Associations of sleep quality with incident atrial fibrillation: a meta-analysis.

BACKGROUND: The strong relationship between sleep apnoea and atrial fibrillation (AF) is well known. However, it remains unclear whether the sleep quality is related with AF. AIM: To evaluate the associations of sleep duration, insomnia and frequent awakening with AF. METHODS: A systematic review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through September 2017 to identify studies that evaluate the risk of AF in adults with short sleep duration, long sleep duration, insomnia and/or frequent awakening. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Ten observational studies (14 296 314 patients) were enrolled. The pooled odds ratios (ORs) of AF in individuals with short sleep (<6 h) and long sleep (>8 h) were 1.20 (95% confidence interval (CI) 0.93-1.55, I2 = 66%) and 1.24 (95% CI 0.96-1.62, I2 = 58%), respectively. There was no association between increase in sleep duration and AF, with a pooled OR of 0.97 (95% CI 0.84-1.12, I2 = 0%). However, there were significant associations of AF with insomnia and frequent awakening, with pooled ORs of 1.30 (95% CI 1.26-1.35, I2 = 3%) and 1.36 (95% CI 1.13-1.63, I2 = 55%), respectively. CONCLUSIONS: Our findings suggest an absence in association between AF and sleep duration but reveal the potential association between AF and both insomnia and frequent nocturnal awakening. As such, the further studies on association of AF and sleep qualities are warranted.

Effect of cholecalciferol supplementation on arterial stiffness: a systematic review and meta-analysis.

BACKGROUND: Vitamin D deficiency increases risk of cardiovascular diseases, arterial stiffness, and endothelial dysfunction. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the impact of vitamin D supplementation on arterial stiffness. METHODS: A comprehensive search of the databases of the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE was performed from inception through November 2015. The inclusion criterion was RCTs that assessed the impact of cholecalciferol supplementation in adults on the surrogate markers of arterial stiffness (aortic pulse wave velocity (PWV) and augmentation index (AIx)). Outcome was the pooled mean difference (MD) of PWV and AIx between the vitamin D supplementation (intervention) group and placebo. RESULTS: The initial search yielded 1164 articles. Twenty-eight articles underwent full-length review and data were extracted from seven RCTs involving totally 547 participants. Dose of cholecalciferol supplementation varied from 1000 IU/day to 120,000 IU/month of cholecalciferol. Duration of treatment ranged from 2 to 12 months. There was no significant difference in the change of PWV (pooled MD = 0.18, 95% CI: -0.17 to 0.52 or AIx (pooled MD = 2.39, 95% CI: -4.43 to 4.92) between the intervention group and placebo. CONCLUSIONS: There was no improvement of markers of arterial stiffness after vitamin D supplementation.

Telemedicine and Remote Monitoring as an Adjunct to Medical Management of Bronchiectasis.

The limited resources and the practice of social distancing during the COVID pandemic create a paradigm shift in the utilization of telemedicine in healthcare. However, the implementation of best practices is hampered in part by a lack of literature devoted to telehealth in bronchiectasis. In this commentary, we examine multiple approaches to structuring of telemedicine care for patients with bronchiectasis, highlight current evidence-based interventions that can be incorporated into the management of bronchiectasis, and describe our experience with telemedicine at the University of Connecticut Center for Bronchiectasis Care during the COVID-19 pandemic. The structural model must be adapted to different local dynamics and available technologies with careful attention to patient characteristics and access to technology to avoid the potential paradoxical effects of increasing patients' burden and healthcare disparities in underserved populations.

Submassive Pulmonary Embolism in Mild COVID-19 Without Lung Infiltrates.

A 66-year-old man who had been diagnosed with mild coronavirus 2019 (COVID-19) infection nine days prior presented to the emergency room with acute-onset chest pain and shortness of breath. Chest CT angiogram (CTA) revealed pulmonary emboli (PE) in the right and left pulmonary arteries with right heart strain; lung parenchyma showed no infiltrates. Although severe COVID-19 infection is associated with thrombotic complications, data regarding the occurrence of PE in mild cases of COVID-19 is scarce. However, even mild cases of COVID-19 are reported to have revealed lung infiltrates, particularly ground-glass opacities, on imaging. The possibility of the lungs being the primary source of COVID-19-associated coagulopathy has been raised. We report an uncommon case of submassive PE occurring in mild COVID-19, without any associated lung infiltrates. This case indicates that mild COVID-19, without significant lung parenchymal involvement, can also cause a hypercoagulable state, resulting in venous thromboembolism (VTE).

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta-analysis.

