/or false-positive CTA.