Association of Bipolar Disorder With Major Adverse Cardiovascular Events: A Population-Based Historical Cohort Study.

OBJECTIVE: This study aimed to assess the association of bipolar disorder (BD) with risk of major adverse cardiac events (MACEs) after adjusting for established cardiovascular disease (CVD) risk factors. METHODS: We conducted a population-based historical cohort study using the Rochester Epidemiology Project. Patients older than 30 years with a clinical encounter from 1998 to 2000 with no prior MACE, atrial fibrillation, or heart failure were followed up through March 1, 2016. BD diagnosis was validated by chart review. Cox proportional hazards regression models were adjusted for established CVD risk factors, alcohol use disorder, other substance use disorders (SUDs), and major depressive disorder (MDD). RESULTS: The cohort included 288 individuals with BD (0.81%) and 35,326 individuals without BD as the reference group (Ref). Median (interquartile range) follow-up was 16.5 (14.6-17.5) years. A total of 5636 MACE events occurred (BD, 59; Ref, 5577). Survival analysis showed an association between BD and MACE (median event-free-survival rates: BD, 0.80; Ref, 0.86; log-rank p = .018). Multivariate regression adjusting for age and sex also yielded an association between BD and MACE (hazard ratio [HR] = 1.93; 95% confidence interval [CI] = 1.43-2.52; p < .001). The association remained significant after further adjusting for smoking, diabetes mellitus, hypertension, high-density lipoprotein cholesterol, and body mass index (HR = 1.66; 95% CI = 1.17-2.28; p = .006), and for alcohol use disorder, SUD, and MDD (HR = 1.56; 95% CI = 1.09-2.14; p = .010). CONCLUSIONS: In this study, BD was associated with an increased risk of MACE, which persisted after adjusting for established CVD risk factors, SUDs, and MDD. These results suggest that BD is an independent risk factor for major clinical cardiac disease outcomes.

The effect of acetazolamide on the improvement of central apnea caused by abusing opioid drugs in the clinical trial.

PURPOSE: Acetazolamide is utilized as a treatment which falls effective in treating some type of CSA. Hence, it might be effective as far as opium addicts who suffer from CSA are concerned. MATERIALS AND METHOD: The current study was a double-blind, placebo-controlled, cross-over study ( clinicalTrials.gov ID: NCT02371473). The whole procedures were identical for both placebo and acetazolamide phases of clinical research. There were 14 CSA more than 5/h and more than 50% of apnea-hypopnea index (AHI). Out of these 14 patients, 10 volunteered to participate in the study. Fast Fourier transformation was used to separate heart rate variability (HRV) into its component VLF (very low frequency band), LF (low frequency band), and HF (high frequency band) rhythms that operate within different frequency ranges. RESULT: There are significant results in terms of decreased mix apnea and central apnea together due to acetazolamide compared with placebo (P < 0.023). Time of SatO2 < 90% is decreased as well (P < 0.1). There is also decrease of SDNN and NN50 after treatment with acetazolamide respectively (P < 0.001). Regarding fast Fourier transformation, there is increase of pHF and decrease of pLF after acetazolamide treatment (P < 0.001). CONCLUSION: Acetazolamide seems to be effective in improving oxygenation and a decrease of mixed and central apnea events together. In HRV analysis section, LF power has decreased significantly, which may more likely improve prognosis of the patients.

The impact of alcohol on breathing parameters during sleep: A systematic review and meta-analysis.

Alcohol, a muscle relaxant, can potentially worsen obstructive sleep apnea (OSA) but the literature on the effects of alcohol on OSA is conflicting. This systematic review and meta-analysis of randomized controlled trials examined the impact of alcohol on breathing parameters during sleep. Ovid Medline, Embase and PsycINFO databases were queried through November 1, 2017 for studies that reported objective measures of breathing during sleep, prior to and after alcohol administration. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated for apnea-hypopnea index (AHI) and mean oxyhemoglobin saturation (SpO2). Secondary outcome measures were examined where available. The meta-analysis of 14 eligible studies (n = 422; 71.9% male) found that AHI increased significantly after alcohol administration (WMD = 2.33; 95% CI = 1.41 to 3.25, I2 = 62%) and mean SpO2 was significantly reduced (WMD = -0.60; 95% CI = -0.72 to -0.49, I2 = 0%). The increase in AHI was greater in snorers (WMD = 4.20; 95% CI = 1.19 to 6.50, I2 = 0%) and those with a diagnosis of OSA (WMD = 7.10; 95% CI = 3.59 to 10.61, I2 = 0%). Additionally, a significant increase in respiratory event duration (WMD = 0.86; 95% CI = 0.18 to 1.55, I2 = 19%) and decrease in nadir SpO2 (WMD = -1.25; 95% CI = -2.00 to -0.50, I2 = 25%) were noted. Alcohol is a modifiable risk factor that can result in the development or worsening of OSA.

Prevalence of Obstructive Sleep Apnea in a High-Risk Population Using the Stop-Bang Questionnaire in Tehran, Iran.