BACKGROUND/OBJECTIVES: Patients with obstructive sleep apnea (OSA) have an increased the risk of developing atrial fibrillation (AF). However, it remains unclear if patients with OSA carry a higher risk of recurrent AF after successful catheter ablation. This meta-analysis was conducted (1) to evaluate the association between OSA and recurrent AF after catheter ablation, and (2) to assess the effect of continuous positive airway pressure (CPAP) on the risk of recurrent AF in patients with OSA. METHODS: A comprehensive literature review was conducted using MEDLINE, EMBASE, Cochrane databases from inception through July 2017 to identify studies that evaluated the risk of recurrent AF after successful catheter ablation in patients with OSA were included. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Seven observational studies with a total of 4572 patients AF after successful catheter ablation were enrolled. Compared to patients without OSA, the pooled OR of recurrent AF in patients with OSA was 1.70 (95% CI, 1.40-2.06, I2  = 0). Among OSA patients with AF after successful catheter ablation, the use of CPAP was significantly associated with decreased risk of recurrent AF with pooled OR of 0.28 (0.19-0.40, I2  = 0). Egger's regression asymmetry test was performed and showed no publication bias for the associations of OSA and CPAP with recurrent AF. CONCLUSIONS: Our meta-analysis suggested a significant association between OSA and recurrent AF after catheter ablation. The use of CPAP in patients with OSA is associated with reduced risk of recurrent AF after catheter ablation.

Association Between Obstructive Sleep Apnea and Osteoporosis: A Systematic Review and Meta-Analysis.

CONTEXT: Hypoxia reduces osteoblast growth resulting in bone thinning and osteoporosis. Although obstructive sleep apnea (OSA) with recurrent hypoxia might be a contributing factor for osteoporosis development, whether OSA is a risk or protective factor for osteoporosis has not been demonstrated. OBJECTIVES: This systematic review and meta-analysis evaluated the association between OSA and osteoporosis using published observational studies. DATA SOURCES: PubMed/MEDLINE and EMBASE databases. STUDY SELECTION: We completed a systematic review and meta-analysis of published observational studies that evaluated incidence or prevalence of osteoporosis or bone mineral density in obstructive sleep apnea compared with controls. Severity of OSA was characterized using the apnea-hypopnea index (AHI). DATA EXTRACTION: Primary outcomes were incidence, prevalence, or odds ratio of having osteoporosis, defined as bone mineral density T-score < -2.5 SD. RESULTS: Of 353 articles, 344 articles were excluded, 9 underwent full-length review and data were extracted from 7 studies consisting of 113,558 patients. Finally, 3 extracted studies were included in the meta-analysis of osteoporosis. Among cohort studies, the pooled odds ratio of osteoporosis in patients with OSA was 1.92 (95% confidence interval [CI]: 1.24 - 2.97) compared with controls. Among cross-sectional studies, odds of osteoporosis was higher in controls compared with patients with OSA (OR = 0.60, 95% CI: 0.42 - 0.87). In subgroup analysis by gender and study design, in both sexes, only cohort studies had higher odds of osteoporosis compared with controls. CONCLUSIONS: There was significant association between OSA and osteoporosis in studies with cohort design. Further prospective studies with large numbers of patients adjusted for the effects of age, sex, or BMI are required to comprehensively determine whether OSA is a risk factor for osteoporosis.

Bariatric surgery reduces urinary albumin excretion in diabetic nephropathy: a systematic review and meta-analysis.

BACKGROUND: Bariatric surgery is found to prevent type 2 diabetes, improve glycemic control, and decrease long-term incidence of microvascular and macrovascular complications in obese persons. However, its effect on urinary albumin excretion (UAE) in patients with diabetic nephropathy (DN) is still unknown. This is a systematic review and meta-analysis of observational studies on bariatric surgery and change in UAE in patients with diabetes. OBJECTIVE: To explore whether there is improvement in UAE after bariatric surgery. METHODS: We comprehensively searched the databases of MEDLINE, Embase, and Cochrane. The inclusion criteria were published studies evaluating effects of bariatric surgery in patients with DN at baseline. The primary outcome was the pre- and postbariatric surgery UAE as characterized by urinary albumin-to-creatinine ratio and albuminuria. A meta-analysis comparing pre- and postsurgery UAE was performed. RESULTS: From 65 full-text articles, 15 observational studies met our inclusion criteria, and 11 studies were included in the meta-analysis based on the random effects model. There was a significant reduction in urinary albumin-to-creatinine ratio after bariatric surgery with a mean difference of -6.60 mg/g of creatinine (95% CI -9.19 to -4.02; P<.001). There was also a reduction in albuminuria with a mean difference of -55.76 mg/24 hours (95% CI -92.11 to -19.41; P<.001) after bariatric surgery. CONCLUSION: Bariatric surgery significantly decreases urinary albumin excretion in DN. However, studies comparing bariatric surgery and conventional or intensive care of diabetes on UAE outcome should be done.