Obstructive sleep apnea and central serous chorioretinopathy.

PURPOSE: The purpose of this study was to determine if there is an association between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSCR). METHODS: Patients with CSCR without a history of steroid use or secondary retinal disease were matched based on age/gender/body mass index with control patients and administered the Berlin Questionnaire to assess for OSA risk. Patients were scored "OSA+" if they were at "high risk" on the Berlin Questionnaire or reported a previous OSA diagnosis. Rates of OSA+ were compared between the 2 groups, odds ratio and its 95% confidence interval was calculated using exact conditional logistic regression. RESULTS: Forty-eight qualifying patients with CSCR were identified. There were no statistically significant differences between the CSCR and control groups by age (mean = 55 years), gender (79% male), body mass index (mean = 28.2), history of diabetes, or hypertension. Within the CSCR group, 22 patients (45.8%) were OSA+ versus 21 control patients (43.8%) (difference = 2.1%; 95% confidence interval, -18.2% to 22.2%; exact odds ratio = 1.08, 95% confidence interval, 0.47-2.49; P = 1.00). CONCLUSION: When compared with matched controls, patients with CSCR did not have statistically significant higher rates of OSA risk or previous diagnosis. This finding contrasts with previous work showing a strong association between the diseases. The divergence is likely due to our matching controls for body mass index, a significant risk factor for OSA.

Implications of complex anatomical junctions on conductance catheter measurements of coronary arteries.

In vivo, the position of the conductance catheter to measure vessel lumen cross-sectional area may vary depending on where the conductance catheter is deployed in the complex anatomical geometry of arteries, including branches, bifurcations, or curvatures. The objective here is to determine how such geometric variations affect the cross-sectional area (CSA) estimates obtained using the cylindrical model. Computer simulations and in vitro and in vivo experiments were used to assess how the electric field and associated CSA measurement accuracy are affected by three typical in vivo conditions: 1) a vessel with abrupt change in lumen diameter (e.g., transition from aorta to coronary ostia); 2) a vessel with a T-bifurcation or a Y-bifurcation; and 3) a vessel curvature, such as in the right coronary artery, aorta, or pulmonary artery. The error in diameter from simulation results was shown to be relatively small (<7%), unless the detection electrodes were placed near the junction between two different lumen diameters or at a bifurcation junction. Furthermore, the present findings show that the effect of misaligned catheter-vessel geometrical configuration and vessel curvature on measurement accuracy is negligible. Collectively, the findings support the accuracy of the conductance method for sizing blood vessels, despite the geometric complexities of the cardiovascular system, as long as the detection electrodes are not placed at a large discontinuity in diameter or at bifurcation junctions.

Conductance catheter measurements of lumen area of stenotic coronary arteries: theory and experiment.

An injection of saline solution is required for the measurement of vessel lumen area using a conductance catheter. The injection of room temperature saline to displace blood in a vessel inevitably involves mass and heat transport and electric field conductance. The objective of the present study is to understand the accuracy of conductance method based on the phenomena associated with the saline injection into a stenotic blood vessel. Computational fluid dynamics were performed to simulate flow and its relation to transport and electric field in a stenotic artery for two different sized conductance catheters (0.9 and 0.35 mm diameter) over a range of occlusions [56-84% cross-sectional area (CSA) stenosis]. The results suggest that the performance of conductance catheter is dependent on catheter size and severity of stenosis more significantly for 0.9 mm than for 0.35 mm catheter. Specifically, the time of detection of 95% of injected saline solution at the detection electrodes was shown to range from 0.67 to 3.7 s and 0.82 to 0.94 s for 0.9 mm and 0.35 mm catheter, respectively. The results also suggest that the detection electrodes of conductance catheter should be placed outside of flow recirculation region distal to the stenosis to minimize the detection time. Finally, the simulations show that the accuracy in distal CSA measurements, however, is not significantly altered by whether the position of detection electrodes is inside or outside of recirculation zone (error was within 12% regardless of detection electrodes position). The results were experimentally validated for one lesion geometry and the simulation results are within 8% of actual measurements. The simulation of conductance catheter injection method may lead to further optimization of device and method for accurate sizing of diseased coronary arteries, which has clinical relevance to percutaneous intervention.