Survival benefit of continuous positive airway pressure in Japanese patients with obstructive sleep apnea: a propensity-score matching analysis.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) improves quality of life in patients with obstructive sleep apneas. However, the long-term benefit in all-cause mortality and cardiovascular death are limited among Japanese. METHODS: We conducted a retrospective study of patients treated in our sleep clinic in Okinawa, Japan. All patients with full-scale polysomnography from September 1990 to December 2010 were investigated in terms of outcomes such as death (dates and causes of death) between 2012 and 2013 by chart review, telephone calls, and letters of inquiry. Propensity-score matching was performed to balance baseline characteristic differences between a CPAP user group and a nonuser group. The primary outcomes were all-cause mortality and a composite of cardiovascular disease mortality, such as heart disease and stroke, between the two groups. RESULTS: The CPAP user group, almost double in number, had more severe obstructive sleep apnea, more comorbidities, smoking, and alcohol consumption compared to the nonuser group but no significant difference in Epworth Sleepiness Scale. Propensity-score matching selected 1,274 of 4,519 patients as the CPAP user group and 1,274 of 2,128 as the CPAP nonuser group. Mean age of the patients was 52.3 (±13.5) years and 79% were men. After a median follow-up of 79 (interquartile interval, 24 to 128) months in the CPAP user group and 73.5 (interquartile interval, 26 to 111) in the non-CPAP group, death from all causes occurred in 53 (4.2%) patients in CPAP user group and in 94 (7.4%) patients in CPAP nonuser group. The leading cause of death was malignancy in each group. The hazard ratios for all-cause mortality and cardiovascular disease deaths were 0.56 (95% confidence interval (CI), 0.41-0.78) and 0.54 (95% CI, 0.28-1.03) between CPAP user group and CPAP nonuser group, respectively. CONCLUSIONS: In obstructive sleep apnea patients, CPAP use was associated with lower all-cause mortality.

Effect of continuous positive airway pressure on nocturnal urine production in patients with obstructive sleep apnea syndrome.

AIM: The aim of this study was to identify the clinical features of patients with obstructive sleep apnea syndrome (OSAS) and investigate the impact of continuous positive airway pressure (CPAP) treatment on nocturnal urine volume. MATERIALS AND METHODS: This study enrolled 53 patients with moderate-to-severe OSAS and an apnea-hypoxia index of >20/hr. Data were collected on serum brain natriuretic peptide (BNP) level, International Prostate Symptom Score-Quality of Life (IPSS-QOL) score, Overactive Bladder Symptom Score (OABSS), International Consultation on Incontinence Modular Questionnaire-Nocturia QOL (ICIQ-NQOL) score, Epworth Sleepiness Scale (ESS) score, and the frequency volume chart. Only patients who continued CPAP treatment for 3 months were included in the analysis. RESULTS: In total, 40 patients (33 men and 7 women) completed the study (75.5%). The mean age was 56.9 years. The night-time frequency to void was significantly decreased from 2.1 to 1.2 after CPAP treatment (P < 0.01). The mean scores as assessed by ESS, IPSS-QOL, OABSS, and ICIQ-NQOL significantly improved after CPAP (P < 0.01). The mean diastolic blood pressure significantly decreased after CPAP treatment. However, there was no significant change in the BNP level before and after CPAP treatment. In the frequency volume chart, hours of undisturbed sleep, total nocturnal voided volume, and nocturnal polyuria index significantly improved after CPAP treatment (P < 0.05). However, 24-hr voided volume and mean voided volume during night-time did not change after CPAP treatment. CONCLUSION: CPAP treatment decreases night-time urinary frequency by reducing nocturnal urine production and improves QOL in patients with OSAS. Neurourol. Urodynam. 36:376-379, 2017. © 2015 Wiley Periodicals, Inc.

[Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT)].

To define and evaluate sleepiness thoroughly has not yet completely established because of its multidimensional aspects of character. Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) have been the important tools to assess sleepiness in the research and clinical settings, although they have several limitations and pitfalls. The coverage by the National Health Insurance of MSLT, since April 1, 2008, in Japan, so far not MWT, would extend the diagnosis and care of sleep disorders concerning excessive daytime sleepiness including narcolepsy and idiopathic hypersomnia. The relevant and appropriate use of these modalities should be always considered in line with clinical history, medical information and judgment.

High Prevalence of chronic kidney disease among patients with sleep related breathing disorder (SRBD).

Sleep apnea syndrome, a sleep-related breathing disorder (SRBD) of which obstructive sleep apnea syndrome (OSAS) is representative, is often associated with obesity, and therefore patients with SRBD might have a high prevalence of chronic kidney disease (CKD). However, the relationship between obesity and the prevalence of CKD has not yet been investigated in a large cohort of patients with SRBD. The Okinawa Nakamura Clinic Sleep Apnea Syndrome (ONSLEEP) registry contains records for all patients evaluated by full-scale polysomnography (PSG) from September 1990 to the end of 2003 (n=5,651). We studied the total of 4,056 (71.8%) of these patients who had an apnea hypopnea index (AHI) of more than 5 events per hour. The glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease equation in the 1,624 patients for whom serum creatinine data was obtained at the time of the PSG. We defined CKD as a GFR of less than 60 mL/min/1.73 m2. The mean age was 49.9+/-13.5 (mean+/-SD) years; the mean body mass index (BMI) was 28.4+/-5.0 (mean+/-SD) kg/m2. We compared the findings with those from participants in the 1993 general screening registry in Okinawa (n=94,267). From among the total 94,267 screening participants, we selected 7,454 subjects who were age- and sex-matched to the experimental group with SRBD; the ratio of cases to controls was thus approximately 1:4. CKD was detected in 496 (30.5%) patients, with SRBD a higher incidence than that in the screened population (9.1%); the adjusted odds ratio (95% confidence interval) was 4.542 (3.922-5.260, p<0.0001). In contrast to the screened population, the prevalence of CKD decreased as BMI increased (it was 35.7% in SRBD patients with a BMI<25.0 kg/m2, 31.4% in those with a BMI 25.0 to 29.9 kg/m2, and 25.2% in those with a BMI > or =30.0 kg/m2); in the controls the values were 8.1%, 10.5%, and 10.6%, respectively. Taken together, these results suggest that surveillance of CKD is warranted among SRBD patients, particularly those who are not obese.

CP0569, a new broad-spectrum injectable carbapenem. Part 1: synthesis and structure-activity relationships.

A series of 1beta-methylcarbapenems bearing an (imidazo[5,1-b]thiazolium-6-yl)methyl moiety, a 5,5-fused heterobicycle, at the C-2 position was synthesized and evaluated for in vitro antibacterial activities. CP0569 (1r) and its analogues showed potent antibacterial activities against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative bacteria, including Pseudomonas aeruginosa. Moreover, CP0569 (1r) exhibited stronger antibacterial activity against MRSA and higher resistance to renal dehydropeptidase-1 (DHP-1) than any currently marketed carbapenems, that is, imipenem (IPM), panipenem (PAPM), and meropenem (MEPM).