BACKGROUND: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Despite its significant morbidities and mortality, the majority of patients with OSA remain undiagnosed. The epidemiology of OSA is well studied in Western countries, while there is scarce information on its epidemiology in other countries. We examined the prevalence of high-risk for OSA in a large urban region of Tehran, Iran. MATERIALS AND METHODS: We randomly selected 4021 individuals above 18 years in clusters from different districts of Tehran and surveyed them using the Stop-Bang questionnaire. The questionnaire also incorporated the demographic characteristics, education level, history of coronary artery disease and diabetes, and women's menopausal status. A score of 3 or higher on the Stop-Bang questionnaire indicated the high risk of OSA. RESULTS: The study population consisted of 2075 (51.6%) females and 1946 (48.4%) males, with the mean age of 40.88 years (SD, 15.4) and mean body mass index (BMI) of 26.18 kg/m2 (SD, 4.43). Overall, 51.4% of males and 26.5% of females (total, 1513; 38.6%) were classified in the high-risk group, according to the Stop-Bang questionnaire. The risk of OSA was directly correlated with BMI, advanced age, and history of cardiovascular diseases and diabetes. CONCLUSION: According to the Stop-Bang questionnaire, almost 1 out of every 3 individuals was classified in the high-risk group for OSA. Considering the significant morbidity and mortality of this disorder, it is considered a major health problem. Therefore, further detailed studies with confirmatory tests are recommended in order to plan strategies for the diagnosis, treatment, and rehabilitation of these patients.

Diagnosis of Obstructive Sleep Apnea Syndrome in Adults: A Brief Review of Existing Data for Practice in Iran.

Obstructive sleep apnea (OSA) is a common disorder associated with major comorbidities. It is estimated that 5-35% of the adult population in Iran are at high risk for OSA. This review article is designed to assist sleep medicine specialists as well as general practitioners in Iran to screen for OSA. It summarizes empirical data for diagnosing OSA including history taking, physical examination, diagnostic testing, and diagnostic criteria with regards to existing sleep medicine centers and availability of diagnostic tests in Iran.

Eighty Kilograms Weight Reduction in a Case of Obstructive Sleep Apnea with Several Comorbidities: Did the Conditions Improve?

Obstructive sleep apnea (OSA) together with metabolic disorders is common in severely obese patients. Weight reduction is considered as a treatment modality in these cases while few of them can succeed in considerable weight loss. Here, we present a severely obese man with body mass index of 54 suffered from OSA, type 2 diabetes, hypothyroidism, and hypertension. He intentionally lost 80 kilograms weight during the 2-year follow-up. Diabetes and hypertension completely resolved with considerable improvement in OSA syndrome after this huge weight reduction.

Sleep-disordered breathing as presenting manifestation of Chiari type I malformation: a case report.

Chiari Type I malformation (CM-I) is a rare disorder with displaced cerebellar tonsils through foramen magnum. Here we present a 30-year-old man with severe central and obstructive sleep apneas as presenting manifestations of CM-I. The patient underwent neurosurgery and the follow-up polysomnography revealed the resolution of central apnea while obstructive apnea remained unchanged. Central sleep apnea (CSA) could be associated with an underlying pathology; thus, further investigation is recommended in affected subjects.

Concept mapping as a method to teach an evidence-based educated medical topic: a comparative study in medical students.

BACKGROUND: The objective of this study was to compare concept mapping with lecture-based method in teaching of evidence based educated topic to medical students. METHODS: This randomized controlled trial was carried out on medical students during sixth year of 7-year MD curriculum clerkship phase. Cluster randomization was used to divide students into intervention and control groups. Both groups, at the beginning, were taught "Diabetic Ketoacidosis" (DKA) using evidence-based tool named Critically Appraised Topics (CAT). Students of intervention group were taught construction of concept maps on DKA and in the control group students had a lecture and a group discussion about what they had been taught on DKA. In the end, all of the students had an exam that they had to answer to 7 questions following to two clinical scenarios. The questions addressed physiopathology, diagnosis and treatment of patients with DKA and were scored separately. Sum of these scores was considered as total score. Scores were compared between intervention and control groups. RESULTS: Seventy six medical students (28 male, 48 female) were participated in this study. Total score among intervention group was higher than control group (78.2% vs. 72.5%, p < 0.001). Subgroup analysis revealed significant differences between scores of students in the intervention group and scores of students in the control group in the diagnostic section of questions (81.0% vs. 71.5%, P < 0.001). The scores of students in the intervention group were also significantly higher than control group in physiopathology section of questions. No statistically significant difference was discovered between two groups in scores of answers to treatment section of questions (78.1 (7.3) vs. 72.5 (5.5) P = 0.03). CONCLUSION: The results of the study showed that concept mapping method was more successful in education of evidence-based educated topic via CATs in comparison with lecture-based method. Interpretation of this finding would be the concept mapping method may develop meaningful learning among medical students.